Planning and Implementing Food Fortification Programs to Combat Micronutrient Malnutrition: Iron

Abstract

Iron deficiency anemia is the most prevalent nutritional deficiency in the world and food fortification is a cost-effective approach to combat it. This paper reviews the food fortification process with micronutrients, with special emphasis on iron and the most critical steps and common difficulties found when implementing a program. The first step is to measure the magnitude of the problem and the groups affected by iron deficiency and anemia, to determine if there is a need for fortification. Then the adequate iron compound and vehicle should be selected, to obtain a bioavailable form of iron in a frequently consumed food item without changing the taste, appearance or cooking characteristics of the final food item or complete meals containing it, to assure the acceptance by consumers. Before implementation, bioavailability studies are in order for the fortified food item and for complete meals especially typical or traditional meals, followed by field studies and pilot tests. Once implemented, the program should be monitored and evaluated continuously, and the impact on health assessed periodically to give the program the flexibility for continuation made changes or finalization when necessary. Other key elements for successful implementation of food fortification programs include the presence of a viable food industry; available channels for food marketing and distribution; a health care system to identify and monitor micronutrient malnutrition in the population; institutions for education, treatment and evaluation of the impact of the program; and continuous and effective input into the planning, implementation, monitoring and evaluation of the intervention to ensure sustainability of the intervention.

Regulatory Monitoring of Fortified Foods: Identifying Barriers and Good Practices

“…At the root of underfortified products is insufficient regulatory monitoring and enforcement that lead to non-compliance among industries. 38 - 40 Industry sees regulatory monitoring as related to how often and how well regulatory agencies inspect facilities and consistently implement enforcement measures. Moral authority can be garnered through perceptions of effectiveness and coordination, which are linked to agency structure, governance, transparency in decision making, and funding prioritization.…”

Interactive effects of salinity and iron deficiency on different rice genotypes

“…When rice is grown on salt‐affected soils with high pH and Na + concentration, the availability of Fe is limited due to: (1) alkaline pH or by the formation of insoluble Fe‐phosphate complexes, (2) inhibited synthesis and uptake of the Fe chelates, and (3) higher ionic strength that reduces the effective complexation of Fe by chelators ( Yousfi et al, 2012). Iron fortification of crops is a way of improving the Fe nutritional status but the feasibility of the process raises many questions ( García‐Casal , 2014). Therefore, to fulfill the food requirements of the growing population, we should look for such rice genotypes which have good salinity resistance and at the same time have good Fe acquisition capacity under saline conditions.…”

Higher bioavailability of iron from whole wheat bread compared with iron‐fortified white breads in caco‐2 cell model: an experimental study

“…28,29 Although the effect of these enhancers can be evaluated by in vitro experiments, the resulting data must be confirmed by human efficacy studies before implementation of a fortification program at the community level. 30 Such studies are also needed to evaluate the effect of regular consumption of the iron-fortified food on iron status of the target population. 25 Data obtained from NIMS I 8 was convincing enough for the stakeholders to take urgent action.…”

“…There are several enhancers of iron absorption from both unfortified and fortified breads . Although the effect of these enhancers can be evaluated by in vitro experiments, the resulting data must be confirmed by human efficacy studies before implementation of a fortification program at the community level . Such studies are also needed to evaluate the effect of regular consumption of the iron‐fortified food on iron status of the target population .…”