Iron fortification in the Americas.

Abstract

Food fortification is an important complement to food-based approaches to satisfy the nutritional needs of people in developing as well as developed countries. The Pan American Health Organization identified iron fortification of foods as one of the strategies for the control of iron deficiency in the Americas. Currently, iron fortification of foods is widely implemented in Central and South America. Wheat and maize, which are staple foods in the region, are considered vehicles for universal fortification. The addition of micronutrients to wheat flour was first introduced in the United States in the 1940s. In Latin America, Chile started with the fortification of wheat flour in the early 1950s. During the 1960s, legislation regarding the addition of iron and B vitamins similar to U.S. levels was proposed in a number of Latin American countries; as a consequence some millers began to fortify on a voluntary basis. Since the 1990s, however, all countries in the region, except Argentina and Uruguay, introduced mandatory wheat flour fortification. Gradually wheat flour fortification has been implemented in the majority of Central America, South America, and the Caribbean countries. Venezuela started a national fortification program using precooked maize flour. Active efforts are under way to overcome the technical limitations of fortifying nixtamalized (i.e., added) maize flours commonly consumed in Mexico and Central America. Corn flour has potent inhibitors of iron absorption, mainly phytic acid (˜550 mg/100 g), and the nixtamalization process adds calcium as a carryover after boiling the corn with quicklime-calcium hydroxide. There are also national and regional intervention programs, with high coverage of the population, that include delivery of targeted iron-fortified foods such as infant complementary foods, milk-based fortified drinks, cereal-based fortified drinks, and biscuits, among others. The majority of these programs are still aimed at preventing malnutrition in vulnerable groups; nevertheless, all of them include fortification with a vitamin-mineral premix that contains iron. In addition, commercially iron-fortified processed foods are available in the region. In this article, the main features of current iron fortification practices in Latin America will be revisited.