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ARS Home » Pacific West Area » Davis, California » Western Human Nutrition Research Center » Obesity and Metabolism Research » Research » Publications at this Location » Publication #342463
Title: Iron, zinc, folate, and vitamin B12 status increased among women and children in Yaounde and Douala, Cameroon, one year after introducing fortified wheat flour

Author
item ENGLE-STONE, REINA - University Of California
item NANKAP, MARTIN - Helen Keller International (HKI), United States
item NDJEBAYI, ALEX - Helen Keller International (HKI), United States
item Allen, Lindsay - A
item Shahab-Ferdows, Setti
item HAMPEL, DANIELA - University Of California
item KILLILEA, DAVID - Children'S Hospital Oakland Research Institute
item GIMOU, MARIE-MADELINE - Centre Pasteur Du Cameroun
item HOUGHTON, LISA - University Of Otago
item FRIEDMAN, AVITAL - Helen Keller International (HKI), United States
item TARINI, ANN - Helen Keller International (HKI), United States
item STAMM, ROSEMARY - University Of Otago
item BROWN, KENNETH - Gates Foundation

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/3/2017
Publication Date: 6/7/2017
Citation: Engle-Stone, R., Nankap, M., Ndjebayi, A.O., Allen, L.H., Shahab-Ferdows, S., Hampel, D., Killilea, D.W., Gimou, M., Houghton, L.A., Friedman, A., Tarini, A., Stamm, R.A., Brown, K.H. 2017. Iron, zinc, folate, and vitamin B12 status increased among women and children in Yaounde and Douala, Cameroon, one year after introducing fortified wheat flour. Journal of Nutrition. 147(7):1426-1436. doi: 10.3945/jn.116.245076.

Interpretive Summary: Background: There is little information available on the effectiveness of large-scale food fortification programs. Objective: To assess the impact of mandatory wheat flour fortification on micronutrient status in Yaounde and Douala, Cameroon. Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (total 300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15–49 y and children 12–59 mo of age. Results: Wheat flour was consumed in the previous 7 d by 90% of participants. Total iron and zinc concentrations in fortified flour samples were 46.2 and 73.6 mg/kg, close to the intended added amounts of 60 and 95 mg/kg, respectively. A significantly lower percent of women had anemia after fortification (46.7% compared with 39.1%), but mean hemoglobin concentrations and child anemia were not improved. For both women and children post fortification, mean plasma concentrations were greater for ferritin and lower for sTfR indicating better iron status. Mean plasma zinc concentrations were greater post fortification and the prevalence of low plasma zinc was lower in women and children. Mean plasma total folate concentrations were ˜250% greater among women (15 compared with 47 nmol/L) and children (20 compared with 56 nmol/L) and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In a non-representative subset of plasma samples, unmetabolized folic acid was detected in 77% of women and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater after fortification. Conclusion: Although the pre-post survey design with lack of a non-intervention group limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.

Technical Abstract: Background: Few data, to our knowledge, are available on the effectiveness of large-scale food fortification programs. Objective: We assessed the impact of mandatory wheat flour fortification on micronutrient status in Yaounde and Douala, Cameroon. Methods: We conducted representative surveys 2 y before and 1 y after the introduction of fortified wheat flour. In each survey, 10 households were selected within each of the same 30 clusters (n = ;300 households). Indicators of inflammation, malaria, anemia, and micronutrient status [plasma ferritin, soluble transferrin receptor (sTfR), zinc, folate, and vitamin B-12] were assessed among women aged 15–49 y and children 12–59 mo of age. Results: Wheat flour was consumed in the past 7 d by 90% of participants. Post fortification, mean total iron and zinc concentrations of flour samples were 46.2 and 73.6 mg/kg (target added amounts were 60 and 95 mg/kg, respectively). Maternal anemia prevalence was significantly lower post fortification (46.7% compared with 39.1%; adjusted P = 0.01), but mean hemoglobin concentrations and child anemia prevalence did not differ. For both women and children post fortification, mean plasma concentrations were greater for ferritin and lower for sTfR, after adjustments for potential confounders. Mean plasma zinc concentrations were greater post fortification and the prevalence of low inflammation-adjusted plasma zinc was lower (women: 39–21%, P < 0.001; children: 47–28%, P < 0.001). Mean plasma total folateconcentrations were ˜250% greater among women (15 compared with 47 nmol/L) and children (20 compared with56 nmol/L) and the prevalence of low plasma folate values was <1% after fortification in both population subgroups. In anon-representative subset of plasma samples, folic acid was detected in 77% of women (73% of those fasting) and 93% of children. Mean plasma and breast-milk vitamin B-12 concentrations were >50% greater post fortification. Conclusion: Although the pre-post survey design limits causal inference, iron, zinc, folate, and vitamin B-12 status increased among women and children in urban Cameroon after mandatory wheat flour fortification.