Abstract
Our global food system lacks the critically needed micronutrients to meet the daily requirements of the most at-risk populations. Diets also continue to shift toward unhealthy foods, including the increased intake of salt. While most countries exceed the WHO’s recommended levels, sodium does play an essential physiological role. Table salt and other salt-containing condiments, such as bouillon, also have cultural importance, as they are used to enhance the flavor of foods cooked at home. Given their universal consumption across income classes and both urban and rural populations, these condiments are an integral part of the food system and should, therefore, be part of its transformation. Fortification of salt and salt-containing condiments can play a catalytic role in the delivery of population-wide nutritional and health benefits. With relatively consistent levels of intake across the population, these condiments hold high potential for delivering micronutrients beyond iodine while also reducing concerns related to high micronutrient intake, particularly so in countries where the industries are relatively consolidated. As a flexible and complementary strategy to an evolving food system, fortification levels can also be adjusted over time to ensure micronutrient delivery targets continue to be achieved as the system improves, whether through lower intakes of sodium in line with WHO recommendations, enhanced consumption of nutrient-dense foods, and/or broader adoption of biofortified crops. Future areas of innovation are required to realize this vision, including developing affordable salt substitutes to meet cost requirements of consumers in low-and middle-income countries, improving the stability and bioavailability of the micronutrients in condiments so that delivery targets can be reached without affecting sensory attributes, and the development of efficient systems for monitoring population intake and micronutrient status to inform fortification program design and management. Rather than being considered antithetical to the transformation, multiply-fortified salt and bouillon can strengthen our ability to meet the cultural, sensory, nutritional, and health needs of an evolving food system.
Highlights
Over 2 billion people are at risk for micronutrient deficiencies globally [1], a figure that has remained unchanged for decades and has only been further exacerbated by the global COVID-19 pandemic that has reduced access to micronutrient-rich diets in low-income countries due to disrupted supply chains and diminished incomes, with a disproportionate impact on women and young children whose higher micronutrient needs place them at higher risk for deficiency [2]
Our global food system lacks the critically needed micronutrients to meet the daily requirements of the most at-risk populations
To maximize the effectiveness of fortification programs, the policy focus for adding micronutrients should be on discretionary salt rather than on salt contained within processed foods, as sodium intake comes largely from the salt used during cooking and at the table for those populations with the highest gaps in intake
Summary
Over 2 billion people are at risk for micronutrient deficiencies globally [1], a figure that has remained unchanged for decades and has only been further exacerbated by the global COVID-19 pandemic that has reduced access to micronutrient-rich diets in low-income countries due to disrupted supply chains and diminished incomes, with a disproportionate impact on women and young children whose higher micronutrient needs place them at higher risk for deficiency [2]. The Green Revolution that began in the 1960s dramatically enhanced the agricultural productivity of wheat and rice, reducing hunger and poverty for hundreds of millions of consumers globally It may have had the unintended consequence of exacerbating micronutrient malnutrition, due in part to a corresponding decrease in the production of micronutrientdense crops, such as legumes, as well as to the milling and polishing of cereal staples that remove between 20% and 95% of their already low levels of micronutrients [4]. In 17 of the 18 countries with nationally representative data available, more than 20% of women of reproductive age are deficient in zinc, a micronutrient that is critical for the optimal growth and development of children [11]. Fortification of table salt and bouillon with multiple micronutrients holds enormous potential for delivering additional population-wide nutritional and health benefits and is compatible with sodium reduction initiatives to reduce population risks of non-communicable diseases
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