Evaluation of dietary iron exposure across iron compounds and fortification levels in Saudi Arabia: simulation modeling study.

Abstract

Background: Iron fortification is a key public health policy in Saudi Arabia, intended to improve iron intake and reduce the prevalence of inadequate iron intake. An effective policy design should support improved intake among at-risk groups while avoiding excessive intakes in other groups. This study evaluated the anticipated impact of the current fortification policy by examining its ability to balance nutritional adequacy and safety in the Saudi population.

Methods: This simulation modelling study followed the guidelines of the Food and Agriculture Organization of the United Nations and the World Health Organization to simulate and model the impact of iron fortification. The modeled usual iron intake was determined, and the population segments with the highest and lowest intakes relative to this average were identified for benefit-risk assessment. All fortification scenarios in SFDA.FD 2539:2022 were evaluated to assess iron adequacy in low-intake groups, reduction in inadequacy prevalence, and risk of exceeding UL in high-intake groups.

Results: At baseline, the modeled mean usual iron intake was 13.0 mg/day for males and 12.0 mg/day for females. Across the simulated fortification scenarios, intake increased, reaching up to 24.3 mg/day in males and 23.6 mg/day in females at the 60-ppm level of fortification. The prevalence of inadequate intake decreased across all scenarios. It declined from 5.99% to 0.2% in males and from 10.56% to 0.3% in females, respectively. Intake above the upper limit (UL) was negligible. It was observed only at 60 ppm, affecting 0.7% of males and 0.4% females. Based on these findings, a fortification level of 30 ppm may achieve population-level adequacy while maintaining a minimal risk of exceeding UL.

Conclusions: The simulation of fortification effects at levels prescribed by current legislation suggests that these levels may reduce inadequate intake. The risk of excess remains minimal, particularly at 30 ppm. This study provides an initial overview of these anticipated impacts.