Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-19T09:12:57.603Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk analysis applied to food fortification

Published online by Cambridge University Press:  02 January 2007

Helle M Meltzer ,
Antti Aro ,
Niels Lyhne Andersen ,
Bente Koch  and
Jan Alexander
Helle M Meltzer*
Affiliation:
NorwegianInstitute of Public Health, Oslo, Division of Environmental Medicine, PO Box 4404 Nydalen, N-0403 Oslo, Norway:
Antti Aro
Affiliation:
National Public Health Institute, Mannerheimvägen 166, FIN-00300 Helsinki, Finland:
Niels Lyhne Andersen
Affiliation:
Danish Veterinary and Food Administration, Mørkhøj Bygade 19, DK-2860 Søborg, Denmark
Bente Koch
Affiliation:
Danish Veterinary and Food Administration, Mørkhøj Bygade 19, DK-2860 Søborg, Denmark
Jan Alexander
Affiliation:
NorwegianInstitute of Public Health, Oslo, Division of Environmental Medicine, PO Box 4404 Nydalen, N-0403 Oslo, Norway:
*
*Corresponding author: Email [email protected].
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objective:

To describe how a risk analysis can be applied to food fortification, with emphasis on voluntary fortification and intake levels that might exceed usual dietary levels.

Design:

Use of the risk analysis model as a frame to classify nutrients according to the risk of exceeding upper safe intake levels. Furthermore, to apply the model when discussing possible consequences of liberal fortification practices on eating behaviour and disease patterns.

Setting:

The discussion on food fortification presently going on internationally.

Results:

Micronutrients can be classified according to their safety margin, i.e. the size of the interval between the recommended intake and the upper safe level of intake. We suggest that nutrients with a small safety margin, i.e. for which the upper safe level is less than five times the recommended intake, be placed in a category A and should be handled with care (retinol, vitamin D, niacin, folate and all minerals). Category B comprises nutrients with an intermediate safety margin (vitamins E, B6, B12 and C), while nutrients that according to present knowledge are harmless even at 100 times the recommendation (vitamin K, thiamin, riboflavin, pantothenic acid and biotin) are categorised as C.

Discussion:

The risk analysis model is a useful tool when assessing the risk of both too low and excess intakes of single micronutrients, but can also be applied to analyse the consequences of fortification practices on eating behaviour and disease patterns. Liberal fortification regulations may, for example, distort the conception of what is healthy food, and drive consumption towards a more unhealthy diet, contributing to the plague of overweight and concomitant increased risk of degenerative diseases.

Conclusion:

The impact of fortification practices on the total eating pattern of a population should become an integrated part of the discussions and regulations connected to the issue.

Keywords

FortificationFoodRisk analysisDiscussion paper
Type
Research Article
Information
Public Health Nutrition , Volume 6 , Issue 3 , June 2003 , pp. 281 - 290
Copyright
Copyright © CAB International 2003

