Specific recommendations and areas for future work
Food fortification is an essential element in nutrition strategies to alleviate micronutrient deficiencies. It is a dynamic area developing in response to the needs of population groups and industry. Efforts should continue to develop improved and new systems of delivering micronutrients to target populations through appropriate fortification procedures. To facilitate this, those involved in the establishment of food fortification programmes locally must have ready access to information concerning fortification techniques and procedures being used all over the world. A multi-disciplinary approach is essential for successful fortification with active collaboration of all sectors involved. These include; government, donor agencies, food industry, local academic institutions, food legislators and consumers. Adequate monitoring of food fortification is essential and should include both, monitoring of critical control points in the production and distribution of fortified foods and monitoring of micronutrient status of target populations, in establishing the need for intervention and to assess food fortification impact. The importance of this underlines the need for agreement on suitable clinical and analytical methodologies to be used, where satisfactory methodologies do not exist, improved procedures should be developed. Following the deliberations of the Consultation, general recommendations for food fortification were agreed upon, and specific recommendations were made with respect to technical aspects of food fortification as deemed necessary.
The Consultation agreed upon the following general recommendations regarding food fortification:
1. Where foodstuffs cannot provide naturally occurring essential nutrients to population groups, the use of fortification, following the principles outlined in Codex Alimentarius, should be given serious consideration as a means of achieving ICN goals.
2. A multi-sectoral approach must be adopted in the establishment of any food fortification programme, encompassing participation of relevant governmental organizations, food industry, trade organizations, consumers, academic and research facilities, marketing specialists and any involved international organizations and agencies.
3. Efforts should continue to harmonize national legislation concerning fortified foods, with the international standards of the Codex Alimentarius.
4. International guidelines to advise food aid donors on acceptable and safe fortification practices should be developed; guidelines should not be so restrictive as to impede the provision of high quality food aid commodities nor hinder communication on fortification between relevant parties.
5. There should be appropriate fortification of foods used in food aid programmes, with donors being required to provide relevant nutritional information particularly through adequate labelling.
6. Levels of fortification should be evaluated and adjusted according to bioavailability of the nutrient(s) in the diets of target populations.
7. It is important to evaluate the potential of local food industries to become involved in the production of high quality fortified food products, including those destined for use in food aid programmes, in areas where problems of micronutrient deficiency are likely to occur.
8. Food control systems based on HACCP principles, risk-based inspection procedures and internationally accepted analytical methods should be developed in support of fortification programmes.
9. The impact of food fortification on the nutritional status of target populations should be monitored so that appropriate corrective action can take place as required.
The Consultation made the following specific recommendations and suggestions for future work:
Food Fortification Technology
1. Determine iodine stability in traditional food processing as very little information on this is currently available.
2. Evaluate efficacy of iodine resins added to water as an iodine source, as findings regarding the effectiveness of this practice are inconclusive.
3. Evaluate iodine interaction with various goitrogens so as to better understand the influence of diet on the effectiveness of iodine fortification.
1. Use methodologies which are accurate and reliable in the presence or absence of recent infection, to define iron status in different population groups.
2. Develop convenient models of iron bioavailability (non-human or in-vitro models) as current methodologies for the evaluation of bioavailability are problematic.
3. Determine the necessity to revise levels of iron fortification in some products because of improved iron bioavailability of new fortificants.
4. Explore the use of new iron fortificants such as liposome micro-encapsulated iron compounds and amino acid chelates. Their bioavailability, long-term safety, regulation of absorption and retention need to be studied.
5. Evaluate long-term risks of iron intake for adult male populations as their iron requirement is lower than that for adult females and children, and iron fortification of foods generally does not allow for preferential targeting among these groups.
6. Assess the contribution of iron fortification, in combination with other strategies, for the control of iron deficiency in specific age/sex groups.
7. Assess issues of multiple fortification (iron/vitamin A; iron/iodine; iron/zinc; iron/calcium, etc) in terms of their practicality, nutrient interaction, stability and bioavailability.
Vitamins A, B, C and D:
1. Identify other potential food vehicles for vitamin A and evaluate suitability of currently available technologies for these new vehicles. Develop new vitamin A forms, if necessary.
2. Develop reliable, accurate, simple and rapid methodology for the assessment of vitamin D status as current methods of assessment are difficult.
3. Develop and evaluate the use of more stable vitamin C compounds for the purpose of fortification.
4. Develop improved methodologies for assessment of B-vitamin status as this is currently difficult to determine.
5. The reported association between plasma homocysteine levels and the roles of vitamin B6, folic acid and vitamin B12 in this relationship should be further investigated.
Practical Problems in Food Fortification:
1. Establishment and maintenance of a database documenting existing food fortification practices in developed and developing countries. Widespread and ready access to such information could reduce time wasted in establishing 'new' fortification procedures globally.
2. Surveys are required in many countries to establish dietary patterns and habits which are critical inputs in determining appropriate vehicles for use in food fortification.
Legislation and international standards
1. Establishment, at an international level, of an advisory list of nutrients for use in food fortification.
2 Determination of the need for additional regulations, at the national level, pertaining to fortified foods according to specific regional, national or even local situations.
3. Further consideration of evidence indicating undesirable effects of excessive intakes of essential micronutrients in order to establish maximum levels of fortification where necessary.
4. The Codex work on Nutrition and Health Claims should be expedited as this is directly related to labelling requirements and allowable claims for fortified foods.
Fortification in food aid
1. Countries receiving food aid should be made aware of existing mechanisms for requesting fortified food products according to local requirements.
2. Evaluate the current and potential capacity of local and regional processing industries to fortify food aid commodities.