Fortification the 'critical and cost-effective intervention' in tackling anemia?
Micronutrient deficiencies are the most widespread form of malnutrition globally, with more than two billion people affected, according to a report from Sight and Life Foundation and World Food Programme. In Latin America, whilst “significant economic progress” had been made and health and nutritional status of populations improved, the report showed micronutrient deficiencies remained “pervasive throughout the region”.
Anemia: prevalence and challenges
The report showed that among children and women of reproductive age in Latin America, anemia was the most important health problem, rated moderate to severe in a number of countries. Anemia among children was highlighted “a severe problem” in Guatemala and Bolivia, with prevalence above 40%, and moderate for children in Nicaragua, Brazil, Mexico, Ecuador, El Salvador, Cuba, Colombia, Dominican Republic, Peru, Panama and Honduras, with prevalence between 20-40%. The research showed anemia severely impacted women in Panama and moderately women in Guatemala, Brazil, Dominican Republic and Bolivia.
Helena Pachón, senior nutrition scientist at Food Fortification Initiative (FFI) and research professor at Emory University, said anemia was clearly the region's biggest health concern but addressing it remained complex.
“The challenge with anemia is that it can have multiple causes: both nutritional and non-nutritional in nature. Nutritional causes include deficiencies in nutrients such as iron, folate and vitamin B12. Non-nutritional causes include health problems such as malaria and parasitic infections,” Pachón told NutraIngredients-LATAM.
“Most countries do not know the causes of anemia in their population; however, it is assumed that iron deficiency is a leading contributor.”
Pachón said analysis on the global anemia problem supported this, showing iron deficiency to be the number one or two cause of anemia in women and men from all regions of Latin America.
Iron-deficiency anemia (IDA) became a key health concern, she said, because it was associated with weakness, fatigue and significant morbidity and for childbearing women an increased risk of preterm delivery, low birth weight, and maternal and child mortality.
The World Health Organization (WHO) estimates half of all global anemia cases are due to iron deficiency and has set targets to reduce anemia by 50% in women of reproductive age by 2025.
Getting 'the staples' fortified
Scott Montgomery, director of FFI, said fortification of staple cereals and grains was a key method in tackling deficiencies such as anemia.
“If we're trying to reach the masses and most vulnerable, fortification is the way to do it,” Montgomery said.
Fortification of wheat flour, maize flour, corn masa flour and rice in a region like Latin America ensured strong reach, he said, and incorporating these fortified grains required “no behavioral change” and “no mass marketing costs” for food firms.
Asked if dietary supplements and functional products also played an important role and could co-exist with fortification programs, he said: “I can't judge the value of some of those products but yes, they can certainly co-exist - that's not an issue at all. You're going to have a market that tries that type of product and offerings but in most cases there's a much larger part of the population that need access to safe, nutritious staple foods. And they probably won't be in that functional food and beverage market; that won't be on their priority list of spending power.”
The nutrition and dietary supplement industry, he said, therefore had to “understand how important this is and what a critical and cost-effective health intervention it can be, and support it.”
Pachón said studies on the impact flour fortification had on reducing iron deficiency and anemia remained “equivocal” but it could be assumed that “consistently and adequately fortified flour, and other foods, could contribute to reductions in micronutrient deficiencies in the region”, particularly given the large proportion of Latin Americans living in urban areas with access to commercial markets.
Government-led, industry monitored
Montgomery said flour fortification programs had to be mandated to be fully impactful and governments also had to ensure solid compliance.
“We want the governments to make it compulsory and we'll work with each government along each step of the way, from advocacy to implementation. But the most critical is monitoring; very rigorous monitoring that isn't too complicated or ultra-expensive.”
Industry too could “play a critical role” in driving monitoring efforts, he said, especially given multiple priorities and costs facing governments.”
