Introduction to Human Nutrition

Policy and Regulatory Issues 295

consumers only.” Now reconsider the above data with
these additional statistics and look at Table 12.3.
Now everything has changed with the fi ve consum-
ers converting population average intakes into con-
sumer-only intakes. For any program in public health
nutrition, three important strategies which are often
lost are (a) strategies to increase or decrease the fi ve
people eating a target food, (b) strategies to alter the
frequency with which a target food is consumed, and
(c) the portion size when the food is eaten. Thus were
we to look solely at population averages, food C was
of no interest. Now it is of interest if not intriguing:
“achievers” universally eat this food while only 30%
of “non-achievers” partake of it, and, among the small
group of “non-achievers” who do eat the food, they
eat it at a much higher level (which might be the same
amount more frequently or a higher amount less
frequently).

12.4 Options to change food and
nutrient intakes

Once the above analysis is complete and peer reviewed,
defi nite directions in the consumption of nutrients
and foods become apparent. In this section we focus
on some of the options but the reader should always
bear in mind that all options are possible and none is
exclusive. Broadly speaking we can think of two con-
trasting options: “supply-driven” nutrition policy and
“demand-driven” nutrition policy.

Supply-driven nutrition policy takes the food

supply and in some way modifi es it so that individuals

consuming a habitual diet will have their nutrient

intake altered without having to make any major

changes in food choice. Mandatory fortifi cation of

foods with micronutrients is by far the best example

of supply-driven food nutrition policy. There are

certain essential prerequisites to the development of

a successful supply-driven fortifi cation program.

These are shown in Box 12.2.

Let us now consider these factors for a typical for-

tifi cation process, the mandatory addition of folic

acid to fl our in the USA to reduce the incidence of

the neural tube birth defect, spina bifi da (Box 12.3).

Let us contrast the data in Box 12.3 with the evi-

dence linking saturated fatty acids (SFAs) to plasma

cholesterol shown in Box 12.4.

Table 12.2 Achievers and non-achievers of nutrient goals

Achievers Non-achievers

(g/day population average)

Food A 100 40
Food B 20 60
Food C 50 50

Box 12.2

a There is unequivocal evidence that the lack of a particular

nutrient very strongly predisposes to some serious condition

b The evidence is based on properly conducted human nutrition

intervention trials

c The effect of the nutrient in question on the problem to be

solved is not dependent on other conditions being met

d There are no adverse effects from the fortifi cation strategy

e The scale of the problem is a true public health issue

Box 12.3

a+b There is certainly unambiguous evidence from randomized

controlled trials involving high-risk women who had a previ-

ous spina bifi da baby that folic acid signifi cantly reduces the

risk of a second event

c The effect is independent of any other factor from age,

smoking, weight, and ethnicity, and so on

d There is some concern that fortifying with folic acid might

cause some B 12 defi ciency to go undiagnosed but the scale of

that problem is not enough to halt the fortifi cation program

e This problem is a truly important public health issue

Table 12.3 Achievers and non-achievers of nutrient goals with consumer-only intakes

Achievers Non-achievers Achievers Non-achievers Achievers Non-achievers

g/day population average % consumers Consumer-only intake

Food A 100 40 20 80 500 50
Food B 20 60 50 50 40 120
Food C 50 50 100 30 50 150