Emerging Issues

As noted above, both mandatory and voluntary fortifications have played important roles in the overall nutritional adequacy of food supply in developed countries. While classic nutrient deficiency diseases have been alleviated, there is increasing awareness that suboptimal intakes of nutrients may occur in some population subgroups. For example, calcium and vitamin D intakes may be inadequate, particularly among women and the elderly. In the US, median calcium intakes among adolescent girls and adult women are below the recommended Adequate Intake levels. Similarly, the lowest dietary intakes of vitamin D in the US are reported by female teenagers and female adults, with only about 30% of adolescent girls and 20-25% of women cosuming sufficient dietary vitamin D to meet the Adequate Intake levels. Dietary patterns are changing among teenagers with a preference for soft drinks over milk and other dairy beverages. Up to 90% of older adults in the US are reported to consume inadequate amounts of vitamin D. In Australia and New Zealand, women and the elderly are also considered high-risk groups for marginal vitamin D status. In Europe, a substantial percentage of the elderly are reported to have low vitamin D status, ranging from about 10% in the Nordic countries to about 40% in France. Current scenarios of food fortification do not appear to be reaching the population groups most at risk of these deficiencies.

In contrast, overfortification and random fortification of the food supply is also a growing concern. Where the regulatory system in the country permits, a wide variety of foods are being fortified with a broad spectrum of nutrients. The need for such a vast number of fortified foods for generally nutritionally adequate populations, particularly given the wide consumption of vitamin and mineral supplements, is questioned. Recently, advances in scientific knowledge have enabled estimations of upper (safe) levels of intake and various government agencies have established tolerable upper intake levels for different micronutrients. These upper levels of nutrient intake are being carefully considered as countries continue to monitor their existing fortification programs and policies to appropriately balance risks of deficiency and toxicity in well-nourished populations.

Another emerging issue relates to the so-called 'functional foods' as consumers look for foods associated with health benefits beyond basic nutrition. Nutrition research in the recent past has shifted from evaluating the benefits of the whole food itself to the benefits of bioactive components isolated from such foods. Substances such as lycopene, lutein, and probiotics are being added to foods with claimed health benefits, although the efficacy of such fortification is largely unknown.

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