Reduce Micronutrient Deficiencies Research Articles

Biofortification: Future Challenges for a Newly Emerging Technology to Improve Nutrition Security Sustainably

Biofortification was coined as a term to define a plant breeding strategy to increase the micronutrient content of staple food crops to reduce the burden of micronutrient deficiencies in low- and middle-income countries (LMICs). In 2003, the HarvestPlus program, based in the centers comprising the Consultative Group on International Agricultural Research (CGIAR), was initiated to implement the biofortification strategy. This paper discusses what has been achieved, what has been learned, and the key challenges to embed biofortification in food systems and to expand its impact.Cost-effectiveness is key to the biofortification strategy. Biofortification piggybacks on the agronomically-superior varieties being developed at agricultural research centers. Central plant breeding research discoveries can be spread globally. Farmers have every motivation to adopt the latest high-yielding, high profit crops. High productivity leads to lower food prices. As a consequence, consumers can increase their mineral and vitamin intakes at no additional cost by substituting biofortified staple foods one-for-one for non-biofortified staple foods. After twenty years of investment, biofortified staple food crops are being produced by farmers in over 40 countries and are eaten by hundreds of millions of people. Published nutrition trials have shown nutrient-rich crops to be efficacious. The biofortification strategy is now recognized by the international nutrition community as one effective approach among several interventions needed to reduce micronutrient deficiencies. This is a promising beginning. However, biofortification is still a newly emerging technology. A limitation of biofortification as implemented to date is that densities of single nutrients have been increased in given staple food crops. To reach a higher trajectory, the impacts of biofortification can be multiplied several-fold using genetic engineering and other advanced crop development techniques to combine multiple-nutrient densities with climate-smart traits.

Using Mine Tailings as a Soil Improver to Reduce Micronutrient Deficiencies in Wheat Crops, Western Morocco

Using Mine Tailings as a Soil Improver to Reduce Micronutrient Deficiencies in Wheat Crops, Western Morocco

The potential contributions of bouillon fortification to meeting micronutrient requirements among women and preschool children in Senegal: A modeling study using household consumption and expenditure survey data.

To reduce micronutrient deficiencies, Senegal mandates the fortification of refined oil with vitamin A and wheat flour with iron and folic acid. Expanding Senegal's large-scale food fortification programs to include fortified bouillon could help fill the remaining gaps in dietary micronutrient requirements. Using 7-day household food consumption data collected between 2018 and 2019, we assessed the potential contributions of bouillon fortified with vitamin A (40-250μg/g bouillon), folic acid (20-120μg/g), vitamin B12 (0.2-2μg/g), iron (0.6-5mg/g), and zinc (0.6-5mg/g) for meeting micronutrient requirements of women of reproductive age (WRA; 15-49 years old) and children (6-59 months old). Most households (90%) reported consuming bouillon, including poor and rural households. At modeled fortification levels, bouillon fortification reduced the national prevalence of inadequacy by up to ∼20 percentage points (pp) for vitamin A, 34 pp (WRA) and 20 pp (children) for folate, 20 pp for vitamin B12, 38 pp (WRA) and 30 pp (children) for zinc, and ∼8 pp for iron. Predicted reductions in inadequacy were generally larger among poor and rural populations, especially for vitamins A and B12. Our modeling suggests that bouillon fortification has the potential to substantially reduce dietary inadequacy of multiple micronutrients and could also help address inequities in dietary micronutrient inadequacies in Senegal.

Enhancing Nutritional Status and Addressing Micronutrient Deficiencies: Evaluating the Impact of Workplace Nutrition Program on Female Workers in Vietnam.

