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Vitamin A (VA) fortification of cooking oil is considered a cost-effective strategy for increasing VA status, but few large-scale programs have been evaluated. We conducted representative surveys in Yaoundé and Douala, Cameroon, 2 years before and 1 year after the introduction of a mandatory national program to fortify cooking oil with VA. In each...
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... Cependant, les résultats de cette étude révèlent un nonrespect de cet arrêté par les producteurs locaux et les importateurs des huiles végétales raffinées, car seulement, 23,73% des échantillons analysés avaient des teneurs en vitamine A conformes. Ceci traduirait également, un non-respect des règles d'enrichissement en vitamine A de l'huile raffinée produites localement et/ou importées au Burkina Faso.Reina et al. (2017) ont trouvé 44% de conformité de la teneur en vitamine A des huiles raffinées au Cameroun. ...
La carence en vitamine A constitue un problème de santé publique dans les pays en développement et affecte en particulier les jeunes enfants et les femmes en âge de procréer. Le but de cette étude était d'évaluer l’application de la politique nationale en matière de production et d’importation, des huiles végétales raffinées, d’enrichissement obligatoire en vitamine A au Burkina Faso, à travers la détermination de la teneur en vitamine A et de l'indice de peroxyde des huiles végétales vendues sur le marché. Cette étude transversale a été menée dans cinq villes sélectionnées selon la densité de la population. Cinquante-neuf échantillons d’huile ont été achetés dans ces villes pour évaluer la teneur en vitamine A, l'indice de peroxyde et leur conformité aux normes nationales et internationales. Dans l'ensemble, 76,27% des huiles n'étaient pas suffisamment enrichies en vitamine A. Pour l'indice de peroxyde, 3,39% des huiles n'étaient pas conformes. Globalement, 77,97% des huiles n'étaient pas conformes pour ces deux paramètres. Au regard de ces résultats il est nécessaire d’intensifier la lutte contre la mise à la consommation des huiles non enrichies en vitamine A au Burkina Faso. English title: valuation of the vitamin A content and the peroxide value of vegetable oils commonly sold in markets in Burkina Faso Vitamin A deficiency is a public health problem in developing countries and particularly affects young children and women of childbearing age. The aim of this study was to assess the implementation of the national policy on the production and importation of refined vegetable oils and mandatory vitamin A fortification in Burkina Faso, through the determination of the vitamin A content and peroxide value of vegetable oils sold on the market. A cross-sectional study was conducted in five cities selected according to population density. Fifty-nine oil samples were purchased in these cities to assess vitamin A content, peroxide value and compliance with national and Codex standards. Overall, 76.17% of the oils were not adequately fortified with vitamin A. For the peroxide value, 3.39% of the oils did not comply. Overall, 77.97% of the oils did not comply for these two parameters. In view of these results, it is necessary to intensify the fight against the consumption of oils not enriched in vitamin A in Burkina Faso.
... Some country programs have achieved high coverage of fortifiable and fortified foods that is equitable across vulnerable populations, such as maize flour in Eastern Cape and Gauteng, South Africa, oil in Abidjan, Cote d'Ivoire [9], and salt in Uganda [35]. Additionally, there are other fortification programs that are well-designed and implemented and have also demonstrated impact on micronutrient deficiencies, such as the oil and wheat flour fortification programs in Cameroon [37,38], and the wheat and maize flour fortification program in Costa Rica [39]. ...
Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (< 50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.
... Informed by estimates of the reach of potentially fortifiable staple foods (21), as well as feasibility and cost estimates, the government of Cameroon mandated fortification of all refined vegetable oil and wheat flour, with distribution of fortified products commencing in August 2011. In 2012, an initial impact evaluation in the 2 largest cities in Cameroon, Yaoundé and Douala, showed no impact on vitamin A status in women or children (25), possibly because only 44% of household oil samples were fortified with vitamin A. In contrast, wheat flour samples collected from markets were fortified at ∼75% of target levels, and the status of iron, zinc, folate, and vitamin B-12 (all nutrients added to wheat flour) was greater among both women and children compared with prefortification values (26). ...
... In a previous evaluation of the program, no change in vitamin A status was observed post-fortification in Yaoundé and Douala, possibly because only ∼44% of oil samples were fortified (25). The results of the current study suggest greater potential for impact because the vitamin A content of oil samples was closer to the target levels (on average, ∼75% of target vitamin A levels). ...
Background:
Since 2011 Cameroon has mandated the fortification of refined vegetable oil with vitamin A and wheat flour with iron, zinc, folic acid, and vitamin B-12. In 2012, measured fortification levels for flour, and particularly oil, were below target.
