IZiNCG Fortification Task Force.
Food Fortification Initiative, Atlanta, GA, USA.
Adv Nutr. 2021 Oct 1;12(5):1821-1837. doi: 10.1093/advances/nmab065.
Seventeen per cent of the world's population is estimated to be at risk of inadequate zinc intake, which could in part be addressed by zinc fortification of widely consumed foods. We conducted a review of efficacy and effectiveness studies to ascertain the effect of zinc fortification [postharvest fortification of an industrially produced food or beverage; alone or with multiple micronutrients (MMN)] on a range of health outcomes. Previous reviews have required that the effect of zinc be isolated; because zinc is always cofortified with MMN in existing fortification programs, we did not impose this condition. Outcomes assessed were zinc-related biomarkers (plasma or serum, hair or urine zinc concentrations, comet assay, plasma fatty acid concentrations, and the proportion of and total zinc absorbed in the intestine from the diet), child anthropometry, morbidity, mortality, cognition, plasma or serum iron and copper concentrations, and for observational studies, a change in consumption of the food vehicle. Fifty-nine studies were included in the review; 54 in meta-analyses, totaling 73 comparisons. Zinc fortification with and without MMN increased plasma zinc concentrations (efficacy, n = 27: 4.68 μg/dL; 95% CI: 2.62-6.75; effectiveness, n = 13: 6.28 μg/dL; 95% CI: 5.03-7.77 μg/dL) and reduced the prevalence of zinc deficiency (efficacy, n = 11: OR: 0.76, 95% CI: 0.60-0.96; effectiveness, n = 10: OR: 0.45, 95% CI: 0.31-0.64). There were statistically significant increases in child weight (efficacy, n = 11: 0.43 kg, 95% CI: 0.11-0.75 kg), improvements in short-term auditory memory (efficacy, n = 3: 0.32 point, 95% CI: 0.13-0.50 point), and decreased incidence of diarrhea (efficacy, n = 3: RR: 0.79, 95% CI: 0.68-0.92) and fever (efficacy, n = 2: RR: 0.85, 95% CI: 0.74-0.97). However, these effects cannot be solely attributed to zinc. Our review found that zinc fortification with or without MMN reduced the prevalence of zinc deficiency and may provide health and functional benefits, including a reduced incidence of diarrhea.
据估计，世界上有 17%的人口面临锌摄入不足的风险，而通过对广泛食用的食物进行锌强化，部分问题可以得到解决。我们对功效和效果研究进行了综述，以确定锌强化（对工业生产的食品或饮料进行产后强化；单独或与多种微量营养素 [MMN] 一起）对一系列健康结果的影响。以前的综述要求必须单独确定锌的效果；由于在现有的强化计划中，锌总是与 MMN 一起进行强化，因此我们没有施加这一条件。评估的结果是与锌相关的生物标志物（血浆或血清、头发或尿液中的锌浓度、彗星试验、血浆脂肪酸浓度以及肠道从饮食中吸收的锌比例和总量）、儿童人体测量、发病率、死亡率、认知能力、血浆或血清铁和铜浓度，对于观察性研究，还评估了食物载体的消费变化。本综述共纳入 59 项研究；54 项进行了荟萃分析，共包含 73 项比较。添加和不添加 MMN 的锌强化增加了血浆锌浓度（功效，n=27：4.68μg/dL；95%置信区间：2.62-6.75；有效性，n=13：6.28μg/dL；95%置信区间：5.03-7.77μg/dL），并降低了锌缺乏的流行率（功效，n=11：OR：0.76，95%置信区间：0.60-0.96；有效性，n=10：OR：0.45，95%置信区间：0.31-0.64）。儿童体重（功效，n=11：0.43kg，95%置信区间：0.11-0.75kg）显著增加，短期听觉记忆（功效，n=3：0.32 分，95%置信区间：0.13-0.50 分）得到改善，腹泻（功效，n=3：RR：0.79，95%置信区间：0.68-0.92）和发热（功效，n=2：RR：0.85，95%置信区间：0.74-0.97）的发生率降低。然而，这些影响不能完全归因于锌。我们的综述发现，添加或不添加 MMN 的锌强化可降低锌缺乏的流行率，并可能提供健康和功能益处，包括降低腹泻的发生率。
