Evidence of Effectiveness of Flour Fortification on Iron Status and Anemia: A Literature Review.
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Date
2015
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Abstract
Objectives: The effectiveness of wheat- and maize-flour fortification for improving iron status and
anemia in real-world situations has not been documented. The objective was to review published
and grey literature on the public-health impact of flour fortification.
Methods: A systematic literature review was undertaken, including a search of 17 databases and
an e-mail appeal for unpublished reports. Two researchers reviewed 1881 documents. Only
studies on government-supported, large-scale fortification programs with anemia or iron outcomes
measured prior to and > 12 months after initiation of fortification were included.
Results: Twelve studies describing 25 sub-groups (n=13 for children < 15 years, n=12 for women
of reproductive age (WRA)) were analyzed. Eight studies used a pre-post design, 4 included a
control population, and none adjusted for possible confounding factors. From the pre- to the postfortification
periods (and as difference-in-difference for those that included a control group),
hemoglobin increased significantly in 4 of 11 studies with children and 5/11 studies with WRA;
hemoglobin decreased significantly in 1/11 studies with children and 2/11 with WRA. Anemia
prevalence decreased significantly in 4/8 studies with children and 3/10 studies with WRA; anemia
prevalence increased significantly in 1/8 studies with children and 2/3 studies with WRA. The
prevalence of low serum ferritin statistically decreased in 1/6 studies with children and 3/3 studies
with WRA.Conclusions: Available studies confirm that large-scale fortification can positively impact iron and
anemia status in children and women of reproductive age; however there is not enough evidence
yet to understand under what conditions such impact is greatest.
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Pachon Helena, Spohrer Rebecca, Mei Zuguo, Serdula Mary. Evidence of Effectiveness of Flour Fortification on Iron Status and Anemia: A Literature Review. European Journal of Nutrition & Food Safety. 2015 Special issue; 5(5): 916-917.