References

1Codex Alimentarius A1. General Principles for the Addition of Essential Nutrients to Foods. Vol. 4. CAC/GL 09-1987 (amended 1989, 1991). Rome: 1994.Google Scholar
2 DG III of the European Commission, ed. Addition of Vitamins and Minerals to Foods and Food Supplements. III/5934/97. Brussels: 1997.Google Scholar
3SCOOP Task 7.1.1 Working Group. Scientific Considerations for the Development of Measures on the Addition of Vitamins and Minerals to Foodstuffs. The Netherlands: TNO Nutrition and Food Research Institute, 1996.Google Scholar
4Mathews, TJ, Honein, MA, Erickson, JD. Spina bifida and anencephaly prevalence – United States, 1991-2001. MMWR Recomm. Rep. 2002; 51: 9–11.Google ScholarPubMed
5Honein, MA, Paulozzi, LJ, Mathews, TJ, Erickson, JD, Wong, LY. Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. J. Am. Med. Assoc. 2001; 285: 2981–6.CrossRefGoogle ScholarPubMed
6Meltzer, HM, Alexander, J, the Food Authorities in the Nordic Countries. Addition of Vitamins and Minerals. A Discussion Paper on Health Risks Related to Foods and Food Supplements. TemaNord 2001:519. Copenhagen: Nordic Council of Ministers, 2001.Google Scholar
7Vose, D. Risk Analysis: A Quantitative Guide, 2nd ed. Chichester, UK: Wiley, 2000.Google Scholar
8Codex Alimentarius Commission. Application of Risk Analysis to Food Standard Issues. Food and Nutrition Paper No. 65. Rome: Food and Agriculture Organization, 1997.Google Scholar
9Suzuki, H, Higuchi, T, Sawa, K, Ohtaki, S, Horiuchi, Y. ‘Endemic coast goitre’ in Hokkaido Japan. Acta Endocrinol. (Copenh.) 1965; 50: 161–76.Google ScholarPubMed
10Yang, GQ, Wang, SZ, Zhou, RH, Sun, SZ. Endemic selenium intoxication of humans in China. Am. J. Clin. Nutr. 1983; 37: 872–81.CrossRefGoogle ScholarPubMed
11Hirsch, S, de la Maza, P, Barrera, G, Gattas, V, Petermann, M, Bunout, D. The Chilean flour folic acid fortification program reduces serum homocysteine levels and masks vitamin B-12 deficiency in elderly people. J. Nutr. 2002; 132: 289–91.CrossRefGoogle ScholarPubMed
12Mills, JL. Fortification of foods with folic acid – how much is enough? N. Engl. J. Med. 2000; 342: 1442–5.CrossRefGoogle Scholar
13Singhal, A, Morley, R, Abbott, R, Fairweather-Tait, S, Stephenson, T, Lucas, A. Clinical safety of iron-fortified formulas. Pediatrics 2000; 105: E38CrossRefGoogle ScholarPubMed
14The National Council on Nutrition and Physical Activity. Vurdering av EU-direktivet for barnemat – ernæringsmessige konsekvenser [Nutritional Consequences of the EU Directive on Infant Foods]. Oslo: The National Council on Nutrition and Physical Activity, 1998.Google Scholar
15Suojanen, A, Raulio, S, Ovaskainen, M-L. Liberal fortification of foods: the risks. A study relating to Finland. J. Epidemiol. Community Health 2002; 56: 259–64.CrossRefGoogle ScholarPubMed
16Seelig, MS. Vitamin D and cardiovascular, renal, and brain damage in infancy and childhood. Ann. NY Acad. Sci. 1969; 147: 539–82.CrossRefGoogle ScholarPubMed
17Blank, S, Scanlon, KS, Sinks, TH, Lett, S, Falk, H. An outbreak of hypervitaminosis D associated with the overfortification of milk from a home-delivery dairy. Am. J. Public Health 1995; 85: 656–9.CrossRefGoogle ScholarPubMed
18Sandström, B, Aro, A, Becker, W, Lyhne, N, Pedersen, JI, Torsdottir, I. Nordiska näringsrekomendationer 1996 [Nordic Nutrition Recommendations 1996]. Copenhagen: Nordic Council of Ministers, 1996.Google Scholar
19Food and Nutrition Board, Institute of Medicine. Dietary Reference Intakes: A Risk Assessment Model for Establishing Upper Intake Levels for Nutrients. Washington, DC: National Academy Press, 1998.Google Scholar
20Trumbo, P, Yates, AA, Schlicker, S, Poos, M. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. J. Am. Diet. Assoc. 2001; 101: 294–301.CrossRefGoogle ScholarPubMed
