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Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods

Bruins, Maaike J, Mugambi, Gladys, Verkaik-Kloosterman, Janneke, Hoekstra, Jeljer, Kraemer, Klaus, Osendarp, Saskia, Melse-Boonstra, Alida, Gallagher, Alison M and Verhagen, Hans (2015) Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods. Food & Nutrition Research, 59 . p. 26020. [Journal article]

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URL: http://dx.doi.org/10.3402/fnr.v59.26020

DOI: http://dx.doi.org/10.3402/fnr.v59.26020

Abstract

Fortification of foods consumed by the general population or specific food products or supplements designed to be consumed by vulnerable target groups is amongst the strategies in developing countries to address micronutrient deficiencies. Any strategy aimed at dietary change needs careful consideration, ensuring the needs of at-risk subgroups are met whilst ensuring safety within the general population. This paper reviews the key principles of two main assessment approaches that may assist developing countries in deciding on effective and safe micronutrient levels in foods or special products designed to address micronutrient deficiencies, that is, the cut-point method and the stepwise approach to risk–benefit assessment. In the first approach, the goal is to shift population intake distributions such that intake prevalences below the Estimated Average Requirement (EAR) and above the Tolerable Upper Intake Level (UL) are both minimized. However, for some micronutrients like vitamin A and zinc, a narrow margin between the EAR and UL exists. Increasing their intakes through mass fortification may pose a dilemma; not permitting the UL to be exceeded provides assurance about the safety within the population but can potentially leave a proportion of the target population with unmet needs, or vice versa. Risk–benefit approaches assist in decision making at different micronutrient intake scenarios by balancing the magnitude of potential health benefits of reducing inadequate intakes against health risks of excessive intakes. Risk–benefit approaches consider different aspects of health risk including severity and number of people affected. This approach reduces the uncertainty for policy makers as compared to classic cut-point methods.

Item Type:Journal article
Keywords:food fortification; nutrient reference values; requirements; cut-point method; risk–benefit assessment; public health
Faculties and Schools:Faculty of Life and Health Sciences > School of Biomedical Sciences
Faculty of Life and Health Sciences
Research Institutes and Groups:Biomedical Sciences Research Institute > Nutrition Innovation Centre for Food and Health (NICHE)
Biomedical Sciences Research Institute
ID Code:30942
Deposited By: Professor Alison Gallagher
Deposited On:03 Feb 2015 14:16
Last Modified:03 Feb 2015 14:16

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