Food fortification
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Food fortification or enrichment is the process of adding micronutrients (essential
trace elements and vitamins) to food. It can be carried out by food manufacturers, or by
governments as a public health policy which aims to reduce the number of people with
dietary deficiencies within a population. The predominant diet within a region can lack
particular nutrients due to the local soil or from inherent deficiencies within the staple
foods; the addition of micronutrients to staples and condiments can prevent largescale deficiency diseases in these cases.[1]
As defined by the World Health Organization (WHO) and the Food and Agricultural
Organization of the United Nations (FAO), fortification refers to "the practice of
deliberately increasing the content of an essential micronutrient, i.e. vitamins and
minerals (including trace elements) in a food, to improve the nutritional quality of the
food supply and to provide a public health benefit with minimal risk to health",
whereas enrichment is defined as "synonymous with fortification and refers to the
addition of micronutrients to a food which are lost during processing". [2]
Food fortification has been identified as the second strategy of four by the WHO and
FAO to begin decreasing the incidence of nutrient deficiencies at the global level. [2] As
outlined by the FAO, the most commonly fortified foods are cereals and cereal-based
products; milk and dairy products; fats and oils; accessory food items; tea and other
beverages; and infant formulas.[3] Undernutrition and nutrient deficiency is estimated
globally to cause the deaths of between 3 and 5 million people per year.[1]
Contents
•
•
•
•
•
1Types
2Rationale
3Around the world
o 3.1Argentina
o 3.2Colombia
o 3.3El Salvador, Guatemala, Honduras and Nicaragua
o 3.4Philippines
o 3.5United Kingdom
o 3.6United States
4Criticism
o 4.1Limited absorption
o 4.2Different forms of micronutrients
5Examples of fortification in foods
o 5.1Iodized salt
o 5.2Folate
o 5.3Niacin
o 5.4Vitamin D
•
•
•
o 5.5Fluoride
6See also
7External links
8References
Types[edit]
Fortification is present in common food items in two different ways: adding back and
addition. Flour loses nutritional value due to the way grains are processed; Enriched
Flour has iron, folic acid, niacin, riboflavin, and thiamine added back to it. Conversely,
other fortified foods have micronutrients added to them that don’t naturally occur in
those substances. An example of this is orange juice, which often is sold with
added calcium.[4]
Food fortification can also be categorized according to the stage of addition:
1. Commercial and industrial fortification (wheat
flour, corn meal, cooking oils)
2. Biofortification (breeding crops to increase their
nutritional value, which can include both
conventional selective breeding, and genetic
engineering)
3. Home fortification (example: vitamin D drops)[5]
Rationale[edit]
Micronutrients serve an important role in bodily development and growth. Deficiencies
of these micronutrients may cause improper development or even disease.
The WHO and FAO, among many other nationally recognized organizations, have
recognized that there are over 2 billion people worldwide who suffer from a variety of
micronutrient deficiencies. In 1992, 159 countries pledged at the FAO/WHO
International Conference on Nutrition to make efforts to help combat these issues of
micronutrient deficiencies, highlighting the importance of decreasing the number of
those with iodine, vitamin A, and iron deficiencies. [2] A significant statistic that led to
these efforts was the discovery that approximately 1 in 3 people worldwide were at risk
for either an iodine, vitamin A, or iron deficiency.[6] Although it is recognized that food
fortification alone will not combat this deficiency, it is a step towards reducing the
prevalence of these deficiencies and their associated health conditions. [6]
In Canada, the Food and Drug Regulations have outlined specific criteria which justify
food fortification:
1. To replace nutrients which were lost during
manufacturing of the product (e.g. the
manufacturing of flour[7])
2. To act as a public health intervention
3. To ensure the nutritional equivalence of
substitute foods (e.g. to make butter
and margarine similar in content, soy milk and
cow's milk, etc.)
4. To ensure the appropriate vitamin and mineral
nutrient composition of foods for special dietary
purposes (e.g., gluten-free products, low sodium,
or any other products specifically designed for
special dietary requirements from an individual).
