Effectiveness of Fortified Rice in Addressing Micronutrient Deficiencies: A Systematic Review and Meta-Analysis

Background Micronutrient fortification of staple foods, including rice, has emerged as a significant policy priority due to its potential to address micronutrient deficiencies. Objective This systematic review aims to comprehensively synthesize existing evidence on the impact of micronutrient-fortified rice. The prime focus is on iron-related biomarkers, specifically haemoglobin, serum ferritin, and anaemia prevalence, to inform future policy decisions and interventions. Methods A systematic literature review was conducted to identify studies using 3 databases: PubMed, Cochrane Library, and Google Scholar (1990-). A meta-analysis was conducted to assess the impact of rice fortification on haemoglobin concentration, serum ferritin levels, and anaemia prevalence, followed by sensitivity and subgroup analyses using Stata SE 17.0. The study has been registered on PROSPERO (CRD42024495114). Results 30 studies were deemed eligible for inclusion in the systematic review. The intervention resulted in a moderate increase in haemoglobin levels ( θ = 0.630[0.3510.909]) and a statistically significant reduction in odds of anaemia ( θ = −0.835[−1.515, −0.155]). While the overall effect on serum ferritin levels was not significant, a subsequent meta-analysis of only randomized controlled trials (RCTs) using weighted mean difference (WMD) showed a significant positive effect. Regression analysis demonstrated a significant negative relationship ( t = −7.85) between baseline haemoglobin levels and the net change post-intervention. The majority of included studies involved iron either alone or in combination with other micronutrients. Conclusions Rice fortification, when implemented with attention to dose, fortificant choice, and local context, may offer cost-effective solutions to address micronutrient deficiencies. However, impacts vary across settings, requiring optimization through understanding modifiers.