Skip to main content


Micronutrient Deficiency Conditions: Global Health Issues


Micronutrient deficiency conditions are widespread among 2 billion people in developing and in developed countries. These are silent epidemics of vitamin and mineral deficiencies affecting people of all genders and ages, as well as certain risk groups. They not only cause specific diseases, but they act as exacerbating factors in infectious and chronic diseases, greatly impacting morbidity, mortality, and quality of life. Deficiencies in some groups of people at special risk require supplementation, but the most effective way to meet community health needs safely is by population based approaches involving food fortification. These complementary methods, along with food security, education, and monitoring, are challenges for public health and for clinical medicine. Micronutrient deficiency conditions relate to many chronic diseases, such as osteoporosis osteomalacia, thyroid deficiency colorectal cancer and cardiovascular diseases. Fortification has a nearly century long record of success and safety, proven effective for prevention of specific diseases, including birth defects. They increase the severity of infectious diseases, such as measles, HIV/AIDS and tuberculosis. Understanding the pathophysiology and epidemiology of micronutrient deficiencies, and implementing successful methods of prevention, both play a key part in the New Public Health as discussed in this section, citing the examples of folic acid, vitamin B12, and vitamin D.


  1. 1.

    World Health Organization. World health report, 2000. Geneva: World Health Organization, 2000.

  2. 2.

    Allen L, de Benoist B, Dary O, Hurrell R. Guidelines on food fortification with micronutrients. World Health Organization and Food and Agricultural Organization of the United Nations. Geneva: World Health Organization; 2006.

  3. 3.

    Harrison GG. Public health interventions to combat micronutrient deficiencies. Public Health Reviews 2010;32:256–266.

  4. 4.

    Holick MF. The vitamin D deficiency pandemic: a forgotten hormone important for health. Public Health Reviews 2010;32:267–283.

  5. 5.

    Oakley GP. Folic acid and vitamin B12 fortification of flour: a global basic food security requirement. Public Health Reviews 2010;32:284–295.

  6. 6.

    Halpin HA, Morales-Suárez-Varela MM, Martin-Moreno JM. Chronic disease prevention and the New Public Health. Public Health Reviews 2010;32:120–154.

  7. 7.

    Schlipköter U, Flahault A. Communicable diseases: achievements and challenges for public health. Public Health Reviews 2010;32:90–119.

  8. 8.

    Fielding JE, Teutsch S, Breslow L. A framework for public health in the United States. Public Health Reviews 2010;32:174–189.

  9. 9.

    Laaser U, Epstein L. Threats to global health and opportunities for change: a new global health. Public Health Reviews 2010;32:54–89.

  10. 10.

    Lind J. A treatise of the scurvy. In three parts. Containing an inquiry into the nature, causes and cure of that disease. together with a critical and chronological view of what has been published on the subject. Edinburgh: Printed by Sands, Murray and Cochran for A Kincaid and A Donaldson, 1753, as cited by Chalmer I. The James Lind Initiative. Available from URL: (Accessed 17 March, 2010).

  11. 11.

    Eijkman C. Nobel Lecture: Antineuritic Vitamin and Beriberi. 1929. Available from URL: html (Accessed 17 March, 2010).

  12. 12.

    Lanoka DJ. Historical aspects of the major vitamin deficiency disorders: the water-soluble B vitamins. Chapter 30: Handb Clin Neurol. 2009:445–76. Available from URL: 19892133/full_citation/Chapter_30_Historical_aspects_of_the_major_ neurological_vitamin_deficiency_disorders:_the_water_soluble_B_vitamins_ (Accessed 11 March, 2010).

  13. 13.

    Office of NIH History. Dr. Joseph Goldberger and the War on Pellagra. Available from URL: (Accessed 17 March, 2010).

  14. 14.

    Scrimshaw NS. Fifty-five-year personal experience with human nutrition worldwide. Annu Rev Nutr. 2007;27:1–18.

  15. 15.

