Temporal Relation between Double Fortification of Wheat Flour with Iron and Folic Acid, and Markers and Prevalence of Anemia in Children

Abstract

Fortification of wheat flour with iron and folic acid became mandatory in Ivory Coast in 2007. The purpose of this study was to determine the time trend relation between mandatory double fortification of wheat flour with iron and folic acid and markers and prevalence of anemia by comparing the data between pre- and post-fortification periods in Ivory Coast children. Data were derived from the pediatric unit of the University Hospital of Treichville, Abidjan, Ivory Coast. Medical records of 467 children from 5 to 14 years old were analyzed from the years 2004 through 2010. Periods from 1 January 2004 to 31 December 2006 and 1 January 2008 to 31 December 2010 were considered as pre- and post-fortification periods, respectively. Data on hemoglobin, hematocrit, red blood cell count (RBC), mean corpuscular volume (MCV), and anemia between pre- and post-fortification periods were compared. There were no significant differences in hemoglobin, hematocrit, RBC, and prevalence of anemia between pre- and post-fortification periods. However, MCV in post-fortification period was significantly higher compared to pre-fortification period in all subjects (77.6 fL vs. 76.8 fL; p = 0.02) and in young girls (79.1 fL vs. 75.2 fL; p = 0.01). Lack of significant differences in anemia and in markers of anemia between pre- and post-fortification periods need further investigation in children of Ivory Coast.

Dietary Approaches to Iron Deficiency Prevention in Childhood—A Critical Public Health Issue

“…Several studies have shown that, especially in low-income countries, iron food fortification, referring to the addition of iron alone or with other micronutrients during food processing, was a safe and cost-effective way of preventing ID despite some technical difficulties related to undesirable changes in the food, such as alterations in appearance and taste [10,82,[141][142][143][144][145][146]. Thus, various commonly consumed foods have been fortified in addition to formula, mainly cereals [10,82,92,93,142,147,148], but also wheat flour [143,145,146,149,150], maize flour [151], rice [143,146,152,153], soy sauce or fish sauce [146,[154][155][156], salt [157,158], and candies [159]. Such strategies may, however, have a limited impact in infants and young toddlers due to their relatively low staple food consumption and even lower seasoning and condiment intake [160].…”

“…Several biases were, however, acknowledged by the authors, mainly linked to the fact that most of the studies were performed in malaria-endemic zones and/or in areas with a low prevalence of ID. Results with fortified flour are even more inconsistent [141,145,146,149,150].…”

“…When solid foods are introduced, the prevention aims primarily to improve the quality of the diet, by favoring natural bioavailable iron-containing foods, especially red meat, poultry, or fish (Table 5), and food rich in vitamin C [10,76,[121][122][123]. The complementary options are to promote the supply of iron-fortified foods [10,82,92,[141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156][157][158][159] or biofortified foods [139,[162][163][164][165][166][167][168][169][170] and to delay the introduction of cow's milk at least until after the age of 1 year or even after 2 years [76,82].…”

Intended and Unintended Benefits of Folic Acid Fortification—A Narrative Review

“…In an observational study that compared the prevalence of anemia in children before and after double fortification of wheat flour with folic acid and iron, no significant difference was found in mean hemoglobin concentrations between pre-fortification and post-fortification. However, MCV concentrations increased significantly in the post-fortification period from the pre-fortification period (from 76.8 fL to 79.1 fL; p = 0.02) [ 30 ]. Another study used NHANES data to evaluate the prevalence of anemia and macrocytosis before and after folic acid fortification (1988–1994 vs. 1999–2004) [ 31 ].…”

Complete genome analysis of Bacillus subtilis derived from yaks and its probiotic characteristics

“…Folic acid has been demonstrated to promote the formation of red blood cells and play important roles in protein synthesis, cell division, and growth ( 64 , 65 ). Folic acid deficiency can cause megaloblastic anemia and affect hemoglobin production and cell maturation in red blood cells ( 65 , 66 ). Currently, folic acid is widely used in animal husbandry due to various important physiological functions.…”