The biofortification continuum: Implications for food and nutrition security in developing countries

Abstract

Addressing vitamin and mineral status of communities has presented challenges to governments and health experts across the globe. These nutrient deficiencies are commonly referred to as ‘hidden hunger' because their symptoms are not visible to the naked eye. Dietary diversity, food fortification and micronutrient supplementation are the three main strategies used for addressing this problem. Because most people in developing countries rely on plant-based diets, biofortification presents an opportunity for addressing vitamin and mineral deficiencies. Although fortification and supplementation are effective in specific target populations, biofortification increases food nutritional value in the dietary diversity option. Supplementation is expensive and requires linkages with health programs such as polio immunization to minimize costs. Food biofortification requires not only laboratories but other facilities to carry out the process. Food fortification also requires a well-equipped laboratory to monitor quality at the factory level and ensure product success in the market. While biofortification is expensive in the beginning, it is more cost-effective and stable in the long run. Supplementation has been done in partnership with UNICEF for iron and folic acid for expectant mothers, as well as vitamin A supplementation for children aged 6-59 months and lactating mothers. Calcium supplementation is also done in some countries for pregnant women. Food fortification is done to edible oils (vitamin A), grain flour (maize and wheat) and complementary foods. Fortification of edible oils with vitamin A and fortification of flour with iron and other micronutrients has been mandatory in Kenya since 2012. Additionally, the Ministry of Health (MoH) developed guidelines for homebased fortification (sprinkles) in 2014/2015. Micronutrient supplementation and food fortification have achieved varied degrees of success in Kenya according to the 2011 National Micronutrient Survey. Biofortification may provide considerable amounts of readily bioavailable micronutrients. As outlined in this paper, biofortification offers a fresh approach to addressing vitamin and mineral deficiencies mainly due to affordability and accessibility. Although salt iodization is mandatory at 30-50 mg/kg, less than 50% of the salt manufacturers have complied with these requirements, indicating the complexities of food fortification.