title: Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new approaches to setting adequate and safe micronutrient levels in foods.
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, orvice 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.
authors: DSM Biotechnology Center, Delft, The Netherlands.
authors: Maaike J
authors: MJ
authors: Bruins
authors: Nutrition and Dietetics Unit, Ministry of Health, Nairobi, Kenya.
authors: Gladys
authors: G
authors: Mugambi
authors: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: Janneke
authors: J
authors: Verkaik-Kloosterman
authors: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors: Jeljer
authors: J
authors: Hoekstra
authors: Sight and Life, Basel, Switzerland.|Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors: Klaus
authors: K
authors: Kraemer
authors: The Micronutrient Initiative, Ottawa, Canada.
authors: Saskia
authors: S
authors: Osendarp
authors: Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands.
authors: Alida
authors: A
authors: Melse-Boonstra
authors: Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland.
authors: Alison M
authors: AM
authors: Gallagher
authors: National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.|Northern Ireland Centre for Food and Health, University of Ulster, Coleraine, Northern Ireland.
authors: Hans
authors: H
authors: Verhagen
keywords: cut-point method; food fortification; nutrient reference values; public health; requirements; risk–benefit assessment