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. 2015 Nov;73(11):780-95.
doi: 10.1093/nutrit/nuv037. Epub 2015 Oct 2.

Evidence of the effectiveness of flour fortification programs on iron status and anemia: a systematic review

Helena Pachón  1 , Rebecca Spohrer  2 , Zuguo Mei  2 , Mary K Serdula  2
Affiliations

Evidence of the effectiveness of flour fortification programs on iron status and anemia: a systematic review

Helena Pachón et al. Nutr Rev. 2015 Nov.

Abstract

Context: More than 80 countries fortify flour, yet the public health impact of this intervention on iron and anemia outcomes has not been reviewed.

Objective: The objective of this systematic review was to review published and gray literature pertaining to the impact of flour fortification on iron and anemia.

Data sources: A systematic review was conducted by searching 17 databases and appealing for unpublished reports, yielding 1881 documents.

Study selection: Only studies of government-supported, widely implemented fortification programs in which anemia or iron status was measured prior to and ≥12 months after initiation of fortification were included.

Data extraction: Details about the design, coverage, compliance with national standards, and evaluation (e.g., anemia prevalence before and after fortification) of flour fortification programs were extracted from the reports.

Data synthesis: Thirteen studies describing 26 subgroups (n = 14 for children ≤15 y, n = 12 for women of reproductive age) were included. During the period from pre- to postfortification (and as difference-in-difference for those studies that included a control group), there were statistically significant decreases in the prevalence of anemia in 4 of 13 subgroups of children and in 4 of 12 subgroups of women of reproductive age as well as significant decreases in the prevalence of low ferritin in 1 of 6 subgroups of children and in 3 of 3 subgroups of women of reproductive age.

Conclusions: . Evidence of the effectiveness of flour fortification for reducing the prevalence of anemia is limited; however, evidence of effectiveness for reducing the prevalence of low ferritin in women is more consistent.

Keywords: enrichment; ferritin; hemoglobin; maize flour; wheat flour.

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Conflict of interest statement

Declaration of interest. The authors have no relevant interests to declare.

Figures

Figure 1
Figure 1
Flow chart of the search and selection process.
See this image and copyright information in PMC

References

    1. World Health Organization, Food and Agriculture Organization of the United Nations. Guidelines on food fortification with micronutrients. Geneva: World Health Organization; 2006.
    1. World Health Organization, Food and Agriculture Organization of the United Nations, United Nations Children’s Fund, Global Alliance for Improved Nutrition, the Micronutrient Initiative, and Flour Fortification Initiative. Recommendations on Wheat and Maize Flour Fortification. Meeting Report: Interim Consensus Statement. Geneva: World Health Organization; 2009. - PubMed
    1. Food Fortification Initiative. FFI website. http://www.ffinetwork.org/global_progress/index.php. Accessed August 31, 2015.
    1. Das JK, Salam RA, Kumar R, et al. Micronutrient fortification of food and its impact on woman and child health: a systematic review. Syst Rev. 2013;2:67. doi:10.1186/2046-4053-2-67. - DOI - PMC - PubMed
    1. Athe R, Rao MVV, Nair KM. Impact of iron-fortified foods on Hb concentration in children (<10 years): a systematic review and meta-analysis of randomized controlled trials. Public Health Nutr. 2013;17:579–586. - PMC - PubMed

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