Guidelines on food fortification with micronutrients - Nutritotal

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1. MICRONUTRIENT MALNUTRITION: A PUBLIC HEALTH PROBLEMthe World Health Assembly passed a landmark resolution urging action byMember States “to prevent and control iodine deficiency disorders” (20). Laterthat year, at the World Summit for Children, the world’s leaders endorsed the“virtual elimination of iodine and vitamin A deficiency and a reduction of theprevalence of iron-deficiency anaemia in women by one third”.These goals havebeen reiterated at a number of subsequent international fora, including theMontreal conference on Ending Hidden Hunger in 1991, the 1992 FAO/WHOInternational Conference on Nutrition held in Rome, the 1993 World HealthAssembly held in Geneva, and the Special Session on Children of the UnitedNations General Assembly, which was held in New York in 2002.There has beenremarkable degree of consensus and support for MNM control between governments,United Nations agencies, multilateral and bilateral agencies, academicand research institutions, nongovernmental organizations (NGOs) and donorfoundations. More recently, following recognition of the essential role played byindustry – in particular, the salt, food and drug industries – stronger links withthe private sector have been forged. This is reflected by the implementation ofseveral public–private coalitions aimed at addressing the main micronutrientdeficiencies, which include the Global Alliance for Improved Nutrition 1 and TheGlobal Network for Sustained Elimination of Iodine Deficiency 2 .1.2 Strategies for the control of micronutrient malnutritionThe control of vitamin and mineral deficiencies is an essential part of the overalleffort to fight hunger and malnutrition. Countries need to adopt and support acomprehensive approach that addresses the causes of malnutrition and the oftenassociated “hidden hunger” which rest intinsic to in poverty and unsustainablelivelihoods. Actions that promote an increase in the supply, access, consumptionand utilization of an adequate quantity, quality and variety of foods for allpopulations groups should be supported. The aim is for all people to be able toobtain from their diet all the energy, macro- and micronutrients they need toenjoy a healthy and productive life.Policy and programme responses include food-based strategies such asdietary diversification and food fortification, as well as nutrition education,public health and food safety measures, and finally supplementation. Theseapproaches should be regarded as complementary, with their relative importancedepending on local conditions and the specific mix of local needs.Of the three options that are aimed at increasing the intake of micronutrients,programmes that deliver micronutrient supplements often provide the fastestimprovement in the micronutrient status of individuals or targeted population12See http://www.gainhealth.org.See http://www.iodinenetwork.net.11
GUIDELINES ON FOOD FORTIFICATION WITH MICRONUTRIENTSgroups. Food fortification tends to have a less immediate but nevertheless amuch wider and more sustained impact. Although increasing dietary diversityis generally regarded as the most desirable and sustainable option, it takes thelongest to implement.1.2.1 Increasing the diversity of foods consumedIncreasing dietary diversity means increasing both the quantity and the range ofmicronutrient-rich foods consumed. In practice, this requires the implementationof programmes that improve the availability and consumption of, and accessto, different types of micronutrient-rich foods (such as animal products, fruitsand vegetables) in adequate quantities, especially among those who at risk for,or vulnerable to, MNM. In poorer communities, attention also needs to be paidto ensuring that dietary intakes of oils and fats are adequate for enhancing theabsorption of the limited supplies of micronutrients.Increasing dietary diversity is the preferred way of improving the nutrition ofa population because it has the potential to improve the intake of many foodconstituents – not just micronutrients – simultaneously. Ongoing research suggeststhat micronutrient-rich foods also provide a range of antioxidants andprobiotic substances that are important for protection against selected noncommunicablediseases and for enhancing immune function. However, as astrategy for combating MNM, increasing dietary diversity is not without its limitations,the main one being the need for behaviour change and for educationabout how certain foods provide essential micronutrients and other nutritivesubstances. A lack of resources for producing and purchasing higher qualityfoods can sometimes present a barrier to achieving greater dietary diversity,especially in the case of poorer populations. The importance of animal sourcefoods for dietary quality is increasingly being recognized, and innovativeapproaches to increase their production and consumption in poorer regions ofthe world are currently being explored (21). Efforts are also underway to helppoorer communities identify, domesticate and cultivate traditional and wildmicronutrient-rich foods as a simple and affordable means of satisfyingmicronutrient needs (22–24).For infants, ensuring a diet of breast milk is an effective way of preventingmicronutrient deficiencies. In much of the developing world, breast milk is themain source of micronutrients during the first year of life (with the exceptionof iron). Exclusive breastfeeding for the first 6 months of life and continuationinto the second year should thus be promoted. Moreover, all lactating womenshould be encouraged to consume a healthful and varied diet so that adequatelevels of micronutrients are secreted in their milk. After the age of 6 months, itis important that the complementary foods provided to breast-fed infants are asdiverse and as rich in micronutrients as possible.12
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Page 13 and 14: List of tablesTable 1.1 Prevalence
Page 17 and 18: ForewordInterest in micronutrient m
Page 21 and 22: PrefaceMore than 2 billion people i
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Page 34: PA RT IThe role of food fortificati
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Page 57 and 58: CHAPTER 2Food fortification: basic
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GUIDELINES ON FOOD FORTIFICATION WI
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IntroductionBy providing a critical
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CHAPTER 5Iron, vitamin A and iodine
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5. IRON, VITAMIN A AND IODINEto phy
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5. IRON, VITAMIN A AND IODINEdiet,
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5. IRON, VITAMIN A AND IODINEcompou
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5. IRON, VITAMIN A AND IODINETABLE
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5. IRON, VITAMIN A AND IODINEtortil
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5. IRON, VITAMIN A AND IODINEnumber
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5. IRON, VITAMIN A AND IODINEstool
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5. IRON, VITAMIN A AND IODINETABLE
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5. IRON, VITAMIN A AND IODINEvitami
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5. IRON, VITAMIN A AND IODINE— in
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5. IRON, VITAMIN A AND IODINEiodine
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5. IRON, VITAMIN A AND IODINEdevelo
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5. IRON, VITAMIN A AND IODINEhypert
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6. ZINC, B VITAMINS, VITAMINS C AND
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PA RT I VImplementing effectiveand
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CHAPTER 8Monitoring and evaluationM
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CHAPTER 10Communication, social mar
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CHAPTER 11National food lawGovernme
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Further readingPart I. The role of
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ANNEX AIndicators for assessing pro
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ANNEX BThe international resource l
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B. THE INTERNATIONAL RESOURCE LABOR
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ANNEX CConversion factors for calcu
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C. CONVERSION FACTORS FOR CALCULATI
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D. A PROCEDURE FOR ESTIMATING FEASI
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ANNEX EA quality control monitoring
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E. A QUALITY CONTROL MONITORING SYS
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E. A QUALITY CONTROL MONITORING SYS
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F. THE CODEX ALIMENTARIUS AND THE W
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IndexAdequate Intake (AI), 146Advoc
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INDEXLower Threshold Intake, 146Rec
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INDEXGambia, Theberiberi, 71calcium
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INDEXMalaysiaiodine fortification,
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INDEXKeshan Disease, 88prevalence o
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INDEXhealth consequences of, 84oste
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