Dietary iron intake over two post-fortification periods in Brazil: data from the National Dietary Surveys 2008-2009 and 2017-2018.

We aimed to assess the dietary iron intake and the prevalence of inadequate iron intake over two post-fortification periods in Brazil. The intake was analysed according to sex, life stage, geographic region, and stratum of family income per capita. Excluding pregnant and lactating women, this population-based study included 32,749 and 44,744 participants aged ≥ 10 years from the National Dietary Survey-Brazilian Household Budget Surveys 2008-2009 and 2017-2018, respectively. The National Cancer Institute method was used to predict usual dietary iron intakes. The prevalence of iron intake inadequacy was estimated following a probabilistic approach for women of childbearing age or with the Estimated Average Requirement cut-off point method. Over an interval of 10 years, the mean iron intake remained almost unchanged for most sex-age groups, except for women of childbearing age. In this specific group, the prevalence of iron intake inadequacy was > 20% in 2008-2009 and have increased to > 25% in 2017-2018, with the highest reductions in mean iron intake found in the highest income strata and richest Brazilian regions. Meanwhile, the highest prevalence of iron intake inadequacy (> 40%) occurred among the poorest women aged 31-50 years from the lowest family income stratum, irrespective of the study period. Beans were the main iron source, while fortified breads, pastas, pizzas, cakes, and cookies contributed approximately 40% of the iron intake. The results provide important insights into the long-standing dietary impacts of food fortification, which can guide future (re)formulation of effective public health strategies to combat iron deficiency.