Archive for December, 2012

Improvement of the Vietnamese Diet for Women of Reproductive Age by Micronutrient Fortification of Staples Foods and Condiments

Laillou A, Berger J, Le BM, Pham VT, Le TH, Nguyen CK, Panagides D, Rohner F, Wieringa F, Moench-Pfanner R.

November 2012, PLoS One

A micronutrient survey carried out in 2010 among randomly selected Vietnamese women in reproductive age indicated that anemia and micronutrient deficiencies are still prevalent. The objective of this study was thus to analyze the dietary micronutrient intakes of these women, to select the food vehicles to be fortified and to calculate their contributions to meet the recommended nutrient intake (RNI) for iron, zinc, vitamin A and folic acid. Consumption data showed that the median intake was 38.4% of the RNI for iron, 61.1% for vitamin A and 91.8% for zinc. However, more than 50% of the women had daily zinc consumption below the RNI. Rice and vegetable oil were consumed daily in significant amounts (median: 320.4 g/capita/day and 8.6 g/capita/day respectively) by over 90% of the women, making them suitable vehicles for fortification. Based on consumption data, fortified vegetable oil could contribute to an additional vitamin A intake of 27.1% of the RNI and fortified rice could increase the intake of iron by 41.4% of the RNI, zinc by 15.5% and folate by 34.1%. Other food vehicles, such as fish and soy sauces and flavoring powders, consumed respectively by 63% and 90% of the population could contribute to increase micronutrient intakes if they are properly fortified and promoted. Wheat flour was consumed by 39% of the women and by less than 20% women from the lowest socioeconomic strata. Therefore, the fortification of edible vegetable oils with vitamin A and of rice with iron, zinc and folic acid are the most promising fortification strategies to increase micronutrient intakes of women in reproductive age in Vietnam.

Performance of iron spot test with Arabic bread made from fortified white wheat flour.

Nichols E, Aburto N, Masa’d H, Wirth J, Sullivan K, Serdula M.

September 2012, Food and Nutrition Bulletin

The iron spot test (IST) is a simple qualitative technique for determining the presence of added iron in fortified flour. IST performance in bread has never been investigated. If found to perform well, the IST has the potential to provide a field-friendly method for testing bread and thus support the monitoring and evaluation of flour fortification programs. To assess the performance of the IST in Arabic bread made from white wheat flour, bread samples were collected from 1,737 households during a national micronutrient survey in Jordan. A subsample of Arabic bread (n = 44) was systematically selected for testing by both the IST and spectrophotometry (criterion reference). Performance measures (sensitivity, specificity, and positive and negative predictive values) were calculated using five cutoffs to define the presence of added iron, including ≥ 15.0 ppm (approximate level of natural iron in Arabic bread) and four additional cutoffs based on test performance. The iron contents of samples testing negative by IST ranged from 10.4 to 18.4 ppm, with one outlier at 41.0 ppm, which was excluded from subsequent analyses. The iron contents of samples testing positive by IST ranged from 16.1 to 38.4 ppm. With the exception of negative predictive values for the two lowest cutoffs (≥ 15.0 and ≥ 16.1 ppm), all performance measures exceeded 83.3%. These results show promise for the IST as an inexpensive, field-friendly method for testing bread that could have a useful role in the monitoring and evaluation process for flour fortification programs.

Vegetable oil of poor quality is limiting the success of fortification with vitamin A in Egypt.

Laillou A, Hafez SA, Mahmoud AH, Mansour M, Rohner F, Fortin S, Berger J, Ibrahim NA, and Moench-Pfanner R.

September 2012, Food and Nutrition Bulletin

Fortification of vegetable oil with vitamin A is considered a cost-effective and simple to implement strategy, but the stability of vitamin A remains a limiting factor. To account for losses of vitamin A, oil producers add an overage. Optimizing the amount of this overage can result in considerable savings for industry and government while ensuring a supply of adequately fortified oil to consumers. To estimate vitamin A losses in oil with different chemical characteristics, samples of fortified oils with different chemical characteristics were collected from two Egyptian companies (oil A and B) and stored for 1 month. Vitamin A levels were analyzed periodically during storage to determine losses over time, and peroxide values were determined. Fortified oil B, with a high peroxide value (5.8 mEq/kg), exposed to sunlight had significantly higher losses of vitamin A after 4 weeks than fortified oil A, with a low peroxide value (0.4 mEq/kg): 31.1% vs. 19.7% (p < .001), respectively. In semi-dark conditions, the vitamin A losses after 4 weeks in fortified oil B and fortified oil A were significantly different: 26.1% and 0.7% (p < .001), respectively. In an accelerated storage test, the vitamin A loss in 8 days was 48.3% for fortified oil B and 4.2% for fortified oil A (p < .001). Based on these results, the study shows a significant effect of peroxide level (one indicator of the quality of oil) on the stability of vitamin A, regardless of storage conditions. To optimize and sustain vitamin A levels in fortified oil, governments and industries should minimize the peroxide level to less than 2 mEq/kg at production.

Applying Dietary Assessment Methods for Food Fortication and Other Nutrition Programs

Coates J, Colaiezzi B, Fiedler J, Wirth J, Lividini K, Rogers B.

September 2012, GAIN Working Paper Series

Dietary assessment data are essential for designing, implementing and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness and cost tradeoffs of employing alternative dietary assessment methods to obtain requisite programming information, but little guidance exists for doing so. This paper strives to fill this gap in the literature while providing practical guidance to inform programming decisions. Twenty-five semi-structured expert interviews were conducted and literature reviewed for scientific and operational information on four of the most common dietary assessment methods used in nutrition programming: Twenty-four hour recall (24HR), Food Frequency Questionnaires/Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditure Surveys (HCES).

A program needs-driven approach to selecting dietary assessment methods for decision-making in food fortification programs


September 2012, Food and Nutrition Bulletin

Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists. To assess the tradeoffs of using alternative dietary methods for food fortification programming, twenty-five semistructured expert interviews were conducted and literature was reviewed for information on the validity, usefulness, and cost of using 24-hour recalls, Food Frequency Questionnaires/ Fortification Rapid Assessment Tool (FFQ/FRAT), Food Balance Sheets (FBS), and Household Consumption and Expenditures Surveys (HCES) for program stage-specific information needs. Criteria were developed and applied to construct relative rankings of the four methods. The following results were identified: Needs assessment: HCES offers the greatest suitability at the lowest cost for estimating the risk of inadequate intakes, but relative to 24-hour recall compromises validity. Design: HCES should be used to identify vehicles and to estimate coverage and likely impact due to its low cost and moderate-to-high validity. Baseline assessment: 24-hour recall should be applied using a representative sample. Monitoring: A simple, low-cost FFQ can be used to monitor coverage. Impact evaluation: 24-hour recall should be used to assess changes in nutrient intakes. FBS have low validity relative to other methods for all programmatic purposes.