R ICE FORTIFIC ATION IN L ATIN A MER IC A CURRENT SITUATION OF MICRONUTRIENTS IN LATIN AMERICA AND THE CARIBBEAN 125 The methodology used in the systematic review has been published in detail.45–49 Briefly, the databases available on deficiencies of vitamins and minerals were accessed to search for the latest National Health Survey for each country. This information was complemented by accessing the web pages of the Ministries of Health and/or the National Office of Statistics to determine whether the databases mentioned were up to date. Additionally, full searches were carried out of research articles published in PubMed, LILACS and SciELO. We also conducted a search of other relevant documents that could contain information not found in the other searches. The main indicators and parameters used by surveys and studies selected for the review to determine deficiencies were: serum retinol for vitamin A, 25-OHD levels for vitamin D, serum α-tocopherol for vitamin E, serum ascorbic acid for vitamin C, serum thiamine for thiamine, erythrocyte glutathione reductase (EGRAC) for riboflavin, erythrocyte activity of aspartate aminotransferase (EAAT) for vitamin B6, serum folate and red cell folate for folate, vitamin B12 in serum or plasma, serum copper, urinary iodine, serum or capillary hemoglobin for anemia, serum ferritin for iron, serum selenium and/or erythrocyte and serum zinc. The cutoffs used for deficiency, insufficient and/or inadequate levels varied widely among studies. However, for some micronutrients classifications with similar cut-off points were identified: lack of vitamin A as retinol < 20 μg/dL and insufficiency as 20.0–29.9 μg/dL; vitamin D deficiency as 25-OHD <25 nmol/L, insufficiency as 25–50 nmol/L and inadequacy as 50–75 nmol/L; vitamin C deficiency as ascorbic acid <0.2 μg/ dL; thiamine deficiency <1.25 μg/dL; folate deficiency as serum folate <3.2 ng/mL or RBC folate <181 nmol/L; vitamin B12 deficiency as serum vitamin B12 <148 pmol/L and marginal levels between 148–221 pmol/L; anemia as hemoglobin <11.0 or <12.0 or <13.0 g/dL; deficiency in iron reserves in the form of serum <12 ferritin or <15 or <20 g/L; mild iodine deficiency as urinary iodine 50–99 g/L, moderate between 20–49 mg/L and severe <20 g/L; zinc deficiency as serum zinc <65 or <70 μg/dL. Reported units were standardized to facilitate comparisons. The magnitude of the public health problem of deficiency of each micronutrient was defined according to the following cut-off points in prevalence: 1) anemia (iron), ≤ 4.9%, not a public health problem; 5%–19.9%, mild; 20%–39.9%, moderate; ≥ 40%, severe, according to WHO recommendations;50 zinc, no problem < 20%, problem > 20%, according to international recommendations;21 vitamin A, no problem < 2%, mild ≤ 2% to <10%, moderate ≤10% to < 20%, and severe ≥ 20%, according to WHO recommendations;23 vitamin D, no problem < 5%, 5–19.9% mild, 20–39.9% moderate and ≥ 40% severe;45 folate, © Sabrina Quezada Methodology Systematic review to determine prevalence of micronutrient deficiency in Latin America A boy eats his lunch in Nicaragua no problem < 5% and problem > 5%; and vitamin B12, no problem < 5% and problem > 5%. Identification of national prevention programs in Latin America The information presented is based on a recent systematic review of nutrition policies and programs in Latin America and the Caribbean conducted by the Pan American Health Organization and the Micronutrient Initiative.51 Results Prevalence of micronutrient deficiencies in Latin America and the Caribbean A total of 25 nationally representative surveys and studies were found (Table 1) which reported data of the nutritional status of iron (anemia), zinc, vitamin A, vitamin D, folate and/or vitamin B12, mainly in children under 6 years of age (Table 2) and women of childbearing age (Table 3). The surveys were conducted between 2000 and 2010. Iron and anemia According to the latest information available in children (Table 2), anemia is not a public health problem in Chile and Costa Rica (<5%). Countries such as Argentina and Mexico

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