The prevalence of anemia in the school children was lower than expected, at 16% [6]. Surprisingly, the prevalence of iron deficiency was very low, with <2% of the children having iron deficiency, and hence, the fortified rice had little impact on anemia prevalence or on improving iron status. Sub-clinical inflammation also played a role here, as in children without inflammation, there was a tendency towards higher haemoglobin concentrations in all the groups receiving fortified rice.
Another surprising outcome of the FORISCA project was the increase in hookworm infection in the children receiving fortified rice. At baseline, all children were dewormed. However, after 6 months, up to 30% of the children were re-infected, and the re-infection rate was higher in the children receiving fortified rice than in the children receiving normal rice[7]. The re-infection rate was highest in the children receiving the fortified rice with the highest iron content, making us believe that the iron in the fortified rice played a role in enabling the re-establishment of the hookworm infection. Also, as hookworm re-infection rate tended to be higher in the cold-extruded fortified rice groups, bioavailability of iron might have been different between the cold- and hot-extruded rice varieties.
Finally, despite the differences in zinc content of the 3 groups of fortified rice, both types of extruded fortified rice (cold vs hot extruded rice) were effective in improving zinc status and therefore production method appears not to be an important factor in determining the impact on zinc status of fortified rice.
The WFP in Cambodia is currently assessing the expanded use of fortified rice in the school meal program, and the aim is to have a rice fortified breakfast for all the children participating in the school meal program, meaning that almost 250,000 children will hopefully receive a fortified rice meal soon.
REFERENCES
1. Wieringa FT, Dahl M, Chamnan C, Poirot E, Kuong K, Sophonneary P, Sinuon M, Greuffeille V, Hong R, Berger J, et al: The High Prevalence of Anemia in Cambodian Children and Women Cannot Be Satisfactorily Explained by Nutritional Deficiencies or Hemoglobin Disorders. Nutrients 2016, 8.
2. Cambodia Demographic and Health Survey 2014. [https://dhsprogram.com/pubs/pdf/FR312/FR312.pdf]
3. Kuong K, Laillou A, Chea C, Chamnan C, Berger J, Wieringa FT: Stability of Vitamin A, Iron and Zinc in Fortified Rice during Storage and Its Impact on Future National Standards and Programs-Case Study in Cambodia. Nutrients 2016, 8.
4. Khanh Van T, Burja K, Thuy Nga T, Kong K, Berger J, Gardner M, Dijkhuizen MA, Hop le T, Tuyen le D, Wieringa FT: Organoleptic qualities and acceptability of fortified rice in two Southeast Asian countries. Ann N Y Acad Sci 2014, 1324:48-54.
5. Kuong K, Tor P, Perignon M, Fiorentino M, Chamnan C, Berger J, Burja K, Dijkhuizen MA, Parker M, Roos N, Wieringa FT: Multi-Micronutrient Fortified Rice Improved Serum Zinc and Folate Concentrations of Cambodian School Children. A Double-Blinded Cluster-Randomized Controlled Trial. Nutrients 2019, 11.
6. Perignon M, Fiorentino M, Kuong K, Dijkhuizen M, Burja K, Parker M, Chamnan C, Berger J, Wieringa FT: Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial.Nutrients 2016, 8:doi:10.3390/nu8010029.
7. de Gier B, Campos Ponce M, Perignon M, Fiorentino M, Khov K, Chamnan C, de Boer MR, Parker ME, Burja K, Dijkhuizen MA, et al: Micronutrient-Fortified Rice Can Increase Hookworm Infection Risk: A Cluster Randomized Trial. PLoS One 2016, 11:e0145351.
