Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

• Type of Material: Article
• Authors: Valerie M. Friesen, Global Alliance for Improved Nutrition; Mduduzi N.N. Mbuya, Global Alliance for Improved Nutrition; Grant J. Aaron, Global Alliance for Improved Nutrition; Helena Pachon, Emory University; Olufemi Adegoke, Oxford Policy Management; Ramadhani A. Noor, Africa Academy for Public Health; Rina Swart, University of the Western Cape; Archileo Kaaya, Makerere University; Frank T. Wieringa, Université de Montpellier; Lynette Neufeld, Emory University
• Language: English
• Date: 2020-08-01
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) on behalf of the American Society for Nutrition 2020.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/jn/nxaa167
• Title of Journal or Parent Work: The Journal of nutrition
• Volume: 150
• Issue: 8
• Start Page: 2183
• End Page: 2191
• Grant/Funding Information: Supported by a Bill & Melinda Gates Foundation grant.
• Keywords: iodine; nutrient intakes; fortified foods; vitamin A; large-scale food fortification; iron; women of reproductive age
• Research Categories: Health Sciences, Nutrition

Abstract

Background Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified. Objectives We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA). Methods In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI). Results Fortified foods made modest contributions to measured iron intakes (0%–13% RNI); potential intakes if standards are met were generally higher (0%–65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%–125% and 88%–253% EAR, respectively); potential intakes were higher (53%–655% and 115%–377% EAR, respectively) and would exceed the tolerable upper intake level among 18%–56% of WRA for vitamin A in Nigeria and 1%–8% of WRA for iodine in Nigeria, Tanzania, and Uganda. Conclusions Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.