Micronutrient restoration and fortification: Communicating change, benefits and risks

Food fortification has played a significant role in the current nutritional health and well-being of populations in industrialized countries for over 70 years. A relative lack of a concentrated food processing chain, less developed commercial markets, and relatively low consumer awareness and demand have hindered the same application of the intervention in the transitional, and even more, in the least developed countries until quite recently. The present paper reviews fortification of foods with micronutrients in advantaged (industrialized), transitional (developing) and least developed countries briefly, including reference to bio-fortification, examining some of the public health issues involved. There are different needs and challenges in getting this technology accepted and making it sustainable. Primary constraints in reaching poor target populations are adequate availability, accessibility, and quality assurance/quality control. The paper then examines some issues of risk and benefit and the communication of these, and finally looks towards the future and draws some conclusions. Despite these issues there has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Along with dietary diversification, supplementation and related public health and private sector interventions, this has resulted in considerable progress in reducing the prevalence of vitamin A and iodine deficiencies, but much less so with iron, even as zinc and folic acid deficiencies have emerged as significant public health problems. Food fortification based on sound principles and supported by clear policies and regulations will play an increasingly large role in the progress towards the prevention and control of micronutrient malnutrition. Success and sustainability require clear communication of the small risks involved and the substantial benefits, particularly to populations with significant levels of micronutrient malnutrition, as a complementary approach with other public health measures, in reducing the prevalence of deficiencies and their health consequences.