This randomized controlled clinical study aimed to assess the effectiveness of a nutrition intervention program for non-pregnant female workers in Vietnam. A total of 500 female workers were randomly assigned to the intervention and control groups. Participants in the intervention group were provided nutrition education, personalized specific dietary, and received oral nutrition supplements (ONS)-which contained multi-minerals and vitamins according to recommendations for adults for a duration of 12 wk, while participants in the control group received only nutrition education. The result shows the percentage of malnutrition by BMI in the control group rose from 15.6% to 21.3% after 12 wk; the figure for counterpart experienced a remain unchanged (p<0.05). Additionally, the mean of serum zinc in the intervention group significantly increased from 49.0±21.2 μg/dL to 53.6±19.5 μg/dL after 12 wk. Moreover, the intervention group demonstrated significant increases in serum iron and total serum calcium levels (p<0.05), with from 13.9±5.6 μmol/L to 15.3±5.8 μmol/L, and from 2.36±0.15 mmol/L to 2.4±0.09 mmol/L, respectively. The participants of the intervention group were more likely to have higher total serum calcium (Coef=0.04, p<0.05), serum iron (Coef=1.99, p<0.05), and serum zinc (Coef=18.9, p<0.05), which presents a reduce micronutrient deficiency. In conclusion, workplace nutrition interventions effectively mitigate micronutrient deficiencies and improve the nutritional status of female workers.

Trade-Off Strategy for Usage of Phosphorus Fertilizer in Calcareous Soil-Grown Winter Wheat: Yield, Phosphorus Use Efficiency, and Zinc Nutrition Response

Although phosphorus (P) fertilizer application is widely used to improve production, irrational P application has a negative impact on the zinc (Zn) nutrition of cereal crops. Previous researchers observed and confirmed that P application decreases grain Zn concentrations and bioavailability in cereal crops. However, it remains unclear whether different P fertilizer types can alleviate the antagonism of P and Zn in the soil and grain and, thus, enhance the Zn nutritional level of cereal crops while maintaining production. Thus, a completely randomized pot experiment was conducted on winter wheat grown in two calcareous soils (lime concretion black soil and fluvo-aquic soil). Five P fertilizer types (single superphosphate, diammonium phosphate, fused calcium–magnesium phosphate, triple superphosphate, and ammonium polyphosphate, abbreviated, respectively, as SSP, DAP, FMP, TSP, and APP) were applied to each soil compared to no P fertilizer (CK). Plant and topsoil samples were collected during the flowering and maturity stages of winter wheat, and biomass, Zn concentrations in each organ, and grain phytic acid concentrations were analyzed. Grain yield was not affected by the application of different P fertilizer types to lime concretion black soil, while it was significantly increased by the application of TSP and APP to fluvo-aquic soil. The application of DAP and APP effectively promoted soil available Zn concentrations in both calcareous soils. In lime concretion black soil, the application of FMP significantly increased Zn remobilization to grains, while the application of DAP increased post-anthesis Zn uptake, thereby increasing grain Zn concentrations and its bioavailability. In fluvo-aquic soil, post-anthesis Zn remobilization and uptake were significantly increased by the application of TSP and APP, finally achieving higher grain Zn concentrations and Zn harvest index and effectively promoting grain Zn bioavailability. In conclusion, the rational application of DAP to wheat grown in lime concretion black soil and of TSP or APP to fluvo-aquic soil can achieve superior grain Zn nutrition quality while concurrently retaining high production and high P use efficiency, reducing micronutrient deficiency and further contributing to green agricultural development and human health.

Assessing the nutritional quality of Pleurotus ostreatus (oyster mushroom).

