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Pachon H.,Food Fortification Initiative | Pachon H.,Emory University | Spohrer R.,Global Alliance for Improved Nutrition | Mei Z.,Centers for Disease Control and Prevention | Serdula M.K.,Centers for Disease Control and Prevention
Nutrition Reviews | Year: 2015

Context. More than 80 countries fortify flour, yet the public health impact of this intervention on iron and anemia outcomes has not been reviewed. Objective. The objective of this systematic review was to review published and gray literature pertaining to the impact of flour fortification on iron and anemia. Data Sources. A systematic review was conducted by searching 17 databases and appealing for unpublished reports, yielding 1881 documents. Study Selection. Only studies of government-supported, widely implemented fortification programs in which anemia or iron status was measured prior to and ≥12 months after initiation of fortification were included. Data Extraction. Details about the design, coverage, compliance with national standards, and evaluation (e.g., anemia prevalence before and after fortification) of flour fortification programs were extracted from the reports. Data Synthesis. Thirteen studies describing 26 subgroups (n = 14 for children ≤15 y, n = 12 for women of reproductive age) were included. During the period from pre- to postfortification (and as difference-in-difference for those studies that included a control group), there were statistically significant decreases in the prevalence of anemia in 4 of 13 subgroups of children and in 4 of 12 subgroups of women of reproductive age as well as significant decreases in the prevalence of low ferritin in 1 of 6 subgroups of children and in 3 of 3 subgroups of women of reproductive age. Conclusions. Evidence of the effectiveness of flour fortification for reducing the prevalence of anemia is limited; however, evidence of effectiveness for reducing the prevalence of low ferritin in women is more consistent. Source

Parra D.C.,Washington University in St. Louis | Iannotti L.,Washington University in St. Louis | Gomez L.F.,Pontifical Xavierian University | Pachon H.,Food Fortification Initiative | And 5 more authors.
Archives of Public Health | Year: 2015

Background: Overweight and underweight increase the risk of metabolic impairments and chronic disease. Interventions at the household level require the diagnosis of nutritional status among family members. The aim of this study was to describe the prevalence and patterns of various anthropometric typologies over a decade in Colombia using a novel approach that considers all children in the household as well as the mother. This approach also allows identifying a dual burden of malnutrition within a household, where one child may be overweight and another one undernourished. Methods: This study used data from the Demographic and Health Survey and the Colombian National Nutrition Survey [2000 n = 2,876, 2005 n = 8,598, and 2010 n = 11,349].Four mutually exclusive household (HH) anthropometric typologies -normal, undernourished, overweight/obese,anddual burden- were created. Anthropometric information of height-for-age Z-scores (HAZ) and body-mass-index-for-age Z-scores (BMIz) in children under the age of 5 y, and on body mass index (BMI) in mothers, 18-49 y was used. Results: Prevalence of overweight/obese HHs increased between 2000 (38.2%) and 2010 (43.1%) (p < 0.05), while undernourished and dual burden HHs significantly decreased between 2005 (13.7% and 10.6%, respectively) and 2010 (3.5% and 5.1%, respectively) (p < 0.05). A greater increase of overweight/obesity was observed for the lowest quintile of wealth index (WI), with an increase of almost 10% between 2000 and 2010, compared to 2% and 4% for the fourth and highest WI, respectively. Although in 2010 there is still a higher prevalence of overweight/obesity HHs in urban areas (43.7%), the prevalence of overweight/obesity HHs in rural areas increased sharply between 2000 (34.3%) and 2010 (41.6%) (p < 0.05).Conclusion: The observed prevalence of dual burden households was not different from the expected prevalence. Results from this study indicate that although overweight/obesity continues to be more prevalent among high-income Colombian households, it is growing at a faster pace among the most economically disadvantaged. © 2015 Parra et al. Source

Zimmerman S.,Food Fortification Initiative | Baldwin R.,Food Fortification Initiative | Codling K.,Food Fortification Initiative | Hindle P.,P and J Communications | And 3 more authors.
Indian Journal of Community Health | Year: 2015

