Consumption of fortified wheat flour and associations with anemia and low serum ferritin in Colombia.

Amy Fothergill, Zulma Y. Fonesca Centeno, Paul R Ocampo Téllez, Helena Pachón


The association was examined between consumption of fortified wheat flour during mandatory wheat flour fortification in Colombia, and two outcomes: low serum ferritin (LSF) and anemia prevalence. A secondary analysis of the 2005 national nutrition survey (ENSIN) was completed for 3988 children 2-4 y, 5669 children 5-12 y and 2053 non-pregnant women 13-49 y. The relationship between consumption (quartiles) of wheat flour containing food (WFCF) and low serum ferritin and anemia was examined using chi-square analyses and logistic regression models. In unadjusted analyses, the prevalence of LSF was similar across all quartiles of WFCF consumption in all age groups. The highest prevalence of anemia was observed in the lowest WFCF consumption quartiles in all age groups (e.g. 31.3% versus 23.0% anemia in lowest versus highest WFCF intake quartile, in children 2-4 y), but was not significantly different in non-pregnant women 13-49 y. In adjusted models controlling for socioeconomic status, animal source food, and supplement intake in the previous 24 h, this relationship between WFCF and anemia remained for children 2-4 y when comparing the highest WFCF intake quartile with the lowest quartile (OR: 0.7, 95% CI: 0.6, 0.9). No association between WFCF and LSF was observed in adjusted (or unadjusted) models. In Colombia, consumption of wheat flour containing foods is associated with lower levels of anemia in pre-school children.

Palabras clave

ferritin, hemoglobin, fortification, wheat flour, enrichment, effectiveness, evaluation

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Food Fortification Initiative. Global Progress of Industrially Milled Cereal Grains [Internet]. [cited 2018 Oct 5]. Available from:

Pachón H, Spohrer R, Mei Z, Serdula MK. Evidence of the effectiveness of flour fortification programs on iron status and anemia: a systematic review. [cited 2018 Oct 28]; Available from:

World Health Organization (WHO). Recommendations on Wheat and Maize Flour Fortification Meeting Report:Interim Consensus Statement. 2009;

Forero de Saade T PE. Decreto Número 1994 de 1996 (Octubre 28). [Internet]. 1996 [cited 2015 Jan 25]. Available from:

Hurrell R, Ranum P, De Pee S, Biebinger R, Hulthen L, Johnson Q, et al. Revised recommendations for iron fortification of wheat flour and an evaluation of the expected impact of Current national wheat flour fortification programs. Vol. 31, Food and Nutrition Bulletin. 2010. 1990-2006 p.

Hurrell RF. Flour fortification as a strategy to prevent anaemia. Br J Nutr [Internet]. 2015 Aug 22 [cited 2018 Oct 28];114(04):501–2. Available from:

Instituto Nacional de Vigilancia de Medicamentos y Alimentos INVIMA. Procedimiento Para Importacion de Productos Cuyo Ingrediente Principal es la Harina de Trigo [Internet]. 2013 [cited 2018 Oct 28]. Available from:

De Colombia R. COLOMBIA Asociación Probienestar de la Familia Colombiana Profamilia SALUD SEXUAL Y REPRODUCTIVA Resultados Encuesta Nacional de Demografía y Salud 2005 Entidades financiadoras: Ministerio de la Protección Social. 2005; Available from:

Instituto Colombiano de Bienestar Familiar, Profamilia, Instituto Nacional de Salud, Universidad de Antioquia, Pan American Health Organization (PAHO). Encuesta Nacional de la Situación Nutricional en Colombia, 2005 [Internet]. Bogota: Instituto Colombiano de Bienestar Familiar (Colombian Institute of Family Wellbeing); 2005 [cited 2018 Oct 28]. Available from:

Kraemer K, Zimmermann MB. SIGHT AND LIFE Press Nutritional Anemia [Internet]. [cited 2018 Oct 28]. Available from:

Dirren H, Logman MH, Barclay D V, Freire WB. Altitude correction for hemoglobin. Eur J Clin Nutr [Internet]. 1994 Sep [cited 2018 Oct 28];48(9):625–32. Available from:

Rothman KJ, Greenland S, Lash T. Modern Epidemiology. Lippincott Williams & Williams. 2005. 896 p.

