Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh

Adams, Aubrey Manack; Ahmed, Rushdiá; Latif, A. H. M. Mahbub; Rasheed, Sabrina; Das, Sumon Kumar; Hasib, Enamul; Farzana, Fahmida Dil; Ferdous, Farzana; Ahmed, Shahnawaz; Faruque, A. S. G.

doi:10.1371/journal.pone.0174673

Cited by 19 publications

(20 citation statements)

References 19 publications

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“…Many studies using vitamin D–fortified wheat or maize flour in LMICs support the use of these foods as a vehicle for increasing vitamin D intake. For example, biscuits made from multinutrient‐fortified wheat flour, which included vitamin D, fed to Bangladeshi school children significantly reduced the risk of vitamin D deficiency and other nutrient deficiencies relative to a control group . One of the few examples of a national wheat flour fortification initiative that includes vitamin D is the Jordanian wheat flour fortification program, introduced in 2009, which mandates vitamin D fortification at the level of 550 IU/kg (13.75 μg/kg) or approximately 58 IU vitamin D/serving (1.45 μg vitamin D/serving) .…”

Section: Interventions To Reduce the Prevalence Of Vitamin D Deficienmentioning

confidence: 99%

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Roth

Abrams

Aloia

et al. 2018

Annals of the New York Academy of Sciences

397

340

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Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood. Because many countries have a relatively low supply of foods rich in vitamin D and inadequate exposure to natural ultraviolet B (UVB) radiation from sunlight, an important proportion of the global population is at risk of vitamin D deficiency. There is general agreement that the minimum serum/plasma 25-hydroxyvitamin D concentration (25(OH)D) that protects against vitamin D deficiency-related bone disease is approximately 30 nmol/L; therefore, this threshold is suitable to define vitamin D deficiency in population surveys. However, efforts to assess the vitamin D status of populations in low- and middle-income countries have been hampered by limited availability of population-representative 25(OH)D data, particularly among population subgroups most vulnerable to the skeletal and potential extraskeletal consequences of low vitamin D status, namely exclusively breastfed infants, children, adolescents, pregnant and lactating women, and the elderly. In the absence of 25(OH)D data, identification of communities that would benefit from public health interventions to improve vitamin D status may require proxy indicators of the population risk of vitamin D deficiency, such as the prevalence of rickets or metrics of usual UVB exposure. If a high prevalence of vitamin D deficiency is identified (>20% prevalence of 25(OH)D < 30 nmol/L) or the risk for vitamin D deficiency is determined to be high based on proxy indicators (e.g., prevalence of rickets >1%), food fortification and/or targeted vitamin D supplementation policies can be implemented to reduce the burden of vitamin D deficiency-related conditions in vulnerable populations.

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Section: Interventions To Reduce the Prevalence Of Vitamin D Deficienmentioning

confidence: 99%

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Roth

Abrams

Aloia

et al. 2018

Annals of the New York Academy of Sciences

397

340

View full text Add to dashboard Cite

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“…Several other similar studies by Mahfuz et al (20) (22). Other study by Adams et al In Banglades show fortified biscuits had a significant positive impact on mean levels of iron, folic acid, vitamin B12, retinol and vitamin D in primary school children (23). Study in China by Zhang et al Study in China showed Community-based complementary food supplements combined with dietary counselling can improve feeding practices and reduce anaemia prevalence in 6-23 mo old (24).…”

Section: S388mentioning

confidence: 88%

Effect of Nutrition Education and Multi-Nutrient Biscuit Interventions on Nutritional and Iron Status: A Cluster Randomized Control Trial on Undernourished Children Aged 6–23 Months in Aceh, Indonesia

