Epidemiology of Dietary and Micronutrient Deficiencies in Mongolia

Abstract

Background: Extreme characteristics of the Mongolian food supply and diet are associated with severe nutritional risks. Understanding these risks is relevant to the study of global chronic disease, but this understanding is hampered by a lack of research, interventions, and data collection platforms in Mongolia. This dissertation aims to address these deficits by (1) characterizing the distribution and determinants of a particularly severe biochemical micronutrient deficiency in Mongolia, (2) characterizing the distribution of multiple intake deficiencies in Mongolia and designing a specific intervention to address them, and (3) evaluating methods for estimating diet from household food consumption data in Mongolia. Methods: Summer and winter vitamin D status, and food and nutrient intake were assessed in 320 healthy urban and rural adults across Mongolia. Severity of vitamin D deficiency and its independent predictors were analyzed using multiple regression analyses. Food and micronutrient intake data were used to project the effectiveness of mandatory multiple micronutrient food fortification under different scenarios using the Intake Modeling, Assessment, and Planning Program. Four methods of estimating diet from household food consumption data were applied to two nationally-representative household surveys, and validated against a 24-hour recall nested within one of the two surveys. Results: Summer and winter serum 25-hydroxyvitamin D concentrations were below 20 ng/mL in 42.4% and 99.6% of the study population, respectively, with independent associations observed between status and season, age, sex, region, urban/rural locality, and sun exposure. Micronutrient intake deficiencies were widespread, particularly of thiamin, folate, and vitamins A, D, and E. Fortification of wheat flour, milk, and edible oil would be effective in addressing these intake deficiencies, is also recommended for iron and riboflavin, and may be unnecessary for zinc, niacin, and vitamin B12. Comparison of household disaggregation methods revealed each to have particular strengths, weaknesses, and applications. Conclusion: Micronutrient deficiencies and dietary inadequacies are widespread in the Mongolian population. Mandatory industrial fortification would be a safe and effective means of improving nutrition as part of a larger national nutrition strategy. The country's Household Socio-economic Survey presents a viable platform for surveillance of dietary trends and for informing the design of nutrition programs.