title: Food fortification improves the intake of all fortified nutrients, but fails to meet the estimated dietary requirements for vitamins A and B6, riboflavin and zinc, in lactating South African women.
abstract: OBJECTIVE
  To investigate the impact of fortification by comparing food records and selected biochemical indicators of nutritional status pre- and post-fortification.
  
  
  METHODS
  Mean intake from 24 h recalls (n 142) was compared with the Estimated Average Requirement (EAR) to determine the proportion with inadequate intake. In a subsample (n 34), diet and serum retinol, folate, ferritin and Zn were compared pre- and post-fortification for fortified nutrients vitamin A, thiamin, riboflavin, niacin, folic acid, Fe and Zn.
  
  
  METHODS
  South Africa.
  
  
  METHODS
  Breast-feeding women (ninety-four HIV-infected, forty eight HIV-uninfected) measured at ~6, 14, 24 weeks, and 9 and 12 months postpartum.
  
  
  RESULTS
  Pre-fortification, >80 % of women did not meet the EAR for vitamins A, C, D, thiamin, riboflavin, niacin, B6, B12 and folate and minerals Zn, iodine and Ca. Dietary intake post-fortification increased for all fortified nutrients. In post-fortification food records, >70 % did not meet the EAR for Zn and vitamins A, riboflavin and B6. Serum folate and Zn increased significantly post-fortification (P < 0.001 for both), with no change in ferritin and a reduction in retinol. Post-fortification marginal/deficient folate status was reduced (73.5 % pre v. 3.0 % post; P < 0.001), as was Zn deficiency (26.5 % pre v. 5.9 % post; P < 0.05). Pre- and post-fortification, >93 % were retinol replete. There was no change in Fe deficiency (16.7 % pre v. 19.4 % post; P = 0.728).
  
  
  CONCLUSIONS
  Micronutrient intake improved with fortification, but >70 % of lactating women did not meet the EAR for Zn, vitamins A, riboflavin and B6. Although 100 % exceeded the EAR for Fe after fortification, Fe status did not improve.
authors.affiliation: Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA. ppapatha@calpoly.edu
authors.forename: Peggy C
authors.initials: PC
authors.lastname: Papathakis
authors.forename: Kerry E
authors.initials: KE
authors.lastname: Pearson
mesh_terms: D000328:Adult; D004034:Diet Surveys; D005260:Female; D005433:Flour; D005527:Food, Fortified; D006801:Humans; D007774:Lactation / Q000378:metabolism / Q000502:physiology*; D018977:Micronutrients / Q000008:administration & dosage* / Q000172:deficiency* / Q000378:metabolism; D009751:Nutritional Requirements; D009752:Nutritional Status; D009753:Nutritive Value; D017063:Outcome Assessment, Health Care; D012256:Riboflavin / Q000008:administration & dosage / Q000378:metabolism; D013019:South Africa / Q000453:epidemiology; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage / Q000378:metabolism; D025101:Vitamin B 6 / Q000008:administration & dosage / Q000378:metabolism; D055815:Young Adult; D015032:Zinc / Q000008:administration & dosage / Q000378:metabolism
chemical_list: D018977:Micronutrients; D014801:Vitamin A; D025101:Vitamin B 6; D015032:Zinc; D012256:Riboflavin