High dietary micronutrient inadequacy in peri‐urban school children from a district in South India: Potential for staple food fortification and nutrient supplementation

Abstract

Multiple micronutrient deficiencies (MNDs) co‐exist, often because of poor intakes and adversely impact health. Habitual diets were assessed in 300 school children (6–17 years old) recruited from two government schools by simple random sampling. Probability of adequacy (PA) for 11 micronutrients and mean probability of adequacy (MPA) was calculated. Haemoglobin, plasma ferritin, folic acid, vitamin B 12 and C‐reactive protein were estimated. Descriptive statistics and regression analysis were used to estimate magnitude and factors associated with MNDs. The contribution of fortified foods and/or supplements in addressing inadequacies and excessive intakes was modelled. The PA ranged from 0.04 for folate to 0.70 for zinc, and the MPA was 0.27. Prevalence of anaemia (53%), iron deficiency (57%; ID), iron deficiency anaemia (38%; IDA), folate deficiency (24%) and B 12 deficiency (43%) was high. Dietary inadequacy of iron, zinc and a low MPA was associated with anaemia and IDA. Inclusion of double fortified salt (DFS), fortified rice (FR) or iron folic acid (IFA) supplements individually in habitual diet reduced probability of iron inadequacy significantly from 82% to ≤13%. Inclusion of DFS and FR simultaneously led to disappearance of iron inadequacy, but risk of excessive intake increased to 16%. Inclusion of DFS, FR and IFA together increased risk of excess iron intake to 40%. Nevertheless, intakes of folate and B 12 remained inadequate even with FR and/or IFA. These results indicate a high risk of dietary MNDs in children and suggest need for more systematic intake measurements in representative sample and adjustment of iron dosages to avoid excessive intakes.

Association of dietary intake with micronutrient deficiency in Indian school children: a cross-sectional study

“…This is in line with a study conducted in South India, that reported an inadequate intake of iron, vitamin B12, and folate in diet of peri-urban school children. ( 29 ) Another study from Manipur, an eastern state of India, reported children and adolescents have low dietary inadequacy of calcium and vitamin A. ( 30 ) The National Nutrition Monitoring Bureau (2011–12) reported that adequacy of calcium, iron, zinc, folate, vitamin A, and vitamin B12 intake was very poor in adolescent girls from ten states of India.…”

Demystifying the micronutrient deficiency burden in India

“…6 Based on the health survey responses of 220 HCPs in urban India (Mar-Apr 2021), nearly 85% of Indian doctors (GPs, ENTs, Internal Medicine experts), and 93% of Indian nutritionists also believe that only 70% (or even lower) of our micronutrient requirements are fulfilled by our daily Indian diet in urban adults aged 25-45 years. 16 Majority of the HCPs agreed that among micronutrients, consumption of calcium, iron, folic acid, zinc, vitamin D3, and B12 are below RDA guidelines in the Indian population. Among MiNDs, iron deficiency anemia, vitamin A deficiency, and riboflavin deficiency are highly prevalent in the Indian population.…”

“…Based on the health survey responses of 220 HCPs in urban India (Mar-Apr 2021), 74% of Indian doctors/nutritionists are positively inclined to prescribe multivitamin/mineral supplements to fulfill micronutrient deficiencies (as per RDA) in daily Indian diet (Figure 3). 16…”

Micronutrient interventions among vulnerable population over a decade: A systematic review on Indian perspective

“…9 Alleviation of micronutrient deficiencies is imperative and is globally addressed through intervention strategies that include supplementation, fortification and food diversification. 10 Major health concerns connected to dietary inadequacy include lack of critical nutrients, protein-energy malnutrition and micronutrient inadequacies. 11 …”