Ahmad

Madanijah

Dwiriani

et al. 2020

J Nutr Sci Vitaminol

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Undernutrition and iron deficiencies on under-five children in Indonesia remain high and very closely related to inadequate complementary feeding. This study investigated the effect of weekly nutrition education by home visite using the food monitoring card (FMC) models and daily provision multi-nutrient biscuits and combination on growth and reduction of iron deficiency and anemia among underweight children aged 6-23 mo in Aceh Indonesia. A 6-mo, cluster randomized, control trial was conducted on 121 children received nutrition education (NE), multi-nutrient biscuit (MNB), combination both nutrition education and biscuits (NE1 MNB), and control group. The outcome weight gain and prevalence of underweight (weight for age z-score ,22SD) were collected by anthropometric and iron deficiency were serum ferritin measuring with ELISA method. After the 6-mo intervention, the rate of weight gain was higher in combination intervention group 1.516 0.68 kg than multi-biscuit group 1.406 0.72 kg, NE group 1.346 0.66 kg and control group 1.216 0.42 kg, and the rate increase of serum ferritin was higher in combination NE1 MNB and biscuit group (2.54 mg/L and 2,17 mg/L). At the end of study there were a significant decrease in prevalence of underweight (p5 0.003), the incidence of underweight in NE1 MNB (45.2%) lower than NE group (63.3%), MNB group (64.5%) and control group (69,0%) and significant decrease of iron deficiency (p5 0.02), the incidence lower in MNB group (6.5%) than NE1 MNB (22.6%), NE group (23.3%) and control group (24.1%). The combination of nutritional education and multi-nutrient biscuits intervention improving nutritional and iron deficiency status on undernourished children. These risearch highlight the need integration of nutrition education and food base intervention to prevent underweight and iron deficiency on children 6-23 mo old.

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“…The fortification concentrations modeled were based on randomized trials in which increased concentrations of biological markers of micronutrient status were observed in participants fed fortified biscuits compared with control ( 22 , 35 – 37 ) ( Table 1 ). We also modeled fortification concentrations higher than those used in these studies under the assumption that such concentrations would also be technically feasible and would not cause adverse organoleptic profiles.…”

Section: Methodsmentioning

confidence: 99%

Micronutrient Fortification of Commercially Available Biscuits Is Predicted to Have Minimal Impact on Prevalence of Inadequate Micronutrient Intakes: Modeling of National Dietary Data From Cameroon

Haile

Luo

Vosti

et al. 2020

Current Developments in Nutrition

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Background Voluntarily-fortified snack products are increasingly available but are not necessarily formulated to meet known dietary nutrient gaps, so potential impacts on population micronutrient intake adequacy are uncertain. Objective We modeled the impacts of hypothetical micronutrient-fortified biscuits on inadequate micronutrient intake among children and women of reproductive age (WRA) in Cameroon. Methods In a nationally-representative survey stratified by macro-region (North, South, and Yaoundé/Douala), 24-h dietary recall data were collected from 883 children 12–59 mo and 912 WRA. We estimated usual nutrient intake by the National Cancer Institute (NCI) method for vitamin A (VA), folate, vitamin B12, zinc, and iron. We simulated the impact of biscuit fortification on prevalence of micronutrient intake below the estimated average requirement, given observed biscuit consumption, in the presence and absence of large-scale food fortification (LSFF) programs. Results Biscuit consumption in the prior 24 h by children and WRA, respectively, ranged from 4.5% and 1.5% in the South, to 20.7% and 5.9% in Yaoundé/Douala. In the absence of LSFF programs, biscuits fortified with retinol (600μg/100g), folic acid (300μg/100g), and zinc (8mg/100g) were predicted to reduce the prevalence of inadequacy among children by 10.3 ± 4.4, 13.2 ± 4.2 and 12.0 ± 6.1 percentage points, respectively, in Yaoundé/Douala. However, when existing VA-fortified oil, and folic acid and zinc-fortified wheat flour programs were considered, the additional impacts of fortified biscuits were reduced substantially. Micronutrient-fortified biscuits were predicted to have minimal impact on dietary inadequacy among WRA, with or without LSFF programs. Conclusions Given observed patterns of biscuit consumption in Cameroon, biscuit fortification is unlikely to reduce dietary inadequacy of studied micronutrients, except possibly for selected nutrients among children in urban areas in the absence of LSFF programs. As voluntary fortification becomes increasingly common, modeling studies may help guide efforts to ensure that fortified products align with public health goals.

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Impact of fortified biscuits on micronutrient deficiencies among primary school children in Bangladesh

Cited by 19 publications

References 19 publications

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Global prevalence and disease burden of vitamin D deficiency: a roadmap for action in low‐ and middle‐income countries

Effect of Nutrition Education and Multi-Nutrient Biscuit Interventions on Nutritional and Iron Status: A Cluster Randomized Control Trial on Undernourished Children Aged 6–23 Months in Aceh, Indonesia

Micronutrient Fortification of Commercially Available Biscuits Is Predicted to Have Minimal Impact on Prevalence of Inadequate Micronutrient Intakes: Modeling of National Dietary Data From Cameroon

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