Friday, 12 December 2014 05:31




Micronutrient malnutrition (MNM) is widespread in the developing regions of the world. It can affect all age groups, but young children and women of reproductive age tend to be among those most at risk of developing micronutrient deficiencies.

Micronutrient malnutrition has many adverse effects on human health. Even moderate levels of deficiency (which can be detected by biochemical or clinical measurements) can have serious detrimental effects on human function. Worldwide, the three most common forms of MNM are iron, vitamin A and iodine deficiency. Together, these affect at least one third of the world’s population, the majority of which are in developing countries. Of the three, iron deficiency is the most prevalent. It is estimated that just over 2 billion people are anaemic, just under 2 billion have inadequate iodine nutrition and 254 million preschool-aged children are vitamin A deficient .

In the poorer regions of the world, MNM is certain to exist wherever there is undernutrition due to food shortages and is likely to be common where diets lack diversity. Generally speaking, whereas wealthier population groups are able to augment dietary staples with micronutrient-rich foods (such as meat, fish, poultry, eggs, milk and dairy products) and have greater access to a variety of fruits and vegetables, poorer people tend to consume only small amounts of such foods, relying instead on more monotonous diets based on cereals, roots and tubers. The micronutrient content of cereals (especially after milling), roots and tubers is low, so these foods typically provide only a small proportion of the daily requirements for most vitamins and minerals. Fat intake among such groups is also often very low and given the role of fat in facilitating the absorption of a range of micronutrients across the gut wall, the low level of dietary fat puts such populations at further risk of MNM. Consequently, populations that consume few animal source foods may suffer from a high prevalence of several micronutrient deficiencies simultaneously.

The strategic method to control Micronutrient malnutrition is “FOOD FORTIFICATION” which refers to the addition of micronutrients to processed foods.

Food fortification is defined as the practice of deliberately increasing the content of essential micronutrients – vitamins and minerals – in a food so as to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health. The public health benefits of fortification includes:

• Prevention or minimization of the risk of occurrence of micronutrient deficiency in a population or specific population groups.

• Contribution to the correction of a demonstrated micronutrient deficiency in a population or specific population groups.

• Plausible beneficial effects of micronutrients consistent with maintaining or improving health (e.g. there is some evidence to suggest that a diet rich in selected anitoxidants might help to prevent cancer and other diseases).

Food fortification can take several forms. It is possible to fortify foods that are widely consumed by the general population (mass fortification), to fortify foods designed for specific population subgroups, such as complementary foods for young children or rations for displaced populations (targeted fortification) and/or to allow food manufacturers to voluntarily fortify foods available in the market place (market-driven fortification).

The choice between mandatory or voluntary food fortification usually depends on national circumstances.

Mass Fortification

Mass fortification is the term used to describe the addition of one or more micronutrients to foods commonly consumed by the general public, such as cereals, condiments and milk. It is usually instigated, mandated and regulated by the government sector.

Mass fortification is generally the best option when the majority of the population has an unacceptable risk, in terms of public health, of being or becoming deficient in specific micronutrients. In some situations, deficiency may be demonstrable, as evidenced by unacceptably low intakes and/or biochemical signs of deficiency. In others, the population may not actually be deficient according to usual biochemical or dietary criteria, but are likely to benefit from fortification. The mandatory addition of folic acid to wheat flour with a view to lowering the risk of birth defects, a practice which has been introduced in Canada and the United States, and also in many Latin American countries, is one example of the latter scenario.

Targeted Fortification

In targeted food fortification programmes, foods aimed at specific subgroups of the population are fortified, thereby increasing the intake of that particular group rather than that of the population as a whole. Examples include complementary foods for infants and young children, foods developed for school feeding programmes, special biscuits for children and pregnant women, and rations (blended foods) for emergency feeding and displaced persons.

The majority of blended foods for feeding refugees and displaced persons are managed by the World Food Programme (WFP) and guidelines covering their fortification (including wheat soy blends and corn soy blends) are already available. Although blended foods usually supply all or nearly the entire energy and protein intake of refugees and displaced individuals, especially in the earlier stages of dislocation, for historical reasons such foods may not always provide adequate amounts of all micronutrients. Therefore, other sources of micronutrients may need to be provided. In particular, it may be necessary to add iodized salt to foods, provide iron supplements to pregnant women or supply high-dose vitamin A supplements to young children and postpartum women. Whenever possible, fresh fruits and vegetables should be added to the diets of displaced persons relying on blended foods. Fortified foods for displaced persons are often targeted at children and pregnant or lactating women.

Market-driven Fortification

The term "market-driven fortification" is applied to situations whereby a food manufacturer takes a business-oriented initiative to add specific amounts of one or more micronutrients to processed foods. Although voluntary, this type of food fortification usually takes place within government-set regulatory limits.

Market-driven fortification can play a positive role in public health by contributing to meeting nutrient requirements and thereby reducing the risk of micronutrient deficiency. Market-driven fortification can also improve the supply of micronutrients that are otherwise difficult to add in sufficient amounts through the mass fortification of staple foods and condiments because of safety, technological or cost constraints. Examples include certain minerals (e.g. iron, calcium) and sometimes selected vitamins (e.g. vitamin C, vitamin B2).

Thus Food fortification can act as one of the most effective food-based approach especially in low per capita income countries for the fight against malnutrition and micronutrient deficiencies as it is considerably more cost-effective than supplementation.