Dietary iron intake over two post-fortification periods in Brazil: data from the National Dietary Surveys 2008–2009 and 2017–2018

Abstract

We aimed to assess the dietary iron intake and the prevalence of inadequate iron intake over two post-fortification periods in Brazil. The intake was analysed according to sex, life stage, geographic region, and stratum of family income per capita. Excluding pregnant and lactating women, this population-based study included 32,749 and 44,744 participants aged ≥ 10 years from the National Dietary Survey-Brazilian Household Budget Surveys 2008–2009 and 2017–2018, respectively. The National Cancer Institute method was used to predict usual dietary iron intakes. The prevalence of iron intake inadequacy was estimated following a probabilistic approach for women of childbearing age or with the Estimated Average Requirement cut-off point method. Over an interval of 10 years, the mean iron intake remained almost unchanged for most sex-age groups, except for women of childbearing age. In this specific group, the prevalence of iron intake inadequacy was > 20% in 2008–2009 and have increased to > 25% in 2017–2018, with the highest reductions in mean iron intake found in the highest income strata and richest Brazilian regions. Meanwhile, the highest prevalence of iron intake inadequacy (> 40%) occurred among the poorest women aged 31–50 years from the lowest family income stratum, irrespective of the study period. Beans were the main iron source, while fortified breads, pastas, pizzas, cakes, and cookies contributed approximately 40% of the iron intake. The results provide important insights into the long-standing dietary impacts of food fortification, which can guide future (re)formulation of effective public health strategies to combat iron deficiency.