Food Fortification Presentation March 15

Food Fortification Presentation March 15 - PERS 2002 –...

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Unformatted text preview: PERS 2002 – Spring 2011 Food Fortification Click to edit Master subtitle style 3/22/11 Some definitions • 3/22/11 Fortification ? Enrichment? Restoration? Micronutrients? • • • Connection between micronutrient and development and poverty reduction 3/22/11 Paucity of data on effectiveness of 3/22/11 international micronutrient programs Global prevalence of micronutrient malnutrition 3/22/11 • Widespread – industrialized nations and developing regions ▫ More than 2 billion people worldwide Young children and women of reproductive age – most at risk Reduced resistance to infection Metabolic disorders (metabolic syndrome, Type 2 • Affects all age groups ▫ • Many adverse effects on human health ▫ ▫ Global prevalence of micronutrient malnutrition 3/22/11 • Three most common forms ▫ Iron Vitamin A Iodine ▫ ▫ • Together, these affect at least one third of world’s population Estimated micronutrient deficiencies account for 7.3% of global burden of disease • Prevalence of the three major micronutrient 3/22/11 deficiencies Risk factors for micronutrient 3/22/11 malnutrition • Monotonous diet resulting in low micronutrient intake, and poor bioavailability Low intake of animal source foods Low prevalence of breastfeeding Low micronutrient density of complementary foods Increased physiological demands for growth during pregnancy and lactation • • • • Risk factors for micronutrient malnutrition 3/22/11 • Increased demand due to acute infection, chronic infection and disease Poor general nutritional status Malabsorption due to diarrhea or presence of intestinal parasites Increased excretion Seasonal variation in food availability, food shortages Social deprivation, illiteracy, low education • • • • • Iron deficiency • Prevalence ▫ 3/22/11 Estimated 2 billion cases of anemia worldwide In developing countries, anemia estimated to be about 50% in pregnant women and infants <2 years and 40% in school-aged children Low intakes of meat/fish/poultry and high intakes of cereals and legumes Parasite infections Malaria Preterm delivery or low birth weight Pregnancy and adolescence ▫ • Risk factors ▫ ▫ ▫ ▫ ▫ • 3/22/11 Vitamin A deficiency 3/22/11 • Prevalence ▫ Affects estimated 254 million preschool children Low intakes of diary products, eggs and βcarotene from fruits and vegetables Presence of helminth infection, ascaris Increased risk of mortality in children and • Risk Factors ▫ ▫ • Health consequence ▫ Vitamin A deficiency 3/22/11 Iodine deficiency • 3/22/11 Prevalence ▫ Estimated 2 billion people Residence in areas with low levels of iodine in soil and water Living in high altitude regions, river plains or far from the sea Consumption of non­detoxified cassava • Risk factors ▫ ▫ ▫ • Health consequences Other micronutrient deficiencies 3/22/11 • More difficult to quantify ▫ Few data on prevalence • Public health implications less well understood Likely some still contribute to global burden of disease ▫ • Zinc Folate Vitamin D ▫ ▫ 3/22/11 Goiter Zinc deficiency • 3/22/11 Prevalence ▫ Likely to be moderate to high in developing countries, especially in Africa, Southeast Asia, and Western Pacific Low intakes of animal products High phytate intakes Malabsorption and infection with intestinal parasites • Risk Factors ▫ ▫ ▫ Folate deficiency • 3/22/11 Prevalence ▫ Insufficient data Low intakes of fruits and vegetables, legumes and dairy products Malabsorption and infection with intestinal parasites Megaloblastic anemia • Risk factors ▫ ▫ Health consequences ▫ Vitamin D deficiency • 3/22/11 Prevalence ▫ Likely to be common in both industrialized and developing countries Low exposure to ultra­violet light from sun Having darkly pigmented skin Severe forms result in rickets in children and osteomalacia in adults • Risk Factors ▫ ▫ • Health consequences ▫ Rickets 3/22/11 Strategies for control of micronutrient malnutrition 3/22/11 • Policy and program responses include ▫ Dietary diversification Food fortification Nutrition education Public health and food safety measures Supplementation ▫ ▫ ▫ ▫ • Approaches should be complementary with importance depending upon local conditions and needs Food fortification • • 3/22/11 Addition of micronutrients to processed foods Relatively rapid improvements in micronutrient status Cost­effective Requires fortified foods to be consumed in adequate amounts Fortificants must be well absorbed and not affect sensory properties of foods • • • Public health benefits of fortification 3/22/11 • Prevention or minimization of risk of occurrence of micronutrient deficiencies Contribute to correction of micronutrient deficiency Potential improvement in nutritional status and dietary intakes that may be or may become suboptimal Possible beneficial effects to maintain or improve health (e.g. diet rich in selected antioxidants might help to prevent cancer and other diseases) • • • Types of fortification • 3/22/11 Mass fortification Targeted fortification Market­driven fortification • • Mass Fortification • 3/22/11 Fortification of foods widely consumed by general population ▫ Cereals, condiments, milk • Usually mandatory and regulated by government Generally best option when majority