Abstract
Background: Few data are available on the effectiveness of large-scale food fortification programs.Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon.Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ∼300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15–49 y and children 12–59 mo of age.Results: Wheat flour was consumed in the past 7 d by ≥90% of participants. Postfortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower postfortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children postfortification, mean plasma concentrations were greater for ferritin and lower for sTfR after adjustments for potential confounders. Mean plasma zinc concentrations were greater postfortification and the prevalence of low plasma zinc concentration in women after fortification (21%) was lower than before fortification (39%, P < 0.001); likewise in children, the prevalence postfortification (28%) was lower than prefortification (47%, P < 0.001). Mean plasma total folate concentrations were ∼250% greater postfortification among women (47 compared with 15 nmol/L) and children (56 compared with 20 nmol/L), and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a nonrepresentative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater postfortification.Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.
Highlights
Micronutrient deficiencies affect millions of people globally and contribute to increased morbidity and mortality among vulnerable population groups [1]
Despite the widespread introduction of large-scale food fortification programs, few data are available on their effectiveness for improving micronutrient status among population groups at risk of deficiency, such as women of reproductive age and young children
Information on program effectiveness is scant for nutrients such as zinc, vitamin B-12, and, in low-income settings, folate
Summary
Micronutrient deficiencies affect millions of people globally and contribute to increased morbidity and mortality among vulnerable population groups [1]. Despite the widespread introduction of large-scale food fortification programs, few data are available on their effectiveness for improving micronutrient status among population groups at risk of deficiency, such as women of reproductive age and young children. In 2009, before the implementation of mandatory large-scale wheat flour fortification in Cameroon, we conducted a national survey to establish the baseline prevalence of micronutrient deficiencies and to collect information on dietary patterns to inform the development of a food fortification program [2, 3]. Conclusion: the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.
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