An Assessment of the Potential Impact of Fortification of Staples and Condiments on Micronutrient Intake of Young Children and Women of Reproductive Age in Bangladesh

Trends and Inequities in Adequacy of Micronutrient Intakes in Rural Bangladesh

BACKGROUND

Micronutrient deficiencies pose a significant public health challenge, yet limited evidence exists on micronutrient intakes over time in Bangladesh.

OBJECTIVES

We assessed trends and adequacies in micronutrient intakes and examined the changes in inequities by age group, sex, and expenditure quintile.

METHODS

We used panel data from the 2011 and 2018 Bangladesh Integrated Household Survey (n = 21,475 and 21,589 household members aged 2 y or older, respectively). Food consumption data were collected using a household dietary recall. Changes in micronutrient intakes were assessed using nonparametric Mann-Whitney-Wilcoxon rank sum test. Inequities in outcomes were examined using the slope index of inequality and concentration index.

RESULTS

Micronutrient intakes remained suboptimal across 2011 and 2018, with low adequacy (<0.50) for all nutrients except niacin. While vitamin A intake increased across various demographics, trends for other micronutrient intakes differed by age. Intakes improved for 10 micronutrients among children aged 2 to <5 y but increased for only half of the examined micronutrients among children aged 5-9 y. For adolescents and adults, most micronutrient intakes slightly declined, with greater inadequacies observed among females than those among males. Pregnant women experienced sharper declines in adequacy of micronutrient intakes than lactating women. The mean probability of adequacy (MPA) was low (around one-third) for all age groups with lower MPA among poorer than that among richer households across age, sex, and survey years. Inequity gaps in MPA mostly declined, except for females aged 50 y or older and pregnant women.

CONCLUSIONS

Micronutrient intakes and adequacies remain suboptimal and have decreased marginally over time for many nutrients and MPA across most age groups. Inequities in micronutrient intakes persist by age, sex, and income levels, disproportionately affecting the poor, adults, and women. Our study calls for evidence-based policies and programs that incorporate a range of proven approaches and tailored solutions to effectively tackle persisting inequities and ensure access to healthy diets for all.

Biological properties of vitamin B12

Vitamin B12, cobalamin, is indispensable for humans owing to its participation in two biochemical reactions: the conversion of l-methylmalonyl coenzyme A to succinyl coenzyme A, and the formation of methionine by methylation of homocysteine. Eukaryotes, encompassing plants, fungi, animals and humans, do not synthesise vitamin B12, in contrast to prokaryotes. Humans must consume it in their diet. The most important sources include meat, milk and dairy products, fish, shellfish and eggs. Due to this, vegetarians are at risk to develop a vitamin B12 deficiency and it is recommended that they consume fortified food. Vitamin B12 behaves differently to most vitamins of the B complex in several aspects, e.g. it is more stable, has a very specific mechanism of absorption and is stored in large amounts in the organism. This review summarises all its biological aspects (including its structure and natural sources as well as its stability in food, pharmacokinetics and physiological function) as well as causes, symptoms, diagnosis (with a summary of analytical methods for its measurement), prevention and treatment of its deficiency, and its pharmacological use and potential toxicity.

Considerations for improvising fortified extruded rice products

Micronutrient fortification of rice by extrusion is an effective strategy to enhance micronutrient levels within rice-consuming individuals. The success of extrusion-based fortification is associated with micronutrient retention, enhanced bioavailability, low postprocessing losses, prolonged storage stability, and minimal sensory changes. The success of an optimally fortified product is primarily reliant upon the compositional considerations, but many attributes of extrudates can be indebted to the processing parameters too. Hence, an exhaustive investigation of this technology has been taken-up here, emphasizing on the compositional parameters in association with process parameters, which influence the final quality attributes like nutrient stability, bioavailability, and sensory properties. Based on these attributes of the end product, a collected data have been presented here to bring out the optimal compositional requirements. These together with cooking processes, extrusion process parameters, and storage conditions will enable formulate a product with enhanced sensory acceptance, better retention during cooking and storage, improved texture, and acceptable color. This review will thus help to optimize a need-based product, its quality, and enhance benefits of fortified extruded rice products.

Vitamin A Fortification Quality Is High for Packaged and Branded Edible Oil but Low for Oil Sold in Unbranded, Loose Form: Findings from a Market Assessment in Bangladesh

Although mandatory fortification of oil with vitamin A is efficacious, its effectiveness can be compromised by suboptimal compliance to standards. In this study, we assessed (1) the availability of oil brands across the eight divisions of Bangladesh, (2) fortification quality (the extent to which vitamin A content is aligned with fortification standards) of oil brands and producers and (3) the market volume represented by available edible oil types. We visited different retail outlets in rural and urban market hubs to ascertain available oil brands and bulk oil types and collected samples. We used high-performance liquid chromatography to quantify average vitamin A content and compared them to the national oil fortification standards. Among the 66 packaged brands analyzed, 26 (39%) were not fortified, and 40 (61%) were fortified, with 28 (42%) fortified above the standard vitamin A minimum. Among the 41 bulk oil type composites analyzed, 24 (59%) were not fortified, and 17 (41%) were fortified, with 14 (34%) fortified below and 3 (7%) fortified above the standard minimum. Vitamin A fortification is high for packaged and branded edible oil but low for oil sold in unbranded, loose form. As bulk oil makes up a large proportion of the oil market volume, this means the majority of the oil volume available to the population is either not (25%) or fortified below the standard requirement (39%). Regulatory inspections of producers selling bulk oil should be prioritized to support and incentivize the industry to make all oil traceable and fortified to standard.

