(P07-023-25) The Positive Impact of Mandatory Food Fortification: A Population-Stratified Analysis of Change in Health Status

Objectives: The Global Fortification Data Exchange collates and visualizes effectiveness data (i.e. from surveys and program evaluations) on change in health status after the initiation of mandatory food fortification. To date, data have been reviewed and uploaded for 88 countries, 5 food vehicles, and 6 nutrients. The purpose of the current study is to analyze these data by health outcome and population group to determine whether health status has changed and where gaps in the data remain.

Methods: We used descriptive statistics to summarize the availability of health impact data by health outcome and population group, determine the range in pre- and post-fortification values for health outcomes, and estimate the proportion of results which represent a positive health change after mandatory fortification.

Results: The availability of data was greatest for three health outcomes by population group: median urinary iodine concentration (MUIC) in school-aged children (SAC) (79 results in 79 countries); prevalence of neural tube defects (NTDs) related to folate fortification (39 results in 11 countries), and; change in plasma or serum folate in women of reproductive age (WRA) (10 results in 8 countries). For all other health outcomes and population groups, there were fewer than 10 results. The range in MUIC in SAC pre- and post- fortification was 11-321 and 46-464 μg/L, respectively. The range in prevalence of NTDs pre- and post-fortification was 2.3-97.0 and 1.4-63.0 per 10,000 births, respectively. The range in plasma or serum folate in WRA pre- and post-fortification was 3.6-18.0 and 9.7-46.9 nmol/L, respectively. The proportion of results representing a positive health change was: 69 of 79 for MUIC in SAC (87%); 31 of 39 for NTDs (80%); 8 of 10 for plasma or serum folate in WRA (80%).

Conclusions: Where data are available, they suggest that change in health status after mandatory fortification is largely positive across health outcomes and population groups. For certain groups (e.g. older adults and pregnant women) and nutrients (e.g. vitamin A and zinc), understanding of the health impact of food fortification remains limited.

Funding Sources: Bill and Melinda Gates Foundation (opportunity INV-058758)