Guidelines on food fortification with micronutrients
Type of Paper: World Health Organization (WHO) Guidelines
Purpose: In 2002, the WHO established an expert group to create guidelines to assist countries in establishing and implementing food fortification programs. The publication of these guidelines provides a thorough review of the worldwide problem of micronutrient malnutrition.
The guidelines are composed of several sections. This summary will focus on Chapter 1, Micronutrient malnutrition: a public health problem as well as information throughout the report that refers to general micronutrient malnutrition.
The Global Prevalence of Micronutrient Malnutrition:
- More than 2 billion people across the globe are estimated to have one or more micronutrient deficiency. The primary cause of a deficiency is an inadequate intake of vitamins and minerals.
- The three most common types of micronutrient malnutrition are iron, vitamin A, and iodine deficiency.
- At least one-third of the world’s population is affected by these three deficiencies. The majority of those affected are in developing countries.
- Iron deficiency is the most prevalent micronutrient deficiency worldwide.
- Less is known about the prevalence and impact of other micronutrient deficiencies. Zinc, folate, and vitamin D deficiencies likely have a large effect on the global burden of disease.
Risk Factors for Micronutrient Malnutrition:
- The risk factors for micronutrient malnutrition in general include:
- Lack of variety in the diet resulting in (1) low micronutrient content and (2) poor bioavailability, especially of minerals
- Low intake of animal source foods
- Low rate of breastfeeding
- Low micronutrient content of complementary foods
- Increased nutritional demands for growth during pregnancy and lactation
- Increased nutritional demands due to acute infection (especially if infections are frequent), chronic infections (e.g., tuberculosis, malaria, HIV/AIDS), and diseases
- Poor general nutritional status (e.g., protein-energy/macronutrient malnutrition)
- Malabsorption due to diarrhea or the presence of intestinal parasites (e.g., Giardia lamblia, hookworms)
- Increased excretion (e.g., due to the parasite schistosomiasis)
- Food shortages or seasonal variation in food availability
- Social deprivation, illiteracy, low education
- Poverty and poor economic status
- Poorer populations are at risk because they:
- Consume a monotonous diet primarily consisting of cereals, roots, and tubers which have low micronutrient content.
- Have less access to micronutrient-rich foods (meat, dairy products, and varieties of fruits and vegetables).
- Have a low fat intake (fat facilitates the absorption of fat-soluble vitamins).
- Consume few animal source foods, which are a rich source of several micronutrients.
- In wealthier populations, the increased consumption of highly processed foods that are energy-dense (high in kilocalories) but micronutrient-poor increases the risk for micronutrient malnutrition. This is also becoming a problem in nations that are undergoing socio-economic transitions.
- Although micronutrient deficiencies are more prevalent in developing countries, they are also a problem in developed countries, particularly for iron and iodine deficiency.
- When there is a dietary deficiency of one nutrient, there is likely to be deficiencies of other nutrients.
Health Consequences of Deficiencies
- The World Health Report, published by the WHO in 2000, described the deficiencies of iodine, iron, vitamin A, and zinc as among the world’s most serious health risk factors.
- Preventing and treating micronutrient malnutrition has the potential to help control diseases such as HIV/AIDS, malaria, tuberculosis, and chronic diseases.
- Three strategies for improving the intake of micronutrients include:
- Micronutrient supplementation:
- Definition: providing large doses of micronutrients often in the form of pills, capsule, or syrups.
- This is the fastest method for improving micronutrient status in targeted groups.
- Food fortification:
- Definition: the addition of micronutrients to processed foods (such as flours).
- The effects are not as immediate as supplementation, but have a broader and more sustained impact on populations.
- Increasing dietary diversity:
- Definition: increasing the access to and consumption of a variety of micronutrient-rich foods including animal products and fruits and vegetables. Adequate fats and oils need to also be available for promoting absorption of some micronutrients.
- Although this intervention is the most preferable and sustainable strategy for improving micronutrient status, it takes the longest time to implement.
- In infants over six months, complementary foods should also be diverse and micronutrient-rich.
- Other considerations:
- Public health and food safety measures: Micronutrient malnutrition is often associated with poor overall nutritional status and the presence of infections. Therefore, measures such as infection control (e.g., immunization, parasite control) and clean water and sanitation are important in reducing micronutrient malnutrition.
- Nutrition education: Quality of child care and maternal education are also important in reducing micronutrient malnutrition.
Strategies to Control Micronutrient Malnutrition: The best way to prevent micronutrient malnutrition is to consume a diet that is balanced and adequate in every nutrient.