Risk-benefit Models for Food Fortification with Micronutrients.

ABSTRACT

Objectives: Micronutrient deficiency can have serious health and economic implications. Food fortification with micronutrients is a main strategy countries can use to address population-wide deficiency. The objective was to compare different risk-benefit models that can be used to set micronutrient fortification levels. Methods: Different models to assess risks and benefits of food fortification were compared. Results: The EAR approach for setting micronutrient fortification levels uses point estimates at the lower and upper end of the intake range which should be both nutritionally adequate and safe. This approach considers the risk in terms of proportion of the population with intakes below the Estimated Average Requirement (EAR) and above the Tolerable Upper Intake Level (UL). However, the UL is based on the no- or lowest-observed adverse effect level (NOAEL or LOAEL) and includes an uncertainty factor and the adverse health consequences at intakes below the EAR may be very different from those above the UL both in terms of nature and severity. Risk-benefit methods exist that equally consider the health impact of micronutrient intake at the two ends of the intake spectrum. A common health metric (e.g. Disability-Adjusted Life Year) is used capturing severity, duration and incidence of the affected health condition(s) and death. Future integrated risk-benefit assessments of country-wide food fortification for example with vitamin A will illustrate the benefits and risks of fortification in terms of health impact. Conclusions: Estimating the health consequences of micronutrient fortification at both ends of the intake spectrum may assist in making deliberate decisions on food fortification programs.