title: Maximizing the benefits and minimizing the risks of intervention programs to address micronutrient malnutrition: symposium report.
abstract: Interventions to address micronutrient deficiencies have large potential to reduce the related disease and economic burden. However, the potential risks of excessive micronutrient intakes are often not well determined. During the Global Summit on Food Fortification, 9-11 September 2015, in Arusha, a symposium was organized on micronutrient risk-benefit assessments. Using case studies on folic acid, iodine and vitamin A, the presenters discussed how to maximize the benefits and minimize the risks of intervention programs to address micronutrient malnutrition. Pre-implementation assessment of dietary intake, and/or biomarkers of micronutrient exposure, status and morbidity/mortality is critical in identifying the population segments at risk of inadequate and excessive intake. Dietary intake models allow to predict the effect of micronutrient interventions and their combinations, e.g. fortified food and supplements, on the proportion of the population with intakes below adequate and above safe thresholds. Continuous monitoring of micronutrient intake and biomarkers is critical to identify whether the target population is actually reached, whether subgroups receive excessive amounts, and inform program adjustments. However, the relation between regular high intake and adverse health consequences is neither well understood for many micronutrients, nor do biomarkers exist that can detect them. More accurate and reliable biomarkers predictive of micronutrient exposure, status and function are needed to ensure effective and safe intake ranges for vulnerable population groups such as young children and pregnant women. Modelling tools that integrate information on program coverage, dietary intake distribution and biomarkers will further enable program makers to design effective, efficient and safe programs.
authors: DSM Biotechnology Center, Delft, The Netherlands. maaike.bruins@DSM.com.
authors: Maaike J
authors: MJ
authors: Bruins
authors: UNICEF, New York, USA.
authors: Roland
authors: R
authors: Kupka
authors: Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland.
authors: Michael B
authors: MB
authors: Zimmermann
authors: Newcastle University, Human Nutrition Research Centre, Newcastle upon Tyne, United Kingdom.
authors: Georg
authors: G
authors: Lietz
authors: University of California, Davis, California, USA.
authors: Reina
authors: R
authors: Engle-Stone
authors: Johns Hopkins University, Bloomberg School of Public Health, Baltimore, Maryland, USA.|Sight and Life, Basel, Switzerland.
authors: Klaus
authors: K
authors: Kraemer
mesh_terms: D003226:Congresses as Topic; D004032:Diet; D019587:Dietary Supplements; D005527:Food, Fortified; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D044342:Malnutrition / Q000097:blood* / Q000175:diagnosis / Q000178:diet therapy; D018977:Micronutrients / Q000008:administration & dosage / Q000097:blood* / Q000172:deficiency; D011634:Public Health; D064167:Recommended Dietary Allowances; D018570:Risk Assessment
chemical_list: D018977:Micronutrients
keywords: food fortification; micronutrient malnutrition; nutritional interventions; nutritional supplements; public health; risk-benefit assessment