Effectiveness of fortified flour for enhancement of vitamin and mineral intakes and nutrition status in northwest Chinese villages.

BACKGROUND: Fortification of flour is one of the approaches for the control and prevention of vitamin and mineral deficiencies. OBJECTIVE: To assess the effect of fortification of flour with seven vitamins and minerals on a population of Chinese women. METHODS: Farmers who offered their land for reforestation in 25 northwest provinces of China received compensation in the form of wheat flour; the amount of flour given depended on the amount of land that was given up for reforestation. This study observed the effects of providing families with fortified flour in the reforestation areas in Gansu Province. The study was conducted for 3 years. Families in the intervention village who offered land for reforestation received flour fortified with seven vitamins and minerals, and those in the control village received unfortified flour. Seven surveys, spaced at least 6 months apart, were carried out in each village from 2004 to 2007. At baseline and at each annual survey, measurements and blood samples were taken from 300 adult female subjects aged 20 to 60 years to assess dietary intake, height, weight, body fat, hemoglobin, serum retinol, serum iron, free erythrocyte protoporphyrin, serum zinc. Serum folic acid was measured at baseline and 36-month only. At each 6-month survey, data were collected on anthropometric features, hemoglobin, and dietary intake. RESULTS: Consumption of fortified flour in the intervention village ranged from 158.7 to 232.7 g per person per day. Serum retinol status was significantly improved after 12-month intervention until the end of the trial compared with both the control group and the baseline level of the intervention group. Iron status expressed as FEP and SI levels showed higher than that of the control group and baseline levels only at 36-month. Hemoglobin levels of the intervention group were higher than that of the control group and baseline levels, but anemia prevalence of both the intervention and control groups remained unchanged in the intervention period. Levels of serum zinc showed increases compared with the control group and baseline data at 24-month and 36-month, and levels of serum folic acid of intervention group in 36-month was higher than that of both the control group and baseline level. CONCLUSIONS: The evidence from this study confirms the positive bioeffectiveness of fortified flour in the rural female population in China, but a higher dosage of electrolytic elementary iron in flour fortification was suggested for anemia prevention and control.

The effectiveness of fortified flour on micro-nutrient status in rural female adults in China.

This research was designed to evaluate the effectiveness of fortified flour on micronutrient status in poor rural adult women. A total of 4,700 farmers as the intervention group were supplied with multi-nutrient fortified wheat flour for three years, while 2750 farmers as the control group were supplied with unfortified wheat flour. Wheat flour was fortified with vitamins A, B-1, B-2, niacin, folic acid, iron and zinc in mg/kg at 2, 3.5, 3.5, 35, 1, 20 and 25, respectively. Blood samples were taken at baseline and annually from about 300 volunteer adult females aged 20-60 years in each group. Hemoglobin (Hb), serum retinol, serum iron, free erythrocyte protoporphyrin, serum zinc were measured annually and a dietary survey conducted every 6 months. Average intakes of fortified micronutrients increased to adequate levels with average consumption of fortified flour at 117 g per person per day. Intervention groups showed a significant increase in terms of Hb levels from 24 m to 36 m and anemia rate decreased from 15.1% at baseline to 10.8% at 36 m. Serum iron levels of the intervention group significantly increased from 12 m to 36 m and erythrocyte protoporphyrin decreased from 24 m to 36 m respectively. Serum retinol and serum zinc of intervention group improved significantly from 12 m to 36 m compared with baseline and control group. The results showed that the fortified flour could improve micronutrient status of adult females in poor rural region.

Anemia prevention and control in four central Asian republics and Kazakhstan.

Kazakhstan and the central Asian republics of Uzbekistan, the Kyrgyz Republic, Tajikistan and Turkmenistan have developed anemia prevention and control (APC) policies based on multiple interventions, including education and promotion, oral supplementation of high risk groups and fortification of wheat flour with iron and other micronutrients. These national strategies are aimed at reducing the prevalence of anemia and iron deficiency among young children and women of child-bearing age. Strategy development has been assisted by funding and technical assistance from the United Nations Children's Fund (UNICEF) with additional technical support from the International Nutrition Foundation, the United Nations University and various national institutions. These countries have been among the most advanced in adopting national strategies that include multiple interventions in an overall package, and national interest in APC remains high. However, reviews of APC activities conducted in 2001 suggests the need for modification and enhancement of current efforts and for a shift to national-level actions if these countries are to progress toward current and future goals. Increased commitment and determination, by both national groups and international organizations, are required to achieve and sustain improvement in micronutrient nutrition.