Osendarp Saskia J M, Martinez Homero, Garrett Greg S, Neufeld Lynnette M, De-Regil Luz Maria, Vossenaar Marieke, Darnton-Hill Ian
1 Osendarp Nutrition, Berkel & Rodenrijs, the Netherlands.
2 Micronutrient Forum, Ottawa, Ontario, Canada.
Food Nutr Bull. 2018 Jun;39(2):315-331. doi: 10.1177/0379572118774229.
Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance.
To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC).
A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a "snowball" process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact.
The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry.
In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.
食品强化和生物强化是解决弱势群体微量营养素缺乏问题的成熟策略。然而，强化计划的有效性不仅取决于强化食品的生物学功效，还取决于有效且可持续的实施，这需要持续监测、质量保证与控制以及纠正措施，以确保高度合规。
概述食品强化和生物强化的功效、有效性、经济性，以及低收入和中等收入国家大规模食品强化计划的现状与面临的挑战。
对2000年至2017年PubMed上的英文出版物以及灰色文献进行综述，目标是专注于该主题的非政府组织，并辅以国家报告和引用搜索的“滚雪球”过程。本文描述了尚存的技术挑战、障碍和证据差距，并优先提出建议以及进一步加速进展和潜在影响的后续步骤。
该综述确定并突出了成功计划的关键组成部分。它还指出了导致计划绩效不佳的问题，包括缺乏充分的监测和执法以及行业对标准的遵守情况不佳。
在过去17年中，大规模食品强化举措已惠及低收入和中等收入国家越来越多的人群。大规模食品强化和生物强化应成为其他预防和控制微量营养素缺乏的特定营养和营养敏感措施的一部分。仍存在技术和食品系统方面的挑战，特别是在提高覆盖范围和供应质量以及衡量国家计划进展方面。
