Quantifying the potential food fortification impact on nutrient intake and anemia prevalence among women of reproductive age in India Open Access

Abstract

Anemia is a public health burden disproportionately affecting women of reproductive age (WRA). Food fortification, the addition of micronutrients to foods, may alleviate anemia caused by nutritional deficiencies. We analyzed the mean daily intake of nutrients (vitamin A, vitamin B12, vitamin B6, vitamin C, vitamin E, iron, riboflavin, thiamine, copper, folic acid, and zinc) involved in hemoglobin synthesis among WRA (15-49 years) in India in a no-fortification compared to a maximum-fortification scenario (at 100% coverage and compliance). We estimated additional nutrients contributed from fortified milk, oil, rice, salt, and wheat flour. We estimated the impact of fortification on nutrient intake, including the percent of nutrient Estimated Average Requirements (EAR) met by WRA. We estimated total change in nutritional anemia prevalence among WRA in both fortification scenarios. 

 

We analyzed a 24-hour dietary recall from the National Nutrition Monitoring Bureau using a food composition table that we created with the 2017 Indian Food Composition and other tables to estimate no-fortification and maximum-fortification intake of the aforementioned nutrients. We calculated mean total intake in both scenarios. To the maximum fortification averages, we applied estimates generated from meta-regressions of daily iron intake to estimate average hemoglobin increase. We calculated the percent of WRA not meeting EARs for the scenarios using the EAR cut-point method. We analyzed hemoglobin values from WRA from another dataset (2015-2016 National Family Health Survey 4). We estimated anemia prevalence for the scenarios. 

 

Compared to the no-fortification scenario, the maximum-fortification scenario increased daily folate intakes by 26-27%, iron by 70-106%, thiamine by 18-42%, vitamin B12 by 12-28%, and zinc by 39-59%. Percentage of women not meeting EARs decreased and 25^th, 50^th, and 75^th percentile intakes increased from the no-fortification to maximum-fortification scenarios for iron, folate, vitamin B12, and zinc. Anemia prevalence decreased by 19-36% in the maximum-fortification scenario as a result of the additional iron consumed from fortified foods. 

Our results suggest that fortification, where 100% of women consume foods that fully meet the nutrient levels stipulated in fortification standards, can improve nutrient intakes and reduce anemia prevalence among WRA. We recommend Indian policy-makers consider these trends when crafting fortification policy. 

Table of Contents

Manuscript............................................................................................................... 1

Abstract .............................................................................................................................. 1        Introduction........................................................................................................................ 2

Methods .............................................................................................................................. 3

Results ................................................................................................................................ 8

Discussion .......................................................................................................................... 17

References.......................................................................................................................... 23

Appendix............................................................................................................................ 25

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Maternal Health Nutrition
Committee Chair / Thesis Advisor	Vijaya Kancherla, Emory University
Committee Members	Hanqi Luo, Emory University Helena Pachon, Emory University
Partnering Agencies	International Non-governmental organization (e.g., CARE, Inc.)

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