Fortification linked to decreased anemia for children and highlights need to review national standards in Colombia

02 June 2020

Disponible en español

Photo: Boris Heger/EC/ECHO


A recent study published in Perspectives in Human Nutrition found that Colombian pre-school children who ate foods containing fortified wheat flour such as bread and pasta were less likely to have anemia than those who ate few fortified wheat flour foods.

For decades, many countries have recommended or required that the food industry produce fortified foods meant to add a small amount of vitamins and minerals—micronutrients—into basic staples almost everyone can afford: for example, wheat flour with added iron and folic acid. Food is fortified to prevent micronutrient deficiencies that can limit a child’s academic achievement, reduce adult productivity and cause disabling or fatal birth defects.

The study analyzed data collected from a 2005 national nutrition survey to evaluate the impact of eating fortified foods on Colombians’ health, the first study of its kind since Colombia set standards for mandatory wheat flour fortification in 1996. At that time, Colombia also required millers to fortify wheat flour and food producers to use fortified wheat flour in processed foods. These standards aimed to ensure people received the iron, folic acid, calcium (optional), riboflavin, thiamin and niacin they need to lead healthy, productive lives and prevent conditions such as anemia.

Anemia, a condition that causes fatigue, a weakened immune system and other symptoms, results from a low amount of hemoglobin in blood—though not necessarily a lack of iron. As a result, the researchers also looked at the level of iron in survey participants’ blood. A low amount of iron in blood indicates iron deficiency, a condition that leads to abnormally low levels of red blood cells.

Of the 11,710 women and young children included in analyses, children aged 2-4 years children who ate the most flour-containing food had the lowest levels of anemia. Eating foods like bread and pasta that might contain fortified wheat flour was linked to low levels of anemia among children aged 5-12 years, though to a lesser extent. The study did not find a significant link between eating fortified wheat flour foods and anemia or iron status for women aged 13-49 years.

Photo: Jonas Schleske


In fact, for all age groups there was no association between eating fortified wheat flour foods and iron status. The researchers suspect one of the three types of iron used in Colombia to fortify wheat flour, a compound called reduced iron, may be the reason. In 2009, the World Health Organization released new guidelines for wheat flour fortification with iron. Reduced iron is not in the guidelines because researchers found that it is a form of iron that the human body does not absorb well.

When the 2005 national nutrition survey was conducted, Colombia’s 1996 standards had not been revised and still allowed millers to use reduced iron. Since reduced iron is one of the least expensive forms of iron, it is likely it was being used by most millers in the country. The Colombian standard for wheat flour fortification was changed in 2005 and requires millers to use iron compounds that are well absorbed by the human body. Analyses of the latest national nutrition survey, conducted in 2015, can assess if there have been improvements in iron status in the Colombian population due to the change in iron compound. The 2015 national nutrition survey data are not yet publicly available. 

The study’s researchers, experts from leading institutions in nutrition research including Emory University, Cornell University, Universidad Nacional de Colombia and the Food Fortification Initiative, commend Colombia’s fortification efforts and see analyses of fortification’s impact as a key step in creating a healthier future. “Analyses such as these can be used to review the fortification program and determine what improvements, if any, can be made to ensure that the maximum health benefit is observed,” noted Amy Fothergill, graduate student at Cornell University and co-author of the study.

Helena Pachón, fellow co-author, scientist for the Food Fortification Initiative and current faculty at Emory University added, “Fortification is one of the few health interventions that the private sector implements. We applaud the wheat flour producers in Colombia for contributing to better health in the country.”

To view Colombia’s and other countries’ national standards and information on fortification, please visit the Global Fortification Data Exchange, available in English and Spanish (en español).