Fortification with multiple micronutrients might result in opposing health effects

Abstract Number Theme Presentation Type Cover Approved
0123 Functional outcomes: e.g. child development, cognition, growth, stunting, birth outcomes, morbidity, long-term health Oral Not Approved


Abstract Content


Fortification of staple foods is considered an effective, sustainable, safe strategy to combat micronutrient deficiencies, thereby improving health. We performed a large rice fortification project (FORISCA) in schoolchildren in Cambodia to access its impact on health indicators


Schoolchildren (N=9,500) received a breakfast at school through the WFP school meal program that contained either normal rice or one of 3 different types of fortified rice. All rice types contained iron, folate, thiamin and zinc, whereas 2 types also contained vitamin A, vitamin B3 and vitamin B12. School absenteeism and morbidity was monitored in all children, whereas in a subsample (N=2,500) data on micronutrient status and intestinal parasite infestation was collected.


Absenteeism tended to be lower in the schools receiving fortified rice. The prevalence of diarrhea in 2-weekly recall was significantly lower in the children receiving fortified rice (prevalence 3-4%) than in the children receiving normal rice (5.7%). In contrast, the prevalence of hookworm infection was significantly increased in children receiving fortified rice (P=0.009), with almost double the prevalence in children receiving the rice with the highest iron content (OR 1.91, P=0.018)


Our results show opposite health effects of rice fortified with multiple micronutrients, with both a decrease in the prevalence of diarrhea and an increase in the prevalence of hookworm. We believe that different micronutrients in the premix underlie these effects, with iron being most likely implicated in the increase in hookworm infection, and zinc in the decrease in the prevalence of diarrhea.

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