Background: Damaging effects of vitamin and mineral deficiencies contribute to health and development problems throughout the world. Food fortification has substantially improved nutrition-related health conditions in many countries, but opportunities for fortification are not fully utilized. Where food fortification is considered, leaders have to determine whether fortification should be mandatory or voluntary. Objective: This article explores experiences with mandatory wheat flour fortification as compared to voluntary fortification to offer insight for policies related to any type of food fortification. Mandatory fortification means the country requires the addition of specific nutrients at predetermined levels to specified foods or food products. Voluntary policies allow food manufacturers to enrich their products but do not require them to do so. Results: Mandatory fortification is more likely than voluntary fortification to reach a high proportion of the population and hence achieve the desired health impact. Mandatory fortification does not require consumers to change food purchasing preferences, it distributes the health benefits more equitably than voluntary fortification across a population, it establishes safe levels of included nutrients, and it is not subject to the food manufacturers’ marketing investments or discretion. Conclusion: The health benefits of mandatory fortification are most likely to be achieved and sustained if national, multi-sector leaders develop a cooperative approach for appropriate food fortification policies that can be feasibly implemented and effectively monitored. Mandatory fortification, however, requires high-level commitment through the political process. Policy makers must contend with possible criticism that it interferes with personal choices or may cause unintended health problems. © 2015, Indian Association of Preventive and Social Medicine. All rights reserved. Source

Barkley J.S.,Food Fortification Initiative | Barkley J.S.,Emory University | Kendrick K.L.,Emory University | Codling K.,Food Fortification Initiative | And 3 more authors.
Asia Pacific Journal of Clinical Nutrition | Year: 2015

Objective: To summarize anaemia prevalence data for children, women, and men using data from the second, third and fourth waves of the Indonesia Family Life Surveys (IFLS), which were conducted in 1997/8, 2000, and 2007/8, respectively. Methods: Anaemia prevalence was determined for children 0 to 5 years, 5 to 12 years, 12 to 15 years, non-pregnant women at least 15 years, pregnant women at least 15 years, and men at least 15 years, based on haemoglobin adjusted for altitude and smoking status. Results: Compared with 1997/8 estimates, anaemia prevalence estimates were lower in 2007/8 for all groups, with the greatest relative decline occurring in children 5 to 12 years (25.4%). Trend analysis found anaemia significantly declined over the survey years for all groups (χ2 p=0.005 for pregnant women, χ2 p<0.001 for all other groups). Conclusions: IFLS anaemia estimates for different population groups decreased between 1997/8 and 2007/8 and were consistent with estimates from Southeast Asia, and with other studies conducted in Indonesia. While the prevalence of anaemia consistently decreased in all groups, anaemia remains a moderate public health problem for children 0 to 5 years, children 5 to 12 years, and non-pregnant and pregnant women. Source

Barkley J.S.,Food Fortification Initiative | Barkley J.S.,Emory University | Wheeler K.S.,Food Fortification Initiative | Wheeler K.S.,Emory University | And 2 more authors.
British Journal of Nutrition | Year: 2015

The effectiveness of flour fortification in reducing anaemia prevalence is equivocal. The goal was to utilise the existing national-level data to assess whether anaemia in non-pregnant women was reduced after countries began fortifying wheat flour, alone or in combination with maize flour, with at least Fe, folic acid, vitamin A or vitamin B12. Nationally representative anaemia data were identified through Demographic and Health Survey reports, the WHO Vitamin and Mineral Nutrition Information System database and other national-level nutrition surveys. Countries with at least two anaemia surveys were considered for inclusion. Within countries, surveys were excluded if altitude was not consistently adjusted for, or if the blood-draw site (e.g. capillary or venous) or Hb quantification method (e.g. HemoCue or Cyanmethaemoglobin) differed. Anaemia prevalence was modelled for countries that had pre- and post-fortification data (n 12) and for countries that never fortified flour (n 20) using logistic regression models that controlled for time effects, human development index (HDI) and endemic malaria. After adjusting for HDI and malaria, each year of fortification was associated with a 2·4 % reduction in the odds of anaemia prevalence (PR 0·976, 95 % CI 0·975, 0·978). Among countries that never fortified, no reduction in the odds of anaemia prevalence over time was observed (PR 0·999, 95 % CI 0·997, 1·002). Among both fortification and non-fortification countries, HDI and malaria were significantly associated with anaemia (P< 0·001). Although this type of evidence precludes a definitive conclusion, results suggest that after controlling for time effects, HDI and endemic malaria, anaemia prevalence has decreased significantly in countries that fortify flour with micronutrients, while remaining unchanged in countries that do not. © The Authors 2015. Source

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