Martorell Reynaldo, Ascencio Melany, Tacsan Luis, Alfaro Thelma, Young Melissa F, Addo O Yaw, Dary Omar, Flores-Ayala Rafael
From the Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA (RM, MFY, OYA, and RF-A); Dirección de Desarrollo Científico y Tecnológico en Salud, Ministerio de Salud, San José, Costa Rica (MA and LT); Centro Nacional de Referencia de Bromatología, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (INCIENSA), Cartago, Costa Rica (TA); Nutrition Division, Office of Health, Infectious Diseases and Nutrition, Bureau for Global Health, United States Agency for International Development (USAID), Washington, DC (OD); and the International Micronutrient Malnutrition Prevention and Control (IMMPaCt) Program, Nutrition Branch, Division of Nutrition, Physical Activity and Obesity, U.S. CDC, Atlanta, GA (RF-A).
Am J Clin Nutr. 2015 Jan;101(1):210-7. doi: 10.3945/ajcn.114.097709. Epub 2014 Nov 5.
Food fortification is one approach for addressing anemia, but information on program effectiveness is limited.
We evaluated the impact of Costa Rica's fortification program on anemia in women aged 15-45 y and children aged 1-7 y.
Reduced iron, an ineffective fortificant, was replaced by ferrous fumarate in wheat flour in 2002, and ferrous bisglycinate was added to maize flour in 1999 and to liquid and powdered milk in 2001. We used a one-group pretest-posttest design and national survey data from 1996 (baseline; 910 women, 965 children) and 2008-2009 (endline; 863 women, 403 children) to assess changes in iron deficiency (children only) and anemia. Data were also available for sentinel sites (1 urban, 1 rural) for 1999-2000 (405 women, 404 children) and 2008-2009 (474 women, 195 children), including 24-h recall data in children. Monitoring of fortification levels was routine.
Foods were fortified as mandated. Fortification provided about one-half the estimated average requirement for iron in children, mostly and equally through wheat flour and milk. Anemia was reduced in children and women in national and sentinel site comparisons. At the national level, anemia declined in children from 19.3% (95% CI: 16.8%, 21.8%) to 4.0% (95% CI: 2.1%, 5.9%) and in women from 18.4% (95% CI: 15.8%, 20.9%) to 10.2% (95% CI: 8.2%, 12.2%). In children, iron deficiency declined from 26.9% (95% CI: 21.1%, 32.7%) to 6.8% (95% CI: 4.2%, 9.3%), and iron deficiency anemia, which was 6.2% (95% CI: 3.0%, 9.3%) at baseline, could no longer be detected at the endline.
A plausible impact pathway suggests that fortification improved iron status and reduced anemia. Although unlikely in the Costa Rican context, other explanations cannot be excluded in a pre/post comparison.
食品强化是解决贫血问题的一种方法，但关于该项目有效性的信息有限。
我们评估了哥斯达黎加强化项目对15 - 45岁女性和1 - 7岁儿童贫血状况的影响。
2002年，小麦粉中使用的效果不佳的还原铁被富马酸亚铁取代；1999年，玉米粉中添加了甘氨酸亚铁，2001年，液体奶和奶粉中也添加了甘氨酸亚铁。我们采用单组前后测设计，并利用1996年（基线；910名女性、965名儿童）和2008 - 2009年（终线；863名女性、403名儿童）的全国调查数据来评估缺铁（仅针对儿童）和贫血状况的变化。1999 - 2000年（405名女性、404名儿童）和2008 - 2009年（474名女性、195名儿童）哨点地区（1个城市、1个农村）的数据也可用，包括儿童的24小时膳食回顾数据。强化水平监测是常规操作。
食品按要求进行了强化。强化提供了儿童铁估计平均需求量的约一半，主要且等量地通过小麦粉和牛奶提供。在全国和哨点地区的比较中，儿童和女性的贫血状况均有所改善。在全国层面，儿童贫血率从19.3%（95%置信区间：16.8%，21.8%）降至4.0%（95%置信区间：2.1%，5.9%），女性贫血率从18.4%（95%置信区间：15.8%，20.9%）降至10.2%（95%置信区间：8.2%，12.2%）。儿童缺铁率从26.9%（95%置信区间：21.1%，32.7%）降至6.8%（95%置信区间：4.2%，9.3%），基线时缺铁性贫血率为6.2%（95%置信区间：3.0%，9.3%），在终线时已无法检测到。
一个看似合理的影响途径表明强化改善了铁营养状况并减少了贫血。尽管在哥斯达黎加的背景下不太可能，但在前后比较中不能排除其他解释。
