Abstract
Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring.
Highlights
Maternal and child undernutrition cause 45% of all deaths in children under five in low- and middle-income countries (LMICs) [1]
Health Organization (WHO) estimates that 42 percent of children less than 5 years of age and 40 percent of pregnant women worldwide are anemic [4]; pregnant women with severe anemia are twice as likely to die during or shortly after pregnancy than non-anemic women, and for their children, micronutrient deficiencies in utero can lead to low birth weight and brain and spinal defects [5]
Fortification programs implemented population-wide were associated with a 34% reduction in anemia from improved population-wide were associated with a by reduction anemia from improved iron iron stores, with greater benefits realized those most atinrisk of deficiency; 74% reducstores, with greater benefits realized by those most at risk of deficiency; 74% reduction tion in the odds of goiter; and a 41% reduction in the odds of neural tube defects (NTDs) [14]
Summary
Maternal and child undernutrition cause 45% of all deaths in children under five in low- and middle-income countries (LMICs) [1]. It has been estimated that micronutrient deficiencies account for about 7.3% of the global burden of disease, and iron and vitamin A deficiency rank among the 15 leading causes of the global disease burden [3], contributing to the deaths of over one million children annually [1]. The World Health Organization (WHO) and the United Nations Food and Agriculture Organization (FAO) have adopted four main strategies for improving dietary intake: food fortification, micronutrient supplementation, nutrition education, and disease control measures. This review systematically synthesizes the available evidence on the advantages and disadvantages of food fortification vehicles (industrial fortification, biofortification and point-of-use or home fortification) and provides an overview of three dimensions by which fortification impacts individuals and societies—social, health and economic.
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