Enrichment of iron and folic acid: the real need and the dangers of this initiative

The article "Considerations on the food fortification policy in Brazil" (1) published in this issue of the Revista Brasileira de Hematologia e Hemoterapia (Journal of Hematology and Hemotherapy) questions whether the mandate to enrich food will or will not worsen the health of individuals that suffer from iron excess-related conditions. Another aspect questioned by this article is whether there is, or there is no danger of an iron and folic acid enriched diet triggering irreversible neurological lesions in vitamin B2-deficient individuals who do not present with anemia. An inadequate folate (folic acid) intake results in megaloblastic anemia and neural tube defects. Neural tube defects are fatal, although preventable if a woman consumes enough folic acid before getting pregnant and at the beginning of pregnancy. Iron deficiency, which mainly results from low bioavailability of iron and insufficient iron in the diet to meet the individual's nutritional needs, causes anemia; this is a global public health issue affecting populations of all social classes and is one of the major factors related to low weight at birth, cognitive deficits in children and maternal mortality. According to World Health Organization (WHO) data, it is estimated that anemia affects 1620 million people worldwide, that is, 24.8% of the population. The highest prevalence is among preschool children (47.4%), followed by pregnant women (41.8%) and childbearing-age woman (30.2%). Neural tube defects, on the other hand, affect more than 300,000 children a year, globally. Among the strategies advocated by the WHO to control iron deficiency anemia, and recommended to ensure a balanced, healthy diet, fortification of food is recognized as the best approach. Additionally this has the best cost effective ratio over medium to long terms. believe that the efficacy of preventing anemia using enriched food has proven to be adequate in disease-prevention programs in several countries; however, they highlight that most of the studies are local and age groups are restricted, thus limiting the representativeness of the sample. With the aim of increasing the availability of iron and folic acid-enriched foods to the Brazilian population, and thus reducing the prevalence of anemia and neural tube defects in Brazil, the Ministry of Health, as of June 18 2004, made the addition of iron (30% daily recommended intake or 4.2 mg/100 g) and folic acid (70% daily recommended intake or 150 µg/100g) to maize and wheat flours mandatory. Few studies evaluating the efficacy or the effectiveness of iron-enriched foods …