(P24-074-24) Vitamin A Degradation and Dietary Adequacy: Modeled Effects on Dietary Adequacy, Child Mortality, and Cost-Effectiveness in Nigeria

Objectives: The degradation of vitamins in fortified foods may undermine the benefits of fortification programs but potential impacts have not been quantified. We modeled consequences of assumed vitamin A (VA) degradation rates in the contexts of wheat flour and bouillon fortification for achieving dietary adequacy and reducing VA-attributable mortality among young children in Nigeria. Impacts of degradation on fortification program cost-effectiveness were also assessed.

Methods: Nationally representative Household Consumption and Expenditure Survey data were used to estimate the contributions of fortified wheat flour (2 mg VA/kg) and a hypothetical VA-fortified bouillon cube (96 mg VA/kg) to dietary adequacy among children 6-59 mo using the nutrient density method, and under VA degradation assumptions ranging from 0-80%. The Lives Saved Tool (LiST) was used to estimate annual child-lives saved. Activity-based cost modeling was used to estimate fortification program costs.

Results: In Nigeria, 21% of children 6-59 mo were estimated to have inadequate VA intakes. As a result of VA-fortified wheat flour, 2.9% of children were predicted to achieve dietary adequacy and 3,079 lives would be saved annually assuming 0% degradation. At 80% degradation, 0.7% of children achieved dietary adequacy and 749 lives were saved annually. As a result of VA-fortified bouillon, 15.8% of children were predicted to achieve dietary adequacy and 16,815 lives were saved annually assuming 0% degradation; with degradation modeled at 80%, only 4.9% of children achieved dietary adequacy and 5,157 lives were saved annually. Estimated cost per life saved for VA-fortified wheat flour and bouillon, respectively, ranged from $1,610-$6,618 and $1,147-$3,740, depending on the assumed VA degradation rate.

Conclusions: Degradation of VA in fortified foods prior to receipt by households may lead to reductions in nutritional and life-saving benefits of fortification programs and reduce their cost-effectiveness. The impact of degradation will be greater for programs with large predicted impacts, as estimated for bouillon in this context. Technological advancements in fortificants and premix storage may reduce VA degradation, and their benefits and costs compared to adding overage warrant exploration.

Funding Sources: Particles for Humanity, with support from the Bill & Melinda Gates Foundation