Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age—The Impact of the Wheat Flour Fortification Program in Uzbekistan

Abstract

Food fortification can be effective in reducing the prevalence of anemia and micronutrient deficiencies. This study assessed risk factors for-and the impact of the wheat flour program in Uzbekistan on-anemia, and iron and folate deficiency (FD) in non-pregnant women (NPW) of reproductive age. National data were analyzed for risk factors using multivariable regression. Additional iron intake from fortified flour was not associated with iron deficiency (ID) and did not result in a significantly different prevalence of anemia regardless of the levels, whereas women with additional folic acid intake had a lower relative risk (RR) of FD (RR: 0.67 [95% CI: 0.53, 0.85]). RR for anemia was greater in women with ID (RR: 4.7; 95% CI: 3.5, 6.5) and vitamin A insufficiency (VAI; RR 1.5; 95% CI: 1.3, 1.9). VAI (RR: 1.4 [95% CI: 1.3, 1.6]) and breastfeeding (RR: 1.1 [95% CI: 0.99, 1.2]) were associated with increased risk of ID, while being underweight reduced the risk (RR: 0.74 [95% CI: 0.58, 0.96]). Breastfeeding (RR: 1.2 [95% CI: 1.1, 1.4]) and inflammation (RR: 1.2 [95% CI: 1.0, 1.3]) increased risk of FD. FD results indicate that the fortification program had potential for impact, but requires higher coverage of adequately fortified wheat flour and a more bioavailable iron fortificant.

The Influence of Various Smoking Categories on The Risk of Gestational Hypertension and Pre-Eclampsia

“…We consider our pilot study of the additive effect of smoking and the pre-pregnancy underweight (BMI < 18.5 kg/m 2 ) on risk of hypertension in pregnancy to be extremely important (Table 4 and Table S3). It is possible that the result is associated with deficiencies of many nutrients in underweight people, including microelements and vitamins involved in oxidative balance, and inflammatory or immunological processes [36]. The sizes of the subgroups were small, but we believe that our result requires further research.…”

Integrating and coordinating programs for the management of anemia across the life course

“…Anemia remains a mild public health problem for both preschool children and WRA 51 . A 2017 national survey in Uzbekistan found that one‐third of women consumed additional iron through fortified wheat flour, but this was not associated with reductions in iron deficiency or anemia, likely due to low bioavailability of the fortificant in use at the time 52 . Large‐scale fortification coverage data collected from eight countries between 2013 and 2015 showed variation between and within countries, with more vulnerable households least likely to benefit despite their potential for greater impact in terms of anemia reduction 53 .…”

“…51 A 2017 national survey in Uzbekistan found that one-third of women consumed additional iron through fortified wheat flour, but this was not associated with reductions in iron deficiency or anemia, likely due to low bioavailability of the fortificant in use at the time. 52 Large-scale fortification coverage data collected from eight countries between 2013 and 2015 showed variation between and within countries, with more vulnerable households least likely to benefit despite their potential for greater impact in terms of anemia reduction. 53 Analysis of coverage data from four African countries determined that iron-fortified wheat flour contributed up to 13% of the Recommended Nutrient Intake for WRA, but could be increased to 65% if flour was consistently fortified to standard levels.…”