Brazilians’ experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy

Vieira, Diva Aliete dos Santos; Steluti, Josiane; Verly, Eliseu; Marchioni, Dirce Maria Lobo; Fisberg, Regina Mara

doi:10.1017/s1368980016001981

Cited by 13 publications

(14 citation statements)

References 23 publications

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“…However, iron deficiency is the most common cause of anemia ( World Health Organization, 2015 ). Iron-deficiency anemia interventions have centered primarily on nutrition-specific approaches (e.g., dietary or micronutrient supplementation ( Galloway et al, 2002 ; Vieira et al, 2017 )), targeting the most proximate determinants of the problem ( Bhutta et al, 2013 ). Much attention has also been given to fortification of cereals and other food crops, for example, production of iron-rich beans and pearl millet ( Haas et al, 2013 ).…”

Section: Introductionmentioning

confidence: 99%

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Nyantakyi-Frimpong

Colecraft

Awuah

et al. 2018

Social Science & Medicine

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Livestock production and Animal-Source Foods (ASFs) like meat, milk, and eggs are excellent sources of essential micronutrients, including iron and zinc. There is evidence that encouraging increased access to and consumption of these ASFs may either positively or negatively impact anemia, or have no nutritional effects. Drawing upon first-hand experiences in Ghana, this study sought to: (1) identify the main motivations for raising livestock in Ghana; (2) describe the major barriers to consuming ASFs, especially among women of reproductive age (WRA); and (3) explore the feasibility of different livestock-centered interventions to reduce anemia. Key informant interviews and focus group discussions were held with relevant stakeholders at different geographical scales - the national, regional, district, and community levels. The results suggest that livestock enable savings, allow resource-poor households to accumulate assets, and help finance planned and unplanned expenditures (e.g., school fees and illness). Due to these multiple and often pressing uses, direct consumption of home-reared ASFs is not a major priority, especially for poor households. Even when ASFs are consumed, intra-household allocation does not favor women and adolescent girls, demographic groups with particularly high micronutrient requirements. The study participants discussed possible interventions to address these challenges, including (1) increasing livestock ownership through in-kind credit; (2) encouraging nutrition-related behavior change; (3) improving livestock housing; and (4) hatchery management. The paper discusses these interventions based upon potential acceptance, feasibility, cost effectiveness, and sustainability in the Ghanaian context.

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Section: Introductionmentioning

confidence: 99%

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Nyantakyi-Frimpong

Colecraft

Awuah

et al. 2018

Social Science & Medicine

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“…Nutrient intake recommendations, such as those from Dietary Reference Intakes, are used worldwide for several purposes in the nutrition field, especially for dietary planning and assessment [1], food guide development [2], and fortification and nutrition-related policies [3]. Studies from developed [4,5] and developing countries [6] have shown a high prevalence of inadequate intakes of some nutrients.…”

Section: Introductionmentioning

confidence: 99%

Reaching culturally acceptable and adequate diets at the lowest cost increment according to income level in Brazilian households

et al. 2020

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Objective To identify food choices allowing the fulfillment of nutritionally adequate diets resembling actual food patterns at the lowest cost achievable for the Brazilian population, stratified by income level. Methods Food consumption and prices were obtained from the Household Budget Survey (n = 55,970 households) and National Dietary Survey (n = 32,749 individuals). The sample was stratified into capitals of the states and further by income levels according to the official minimum wage (totaling 108 geographic-economic strata, or GES). Linear programming models were performed for each GES in order to find the lowest cost of diets that meet a set of nutritional constraints. In order to find realistic diets, constraints referring to preferences were introduced in the models allowing optimized food quantities to depart progressively from the current intake for each food and food group. The impact of meeting each target nutrient was assessed by performing models removing each nutrient at the time.

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“…The mandatory fortification of wheat flour with iron and folic acid in Brazil may be one possible explanation for the lower iron intake in the post-modeled estimations, since whole wheat flour is not enriched (BRASIL, 2017). Consistent with this, bread (including all types of bread) was among the main contributors to iron intake in post-fortification period among São Paulo residents (VIEIRA et al, 2017). In this sense, findings support the balance between refined and whole grains, but raises questions whether the replacement should be done to all grain foods consumed (JONES; GARCÍA; BRAUN, 2019).…”

Section: Discussionmentioning

confidence: 54%

“…In this sense, findings support the balance between refined and whole grains, but raises questions whether the replacement should be done to all grain foods consumed (JONES; GARCÍA; BRAUN, 2019). On the other hand, the Brazilian diet comprises other iron food sources, such as beans and meat, that along with vegetables, were the main contributors to iron intake in the pre-fortification period (SOUZA et al, 2013;VIEIRA et al, 2017). In this sense, dietary strategies aiming at improving nutritional quality of grain foods consumed by the population must be combined with simultaneous actions to improve diet quality, such as increase fruits and lower sodium intake (OTTO et al, 2016;GBD…, 2019).…”

