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European Journal of Nutrition & Food Safety, ISSN: 2347-5641,Vol.: 5, Issue.: 4 (October-December)

Review Article

Symposium Report: Effective and Safe Micronutrient Interventions, Weighing the Risks against the Benefits


Ingrid Bielderman1*, Maaike J. Bruins2, Reina Engle-Stone3, Noel W. Solomons4, Hans Verhagen5,6, Lindsay H. Allen7, Lynnette M. Neufeld8, Klaus Kraemer1 and Jane Badham1

1Sight and Life, Basel, Switzerland.
2DSM Biotechnology Center, Delft, The Netherlands.
3Department of Nutrition, University of California, Davis, CA, USA.
4Center for Studies of Sensory Impairment, Aging and Metabolism (CeSSIAM), Guatemala City, Guatemala.
5National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
6University of Ulster, Northern Ireland Centre for Food and Health (NICHE), Coleraine, Northern Ireland, UK.
7US Department of Agriculture (USDA), ARS Western Human Nutrition Research Center, Davis, CA, USA.
8Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland.


Micronutrient fortification of staple foods can be an effective strategy to combat micronutrient malnutrition. When planning on fortification, challenges faced include the collection of essential information on population food and nutrient intake patterns, as well as the use of this information in a method to select appropriate fortification levels. A symposium was organized aimed at discussing the existing approaches to set effective and safe micronutrient fortification levels and to outline the challenges and needs in this area. Two different approaches to establish effective and safe fortification levels for food fortification were presented. In the first approach, the Estimated Average Requirement (EAR) and Tolerable Upper Intake Level (UL) are used as cut-points in the micronutrient intake distribution to evaluate and simulate effective and safe micronutrient intakes. This was exemplified by challenges encountered in Guatemala and Cameroon towards unequal vitamin A intake distribution and the impact of the food vehicle choice. Secondly, the risk-benefit approach was presented as an approach in which risks and benefits of micronutrient intakes can be quantified and balanced in order to optimize fortification benefits with the least risks and to allow decision making. This was illustrated by a case on folic acid fortification in The Netherlands.
Irrespective of the approach, food and nutrient intake data are required to identify potential vehicles for fortification, quantify the nutrient gap to be addressed, and set the appropriate level of fortification based on consumption pattern. Such information is rarely available to the quality and extent ideal to set fortification levels and requires regular updating, as exemplified in the case of sugar fortification in Guatemala. While the EAR cut-point method can be used to determine the proportion of the population meeting their required and safe nutrient intakes and set goals, risk-benefit assessment may offer an answer to commonly-asked questions as to whether, and at which levels, the benefits of increasing micronutrient intakes outweigh the risks.

Keywords :

Public health; fortification; risk-benefit assessment; deficiency; toxicity; micronutrients.

Full Article - PDF    Page 202-228

DOI : 10.9734/EJNFS/2015/17357

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