Examination of vitamin A supplementation and fortification

We examined potential interventions to address vitamin A, iron and zinc gaps in countries with apparent intake deficits relative to requirements. First, the number of vitamin A supplementation capsules required to prevent vitamin A deficiency in children 6-59 months (C6-59) was calculated. The number of children from deficit countries ages 6-11 months, 1-3 years, and 4 years of age were tabulated and their total annual requirements were calculated. Vitamin A supplementation protocol specifies that infants 6-11 months receive one 100K IU (30,000 mcg) capsule annually while children 1-4 years receive two 200K IU (60,000 mcg) capsules annually⁴⁰. The number of supplements required was then calculated, first by dividing the total annual requirements among infants 6-11 mo and children 1-4 years by the number of micrograms of vitamin A supplied in 100K IU and 200K IU capsules, respectively, and second by calculating the number of capsules needed based on the delivery protocol.

Next, the quantity of fortified wheat flour required to fill apparent dietary intake gaps of vitamin A, bioavailable iron (calculated using the Rickard 2009 algorithm) and bioavailable zinc were calculated. For each nutrient separately, among deficit countries, annual deficits were calculated. Next, the quantity of fortified wheat flour expressed in 1000 metric tons (MT) required to fill each gap was determined based on the following fortificants: 3mg/kg retinol for vitamin A; 35 mg/kg sodium-iron EDTA for iron; and 30 mg/kg zinc oxide for zinc. The bioavailability of sodium iron EDTA was assumed to be 10%¹⁰⁹ while the bioavailability of zinc oxide was assumed to be 30% based on differences between EFSA ARs and physiological requirements for zinc¹¹⁰ The resulting values were expressed as percentages of aggregate wheat flour supplies across the deficit countries.