Efficacy and Prestige of Food Fortification can be damaged by Abuse and Exaggeration

Food fortification is the addition of micronutrients to an edible product. Three types of food fortification are recognized: mass-fortification is associated to foods commonly consumed; targeted fortification identifies products intended for specific groups of the population; and market-driven fortification defines the practice aimed to profit based on the added value. Mass-fortification has the largest public health potential because the wide population coverage. Thus, consumption of iodized salt has prevented iodine deficiency disorders worldwide; sugar with vitamin A has practically eliminated blindness due to the deficiency of this vitamin in Central America; and fish sauce containing iron from NaFeEDTA has reduced the prevalence of anemic women in Viet Nam. The common feature of these examples is that the additional intake of the corresponding micronutrients is from 50 to 200% of the Estimated Average Recommendations. When intake is lower, biological effects may not be seen. Review of the literature and more than 15 years of direct experience with food fortification, have revealed that advocacy strategies sometimes generalize successes to situations for which they are not applicable and so creating false expectations. Governments usually regulate mass- and targeted fortifications, but rarely market-driven fortification. This condition has allowed two misuses: Exaggerated health claims attributed to the product consumption; and/or supply of excessive amounts of micronutrients that may be risky. Fortification formulations should be complementary, and claims should promote healthy practices and basic knowledge in order to protect the public appreciation of this effective intervention on human nutrition.