Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods

  • Maaike J. Bruins DSM Biotechnology Center, Delft
  • Gladys Mugambi Ministry of Health Kenya
  • Janneke Verkaik-Kloosterman National Institute for Public Health and the Environment (RIVM), Bilthoven
  • Jeljer Hoekstra National Institute for Public Health and the Environment (RIVM), Bilthoven
  • Klaus Kraemer Sight and Life, Basel, Switzerland
  • Saskia Osendarp Micronutrient Initiative, Ottawa
  • Alida Melse-Boonstra Wageningen University, Wageningen
  • Alison M. Gallagher University of Ulster, Coleraine, Northern Ireland
  • Hans Verhagen National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
Keywords: Micronutrient, Vitamin, Mineral, Food fortification, supplementation, Nutrient reference values, Dietary planning, Inadequacy, Deficiency, Requirements, Safety, Cut-point method, Risk-benefit assessment, Cost-effective, Public health

Abstract

Fortification of foods consumed by the general population or specific food products or supplements designed to be consumed by vulnerable target groups is amongst the strategies in developing countries to address micronutrient deficiencies. Any strategy aimed at dietary change needs careful consideration, ensuring the needs of at-risk subgroups are met whilst ensuring safety within the general population. This paper reviews the key principles of two main assessment approaches that may assist developing countries in deciding on effective and safe micronutrient levels in foods or special products designed to address micronutrient deficiencies, that is, the cut-point method and the stepwise approach to risk–benefit assessment. In the first approach, the goal is to shift population intake distributions such that intake prevalences below the Estimated Average Requirement (EAR) and above the Tolerable Upper Intake Level (UL) are both minimized. However, for some micronutrients like vitamin A and zinc, a narrow margin between the EAR and UL exists. Increasing their intakes through mass fortification may pose a dilemma; not permitting the UL to be exceeded provides assurance about the safety within the population but can potentially leave a proportion of the target population with unmet needs, or vice versa. Risk–benefit approaches assist in decision making at different micronutrient intake scenarios by balancing the magnitude of potential health benefits of reducing inadequate intakes against health risks of excessive intakes. Risk–benefit approaches consider different aspects of health risk including severity and number of people affected. This approach reduces the uncertainty for policy makers as compared to classic cut-point methods.

Keywords: food fortification; nutrient reference values; requirements; cut-point method; risk–benefit assessment; public health

(Published: 27 January 2014)

Citation: Food & Nutrition Research 2015, 59: 26020 - http://dx.doi.org/10.3402/fnr.v59.26020

Responsible Editor: Anja Biltoft-Jensen, Technical University of Denmark, Denmark.

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Published
2015-01-27
How to Cite
Bruins, M. J., Mugambi, G., Verkaik-Kloosterman, J., Hoekstra, J., Kraemer, K., Osendarp, S., Melse-Boonstra, A., Gallagher, A. M., & Verhagen, H. (2015). Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods. Food & Nutrition Research, 59. https://doi.org/10.3402/fnr.v59.26020
Section
Review Articles

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