RESUMO
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, riskbenefit 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.
RESUMO
Objectives: The Codex Alimentarius guidelines on formulated complementary foods for older infants and young children have important implications for maintaining nutritional status and health and preventing malnutrition. Governments and companies rely on these guidelines, yet they were outdated due to the lag between advances in science and the lengthy process required to establish Codex guidance. Methods: In 2008, Ghana initiated and led revision of these guidelines, which were adopted by Codex in 2013. Results: Benefits of the revised Guidelines include: (1) Smaller recommended serving sizes to protect breastmilk intake; (2) Specific mention of essential fatty acids and their optimal ratio; (3) At least 50% RNI of essential vitamins and minerals per serving; (4) Expanded scope of complementary foods to include small-quantity lipid-based nutrient supplements and multi-nutrient supplements; (5) Processing techniques to minimize or reduce anti-nutrients and trans-fatty acids. Conclusions: The revised guidelines help countries to develop national regulations covering all forms of formulated complementary foods and provide updated guidance for formulating good quality foods used for infants and young children, particularly in developing countries.