NUTRITION HEALTH EDUCATION AND COMMUNICATION

SUBMITTED TO: DR. WAHAB ALI KHAN

SUBMITTED BY: AYESHA ISHTIAQ

BS HUMAN NUTRITION AND DIETETICS

SESSION: 2021-2025

4th SEMESTER/SECTION B

ROLL NO: (033)M

SECTION B

DEPARTMENT OF NUTRITION AND HEALTH PROMOTION

UNIVERSITY OF HOME ECONOMICS, LAHORE

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 TABLE OF CONTENT

Topics Page no

Abstract 3
Introduction 4
Background influence 5

Methodology 6
Plans for dissemination 7
Ethical consideration 8
Results and discussion 9

Conclusion and 11
recommendation
References 12

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ABSTRACT:
Growth and metabolism are dependent on vitamins and minerals. According to
World Health Organization (WHO) that multiple billion individuals are lacking in
key nutrients and minerals, especially vitamin A, iodine, iron and zinc. i The
majority of these people are from developing nations with multiple micronutrient
(MMN) deficiencies.
Due to their increased demands, pregnant and lactating women and young children
are the population groups most at risk for these micronutrient deficiencies ii.As per
ongoing WHO gauges, universally around 190 million preschool kids and 19.1
million pregnant ladies are vitamin A insufficient (that is, have serum retinol <0.70
μmol/l), roughly 100 million ladies of regenerative age (WRA) have iodine
inadequacy, and an expected 82% of pregnant ladies overall have deficient zinc
admissions to meet the typical necessities of pregnancy.iii Lack of iron is boundless
and worldwide around 1.62 billion individuals are frail, with the most noteworthy
pervasiveness among preschool youngsters (47%) trailed by pregnant ladies
(42%).iv Poor vitamin B6 and B12 status have additionally been seen in many non-
industrial nations. These micronutrient lacks are likewise connected with expanded
occurrence and seriousness of irresistible sickness and mortality from the runs,
measles, jungle fever and pneumonia. The results of micronutrient lacks are not
restricted to wellbeing boundaries alone yet have sweeping consequences for
economies through optional physical and mental handicaps and adjusted work
efficiency.

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 MICRONUTRIENTS FORTIFICATION OF FOOD AND IT’S
IMPACT ON WOMAN AND CHILD HEALTH

INTRODUCTION:
A few techniques have been utilized to enhance micronutrients to ladies and kids. These
incorporate instruction, dietary alteration, food apportioning, supplementation and stronghold.
One of the methods for preventing micronutrient deficiencies that has been used safely and
effectively for well over a century in developed nations is food fortification. In the mid twentieth
hundred years, salt iodization started in Switzerland; vitamin A-strengthened margarine was
presented in Denmark in 1918; Additionally, vitamin A-fortified milk and Iron-B complex flour
were introduced in several developed nations in the 1930s. v These stronghold systems are
presently practically widespread in the created world and progressively sent in many center pay
nations. Generally, not many of these projects have been sufficiently assessed to survey their
effect on populace wellbeing.
WHO arranges food fortification methodologies into three potential methodologies: targeted,
mass, and driven by the market. Wheat, salt, and sugar, among other widely consumed foods, are
examples of mass fortification; designated approaches invigorate food sources ate by
unambiguous age bunches like baby integral food sources; what’s more, the market-driven
approach is the point at which a food maker braces a particular brand for a specific buyer
specialty. Food vehicles normally utilized can be assembled into three general classes: staples
(wheat, rice, oils), fixings (salt, soy sauce, sugar), and handled business food sources (noodles,
baby correlative food varieties, dairy items).
Food fortification is an alluring general wellbeing technique and enjoys the benefit of coming to
more extensive in danger populace bunches through existing food conveyance frameworks,
without requiring significant changes in existing utilization designs. Food fortification may be

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less expensive than other interventions and has the advantage of maintaining stable body stores if
consumed frequently.
The impact of food fortification on health outcomes has been the subject of numerous systemic
reviews and meta-analyses. A broad survey of zinc fortification in kids portrayed a by and large
critical effect on serum zinc levels with no unfriendly impacts. Surveys on multi-
micronutrients(MMN) stronghold in kids showed further developed micronutrient status and
diminished weakness commonness. A review of iron supplementation in the general population
also revealed a decrease in the prevalence of anemia and an increase in serum hemoglobin
levels . Albeit iron, zinc and MMN stronghold has been reliably examined, writing on vitamin A,
iodine and vitamin D fortification in youngsters has not been adequately surveyed. Besides, iron
and MMN fortification in ladies of various age bunches has not been sufficiently assessed. We
subsequently feel that the ongoing proof of specific micronutrients and populace gatherings may
not be adequate for giving a way forward. Subsequently we embraced an efficient survey of the
ongoing proof to evaluate the viability of food fortification with single micronutrients (iron, folic
corrosive, vitamin A, vitamin D, iodine, zinc) as well as MMN when contrasted and no
stronghold on the wellbeing and sustenance of ladies and kids

