Public health aspects of food fortification: a question of balance
Public health aspects of food fortification: a question of balance
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DOI：
10.1079/pns2004391
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发表时间：
2004-11-01
影响因子：
7
通讯作者：
Lambert, JP
中科院分区：
文献类型：
--
作者：
Fletcher, RJ;Bell, IP;Lambert, JP
营养不良在世界各地普遍存在，对健康和经济造成严重后果。解决这一问题的手段包括食品强化、补充和饮食多样化，每种手段都有不同的互补作用。强化（强制性和自愿性）在西方国家和发展中国家已实行了几十年。碘盐于1924年引入美国，以减少严重的碘缺乏症。1938年，人们开始在面粉和面包中添加烟酸和铁，以分别降低糙皮病和缺铁性贫血的发病率。欧洲国家的非营养素摄入量似乎对大多数营养素来说一般是足够的。然而，一些人口亚群对某些微量营养素，如儿童、青少年和年轻妇女中的叶酸、铁、锌和钙的摄入量低于最佳摄入量（低于较低的参考营养素摄入量）的风险较高。膳食调查表明，强化食品在减轻几种重要营养素的这种风险方面发挥着作用。适合强化的食品数量受到几个因素的限制，包括技术特性（特别是水分，pH值和O-2渗透性），导致不可接受的味道和外观，以及成本和消费者期望。在广泛实行自愿强化的国家，微量营养素摄入量大大低于可容忍的摄入量上限。针对强化食品的潜在水平或比例增加（例如，遵循潜在的欧盟立法），针对具有相对较低的可耐受上限摄入水平的营养素，以及在不同亚群中的潜在益处和风险（例如，叶酸），解决了对安全性的担忧。最近的模型评估这些问题进行了讨论。
Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O-2 permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.