FORTIFICATION OF FOODS WITH VITAMINS AND MINERALS

Fortification of foods with essential micronutrients is one of the great accomplishments of nutritional science, and its benefits to mankind rank with those of the greatest medical discoveries of this century.' The virtual disappearance of pellagra and rickets and the substantial reduction of iodine deficiency goiter in the United States are the most outstanding examples of success. Those benefits outweigh by far other aspects that were not nearly as successful-for example, attempts to eliminate iron deficiency anemia by iron fortification. Yet, from the point of view of t h e nutritionist, even the most successful fortification programs are compromise solutions. The ideal solution, and the ultimate goal of national and international nutrition policies, must be to make available to all people diets that meet all nutrient requirements. When this goal is met, fortification will be unnecessary, and a great amount of scientific effort now being spent on problems of fortification can be used elsewhere. Unfortunately, this ideal situation is unlikely to be achieved in the foreseeable future, either in the United States or abroad. Therefore, programs of enrichment and fortification will not only maintain but increase their scope to reach more people and include more micronutrients, as our knowledge of human requirements and of the existence of deficiencies increases. The potential benefits to human health of an enrichment program on a global scale are enormous if the program is based on sound scientific and technological knowledge and if experience gained from past errors can be applied. The cost-to-benefit ratio of enrichment with micronutrients is among the most favorable of any nutritional or other intervention. The following discussion will examine the various conditions necessitating fortification policies, evaluate the state of scientific knowledge pertinent to such policies, and point out problem areas where our knowledge must be increased if future fortification efforts are to be effective. The fact that problems of mineral nutrition are treated preferentially is not meant to detract from the importance of the vitamins; it merely reflects the greater gaps in our knowledge of the inorganic micronutrients.