Objectives:
We assessed Cameroon's food fortification program using a program impact pathway (PIP) to identify barriers to optimal performance.
Methods:
We developed a PIP through literature review and key informant interviews. We conducted interviews at domestic factories for refined vegetable oil (n = 9) and wheat flour (n = 10). In 12 sentinel sites distributed nationally, we assessed availability and storage conditions of fortified foods in markets and frequency of consumption of fortified foods among women and children (n = 613 households). Food samples were collected from factories, markets, and households for measurement of micronutrient content.
Results:
Two-thirds of factories presented quality certificates for recent premix purchases. All factories had in-house capacity for micronutrient analysis, but most used qualitative methods. Industries cited premix import taxes and access to external laboratories as constraints. Mean vitamin A levels were 141% (95% CI: 116%, 167%), 75% (95% CI: 62%, 89%), and 75% (95% CI: 60%, 90%) of target in individual samples from factories, markets, and households, respectively. Most industry flour samples appeared to be fortified, but micronutrient levels were low. Among composite flour samples from markets and households, the mean iron and zinc content was 25 mg/kg and 43 mg/kg, respectively, ∼45% of target levels; folic acid (36%) and vitamin B-12 (29%) levels were also low. In the previous week, the majority of respondents had consumed "fortifiable" oil (63% women and 52% children) and wheat flour (82% women and 86% children).
Conclusions:
In Cameroon, oil fortification program performance appears to have improved since 2012, but fortification levels remain below target, particularly for wheat flour. Consistent regulatory monitoring and program support, possibly through premix procurement and micronutrient analysis, are needed.
... We analyzed the national dietary survey data from Cameroon 47 to examine the existing prevalence of dietary adequacy and excess, and the potential effects of intervention programs. In Cameroon, existing fortification programs (addition of 12 mg VA/kg to refined vegetable oil, and addition of 60 mg iron/kg, 95 mg zinc/kg, 5.0 mg folic acid/kg, and 0.04 mg vitamin B12/kg to wheat flour) would not be expected to contribute to excessive intake 74,82,84 given the reported oil and flour intakes in the population. While fortification at the target levels is predicted to substantially reduce the prevalence of inadequate intake, the effect of oil and flour fortification is limited by the reach (i.e., proportion of the population consuming these foods) in some areas, so we explored scenarios to fortify multiple food vehicles, with varying predicted effects on excessive intake. ...
Several intervention strategies are available to reduce micronutrient deficiencies, but uncoordinated implementation of multiple interventions may result in excessive intakes. We reviewed relevant data collection instruments and available information on excessive intakes for selected micronutrients and considered possible approaches for weighing competing risks of intake above tolerable upper intake levels (ULs) versus insufficient intakes at the population level. In general, population‐based surveys in low‐ and middle‐income countries suggest that dietary intakes greater than the UL are uncommon, but simulations indicate that fortification and supplementation programs could lead to high intakes under certain scenarios. The risk of excessive intakes can be reduced by considering baseline information on dietary intakes and voluntary supplement use and continuously monitoring program coverage. We describe a framework for comparing risks of micronutrient deficiency and excess, recognizing that critical information for judging these risks is often unavailable. We recommend (1) assessing total dietary intakes and nutritional status; (2) incorporating rapid screening tools for routine monitoring and surveillance; (3) addressing critical research needs, including evaluations of the current ULs, improving biomarkers of excess, and developing methods for predicting and comparing risks and benefits; and (4) ensuring that relevant information is used in decision‐making processes.
... 456) still claimed that "the development and commerce of these products is rather complex, expensive and risky, as special requirements should be answered". Nowadays food fortification is still a significant trend all around the world, which is important for developing countries and for vulnerable consumer groups as well e.g., [3][4][5]. This increases the need for revealing new functional food product development opportunities that keep consumer behavior in mind. ...
This study has revealed the role of a new factor, perceived correspondence of health effects, in consumer acceptance of functional foods. Using a web survey of 1016 people, we hypothesized and verified the following: when an ingredient does not occur naturally in the carrier but the consumer assigns the same health effect to it as to the carrier, the product's acceptance will be more positive than it would be if an identical health effect was not associated with the carrier and the functional ingredient. Factors influencing consumer acceptance were examined via binary logistic regression models. According to the results, if a functional food developer fortifies the carrier with an ingredient that does not occur naturally in the carrier, the product can expect higher acceptance if the health effects perceived by consumers are properly matched. In general, it has been found that expected taste and awareness of the product were decisive in all demographic and income groups, whereas perceived correspondence of health effects had a lesser, but still positive influence on acceptance.
