title: Voluntary food fortification in the United States: potential for excessive intakes.
abstract: BACKGROUND
  Historically, the voluntary addition of micronutrients to foods in the United States has been regarded as an important means to lessen problems of nutrient inadequacy. With expanding voluntary food fortification and widespread supplement use, it is important to understand how voluntary food fortification has an impact on the likelihood of excessive usual intakes. Our objective was to investigate whether individuals in the United States with greater frequency of exposure to micronutrients from voluntarily fortified foods (vFF) are more likely to have usual intakes approaching or exceeding the respective tolerable upper intake levels (UL).
  
  
  METHODS
  The National Cancer Institute method was applied to data from the 2007-2008 National Health and Nutrition Examination Survey (NHANES) to estimate the joint distribution of usual intake from both vFF and non-vFF sources for 12 nutrients and determine the probability of consuming these nutrients from vFF on a given day. For each nutrient, we estimated the distribution of usual intake from all food sources by quintile of probability of consuming vFF and compared the distributions with ULs.
  
  
  RESULTS
  An increased probability of consuming zinc, retinol, folic acid, selenium and copper from vFF was associated with a greater risk of intakes above the UL among children. Among adults, increased probability of consuming calcium and iron from vFF was associated with a greater risk of intakes above the UL among some age/sex groups.
  
  
  CONCLUSIONS
  The high nutrient exposures associated with vFF consumption in some population subgroups suggest a need for more careful weighing of the risks and benefits of uncontrolled food fortification.
authors: Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: J E
authors: JE
authors: Sacco
authors: K W
authors: KW
authors: Dodd
authors: S I
authors: SI
authors: Kirkpatrick
authors: V
authors: V
authors: Tarasuk
mesh_terms: D000328:Adult; D000367:Age Factors; D002136:Calcium, Dietary / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D002648:Child; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D003677:Deficiency Diseases / Q000517:prevention & control; D019587:Dietary Supplements / Q000009:adverse effects / Q000032:analysis; D005260:Female; D005527:Food, Fortified / Q000009:adverse effects* / Q000032:analysis; D005525:Food-Processing Industry / Q000379:methods*; D017408:Guidelines as Topic; D006293:Health Promotion; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage* / Q000009:adverse effects / Q000032:analysis; D015969:National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division; D018673:Nutrition Policy; D009749:Nutrition Surveys; D012306:Risk; D014481:United States / Q000453:epidemiology; D035141:Voluntary Programs
chemical_list: D002136:Calcium, Dietary; D018977:Micronutrients