The Nigerian government has enacted a new industrial standard for bouillon which includes a provision for adding vital micronutrients. The new standard specifies the inclusion of iron, zinc, folic acid and vitamin B12 on a voluntary basis in nationally produced and imported bouillon cubes to reduce malnutrition and child mortality.
An international team, including researchers from the University of California, Davis, worked with the government of Africa's most populous country to model the public health benefits of fortifying bouillon cubes, a staple in West African cooking. While fortification standards for foods like wheat flour and edible oils are in place, these foods have limited impacts on dietary quality because they are either not consumed frequently or in sufficient amounts by those most in need. Bouillon cubes, however, are a popular ingredient in West African cooking, consumed by the vast majority of households regardless of socioeconomic status or location, offering a more equitable pathway for impact.
The policy change has the potential to save over 57,000 lives of children under the age of 5 in Nigeria between 2023 and 2030, the research team predicts.
Micronutrients are essential dietary elements that help regulate the physiological functions of cells and organs - supporting healthy growth and development during critical phases of life. Micronutrient deficiencies are widespread in West Africa, contributing to poor child health, development and mortality.
Addressing micronutrient deficiencies
Led by the UC Davis Institute of Global Nutrition and Department of Agricultural and Resource Economics, experts Stephen A. Vosti, Reina Engle-Stone, Katherine Adams, Michael Jarvis and their national and international collaborators, including UC Davis alum Seth Adu-Afarwuah, developed and used the Micronutrient Intervention Modeling (MINIMOD) tools to generate the evidence needed by the many stakeholders involved in the international bouillon fortification project.
In parallel, the researchers from UC Davis, in collaboration with the University of Ghana, conducted a community-based study to test the acceptability of multiple micronutrient-fortified bouillon cubes with different levels of iron, zinc, vitamin A, folic acid and vitamin B12 by women and their households. All formulations were well-liked by more than 90% of the respondents, suggesting that a broad array of formulations of the micronutrients can be used for further research and to test the impacts of the bouillon cubes on nutritional status and other outcomes.
The team followed this work with a randomized controlled study in the same region to gauge the impact of the multiple micronutrient-fortified bouillon on micronutrient status and related outcomes. Results of this study, supervised by UC Davis researcher Sika Kumordzie, are being analyzed.
"This was the first field-based study undertaken to measure the impacts of multiple micronutrient-fortified bouillon. It therefore provides an important 'cornerstone' of evidence needed to understand the impact of fortification of bouillon in contexts where the condiment has broad and equitable reach," said Engle-Stone.
Using the MINIMOD tool in three countries (Burkina Faso, Senegal and Nigeria), this study showed important gaps in the availability of nutrients in the household food supply to meet dietary requirements for children. Folate, zinc and vitamin A show the highest inadequacy levels, with iron and B12 problematic, but to a lesser extent. In collaboration with Johns Hopkins University, the Lives Saved Tool was used to estimate the impacts of fortification with selected micronutrients (vitamin A, folic acid and zinc) on child mortality.
According to national household data from Senegal, based on food intake alone, 92% of women of reproductive age nationally have dietary inadequacy of folate. Adding fortified bouillon to the existing wheat flour fortification program would decrease national inadequacy to 23%. Researchers also suggest that bouillon fortification would substantially decrease inadequacies among children in vitamin A, zinc and folate, with modest gains for vitamin B12 and minimal impact on iron inadequacy.
Reductions in folate inadequacy among women of reproductive age, and in vitamin A and zinc inadequacies among children, could lead to significant reductions in child mortality, according to previously published studies by the team.
"We're pleased to see the government of Nigeria implement these new standards," said Vosti. "We hope these models will support discussions and policy changes needed to tackle preventable health problems throughout West Africa and more broadly."
The research is supported by a subaward to UC Davis of a grant to Helen Keller Intl by the Bill & Melinda Gates Foundation. The project is part of the larger West Africa Bouillon Initiative, which includes Country Working Groups in Nigeria, Burkina Faso and Senegal, other research institutions and NGOs, and representatives of the international and national private sector.
The Institute for Global Nutrition is a special research program within the Office of Research whose mission is to advance human nutrition research, training and outreach to improve the lives of vulnerable people worldwide. The institute conducts interdisciplinary research on issues of human nutrition through a lens of equity; provides technical assistance to national governments and international agencies concerned with food and nutrition policies; and fosters collaborative exchanges of students and faculty between UC Davis and research and training institutions abroad.
