Lysine fortification: past, present, and future.

Fortification with lysine to improve the protein value of human diets that are heavily based on cereals has received support from the results of these recent studies [1,2]. Support also comes from examination of average food and nutrient availability data derived from food balance sheets. Whereas nutritional status is influenced by the nutrient content of foods consumed in relation to need, the requirements for protein and amino acids are influenced by many additional factors [10, 12, 14, 28, 29]. These include age, sex, body size, physical activity, growth, pregnancy and lactation, infection, and the efficiency of nutrient utilization. Even if the immune response was influenced by the added lysine, adequate water and basic sanitation would remain essential. Acute and chronic undernutrition and most micronutrient deficiencies primarily affect poor and deprived people who do not have access to food of adequate nutritional value, live in unsanitary environments without access to clean water and basic services, and lack access to appropriate education and information [30]. A further variable is the possible interaction between protein and food energy availability [31]. This could affect the protein value of diets when food energy is limiting to a significant degree. Thus, the additional effects of food energy deficiency on protein utilization could well be superimposed on the very poorest. The improvement of dietary diversity must be the long-term aim, with dietary fortification considered only a short-term solution. The former should take place as wealth improves and the gaps between rich and poor diminish. Although such changes are taking place, they are highly uneven. Over the last several decades, increases have occurred in the availability of food energy, total protein, and animal protein for both developed and developing countries. However, for the very poorest developing countries over the same period, changes have been almost nonexistent, and the values for some nutritional indicators have even declined. For estimated lysine value, the developed countries showed increases in per capita availability from 5,400 to 6,167 mg per day and the developing countries from 2,400 to 3,454 mg per day, while in contrast, the very poorest countries remained static at about 2,400 to 2,500 mg per day. Thus, although lysine fortification may be theoretically only a short-term solution, in the very poorest countries changes in wealth such that dietary diversity and lysine availability may increase by natural progression remain remote. If we can justify using lysine to fortify animal feed in the rich regions of the world for economic gain, perhaps we should now consider adding lysine to the flour consumed by the deprived people in the poorest regions of the world to improve both their nutrition and their resistance to disease.