21 Scientific Committee on Food E. Tolerable Upper Intake Levels for Vitamins and Minerals [online]. Available at http://europa.eu.int/comm/food/fs/sc/scf/out80_en.html, 2002.Google Scholar
22Report of the Scientific Committee for Food. Nutrient and Energy Intakes for the European Community. Luxembourg: Commission of the European Communities, 1993.Google Scholar
23Ziegler, EE, Filer, LJ. Present Knowledge in Nutrition, 7th ed. Washington, DC: International Life Sciences Institute, 1996.Google Scholar
24Shils, ME, Olson, JA, Shike, M, Ross, AC. Modern Nutrition in Health and Disease, 9th ed. Baltimore, MD: Lippincott Williams & Wilkins, 1999.Google Scholar
25Sandstrom, B. Micronutrient interactions: effects on absorption and bioavailability. Br. J. Nutr. 2001; 85(Suppl. 5): S181–5.CrossRefGoogle ScholarPubMed
26Solomons, NW, Jacob, RA. Studies on the bioavailability of zinc in humans: effects of heme and nonheme iron on the absorption of zinc. Am. J. Clin. Nutr. 1981; 34: 475–82.CrossRefGoogle ScholarPubMed
27Craig, WJ, Balbach, L, Vyhmeister, N. Zinc bioavailability and infant formulas. Am. J. Clin. Nutr. 1984; 39: 981–3.CrossRefGoogle ScholarPubMed
28Barclay, SM, Aggett, PJ, Lloyd, DJ, Duffty, P. Reduced erythrocyte superoxide dismutase activity in low birth weight infants given iron supplements. Pediatr. Res. 1991; 29: 297–301.CrossRefGoogle ScholarPubMed
29 European Union. European Parliament and Council Directive No. 94/35/EC of 30 June 1994 on sweeteners for use in foodstuffs.Google Scholar
30 European Union. European Parliament and Council Directive No. 94/36/EC of 30 June 1994 on colours for use in foodstuffs.Google Scholar
31 European Union. European Parliament and Council Directive No. 95/2/EC of 20 February 1995 on food additives other than colours and sweeteners.Google Scholar
32Kroes, R, Muller, D, Lambe, J, Lowik, MR, van Klaveren, J, Kleiner, J, et al. . Assessment of intake from the diet. Food Chem. Toxicol. 2002; 40: 327–85.CrossRefGoogle ScholarPubMed
33Lambe, J, Cadby, P, Gibney, M. Comparison of stochastic modelling of the intakes of intentionally added flavouring substances with theoretical added maximum daily intakes (TAMDI) and maximized survey-derived daily intakes (MSDI). Food Addit. Contam. s2002; 19: 2–14.CrossRefGoogle ScholarPubMed
34Carriquiry, AL. Assessing the prevalence of nutrient inadequacy. Public Health Nutr. 1999; 2: 23–33.CrossRefGoogle ScholarPubMed
35Hunter, D. Biochemical indicators of dietary intake. In: Willett, WC, ed. Nutritional Epidemiology. New York: Oxford University Press, 1998; 174–243.Google Scholar
36Bundred, P, Kitchiner, D, Buchan, I. Prevalence of overweight and obese children between 1989 and 1998:population based series of cross sectional studies. Br. Med. J. 2001; 322: 326–8.CrossRefGoogle ScholarPubMed
37Chinn, S, Rona, RJ. Prevalence and trends in overweight and obesity in three cross sectional studies of British children, 1974-94. Br. Med. J. 2001; 322: 24–6.CrossRefGoogle ScholarPubMed
38Bonner, G, Warwick, H, Barnardo, M, Lobstein, T. Fortification Examined. How Added Nutrients Can Undermine Good Nutrition. London: The Food Commission (UK) Ltd, 1999.Google Scholar
39Gussow, JD, Akabas, S. Are we really fixing up the food supply? J. Am. Diet. Assoc. 1993; 93: 1300–4.CrossRefGoogle ScholarPubMed
40Mertz, W. Food fortification in the United States. Nutr. Rev. 1997; 55: 44–9.CrossRefGoogle ScholarPubMed
41Backstrand, JR. The history and future of food fortification in the United States: a public health perspective. Nutr. Rev. 2002; 60: 15–26.CrossRefGoogle ScholarPubMed
42King, H, Rewers, M. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults WHO Ad Hoc Diabetes Reporting Group. Diabetes Care 1993; 16: 157–77.CrossRefGoogle ScholarPubMed