Iron, Zinc, Folate, and Vitamin B-12 Status Increased among Women and Children in Yaoundé and Douala, Cameroon, 1 Year after Introducing Fortified Wheat Flour

Abstract

Background: Few data are available on the effectiveness of large-scale food fortification programs.Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaoundé and Douala, Cameroon.Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ∼300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15–49 y and children 12–59 mo of age.Results: Wheat flour was consumed in the past 7 d by ≥90% of participants. Postfortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower postfortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children postfortification, mean plasma concentrations were greater for ferritin and lower for sTfR after adjustments for potential confounders. Mean plasma zinc concentrations were greater postfortification and the prevalence of low plasma zinc concentration in women after fortification (21%) was lower than before fortification (39%, P < 0.001); likewise in children, the prevalence postfortification (28%) was lower than prefortification (47%, P < 0.001). Mean plasma total folate concentrations were ∼250% greater postfortification among women (47 compared with 15 nmol/L) and children (56 compared with 20 nmol/L), and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a nonrepresentative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater postfortification.Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.

Prevalence and predictors of overweight and obesity among Cameroonian women in a national survey and relationships with waist circumference and inflammation in Yaoundé and Douala

“…There has been limited progress on indicators related to health and undernutrition over the past decade: The under‐5 mortality rate was 95 per 1,000 in 2012, ranked 21st globally, and stunting prevalence was 33% in 2011 (Global Nutrition Report, ). Previous work revealed a high prevalence of anaemia and micronutrient deficiencies among women and children (Engle‐Stone, Ndjebayi, Nankap, & Brown, ), although large‐scale fortification appears to have reduced this risk for selected micronutrients (Engle‐Stone et al, ). At the same time, concerns about overweight and associated chronic disease risk in Cameroon have arisen.…”

“…The 2012 survey was conducted to examine the impact of large‐scale food fortification on micronutrient status (Engle‐Stone et al, ). The sampling framework was confined to Yaoundé and Douala due to resource limitations and greater expected availability of fortified foods compared with rural areas.…”

“…• Underweight and micronutrient deficiencies are still prevalent in Cameroon, particularly the North, so interventions to prevent malnutrition in all forms are needed. 2012), although large-scale fortification appears to have reduced this risk for selected micronutrients (Engle-Stone et al, 2017). At the same time, concerns about overweight and associated chronic disease risk in Cameroon have arisen.…”

“…The 2012 survey was conducted to examine the impact of large-scale food fortification on micronutrient status(Engle-Stone et al, 2017).The sampling framework was confined to Yaoundé and Douala due to resource limitations and greater expected availability of fortified foods compared with rural areas. To improve statistical power to detect changes over time, the 2012 survey was conducted in the same clusters that were selected in 2009, using the same methodology to select households (although the participating households differed between the two surveys).…”

Countries with an immediate potential for primary prevention of spina bifida and anencephaly: Mandatory fortification of wheat flour with folic acid

“…Countries with existing industrial milling capacity have a unique and timely opportunity to accelerate the rate of prevention of folic acidpreventable spina bifida and anencephaly (FAPSBA) by enabling mandatory fortification. Additionally, the prevention potential in these countries can extend beyond FAPSBA, to folate deficiency anemia and other nutritional deficiencies that can be addressed simultaneously through flour fortification (Barkley, Wheeler, & Pach on, 2015;Engle-Stone et al, 2017;Pach on, Spohrer, Mei, & Serdula, 2015).…”