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.位于中亚腹地的乌兹别克斯坦共和国，国土总面积达44.897万平方千米。根据2026年初的最新估算，该国总人口已突破3820万。乌兹别克斯坦的人口增速在中亚各国中位居首位。伴随这一人口增长态势的是一项严峻的公共卫生挑战：铁缺乏（iron deficiency, ID）——这是全球范围内最普遍的微量营养素缺乏症，影响着约四分之一的人群。脆弱群体的铁缺乏患病率尤其高：在乌兹别克斯坦，80%的孕妇、60%的育龄女性以及57%的学龄儿童均存在缺铁性贫血（iron deficiency anemia, IDA）问题（Petry等，2016；Atajanova等，2022）。 贫血可由营养素缺乏、慢性感染以及遗传性血液疾病引发（Roy等，2010）。根据人群分组、区域以及整体环境条件的不同，上述因素对贫血总患病率的影响机制也存在差异（Kassebaum等，2010）。铁缺乏相关的主要健康问题包括免疫系统紊乱、认知功能受损、劳动能力下降，还会增加孕产妇死亡风险与婴儿死亡率（Hunt等，2005）。已有研究观察到，12岁以下儿童与孕妇群体受铁缺乏的影响更为严重，因为婴幼儿与孕妇在生长发育过程中需要大量的铁元素（De Benoist等，2008）。通过选择富含生物可利用铁且摄入量充足的均衡膳食，并合理关注食物成分构成，可有效预防铁相关健康问题（Hennig等，2012）。 目前已有多种食物铁强化方式，各有利弊。对主粮作物开展生物强化（biofortification）似乎是满足人群营养需求的有效途径（Bouis等，2011）。遗传（植物育种）与农艺生物强化（肥料施用）是目前被认为在经济上可行的补铁解决方案（White等，2009）。多项研究结果显示，小麦是人类膳食五大主要营养来源之一，也是谷物类食品中消费量稳定的品类（Montenegro等，2017）。 近十年来，随着居民膳食中精制谷物占比提升，食物中微量营养素的作用愈发被忽视，进而导致不同程度的营养不良、蛋白质缺乏与微量营养素缺乏。经加工得到的白面粉中铁含量约为6.7 mg/kg、锌含量约为8.4 mg/kg，而全谷物中的铁含量可达28.2 mg/kg、锌含量可达28.6 mg/kg（Tang等，2008）。农艺强化手段可通过向作物施用锌盐来提升谷物锌含量：例如，叶面喷施硫酸锌（ZnSO₄）可使谷物总锌含量提升约60%（Zhang等，2012）。但此类农艺手段对铁元素的强化效果相对有限，除非配合增施氮肥（Aciksoz等，2011）。 小麦是人类获取蛋白质与能量的重要来源，通过培育高铁含量小麦品种，可进一步提升其对抗铁缺乏的潜力。尽管目前通常会在小麦加工过程中进行铁强化，但更具前景的长效解决方案是基于培育高铁含量特性新品种的小麦生物强化技术。然而，培育此类品种需要考量现代环境挑战，尤其是全球气温升高的问题。近期研究强调，为保障气候变化下作物稳产性，需在小麦生长早期对其种质资源开展耐热胁迫评估（Erjigitov等，2025；Mamatkulova等，2025）。将营养生物强化与非生物胁迫抗性相结合，是培育气候适应性强、品质优良小麦品种的关键。而依赖大量矿质肥料的集约化小麦品种种植，往往会导致土壤贫瘠。研究表明，施用富含铁（Fe）、锰（Mn）、锌（Zn）与铜（Cu）等微量营养素的肥料，可显著提升谷物与秸秆产量、千粒重以及每穗粒数（Ziaeian等，2001）。合理施用微量营养素可改善多项小麦产量指标，包括叶面积指数（leaf area index, LAI）、叶面积持续期、植株生长速率、同化系数、穗长以及籽粒产量（Zuurbier等，2020）。 本研究的核心目标为：分析费尔干纳省人群中与铁、锌、叶酸等微量营养素缺乏相关的贫血患病率及其致病原因，并评估农艺生物强化手段对改善当地小麦品种营养品质的效果。