Fortifying Cooking Oil with Vitamin A in Two Rural Districts of Indonesia: Impact on Vitamin A Status of Mothers and Children
Sandjaja Sandjaja *
National Health and Development Research Institute, Ministry of Health, Jakarta, Indonesia and Indonesian Nutrition Foundation for Food Fortification, Jakarta, Indonesia.
Idrus Jus'at
Esa Unggul University, Jakarta, Indonesia and Indonesian Nutrition Foundation for Food Fortification, Jakarta, Indonesia.
Abas Basuni Jahari
National Health and Development Research Institute, Ministry of Health, Jakarta, Indonesia.
Robert Tilden
Indonesian Nutrition Foundation for Food Fortification, Jakarta, Indonesia and University of Indonesia, School of Public Health, Jakarta, Indonesia.
Fitrah Ernawati
National Health and Development Research Institute, Ministry of Health, Jakarta, Indonesia.
Damayanti Soekarjo
SAVICA Public Health Nutrition & Communication Consultancy, Surabaya, Indonesia.
Eline Korenromp
Global Alliance for Improved Nutrition, Geneva, Switzerland.
*Author to whom correspondence should be addressed.
Abstract
Objectives: To measure impact of fortifying unbranded palm oil with retinyl palmitate on vitamin A status in poor households through two surveys, just before fortification started (four months after the twice-yearly vitamin A capsule supplementation for children 6-59 months) and a year later.
Methods: 24 villages from a pilot area on West Java were randomly selected, and poor families sampled. Serum retinol (adjusted for sub-clinical infections) was analyzed in lactating mothers and their infants 6-11 months, children 12-59 months and 5-9 years and women 15-29 years, in relation to socio-economic conditions, oil consumption, and food intake. Fortified oil was sold through existing market channels.
Results: Fortified oil improved vitamin A intakes, contributing an estimated 34%, 77%, 55%, 42%, 50% of Recommended Nutrient Intake (RNI) for children 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women, respectively. Serum retinol increased by 13-17% across groups (p<0.02 except in 12-23 months). Deficiency prevalence (retinol <20 mg/dL) decreased by 67%, 64%, 96%, 89%, 79%, and 89% in infants 6-11 months, children 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women (p<0.011, all groups).
Households' non-food expenditures, housing conditions and capital assets also improved from baseline to endline. However, in multivariate regressions, socio-economic variables did not independently influence retinol status, whereas RNI contributions from oil positively predicted improving retinol for children 6-59 months (p=0.003) and 5-9 years (p=0.03).
Conclusions: Fortification of cooking oil proved an effective way to reduce the vitamin A intake gap in underprivileged women and children in rural communities.