Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Mar 7;12(3):714.
doi: 10.3390/nu12030714.

Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age-The Impact of the Wheat Flour Fortification Program in Uzbekistan

Nicolai Petry  1 , Fakhriddin Nizamov  2 , Bradley A Woodruff  1 , Regina Ishmakova  3 , Jasur Komilov  4 , Rita Wegmüller  1 , James P Wirth  1 , Diyora Arifdjanova  2 , Sufang Guo  2 , Fabian Rohner  1
Affiliations

Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age-The Impact of the Wheat Flour Fortification Program in Uzbekistan

Nicolai Petry et al. Nutrients. .

Abstract

Food fortification can be effective in reducing the prevalence of anemia and micronutrient deficiencies. This study assessed risk factors for-and the impact of the wheat flour program in Uzbekistan on-anemia, and iron and folate deficiency (FD) in non-pregnant women (NPW) of reproductive age. National data were analyzed for risk factors using multivariable regression. Additional iron intake from fortified flour was not associated with iron deficiency (ID) and did not result in a significantly different prevalence of anemia regardless of the levels, whereas women with additional folic acid intake had a lower relative risk (RR) of FD (RR: 0.67 [95% CI: 0.53, 0.85]). RR for anemia was greater in women with ID (RR: 4.7; 95% CI: 3.5, 6.5) and vitamin A insufficiency (VAI; RR 1.5; 95% CI: 1.3, 1.9). VAI (RR: 1.4 [95% CI: 1.3, 1.6]) and breastfeeding (RR: 1.1 [95% CI: 0.99, 1.2]) were associated with increased risk of ID, while being underweight reduced the risk (RR: 0.74 [95% CI: 0.58, 0.96]). Breastfeeding (RR: 1.2 [95% CI: 1.1, 1.4]) and inflammation (RR: 1.2 [95% CI: 1.0, 1.3]) increased risk of FD. FD results indicate that the fortification program had potential for impact, but requires higher coverage of adequately fortified wheat flour and a more bioavailable iron fortificant.

Keywords: Uzbekistan; anemia; folate deficiency; folic acid; iron; iron deficiency; vitamin A insufficiency; wheat flour fortification; women of reproductive age.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of UNICEF. UNICEF as the funding organization was involved in the study design and collection of data, but was not involved in data analysis and reporting, nor the decision to publish this manuscript.

Figures

Figure 1
Figure 1
Distribution of wheat flour consumption among non-pregnant women (NPW) in g/d, Uzbekistan 2017.
Figure 2
Figure 2
Additional iron (a) and folic acid (b) intake from fortified wheat flour for NPW, expressed as % of the reference nutrient intake (RNI), Uzbekistan 2017.
See this image and copyright information in PMC

References

    1. Global Burden of Disease Study Collaborators 2013. Vos T., Allen C., Arora M., Barber R.M., Bhutta Z.A., Brown A., Liang X., Kawashima T., Coggeshall M., et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800. doi: 10.1016/S0140-6736(15)60692-4. - DOI - PMC - PubMed
    1. Rogers L.M., Cordero A.M., Pfeiffer C.M., Hausman D.B., Tsang B.L., De-Regil L.M., Rosenthal J., Razzaghi H., Wong E.C., Bailey L.B., et al. Global folate status in women of reproductive age: A systematic review with emphasis on methodological issues. Ann. N. Y. Acad. Sci. 2018 doi: 10.1111/nyas.13963. - DOI - PMC - PubMed
    1. De-Regil L.M., Peña-Rosas J.P., Fernández-Gaxiola A.C., Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst. Rev. 2015 doi: 10.1002/14651858.CD007950.pub3. - DOI - PMC - PubMed
    1. Keats E., Haider B., Tam E., Bhutta Z. Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database Syst. Rev. 2019 doi: 10.1002/14651858.CD004905.pub6. - DOI - PMC - PubMed
    1. Van der Spoel E., Rozing M.P., Houwing-Duistermaat J.J., Slagboom P.E., Beekman M., de Craen A.J., Westendorp R., van Heemst D. Optimal Serum and Red Blood Cell Folate Conentration in Women of Reproductive Age for Prevention of Neural Tube Defects. World Health Organization; Geneva, Switzerland: 2015. - DOI

MeSH terms

Grants and funding