There is a huge gap between food production and the exploding population demands in various parts of the world, especially developing countries. This increases the chances of malnutrition, leading to increased disease incidence and the need for functional foods to reduce mortality. Pleurotus ostreatus are edible mushrooms that are cheaply sourced and rich in nutrient with the potential to be harnessed toward addressing the present and future food crisis while serving as functional foods for disease prevention and treatment. This study evaluated the nutritional, proximate, vitamins and amino acids contents of Pleurotus ostreatus. The proximate composition of Pleurotus ostreatus in this study revealed that it contains 43.42% carbohydrate, 23.63% crude fiber, 17.06% crude protein, 8.22% ash, 1.21% lipid and a moisture content of 91.01 and 6.46% for fresh and dry samples of Pleurotus ostreatus, respectively. The monosaccharide and disaccharide profile of Pleurotus ostreatus revealed the presence of glucose (55.08 g/100 g), xylose (7.19 g/100 g), fructose (19.70 g/100 g), galactose (17.47 g/100 g), trehalose (7.37 g/100 g), chitobiose (11.79 g/100 g), maltose (29.21 g/100 g), sucrose (51.60 g/100 g) and lower amounts of cellobiose (0.01 g/100 g), erythrose (0.48 g/100 g) and other unidentified sugars. Potassium, Iron and Magnesium were the highest minerals present with 12.25 mg, 9.66 mg and 7.00 mg amounts, respectively. The vitamin profile revealed the presence of vitamin A (2.93 IU/100 g), C (16.46 mg/100 g), E (21.50 mg/100 g) and B vitamins with vitamin B2 having the highest concentration of 92.97 mg/kg. The amino acid scores showed that Pleurotus ostreatus had more non-essential amino acids (564.17 mg/100 g) than essential amino acids (67.83 mg/100 g) with a ratio of 0.11. Lysine (23.18 mg/100 g) was the highest essential amino acid while aspartic acid (492.12 mg/kg) was the highest non-essential amino acid present in Pleurotus ostreatus. It had a higher concentration of acidic amino acids, 492.12 mg/100 g (77.87%), followed by neutral amino acids, 106.66 mg/100 g (16.88%) and least were the basic amino acids, 23.18 mg/100 g (3.67%). Based on the nutritional assessment of the Pleurotus ostreatus analyzed in this study, it can be concluded that it can serve as an important functional food source that can be exploited to meet the increasing food demands and reduce micronutrient deficiencies in many parts of the world, especially developing countries.

Global Coverage of Mandatory Large-Scale Food Fortification Programs: A Systematic Review and Meta-Analysis.

Food fortification with micronutrients is widely implemented to reduce micronutrient deficiencies and related outcomes. Although many factors affect the success of fortification programs, high population coverage is needed to have a public health impact. We aimed to provide recent global coverage estimates of salt, wheat flour, vegetable oil, maize flour, rice, and sugar among countries with mandatory fortification legislation. The indicators were the proportion of households consuming the: food, fortifiable food (that is, industrially processed), fortified food (to any extent), and adequately fortified food (according to national or international standards). We estimated the number of individuals reached with fortified foods. We systematically retrieved and reviewed all applicable evidence from: published reports and articles from January 2010 to August 2021, survey lists/databases from key organizations, and reports/literature received from key informants. We analyzed data with R statistical package using random-effects meta-analysis models. An estimated 94.4% of households consumed salt, 78.4% consumed fortified salt (4.2 billion people), and 48.6% consumed adequately fortified salt in 64, 84, and 31 countries, respectively. Additionally, 77.4% of households consumed wheat flour, 61.6% consumed fortifiable wheat flour, and 47.1% consumed fortified wheat flour (66.2 million people) in 15, 8, and 10 countries, respectively, and 87.0% consumed vegetable oil, 86.7% consumed fortifiable oil, and 40.1% consumed fortified oil (123.9 million people) in 10, 7, and 5 countries, respectively. Data on adequately fortified wheat flour and vegetable oil and coverage indicators for maize flour, rice, and sugar were limited. There are major data gaps on fortification coverage for most foods except salt. All countries with mandatory fortification programs should generate and use more coverage data to assess program performance and adjust programs as needed to realize their potential to reduce micronutrient deficiencies (PROSPERO CRD42021269364).

