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Average daily intake of fortified flour (fortified flour consumption)
This indicator describes documentation of the daily consumption of flour that, by law or standards, should be fortified. Among a target population, this can be expressed as the average intake of fortified flour over a 24-hour period by consumers surveyed. This indicator refers to the ingestion of fortified flour, not all foods in the diet.
The purpose of large-scale flour fortification is to improve the nutrition and health status of the target population(s). Assessing the intake of fortified flour reflects exposure to the intervention and is useful for understanding the expected impacts of the intervention.
The purpose of large-scale flour fortification is to improve the nutrition and health status of the target population(s). Assessing the intake of fortified flour reflects exposure to the intervention and is useful for understanding the expected impacts of the intervention.
To calculate the fortified flour intake for target populations, two main steps must be followed: 1) apply fortified flour intake questions in a survey, and 2) estimate fortified flour intake for target populations.
For the first step, questions must be asked about how much flour was used by the individual or household. For this, apply one of several methods to estimate the intake of fortified flour by individuals or households, such as 24-hour dietary recall (1), semi-quantitative food frequency questionnaire (2), weighed food record (3), and household income and expenditure survey (4).
Depending on the survey, there are different ways to estimate intake of fortified flour. In some nutrition surveys, the interviewee is asked to recall the quantity of specified foods (e.g. foods that contain wheat flour) that s/he (as an individual) or the household (as a collective) consumed during a particular period of time (e.g. previous day or week). If the amount for a period is greater than one day, it is divided by the number of recall days. Household-level flour intake can be converted into individual-level intake by dividing the daily household intake of flour by the total number of household members (to generate per capita intake) or by expressing household-level intake per adult male equivalents (5).
In economics surveys, the interviewee is asked to recall how much fortified flour or foods prepared with fortified flour s/he acquired (through purchase, harvest, as a gift, food aid, barter) for their household in a particular period of time (e.g. previous week, two weeks or month). Such information can be used to assess “apparent consumption” for the household, per capita, or per adult male equivalent.
Considerations for the calculation:
Nutrition surveys are designed to estimate individual intake; however, nationally representative surveys are not carried out very frequently. On the other hand, nationally representative economics surveys are carried out on a regular basis; however they are designed to estimate household purchases (not intake).
consumption,consumption monitoring,diet,flour,fortified flour utilization,household monitoring,individual monitoring,ingest,intake
Food fortification
Regular appropriate use
12-23 months, 24-35 months, 36-47 months, 48-59 months, 6-11 months, Adolescents, Men, School age children, Women of reproductive age
None,
All
Market-based
• Fortified flour programs may target beneficiaries, such as women of childbearing reproductive age. If such beneficiaries are specified in programme documentation (such as legislation and regulations), they should be the focus of the analysis.
• By law, not all types of flour may require fortification with vitamins and minerals. Therefore, it is important to document intake only of flour or flour products that are made with the flour types that are supposed to be fortified.
This indicator quantifies fortified flour intake using appropriate quantitative dietary assessment methods and provides an indication of the fortified flour being consumed by targeted beneficiaries.
• Reported dietary intake can suffer from reporting bias (6).
• Analyzing food samples requires human and material resources.
• Identifying and updating food composition tables for the country if not already available may be costly, time-consuming, and burdensome.
• Validly collecting and calculating this indicator requires expertise that might not be readily available in all countries.
A household income and expenditure survey was applied to 6000 households in a country. As part of the survey, households were asked how many individuals consumed meals from the family pot in the previous 14-day period and how much fortified maize flour was purchased in the same period. The two-week amount of flour “apparently consumed” per individual was simply the amount of flour purchased, divided by the number of people who ate from the family pot; dividing this figure by 14 days yielded the daily amount of flour “apparently consumed” per capita.
For example, household 4 had 2 individuals who ate from the family pot and 3 kg of fortified maize flour was consumed for a 14-day period.
Amount of fortified maize flour apparently consumed:
(3 kg / 1000 g) / 2 people / 14 days = 107 grams/capita/day.
The amount of fortified maize flour apparently consumed per capita (expressed in grams per day) was calculated by multiplying “amount of maize purchased (kg)” by 1000 g, dividing that value by the “number of individuals who ate from family pot”, and dividing that value by 14 days.
1. Coates J, Colaiezzi B, Fiedler J, Wirth J, Lividini K, Rogers B. Applying dietary assessment methods for food fortification and other nutrition programs. Geneva: Global Alliance for Improved Nutrition (GAIN); 2012 ( https://www.gainhealth.org/sites/default/files/publications/documents/applying-dietary-assessment-methods-for-food-fortification-2012.pdf, accessed 14 April 2021).
2. Fortification Rapid Assessment Tool (FRAT). Ottawa: Micronutrient Initiative; 2003 (https://www.nutritionintl.org/wp-content/uploads/2020/05/FRATguidelines2003_Nov_2008.pdf, accessed 14 April 2021).
3. Gibson RS. Principles of nutritional assessment, 2nd edition. New York: Oxford University Press; 2005.
4. Fiedler JL. Strengthening Household Income and Expenditure Surveys as a tool for designing and assessing food fortification programs. ISHN Working Paper No. 1. International Household Survey Network; 2009 ( http://www.ihsn.org/HOME/sites/default/files/resources/IHSN-WP001.pdf, accessed 14 April 2021).
5. Imhoff-Kunsch B, Flores R, Dary O, Martorell R. Methods of using Household Consumption and Expenditures Survey (HCES) data to estimate the potential nutritional impact of fortified staple foods. Food Nutr Bull. 2012;33(3 Suppl):S185-9,. doi: 10.1177/15648265120333S206.
6. Willett W, editor. Nutritional epidemiology, 3rd edition. New York: Oxford University Press; 2013.