Search Results (21)

Objective: The aim of this study was to compare micronutrient intake and inadequacy estimates using household consumption and expenditure survey (HCES) and quantitative 24-h recall (24HR) data among women of reproductive age (WRA) in Kasungu district, Malawi. Methods: We conducted a secondary data analysis utilizing HCES dietary data from a subsample of households in rural areas of Kasungu district, which were sourced from the 2019/20 Malawi Fifth Integrated Household Survey (n = 183); and 24HR data were obtained from WRA in a community-based Addressing Hidden Hunger with Agronomy (AHHA) trial in the same district (n = 177). Micronutrient intakes and inadequacy were estimated under two alternative scenarios of large-scale food fortification (LSFF). We standardized apparent nutrient intakes from the HCES data using the adult female equivalent metric. Results: Estimated prevalence of micronutrient inadequacy fell within 20 percentage points between HCES and 24HR for iron (Fe), zinc (Zn), vitamins B2 and B9 under both no fortification and fortification scenarios. There were some discrepancies for the remaining B vitamins, being consistently large for vitamin B3. Conclusions: In the absence of 24HR data, HCES data can be used to make inferences about some micronutrient intakes and inadequacies among rural WRA in Malawi and to inform decisions regarding LSFF, including vehicle selection and coverage. However, additional efforts are needed to improve HCES for dietary nutrient surveillance given existing limitations. Full article

Waste and chemicals generated from industry have been a major source of pollution and a prominent threat to human health via the food chain; hence, an efficient and durable material that can be used to detoxify polluted soil and water bodies is necessary to attain ecosystem equity and security. This study hypothesized that biochar (BC) made from poultry manure (PM) through pyrolysis and fortification with iron (Fe–BC) can be used to remove methyl orange dye from aqueous solution. Furthermore, this study evaluated the effect of solution pH on the sorption of methyl orange through batch sorption studies. The similarity in the modeled data and experimental data was measured by the standard error of estimate, whereas sorption isotherms were examined using nonlinear forms of different sorption equations. With the use of Langmuir models, a maximum sorption capacity of 136.25 mg·g⁻¹ and 98.23 mg·g⁻¹ was recorded for Fe–BC and BC, respectively. Fe–BC possessed a higher adsorption ability in comparison to BC. The pseudo-second-order best described the sorption kinetics of both adsorbents at R² = 0.9973 and 0.9999, indicating a strong interaction between MO and Fe–BC. Furthermore, the efficiency with which MO was removed by the absorbent was highest at lower pH (pH = 4). It is therefore concluded that Fe–BC can be used as an effective and environmentally friendly material for detoxification of wastewater; however, further research on the application and usage of biochar modified techniques for enhancing adsorption efficacy on a large scale should be encouraged. Full article

Food fortification with micronutrients was initially justified in developed countries by a lack of availability of micronutrients in staple crops, mainly due to soil exhaustion. However, in Sub-Saharan arable lands, soil fatigue is not predominant, and communities consume mostly home-grown, organic, non-processed crops. Sub-Saharan food systems are nevertheless deeply entwined with food insecurity, driver of illnesses. Family production can promote subsistence, food stability, and self-sufficiency, the main SSA setback being the vicious cycle of poverty and the lack of dietary variety, contributing to malnutrition. Poverty reduction and women’s education are significant strategies for reducing child and adolescent undernourishment. Fortification of foods consumed daily by individuals makes sense and can minimize, if not entirely, eliminate deficiencies. Compulsory mass fortification of foods in Sub-Saharan Africa (SSA) with single micronutrients is, however, controversial since they work in synergy among each other and with the food matrix, for optimal absorption and metabolism. Since the causes of malnutrition are many, caused by diverse, unequal, and unjust food distribution, interrelated with political, social, cultural, or economic factors, education status of the population, season and climatic changes, and effectiveness of nutrition programs, just food fortification cannot solve the composite of all these elements. Further, compulsory fortification is excessive, unproductive, and likely harmful to human health, while many challenges remain in assessing the quality of available premixes. Furthermore, aiming at dietary diversification is the best approach of increasing trace element intake from commonly accessible and easily available food sources. Full article

