Study Links Flour Fortification to Reduced Anemia Prevalence

This woman lives in Peru which had a decline in anemia among women after fortifying flour. Photo by Steve Evans on Flickr.

This woman lives in Peru which had a decline in anemia among women after fortifying flour. Photo by Steve Evans on Flickr.

07 July 2015

Each year of flour fortification is associated with a 2.4% decrease in anemia prevalence among non-pregnant women, according to a recently published study. Researchers analyzed the change in anemia prevalence over time in countries that fortify wheat flour alone or in combination with maize flour in comparison to countries that do not fortify flour.

The paper notes that the type of evidence presented in this study “precludes a definitive conclusion” on the reduction of anemia prevalence attributable to fortifying flour with vitamins and minerals. However, the overall results do indicate that “flour fortification may be able to significantly reduce anemia burden at the population level," as is evidenced by the 2.4% yearly decrease in anemia in fortification countries.

The paper, published in the British Journal of Nutrition, compares nationally representative anemia data from 12 fortification countries and 20 non-fortification countries. Research was conducted by Jonathan Barkley, Kathleen Wheeler and Helena Pachón, investigators at the Food Fortification Initiative (formerly, Flour Fortification Initiative) and Emory University.

The primary objective of the study was to assess whether anemia was reduced in non-pregnant women due to flour fortification.

The World Health Organization (WHO) estimates that 30 percent of women globally are anemic. Anemia has several significant health consequences including increased maternal and infant mortality and impaired physical and mental development during childhood. Anemia can also result in fatigue and reduced work performance, resulting in economic consequences in addition to the physical and cognitive ones. Read personal stories about having anemia here.

Within this study, anemia prevalence in non-pregnant women was determined using nationally representative surveys such as Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Vitamin and Mineral Nutrition Information System from the World Health Organization.

At the outset of this research, 78 countries had mandates to fortify wheat flour alone or in combination with maize flour. Of those, only 12 had anemia data on women of reproductive age for periods before fortification began and after fortification was implemented. Researchers found 20 countries that were not fortifying that had at least two national surveys on anemia. Now 83 countries have mandates to fortify wheat flour, maize flour, and/or rice.

For inclusion in the study, the fortification countries must fortify wheat flour alone or in combination with maize flour with at least iron, folic acid, vitamin A or vitamin B12. Deficiencies in any of these nutrients can cause anemia.

This paper also discusses how the impact of fortification on anemia can be improved, such as using the recommended forms of higher-bioavailability iron compounds. For the best form of iron for fortifying wheat flour, based on the flour’s extraction rate and the average per capita flour availability, see the World Health Organization recommendations.

More information: Please contact info@ffinetwork.org for a copy of the full paper.

Improved Anemia