Micronutrient Deficiencies and Anemia in Urban India-Do We Need Food Fortification?

Prevalence of anemia in India is almost 40% with no significant change since 1998-99, whereas globally this prevalence has been reduced to < 15%. This could be because our national nutritional programs (mainly National Nutritional Anemia Control Program-NNACP) focus on supplementation with iron and folate but not with vitamin B12. Some Indian studies, including our study (2012), indicated high prevalence of B12 deficiency in North Indian urban population. Hence, we conducted a retrospective analysis of 3 years' data (2012-2014 including 48,317 subjects) and compared it with last year's retrospective data (April 2019-March 2020 including 4775 subjects) to ascertain prevalence of deficiencies of these micronutrient with special reference to patients of anemia, and improvement therein over the subsequent 5-year period. Our results indicate that amongst our subjects with anemia, iron deficiency has reduced from 66.73% (2012-2014) to 56.86% (2019), but prevalence of vitamin B12 deficiency is still the same (36.54% in 2012-2014; 37.04% in 2019). Folate deficiency was similar in both sets of data (2.95% in 2012-2014 and 2.55% in 2019). Thus, NNACP has reduced prevalence of iron deficiency by ~ 10%points and folate deficiency marginally; B12 deficiency has not been addressed. It would, therefore, follow that we need to add to our current national programs to effectively deal with these deficiencies. Food fortification (with iron, folate and B12) seems the most likely means to add value to the existing programs. In addition, food diversification needs to be included in regular school curriculum to bring about community awareness and change in food habits.