Fiedler John L, Lividini Keith, Zulu Rodah, Kabaghe Gladys, Tehinse John, Bermudez Odilia I
HarvestPlus, International Food Policy Research Institute, Washington, DC, USA.
International Center for Tropical Agriculture (CIAT), Lilongwe, Malawi.
Food Nutr Bull. 2013 Dec;34(4):480-500. doi: 10.1177/156482651303400412.
Zambia was a pioneer when it started fortifying sugar with vitamin A in 1998. Micronutrient deficiencies-especially among young children-have changed little over the past decade. In 2008 an initiative to introduce fortified flours was halted when last-hour questions about the program could not be answered.
To provide information about the need, coverage, and impact of alternative fortification portfolio options to help Zambia overcome its fortification impasse.
Using household data from the 2006 Living Conditions Monitoring Survey, apparent micronutrient intake levels and apparent consumption levels of sugar, vegetable oil, wheat flour and maize meal were estimated. The household level data were used to estimate individual intakes by assuming that food was distributed among household members in direct proportion to their share of the household's total adult consumption equivalent. Intake adequacy was measured relative to age- and gender-specific Estimated Average Requirements. Combining information on the industrial structure and estimated fortifiable quantities consumed of each food, and assuming the nutrient content is that specified in official regulations, simulations were conducted of the coverage and impact of 14 fortification portfolios.
Maize, the most commonly consumed food, is consumed in a fortifiable form by only 23% of the population. Sugar fortification is estimated to have reduced inadequate intake of vitamin A from 87% to 79%. Introducing oil fortification could reduce the prevalence of inadequate vitamin A intake to 61%, and fortifying roller and breakfast maize meal would further reduce it to 57%, and reduce inadequate iron and zinc intakes by 2.2% and 5.5%, respectively. Implementing WHO flour guidelines would triple the potential iron and zinc impacts.
Analysis of LCMS apparent consumption data have helped address important information gaps and provide better understanding of the coverage and impacts of alternative fortification portfolios.
赞比亚在1998年开始对糖进行维生素A强化时堪称先驱。在过去十年中，微量营养素缺乏状况——尤其是在幼儿中——几乎没有改变。2008年，一项引入强化面粉的倡议在最后一刻因项目相关问题无法得到解答而叫停。
提供有关替代强化组合方案的必要性、覆盖率和影响的信息，以帮助赞比亚打破强化工作的僵局。
利用2006年生活条件监测调查中的家庭数据，估算了微量营养素的表观摄入量以及糖、植物油、小麦粉和玉米粉的表观消费水平。通过假设食物在家庭成员间的分配与他们在家庭总成人消费当量中所占份额成正比，利用家庭层面的数据估算个人摄入量。摄入量是否充足是相对于特定年龄和性别的估计平均需求量来衡量的。结合每种食物的产业结构信息和估计的可强化消费量，并假设营养素含量符合官方规定，对14种强化组合的覆盖率和影响进行了模拟。
玉米是最常食用的食物，只有23%的人口食用可强化形式的玉米。据估计，糖强化使维生素A摄入不足的比例从87%降至79%。引入油强化可将维生素A摄入不足的患病率降至61%，强化辊磨玉米粉和早餐玉米粉可进一步将其降至57%，同时分别将铁和锌摄入不足的比例降低2.2%和5.5%。实施世界卫生组织的面粉指南将使铁和锌的潜在影响增加两倍。
对生活条件监测调查表观消费数据的分析有助于填补重要的信息空白，并更好地了解替代强化组合的覆盖率和影响。