... In Cameroon, existing fortification programs (addition of 12 mg/kg VA to refined vegetable oil, and addition of 60 mg/kg iron, 95 mg/kg zinc, 5.0 mg/kg folic acid, and 0.04 mg/kg vitamin B12 to wheat flour) would not be expected to contribute to excessive intake. 35,36 However, fortifying multiple food vehicles without modifying ongoing programs could have varying effects on excessive intake. In particular, fortifying sugar or wheat flour in addition to oil was predicted to increase the prevalence of excessive VA intakes among young children, while fortification of bouillon cubes with VA, in combination with an oil fortification program, was not predicted to cause excessive intakes. ...
The excessive consumption of certain vitamins and minerals could have deleterious consequences on health and development of individuals and populations. Simultaneous micronutrient‐delivery interventions could be challenging in terms of safety as the target populations may overlap, posing a risk of excessive intake of certain micronutrients. The Evidence and Programme Guidance Unit of the Department of Nutrition for Health and Development of the World Health Organization convened a technical consultation on the risk of excessive intake of vitamins and minerals delivered through public health interventions in October 2017. The technical consultation's working groups identified important and emerging technical issues, lessons learned, and research priorities related to (1) planning, implementing, monitoring, and evaluating nutrition programs for the detection and control of the risk of excessive intakes; (2) safety, quality control, and assurance considerations; (3) coordination between public health nutrition interventions and other interventions and sectors; and (4) the legislative framework and policy coherence needed for simultaneous nutrition interventions. This paper provides the background and rationale of the technical consultation, synopsizes the presentations, and provides a summary of the main considerations proposed by the working groups.
... The remaining studies measured fat by using the Roese-Gottlieb (35), Zöllner and Kirsch (36), or Bucolo and David (45) methods. The CV for fat was reported in 5 studies and ranged from 1.3% to <10% (8,22,24,27,28). ...
... In 3 studies, human-milk samples were pretreated with bile salts, protease, and lipase by using the method of Liu et al. (18,19,21,33). Reported CVs for retinol were ≤10% in all but 3 studies, in which interassay CVs were <12%, 13.3%, and 13.4% (27,33,43). ...
Vitamin A in human milk is critical for meeting infant requirements and building liver stores needed after weaning. A number of studies have measured milk retinol, but only a subset have corrected for fat, which serves as the retinol carrier in breast milk. The purpose of the present work was to review and analyze studies in which human-milk retinol concentrations were reported in relation to milk fat and to compare these results with unadjusted breast-milk retinol concentrations in terms of time trends over the course of lactation, influences of maternal nutritional and constitutional factors, and effects of maternal vitamin A supplementation. A systematic approach was used to search the available literature by using the US National Library of Medicine's MEDLINE/PubMed bibliographic search engine. Observational and intervention studies were included if the research was original and the retinol-to-fat ratio (retinol:fat) in human milk was measured at ≥1 time point during the first 12 mo of lactation. Retinol:fat and retinol were highest in colostrum, declined rapidly in early lactation, and achieved statistical stability by 2 and 4 wk lactation, respectively. In mature milk, retinol concentration was positively correlated with milk fat (r = 0.61, P = 0.008). Breast-milk retinol:fat and retinol were positively associated with maternal vitamin A intake but were associated with plasma retinol only when dietary intake was inadequate. Postpartum supplementation with high-dose vitamin A (200,000-400,000 IU) resulted in significantly higher breast-milk retinol:fat for 3 mo and retinol for 6 mo (P < 0.05). In populations, the 2 indexes show similar trends and associations with maternal factors. Future studies should monitor how the uptake of retinol into the mammary gland affects maternal vitamin reserves, particularly in women who are at risk of vitamin A deficiency.
... The study design and methods have been described in detail elsewhere [20][21][22]. The primary objective of the study was to assess the change in micronutrient status following implementation of a large-scale food fortification program. ...
... Details of the survey recruitment and response rate have been presented elsewhere [20,21]. Thirty-four different ethnic groups were represented by the mothers (not including subgroups within these ethnic groups), in addition to a small proportion (<2%) who reported being of mixed ethnicity, and 2 mothers of non-Cameroonian descent. ...
