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Supporting Government Policy in Morocco to Address Micronutrient Deficiencies

IAEA-supported study confirms type of iron fortificant to be added to wheat flour

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Test meal preparation (30g brioche, 10g butter, 25g honey). (Photo: Hassan Aguenaou, Ibn Tofail University-CNESTEN)

According to the year 2000 figures from Morocco’s Ministry of Health, 37% of pregnant women, 36% of women of reproductive age, 31% of children under 5 years of age and 18% of men are iron deficient. This leads to iron deficiency anaemia, which causes extreme fatigue, weakness, shortness of breath and headaches. In infants and children, severe forms delay growth and development in addition to increased susceptibility to infections. Morocco therefore created a National Fortification Alliance (NFA) to combat micronutrient deficiencies and in 2002, decided to fortify wheat flour, which is consumed widely by Moroccans (365g flour/day), with elemental iron[1].

However, a study carried out from 2006 to 2008 showed that iron deficiency has not reduced despite implementation of the wheat flour fortification programme. In 2016, the Government changed the type of iron fortificant, from elemental iron, which is highly affected by dietary iron inhibitors, to NaFeEDTA[2], which is more bioavailable and less affected by dietary iron inhibitors. The same year, to support this change in strategy, the Moroccan Government requested IAEA support to help confirm the bioavailability of NaFeEDTA from wheat flour. Support was also requested to study the effect on iron bioavailability of consuming tea with fortified bread, because this is often practiced in Moroccan culture.

Study participant consuming the test meal. (Photo: Hassan Aguenaou, Ibn Tofail University-CNESTEN)

The study was carried out with the support of a targeted IAEA technical cooperation project that focused on reducing anaemia in women and children[3]. It was conducted by the Joint Research Unit for Nutrition and Food Research “Ibn Tofail University-CNESTEN” (an AFRA regional designated centre for nutrition) together with the Ministry of Health, Ministry of Agriculture, Ibn Tofail University, and the National Reference Centre of Neonatology and Nutrition in collaboration with the Human Nutrition Laboratory of ETH Zurich. Forty-eight women participated in the study, of which half were iron deficient and the other half iron replete. The study outcomes demonstrated that NaFeEDTA is highly absorbed; in iron deficient women 33% of the iron was absorbed and in iron replete women 14%. These results will contribute to solving the iron deficiency problem in Morocco, as the Government Council will approve a decree and its application texts to change the type of iron fortificant from elemental iron to NaFeEDTA. This will be effective at the end of 2018.

The study results also showed that tea consumed together with wheat products greatly reduces the absorption of NaFeEDTA. This will require a strong communication strategy that recommends consumption of tea either one hour before or one hour after a meal.

Participants at the dissemination event. (Photo: Hassan Aguenaou, Ibn Tofail University-CNESTEN)

The findings of the study were disseminated on 8 July 2018 in Rabat to policy makers from the Ministry of Health, Ministry of Agriculture, Ministry of Education, Higher Education and Scientific Research and the National Office of Food Safety by the study team from the Joint Research Unit for Nutrition and Food Research “Ibn Tofail University-CNESTEN”, the National Reference Centre of Neonatology and Nutrition, and the Human Nutrition Laboratory of ETH Zurich. IAEA technical officer Cornelia Loechl, Division of Human Health, provided an introduction on how stable isotope techniques can help improve nutrition, particularly with respect to micronutrient nutrition.

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[1] Elemental iron is pure iron and insoluble in water and poorly soluble in diluted acid.

[2] NaFeEDTA or sodium iron (Fe3+) ethylenediaminetetraacetic acid is a water-soluble iron compound used to fortify especially grain-based products.

[3] The three-year IAEA technical cooperation project MOR6022 is supporting Morocco in reducing anaemia in women and children according to the objectives of the "National Strategy of Nutrition 2011-2019".

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