(1) Background: Fortifying maize and wheat flours with folic acid has effectively reduced neural tube defect-affected births. However, maize and wheat flours may not be widely consumed in all countries; further reduction in neural tube defect-affected births could benefit from the identification of alternative food vehicles. We aimed to use dietary intake or apparent consumption data to determine alternative food vehicles for large-scale fortification with folic acid in low-income and lower-middle-income countries (LILMICs) and identify current research related to examining the technological feasibility of fortifying alternative foods with folic acid. (2) Methods: We identified 81 LILMICs, defined by the World Bank’s (WB) 2018 income classifications. To identify dietary intake or apparent consumption, we reviewed WB’s Microdata Library and Global Health Data Exchange for national surveys from 1997–2018. We reviewed survey reports for dietary intake or apparent consumption data and analyzed survey datasets for population coverage of foods. We defined alternative food vehicles as those that may cover/be consumed by ≥30% of the population or households; cereal grains (maize and wheat flours and rice) were included as an alternative food vehicle if a country did not have existing mandatory fortification legislation. To identify current research on fortification with folic acid in foods other than cereal grains, we conducted a systematic review of published literature and unpublished theses, and screened for foods or food products. (3) Results: We extracted or analyzed data from 18 national surveys and countries. The alternative foods most represented in the surveys were oil (n = 16), sugar (n = 16), and salt (n = 14). The coverage of oil ranged from 33.2 to 95.7%, sugar from 32.2 to 98.4%, and salt from 49.8 to 99.9%. We found 34 eligible studies describing research on alternative foods. The most studied alternative foods for fortification with folic acid were dairy products (n = 10), salt (n = 6), and various fruit juices (n = 5). (4) Conclusions: Because of their high coverage, oil, sugar, and salt emerge as potential alternative foods for large-scale fortification with folic acid. However, except for salt, there are limited or no studies examining the technological feasibility of fortifying these foods with folic acid. Full article

Large-scale food fortification (LSFF) has been recognized as one of the most cost-effective interventions to improve the intake of vitamins and minerals and decrease the burden of micronutrient deficiency. Indeed, the simple addition of micronutrients to staple foods, such as wheat, maize and rice, or condiments, including salt and bouillon, has tremendous potential to impact malnutrition. However, most LSFF programs have been poorly designed and have not taken into consideration critical inputs, including current levels of nutrient inadequacy and per capita consumption of different food vehicles when deciding which nutrients to add and at what concentrations. LSFF programs, like some other nutrition interventions, also tend to have low coverage and reach and lack monitoring to measure this and course correct. These program design flaws have resulted in limited effectiveness and have made it difficult to determine how best to harmonize LSFF with other interventions to reduce micronutrient deficiencies, including efforts to enhance dietary diversity, biofortification and supplementation. Furthermore, LSFF has often been touted as a population-based intervention, but in fact has heterogenous effects among sub-groups, particularly those with limited access to or inability to afford fortified foods, as well as those with higher physiological requirements, such as pregnant and lactating women. This article focuses on these limitations and the concerted efforts underway to improve the collection, analysis, and use of data to better plan LSFF programs, track implementation, and monitor coverage and impact. This includes a more sophisticated secondary analysis of existing data, innovations to increase the frequency of primary data collection and programmatically relevant visualizations of data of sub-national estimates. These improvements will enable better use of data to target resources and programmatic efforts to reach those who stand to benefit most from fortification. Full article

