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Public health aspects of food fortification: a question of balance

Published online by Cambridge University Press:  07 March 2007

Reginald J. Fletcher ,
Ian P. Bell  and
Janet P. Lambert
Reginald J. Fletcher*
Affiliation:
Kellogg Europe, Talbot Road, Manchester, M16 0PU, UK
Ian P. Bell
Affiliation:
Kellogg Europe, Talbot Road, Manchester, M16 0PU, UK
Janet P. Lambert
Affiliation:
Lambert Nutrition Consultancy, 5 Britwell Road, Watlington, OX49 5JS, UK
*
*Corresponding author: Reginald J. Fletcher, fax +44 161 869 2103, email [email protected]
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Abstract

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Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O2 permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.

Keywords

Food fortificationMicronutrient intakes
Type
Symposium on ‘Micronutrient interactions and public health’
Information
Proceedings of the Nutrition Society , Volume 63 , Issue 4 , November 2004 , pp. 605 - 614
Copyright
Copyright © The Nutrition Society 2004

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