Considerations on the food fortification policy in Brazil

Abstract

Government health authorities approved, in December 2002, the ANVISA (National Sanitary Vigilance Agency) resolution number 344, making the addition of iron and folic acid to all wheat and maize flours industrialized in Brazil obligatory. After a brief review of iron deficiency, iron overload and folic acid deficiency several questions and remarks need to be made about this universal food fortification program. Iron salts and folic acid are drugs widely used in medicine and they may present undesirable side effects. There are potential risks with offering iron to the normal population for a long period of time and to patients with iron overload. Other important remarks are: there is no medical follow up of this treatment in the Brazilian population; patients can decide the quantity of foods (and of these nutrients) that they want to ingest; fortified foods may correct iron deficiency anemia but not necessarily the causes, which include gastrointestinal neoplasms; and folic acid in the diet may interfere with several treatment protocols that use folic acid antagonists, such as methotrexate. Finally, with the exception of some social programs, the costs of treatment using fortified foods are passed on to the population. Considering that Brazil has 330,000 active medical doctors it is suggested that our Health Ministry should invite them to take care of these important medical conditions.

Micronutrient Intake in Healthy Toddlers: A Multinational Perspective

“…While folate intake was found to be inadequate for up to 64% of German toddlers, this was the case in fewer than 10% of Brazilian and US toddlers (FITS only). One explanation for these cross-national differences might be the implementation of policies in Brazil and the United States which require fortification of grain products with folic acid [ 43 , 44 ]. For example, 100 g of wheat or maize flour must be fortified with 150 µg of folic acid in Brazil and 100 g of all cereal grains must be fortified with 140 µg of folic acid in the United States [ 43 , 44 ].…”

“…One explanation for these cross-national differences might be the implementation of policies in Brazil and the United States which require fortification of grain products with folic acid [ 43 , 44 ]. For example, 100 g of wheat or maize flour must be fortified with 150 µg of folic acid in Brazil and 100 g of all cereal grains must be fortified with 140 µg of folic acid in the United States [ 43 , 44 ]. Such food fortification with folate is not very common across Europe [ 45 ], which might explain inadequate intakes found also in older age groups from this region.…”

Universal iron fortification of foods: the view of a hematologist

“…In a recent work entitled "Considerations on the food fortification with iron and folic acid" published in the Revista Brasileira de Hematologia e Hemoterapia we demonstrated our concern about this measure (6) .…”

Goals, globalization and the impact factor of the journal

“…Submissions until then had basically been limited to the states of Rio de Janeiro and São Paulo but with this change there was an increase in the numbers of contributions from every state in the country 1 . In order to illustrate this, I will mention subject matters such as the damaging effect of the fortification of flour with iron, 2 , 3 Dengue fever, 4 - 8 the compassionate use of cell therapy in the country, 9 articles on the Associação Médica Brasileira (AMB) and Associação Brasileira de Hematologia, Hemoterapia e Terapia Celular (ABHH) guidelines project 10 - 14 and many others of scientific and national interest that were published and had a great impact. I endorse this and ask the readers a question: would the themes mentioned be accepted by a journal published in another country?…”