Predicted Impact of Large-scale Fortification on Adequacy of Vitamin A Intakes among Women and Young Children in Cameroon: Simulations Using Nationally-representative 24-h Recall Data

Abstract

Objectives: WHO recommends using information on dietary intakes to design food fortification programs, but nationally-representative, individual dietary data are rarely available in low-income countries. Prior to initiating a fortification program in Cameroon, we assessed intakes of vitamin A (VA) and fortifiable foods (vegetable oil, sugar, wheat flour, and bouillon cube), to simulate the effects of fortification with different foods and VA levels on VA intakes. Methods: In a nationally-representative, cluster survey with 3 strata (North, South, Cities), we conducted 24-h dietary recalls among 912 women 15-49 y and 883 children 12-59 mo (with duplicates in a subset). Results: Among women, 50% had usual VA intakes < 500 μg RAE/d (17% South, 99% North, 44% Cities); 58% of non-breastfeeding children had VA intake < 210 μg RAE/d (41% South, 86% North, 60% Cities). Oil fortification with 12 mg VA/kg, as currently mandated, would decrease the prevalence of inadequate intakes to 33% among women and 34% among children (73% and 55% in the North region, where VA deficiency is most common). Increasing the VA in oil or fortifying a second food would further decrease the prevalence of inadequate intakes, but would also increase the prevalence of retinol intakes above the UL, mainly among children. Conclusions: The current food fortification program can be expected to improve dietary VA adequacy among women and children in Cameroon. Modifications to the program must balance the potential to further increase VA intakes with the risk of retinol intake above the UL among children.