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- According to the World Health Organisation, dietary zinc deficiency is a global problem affecting 17% of the world's population, with the greatest burden in developing countries. The most recent national survey in Pakistan indicates that over 40% of women are zinc deficient, compared with less than 15% in Europe and North America. The consequences of zinc deficiency are profound and far reaching, ranging from stunted growth and development in children, increased susceptibility to infections in children and adults, and complications during pregnancy and childbirth. This has a negative economic impact on the family, the community and the region. Various strategies to overcome zinc deficiency have been attempted but it is difficult to achieve when large populations are concerned. Dietary zinc supplements are expensive and do not always reach the most vulnerable groups who may live in remote or difficult to reach locations due to poor infrastructure or security problems. In contrast, biofortification of staple foods has potential as a sustainable means of increasing population dietary zinc intake. However to date, few studies have been undertaken to evaluate the efficacy and cultural acceptability of this strategy. One of the key challenges in measuring the effectiveness of such strategies is the lack of a sensitive biomarker of zinc status that is suitable for use in remote settings We have an opportunity to evaluate the potential of a newly developed strain of biofortified wheat, produced by HarvestPlus, as a means of increasing dietary zinc intake in Pakistan. Through a collaboration with a Pakistan based fertilizer company, we will examine the impact of fertilization strategies and soil conditions on the wheat zinc content by of the addition of zinc rich fertilizer to the soil and foliage during the growing season in regions of Pakistan with contrasting soil zinc status. Previous studies have indicated that this new strain of wheat has potential to reach a zinc content that is around 45% higher than the standard varieties. The grain grown in our study will be analysed to measure the zinc content, and also the location of the zinc within the individual grains. A double blind trial will be conducted to examine whether or not consuming the flour made from the high zinc grain has a beneficial impact on the zinc status of zinc deficient women living in a rural community in North West Pakistan. The high zinc grain will be compared with standard grain, both of which will be provided to forty families to consume for eight weeks, with group A (20 families) consuming the high zinc grain, and group B (20 families) consuming the control grain. The families will switch over after eight weeks. To monitor the impact of consuming the flour on zinc status we will use established methods (plasma and hair zinc concentration), and we will also evaluate new indicators of zinc status that have potential for use in population based surveys, including markers of DNA damage and a novel portable laser technique for measuring nail Zn concentration. The success of a biofortification strategy requires that the intervention achieves wide and sustained uptake at production and consumption stages. Therefore, through our extensive and established networks with community leaders and farmers, we will assess the cultural context, traditions, knowledge and attitudes to biofortification in this setting, through focus groups and interviews. A key component of this research is training and capacity building. This is a two-way process by which expertise is shared among the project partners, so that young researchers in Pakistan and in the UK are better equipped to take this important research agenda forward into the future, and to build on the collaborative links generated during this project. The findings of this research will be disseminated to researchers and policy makers word wide.