Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?

Abstract

In order to prioritise interventions for micronutrient deficiencies in China, the populations affected by iron and zinc deficiencies were assessed based on data from the 2002 China National Nutrition and Health Survey. The costs and costeffectiveness of supplementation, food diversification and food fortification were estimated using the standard World Health Organization ingredients approach. Results indicated that 30% of children (,2 years), adults (.60 years), pregnant and lactating women, and 20% of women of reproductive age were anaemic, some 245 million people. Approximately 100 million people were affected by zinc deficiency (zinc intake inadequacy and stunting), the majority living in rural areas. Among interventions on iron and zinc deficiency, biofortification showed the lowest costs per capita, I$0.01 (international dollars), while dietary diversification through health education represented the highest costs at I$1148. The costeffectiveness of supplementation, food fortification and dietary diversification for iron deficiency alone was I$179, I$66 and I$103 per disability-adjusted life-year (DALY), respectively. Data for biofortification were not available. For zinc deficiency, the corresponding figures were I$399, I$153 and I$103 per DALY, respectively. In conclusion, iron and zinc deficiencies are of great public health concern in China. Of the two long-term intervention strategies, i.e. dietary diversification and biofortification with improved varieties, the latter is especially feasible and cost-effective for rural populations. Supplementation and fortification can be used as short-term strategies for specific groups. Keywords Micronutrient deficiencyIron Zinc Cost-effectiveness ChinaThe latest World Health Organization (WHO) estimates reveal that undernutrition is an underlying cause of 53% of all deaths in children ,5 years of age 1 . It has been estimated that more than 2 billion of the world's population, nearly all in developing countries, are irondeficient 2,3 . Billions of individuals are also at risk for zinc deficiency 4 . Micronutrient deficiency not only affects the health and development of people 5-9 , but also hinders the social and economic development of countries. It is estimated that the loss in economic productivity due to iron deficiency in China is more than 3.6% of the gross national product 10 .The causes of micronutrient deficiencies include inadequate intakes, impaired absorption and/or utilisation, excessive losses, increased physiological need or the combination of these factors 11 . Insufficient intake and poor bioavailability are major causes in developing countries [12][13][14] . Micronutrient content and bioavailability can be improved by either increasing the quantity of a micronutrient or increasing enhancing factors/decreasing inhibiting factors in foods using different techniques or sources. Strategies for increasing the effective supply of nutrients fall into two categories, supplementation and food-based approaches. Supplementation is the addition of ...

Nutritionally Enhanced Staple Food Crops

“…Zinc biofortified rice and wheat may reduce this burden by 20%-51% and save 0.6-1.4 million DALYs each year. The costs for saving one DALY through crop biofortification amount to US$ 0.73-7.31, which is very cost-effective and lower than that of most other micronutrient interventions (Stein 2006;Ma et al 2007). More recently, Meenakshi et al (2010) concluded that overall, biofortification can make a significant impact on reducing the burden of micronutrient deficiencies in the developing world in a highly cost-effective manner; however, the impacts differ depending on the combination of crop, micronutrient and country, and the major reasons underlying these differences are identified to inform policy.…”

Market Potential of Folate Biofortified Rice in China

“…There is currently no evidence of the health impact to tackle folate deficiency through biofortification, or the burden of folate deficiency. Despite China's support for GM technology and biofortification (Campos-Bowers and Wittenmyer, 2007)(see section 2.5), China is a relatively new area to conduct health impact studies on biofortified staple crops (Ma et al, 2007;Fan et al, 2009). At present, no (health impact) studies focused on GM biofortification in China.…”

“…With respect to zinc deficiency, estimates of people with an inadequate intake of zinc vary between 86 (Ma et al, 2007) and 183 million (Micronutrient Initiative, 2009). …”

“…The number of people affected by iron deficiency anemia (IDA), i.e. 208.6 million, is a reliable indicator of the importance of iron deficiency in China (Ma et al, 2007). The high IDA prevalence rate of women of childbearing age (21 %) demonstrates that China's fight against iron deficiency is still going on (Brabin et al, 2001;Shian et al, 2004;UNICEF, 2004a).…”

“…China is a relatively new area to evaluate biofortified staple crops (Ma et al, 2007;Fan et al, 2009). …”