Symposium: Food Fortification in Developing Countries Overview of Experimental Biology 2005 Symposium: Food Fortification in Developing Countries

Micronutrient malnutrition is a major global public health problem affecting more than a third of the world population. Consequences of this malnutrition are widespread and severe. It has been estimated that iron deficiency impairs the mental development of 40 to 60% of children in developing countries, vitamin A deficiency affects 40% of children,5 y of age in the developing world and is a factor in .1 million child deaths per year, and iodine deficiency during pregnancy causes mental impairment in 18 million babies born every year (1). Several strategies have been proposed to address the problem. They include food fortification, dietary diversification, dietary supplementation, nutrition education, and public health measures to control intestinal parasites and other infectious diseases. Although significant reductions in the high prevalences of micronutrient malnutrition will require multiple, complementary approaches, food fortification, the focus of this symposium, is arguably the most cost-effective and practically feasible strategy over the near term. Fortification has been a major strategy aimed at improving the nutritional quality of the food supply in industrialized countries for many decades but has only recently been applied in many developing countries. Several conditions are necessary for a successful national food fortification program. These include nutritional surveillance procedures to assess the prevalence of malnutrition and the shortfall of individual nutrients in the food supply; a suitable food vehicle that is widely consumed, especially by population groups most at risk for deficiency; centralized food-processing infrastructure, and technical expertise to ensure uniform addition of the nutrients to the food at low costs; availability of fortificants in forms that are stable to storage and cooking and that do not cause changes in the appearance or flavor of the food; suitable government oversight and quality control procedures to monitor addition to the food vehicle; an education program to inform people of the benefits of consuming fortified foods; and continued nutritionmonitoring programs to assess the impact of fortification and to guard against excessive intakes of nutrients. A recent WHO publication titled ‘‘Guidelines on Food Fortification with Micronutrients for the Control of Micronutrient Malnutrition’’ (2) provides a comprehensive overview of food fortification in developing countries. Although many if not all of the above conditions are in place in most industrialized nations, many less-developed countries lack the resources to meet them, creating difficult challenges for implementing successful fortification programs. This symposium addressed some of these challenges and offered some solutions. The authors represent a variety of academic disciplines, demonstrating the breadth of expertise needed to understand the limitations to food fortification as it applies to developing countries and the novel approaches needed to overcome technical, nutritional, social, and economic challenges in these resource-limiting settings. Lindsay Allen, a nutrition scientist, reviews the basic elements of successful food fortification programs, pointing out constraints to their implementation in less-developed countries. She suggests a series of formative research procedures that should be considered by nutrition scientists to improve program success. Haile Mehansho, a food scientist, describes a new technology for adding iron to foods that prevents the adverse changes in appearance, taste, and stability that often occur. With this technology, iron is stabilized using a combination of encapsulation, chelation, and redox modulation. The bioavailability of the stabilized iron added to a powdered fruit beverage was comparable to that of ferrous sulfate. Penelope Nestel and her co-authors, who represent the diverse disciplines of nutrition, economics, and plant breeding, describe a promising new approach called biofortification. With this strategy, staple food crops such as rice, wheat, maize, and sweet potatoes are enriched with selected micronutrients through plant breeding. The nutritionally enhanced seeds are then distributed to farmers who plant them and harvest crops with increased micronutrient density. The authors conclude that biofortification is technically feasible and that the nutritionally enhanced foods can help to control micronutrient deficiencies. Susan Horton, an economist, reviews some of the literature on cost-effectiveness and cost-benefit of food fortification strategies as they apply to developing countries. She reports that fortification of selected nutrients has been shown to have a 1 Presented as part of the symposium ‘‘Food Fortification in Developing Countries’’ given at the 2005 Experimental Biology meeting, April 5, 2005, in San Diego, CA. The symposium was sponsored by the American Society for Nutrition and the Society for International Nutrition Research and was supported in part by an educational grant from Akzo Nobel, Inc. The proceedings are published as a supplement to The Journal of Nutrition. This supplement is the responsibility of the editors to whom the Editor of The Journal of Nutrition has delegated supervision of both technical conformity to the published regulations of The Journal of Nutrition and general oversight of the scientific merit of each article. The opinions expressed in this publication are those of the authors and are not attributable to the sponsors or the publisher, editor, or editorial board of The Journal of Nutrition. Guest editors for the symposium are Jere D. Haas and Dennis D. Miller, Cornell University, Ithaca, NY. Guest Editor Disclosure: Jere Haas and Dennis Miller have no relationships to disclose. 2 To whom correspondence should be addressed. E-mail: [email protected].