ON FOOD fORTI - DOH Central Library - Department of Health

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t started in Guatemala, followed by Honduras and El Salvador. In Canada, in 1943, flour was enriched with a series of B-vitamins and iron and calcium, and margarine was also fortified withvitamin A. Whatwerethe resultsor thenutritional impact of fortification? In 1944, some clinical indicators of deficiencies'showed an improvement, after the introduction in 1943 and 1945 of the fortification of flour and margarine. By 1948;percentage .changes were seen as a result of vitamin A supplementation as well. We can see, anoverall improvement,basedon clinical findings, after the population had been given fortified foods. Thus, there is, in a sense, a healthbenefitwhencertaintypes of foods are fortified and this benefit can be measured to ·show the contribution of fortified foods to the h;aith of the population. In America, prior to 1938, before-the enrichment of bread and flour, there was quite a high incidence of pellagra, which is a deficiency of vitamin B3, or niacin. -..When fortification started in 1938, ,the,incidence due to pellagra dropped. By 1943, enrichment wasmaridated in particular states facing the problem and there followed a drop in the' incidence of pellagra. By 1948,22 states in America decided to have mandatory enrichment . of flours and bread with B-complex A Report on Food Fortification 15 vitaminsand iron. In thePhilippines,way back in 1947, there was an increased prevalence of beriberi due to a deficiency' of B1 because of the intake of polished rice. You lose the nutrients here, because, the nutrients are in the outer coating' of the rice, so that there was quite a high incidence of beriberi for some 100,000 of the population. When rice was fortified, 'mortality due to beriberi dropped. In 1992, in Rome, representatives from manycountriesattended ajoinfFAD WHONutritiorialMeetingontheproblem of Hidden Hunger.' From statistics on vitaminAdeficiency alone, 70to 80million children and women were afflicted and mortalityamongchildrenwasin the region of 300,000 per year. In the case of iron deficiency, about 1 million children and women were affected. Iron deficiency increased the risk of premature birth and maternal' death. Thus, in the meeting, participants agreed that by the year 2000 deficiency in vitamin 'A and iron must be eliminated. In the case of iodine, about a billion people in the world suffer from its -lack. In addition to these micronutrients, the meeting stressed the importance of B-complex vitamins, calcium and zinc. What are the health consequences ,of iron deficiencies? Anemia causes lethargy, decreased' working capacity, increased fetal-maternal deaths, impaired ,immuneresponse, arid, impairedlearning ability. For iodine deficiency, consequencesare hypothyroidism" goiter,
16 cretinism, irreversible brain damage, mental retardation. Inthe case of vitamin A deficiency, the main symptom is nutritionalblindnessand anemia, because basically, deficiency in vitaminAcan result in iron deficiency as well. Vitamin A deficiency can also cause an impaired immune response as well as measles, diarrheal diseases and high infant mortality. These are based on quite recent reports from many parts of the world. Wha t about the health consequences of B-vitamin complex deficiencies? Let's start with the relative risk here: anemia. We all know that the folate, B12 and B2 are essential. Vitamin C has also helped in the absorption of iron if taken with vitamin A. On infectious diseases, B6 helps in improving the immune function, in addition to vitamins C and E. Folate or folic acid plays an important role in preventing the development of birth defects among newborns, and cervical cancer. Of course, there are some correlations with some other nutrients, such as vitamins C and E, and the carotenoid. Deficiencies in vitamin A and iron, tend to affect particular groups of women and children so that it becomes very important that during pregnancy and lactation, the adequacy of these critical nutrients has to be' ensured. A low level of iron will result in A Report on Food Fortification low birth weight, a higher risk of premature child birth, and'increased risk of maternal death. It is also well documented that the risk of having a child born with defects is increased if there's an inadequate amount of folic acid during pregnancy, while the lack of calcium and magnesium increases risk of cancer. What would be the strategy then for the prevention of the so-called micronutrient deficiencies?·There are a number of strategies, and it is possible that we should try to emphasize all of them. The first one is dietary diversification and it is imperative that the population in general should be encouraged to eata widervariety offoods. Anotherapproach wouldbe to encourage dietary supplementation, in countries which can afford it. The third strategy would be food fortification. As societies become more developed, the food industries play a more prominent role in providing nutritious foods to the population in general because with more peopleat work, industry assumes a bigger responsibility over the household -,
Page 2 and 3: PREFACE· The first ConsultativeMee
Page 4 and 5: PROGRAMME 8:00 Registration • 9:0
Page 6 and 7: A Report on Food Fortification OPEN
Page 8 and 9: , on the Issue of improving the nut
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Page 24: On this occasion, I would like to t
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