Current levels of coverage of iron and folic acid fortification are insufficient to meet the recommended intake for women of reproductive age in low- and middle-income countries

Abstract

Background Food fortification can be an effective intervention to improve maternal and child health. Folic acid fortification can reduce neural tube defects due to folate deficiency. Iron fortification is effective to reduce maternal anemia due to iron deficiency. The paper describes the methods for estimating current coverage levels for iron fortification and folic acid fortification and estimates current impact of fortification in low- and middle-income countries (LMICs) using the Lives Saved Tool (LiST). Methods The database was obtained from Global Fortification Data Exchange. We used the following indicators from the database: food intake, fortification standard, percent of food produced in industrial mills, and percent of industrially milled food that is fortified. Together with the recommended dietary allowances for women of reproductive age (WRA), we calculated percentage of WRA getting recommended intake through fortification and used the percentage as an estimate for fortification coverage. We then used LiST to estimate the health impact of fortification on maternal and child health. Results Folic acid was fortified in 72 countries, with a median coverage of 43%. Iron was fortified in 87 countries, with a median coverage of 23%. Forty-six LMICs fortified either folic acid, iron, or both. And the weighted coverage of folic acid fortification and iron fortification were 34% and 19%, respectively. A greater percentage of WRA got appropriate levels of folic acid and iron via fortification in higher income countries. Based on LiST projection, it is estimated that in 2021, over 4 million anemia cases among WRA will be averted due to consumption of iron fortified food. About 1900 stillbirths and 3000 neonatal deaths due to neural tube defects will be averted due to consumption of folic acid fortified food. Conclusions We estimated the coverage of folic acid fortification and iron fortification in LMICs and included them in the most recent version of LiST. Trends in coverage will be included in LiST as data become available. Our analysis shows that while most LMICs have fortification programs, currently the effects of these programs are limited either through low levels of fortification in industrialized food, low consumption of fortified food or both.

Folic acid: friend or foe in cancer therapy

“…Although fortification programs are being introduced in most low and middle-income countries, the impacts of these programs have been restricted either by low levels of fortification in industrialized food, low consumption of fortified food, or both. 165 Folic acid receptors and cancer risk: future prospectives Many types of human cancer, such as BC, ovarian cancer, endometrial cancer, lung cancer, CRC, and cerebral tumors, have shown increased FR expression levels compared with healthy tissues. 166,167 FR can be a target to improve cancer therapy outcomes.…”

Folic acid deficiency and neural tube defects: the awareness dilemma

“…There is a high prevalence in micronutrient malnutrition in (LMICs), after applying large-scale food fortification, major improvements were recorded for multiple diseases, including NTDs prevalence which decreased by 41% after folic acid fortification programs were applied for a mean of 4.2 years (17). In comparison with high-income countries, LMICs may have a folic acid fortification programs, but the desirable benefits have not achieved, one of the main limitations are low awareness and compliance of consumption of folic acid fortified meals among general populations, especially females of childbearing age (18).…”

Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs

“…Several studies have reported that in vulnerable populations in LMICs, the diets that are both available and affordable are not sufficient to cover nutritional needs of women or children (de Jager et al, 2018; Fahmida et al, 2014; Hlaing et al, 2016; Shi et al, 2010). Fortification programs have shown some successes in improving micronutrient intakes, but several gaps are still to be covered (Castillo‐Lancellotti et al, 2013; Keats et al, 2019; Osendarp et al, 2018; Tong & Walker, 2021). For example, while fortified food has been shown to be major contributor to apparent intakes of vitamin A and iodine in women in four African countries, iron fortification programs appeared to underperform notably due to the low consumption of fortified flour (Friesen et al, 2020).…”

“…Fortification programs have shown some successes in improving micronutrient intakes, but several gaps are still to be covered (Castillo-Lancellotti et al, 2013;Keats et al, 2019;Osendarp et al, 2018;Tong & Walker, 2021). For example, while fortified food has been shown to be major contributor to apparent intakes of vitamin A and iodine in women in four African countries, iron fortification programs appeared to underperform notably due to the low consumption of fortified flour (Friesen et al, 2020).…”