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The Importance of Using Food and Nutrient Intake Data to Identify Appropriate Vehicles and Estimate Potential Benefits of Food Fortification in Uganda

Kyamuhangire, William, Lubowa, Abdelrahman, Kaaya, Archileo, Kikafunda, Joyce, Harvey, Philip W. J., Rambeloson, Zo, Dary, Omar, Dror, Daphna K., Allen, Lindsay H.
Tolerable Upper Intake Level, calcium, children, corn flour, folic acid, food fortification, food intake, iron, models, niacin, nutrient intake, nutrients, nutrition risk assessment, riboflavin, sugars, thiamin, variance, vegetable oil, vitamin A, vitamin B12, wheat flour, women, zinc, Uganda
Concern over micronutrient inadequacies in Uganda has prompted the introduction of mass fortification. To use food intake to determine nutrient inadequacies in children aged 24 to 59 months and nonpregnant women of reproductive age, and to model the adequacy of mass fortification. Data were collected by the 24-hour recall method in three regions. Usual nutrient intakes were calculated by adjusting actual intake distribution for the intraindividual variance. The impact of fortification on intake adequacy was simulated. The nutrients with the highest prevalence of inadequate intake across regions were vitamin A (30% to 99%), vitamin B₁₂ (32% to 100%), iron (55% to 89%), zinc (18% to 82%), and calcium (84% to 100%). According to simulations, fortification of vegetable oil and sugar with vitamin A would reduce the prevalence of vitamin A inadequacy in the Western and Northern regions; in Kampala it would eliminate vitamin A inadequacy but would cause 2% to 48% of children to exceed the Tolerable Upper Intake Level (UL). The proposed fortification of wheat flour would reduce the prevalence of inadequate intakes of thiamine, riboflavin, folate, and niacin in Kampala, but would have little impact in the other two regions due to low flour consumption. Micronutrient fortification of vegetable oil and sugar in all regions and of wheat flour in Kampala would reduce the prevalence of micronutrient inadequacies. However, the wheat flour formulation should be modified to better meet requirements, and the vitamin A content in sugar should be reduced to minimize the risk of high intakes. Maize flour may be suitable for targeted fortification, but prior consolidation of the industry would be required for maize flour to become a good vehicle for mass fortification.