Assessment of dietary intake of Vitamin A-rich foods and associated factors among lactating mothers attending Lunga Lunga Health Centre, in Sinai slum, Nairobi County, Kenya

Vitamin A deficiency is a problem of public health significance among lactating mothers. Low dietary intake of vitamin A results in inadequate vitamin A concentration in breastmilk, thereby putting the life of the breastfed child at risk. Food availability is critical for quality nutrition that leads to a balanced diet. The poor in urban areas spend most of their income on food yet do not meet their dietary needs. This study aimed to assess the dietary intake of vitamin A rich foods, prevalence of undernutrition and household food insecurity among lactating mothers (15-49 years) attending Lunga Lunga Health Centre from Sinai Slum, Nairobi, Kenya. This cross-sectional study was undertaken using systematic random sampling for 384 lactating mothers from April to June 2017. A structured questionnaire was used to obtain socio-demographic information. Dietary intake was assessed using a 24-hour recall and Food Frequency Questionnaire (FFQ). Prevalence of undernutrition was determined through anthropometric measurements: Body Mass Index (BMI) and Mid Upper Arm Circumference (MUAC). Household food security was determined using food insecurity access scale and dietary diversity questionnaires. Statistical analysis was undertaken using Microsoft excel and SPSS. Chi-square test was used to determine for associations between inadequate intake of vitamin A, maternal undernutrition, household food security and socio-demographics. Logistic regression analysis determined the predictors of adequate dietary intake of vitamin A, undernutrition and food security. The mean age of the lactating mothers was 26.5 (SD 5.6) years. Majority (72.9%) had primary education while 57.6% were self-employed. Inadequate dietary intake of vitamin A was reported amongst 58.6% of the mothers, 31.3% had low MUAC&lt;220mm while 13.8% had low BMI. Mothers who consumed dark green leafy vegetables were 26.6% compared to those consuming fruits like bananas (18.2%), mangoes (13.3%), pineapple (10.7%) and papaya (8.3%). Fish formed the main source of proteins (18.8%), followed by meat (16.7%) and eggs (14.8%). Vitamin A intake had a significant association with income (p&lt;0.001), energy (p&lt;0.001), food insecurity (p&lt;0.001) and buying food (p&lt;0.001). Household Dietary Diversity Score (HDDS) had a significant association with low MUAC (χ2 = 1.694, p =0.031 and low BMI (χ2 = 3.039, p = 0.042). Lactating mothers from Sinai slum had inadequate dietary vitamin A intake, were under nourished and food insecure. Food security interventions: food-based strategies and policies that include Vitamin A food fortification aimed at increasing intake of Vitamin A rich food, campaigns for increased dietary diversity, alongside routine nutrition education among mothers should be emphasized to enhance their nutritional status and reduce micronutrient deficiencies. Key words: Vitamin A, Nutritional status, Slum, dietary diversity, Food Frequency

Impact of zinc and iron agronomic biofortification on grain mineral concentration of finger millet varieties as affected by location and slope.

Food crop micronutrient concentrations can be enhanced through agronomic biofortification, with the potential to reduce micronutrient deficiencies among rural population if they have access to fertilizers. Here we reported the impact of agronomic biofortification on finger millet grain zinc (Zn) and iron (Fe) concentration. A field experiment was conducted in farmers' fields in Ethiopia in two locations; over two seasons in one district (2019 and 2020), and over a single season (2019) in a second district. The experimental design had 15 treatment combinations comprising 3 finger millet varieties and 5 soil-applied fertilizer treatments: (T1) 20 kg ha-1 FeSO4 + 25 kg ha-1 ZnSO4 + NPKS; (T2) 25 kg ha-1 ZnSO4 + NPKS; (T3) NPKS; (T4) 30% NPKS; (T5) 20 kg ha-1 FeSO4 + NPKS. The treatments were studied at two slope positions (foot and hill), replicated four times in a randomized complete block design. Grain Zn concentration increased by 20% in response to Fe and Zn and by 18.9% due to Zn addition. Similarly, grain Fe concentration increased by 21.4% in T1 and 17.8% in T5 (Fe). Zinc fertilizer application (p < 0.001), finger millet variety (p < 0.001), and an interaction of Fe and Zn had significant effect on grain Zn concentration. Iron fertilizer (p < 0.001) and interactive effect of Fe fertilizer and finger millet variety (p < 0.01) had significant effects on grain Fe concentration. Location but not slope position was a source of variation for both grain Zn and Fe concentrations. Soil application of Zn and Fe could be a viable strategy to enhance grain Zn and Fe concentration to finger millet grain. If increased grain Zn and Fe is bioavailable, it could help to combat micronutrient deficiencies.