BACKGROUND INFLUENCE:
In the 1920s, micronutrients food fortification emerged as a strategy in the United States to
address and prevent the lack of micronutrients in the population's diet. Specifically, it was
discovered in the 1930s and 1940s, that micronutrient deficiency is often linked to specific
diseases and syndromes. Food fortification programs have been conducted in several countries to
overcome micronutrient deficiency and related problems with various degrees of effectiveness.
Available information regarding the success of food fortification programs in some developing
countries, including Indonesia, is still limited. Thus, this study conducts a systematic review of
the effects of food fortification of mothers and children using biochemical and anthropometric
measures focusing on linear growth. Three databases were used in the literature search, namely
PubMed, Science Direct and Google Scholar. Fifteen articles were included for analysis from
517 studies found consisting of Indonesian and English articles published from 2000 to June
2020. Fortification of iron, vitamin A, and iodine can increase the level of hemoglobin, serum
ferritin, and serum retinol and median urine iodine excretion, especially in toddlers and

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schoolchildren. However, multinutrient fortification interventions were associated with various
effects on hemoglobin, serum ferritin, and serum retinol but a positive association was found
with linear growth indicators in the form of body length for age. The effectiveness of food
fortification in reducing the prevalence of stunting still needs more and stronger evidence
through studies with large sample size and longer duration.
EPIDEMIOLOGY:
Approximately, 149 million children under 5 years were stunted in 2020, with 45 million to be
wasted and underweight children are 85 million. 1 in ten women (11%) is underweight or
malnourished.
METHODOLOGY:
A comprehensive search was done to identify all available evidence for the impact of
fortification interventions. Studies were included if food was fortified with a single, dual or
multiple micronutrients and impact of fortification was analyzed on the health outcomes and
relevant biochemical indicators of women and children. We performed a meta-analysis of
outcomes using Review Manager.
Conceptual framework
We analyzed the impact of micronutrient fortification strategies – single, dual or multiple – on
various outcomes guided by our conceptual framework. These micronutrients were administered
through one of the three food vehicles (staples, condiments or processed foods) to reach the
population targeted. For the scope of this review, we focused on a priori defined population
groups of infants, children and adolescents under 18 years of age, WRA and post-menopausal
women. The outcomes analyzed were broadly categorized into biochemical indicators,
hematologic markers, anthropometric indicators, pregnancy outcomes, and relevant morbidity
and mortality.
Search strategy
All available evidence for the impact of fortification interventions was systematically retrieved
and analyzed. A comprehensive search was done for key words including Medical Subject
Headings and free text terms for all the micronutrients included in this review. We searched
MEDLINE, PubMed, POPLINE, Literatura Latino Americana em Ciências da Saúde,
Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, British Library for
Development Studies at the International Development Statistics, WHO regional databases and

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the IDEAS database of unpublished working papers, Google and Google Scholar. Detailed
manual searches were undertaken, including cross-references and bibliographies of available
data and publications. Existing relevant reviews were used to identify additional sources of
information. The search was extended to review the gray literature in non-indexed and non-
electronic sources. The bibliographies of books with relevant sections were also searched
manually to identify relevant reports and publications. We did not apply any language or date
restriction and the date of last search was 1 November 2012.
Inclusion and exclusion criteria
It included randomized controlled preliminaries (RCTs), semi exploratory and before-after
investigations. In order to comprehend the context in which these interventions were
implemented, other less rigorous study designs, such as observational studies (cohort and case–
control), program evaluations, and descriptive studies, were also examined. Studies were
incorporated in the event that food was sustained with a solitary, double or various
micronutrients and the effect of stronghold was broke down on the wellbeing results and
important biochemical signs of ladies and kids. Studies were not viewed as that zeroed in on
home fortification with micronutrient powders, food contents, admission levels, bioavailability,
correlations between various food vehicles or examinations among mixtures of similar
micronutrient, correlations among stronghold and supplementation, bio-fortification and studies
assessing the tactile effects of fortification.
Study selection process
All the available studies underwent triage with standardized criteria for evaluating outputs from
primary screening. Following an agreement on the search strategy, the abstracts and full texts
were screened by two independent abstractors to identify studies adhering to the objectives. Any
disagreements on selection of studies between the two primary abstractors were resolved by the
third reviewer.
Data extraction
After retrieval of the full texts of all the relevant studies, each study was double data abstracted
into a standardized form, which included the general information, intervention fortification etc.
Key outcome measures
Result measures were recognized and assessed independently for the different micronutrients.
Pertinent biochemical pointers included serum micronutrient levels and hematologic markers

