Micronutrient malnutrition (MNM) is widespread in the industrialized nations,but even more so in the developing regions of the world. It can affect all agegroups, but young children and women of reproductive age tend to be amongthose most at risk of developing micronutrient deficiencies.
Micronutrient malnutritionhas many adverse effects on human health, not all of which are clinicallyevident. Even moderate levels of deficiency (which can be detected by biochemical or clinical measurements) can have serious detrimental effects onhuman function. Worldwide, the three most common forms of MNM are iron, vitamin A and iodine deficiency majority of them are predominantin developing countries. From a public health viewpoint, MNM is a concern not just because suchlarge numbers of people are affected, but also because MNM, being a risk factorfor many diseases, can contribute to high rates of morbidity and even mortality. In the poorer regions of the world, MNM is certain to exist wherever thereis undernutrition due to food shortages and is likely to be common where dietslack diversity. Generally speaking, whereas wealthier population groups are ableto augment dietary staples with micronutrient-rich foods (such as meat, fish,poultry, eggs, milk and dairy products) and have greater access to a variety offruits and vegetables, poorer people tend to consume only small amounts of suchfoods, relying instead on more monotonous diets based on cereals, roots andtubers. In the wealthier countries, higher incomes, greater access to a wider varietyof micronutrient-rich and fortified foods, and better health services, are allfactors that contribute to the lowering of the risk and prevalence of MNM. However, consumption of a diet that contains a high proportion of energy-densebut micronutrient-poor processed foods can put some population groups at riskof MNM.
Control of micronutrient malnutrition:
The control of vitamin and mineral deficiencies is an essential part of the overalleffort to fight hunger and malnutrition. food-based strategies such asdietary diversification and food fortification, as well as nutrition education,public health and food safety measures, and finally supplementation is suitable Strategies for the control of micronutrient malnutrition. Theseapproaches should be regarded as complementary, with their relative importancedepending on local conditions and the specific mix of local needs. Increasing dietary diversity means increasing both the quantity and the range ofmicronutrient-rich foods consumed. Increasing dietary diversity is the preferred way of improving the nutrition ofa population because it has the potential to improve the intake of many foodconstituents. Several researches suggeststhat micronutrient-rich foods also provide a range of antioxidants andprobiotic substances that are important for protection against selected noncommunicablediseases and for enhancing immune function. A lack of resources for producing and purchasing higher qualityfoods can sometimes present a barrier to achieving greater dietary diversity,especially in the case of poorer populations. For infants, ensuring a diet of breast milk is an effective way of preventingmicronutrient deficiencies. In much of the developing world, breast milk is themain source of micronutrients during the first year of life (with the exceptionof iron). All lactating womenshould be encouraged to consume a healthful and varied diet so that adequatelevels of micronutrients are secreted in their milk. After the age of 6 months, itis important that the complementary foods provided to breast-fed infants are asdiverse and as rich in micronutrients as possible. Food fortification refers to the addition of micronutrients to processed foods. Food fortificationapproach is a very cost-effective for public health. It isalso necessary to have access to, and to use, fortificants that are well absorbedand do not affect the sensory properties of foods. In most cases, it is preferable In most cases, it is preferableto use food vehicles that are centrally processed, and to have the support of thefood industryto use food vehicles that are centrally processed, and to have the support of thefood industry. Fortification of food with micronutrients is a valid technology for reducingmicronutrient malnutrition as part of a food-based approach when and whereexisting food supplies and limited access fail to provide adequate levels of therespective nutrients in the diet.Supplementation is the term used to describe the provision of relatively largedoses of micronutrients, usually in the form of pills, capsules or syrups.It hasthe advantage of being capable of supplying an optimal amount of a specificnutrient or nutrients, in a highly absorbable form, and is often the fastest wayto control deficiency in individuals or population groups that have been identifiedas being deficient.In developing countries, supplementation programmes have been widely usedto provide iron and folic acid to pregnant women, and vitamin A to infants, childrenunder 5 years of age and postpartum women.Supplementation usually requires the procurement andpurchase of micronutrients in a relatively expensive pre-packaged form, aneffective distribution system and a high degree of consumer compliance.
Advantages of food fortification:
Being a food-based approach, food fortification offers a number of advantages:
1. Fortified foods will maintainbody stores of nutrients more efficiently and more effectively than will intermittentsupplements, if consumed on a regular and frequent basis(fig.1).
2. Fortification generally aims to supply micronutrients in amounts that approximateto those provided by a good, well-balanced diet.
3. Potentialto improve the nutritional status of a large proportion of the population,both poor and wealthy.
4. Requires neither changes in existing food patterns
5. Possible to add one or several micronutrients without adding substantiallyto the total cost of the food product at the point of manufacture.
6. When properly regulated, fortification carries a minimal risk of chronic toxicity
7. More cost-effective than other strategies
Limitations of food fortification:
Although it is generally recognized that food fortification can have an enormouspositive impact on public health, there are some limitations to thisstrategy for MNM control:
1. While fortified foods contain increased amounts of selected micronutrients, they are not a substitute for a good quality diet that supplies adequate.
2. A specific fortified foodstuff might not be consumed by all members of atarget population
3. Infants and young children, who consume relatively small amounts of food,are less likely to be able to obtain their recommended intakes of all micronutrientsfrom universally fortified staples
4. Fortified foods often not available to the poorest segments of the general populationwho are at the greatest risk of micronutrient deficiency