Nutritional reformulation: Fortification in the factory and in the field.

Deficiencies in DHA/EPA are widespread, but not widely recognised. The scale of the problem is difficult to assess, because targets for consumption vary and intakes are poorly measured, but most people in most countries eat too little. The principal policies to correct the shortfalls have been educational programmes urging people to eat more fish. Two problems limit this approach: many do not like fish; and there are not enough fish available if everyone ate recommended levels. One pragmatic alternative is to start with the popular foods people actually eat, then fortify them with DHA/EPA. The paper discusses technical options for doing this, and three problems: the scale of sales, the use of inappropriate forticants, and the costs. The key to reducing costs lies in obtaining new, larger, sustainable and cheaper sources of DHA/EPA. Major efforts to achieve this are underway the genetically modified crops and new sources of algae. The public health goal is affordable fortified foods consumed by billions, not just affluent, health-conscious minorities. It is a strategy for nutritional improvement without dietary change.