Wheat Flour Fortification Is Unlikely to Benefit the Neediest in Guatemala

Abstract

The potential impact of wheat flour fortification with iron and folic acid was assessed using data about food purchases from the nationally representative 2000 Guatemalan Living Standards Measurement Survey. Of 7265 households, 35% were indigenous and 57% rural; 11% were extremely poor, 35% were poor, and 54% were nonpoor. The percentage of households that purchased wheat flour, sweet bread, French rolls, and sliced bread in the previous 15 d was 10, 88, 59, and 11%, respectively. The median amount of fortified wheat flour equivalents in purchased foods was 50 g/d per adult equivalent; fortified wheat flour equivalents were 7, 25, and 110 g/d for the poverty groups, 16 g/d in indigenous households and 24 g/d in rural households. Wheat flour fortification contributed 2.3 mg/d of iron and 90 microg/d of folic acid per adult equivalent. Assuming 5% bioavailability, wheat flour fortification provided 2% of the recommended dietary allowance (RDA) and 6% of estimated average requirement (EAR) iron levels for women of reproductive age; values were 1, 3, and 12% of EAR levels for the poverty groups, respectively. Wheat flour fortification met 26% of folic acid RDA and 33% of EAR levels for women; values were 5, 16, and 71% of EAR levels for the poverty groups, respectively. In conclusion, the impact of fortification is likely to be substantial for folate status in nonpoor and urban women but limited in the case of iron status among all social groups. The poorest, rural, indigenous populations who suffer the highest burden of nutritional deficiencies likely benefit least from wheat flour fortification.

Recommendations for Improving Guatemala's Food Fortification Program Based on Household Income and Expenditure Survey (HIES) Data

“…As already noted, the departure point of this study was the 2007 study of Imhoff-Kunsch et al [4]. That study estimated the impact of the Guatemalan wheat flour fortification program using unconditional consumption levels and concluded that the program's impact was minor.…”

“…This is not the first time this type of survey has been used for this purpose in Guatemala. Imhoff-Kunsch et al [4] analyzed the 2000 ENCOVI to assess the potential impact of wheat flour fortification. That study served as a point of departure for the analysis presented here.…”

“…The approach of Imhoff-Kunsch et al [4] is based on Guatemalans' unconditional consumption levels, i.e., the consumption levels of the entire population, regardless of whether or not households or individuals consume any of the fortification food vehicle. In contrast, the approach adopted here posits the need for impact assessments to be considered two-part undertakings.…”

Flour fortification with iron has no impact on anaemia in urban Brazilian children

“…Although evaluations in Guatemala (26) and Sri Lanka (27) showed that flour fortification has little impact on anaemia, in Venezuela compulsory fortification of corn and wheat flours seems to have restored the Fe status of adolescents of low socio-economic status (28) .…”

Nutritionally Enhanced Staple Food Crops

“…In the past, food fortification, diet diversification, and nutrient supplementation have been most frequently used as public health interventions to reduce micronutrient-induced morbidity and mortality worldwide (Suharno et al 1993;Haider et al 2003;Brown et al 2007;Wienecke and Gruenwald 2007;Casey et al 2010;Eneroth et al 2010). However, these approaches have had only limited success and could not by themselves attain sufficiently millennium development goals mainly because such interventions require infrastructure, continuous flow of resources, purchasing power, or access to markets and health care systems to their success, often not available to people living in remote areas (Underwood 1999;Imhoff-Kunsch et al 2007;Ssemakula and Pfeiffer 2011).…”