Aligning the Epidemiology of Malnutrition with Food Fortification: Grasp Versus Reach

Large-scale food fortification (LSFF) has been recognized as one of the most cost-effective interventions to improve the intake of vitamins and minerals and decrease the burden of micronutrient deficiency. Indeed, the simple addition of micronutrients to staple foods, such as wheat, maize and rice, or condiments, including salt and bouillon, has tremendous potential to impact malnutrition. However, most LSFF programs have been poorly designed and have not taken into consideration critical inputs, including current levels of nutrient inadequacy and per capita consumption of different food vehicles when deciding which nutrients to add and at what concentrations. LSFF programs, like some other nutrition interventions, also tend to have low coverage and reach and lack monitoring to measure this and course correct. These program design flaws have resulted in limited effectiveness and have made it difficult to determine how best to harmonize LSFF with other interventions to reduce micronutrient deficiencies, including efforts to enhance dietary diversity, biofortification and supplementation. Furthermore, LSFF has often been touted as a population-based intervention, but in fact has heterogenous effects among sub-groups, particularly those with limited access to or inability to afford fortified foods, as well as those with higher physiological requirements, such as pregnant and lactating women. This article focuses on these limitations and the concerted efforts underway to improve the collection, analysis, and use of data to better plan LSFF programs, track implementation, and monitor coverage and impact. This includes a more sophisticated secondary analysis of existing data, innovations to increase the frequency of primary data collection and programmatically relevant visualizations of data of sub-national estimates. These improvements will enable better use of data to target resources and programmatic efforts to reach those who stand to benefit most from fortification.

Coverage, Apparent Consumption, and Monthly Use of Packaged Maize Flour in Morogoro Region, Tanzania.

Tanzania aimed to reduce micronutrient deficiencies and neural tube defects by introducing mandatory fortification of large-scale packaged wheat and maize flour but not for small- and medium-scale mills. Ascertain the proportion of the population in Morogoro region, Tanzania, that consumes packaged maize flour from small-, medium- and large-mills; and understand the impact of monthly apparent purchase and consumption of packaged flour. In 2018, a regional, multistage cluster probability study was conducted among residents in Morogoro region living in households that reported consuming maize flour. Interviews collected information on sociodemographic factors and patterns of household flour consumption. Weighted medians estimated daily apparent flour consumption and the estimated average requirement (EAR), according to age. Information was collected on 711 households. Packaged maize flour was purchased 10-12 months of the year by 22.9% of households, 6-9 months by 17.6% of households, 1-5 months by 25.1% of households, and 34.4% did not purchased maize flour. Median apparent daily consumption of maize flour was 209.7 g/d/adult male equivalent (AME). Apparent median daily consumption of maize flour was 230.1 g/d/AME in rural areas and 176.2 g/d/AME in urban areas; 228.7 g/d/AME among males and 196.4 g/d/AME among females. If all packaged maize flour were fortified according to standards, those consuming packaged maize flour 10-12 months of the year would apparently consume 199.9 µg folic acid/d representing 49.7% of daily EAR requirements. Fortifying packaged maize flour at small-, medium- and large-mills is a promising strategy for increasing access to micronutrients, including folic acid.

Knowledge, Attitudes and Practices of Pregnant Women and Healthcare Providers in Bangladesh regarding Multivitamin Supplements during Pregnancy