Reorientation of aquaculture production systems can reduce environmental impacts and improve nutrition security in Bangladesh

Aquatic foods are a critical source of human nutrition in many developing countries. As a result, declines in wild-caught fish landings threaten nutritionally vulnerable populations. Aquaculture presents an opportunity to meet local demand, but it also places pressure on natural resource inputs and causes a range of environmental impacts. Here, we examine whether current aquaculture systems in Bangladesh can be reoriented to address prevailing nutritional deficiencies while minimizing these environmental impacts. Current fish farming practices, even when optimized, cannot fully supply the same essential micronutrient densities of zinc, iron and calcium as wild-caught fish. However, when the proportion of highly nutrient-dense small indigenous fish species (SIS) was increased to at least 30% of the total output in any of the 14 aquaculture production systems analysed, these systems were able to meet or surpass the nutrient densities of average wild-capture fisheries. Extensive aquaculture systems that co-produce fish and rice had the lowest environmental burdens in six out of seven metrics examined when the composition of all aquaculture systems was modified to include 50% SIS. Nutrition-sensitive aquaculture that provides greater human health benefits and minimizes environmental impacts is a key societal challenge that requires targeted interventions and supportive policies.

Compositional Analysis of Genetically Engineered GR2E "Golden Rice" in Comparison to That of Conventional Rice

Compositional analyses were performed on samples of rice grain, straw, and derived bran obtained from golden rice event GR2E and near-isogenic control PSBRc82 rice grown at four locations in the Philippines during 2015 and 2016. Grain samples were analyzed for key nutritional components, including proximates, fiber, polysaccharides, fatty acids, amino acids, minerals, vitamins, and antinutrients. Samples of straw and bran were analyzed for proximates and minerals. The only biologically meaningful difference between GR2E and control rice was in levels of β-carotene and other provitamin A carotenoids in the grain. Except for β-carotene and related carotenoids, the compositional parameters of GR2E rice were within the range of natural variability of those components in conventional rice varieties with a history of safe consumption. Mean provitamin A concentrations in milled rice of GR2E can contribute up to 89-113% and 57-99% of the estimated average requirement for vitamin A for preschool children in Bangladesh and the Philippines, respectively.

Household coverage of vitamin A fortification of edible oil in Bangladesh

Mandatory fortification of edible oil (soybean and palm) with vitamin A was decreed in Bangladesh in 2013. Yet, there is a dearth of data on the availability and consumption of vitamin A fortifiable oil at household level across population sub-groups. To fill this gap, our study used a nationally representative survey in Bangladesh to assess the purchase of fortifiable edible oil among households and project potential vitamin A intake across population sub-groups. Data is presented by strata, age range and poverty-the factors that potentially influence oil coverage. Across 1,512 households, purchase of commercially produced fortifiable edible oil was high (87.5%). Urban households were more likely to purchase fortifiable oil (94.0%) than households in rural low performing (79.7%) and rural other strata (88.1%) (p value: 0.01). Households in poverty were less likely to purchase fortifiable oil (82.1%) than households not in poverty (91.4%) (p <0.001). Projected estimates suggested that vitamin A fortified edible oil would at least partially meet daily vitamin A estimated average requirement (EAR) for the majority of the population. However, certain population sub-groups may still have vitamin A intake below the EAR and alternative strategies may be applied to address the vitamin A needs of these vulnerable sub-groups. This study concludes that a high percentage of Bangladeshi population across different sub-groups have access to fortifiable edible oil and further provides evidence to support mandatory edible oil fortification with vitamin A in Bangladesh.

Factors associated with nutritional status and dietary practices of Bangladeshi adolescents in early pregnancy

Bangladesh has a high prevalence of adolescent pregnancy, but little is known about the nutritional status and dietary practices of Bangladeshi adolescents in early pregnancy or associated factors. We used the baseline data of 1552 pregnant adolescents from a longitudinal, cluster-randomized effectiveness trial conducted in northwest Bangladesh. Forty-four percent of the adolescents were short for their age, 36% had low body mass index, 28% were anemic, 10% had iron deficiency, and 32% had vitamin A deficiency. The mean consumption of animal-source foods was 10.3 times/week. In multivariate analysis, socioeconomic status, education, and food security were generally positively associated with anthropometric indicators and dietary practices but not with iron or vitamin A status. Our findings confirm that there is a high burden of undernutrition among these Bangladeshi adolescents in early pregnancy. Understanding factors related to undernutrition can help to identify adolescent pregnant women at higher risk and provide appropriate counseling and care.

Vitamin A deficiency and determinants of vitamin A status in Bangladeshi children and women: findings of a national survey

OBJECTIVE

Using data from the national micronutrients survey 2011-2012, the present study explored the status of subclinical vitamin A nutrition and the underlying determinants in the Bangladeshi population.

DESIGN

A nationwide cross-sectional study. Settings The survey covered 150 clusters; fifty in each of rural, urban and slum strata.

SUBJECTS

Three population groups: (i) pre-school age children (6-59 months; PSAC); (ii) school age children (6-14 years; SAC); and (iii) non-pregnant non-lactating women (15-49 years; NPNLW).

RESULTS

National prevalence of subclinical vitamin A deficiency was 20·5, 20·8 and 5·3 % in PSAC, SAC and NPNLW, respectively. Slum populations had higher prevalence compared with urban (PSAC: 38·1 v. 21·2 %, P0·05 for differences in β between <3 months v. 3-6 months, 6-9 months and 9-12 months).

CONCLUSIONS

Prevalence of subclinical vitamin A deficiency was high in children in Bangladesh. Intakes of animal-source foods and leafy vegetables were associated with higher and lower retinol status, respectively. Increased food diversity through animal-source foods is required.