of population has unacceptable risk of being or becoming deficient in specific micronutrients Example – Folic acid to grain products to lower risk of birth defects • • Targeted fortification • 3/22/11 Fortified foods aimed at specific subgroups of population Mandatory or voluntary depending upon public health significance of problem • 3/22/11 Market­driven fortification • Food manufacturer voluntarily fortifies food Governed by regulatory limits More widespread in industrialized countries • • History of food fortification • ▫ 3/22/11 Vitamin A fortification in margarine in late 1910s Denmark Prevention of xeropthalmia Switzerland and United States Prevention of goiter Progressively expanded all over world and used in most countries ▫ • Salt iodization introduced in early 1920s ▫ ▫ ▫ • Vitamin D fortification in milk in early 1930s History of food fortification • ▫ 3/22/11 Fortification of cereal products in early 1940s Thiamin (B1), riboflavin (B2), niacin (B3), and iron US and some European countries Prevention of beriberi, mouth sores, pellagra, and anemia Began in Guatemala in 1974 Extended to other Central American countries ▫ ▫ • Vitamin A fortification of sugar in 1970s ▫ ▫ History of food fortification • 3/22/11 Fortification of calcium in late 1980s ▫ Prevention and management of osteoporosis Added to soft drinks, juices and cereals ▫ • Folic acid fortification in 1996 ▫ Addition of folic acid to grain products US and Canada Prevention of neural tube defects (NTDs) ▫ ▫ Iodine fortification effectiveness 3/22/11 • Began in U.S., large­scale iodization of salt in Michigan ▫ Goiter rate decreased from 40% to below 10% • In Switzerland, prevalence of goiter and deaf mutism in children dropped dramatically In 2003, still estimated 54 countries still have inadequate iodine nutrition • Iron fortification effectiveness • 3/22/11 In U.S., fortification of infant formulas ▫ Associated with decreased prevalence of anemia in children <5 y • In Venezuela, fortification of wheat and maize flours ▫ Decreased prevalence of iron deficiency and anemia in children Rapid reduction of iron deficiency prevalence in • In Chile, fortification of milk ▫ Effect of dual­fortified salt (iron and iodine) on iron status 3/22/11 of Moroccan schoolchildren supplying both iodine and iron, impact of iodine fortification is maximized • Vitamin A fortification effectiveness 3/22/11 • In Central Americas, fortification of sugar began in 1974 Reduced prevalence of low serum retinol values from 27% (1965) to 9% (1977) Substantially increases concentration of vitamin A in breast milk ▫ ▫ Folic acid fortification • 3/22/11 Introduction began in 1996 ▫ addition of folic acid to enriched breads, flours, corn meals, pastas and rice • Became mandatory to all grain products in 1998 Significant reductions ▫ • Prevalence of neural tube defects (NTDs) Plasma homocysteine Elevated levels are risk factor for cardiovascular disease ▫ Effect of flour fortification with folic acid on folate 3/22/11 status of elderly Canadian women Vitamin D fortification effectiveness 3/22/11 • Associated with virtual elimination of childhood rickets in industrialized countries Also reduces risk of osteoporosis in elderly ▫ • Especially in higher latitude regions where UV light levels lower during winter months Advantages of food fortification 3/22/11 • If consumed regularly, maintains nutrient body stores better than intermittent supplements Aims to supply micronutrients in amounts closer to those provided by well­balanced diet Potential to improve nutritional status of large proportion of population (poor and wealthy) Does not require changes to existing food • • • Advantages of food fortification 3/22/11 • Delivery system for fortified food usually already in place Can fortify foods with several micronutrients Does not add substantially to total cost of food Minimal risk of chronic toxicity (when properly regulated) • • • Limitations of food fortification 3/22/11 • Not a substitute for good quality diet May not be consumed by all members of target population Entire population exposed to increased levels of micronutrients whether or not will benefit Infants and young children less likely to consume enough of these foods to obtain their recommended intakes; need for fortified complementary foods • • • Limitations of food fortification • 3/22/11 Often fail to reach poorest segments of population who are at greatest risk of micronutrient deficiencies Technological issues yet to be fully resolved ▫ • Appropriate levels, stability, interactions, etc. • Food vehicle and/or fortificant may limit amount that can be successfully added Interactions can occur between fortificant and nutrients Significant costs associated with process • • Sources • 3/22/11 Allen L, DeBenoist B, Dary O, Hurrell R. Guidelines on food fortification with micronutrients. World Health Organization and Food and Agriculture Organization of the United Nations. 2006. Bishai D, Nalubola R. The history of food fortification in the United States: its relevance for current fortification efforts in developing • ...
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This note was uploaded on 03/21/2011 for the course PERS 2002 taught by Professor Roman during the Spring '07 term at Georgia State.

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