Skip to main content
    • Aa
    • Aa
  • Access
  • Cited by 20
  • Cited by
    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Garcia-Casal, Maria N Peña-Rosas, Juan Pablo Pachón, Helena De-Regil, Luz Maria Centeno Tablante, Elizabeth Flores-Urrutia, Monica C and Peña-Rosas, Juan Pablo 2016. Cochrane Database of Systematic Reviews.

    Wang, Yue-Hong Zou, Chun-Qin Mirza, Zakaria Li, Hong Zhang, Zhen-Zhen Li, Dan-Ping Xu, Chun-Li Zhou, Xin-Bin Shi, Xiao-Jun Xie, De-Ti He, Xin-Hua and Zhang, Yue-Qiang 2016. Cost of agronomic biofortification of wheat with zinc in China. Agronomy for Sustainable Development, Vol. 36, Issue. 3,

    Zhao, Peng Yang, Fan Sui, Fuqing Wang, Qiaoyan and Liu, Hongen 2016. Effect of nitrogen fertilizers on zinc absorption and translocation in winter wheat. Journal of Plant Nutrition, Vol. 39, Issue. 9, p. 1311.

    Li, Meng Wang, Shaoxia Tian, Xiaohong Zhao, Jihong Li, Hongyun Guo, Chunhui Chen, Yanlong and Zhao, Aiqing 2015. Zn distribution and bioavailability in whole grain and grain fractions of winter wheat as affected by applications of soil N and foliar Zn combined with N or P. Journal of Cereal Science, Vol. 61, p. 26.

    Wang, Xiao-Zhong Liu, Dun-Yi Zhang, Wei Wang, Cheng-Ju Cakmak, Ismail and Zou, Chun-Qin 2015. An effective strategy to improve grain zinc concentration of winter wheat, Aphids prevention and farmers’ income. Field Crops Research, Vol. 184, p. 74.

    Wang, Zhangmin Liu, Qi Pan, Fei Yuan, Linxi and Yin, Xuebin 2015. Effects of increasing rates of zinc fertilization on phytic acid and phytic acid/zinc molar ratio in zinc bio-fortified wheat. Field Crops Research, Vol. 184, p. 58.

    Zhang, Wei Liu, Dunyi Li, Chao Cui, Zhenling Chen, Xinping Russell, Yost and Zou, Chunqin 2015. Zinc accumulation and remobilization in winter wheat as affected by phosphorus application. Field Crops Research, Vol. 184, p. 155.

    Liu, Hui Wang, Zhaohui H. Li, Fucui Li, Keyi Yang, Ning Yang, Yuee Huang, Donglin Liang, Dongli Zhao, Hubing Mao, Hui Liu, Jinshan and Qiu, Weihong 2014. Grain iron and zinc concentrations of wheat and their relationships to yield in major wheat production areas in China. Field Crops Research, Vol. 156, p. 151.

    Duan, Guilan Liu, Wenju Chen, Xueping Hu, Ying and Zhu, Yongguan 2013. Association of arsenic with nutrient elements in rice plants. Metallomics, Vol. 5, Issue. 7, p. 784.

    Qin, Yu Melse-Boonstra, Alida Pan, Xiaoqun Yuan, Baojun Dai, Yue Zhao, Jinkou Zimmermann, Michael B Kok, Frans J Zhou, Minghao and Shi, Zumin 2013. Anemia in relation to body mass index and waist circumference among chinese women. Nutrition Journal, Vol. 12, Issue. 1,

    Wieser, Simon Plessow, Rafael Eichler, Klaus Malek, Olivia Capanzana, Mario V Agdeppa, Imelda and Bruegger, Urs 2013. Burden of micronutrient deficiencies by socio-economic strata in children aged 6 months to 5 years in the Philippines. BMC Public Health, Vol. 13, Issue. 1,

    You, Jing 2013. The role of microcredit in older children’s nutrition: Quasi-experimental evidence from rural China. Food Policy, Vol. 43, p. 167.

    Gyles, Collin L Lenoir-Wijnkoop, Irene Carlberg, Jared G Senanayake, Vijitha Gutierrez-Ibarluzea, Inaki Poley, Marten J Dubois, Dominique and Jones, Peter J 2012. Health economics and nutrition: a review of published evidence. Nutrition Reviews, Vol. 70, Issue. 12, p. 693.

    Li, Lan-Hua Chen, Hui-Bo Zhang, Li-Ping Wang, Zeng-Wu and Wang, Chun-Ping 2012. A community-based investigation on restless legs syndrome in a town in China. Sleep Medicine, Vol. 13, Issue. 4, p. 342.

    Wang, Jianwei Mao, Hui Zhao, Hubing Huang, Donglin and Wang, Zhaohui 2012. Different increases in maize and wheat grain zinc concentrations caused by soil and foliar applications of zinc in Loess Plateau, China. Field Crops Research, Vol. 135, p. 89.

    Zhang, Yue-Qiang Sun, Yi-Xiang Ye, You-Liang Karim, Md. Rezaul Xue, Yan-Fang Yan, Peng Meng, Qing-Feng Cui, Zhen-Ling Cakmak, Ismail Zhang, Fu-Suo and Zou, Chun-Qin 2012. Zinc biofortification of wheat through fertilizer applications in different locations of China. Field Crops Research, Vol. 125, p. 1.

