Guidelines on food fortification with micronutrients - Nutritotal

1. MICRONUTRIENT MALNUTRITION: A PUBLIC HEALTH PROBLEMoccurred over the same period of time. Evidence that food fortification programmesdo indeed improve nutritional status has therefore tended to comefrom either efficacy trials and/or reports of programme effectiveness. Efficacytrials, i.e. trials conducted in controlled feeding situations, are relatively numerousand have usefully documented the impact of fortified foods on nutritionalstatus and other outcomes. Evidence of programme effectiveness, which isobtained by assessing changes in nutritional status and other outcomes oncea programme has been implemented, is less widely available. Of the feweffectiveness studies that have been conducted, even fewer included a noninterventioncontrol group, an omission that weakens the evidence that can beobtained from studies of this type.1.3.1 Efficacy trialsAs indicated above, efficacy trials evaluate the impact of a test intervention underideal circumstances. In the case of food fortification, this typically involves alltest subjects consuming a known amount of the fortified food. In the majorityof efficacy trials conducted to date, fortified foods have been shown to improvemicronutrient status. Selected examples, involving a range of micronutrients, arebriefly described below. The general principles of programme impact evaluation,including the design of efficacy trials, are discussed in greater detail inChapter 8 of these guidelines.1.3.1.1 Iron fortificationIn Viet Nam, 6-month efficacy trials have established that fortification of fishsauce with iron can significantly improve iron status and reduce anaemia andiron deficiency (28). The subjects were non-pregnant anaemic female factoryworkers who consumed 10 ml per day of a sauce that was fortified with 100 mgiron (as NaFeEDTA) per 100 ml. Figure 1.1 illustrates the effect of the interventionon iron deficiency and iron-deficiency anaemia; both were significantlyreduced after 6 months in the group receiving the fortified sauce relative to theplacebo control group.In China, a series of studies have been conducted to assess the efficacy, effectivenessand feasibility of fortifying soy sauce with iron (in the form ofNaFeEDTA). Daily consumption of 5 mg or 20 mg iron in the fortified saucewas reported to be very effective in the treatment of iron-deficiency anaemia inchildren; positive effects were seen within 3 months of the start of the intervention(J. Chen, cited in (29). In a double-blind placebo-controlled effectivenesstrial of the iron-fortified sauce, involving about 10 000 children and women,a reduction in the prevalence of anaemia was observed within 6 months (seealso section 1.3.2.2).15