(P44-32-26) Modeling the Impact of Iron Fortification of Fish Sauce on Iron Intake Adequacy in Women of Reproductive Age in Viet Nam

Objectives: Iron deficiency affects many Vietnamese women of reproductive age (WRA, 19-49 years), contributing to adverse health outcomes and a burden on the healthcare system. This study aims to estimate the potential of iron fortification in fish sauce, a widely consumed condiment, to raise dietary iron intake among WRA in Viet Nam.

Methods: We conducted a secondary analysis of the nationally representative Viet Nam General Nutrition Survey 2019, which collected sociodemographic, anthropometric and nutrient biomarker status, and 24-hour dietary recall data. Prevalence of iron deficiency (serum ferritin < 15 µg/dL), iron deficiency anemia (IDA) (Hb < 11 g/dL for pregnant mothers and < 12 g/dL for non-pregnant non-lactating (NPNL) women and lactating mothers), daily fish sauce intake, and dietary iron intake (heme and non-heme) and prevalence of intake inadequacy were summarized using descriptive statistics. Changes in iron intake under fortification will be modeled in the Intake Monitoring Assessment and Planning Program (IMAPP, University of Iowa) by different fortificants (NaFeEDTA and FeSO₄) and levels.

Results: Among 2,747 women (15% pregnant; 21% lactating; mean age (+SD) 33±8 years), 11% had iron deficiency. 5% WRA had IDA, representing 31% of total WRA with anemia. Daily fish sauce intake was 3.8±12.1 g/day. Daily iron intake was 11.9±6.3 mg in NPNL women, 14.4±7.1 mg in pregnant women, and 14.7±7.8 mg in lactating mothers. 32% of WRA had inadequate dietary iron intake (< EAR), with highest prevalence among pregnant mothers (88%) whose EAR is ~3x higher than for NPNL women. Preliminary IMAPP projections suggest that fortifying fish sauce at 7 mg iron/g (assuming 10% bioavailability) could reduce intake inadequacy among WRA, with the largest potential benefit to pregnant women (prevalence reduced to < 30%). Estimates of impact specific to fortificants and levels will be reported.

Conclusions: Iron deficiency and IDA among Vietnamese WRA remains a public health concern, accompanied by a widespread inadequate intake of dietary iron. Fortifying iron in fish sauce may help reduce the prevalence of inadequate iron intake and reduce risk of IDA among WRA.

Funding Sources: Viet Nam General Nutrition Survey was funded by the Viet Nam National Institute of Nutrition. HT is funded by the Vingroup Scholarship Program and the George G. Graham Travel Scholarship.