About this item:

47 Views | 28 Downloads

Author Notes:


The authors’ responsibilities were as follows—VMF, MNNM, FTW, and LMN: designed the research; OA, RAN, RS, and AK: conducted the surveys; VMF: analyzed the data, wrote the manuscript, and had primary responsibility for the final content; MNNM, GJA, HP, OA, RAN, RS, AK, FTW, and LMN: contributed to the interpretation of the data and critically reviewed the manuscript; and all authors: read and approved the final manuscript.

We thank Yaw Addo, Rafael Flores-Ayala, Maria Elena Jefferds, Abdelrahman Lubowa, Zuguo Mei, Bernadette Ng'eno, Laird Ruth, Mary Serdula, Katie Tripp, and Ralph D Whitehead Jr. for their support to the design, data collection, and/or analysis of the surveys presented in this paper; Ty Beal for his support to data visualization; and the many individuals from Oxford Policy Management, University of the Western Cape, Africa Academy for Public Health, and Makerere University for their participation in the data collection for the surveys.

The authors report no conflicts of interest.

Research Funding:

Supported by a Bill & Melinda Gates Foundation grant.


  • large-scale food fortification
  • fortified foods
  • nutrient intakes
  • iron
  • vitamin A
  • iodine
  • women of reproductive age

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


Journal Title:

The Journal of nutrition


Volume 150, Number 8


, Pages 2183-2191

Type of Work:

Article | Final Publisher PDF


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.

Copyright information:

© The Author(s) on behalf of the American Society for Nutrition 2020.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
Export to EndNote