Fortified wheat flour, anemia and folate in Uzbek women
What it found
In women of reproductive age in Uzbekistan, eating fortified wheat flour was linked to a lower risk of folate deficiency, but not to a lower risk of anemia or iron deficiency.
What they found
Studies in people
Folate deficiency
Women who got more folic acid from fortified wheat flour were less likely to have folate deficiency. The authors say there was a possible dose-response relationship.
Anemia and iron
Extra iron from fortified flour was not linked to a lower risk of anemia or iron deficiency, no matter how much was consumed.
Iron deficiency and anemia
Women with iron deficiency were much more likely to have anemia. Vitamin A insufficiency also raised the risk of anemia.
Risk factors for iron deficiency
Vitamin A insufficiency and breastfeeding were linked to a higher risk of iron deficiency. Being underweight was linked to a lower risk.
Risk factors for folate deficiency
Breastfeeding and inflammation were linked to a higher risk of folate deficiency.
Other findings
Fortification coverage
Only about one-third of flour samples were fortified. Most women got no extra iron or folic acid from wheat flour.
What the authors conclude
“These results indicate that the fortification program has the potential for an impact, but requires higher coverage of adequately fortified wheat flour and a more bioavailable iron fortificant.”
Also in their conclusions
- They say the fortification program has the potential for an impact but needs higher coverage of adequately fortified wheat flour and a more bioavailable iron fortificant.
- They note that the government has recently switched from electrolytic iron to NaFeEDTA.
How it was done
The authors wanted to find out why folate deficiency had risen sharply in Uzbekistan while anemia and iron deficiency stayed about the same, and whether the wheat flour fortification program was helping.
They analyzed national survey data from 2017 on 2269 non-pregnant women aged 15 to 49 in Uzbekistan, including blood samples and flour samples from their households. They estimated how much extra iron and folic acid each woman got from fortified wheat flour and looked at links with anemia, iron deficiency and folate deficiency.
What it can’t tell you
- This was a cross-sectional survey, so it cannot prove that fortified flour caused the differences seen.
- The method used to estimate flour intake may underestimate how much women actually ate.
Who paid
- Funding
- Funded by UNICEF (from the PubMed record).
- Conflicts
- 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.
The paper
- Title
- Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age-The Impact of the Wheat Flour Fortification Program in Uzbekistan
- Type
- Study
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Petry N, Nizamov F, Woodruff BA, et al (2020). Risk Factors for Anemia and Micronutrient Deficiencies among Women of Reproductive Age-The Impact of the Wheat Flour Fortification Program in Uzbekistan. Nutrients. doi:10.3390/nu12030714Free full textPubMed 32156021DOI
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