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(sickliness, iron inadequacy frailty, hemoglobin). Steadiness was indicated by anthropometrics;
wasting; underweight; what’s more, changes in Z-scores for level for age (HAZ), weight for age
(WAZ) and weight for level (WHZ). Pregnancy results included twinning and inherent
irregularities. Dreariness results included looseness of the bowels, pneumonia, intestinal
sickness, urinary lot contaminations (UTI), fever and mortality. These were accounted for as
means, standard deviations, number of occasions or other usable results that could be pooled.
Where data was absent or deficient, the creators were reached for explanation and admittance to
information. In situations where it was impractical, the result was not considered for additional
examination
STATISTICAL ANALYSIS:
It performed meta-examinations of all results using Review Chief Programming variation .. For
dichotomous data, we presented results as once-over risk extent and chances extent (OR) and
their individual 95% sureness extends (CI). When the results were nearly identical, we used the
standard mean difference to ensure consistent data. To keep up with the nature of the proof, we
directed separate meta-examinations for RCTs or semi trial studies and before-after
investigations. Provided that there were no RCTs or semi trial concentrates on in a specific
classification of micronutrient fortress were the when meta-examinations’ discoveries detailed.
The whole bunch was utilized as the unit of randomization for group randomized preliminary
information investigation and pooling, and the plan of the examination was changed. The data of
gathering randomized fundamentals were solidified including a nonexclusive in reverse contrast
strategy in which logarithms of RR measures were used close by the standard mix-up of the
logarithms of RR checks. Subgroup assessments were performed by the different age get-
togethers, countries, people ascribes, kind of food supported and the term of intervention. In the
cases where only medians were taken into account, medians were completely transformed into
estimated of the means and then pooled for analysis.

The level of consistent misfortune was noted for each audit and its impact on the overall
evaluation of treatment influence researched by using mindfulness assessment. Heterogeneity
between starters was studied using the I-squared estimation (I2 >30) and a p-regard <0.1 (on chi-
square) and by visual survey of woods plots, and an erratic effect model was used.

PLANS FOR DISSEMINATION:

 By distributing pamphlets among general public especially among the people in hospitals
including patients and their attendants.
 Through midwives or obs staff explaining it to the mothers.
 By distributing handouts in other public areas like shopping malls Via ads on TV.

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  By conducting seminars, workshops and by media help.
Strategies to improve micronutrients fortification:
Several strategies have been employed to improve micronutrients fortification..These include
 Nutritional counseling to individuals designed to promote healthy food practices,
provision of fortified foods and supplementation with foods either fortified with multiple
micronutrients or with increased energy content.
 Dual or multiple food fortification.
ETHICAL CONSIDERATION:
Ethical considerations in research are a set of principles that guide your research designs and
practices. These principles include
 Voluntary participation
 Informed consent
 Anonymity
 Confidentiality
 Potential for harm
 Results communication
We should ethically recruit subjects for our study, obtain informed consent, minimize any risks,
be transparent throughout the study, always protect the anonymity and confidentiality of subjects
and data.
MISCONDUCTS:
(a) Fabrication - making up data or results and recording or reporting them.
(b) Falsification - manipulating research materials, or changing or omitting data or results such
that the research is not accurately represented in the research record.
(c) Plagiarism - the appropriation of another person's ideas, processes, results, or words without
giving appropriate credit
RESULTS AND DISCUSSION:
The orderly audit recognized 201 investigations that we assessed for results of significance.
Stronghold for youngsters showed critical effects on expanding serum micronutrient fixations. vi
Hemoglobin concentrations, one of the hematologic markers, showed a significant rise when
food was fortified with vitamin A, iron, and a variety of micronutrients. Stronghold with zinc

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antagonistically affected hemoglobin levels.vii Numerous micronutrient stronghold showed non-
huge effects on level for age, weight for age and weight for level Z-scores, despite the fact that
they showed positive patterns. The outcomes for stronghold in ladies showed that calcium and
vitamin D fortress had critical effects in the post-menopausal age bunch. Iron stronghold
prompted a huge expansion in serum ferritin and hemoglobin levels in ladies of regenerative age
and pregnant ladies. Folate fortification fundamentally decreased the occurrence of innate
irregularities like brain tube surrenders without expanding the rate of twinning. The quantity of
investigations pooled for zinc and various micronutrients for ladies were not many, however the
proof recommended benefit. There was a shortage of proof for the effect of stronghold
techniques on bleakness and mortality results in ladies and youngsters.
 Micronutrients Fortification recommendations for children