Micronutrient deficiencies are widespread among pregnant women in low- and middle-income countries (LMIC) and lead to potentially adverse effects for mother and baby. In Bangladesh, maternal malnutrition remains a severe problem, with high rates of anemia (49.6% of pregnant women and 47.8% of lactating women are anemic) and other nutritional deficiencies. A Knowledge, Attitudes, and Practices (KAP) study was conducted to assess Bangladeshi pregnant women's perceptions and related behaviors, as well as awareness and knowledge among pharmacists and healthcare professionals concerning prenatal multivitamin supplements. This was done in both rural and urban areas across Bangladesh. A total of 732 quantitative interviews were conducted (330 with providers and 402 with pregnant women, with an equal split between urban and rural areas for both sets of audiences; 200 women were users of prenatal multivitamin supplements, while 202 women were aware non-users). The study identified a few findings that can guide further research or market-based interventions to reduce micronutrient deficiencies. These include most pregnant women not knowing the right time to start multivitamin supplements (56.0%, [n = 225], stating that a woman should start taking supplements 'after the first trimester'), not knowing their benefits, and how they help both the mother and baby-only 29.5% [n = 59] stated that they believed the supplements helped their baby to grow well). Further, barriers to taking the supplements include women believing a nutritious diet is a substitute (88.7% [n = 293]), and a perceived lack of support from other family members (21.8%, [n = 72]). This suggests that there is a need for further awareness-raising among all pregnant women, their family members, and providers.

Витаминно-минеральные комплексы для пациентов с постковидным синдромом

A diet that is deficient in micronutrients with anti-inflammatory and/or antioxidant properties and potential immunomodulatory and antiviral activity, and may also be a predisposing but preventable factor for both the more severe course of SARS-CoV-2 and the development of persistent long-term symptoms after the acute phase of the disease. The long-term effects of COVID-19 may worsen pre-existing micronutrient deficiencies, and conversely, associated micronutrient deficiencies contribute to the prolongation of post-COVID symptoms. The same cohorts of people are also at risk of micronutrient deficiencies and the development of post-COVID conditions. There are many overlaps between the symptoms of prolonged post-COVID and manifestations of micronutrient deficiency, which, apparently, reflects the participation of micronutrients in maintaining the normal function of organs and tissues of the body. The first studies using multiple vitamin-mineral supplements show that already within a month, according to subjective estimates, chronic fatigue decreases and the quality of life improves, as well as the grip strength and the number of repetitions in the test of getting up from a chair. The intake of vitamin-mineral supplements to reduce micronutrient deficiencies and overcome the consequences of post-COVID symptoms is a reasonable approach. Key words: post-COVID syndrome, vitamin-mineral supplements, specialized food products, clinical efficacy

Agronomic biofortification of forage crops with zinc and copper for enhancing nutritive potential: a systematic review.

Many developing countries are facing a silent increase in deficiency of micronutrients in forage crops that results in decreased levels of essential nutrients in animals. Micronutrients are essential not only for basic metabolic processes of forage crops but also for sustaining animal health. Forage productivity and quality are severely affected by soil micronutrients deficiencies, especially zinc and copper. This review summarizes the literature highlighting the significance of different methodologies used to increase the biomass and quality of forage so as to enhance the micronutrient content of the forage crops through biofortification. Biofortification is a promising and sustainable agriculture-based strategy to reduce micronutrient deficiency in crops. The experiments and trials conducted at different locations of the world showed that copper and zinc concentrations in animal fodders can be enhanced through the process of foliar application. Additionally, agronomic biofortification showed more promising results, and thus is an outstanding, fast, and cost-effective technique for the immediate enrichment of forage in order to overcome malnutrition in animals. © 2022 Society of Chemical Industry.

