Micronutrient Forum, Washington, DC 20005, USA.
Bill & Melinda Gates Foundation, Seattle, WA 98109, USA.
Nutrients. 2023 Apr 22;15(9):2021. doi: 10.3390/nu15092021.
Large-scale food fortification (LSFF) has been recognized as one of the most cost-effective interventions to improve the intake of vitamins and minerals and decrease the burden of micronutrient deficiency. Indeed, the simple addition of micronutrients to staple foods, such as wheat, maize and rice, or condiments, including salt and bouillon, has tremendous potential to impact malnutrition. However, most LSFF programs have been poorly designed and have not taken into consideration critical inputs, including current levels of nutrient inadequacy and per capita consumption of different food vehicles when deciding which nutrients to add and at what concentrations. LSFF programs, like some other nutrition interventions, also tend to have low coverage and reach and lack monitoring to measure this and course correct. These program design flaws have resulted in limited effectiveness and have made it difficult to determine how best to harmonize LSFF with other interventions to reduce micronutrient deficiencies, including efforts to enhance dietary diversity, biofortification and supplementation. Furthermore, LSFF has often been touted as a population-based intervention, but in fact has heterogenous effects among sub-groups, particularly those with limited access to or inability to afford fortified foods, as well as those with higher physiological requirements, such as pregnant and lactating women. This article focuses on these limitations and the concerted efforts underway to improve the collection, analysis, and use of data to better plan LSFF programs, track implementation, and monitor coverage and impact. This includes a more sophisticated secondary analysis of existing data, innovations to increase the frequency of primary data collection and programmatically relevant visualizations of data of sub-national estimates. These improvements will enable better use of data to target resources and programmatic efforts to reach those who stand to benefit most from fortification.
大规模食品强化（LSFF）已被公认为改善维生素和矿物质摄入量、减少微量营养素缺乏负担的最具成本效益的干预措施之一。事实上，将微量营养素简单地添加到主食（如小麦、玉米和大米）或调味料（包括盐和肉汤）中，就具有巨大的潜力来改善营养不良问题。然而，大多数 LSFF 计划设计不佳，没有考虑到关键投入，包括目前的营养不足水平和不同食物载体的人均消费量，在决定添加哪些营养素以及添加的浓度时。LSFF 计划，就像其他一些营养干预措施一样，往往覆盖范围和影响力有限，缺乏监测来衡量这一点并进行调整。这些计划设计缺陷导致了效果有限，也使得很难确定如何最好地协调 LSFF 与其他减少微量营养素缺乏的干预措施，包括努力增加饮食多样性、生物强化和补充。此外，LSFF 经常被吹捧为一种基于人群的干预措施，但实际上，它在亚人群中具有不同的效果，特别是那些获取或负担强化食品能力有限的人群，以及那些生理需求较高的人群，如孕妇和哺乳期妇女。本文重点讨论了这些局限性以及正在进行的协调努力，以改善数据的收集、分析和使用，从而更好地规划 LSFF 计划、跟踪实施情况以及监测覆盖范围和影响。这包括对现有数据进行更复杂的二次分析、创新以增加主要数据收集的频率以及针对国家以下估计数据的计划相关可视化。这些改进将使数据得到更好的利用，以针对资源和计划工作，使那些最受益于强化的人群受益。