Iron fortification of foods has always been a challenge. This is because iron fortification compounds vary widely in relative absorption; because many foods undergo unacceptable changes in color or flavor from the addition of iron; and because many of the iron-fortified foods contain potent inhibitors of iron absorption. These technical barriers have largely been overcome, and efficacious iron-fortified foods, that maintain or improve the iron status of women or children in long-term feeding studies, can be designed. Commercially fortified infant foods are efficacious, and other commercial iron-fortified foods targeted at women and children will provide a useful amount of iron provided the fortification level is adjusted according to the relative absorption of the iron compound. Technologies for the large-scale fortification of wheat and maize flour are also well established, and iron fortification of rice, using the recently developed extruded premix technique, is showing great promise. However, some important knowledge gaps still remain, and further research and development is needed in relation to iron (and iodine)-fortified salt and iron-fortified liquid milk. The usefulness of less-soluble iron compounds, such as ferrous fumarate, to fortify foods for infants and young children in low- and middle-income countries (LMICs) also needs further investigation. A more formidable barrier to efficacious iron-fortified food has been reported in recent years. This is the infection-initiated inflammation barrier, which inhibits iron absorption in response to infection. This barrier is particularly important in LMICs where infections such as malaria and HIV are widespread, and gastrointestinal infections are common due to poor quality water supplies and sanitation. Another source of inflammation in such countries is the high prevalence of obesity in women. Most countries in sub-Saharan Africa have high inflammation which not only decreases the efficacy of iron-fortified and iron-biofortified foods but complicates the monitoring of large-scale iron fortification programs. This is because iron deficiency anemia cannot be differentiated from the more prominent anemia of inflammation and because inflammation confounds the measurement of iron status. There is an urgent need to better quantify the impact of inflammation on the efficacy of iron-fortified foods. However, at present, in LMICs with high inflammation exposure, infection control, cleaner water, improved sanitation, and a decrease in obesity prevalence will undoubtedly have a greater impact on iron status and anemia than the iron fortification of foods. Full article

Our global food system lacks the critically needed micronutrients to meet the daily requirements of the most at-risk populations. Diets also continue to shift toward unhealthy foods, including the increased intake of salt. While most countries exceed the WHO’s recommended levels, sodium does play an essential physiological role. Table salt and other salt-containing condiments, such as bouillon, also have cultural importance, as they are used to enhance the flavor of foods cooked at home. Given their universal consumption across income classes and both urban and rural populations, these condiments are an integral part of the food system and should, therefore, be part of its transformation. Fortification of salt and salt-containing condiments can play a catalytic role in the delivery of population-wide nutritional and health benefits. With relatively consistent levels of intake across the population, these condiments hold high potential for delivering micronutrients beyond iodine while also reducing concerns related to high micronutrient intake, particularly so in countries where the industries are relatively consolidated. As a flexible and complementary strategy to an evolving food system, fortification levels can also be adjusted over time to ensure micronutrient delivery targets continue to be achieved as the system improves, whether through lower intakes of sodium in line with WHO recommendations, enhanced consumption of nutrient-dense foods, and/or broader adoption of biofortified crops. Future areas of innovation are required to realize this vision, including developing affordable salt substitutes to meet cost requirements of consumers in low-and middle-income countries, improving the stability and bioavailability of the micronutrients in condiments so that delivery targets can be reached without affecting sensory attributes, and the development of efficient systems for monitoring population intake and micronutrient status to inform fortification program design and management. Rather than being considered antithetical to the transformation, multiply-fortified salt and bouillon can strengthen our ability to meet the cultural, sensory, nutritional, and health needs of an evolving food system. Full article

Growth in the human population and intensive, large-scale farming results in a lowering in the quality of nutrition. An oversupply of food energy is often accompanied with a deficiency in micronutrients. To address this problem, the food industry provides products enriched with bioactive substances. The main challenge of this technology is the even distribution of micronutrients in the matrix of the fortified food. A possible solution to this challenge is to use stable and effective carriers. The aim of this work was to verify the applicability of native potato starch and modified starches (commonly used in the food industry) as carriers for microelements. Adsorptions were carried out in starch suspensions at a temperature below gelatinisation. The native potato starch and the modified starches (E 1404, E 1412, E 1420, and E 1422) were assessed for their effectiveness in adsorbing copper, iron, and zinc sulphates or gluconates. Pasting characteristics were analysed using a Brabender viscograph and light microscopy. Furthermore, texture profile analysis of starch-based desserts was carried out with the use of the tested carriers. Starch in both its native and modified forms was able to effectively adsorb copper, iron, and zinc ions. Adsorption was more efficient when using modified starches containing hydrophilic carboxyl groups. The effectiveness of adsorption with oxidised starches increased with an increase in the degree of substitution. Starches containing more hydrophobic acetyl groups were less effective as adsorbents of microelements. The cation adsorption efficiency decreased in the order copper > iron > zinc, and sulphates were better adsorbed than gluconates. Copper ions influenced the pasting characteristics of the oxidised starches, and these effects were dependent on the degree of substitution with carboxyl groups. As observed by light microscopy, the presence of copper ions changes the interaction between the starch macromolecules and water. However, the above-mentioned changes did not significantly affect the texture of traditional sweet desserts. Starch, particularly its oxidised derivatives containing hydrophilic oxidised groups, can be recommended as a carrier of microelements for food fortification. The use of modified starches containing relatively hydrophobic acetyl groups is not appropriate because they absorb microelements less efficiently than native starch. Full article

