Supplementation is better and more efficacious than fortification

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Good nutrition is vital to good health and absolutely essential for the healthy growth and development of children and adolescents. Supplementation or fortification may be useful when they fill a specific identified nutrient gap that cannot or is not otherwise being met by the individual’s intake of food. However, these measures cannot replace a healthful diet. In fact, in some cases, supplements and fortified foods may cause intakes to exceed the safe levels of nutrients.

Favour

Supplementation is used for treatment of deficiencies while fortification per se does not treat deficiency but plays an important role in preventing it. Further, fortification may be less efficacious than supplementation because of technical constraints; it is not feasible to fortify food with large doses of micronutrients. A study from Vietnam have shown that the efficacy of iron fortification is about half of the maximum impact of iron supplementation with optimal compliance, largely because of the smaller amount of iron provided in the fortified food as opposed to the supplement [Thi Le et al., 2006].

In general, supplementation may be more cost effective, when the deficiency is not widespread across the population, but there is a narrowly defined target group that can be reached readily without compliance issues. For example, supplementation is considered essential for pregnant women and lactating mothers [James Berry 2012].

Against

Adoption and compliance rates may differ between fortification and supplementation. It may be more difficult to ensure compliance for supplements, which require modification of behaviour, while fortified staples may be more easily substituted for unfortified staples. Baltussen et al. found that the effectiveness of supplementation interventions is reduced by suboptimal geographic coverage, non-compliance. Patient factors such as failure to follow instructions,   incorrect beliefs about side effects, or dosing related issues also limit the overall compliance [Baltussen et al., 2004].

Pauline EA Andang’o et al. studied the effect of consumption of whole maize high-phytate flour (high phytate content inhibits absorption of iron, zinc, and calcium) fortified with iron as NaFeEDTA or electrolytic iron on children's iron status. NaFeEDTA was found to be more suitable than electrolytic iron for supplementation of iron in the diet. High-dose NaFeEDTA reduced iron-deficiency anaemia, and iron deficiency in Kenyan children. Electrolytic iron did not confer protection against any of these disorders.

The dietary intakes of many Indians do not meet recommended nutrient intake levels. It is among the roles and responsibilities of dietetics practitioners to help educate the public on healthful dietary patterns and on the safe and appropriate selection and use of nutrient supplements or fortificants to meet their nutrient needs and optimize health.

Reference:

  • Thi Le H, Brouwer ID, Burema J, Nguyen KC, Kok FJ. Efficacy of iron fortification compared to iron supplementation among Vietnamese schoolchildren. Nutr J. 2006 Dec 5;5:32.
  • Berry J, Mukherjee P, Shastry GK. Taken with a grain of salt? Micronutrient fortification in South Asia. CESifo Economic Studies. 2012 May 4:ifs011.
  • Baltussen R, Knai C, Sharan M. Iron fortification and iron supplementation are cost-effective interventions to reduce iron deficiency in four subregions of the world. The Journal of nutrition. 2004 Oct 1;134(10):2678-84.
  • Andang'o PE, Osendarp SJ, Ayah R, West CE, Mwaniki DL, De Wolf CA, Kraaijenhagen R, Kok FJ, Verhoef H. Efficacy of iron-fortified whole maize flour on iron status of schoolchildren in Kenya: a randomised controlled trial. Lancet. 2007 May 26;369(9575):1799-806.