Coverage and Seasonality Use of Fortifiable Maize Flour in Morogoro, Tanzania

ObjectivesMaize flour is a staple consumed by 93% of the population in Tanzania. In 2011, Tanzania aimed to reduce micronutrient deficiencies and neural tube defects by introducing mandatory fortification of large-scale industrially produced wheat and maize flour. However, maize production is often fragmented (produced at smaller commercial mills) that are not required to fortify under the existing mandate. Objective: 1. Ascertain the proportion of the population of Morogoro region, Tanzania, that consumes packaged maize flour from commercial, ills; 2. understand if consumption of packaged maize flour is affected by changes in seasons and 3. determine who might potentially be reached by point-of-milling fortification in smaller packaging mills. MethodsIn 2018, a regional, multistage cluster probability study was conducted among residents in Morogoro region, Tanzania, living in households that reported consuming maize flour as the main staple. Interviews collected information on socio-demographic factors and patterns of household flour consumption. Weighted medians estimated daily individual flour intake [g/day/Adult Male Equivalent (AME)]. Daily estimated intake of folic acid was reported in μg and as percentages of the estimated average requirements (EAR) according to age. ResultsInformation was collected on 711 households (out of 984 households selected). Use of wheat flour was reported by 49.5% of households. Package maize flour was purchased 10–12 months, 6–9 months, and 1–5 months of the year by 22.9%, 17.6% and 25.1% of households, respectively; and 34.4% of households never purchased package maize flour. Per capita median daily consumption of any maize flour (including non-packaged flour) was 209.7 g/d/AME. Median daily intake was 230.1 g/d/AME among females. If all packaded maize flour were fortified according to mandate standards, those consuming packaded maize flour 10–12 months of the year would intake 199.9 μg folic acid/d representing 49.7% of daily EAR requirements. ConclusionsFortifying maize flour at small- and medium-packaging scale mills is a promising strategy for increasing household access to micronutrients including folic acid in Tanzania. Funding SourcesN/A.

Review of the Impact Pathways of Biofortified Foods and Food Products.

Biofortification is the process of increasing the concentrations and/or bioavailability of micronutrients in staple crops and has the potential to mitigate micronutrient deficiencies globally. Efficacy trials have demonstrated benefits of consuming biofortified crops (BFCs); and in this paper, we report on the results of a systematic review of biofortified crops effectiveness in real-world settings. We synthesized the evidence on biofortified crops consumption through four Impact Pathways: (1) purchased directly; (2) in informal settings; (3) in formal settings; or (4) in farmer households, from their own production. Twenty-five studies, covering Impact Pathway 1 (five studies), Impact Pathway 2 (three), Impact Pathway 3 (three), Impact Pathway 4 (21) were included. The review found evidence of an improvement in micronutrient status via Impact Pathway 4 (mainly in terms of vitamin A from orange sweet potato) in controlled interventions that involved the creation of demand, the extension of agriculture and promotion of marketing. In summary, evidence supports that biofortified crops can be part of food systems interventions to reduce micronutrient deficiencies in farmer households; ongoing and future research will help fully inform their potential along the other three Impact Pathways for scaling up.

Global, regional, and national burdens of common micronutrient deficiencies from 1990 to 2019: A secondary trend analysis based on the Global Burden of Disease 2019 study.

SummaryBackgroundUnderstanding micronutrient deficiency burdens and trends can help guide effective intervention strategies. This study aims to elucidate trends in common micronutrient deficiencies, in particular, dietary iron, iodine and vitamin A deficiencies, from 1990 to 2019 using Global Burden of Disease (GBD) 2019 study data.MethodsWe analyzed data from the GBD 2019 study to calculate the prevalence, incidence, and disability-adjusted life year (DALY) rates of micronutrient deficiencies in geographic populations worldwide from 1990 to 2019. The estimated annual percentage changes (EAPCs) and age-standardized rates were calculated to evaluate the temporal trends.FindingsGlobally, the age-standardized prevalence rates of iodine deficiency, vitamin A deficiency, and dietary iron deficiency decreased, with EAPCs of -0.690 (95% CI, -0.842 to -0.538), -3.15 (95% CI, -3.20 to -3.02), and -0.546 (95% CI, -0.585 to -0.507) between 1999 and 2019, respectively. Regarding the sociodemographic index (SDI), the highest age-standardized prevalence, incidence, and DALY rates of micronutrient deficiency were found in low-SDI countries in 2019. There were linear associations between the SDI and the healthcare access and quality (HAQ) index and age-standardized prevalence, incidence, and DALY rates.InterpretationGlobal micronutrient deficiency burdens have decreased since 1990. The potential burden of iodine deficiency in some developed countries is worthy of attention. The results of this study could guide policy makers in implementing cost-effective interventions to reduce micronutrient deficiency burdens, particularly in low-SDI and low-HAQ index countries.FundingThis work was supported by the National Natural Science Foundation of China (Grant No. 82000753) and the China Postdoctoral Science Foundation (Grant No. 2021MD703910).

