Quantifying the Potential Impact of Food Fortification on Iron Intake, Hemoglobin Concentration and Anemia Prevalence...

Anemia is a public health burden, particularly in women of reproductive age (WRA). Food fortification, by adding micronutrients to foods, may alleviate anemia caused by nutritional deficiencies. To model the impact of iron-fortified rice, wheat flour, and salt in India, we simulated three scenarios: no fortification, intermediate fortification (50% coverage for rice and wheat flour and 26.6% coverage for salt, with 100% industry compliance), and maximum fortification (100% coverage and compliance) in WRA. We first used a single-day, 24-h dietary recall survey from the National Nutrition Monitoring Bureau to simulate mean iron intake under these scenarios (n = 11,625). We then used data from the National Family Health Survey 4 (n = 667,258) to simulate hemoglobin changes due to increased iron intake, based on established parameters from a meta-regression analysis. Subsequently, we calculated anemia prevalence. Compared to the no-fortification scenario, the intermediate and maximum fortification scenarios were predicted to increase daily iron intake by 4.3-6.5 mg and 8.6-13.1 mg (35%-53% and 70%-106% increases), respectively, and decrease anemia prevalence from 52.6% to 45-48% and 36-43%, respectively. Our results suggest that combined fortification of rice, wheat flour, and salt with iron at varying levels of coverage and 100% compliance can improve iron intakes and hemoglobin concentration and thus reduce anemia prevalence among WRA in India.