The species Pleurotus ostreatus is a commercially, gastronomically, and biotechnologically important fungus. Its strain variability has been little researched. The study provides an evaluation of 59 oyster mushroom production strains in terms of the ability to accumulate selected metals in the cap and stipe. The fruiting bodies were grown under identical model conditions on straw substrate. Metal concentrations (ET-AAS) in dry fruiting bodies ranged in values 1.7–22.4 mg kg⁻¹ for Al, 2.6–9.7 mg kg⁻¹ Ba, 199–4560 mg kg⁻¹ Ca, 1.7–12.0 mg kg⁻¹ Cu, 12–120 mg kg⁻¹ Fe, 16,000–49,500 mg kg⁻¹ K, 876–2400 mg kg⁻¹ Mg, 0.39–11.0 mg kg⁻¹ Mn, 46–920 mg kg⁻¹ Na and 11–920 mg kg⁻¹ for Zn. More Cu, Fe, K, Mg, Mn, Zn accumulated in the cap, while in the stipe Ba was amassed. No significant difference was found between Al, Ca and Na between the accumulation in the cap and the stipe. Furthermore, the dependence of metal uptake from the substrate depending on the fortification of the substrate was confirmed. Statistically significant (p < 0.05) synergistic relationships were shown in pairs Al and Ba, Al and Fe, Ba and Na, Ba and Ca, Ca and Na, Cu and Fe, Fe and Mn, Fe and Zn, K and Mg, K and Mn, K and Zn, Mg and Mn, Mg and Na, Mg and Zn and Mn and Zn in the substrate without the addition of sodium selenate to the substrate. Altered relationships were observed after the application of sodium selenate to the substrate, synergism of Se and Ni, Se and Co and Se and Hg, Cu and Mn, Cu and Fe, Zn and Co, Zn and Ni, Zn and Hg, Mn and Fe, Mn and Cr, Co and Ni, Co and Hg, Ni and Hg, Pb and Cd. The findings of the study may help in the selection of production strains with hypercumulative properties for a particular metal and subsequent use in the addition of fortified fruiting bodies (e.g., with Zn). Based on the study the strains less sensitive to the accumulation of hazardous metals is possible to select for large-scale production, which is important from the perspective of food safety. Full article

Adequate zinc nutrition is important for child growth, neurodevelopment, immune function, and normal pregnancy outcomes. Seventeen percent of the global population is estimated to be at risk for inadequate zinc intake. However, zinc is not included in the fortification standards of several low- and middle-income countries with mandatory fortification programs, despite data suggesting a zinc deficiency public health problem. To guide policy decisions, we investigated the factors enabling and impeding the inclusion of zinc as a fortificant by conducting in-depth interviews with 17 key informants from 10 countries. Findings revealed the decision to include zinc was influenced by guidance from international development partners and enabled by the assessment of zinc deficiency, mandatory regional food fortification standards which included zinc, the World Health Organization (WHO) guidelines for zinc fortification, and the low cost of zinc compound commonly used. Barriers included the absence of zinc from regional fortification standards, limited available data on the efficacy and effectiveness of zinc fortification, and the absence of national objectives related to the prevention of zinc deficiency. To promote zinc fortification there is a need to put the prevention of zinc deficiency higher on the international nutrition agenda and to promote large-scale food fortification as a key deficiency mitigation strategy. Full article

Efforts to address Micronutrient deficiencies (MNDs) in lower-and middle-income countries (LMICs) have been gaining pace in recent years. Commodities such as staple foods (e.g., cereals, roots, and tubers) and condiments (e.g., salt) have been targeted as ‘vehicles’ for fortification and biofortification through numerous projects and initiatives. To date, there have been mixed experiences with delivery and coverage with very little documented on the range of business models applied in different geographies, business conditions and polities and this makes classification and measurement of success and failure difficult. This research aims to address this gap in knowledge through proposing a typology that clarifies similarities (internal heterogeneity) and differences (external heterogeneity) between models and that can allow all types to be defined by the combination of attributes. Building on a comprehensive literature review; NVivo was used to code initiatives from 34 key references (955 cases in total) which have been grouped into 17 categories. Using non-metric multidimensional scaling (NMDS) we find evidence of four business model groupings that typify fortification initiatives: (1) Large-scale private, unregulated, (2) Mixed-Scale, private, unregulated (3) Large-scale, public-private, regulated; and (4) Large-scale, private, regulated. We characterise these four groups with country examples and suggest that this typology can help the discourse around viability of food fortification initiatives. Full article

Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring. Full article

Large-scale food fortification is an effective, sustainable, and scalable intervention to address vitamin and mineral deficiencies, however, pressing gaps exist globally around ensuring the quality of fortified foods. This paper summarizes the global challenges and gaps faced in monitoring the quality of fortified foods, the guidance produced in response to these challenges, where we are today in terms of effective implementation, and what approaches and opportunities may be usefully applied to enhance the quality of fortified foods moving forward. Full article

Background: Initiatives to tackle micronutrient deficiencies (MNDs) in low-and middle-income countries (LMICs) have increased steadily in recent years. Commodities such as staple foods (e.g., cereals) and condiments (e.g., salt) have been targeted as ‘vehicles’ for industrial fortification through numerous projects and initiatives. However, mixed experiences with delivery, coverage and sustainability have been found. Methods: Using an online survey of 71 key stakeholders (from 35 countries) consisting of the public/private sector, academia and civil society, this study sought to unpack the ‘business model’ for fortification initiatives to identify the key drivers of success and constraints faced by stakeholders in LMICs. Bivariate analysis was conducted to identify factors associated with the coverage of the target market and the perceived success and sustainability of fortification initiatives. Results: We identified four key factors contributing to the success of fortification initiatives. The first involves the size of the firm. Large firms had a significantly higher (p 0.05) self-sustaining index (perceived level of sustainability of the fortification initiative) than smaller sized firms. In addition, a higher perceived success score (p 0.05) was associated with non-targeted initiatives compared to those specifically targeted at a certain cohort of the population, further illustrating the benefits of producing at scale. Secondly, a significant relationship was found between whether standards were enacted and the coverage of the target market by the project/firm (p 0.05).). The third key factor relates to the ability to source adequate testing for the fortified produce in-house. A positive correlation was found for post-mix in-factory testing and the self-sustaining index (p 0.05). Finally, delays to importation and high charges were cited as key constraints to the use of premix. Conclusions: We argue therefore that a successful ‘business model’ for industrial fortification initiatives invariably consist of: (i) the involvement of larger sized firms that have the advantage of benefiting from economies of scale; (ii) the availability and application of agreed standards by the producer; (iii) high quality assurance/compliance monitoring (including post-mix testing where relevant), and; (iv) the ability to procure premix in a timely/cost-effective manner. These criteria are likely to be important factors that contribute to the success of fortification initiatives in LMICs. Full article

In many poorer parts of the world, biofortification is a strategy that increases the concentration of target nutrients in staple food crops, mainly by genetic manipulation, to alleviate prevalent nutrient deficiencies. We reviewed the (i) prevalence of vitamin A, iron (Fe) and zinc (Zn) deficiencies; (ii) availability of vitamin A, iron and Zn biofortified crops, and their acceptability in South Africa. The incidence of vitamin A and iron deficiency among children below five years old is 43.6% and 11%, respectively, while the risk of Zn deficiency is 45.3% among children aged 1 to 9 years. Despite several strategies being implemented to address the problem, including supplementation and commercial fortification, the prevalence of micronutrient deficiencies is still high. Biofortification has resulted in the large-scale availability of βcarotene-rich orange-fleshed sweet potatoes (OFSP), while provitamin A biofortified maize and Zn and/or iron biofortified common beans are at development stages. Agronomic biofortification is being investigated to enhance yields and concentrations of target nutrients in crops grown in agriculturally marginal environments. The consumer acceptability of OFSP and provitamin A biofortified maize were higher among children compared to adults. Accelerating the development of other biofortified staple crops to increase their availability, especially to the target population groups, is essential. Nutrition education should be integrated with community health programmes to improve the consumption of the biofortified crops, coupled with further research to develop suitable recipes/formulations for biofortified foods. Full article