Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data

Abstract

Objective: To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula. Design: Quantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour. Setting: Households in Gaza City and Hebron that were not receiving food aid from social programmes. Subjects: Non-pregnant women (18-49 years) and children aged 36-83 months. Results: The micronutrients with highest prevalence of insufficiency were vitamin D in women (84-97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B 12 in women and children (43-82 % with serum B 12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B 12 , Zn and folic acid may be indicated. Conclusions: Micronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.

Serum 25-hydroxyvitamin D and bone turnover markers in Palestinian postmenopausal osteoporosis and normal women

“…The present data showed vitamin D deficiency to be common among Palestinian postmenopausal women which is consistent with the widespread vitamin D deficiency in Palestine [ 39 ] and Middle Eastern Arab countries [ 15 , 27 , 40 ]. The level of vitamin D depends on several factors including diet, exposure to sun, age, feeding habits, life style, metabolic, genetic, and other environmental factors [ 7 , 41 ].…”

“…Table 2 showed that 14.1% of the study subjects had severe vitamin D deficiency (< 10 ng/ml 25(OH)D with mean ± SD 8.51 ± 1.28 ng/ml), whereas 71.8% had vitamin D insufficiency or borderline [25(OH)D 10 to < 20 ng/ml with mean ± SD 13.26 ± 2.20 ng/ml]. Subjects with normal (vitamin D sufficient) represented 14.1% [25(OH)D ≥ 20 ng/ml with mean ± SD 24.55 ± 3.60 ng/ml] [ 7 , 39 ]. Chi-square analysis showed no statistically significant difference in the prevalence of vitamin D groups between osteoporosis and control subjects.…”

Risk factors for vitamin A and D deficiencies among children under-five in the state of Palestine

“…The evidence suggests that the State of Palestine has a higher prevalence of vitamin A and D deficiencies than some of its neighboring countries. Vitamin A deficiency was found in 73.1% of children, which is similar to the 76% prevalence rate found in two previous cross-sectional studies in the State [ 14 , 24 ], however, it is much larger than the 15% to 40% range observed in Southern Israel, Turkey and Iran [ 16 , 20 , 21 , 25 ]. As for vitamin D, 60.7% of children were deficient, which falls in the upper end of the range of deficiency reported by Bassil et al in a systematic review of VDD in the Middle East and North Africa (30–75%) [ 3 ].…”

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

“…This is often due to the high costs of data collection and analysis. In fact, few countries-with a few notable exceptions such as Cameroon [25,26] and Palestine [27]-have used recent dietary intake and micronutrient deficiency data to inform the design of food fortification programs, including the selection of foods and setting of national standards. Consequently, some fortification programs have selected food vehicles that are not widely consumed in a fortifiable form [9] and/or set standards that are not aligned with the consumption patterns and the nutritional needs of the population [28].…”