Predicted Effects and Cost-Effectiveness of Wheat Flour Fortification for Reducing Micronutrient Deficiencies, Maternal Anemia, and Neural Tube Defects in Yaoundé and Douala, Cameroon.

Policy makers aiming to reduce micronutrient deficiencies (MNDs) and their health effects must choose among alternative definitions of impact when evaluating cost-effectiveness. Estimate the cost-effectiveness of a mandatory wheat flour fortification program for reducing cases of MNDs (iron, zinc, folate, vitamin B12), anemia and neural tube defects (NTDs) averted, and disability-adjusted life years (DALYs) averted in urban Cameroon. A 13-year predictive model was developed, including a 3-year start-up period and 10 years of program activity. Costs were estimated using historical program budgets. Effects were calculated based on observed changes in prevalence of MND and anemia 1 year postfortification and predicted reductions in NTDs based on NTD burden and wheat flour intake. Total DALYs averted were estimated for anemia and NTDs. The program cost ∼$2.4 million over 13 years and averted an estimated ∼95 000 cases of maternal anemia and ∼83 500 cases of iron deficiency among children after 1 year. Cost/case-year averted for MNDs ranged from $0.50 for low plasma folate to $3.30 for iron deficiency and was $2.20 for maternal anemia. The program was predicted to avert 1600 cases of NTDs over 10 years at ∼$1500 per case averted. Estimated cost/DALY averted was $50 for NTDs and $115 for anemia. In Cameroon, cost-effectiveness of wheat flour fortification varied by the measure of impact employed, but was classified as "very cost-effective" for all outcomes using World Health Organization criteria. Policy makers and their advisors must determine how best to use information on program costs and benefits to inform their decisions.

Biofortification of tomatoes in Italy: Status and level of knowledge

Biofortification is a strategy to reduce micronutrient deficiency in humans by fortifying food through natural processes, agronomic practices and genetic modification. In this study, we seek to shed light on what consumers understand by the term 'biofortified products' and thus to understand their level of knowledge about these products, as well as the reasons that dictate their purchasing choices and the relationship between consumption choices and lifestyles. The analysis focuses on vegetables and, in particular, on tomatoes with a high lycopene content. Research shows that consumers of biofortified food products are generally confused and uninformed, even though they show a high willingness to pay. This confusion seems to result, moreover, from the lack of a clear definition of a biofortified product, as well as from the lack of clear information on the specifics of biofortified products and the benefits they can bring. The future of biofortified products can, therefore, be improved by the creation of clear standards and reference definitions and better information and transparency that would benefit the consumer.

Effect of Fortification with Multiple Micronutrient Powder on the Prevention and Treatment of Iron Deficiency and Anaemia in Brazilian Children: A Randomized Clinical Trial.

Fortification with multiple micronutrient powder has been proposed as a public health intervention able to reduce micronutrient deficiencies in children. Our objective was to compare the effectiveness of fortification with multiple micronutrient powder with drug supplementation in the prevention and treatment of iron deficiency and anaemia. This was a cluster trial with anemic and non-anaemic children between six and 42 months old, in randomization data. Non anaemic children received fortification with multiple micronutrient powder or standard drug supplementation of ferrous sulfate associated with folic acid in a prevention dose. Anaemic children who were randomized to receive multiple micronutrient powder also received the recommended iron complementation for anaemia treatment. A total of 162 children were evaluated. The prevalence of anaemia decreased from 13.58 to 1.85%. Iron deficiency decreased from 21.74% to 7.89% (by serum ferritin) and iron deficiency decreased from 66.81 to 38.27% (by soluble transferrin receptor). No difference was identified between interventions for hemoglobin (p = 0.142), serum ferritin (p = 0.288), and soluble transferrin receptor (p = 0.156). Fortification with multiple micronutrient powder was effective in preventing iron deficiency and anaemia in children aged six to 48 months. In anaemic children; it was necessary to supplement the dose of multiple micronutrient powder with ferrous sulfate.