    Centers for Disease Control. Achievements in public health, 1900–1999: Safer and healthier foods. MMWR Morb Mortal Wkly Rep. 1999;48:905–13.

  16. 16.

    Andersson M, de Benoist B, Darnton-Hill I, Delange F. Iodine deficiency in Europe: A continuing public health problem. Geneva: World Health Organization; 2007. Available from URL: 9789241593960_eng.pdf (Accessed 11 March, 2009).

  17. 17.

    Zimmermann MB. Iodine Deficiency. Endocrine Rev. 2009.30:376–408.

  18. 18.

    Backstrand JR. The history and future of food fortification in the United States: a public health perspective. Nutr Rev. 2002;60:15–26.

  19. 19.

    Nathoo T, Holmes CP, Ostry A. An analysis of the development of Canadian food fortification policies: the case of vitamin B. Health Prom Inter. 2005;20: 375–82.

  20. 20.

    MRC Vitamin Study Research Group. Prevention of neural tube defects: results of the Medical Research Council vitamin study. Lancet. 1991:338:131–7. Available from URL: (Accessed 12 March, 2010).

  21. 21.

    Centers for Disease Control. Use of dietary supplements containing folic acid among women of childbearing age, United States–2005. MMWR Morb Mortal Wkly Rep. 2005;54:955–8.

  22. 22.

    Centers for Disease Control. Trends in wheat-flour fortification with folic acid and iron–worldwide, 2004 and 2007. Morb Mortal Wkly Rep. 2008;57:8–10.

  23. 23.

    Tulchinsky TH, Nizan Kaluski D, Berry E. 2004. Food fortification and risk group supplementation are vital parts of a comprehensive nutrition policy for prevention of chronic diseases. Eur J Public Health. 2004:14:226–8.

  24. 24.

    Food Safety Authority of Ireland. Food fortification: the addition of vitamins and minerals to foods. EC Regulation1925/2006/EC Available from URL: (Posted 26 March, 2009, accessed 28 March, 2010).

  25. 25.

    ESCO Report on Analysis of Risks and Benefits of Fortification of Food with Folic Acid. Available at URL: htm (Adopted: 6 October 2009, posted November, 2009, and accessed 23 March, 2010).

  26. 26.

    United Kingdom Food Standards Agency. Folic acid fortification. Available from URL: (Updated and accessed 28 March, 2010).

  27. 27.

    Wagner CL, Greer FR, and the Section on Breastfeeding and Committee on Nutrition. Prevention of rickets and vitamin D deficiency in infants, children and adolescents. Pediatrics. 2008;122:1142–52.

  28. 28.

    Institute of Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin and choline. Washington DC: National Academy Press; 2008.

  29. 29.

    Institute of Medicine, Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium and zinc. Washington DC: National Academy Press; 2001.

  30. 30.

    Willett WC, Stampher MJ. What Vitamins should I be taking, doctor? N Engl J Med. 2001;345:1819–24.

  31. 31.

    U.S. Department of Health and Human Services. Dietary Guidelines for Americans 2005. U.S. Department of Agriculture. Available from URL: (Updated 8 October, 2009 and accessed 11 March, 2010).

  32. 32.

    Office of Dietary Supplements, National Institutes of Health. Vitamin D and healthful diets. Dietary Supplement Fact Sheet. Available from URL: (Updated 13 November, 2009 and accessed 9 March, 2010).

  33. 33.

    Tulchinsky TH, Varavikova EA. The New Public Health, Second Edition. San Diego (CA): Academic Press/Elsevier. 2009. Chapter 8.

Download references

Author information

Correspondence to Theodore H. Tulchinsky MD, MPH.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Tulchinsky, T.H. Micronutrient Deficiency Conditions: Global Health Issues. Public Health Rev 32, 243–255 (2010).

Download citation

Key Words

  • micronutrient deficiency conditions
  • global health
  • folic acid
  • vitamin D
  • vitamin B12
  • deficiency