Vitamin A deficiency remains a leading cause of morbidity and mortality in Indonesian children and women. In 2011, fortification of unbranded palm oil with retinyl-palmitate began in selected districts on a voluntary basis. As a pre-post evaluation, this study assessed consumption of fortified oil, changes in vitamin A intake and retinol status in 2 surveys of women and children, just before fortification started and a year later.
Poor households were randomly sampled from twenty-four peri-urban villages in two districts on West Java. Serum retinol (adjusted for sub-clinical infection) was analysed in cross-sectional samples of lactating mothers and their infants 6-11 months, and children 12-59 months, and in cohorts of children 5-9 years and women 15-29 years, alongside household socio-economic conditions, and individual-level oil and food consumption from single 24-hour dietary recall.
Fortified oil improved vitamin A intakes, contributing an average 26%, 40%, 38%, 29% and 35% of daily Recommended Nutrient Intake (RNI) for children 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women, respectively. Serum retinol was 2-19% higher at end line compared to baseline (p<0.001 in infants 6-11 months, children 5-9 years, lactating and non-lactating women; p=0.057 in children 24-59 months; nonsignificant in children 12-23 months). Retinol in breast milk averaged 20.5 μg/dL at baseline, 32.5 μg/dL at end line (p<0.01). Deficiency prevalence (retinol <20μg/dL) was 6.5-18% across groups at baseline, and 0.6-6% at end line (p<0.011, all groups). In multivariate regressions adjusting for socio-economic differences, fortified oil consumption predicted improved retinol status for children 6-59 months (p=0.003) and 5-9 years (p=0.03).
Although this evaluation without comparison group cannot prove causality, retinyl content measured in oil samples, RNI contributions and the relation between vitamin A intake and serum retinol across age groups provides strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.