title: Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data.
abstract: OBJECTIVE
  To utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula.
  
  
  METHODS
  Quantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour.
  
  
  METHODS
  Households in Gaza City and Hebron that were not receiving food aid from social programmes.
  
  
  METHODS
  Non-pregnant women (18-49 years) and children aged 36-83 months.
  
  
  RESULTS
  The micronutrients with highest prevalence of insufficiency were vitamin D in women (84-97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43-82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated.
  
  
  CONCLUSIONS
  Micronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.
authors.affiliation: 1Nutrition and Health Research Institute,Al-Quds University,Jerusalem,Israel.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Abdeen
authors.affiliation: 2Ministry of Health,Palestinian Authority,Ramallah,West Bank,Palestinian Territories.
authors.forename: Asa'd
authors.initials: A
authors.lastname: Ramlawi
authors.affiliation: 1Nutrition and Health Research Institute,Al-Quds University,Jerusalem,Israel.
authors.forename: Radwan
authors.initials: R
authors.lastname: Qaswari
authors.affiliation: 2Ministry of Health,Palestinian Authority,Ramallah,West Bank,Palestinian Territories.
authors.forename: Ala' Abu
authors.initials: AA
authors.lastname: Alrub
authors.affiliation: 3A2Z/The USAID Project on Micronutrients and Child Blindness,FHI-360,Washington DC,USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Dary
authors.affiliation: 3A2Z/The USAID Project on Micronutrients and Child Blindness,FHI-360,Washington DC,USA.
authors.forename: Zo
authors.initials: Z
authors.lastname: Rambeloson
authors.affiliation: 4USDA,ARS Western Human Nutrition Research Center,Davis,CA,USA.
authors.forename: Setareh
authors.initials: S
authors.lastname: Shahab-Ferdows
authors.affiliation: 4USDA,ARS Western Human Nutrition Research Center,Davis,CA,USA.
authors.forename: Daphna
authors.initials: D
authors.lastname: Dror
authors.affiliation: 4USDA,ARS Western Human Nutrition Research Center,Davis,CA,USA.
authors.forename: Lindsay H
authors.initials: LH
authors.lastname: Allen
authors.affiliation: 5Department of Statistics,Iowa State University,Ames,IA,USA.
authors.forename: Alicia
authors.initials: A
authors.lastname: Carriquiry
authors.affiliation: 3A2Z/The USAID Project on Micronutrients and Child Blindness,FHI-360,Washington DC,USA.
authors.forename: Rand
authors.initials: R
authors.lastname: Salman
authors.affiliation: 1Nutrition and Health Research Institute,Al-Quds University,Jerusalem,Israel.
authors.forename: Sahar
authors.initials: S
authors.lastname: Dkeidek
mesh_terms: D000293:Adolescent; D000328:Adult; D018912:Arabs; D002648:Child; D002675:Child, Preschool; D004032:Diet; D005215:Fasting; D005260:Female; D005433:Flour / Q000032:analysis*; D005492:Folic Acid / Q000008:administration & dosage / Q000097:blood; D063105:Food Assistance; D005527:Food, Fortified / Q000032:analysis*; D006801:Humans; D019266:Iron, Dietary / Q000008:administration & dosage / Q000097:blood; D008297:Male; D018977:Micronutrients / Q000097:blood / Q000172:deficiency; D008875:Middle Aged; D011795:Surveys and Questionnaires; D014908:Triticum / Q000737:chemistry*; D014801:Vitamin A / Q000008:administration & dosage / Q000097:blood; D014802:Vitamin A Deficiency / Q000097:blood; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000097:blood; D014806:Vitamin B 12 Deficiency / Q000097:blood; D014807:Vitamin D / Q000008:administration & dosage / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood; D035862:Vulnerable Populations; D055815:Young Adult; D015032:Zinc / Q000008:administration & dosage / Q000097:blood
chemical_list: D019266:Iron, Dietary; D018977:Micronutrients; D014801:Vitamin A; D014807:Vitamin D; D005492:Folic Acid; D015032:Zinc; D014805:Vitamin B 12
keywords: Palestinian Authority