Addressing the risk of inadequate and excessive micronutrient intakes: traditional versus new
approaches to setting adequate and safe micronutrient levels in foods
Sammanfattning
Fortification of foods consumed by the general population or specific food products or
supplements designed to be consumed by vulnerable target groups is amongst the strategies in
developing countries to address micronutrient deficiencies. Any strategy aimed at dietary change
needs careful consideration, ensuring the needs of at-risk subgroups are met whilst ensuring safety
within the general population. This paper reviews the key principles of two main assessment
approaches that may assist developing countries in deciding on effective and safe micronutrient
levels in foods or special products designed to address micronutrient deficiencies, that is, the cut-
point method and the stepwise approach to risk-benefit assessment. In the first approach, the goal is
to shift population intake distributions such that intake prevalences below the Estimated Average
Requirement (EAR) and above the Tolerable Upper Intake Level (UL) are both minimized. However,
for some micronutrients like vitamin A and zinc, a narrow margin between the EAR and UL exists.
Increasing their intakes through mass fortification may pose a dilemma; not permitting the UL to be
exceeded provides assurance about the safety within the population but can potentially leave a
proportion of the target population with unmet needs, or vice versa. Risk-benefit approaches assist in
decision making at different micronutrient intake scenarios by balancing the magnitude of potential
health benefits of reducing inadequate intakes against health risks of excessive intakes. Risk-benefit
approaches consider different aspects of health risk including severity and number of people
affected. This approach reduces the uncertainty for policy makers as compared to classic cut-point
methods.