Vélez CE, Castaño E, Deutsch R. An Economic Interpretation of Colombia’s SISBEN: A Composite Welfare Index Derived from the Optimal Scaling Algorithm An Economic Interpretation of Colombia’s SISBEN : A Composite Household Welfare Index Derived from the Optimal Scaling Algorithm [Internet]. 1998 [cited 2018 Oct 28]. Available from:

Tazhibayev S, Dolmatova O, Ganiyeva G, Khairov K, Ospanova F, Oyunchimeg D, et al. Evaluation of the potential effectiveness of wheat flour and salt fortification programs in five Central Asian countries and Mongolia. Food Nutr Bull [Internet]. 2002 [cited 2018 Oct 28];29(4):255–65. Available from:

Assunção MC, Santos IS, Barros AJ, Gigante DP, Victora CG. Flour fortification with iron has no impact on anaemia in urban Brazilian children. Public Health Nutr [Internet]. 2012 Oct 15 [cited 2018 Oct 28];15(10):1796–801. Available from:

Sadighi J, Mohammad K, Sheikholeslam R, Amirkhani MA, Torabi P, Salehi F, et al. Anaemia control: Lessons from the flour fortification programme. Public Health [Internet]. 2009 Dec 1 [cited 2018 Oct 28];123(12):794–9. Available from:

Grimm K, Sullivan K, Alasfoor D, Parvanta I, Mohammed Suleiman AJ, Kaur M, et al. Iron-fortified wheat flour and iron deficiency among women. Food Nutr Bull [Internet]. 2012 [cited 2018 Oct 28];33(3):180–5. Available from:

Martorell R, Ascencio M, Tacsan L, Alfaro T, Young MF, Addo OY, et al. Effectiveness Evaluation of the food fortification program of Costa Rica: impact on anemica prevalence and hemoglobin concentrations in women and children. Am J Clin Nutr [Internet]. 2015;5(4):e67860.Available from: to ISI%3E://FSTA:2013-12-Mg3873%5Cn

Layrisse M, Garcia-Casal MN, Mendez-Castellano H, Jimenez M, Olavarria C. H, Chavez J, et al. Impact of fortification of flours with iron to reduce the prevalence of anemia and iron deficiency among schoolchildren in Caracas, Venezuela: A follow-up. Food Nutr Bull [Internet]. 2002 [cited 2018 Oct 28];23(4):384–9. Available from:

Northrop-Clewes C, Hund L, Valadez J et al. LC-LQAS Survey Report: Ministry of Health, Uzbekistan. National Flour Fortification Program. In Tashkent, Uzbekistan; 2013.

Schultz J, Vatucawaqa P. Impact of Iron Fortified Flour in Child Bearing Age (CBA) Women in Fiji [Internet]. 2012 [cited 2018 Oct 28]. Available from:

Lofti M, Mannar M, Merx R, Naber-van den Heuvel P. Micronutrient Fortification of Foods. Curr Pract Res Oppor. 1996;The Micronutrient Initiative.

Andrew A, Attanasio O, Fitzsimons E, Rubio-Codina M. Why is multiple micronutrient powder ineffective at reducing anaemia among 12–24 month olds in Colombia? Evidence from a randomised controlled trial. SSM - Popul Heal [Internet]. 2016 Dec 1 [cited 2018 Oct 28];2:95–104. Available from:

VMNIS (WHO). Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity [Internet]. 2011 [cited 2018 Oct 28]. Available from:

VMNIS (WHO). Serum ferritin concentrations for assessment of iron status and iron deficiency in populations [Internet]. 2011 [cited 2018 Oct 28]. Available from:

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