(P24-030-24) Does the Data Source Matter? A Comparison of Different Approaches to Planning Food Fortification Programs

Objectives: To compare target micronutrient concentrations for wheat flour fortification based on different approaches and data availability situations.

Methods: We compared target fortification levels selected for wheat flour using modeling of national survey data or information on food vehicle availability. We used 24-hr recall data (24hr) (Cameroon, n=972 women) and household consumption and expenditure survey (HCES) data (Cameroon, n= 11,391 households (hh); Nigeria, n=22,116 hh; Senegal, n=7,100 hh). Fortification levels were selected by modeling micronutrient addition to wheat flour and identifying where the impact on dietary inadequacy among women plateaued or where intake above the tolerable upper intake level exceeded 5%, whichever occurred first. For each country, we also selected fortification levels according to WHO wheat flour fortification recommendations (WHO-R) based on categories of per capita wheat flour availability from FAO’s Supply Utilization Accounts.

Results: Target levels from modeling, which were influenced by dietary micronutrient gaps and wheat flour consumption, varied widely across countries, and in comparison to WHO-R. For vitamin A (VA) and iron, modeling using 24hr or HCES resulted in target fortification levels that were higher than those based on WHO-R. For example, fortification levels based on modeling were 7-14 mg VA/kg and 110-240 mg iron/kg, while levels based on WHO-R were 3.0 or 5.9 mg VA/kg and 40 or 60 mg iron/kg. However, the pattern differed for folate in Nigeria and Cameroon (modeling: 3.15-4.5 mg folic acid/kg; WHO-R: 5 mg/kg), and results for zinc and B12 were mixed. Modeling-based levels for vitamins B1, B2, B3, and B6 were substantially higher than WHO-R, which were set to replace nutrients lost in processing (e.g., modeling: 36-53 mg riboflavin/kg; WHO-R: 2 mg/kg). In Cameroon, levels suggested by modeling with 24hr versus HCES differed by < 25% for folic acid, iron, and zinc, but >2-fold for vitamins A and B12.

Conclusions: Different approaches and data sources yielded inconsistent target fortification levels, and these patterns varied by nutrient. Approaches that cannot account for background dietary intake may underestimate target fortification levels for filling dietary gaps.

Funding Sources: None