Neufeld Lynnette M, Baker Shawn, Garrett Greg S, Haddad Lawrence
Global Alliance for Improved Nutrition, Geneva, Switzerland; and
Bill & Melinda Gates Foundation, Seattle, WA.
J Nutr. 2017 May;147(5):1015S-1019S. doi: 10.3945/jn.116.246157. Epub 2017 Apr 12.
The need for evidence to inform nutrition program design and implementation has long been recognized, yet the generation and use of evidence for program decision making has lagged. The results of the coverage surveys reported in this supplement highlight some of the strengths and areas for improvement of current population-based (i.e., staple foods and condiments) and targeted (e.g., foods for infants and young children) fortification programs. Among other topics, the results identify a few striking successful fortification programs whereby the majority of the food vehicle used is fortifiable and fortified, and coverage is equitable among those classified as vulnerable and not. Other programs have great potential based on very high use of a fortifiable food vehicle, including in most cases among the vulnerable, but that potential is not currently reached because of low compliance with fortification requirements. Programs were also identified whereby the food vehicle has limited potential to make public health contributions to micronutrient intake, given the low proportions of the population who consume the food vehicle in general or who consume the fortifiable food vehicle. Four key lessons were learned: ) the potential for impact of food fortification depends on the appropriate choice of food fortification vehicle but also on the proportion of the food vehicle consumed that is fortifiable; ) the design of fortification programs should be informed by the magnitude and distribution of inadequate intake and deficiency and consumption of fortifiable foods, and part of micronutrient deficiency control strategies to ensure coordination with other programs; ) effective quality control of fortification levels in foods urgently needs strengthening, including the many governance and other policy factors that influence the capacity, resources, and commitment to do this; ) periodic review of the assumptions related to dietary patterns that underpin food fortification is needed to ensure continual safe and impactful programs.
长期以来，人们一直认识到需要证据来为营养项目的设计和实施提供信息，但用于项目决策的证据的生成和使用却滞后了。本增刊中报告的覆盖范围调查结果突出了当前基于人群（即主食和调味品）和针对性（如婴幼儿食品）强化项目的一些优势和改进领域。在其他主题中，结果确定了一些引人注目的成功强化项目，其中使用的大多数食品载体是可强化的且已进行了强化，并且在被归类为弱势群体和非弱势群体中覆盖是公平的。其他项目基于可强化食品载体的高使用率具有很大潜力，包括在大多数情况下在弱势群体中，但由于对强化要求的低依从性，目前尚未实现这一潜力。还确定了一些项目，鉴于一般食用该食品载体或食用可强化食品载体的人群比例较低，该食品载体对微量营养素摄入的公共卫生贡献潜力有限。吸取了四个关键教训：）食品强化的影响潜力不仅取决于食品强化载体的适当选择，还取决于食用的可强化食品载体的比例；）强化项目的设计应依据摄入量不足和缺乏的程度及分布以及可强化食品的消费情况，并且应作为微量营养素缺乏控制策略的一部分，以确保与其他项目协调；）迫切需要加强对食品强化水平的有效质量控制，包括影响开展此项工作的能力、资源和承诺的许多治理及其他政策因素；）需要定期审查支撑食品强化的与饮食模式相关的假设，以确保项目持续安全且有效。
