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

Abstract

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.

Introduction to the SIMPLE Macro, a Tool to Increase the Accessibility of 24-Hour Dietary Recall Analysis and Modeling

“…The SIMPLE macro is a single macro that links 3 NCI macros, the MIXTRAN, DISTRIB, and BRR_PVALUE_CI, to facilitate estimation of usual intake distributions for food and nutrients consumed “nearly-daily.” The SIMPLE macro also includes additional features, such as carrying out checks on the input data sets and supporting a variety of specific analyses, including modeling nutrition-related interventions ( 13 , 15 , 24 , 25 ); however, before this article, the associated codes and analytical details have not been published, which may have limited the extent to which other researchers could then apply these methods to their own data.…”

Zinc Fortification: Current Trends and Strategies

“…The changes in absorbed zinc were predicted using Miller’s 2007 equation and compared with the physiological requirement for absorbed zinc. Another study showed that fortifying biscuits with zinc would not substantially change the absorbed zinc, given the amounts of zinc fortified wheat flour already consumed in the usual diet [ 40 ].…”