Associate Professor, Advanced Eye Centre, PGIMER, Chandigarh, India.
Former Director, National Institute of Nutrition, Indian Council of Medical Research, Hyderabad, Telangana, India.
Indian J Public Health. 2022 Jul-Sep;66(3):313-320. doi: 10.4103/ijph.ijph_708_22.
The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling-up scientifically proven, cost-effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost-effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large-scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly.
全球和印度在微量营养素营养不良方面的缓慢改善情况表明，需要扩大科学证明、具有成本效益的公共卫生干预措施的规模。本综述讨论了主食强化作为解决微量营养素缺乏问题的补充策略的潜力，同时解决了目前对其实施提出的关切。该综述表明，目前在印度解决多种微量营养素缺乏症的饮食多样性和补充等策略的状况不佳，需要采取补充策略来解决这个问题。基于系统评价和荟萃分析，全球和国家证据表明，主食强化是解决微量营养素缺乏问题的一种经过验证且被广泛认可的具有成本效益的解决方案。印度政府已表现出强烈的领导力来推广这一经过验证的干预措施。此外，本文还解决了一个担忧，即大规模主食强化（LSFF）在与其他干预措施（如补充剂、饮食多样性等）同时在同一人群中实施时，可能会导致过度的营养摄入。本文的一个关键信息是，LSFF 在当前的饮食摄入和微量营养素缺乏以及其他干预措施的低覆盖率情况下是安全的。考虑到 COVID-19 大流行进一步加剧的当前粮食和营养不安全状况，以及营养在增强免疫力方面的关键作用，保护和加强人口，特别是弱势群体的健康和营养更为重要。LSFF 应尽快实施，以覆盖最脆弱的人群，缩小膳食营养素差距，预防微量营养素缺乏。有效的监测和定期膳食调查将有助于确保这些干预措施得到正确部署。
