ORCID ID: 0000-0002-9943-4006 Abstract Uzbekistan, located in Central Asia, is currently experiencing significant population growth, with the total population exceeding 38.2 million as of early 2026. This demographic expansion is accompanied by a high prevalence of iron deficiency (ID), affecting 80% of pregnant women, 60% of women of reproductive age, and 57% of school-age children across the republic. This study analyzed the demographics and the distribution of micronutrient deficiency-related diseases in three districts of the Fergana region (Kuva, Yozyovon, and Fergana). Health data from district polyclinics were evaluated across different age groups, focusing on four types of anemia-related conditions. Additionally, 30 samples of wheat flour from these districts were analyzed, revealing low nutritional quality with raw gluten levels ranging from 24% to 28%. To address this, agronomic biofortification through foliar application of iron chelate was conducted during the wheat vegetat

Located in the center of Central Asia, the Republic of Uzbekistan covers a total area of 448,970 km2. According to current estimates for early 2026, the population of the republic exceeds 38.2 million people. Uzbekistan leads Central Asian countries in terms of population growth. This demographic expansion is accompanied by a significant public health challenge: iron deficiency (ID), which is the most prevalent micronutrient deficiency globally, affecting approximately one in four people. The prevalence is particularly high among vulnerable groups; in Uzbekistan, iron deficiency anemia (IDA) is found in 80% of pregnant women, 60% of women of reproductive age, and 57% of school-age children (Petry et al. 2016; Atajanova et al. 2022). Anemia can be caused by nutrient deficiencies, chronic infections, and inherited blood disorders (Roy et al. 2010). These factors contribute to the total prevalence of anemia in different ways depending on the population group, region, and overall environmental conditions (Kassebaum et al. 2010). The main health problems associated with iron deficiency are immune system disorders, cognitive impairment, and reduced work capacity, as well as maternal death and increased infant mortality (Hunt et al. 2005). It has been observed that populations including children under 12 and pregnant women suffer more severely from this, as infants and pregnant women require large amounts of iron for growth (De Benoist et al. 2008). By choosing a balanced diet with bioavailable and sufficient iron and paying due attention to the composition of food, iron-related health problems can be prevented (Hennig et al. 2012). There are several ways to enrich food with iron, each with its advantages and disadvantages. Biofortification of major crops appears to be an effective method of meeting the population’s nutritional needs (Bouis et al. 2011). Genetic (plant breeding) and agronomic biofortification (fertilizer application) are approaches considered economically effective for addressing this problem (White et al. 2009). According to the findings of numerous studies, wheat is one of the five main sources of nutrition in the human diet, consistently consumed among grain products (Montenegro et al. 2017). Over the last decade, as a result of refined grain processing in the population’s diet, less attention has been paid to the role of micronutrients in food. This has led to malnutrition, protein, and micronutrient deficiencies to varying degrees. While white flour obtained from processed grains contains approximately 6.7 mg/kg of iron and 8.4 mg/kg of zinc, whole grains contain 28.2 mg/kg of iron and 28.6 mg/kg of zinc (Tang et al. 2008). Agronomic methods can increase the zinc content of grain simply by fertilizing plants with zinc salts; for example, foliar application of ZnSO_4 increased the total zinc content of grain by approximately 60% (Zhang et al. 2012). However, such agronomic methods are less effective for iron, except when combined with increased nitrogen fertilization (Aciksoz et al. 2011). Wheat is a major source of protein and energy for humans, and its potential to combat iron deficiency can be increased by producing varieties with high iron content. Although wheat is usually enriched during processing, a more promising and long-term solution is the biological enrichment of wheat based on the production of new varieties with characteristically higher iron content. However, developing such varieties requires considering modern environmental challenges, particularly rising global temperatures. Recent studies have emphasized the importance of evaluating wheat germplasm for heat stress tolerance at early growth stages to ensure crop stability under climate change (Erjigitov et al. 2025; Mamatkulova et al. 2025). Combining nutritional biofortification with abiotic stress resilience is crucial for developing climate-resilient and high-quality wheat cultivars. The cultivation of intensive varieties that require large amounts of mineral fertilizers often leads to soil depletion. The use of fertilizers fortified with micronutrients such as Fe, Mn, Zn, and Cu has been shown to significantly increase grain and straw yield, natural weight, and the number of grains per spike (Ziaeian et al. 2001). Balanced application of micronutrients improves wheat yield indicators, including leaf area index (LAI), leaf area duration, plant growth rate, assimilation coefficient, spike length, and grain yield (Zuurbier et al. 2020). The primary objective of our study is to analyze the prevalence and causes of anemia associated with iron, zinc, and folate micronutrient deficiencies in the population of Fergana Province and to evaluate the efficacy of agronomic biofortification in improving the nutritional profile of local wheat varieties.