Revisiting Dietary Iron Requirement and Deficiency in Indian Women: Implications for Food Iron Fortification and Supplementation

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.

Section: Potential Contribution Of Staple Food Fortification and Nusupporting

confidence: 88%

“…reported (Ghosh, Sinha, Thomas, Sachdev, & Kurpad, 2019;Swaminathan et al, 2019), which are higher compared with IOM recommendations. As a consequence, the risk of iron inadequacy increased further (93% vs. 82%) when these EARs were considered (Table S7).…”

Section: Magnitude and Factors Associated With Dietary Micronutrienmentioning

confidence: 67%

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

Madhari

Boddula

Palika

et al. 2020

“…Globally, more than 820 million people are undernourished, and more than 2 billion people suffer from micronutrient deficiencies (FAO, 2017). More than one fifth of women in India are undernourished with chronic energy deficiency (CED), and more than 50% of them have anaemia (National Family Health Survey [NFHS]-4, 2015).…”

Section: Introductionmentioning

confidence: 99%

Agroforestry diversity, indigenous food consumption and nutritional outcomes in Sauria Paharia tribal women of Jharkhand, India

Ghosh-Jerath

Kapoor

Singh

et al. 2020

Like several indigenous populations, Sauria Paharias, a vulnerable indigenous tribal group residing in a biodiverse environment of Jharkhand, India, have high levels of undernutrition. We assessed agroforestry and dietary diversity, food consumption especially indigenous food (IF) intake and nutritional status of Sauria Paharia women through a cross‐sectional study conducted in 18 villages of Godda district, Jharkhand. Household level information was elicited through household surveys including a dietary survey and a food frequency questionnaire. Twenty‐four‐hour dietary recalls (24 HDR) and anthropometric assessments were taken on one randomly selected woman per household. An index, Food Accessed Diversity Index (FADI) created to measure agroforestry diversity, showed a low mean score of 0.21 ± 0.15 and range: 0, 0.85. Fifty‐nine percent of women consumed any IF during 24 HDR. Median minimum dietary diversity score for women (MDD‐W) was 3 (acceptable score ≥5). More than 96% of women had intakes below estimated average requirements for all nutrients studied (energy; vitamins A, C, thiamine, riboflavin, niacin, pyridoxine; folate; iron; calcium and zinc) except protein; 41% women were underweight. IF consumption was independently associated with calcium and vitamin A intake. Decision trees developed for micronutrient consumption at different levels of MDD‐W score and IF consumption scenarios revealed 1.3 to 2.9 times higher consumption of micronutrients among women with MDD‐W ≥ 3 or 4. Strategies like agricultural extension programmes promoting indigenous varieties and nutrition education for increasing dietary diversity with IFs have potential to address undernutrition in Sauria Paharia women.

“…¥EAR and RDA values for WRA, children and adolescents were adopted from Ghosh, Sinha, Thomas, et al, 2019; Ghosh, Sinha, Shivakumar, et al, 2019.…”

Section: Resultsmentioning

confidence: 99%

“…To understand the potential contribution of the fortified rice to the dietary iron intakes among different age groups, the habitual iron intake data was summed with additional iron contributed by fortified rice considering the rice intake data of Andhra Pradesh (NNMB, 2012), a predominantly rice consuming south Indian state. The percentage iron intake with respect to EAR and RDA (Ghosh et al, 2019; Ghosh, Sinha, Thomas, Sachdev, & Kurpad, 2019) was then computed to reflect the potential differences due to fortified rice. The current regulation of iron content in fortified rice in India ranges from 28 to 42.5 mg/kg rice when ferric pyrophosphate is used as the iron fortificant (https://ffrc.fssai.gov.in/commodity?commodity=fortified-rice).…”

Section: Methodsmentioning

confidence: 99%

Retention, stability, iron bioavailability and sensory evaluation of extruded rice fortified with iron, folic acid and vitamin B₁₂

Jyrwa

Palika

Boddula

et al. 2020

Fortification of rice with micronutrients using extrusion technology is considered a sustainable strategy to prevent nutritional deficiencies in general population. The objective of the present study is to assess the retention, stability and iron bioavailability from indigenously developed triple fortified rice (iron, folic acid and vitamin B 12 ) during rinsing and different cooking methods. Further, we also assessed the acceptability of fortified rice in adult human volunteers. The retention of iron during rinsing with excess water was ≥90%, whereas folic acid and vitamin B 12 levels were reduced by ~25% during rinsing. Watertight cooking of rice (in electric cooker or on flame) had no additional effect on the nutrient levels as compared with rinsed rice, implying their stability during cooking. However, cooking with excess water followed by decanting led to loss of 45% iron and ≥70% folic acid and vitamin B 12 . The dialyzable iron and ferritin synthesis in Caco‐2 cells was significantly ( P < .01) higher from fortified rice compared with unfortified rice. In addition, inclusion of ascorbic acid significantly ( P < .01) increased the iron bioavailability from the fortified rice. Triangle tests in adult human subjects revealed that there are no significant sensory differences among fortified and unfortified rice. Further, fortified rice consumption appears to bridge the gaps in dietary iron intake deficits in children and women of reproductive age. These results suggest that the iron‐, folic acid‐ and vitamin B 12 ‐fortified rice has higher retention and stability of fortified nutrients and is acceptable for consumption in adult human volunteers.