Fortification strategies to meet micronutrient needs: sucesses and failures

Abstract

Food fortification is likely to have played an important role in the current nutritional health and well-being of populations in industrialized countries. Starting in the early part of the 20th century, fortification was used to target specific health conditions: goitre with iodized salt; rickets with vitamin D-fortified milk; beriberi, pellagra and anaemia with B-vitamins and Fe-enriched cereals; more recently, in the USA, risk of pregnancy affected by neural-tube defects with folic acid-fortified cereals. A relative lack of appropriate centrally-processed food vehicles, less-developed commercial markets and relatively low consumer awareness and demand, means it has taken about another 50 years for fortification to be seen as a viable option for the less-developed countries. The present paper reviews selected fortification initiatives in developing countries to identify different factors that contributed to their successful implementation, as well as the challenges that continually threaten the future of the se programmes. Ultimately, the long-term sustainability of fortification programmes is ensured when consumers are willing and able to bear the additional cost of fortified foods. There has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Considerable progress has been made in reducing vitamin A and I deficiencies, although less so with Fe, even as Zn and folic acid deficiencies are emerging as important public health problems. Food fortification based on sound principles and supported by clear policies and regulations can play an increasingly large role in this progress towards prevention and control of micronutrient malnutrition.

The Effectiveness of Mass Communication to Change Public Behavior

“…And finally, campaigns can be used to target members of the affected population-and/or the people who influence them-to encourage them to seek and purchase only fortified food staples. A recent review of the literature concluded that the most effective micronutrient fortification programs are those that take measures both to ensure the wide availability of fortified foods and to create consumer demand for such foods (13).…”

Hemoglobin curves during pregnancy before and after fortification of flours with iron

“…Although the food fortification is positively evaluated in many countries, this assertive is not clear for the iron fortification (16) . Besides, the real effects of this policy are not yet clear and must be considered, once declines in the anemia prevalence can result in structural changes in life conditions and, therefore, in the food offer, in eating patterns and in the improvement of access to health services.…”

Vitamin A Deficiency

“…Numerous foods have long been fortified in economies in which food production and marketing systems are highly industrialized, integrated, and readily reach the consumer [330,331]. Fortification is likely to be most effective when one or more food vehicles are widely consumed by high-risk groups, and their intake is reasonably narrow across other segments of a population (to minimize risk of overconsumption), processing and distribution are centralized (in a limited number of facilities to maintain quality control), organoleptic change from addition of vitamin A is imperceptible over time under ambient conditions, and costs of fortification are both small relative to the product itself and absorbable by the consumer [2,329,330,332,333].…”