Discussion
anaemia, wheat flourNo, TfR, malaria, micronutrient deficiencies, infection
ANAEMIA, MALARIA, INFLAMMATION, INFECTION, PROTEIN-ENERGY MALNUTRITION
In this study, we hypothesised that MMB compared with UB consumption 5 d weekly for 26 weeks would improve adolescent girls’ micronutrient status. We also explored to what extent the intervention effect varied before or after menarche. Contrary to our hypothesis, we found no evidence that MMB consumption improves iron and haemoglobin status. Our study population had a low socio-economic status with high household food insecurity, and the prevalence of anaemia was higher than that reported by Gosdin A modest improvement in ferritin meant that post-intervention IDA did not decrease in the MMB group compared with the UB group. In conformity with Righetti Our findings contrast with the results of the meta-analysis by Das Our findings highlight the complex interplay of various factors, such as iron compound choice and dose, dietary patterns, infection and inflammation, in determining the efficacy of micronutrient interventions. In the present study, ferrous fumarate was the fortificant used for iron, while dry vitamin A palmitate (retinyl palmitate) was used for vitamin A, both of which have been suggested by the WHO/FAO for the fortification of wheat flourNo difference was observed in the TfR of girls receiving MMB compared with girls receiving UB after the intervention, indicating poor iron erythropoiesisThe lack of effect on RBP and vitamin A status indicators in the study cannot be solely explained by the dosage used as comparable studiesAsymptomatic malaria can have a significant impact on haematologic and micronutrient biomarkers; it reduces Hb and RBP levels while increasing PF and TfR concentrationsApart from ID, other micronutrient deficiencies like folate, riboflavin, vitamin A, BThe decline in Hb in our post-menarche girls and the improvement in vitamin A status suggest that, in some circumstances, vitamin A improvement may not affect Hb. For instance, Leenstra The difference in Hb measurement between capillary (finger prick at baseline) and venous blood (at endline) might have caused a systematic overestimation of baseline Hb levels in the studyRetinol remains the recommended biomarker for assessing the vitamin A status of populations; RBP is an acute-phase protein, and its levels can be affected by factors such as protein-energy malnutrition, infection and inflammationWhile the study focused on rural adolescent girls, caution should be exercised when extrapolating the results to populations with different nutritional profiles or health conditions. In this group of rural Ghanaian adolescent girls, MMB consumption did not improve Hb and iron status, but it reduced the prevalence of deficient/marginal vitamin A status among post-menarche girls. Despite the modest effects observed in our study, food fortification programmes remain relevant considering the high burden of anaemia, ID and IDA in the present study. Micronutrient supplements may be a better approach, but poor compliance still limits their effectiveness