Zinc is accessible in supplements containing just zinc; supplements containing zinc in mix with
different fixings; what’s more, in numerous multivitamin/multimineral items . Enhancements can
contain any of various types of zinc, including zinc sulfate, zinc acetic acid derivation, and zinc
gluconate. Wellsprings of zinc sustained food sources like green vegetables: for example
spinach, watercress, wavy kale, broccoli, spring greens, sprinter beans and expansive beans. Iron
fortress affects great soundness of kids. Invigorated Breakfast grains: Examples include
Weetabix, Readybrek, Cheerios, and Shreddies (look for iron-fortified products on the label).
Fruit, Dried: sultanas, currants, dates, apricots, figs, prunes, raisins, and so on Vitamin D aids in
the absorption of calcium, an essential component of healthy bones. Not at all like with vitamin
D, kids as a rule can get sufficient calcium from food. High-calcium food sources incorporate
milk, cheddar, and yogurt. Food creators frequently strengthen food varieties like grain, bread, or
squeeze with calcium. Vitamin A sustained corresponding food with 500 mg RE/100 g of dry
item given day to day in a solitary proportion of 40 g would meet half of the hole for weaned
newborn children matured 6-11 mo and would raise the all out consumption above RDI for
bosom took care of babies matured 6-8 mo (125%) and 9-11 mo (127%).Many breakfast oats,
juices, dairy items, and different food sources are braced with retinol (preformed vitamin A).
Beta-carotene, lycopene, lutein, and zeaxanthin are found In a lot of fruits and vegetables, as
well as in some supplements. Eating iodine-containing food varieties is an extraordinary method
for ensuring you and your kid are getting sufficient iodine in your eating routine.

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One of the many public health interventions aimed at reducing children’s stunted growth and
development and micronutrient malnutrition is fortification. Fortress alludes to the purposeful
expansion of supplements to food to fulfill the need of expanded consumption necessities of a
designated populace. Fortification often focuses on restoring nutrients that are lost during
processing, improving nutrients that are lost during processing, increasing the nutrient levels of
food vehicles with less than necessary content, and adding nutrients that are typically not found
in food to some commonly consumed food vehicles to increase intake of that particular nutrient.
It is well known in science that nutrients and minerals assume a significant part in metabolic
cycles and are exceptionally basic in macronutrient digestion. As a result, the hidden role in
growth cannot be denied.

 Micronutrients fortification for women

Wom should get this measure of folic acid something like one month prior to becoming pregnant
to assist with forestalling NTDs. Women can get folic acid in these ways: Every day, take a
vitamin that contains 400 mcg of folic acid. Folic corrosive is a type of folate that can be added
to food varieties during the assembling system. Food sources that are sustained with folic
corrosive include: improved breads, flours, pastas, rice, and cornmeal; sustained corn masa flour
(used to make corn tortillas and tamales, for instance); furthermore, certain sustained breakfast.
Iodine calcium, vitamin D and iron stronghold with food is fundamental for good wellbeing.
Double or different fortress with food likewise completes in diet.
CONCLUSION

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Despite its potential, fortification is not a solution to the widespread nutritional deficiencies that
exist worldwide. With high weights of loose bowels and enteropathy, inescapable malabsorption
might be a boundary to this system producing maximal results. Joining of stronghold and
supplementation systems along with other mother and kid wellbeing and anticipation projects
might be the solution to address the far and wide worldwide under-nourishment and to guarantee
practical advantages. Local area schooling and advancement missions ought to likewise be
executed lined up with the essential fortress projects to build mindfulness, worthiness and value.
Stronghold is possibly a compelling methodology yet proof from the creating scene is scant and
future projects additionally need to evaluate the immediate effect of fortress on dismalness and
mortality.
REFERENCES
https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/2046-4053-2-67

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i
WHO: World Health Report. 2000, Geneva: World Health Organization
ii
Black RE: Micronutrients in pregnancy. Br J Nutr. 2001, 85 (S2): S193-S197.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, Mathers C, Rivera J: Maternal and child undernutrition:
global and regional exposures and health consequences. Lancet. 2008, 371 (9608): 243-260.

iii
Caulfield LE, Zavaleta N, Shankar AH, Merialdi M: Potential contribution of maternal zinc supplementation during
pregnancy to maternal and child survival. Am Journal Clin Nutr. 1998, 68 (2): 499S-
iv
Benoist B, McLean E, Egll I, Cogswell M: Worldwide prevalence of anaemia 1993–2005: WHO global database on
anaemia. 2008, Geneva: World Health Organization

vi
Walravens PA, Hambidge KM: Growth of infants fed a zinc supplemented formula. Am J Clin Nutr. 1976, 29 (10): 1114-
1121.

vii
Le Huong T, Inge B, Jan B, Khan N, Frans K: Efficacy of iron fortification compared to iron supplementation among
Vietnamese schoolchildren. Nutr J. 2006, 5: 32-