Iron and Micronutrients: Complementary Food Fortification

Iron deficiency, one of the most prevalent problems of micronutrient malnutrition, occurs in both developing and industrialized countries. The impact of iron deficiency and iron-deficiency anaemia on the individual can result in lifelong disadvantages. The causes of the problem are many, but the principal cause is lack of iron-rich food. The International Conference of Nutrition sponsored by the World Health Organization (WHO) in Rome in 1992 estimated that over 2,000 million people worldwide suffer from anaemia, most of which is related to iron deficiency. Infants and young children are decidedly vulnerable groups, for a number of reasons. Their food choices are limited. The amount of food they consume is relatively low, but the demand for nutrients is high. Experience from industrialized countries indicates that one of the best strategies to eliminate or markedly reduce micronutrient malnutrition globally is through food fortification, with the goal of increasing the level of consumption of added nutrients to improve the nutritional status of the target population. The current recommendation for infant feeding to ensure good iron status is breastfeeding for at least four to six months. The range of iron bioavailability in breastmilk is 50% to 80%, probably because of the presence of lactoferrin, which enhances iron absorption. Thus, it is not surprising that the prevalence of iron-deficiency anaemia in early infancy is inversely correlated with the incidence of breastfeeding. If breastfeeding is not possible, iron-fortified formula should be substituted. By about four to six months, an exogenous source of iron is required. The limited food choices and the few iron-rich foods generally available make fortification of complementary food mandatory. Iron-fortified cereal has been demonstrated to be one of the most effective food vehicles in combating iron deficiency. It is usually the first solid introduced to infants to supplement breastmilk. Clinical research in China, Chile, and Canada has shown that the iron is bioavailable and the iron-fortified infant cereals are effective in the prevention and treatment of iron deficiency. In the United States the use of iron-fortified infant formula and cereal has significantly reduced iron deficiency among infants and pre-schoolers. Many other examples illustrate the importance of the food industry and food fortification in combating micronutrient malnutrition. The Global Plan of Action advocated collaboration among governments, non-governmental organizations, the private sector, local communities, etc. in the elimination of the problem. It is clear that without the food industry, iron-rich foods will not be available. Support and recognition of public health organizations must be given to the food industry to encourage the development of affordable and culturally appropriate iron-fortified foods.