title: Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia.
abstract: OBJECTIVE
  To assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.
  
  
  METHODS
  Pre-post evaluation between two surveys.
  
  
  METHODS
  Twenty-four villages in West Java.
  
  
  METHODS
  Poor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baseline n 324/endline n 349), their infants aged 6-11 months (n 318/n 335) and children aged 12-59 months (n 469/477), and cohorts of children aged 5-9 years (n 186) and women aged 15-29 years (n 171), alongside food and oil consumption from dietary recall.
  
  
  RESULTS
  Fortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women, respectively. Serum retinol was 2-19 % higher at endline than baseline (P<0·001 in infants aged 6-11 months, children aged 5-9 years, lactating and non-lactating women; non-significant in children aged 12-23 months; P=0·057 in children aged 24-59 months). Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 μg/dl) was 6·5-18 % across groups at baseline, and 0·6-6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6-59 months (P=0·003) and 5-9 years (P=0·03).
  
  
  CONCLUSIONS
  Although this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.
authors.affiliation: 1National Institute for Health Research and Development (NIHRD),Ministry of Health,Republic of Indonesia,Jakarta,Indonesia.
authors.lastname: Sandjaja
authors.affiliation: 2Indonesian Nutrition Foundation for Food Fortification (formerly Koalisi Fortifikasi Indonesia),Jakarta,Indonesia.
authors.forename: Idrus
authors.initials: I
authors.lastname: Jus'at
authors.affiliation: 1National Institute for Health Research and Development (NIHRD),Ministry of Health,Republic of Indonesia,Jakarta,Indonesia.
authors.forename: Abas B
authors.initials: AB
authors.lastname: Jahari
authors.affiliation: 2Indonesian Nutrition Foundation for Food Fortification (formerly Koalisi Fortifikasi Indonesia),Jakarta,Indonesia.
authors.lastname: Ifrad
authors.affiliation: 5Center of Community Health and Population Studies,The Research Institute,Trisakti University,Jakarta,Indonesia.
authors.forename: Min Kyaw
authors.initials: MK
authors.lastname: Htet
authors.affiliation: 2Indonesian Nutrition Foundation for Food Fortification (formerly Koalisi Fortifikasi Indonesia),Jakarta,Indonesia.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Tilden
authors.affiliation: 6Savica Public Health Nutrition & Communication Consultancy,Surabaya,Indonesia.
authors.forename: Damayanti
authors.initials: D
authors.lastname: Soekarjo
authors.affiliation: 7University of Indonesia School of Public Health,Jakarta,Indonesia.
authors.forename: Budi
authors.initials: B
authors.lastname: Utomo
authors.affiliation: 8Global Alliance for Improved Nutrition,Singapore.
authors.forename: Regina
authors.initials: R
authors.lastname: Moench-Pfanner
authors.affiliation: 2Indonesian Nutrition Foundation for Food Fortification (formerly Koalisi Fortifikasi Indonesia),Jakarta,Indonesia.
authors.lastname: Soekirman
authors.affiliation: 9Global Alliance for Improved Nutrition,PO Box 55,1211 Geneva 20,Switzerland.
authors.forename: Eline L
authors.initials: EL
authors.lastname: Korenromp
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003296:Cooking; D003430:Cross-Sectional Studies; D004032:Diet; D004224:Diterpenes; D005260:Female; D005527:Food, Fortified; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D008297:Male; D008895:Milk, Human / Q000378:metabolism; D009752:Nutritional Status; D000073878:Palm Oil; D010938:Plant Oils; D011203:Poverty; D015995:Prevalence; D015397:Program Evaluation; D000084562:Retinyl Esters; D014801:Vitamin A / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D014802:Vitamin A Deficiency / Q000453:epidemiology / Q000378:metabolism / Q000517:prevention & control*; D014815:Vitamins / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D004224:Diterpenes; D010938:Plant Oils; D000084562:Retinyl Esters; D014815:Vitamins; D014801:Vitamin A; C014794:retinol palmitate; D000073878:Palm Oil
keywords: Children; Food fortification; Impact evaluation; Mothers; Vitamin A