Information on the etiology of anemia is necessary to design effective anemia control programs. Our objective was to measure the prevalence of inherited hemoglobin disorders (IHD) in a representative sample of children in urban Cameroon, and examine the relationships between IHD and anemia. In a cluster survey of children 12–59 months of age (n = 291) in Yaoundé and Douala, we assessed hemoglobin (Hb), malaria infection, and plasma indicators of inflammation and micronutrient status. Hb S was detected by HPLC, and α⁺thalassemia (3.7 kb deletions) by PCR. Anemia (Hb < 110 g/L), inflammation, and malaria were present in 45%, 46%, and 8% of children. A total of 13.7% of children had HbAS, 1.6% had HbSS, and 30.6% and 3.1% had heterozygous and homozygous α⁺thalassemia. The prevalence of anemia was greater among HbAS compared to HbAA children (60.3 vs. 42.0%, p = 0.038), although mean Hb concentrations did not differ, p = 0.38). Hb and anemia prevalence did not differ among children with or without single gene deletion α⁺thalassemia. In multi-variable models, anemia was independently predicted by HbAS, HbSS, malaria, iron deficiency (ID; inflammation-adjusted ferritin <12 µg/L), higher C-reactive protein, lower plasma folate, and younger age. Elevated soluble transferrin receptor concentration (>8.3 mg/L) was associated with younger age, malaria, greater mean reticulocyte counts, inflammation, HbSS genotype, and ID. IHD are prevalent but contribute modestly to anemia among children in urban Cameroon.
Vitamin A deficiency (VAD) increases risk for morbidity and mortality. Food-based approaches offer one strategy to improve vitamin A status. This systematic review assessed evidence of the effects of food-based approaches on the vitamin A status of women and children under 5 y. VAD was defined as clinical ocular symptoms, such as loss of vision, and/or retinol plasma or serum concentration <0.70 μmol/L. Searches on food-based approaches to improve vitamin A status were conducted for the period 2011–2022 on PubMed, CINHAL, Web of Science, and Google Scholar using PRISMA guidelines. English-language publications were included. Case studies, unpublished dissertations, and non-peer-reviewed studies were excluded. This review comprises 24 of 27,322 identified studies; 23 included studies focused on provitamin A carotenoids. There were 17,214 participants across the 24 studies with sample sizes ranging from 8 to 3571 individuals. Intervention studies spanned from 3 wk to 2 y. Fifteen (63%) studies were randomized control trials, 7 were cross-sectional, and 2 were longitudinal studies. Most studies (N = 21) used biochemical measurements, for example, serum retinol, to assess vitamin A status; other studies used clinical symptoms (for example, xerophtalmia) or dietary intake. Thirteen (54%) studies reported a statistically significant effect of food-based interventions (N = 8) or an association of diet (N = 5) on vitamin A status. This systematic review indicated that some food-based interventions improved vitamin A status, thus offering a safe and effective delivery mechanism for vitamin A. There appeared to be significant association between vitamin A status and consumption of foods with high concentrations of preformed vitamin A and provitamin A carotenoids. Differences across studies in regard to the period of evaluation, food approaches used, and statistical power may explain the lack of effectiveness of food-based approaches on vitamin A status in some studies.
Vitamin A supplementation (VAS) in 6-59-month-old children is recommended but its sustainability is currently questioned. In Senegal, available data suggest that VAS should be maintained, but geographic and age-related specificities need to be addressed to better implement and target VAS programming. The objective of this comparative cross-sectional study, conducted in urban settings of Dakar, was to compare the vitamin A liver stores (VALS) assessed using the modified-relative dose response (MRDR) test between supplemented and non-supplemented 9-23 month-old children and to study their relationship with VAS. The supplemented group (n = 119) received VAS (either 100 000 UI or 200 000 UI) 2 to 6 months before evaluation while the non-supplemented group (n = 110) had not received VAS during the past 6 months. In addition to MRDR, serum retinol concentrations (SR), and biomarkers of subclinical inflammation were measured. Children's health-related data and feeding patterns were collected. Mean MRDR values (VAS: 0.030 ± 0.017, non-VAS: 0.028 ± 0.016, P = 0.389) and inflammation-adjusted SR (VAS: 1.34 ± 0.37, non-VAS: 1.3 ± 0.35, P = 0.515) of children were adequate. Low prevalence of VALS (VAS: 5.2%, non-VAS: 5.4%) and inflammation-adjusted VAD (VAS: 2.6%, non-VAS: 0.9%) were detected despite high presence of infections and inflammation. Children were mostly still being breastfed (VAS: 85.7%, non-VAS: 77.3%) and complementary feeding indicators were similar in both groups. Only breastfeeding was associated with VALS and was found to reduce by 76% at least, the odds of VAD (adjusted OR = 0.24, 95% CI: 0.07-0.8, P = 0.020). Based on MRDR values, VAS was not related to improved VALS and SR as well as VAD reduction among these children with adequate VALS. Reinforcing breastfeeding advocacy and morbidity pre-vention/control are essential in this setting. Scaling-back VAS in this subpopulation should PLOS ONE
