Global Nutrition (Oral Session 1)

(OR01-03-25) Effect of Multiple Micronutrient-Fortified Bouillon on the Anemia and Iron Status of Non-Pregnant, Non-Lactating Women of Reproductive Age in Northern Ghana

Saturday, May 31, 2025

10:24 AM – 10:36 AM ET

Location: S220 E-G

Presenting Author(s)

Seth Adu-Afarwuah, Ph.D. (he/him/his)

Head of Department of Nutrition and Food Science
University of Ghana
Accra, Greater Accra, Ghana

Disclosure information not submitted.

Co-Author(s)

SK

Sika M. Kumordzie, PhD

Postdoctoral Scholar
University of California, Davis
Kansas City, Missouri, United States
KW

K. R. Wessells

Institute for Global Nutrition, University of California, Davis
Davis, California, United States
CA

Charles D. Arnold, MS

Statistician
University of California, Davis
Davis, California, United States
XT

Xiuping Tan, BS

University of California, Davis
Davis, California, United States
AF

Ahmed D. Fuseini

University of Ghana, Legon
SV

Stephen A. Vosti, PhD

Adjunct Professor Emeritus
University of California, Davis
St Helena, California, United States
MH

Marjorie J. Haskell, MPH, PhD

Associate Research Nutritionist
University of California, Davis
Davis, California, United States
EB

Emily R. Becher, BS (she/her/hers)

PhD Candidate
University of California, Davis
Davis, California, United States
Jennie N. Davis, PhD, RDN (she/her/hers)

Postdoctoral Scholar
University of California, Davis
Bend, Oregon, United States
KA

Katherine P. Adams, PhD

Assistant Project Scientist
University of California, Davis
Davis, California, United States
Reina Engle-Stone, PhD

Associate Professor
University of California, Davis
Davis, California, United States

Objectives: This randomized, controlled, doubly-masked trial aimed to evaluate the impact of multiple micronutrient-fortified bouillon cubes on anemia and iron status among non-pregnant, non-lactating women of reproductive age (WRA) in the Kumbungu and Tolon districts in northern Ghana.

Methods: Women were recruited via a random walk-based search, underwent baseline assessments, and their households were assigned to rations of bouillon cubes containing either (1) vitamin A, folic acid, vitamin B12, iodine, iron, and zinc (Intervention group, IG), or (2) iodine only (Control, CG). The IG bouillon provided an expected iron dose of 10 mg/d (4 mg/g, 2.5 g/d intake). Study duration was 9 mo. The first endline data collection occurred at wk 35 and the second at wk 38. Venous blood measurements included hemoglobin (Hemocue 301), and plasma ferritin and soluble transferrin receptor, sTfR (ELISA). Ferritin was adjusted for inflammation. Outcomes were analyzed using generalized linear mixed models accounting for all 3 time points, with interaction terms to assess potential effect modifiers.

Results: IG (n = 388) and CG (n = 382) were balanced in mean age (34 y overall) and body mass index, BMI (22.5 kg/m²). Over the entire period, the intervention had no significant effect on any anemia (Hb < 12 g/dL), but was associated with a 42% reduction in the prevalence of moderate-to-severe (MTS) anemia (Hb < 11 g/dL; Prevalence Ratio (PR): 0.58, 95% CI: 0.36, 0.95; p = 0.029) and a potential reduction in any iron deficiency, ID (PR: 0.85, 95% CI: 0.71, 1.00; p = 0.054). No effects were found for low ( < 15 µg/L) ferritin, high ( > 8.3 mg/L) sTfR, low ( < 0 mg/kg) body iron stores, or iron deficiency anemia (IDA). Intervention effects were modified by several factors, with BMI category and household water insecurity being the most frequent effect modifiers across multiple outcomes.

Conclusions: Among WRA in this setting, fortified bouillon significantly reduced MTS anemia and showed potential for reducing ID, with effects most frequently observed in those with a normal BMI and household water insecurity.

Funding Sources: Bill & Melinda Gates Foundation, via Helen Keller Intl