    Willows, Noreen D. Barbarich, Bobbi N. Wang, Larry C.H. Olstad, Dana Lee and Clandinin, Michael T. 2011. Dietary inadequacy is associated with anemia and suboptimal growth among preschool-aged children in Yunnan Province, China. Nutrition Research, Vol. 31, Issue. 2, p. 88.

    Shi, Rongli Zhang, Yueqiang Chen, Xinping Sun, Qinping Zhang, Fusuo Römheld, Volker and Zou, Chunqin 2010. Influence of long-term nitrogen fertilization on micronutrient density in grain of winter wheat (Triticum aestivum L.). Journal of Cereal Science, Vol. 51, Issue. 1, p. 165.

    White, Philip J. and Broadley, Martin R. 2009. Biofortification of crops with seven mineral elements often lacking in human diets - iron, zinc, copper, calcium, magnesium, selenium and iodine. New Phytologist, Vol. 182, Issue. 1, p. 49.

    Hughes, Roger 2008. In this issue. Public Health Nutrition, Vol. 11, Issue. 06,


Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?

  • Guansheng Ma (a1) (a2), Ying Jin (a1), Yanping Li (a1) (a2), Fengying Zhai (a1), Frans J Kok (a2), Evert Jacobsen (a2) and Xiaoguang Yang (a1)
  • DOI:
  • Published online: 01 June 2008

In order to prioritise interventions for micronutrient deficiencies in China, the populations affected by iron and zinc deficiencies were assessed based on data from the 2002 China National Nutrition and Health Survey. The costs and cost-effectiveness of supplementation, food diversification and food fortification were estimated using the standard World Health Organization ingredients approach. Results indicated that 30% of children (<2 years), adults (>60 years), pregnant and lactating women, and 20% of women of reproductive age were anaemic, some 245 million people. Approximately 100 million people were affected by zinc deficiency (zinc intake inadequacy and stunting), the majority living in rural areas. Among interventions on iron and zinc deficiency, biofortification showed the lowest costs per capita, I$0.01 (international dollars), while dietary diversification through health education represented the highest costs at I$1148. The cost-effectiveness of supplementation, food fortification and dietary diversification for iron deficiency alone was I$179, I$66 and I$103 per disability-adjusted life-year (DALY), respectively. Data for biofortification were not available. For zinc deficiency, the corresponding figures were I$399, I$153 and I$103 per DALY, respectively. In conclusion, iron and zinc deficiencies are of great public health concern in China. Of the two long-term intervention strategies, i.e. dietary diversification and biofortification with improved varieties, the latter is especially feasible and cost-effective for rural populations. Supplementation and fortification can be used as short-term strategies for specific groups.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?
      Your Kindle email address
      Available formats
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account. Find out more about sending content to Dropbox.

      Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?
      Available formats
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account. Find out more about sending content to Google Drive.

      Iron and zinc deficiencies in China: what is a feasible and cost-effective strategy?
      Available formats
Corresponding author
Corresponding author: Email
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1J Bryce , C Boschi-Pinto , K Shibuya , RF Black . WHO estimates of the causes of death in children. Lancet 2005; 365: 11471152.

5E Pollitt . Iron deficiency and cognitive function. Annual Review of Nutrition 1993; 13: 521537.

13W Willett . Nutritional Epidemiology, 2nd ed. New York: Oxford University Press, 1998.

16PJ White , MR Broadley . Biofortifying crops with essential mineral elements. Trends in Plant Science 2005; 10: 586592.

30G Ma , Y Jin , J Piao , JF Kok , G Bonnema , E Jacobsen . Phytate, calcium, iron and zinc contents and their molar ratio in foods commonly consumed in China. Journal of Agricultural and Food Chemistry 2005; 53: 1028510290.

31G Ma , Y Li , Y Jin , F Zhai , FJ Kok , X Yang . Phytate intake and molar ratios of phytate to zinc, iron and calcium in the diets of people in China. European Journal of Clinical Nutrition 2007; 61: 368374.

34CJ Murray , DB Evans , A Acharya , RM Baltussen . Development of WHO guidelines on generalized cost-effectiveness analysis. Health Economics 2000; 9: 235251.

36CJ Murray , JA Lauer , RC Hutubessy , L Niessen , N Tomijima , A Rodgers , Effectiveness and cost of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk. Lancet 2003; 361: 717725.

43D Suharno , CE West , Muhilal, D Karyadi , JG Hautvast . Supplementation with vitamin A and iron for nutritional anaemia in pregnant women in West Java, Indonesia. Lancet 1993; 342: 13251328.

49W Mertz . Food fortification in the United States. Nutrition Reviews 1997; 55: 4449.

50MA Honein , LJ Paulozzi , TJ Mathews , JD Erickson , LY Wong . Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA: Journal of the American Medical Association 2001; 285: 29812986.

51JG Ray , C Meier , MJ Vermeulen , S Boss , PR Wyatt , DE Cole . Association of neural tube defects and folic acid food fortification in Canada. Lancet 2002; 360: 20472048.

54J Chen , X Zhao , X Zhang , S Yin , J Piao , J Huo , Studies on the effectiveness of NaFeEDTA-fortified soy sauce in controlling iron deficiency: a population-based intervention trial. Food and Nutrition Bulletin 2005; 26: 177186.

59RM Welch . Biotechnology, biofortification, and global health. Food and Nutrition Bulletin 2005; 26: 419421.

60B Caballero . Fortification, supplementation, and nutrient balance. European Journal of Clinical Nutrition 2003; 57: S76S78.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
  • URL: /core/journals/public-health-nutrition
Please enter your name
Please enter a valid email address
Who would you like to send this to? *