Advantages and Limitations of Food Fortification
Being a food-based approach, food fortification offers a number of advantages over other interventions aimed at preventing and controlling MNM. These include:
- If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittent supplements. Fortified foods are also better at lowering the risk of the multiple deficiencies that can result from seasonal deficits in the food supply or a poor quality diet. This is an important advantage to growing children who need a sustained supply of micronutrients for growth and development, and to women of fertile age who need to enter periods of pregnancy and lactation with adequate nutrient stores. Fortification can be an excellent way of increasing the content of vitamins in breast milk and thus reducing the need for supplementation in postpartum women and infants.
- Fortification generally aims to supply micronutrients in amounts that approximate to those provided by a good, well-balanced diet. Consequently, fortified staple foods will contain “natural” or near natural levels of micronutrients, which may not necessarily be the case with supplements.
- Fortification of widely distributed and widely consumed foods has the potential to improve the nutritional status of a large proportion of the population, both poor and wealthy.
- Fortification requires neither changes in existing food patterns – which are notoriously difficult to achieve, especially in the short-term – nor individual compliance.
- In most settings, the delivery system for fortified foods is already in place, generally through the private sector. The global tendency towards urbanization means that an ever increasing proportion of the population, including that in developing countries is consuming industry-processed, rather than locally-produced, foods. This affords many countries the opportunity to develop effective strategies to combat MNM based on the fortification of centrally-processed dietary staples that once would have reached only a very small proportion of the population.
- Multiple micronutrient deficiencies often coexist in a population that has a poor diet. It follows that multiple micronutrient fortification is frequently desirable. In most cases, it is feasible to fortify foods with several micronutrients simultaneously.
- It is usually possible to add one or several micronutrients without adding substantially to the total cost of the food product at the point of manufacture.
- When properly regulated, fortification carries a minimal risk of chronic toxicity.
- Fortification is often more cost-effective than other strategies, especially if the technology already exists and if an appropriate food distribution system is in place
Although it is generally recognized that food fortification can have an enormous positive impact on public health, there are, however, some limitations to this strategy for MNM control:
- While fortified foods contain increased amounts of selected micronutrients, they are not a substitute for a good quality diet that supplies adequate amounts of energy, protein, essential fats and other food constituents required for optimal health.
- A specific fortified foodstuff might not be consumed by all members of a target population. Conversely, everyone in the population is exposed to increased levels of micronutrients in food, irrespective of whether or not they will benefit from fortification.
- Infants and young children, who consume relatively small amounts of food, are less likely to be able to obtain their recommended intakes of all micronutrients from universally fortified staples or condiments alone; fortified complementary foods may be appropriate for these age groups. It is also likely that in many locations fortified foods will not supply adequate amounts of some micronutrients, such as iron for pregnant women, in which case supplements will still be needed to satisfy the requirements of selected population groups.
- Fortified foods often fail to reach the poorest segments of the general population who are at the greatest risk of micronutrient deficiency. This is because such groups often have restricted access to fortified foods due to low purchasing power and an underdeveloped distribution channel. Many undernourished population groups often live on the margins of the market economy, relying on own-grown or locally produced food. Availability, access and consumption of adequate quantities and a variety of micronutrient-rich foods, such as animal foods and fruits and vegetables, is limited. Access to the food distribution system is similarly restricted and these population groups will purchase only small amounts of processed foods. Rice production, in particular, tends to be domestic or local, as does maize production. In populations who rely on these staples, it may be difficult to find an appropriate food to fortify. Fortification of sugar, sauces, seasonings and other condiments may provide a solution to this problem in some countries, if such products are consumed in sufficient amounts by target groups.
- Very low-income population groups are known to have coexisting multiple micronutrient deficiencies, as a result of inadequate intakes of the traditional diet. Although multiple micronutrient fortification is technically possible, the reality is that the poor will be unable to obtain recommended intakes of all micronutrients from fortified foods alone.
- Technological issues relating to food fortification have yet to be fully resolved, especially with regard to appropriate levels of nutrients, stability of fortificants, nutrient interactions, physical properties, as well as acceptability by consumers including cooking properties and taste
- The nature of the food vehicle, and/or the fortificant, may limit the amount of fortificant that can be successfully added. For example, some iron fortificants change the colour and flavour of many foods to which they are added, and can cause the destruction of fortificant vitamin A and iodine. Ways of solving some of these problems (e.g. microencapsulation of fortificants with protective coatings) have been developed, but some difficulties remain
- While it is generally possible to add a mixture of vitamins and minerals to relatively inert and dry foods, such as cereals, interactions can occur between fortificant nutrients that adversely affect the organoleptic qualities of the food or the stability of the nutrients. Knowledge is lacking about the quantitative impact of interactions among nutrients that are added as a mixture on the absorption of the individual nutrients. This complicates the estimation of how much of each nutrient should be added. For example, the presence of large amounts of calcium can inhibit the absorption of iron from a fortified food; the presence of vitamin C has the opposite effect and increases iron absorption.
- Although often more cost-effective than other strategies, there are nevertheless significant costs associated with the food fortification process, which might limit the implementation and effectiveness of food fortification programmes. These typically include start-up costs, the expense of conducting trials for micronutrient levels, physical qualities and taste, a realistic analysis of the purchasing power of the expected beneficiaries, the recurrent costs involved in creating and maintaining the demand for these products, as well as the cost of an effective national surveillance system to ensure that fortification is both effective and safe
To ensure their success and sustainability, especially in resource-poor countries, food fortification programmes should be implemented in concert with poverty reduction programmes and other agricultural, health, education and social intervention programmes that promote the consumption and utilization of adequate quantities of good quality nutritious foods among the nutritionally vulnerable. Food fortification should thus be viewed as a complementary strategy for improving micronutrient status.
Source : WHO (2006) Guidelines on food fortification with micronutrients, edited by Lindsay Allen et al. World Health Organization and Food and Agriculture Organization of the United Nations