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United States Department of Agriculture

Agricultural Research Service

Research Project: Novel Functions and Biomarkers for Vitamins and Minerals

Location: Obesity and Metabolism Research Unit

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

Authors
item Dary, Omar -
item Rambelson, Zo -
item Shahab-Ferdows, Setti
item Dror, Daphna -
item Allen, Lindsay
item Carriquiry, Alicia -
item Salman, Rand -

Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: June 23, 2014
Publication Date: August 7, 2014
Citation: Dary, O., Rambelson, Z., Shahab-Ferdows, S., Dror, D., Allen, L.H., Carriquiry, A., Salman, R. 2014. Predicted efficacy of the Palestinian wheat flour fortification program: complementary analysis of biochemical and dietary data. Public Health Nutrition. DOI: 10.1017/S1368980014001554.

Interpretive Summary: Biochemical analysis of nutritional status biomarkers, and dietary data, were collected before a national flour fortification programme was started and used to 1) identify micronutrient insufficiencies and deficiencies, and dietary inadequacies in Palestinian women and children in vulnerable communities, and 2) assess whether the current formulation for micronutrient fortification of wheat flour is suitable. Households were randomly selected in Gaza City and Hebron. Diet intake was assessed quantitatively with questionnaires and fasting venous blood was collected. The impact of fortification was simulated by estimating the additional micronutrient intake that would come from fortified flour. Participants were non-pregnant women age 18-49 y and children age 36-43 mo. The micronutrients with the highest prevalence of insufficiency were vitamin D in women (84-97% with serum 25(OH)D <50 nmol/L) and vitamin B12 in women and children (43-82% with serum B12 < 221 pmol/L). Deficiencies of vitamin A, iron, and zinc were also of public health concern. Current levels of micronutrients proposed for addition to flour would improve but not eliminate inadequacies. Changes may be indicated in the amounts of vitamin D, thiamin, vitamin B12, zinc and folic acid that should be added. We conclude that micronutrient deficiencies and insufficiencies were prevalent based on either biochemical or dietary data. Adjustments to the current flour fortification formula are recommended.

Technical Abstract: Objective: To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to 1) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and 2) 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 programs. Subjects: Non-pregnant women (18-49 y) and children aged 36-83 months Results: The micronutrients with highest prevalence of insufficiency were vitamin D in women (84-97% with serum 25(OH)D < 50 nmol/L) and vitamin B12 in women and children (43-82% with serum B12 < 221 pmol/L). Deficiencies of vitamin A, iron, and zinc 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 B12, zinc 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.

Last Modified: 10/23/2014
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