PERCEPTIONS AND REALITIES OF FOOD FORTIFICATION IN PREVENTING ANEMIA

Purpose:   In Armenia 37% of children under-five years of age and 25% of women suffer from some degree (mild, moderate, or severe) of anemia. In response to these health challenges in 2009 the Government of Armenia decided to launch national flour fortification initiative. This study was conducted to determine the perception of Armenians toward food fortification for anemia prevention and to assess effectiveness of fortification from the internationally published literature.  

Method:   Nine qualitative focus group discussions were conducted with the general population, millers and health care providers in Armenia. A systematic review of 32 randomized controlled trials, meta-analyses, and other systematic reviews was performed to assess benefits and shortcomings of iron food fortification. PubMed and Hinari databases were searched for relevant English language articles published between 1975 and 2011. Studies were categorized based on the following study populations: children (17 studies), adults (9 studies), and entire population (6 studies). Differences were evaluated between methods (sprinkling/ fortification) and types of iron supplementation.

Result:   The majority of focus group participants expressed distrust toward flour fortification. Concerns included the lack of studies in Armenia showing the need for food fortification, negative aspects of additional iron intake by non-anemics, and insufficient research on the health benefits and adverse affects of fortification. Systematic review of studies with children showed anemia prevalence decrease after iron fortification. Two-thirds of the studies including the whole population found iron fortification ineffective. Comparing type of iron supplementation (electrolytic /sodium iron edetic acid /ferrous fumarate, etc.), electrolytic iron supplementation was found to be the least effective. Comparative studies showed sprinkling more effective than fortification. Focus group concerns for food fortification leading to accumulation and overdosing of iron in the body, taste changes and obesity were discredited by the systematic review.  Focus group participants suggested having both fortified and non-fortified products with identifying labels in the market to provide a choice for consumers.

Conclusion:   There are many misconceptions about iron fortification in the population.  There is also lack-of-clarity on the effectiveness of supplementation to reduce anemia in the general population. For successful implementation of effective fortification, an educational promotional campaign to correct misconceptions and further research to assure effectiveness are both necessary.