Combating Micronutrient Deficiencies: Food-based Approaches

The importance of coexisting micronutrient defi ciencies in developing countries is gaining recognition, prompted by the disappointing responses often observed with single micronutrient supplements. Further, of concern is the feasibility and sustainability of supplementation as a mode of delivery in poor resource settings. Consequently, there is increasing emphasis on food-based approaches: fortifi cation, dietary diversifi cation and modifi cation, and biofortifi cation. Novel delivery approaches exist for fortifying complementary foods in the household using tablets, sprinkles and fat-based spreads. These are all designed to supply micronutrients without any changes in feeding practices, and irrespective of the amount of food consumed. A version of the fortifi ed spread is also used as a ready-to-use therapeutic food for treating malnourished children. Dietary diversifi cation and modifi cation, in conjunction with nutrition education, focuses on improving the availability, access to and utilization of foods with a high content and bioavailability of micronutrients throughout the year. The strategies are designed to enhance the energy and nutrient density of cereal-based porridges; increase the production and consumption of micronutrient-dense foods (especially animal-source foods); incorporate enhancers of micronutrient absorption; and reduce the phytate content of cereals and legumes through germination, fermentation and soaking. In the future, biofortifi cation via processes such as agronomic practices, conventional plant breeding or genetic modifi cation holds promise as a sustainable approach to improve micronutrient adequacy in the diets of entire households and across generations in developing countries. This review summarizes new developments in food-based approaches, their advantages and limitations, and examines some of the effi cacy studies and programmes utilizing food-based strategies to alleviate micronutrient defi ciencies.