Section: Discussionmentioning

confidence: 99%

Razão carboidrato fibra ≤ 10:1 na identificação de alimentos à base de cereais saudáveis: panorama do consumo, associação com fatores de risco cardiometabólico e impacto na ingestão de nutrientes

Fontanelli¹

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Introduction: There is a pressing need for methods to assess the healthfulness of grain foods to promote consumer awareness, evidence-informed industry reformulations, and policy efforts such as guidelines, labeling, and health claims. In this sense, the presence per 10 g of carbohydrate of at least 1 g of fiber (≤10:1-ratio) has been proposed as a pragmatic metric to identify healthier grain products. Objective: To investigate the application of the ≤10:1-ratio to identify healthful grain foods, and its association with cardiometabolic risk factors, to evaluate trends and determinants of this intake, as well as to estimate the potential nutritional impact of strategies to increase the consumption of these foods in São Paulo population. Methods: Data came from the population-based study Health Survey of São Paulo (2003, 2008 and 2015). This is a cross-sectional, population-based study including a probabilistic sample of urban residents in São Paulo. Participants aged 12+ years answered a structured questionnaire, at least one 24-h dietary recall, had blood sample, anthropometric and blood pressure measurements collected. The nutritional value of grain foods meeting the ≤10:1-ratio was compared to grain foods not meeting this criterion using univariate linear regressions with robust variance. The association between the intake of grain foods meeting the ≤10:1ratio and cardiometabolic risk factors was assessed by multivariable linear regression models (First manuscript). The consumption of grain foods meeting the ≤10:1-ratio from 2003 to 2015 was investigated using linear regression models. Determinants of these intakes and prediction of the prevalence of intake for the next years were estimated using multivariable logistic regression models (Second manuscript). We estimated the potential nutritional impact of replacing white rice and white bread with healthful equivalent options in mean change of healthful grain foods, energy and nutrients intake (Third manuscript). Results: Foods meeting the ≤10:1-ratio had lower available carbohydrate (-3.0 g/serving), total sugar (-7.4 g/serving), added sugar (-7.2 g/serving) and saturated fatty acids (-0.7 g/serving), as well as more dietary fiber (+3.5 g/serving), protein (+2.1 g/serving), potassium (+100.1 mg/serving), iron (+0.9 mg/serving), selenium (+4.2 µg/serving), magnesium (+38.7 mg/serving) and zinc (+1.1 mg/serving). Each increase in 1% of energy (E) of these foods was associated with lower levels of blood triacylglycerol (-10.7%), the triacylglycerol/HDL-c ratio (-14.9%), fasting insulin (-13.6%), and HOMA-IR (-14.0%). From 2003 to 2015, a growing trend in the intake of grain foods meeting the ≤10:1-ratio (from 0.9 %E to 1.5%E) was observed. Also, the proportion of the population consuming at least one-grain food meeting the ≤10:1-ratio increased from 8,7% in 2003 to 15,8% in 2015, and 19,9% of the population would be consuming some kind of healthful gain food by 2030. Older individuals (+78%), females (+28%), those with higher education (+137%), and higher family ...

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Brazilians’ experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy

Abstract: Objective: To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a populationbased study, reflecting before and after the mandatory fortification of flour with Fe.

Cited by 13 publications

References 23 publications

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Reaching culturally acceptable and adequate diets at the lowest cost increment according to income level in Brazilian households

Razão carboidrato fibra ≤ 10:1 na identificação de alimentos à base de cereais saudáveis: panorama do consumo, associação com fatores de risco cardiometabólico e impacto na ingestão de nutrientes

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Brazilians’ experiences with iron fortification: evidence of effectiveness for reducing inadequate iron intakes with fortified flour policy

Abstract: Objective: To assess Fe intake, calculate the prevalence of inadequate Fe intake and identify food contributors to Fe intake during 2003 and 2008 in a populationbased study, reflecting before and after the mandatory fortification of flour with Fe.

Cited by 13 publications

References 23 publications

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Leveraging smallholder livestock production to reduce anemia: A qualitative study of three agroecological zones in Ghana

Reaching culturally acceptable and adequate diets at the lowest cost increment according to income level in Brazilian households

Razão carboidrato fibra &le; 10:1 na identificação de alimentos à base de cereais saudáveis: panorama do consumo, associação com fatores de risco cardiometabólico e impacto na ingestão de nutrientes

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Razão carboidrato fibra ≤ 10:1 na identificação de alimentos à base de cereais saudáveis: panorama do consumo, associação com fatores de risco cardiometabólico e impacto na ingestão de nutrientes