There are also several advantages to approaching nutrient deficiencies among
populations via food fortification as opposed to other methods. These may include, but
are not limited to: treating a population without specific dietary interventions therefore
not requiring a change in dietary patterns, continuous delivery of the nutrient, does not
require individual compliance, and potential to maintain nutrient stores more efficiently if
consumed regularly.[5]
Around the world[edit]
The subsections below describe fortifications in some jurisdictions around the world. A
more comprehensive view is given by the online Global Fortification Data Exchange. It
indicates which of 197 countries worldwide have mandatory and voluntary food
fortification in their datasets[8] and country profiles.[9] The website is maintained by
the Food Fortification Initiative, GAIN, Iodine Global Network, and the Micronutrient
Forum.[10]
Argentina[edit]
In Argentina, wheat flour must by law (Ley 25.630 of 2002)[11] be fortified with iron,
thiamine (vitamin B1), riboflavin (B2), niacin (B3), and folic acid (B9).[12]
Colombia[edit]
Wheat flour sold in Colombia must by law be fortified with vitamin B 1, vitamin B2, niacin
(B3), folic acid (B9) and iron (Decreto 1944 of 1996).[13]
El Salvador, Guatemala, Honduras and Nicaragua[edit]
The four countries, also called the C-4, all legally require wheat flour to be fortified with
vitamins B1, B2, B3, B9, and iron.[14][15]
Philippines[edit]
The Philippine law on food fortification has two components: mandatory (covering select
staples)[16] and voluntary (under the Sangkap Pinoy program). The latter has been
criticized for covering only low nutritional-value food, namely, junk food, to enable them
to be sold in schools.[17]
United Kingdom[edit]
UK law (The Bread and Flour Regulations 1998)[18][19] requires that all flour (except
wholemeal and some self-raising flours) be fortified with calcium. Wheat flour must also
be fortified with iron, thiamine (vitamin B1) and vitamin B3.[20]
United States[edit]
In the 1920s food fortification emerged as a strategy in the United States to address and
prevent the lack of micronutrients in the population’s diet. Specifically, it was
discovered in the 1930s and 1940s that micronutrient deficiency is often linked to
specific diseases and syndromes. Consequently, The Committee on Food and Nutrition
suggested that micronutrients be added to flour.[21] In 1980, The Food and Drug
Administration put into action its Food Fortification Policy which included six
fundamental rules. In addition to establishing safety guidelines of food fortification, this
policy aimed to ensure that food fortification was solely for when the supplemental
micronutrient had a national deficiency and that the food chosen to provide that nutrient
was consumed by enough of the population to make a change. This policy also
emphasized the importance of clinical data, a shift from earlier policies which relied on
dietary data alone.[22] The 2002 farm bill (P.L. 107-171, Sec. 3013) requires
the Administrator of USAID, in consultation with the Secretary of Agriculture, to
establish micronutrient fortification programs under P.L. 480 food aid. Section 3013
replaces a pilot program similarly named and authorized in the 1996 farm bill (P.L. 104127, Sec. 415). Under the programs, grains and other commodities made available to
countries selected for participation will be fortified with micronutrients (e.g., iron, vitamin
A, iodine, and folic acid).
Criticism[edit]
The WHO states that limitations to food fortification may include human rights issues
indicating that consumers have the right to choose if they want fortified products or not,
the potential for insufficient demand of the fortified product, increased production costs
leading to increased retail costs, the potential that the fortified products will still not be a
solution to nutrient deficiencies among low-income populations who may not be able to
afford the new product, and children who may not be able to consume adequate
amounts thereof.[2]
Manufacturers once proposed selling fortified junk food and beer, but USFDA policies of the time forbade it
In addition to criticism of government-mandated fortification, food companies have been
criticized for indiscriminate enrichment of foods for marketing purposes. Food safety
worries led to legislation in Denmark in 2004 restricting foods fortified with extra
vitamins or minerals. Products banned include: Rice
Krispies, Shreddies, Horlicks, Ovaltine and Marmite.[23]
Limited absorption[edit]
One factor that limits the benefits of food fortification is that isolated nutrients added
back into a processed food that has had many of its nutrients removed, does not always
result in the added nutrients being as bioavailable as they would be in the original,
whole food. An example is skim milk that has had the fat removed, and then had vitamin
A and vitamin D added back. Vitamins A and D are both fat-soluble and non-watersoluble, so a person consuming skim milk without fats may not be able to absorb as
much of these vitamins as one would be able to absorb from drinking whole milk. On the
other hand, the nutrient added as a fortificant may have a higher bioavailability than
from foods, which is the case with folic acid used to increase folate intakes. [24]
Phytochemicals such as phytic acid in cereal grains can also impact nutrient absorption,
limiting the bioavailability of intrinsic and additional nutrients, and reducing the
effectiveness of fortification programs.
Different forms of micronutrients[edit]
There is a concern that micronutrients are legally defined in such a way that does not
distinguish between different forms, and that fortified foods often have nutrients in a
balance that would not occur naturally. For example, in the U.S., food is fortified with
folic acid, which is one of the many naturally-occurring forms of folate, and which only
contributes a minor amount to the folates occurring in natural foods. [25] In many cases,
such as with folate, it is an open question of whether or not there are any benefits or
risks to consuming folic acid in this form.
In many cases, the micronutrients added to foods in fortification are synthetic.
Certain forms of micronutrients can be actively toxic in a sufficiently high dose, even if
other forms are safe at the same or much higher doses. There are examples of such
toxicity in both synthetic and naturally occurring forms of vitamins. Retinol, the active
form of Vitamin A, is toxic in a much lower dose than other forms, such as beta
carotene. Menadione, a phased-out synthetic form of Vitamin K, is also known to be
toxic.[medical citation needed]
Examples of fortification in foods[edit]
Many foods and beverages worldwide have been fortified, whether a voluntary action by
the product developers or by law. Although some may view these additions as strategic
marketing schemes to sell their product, there is a lot of work that must go into a
product before simply fortifying it. To fortify a product, it must first be proven that the
addition of this vitamin or mineral is beneficial to health, safe, and an effective method
of delivery. The addition must also abide by all food and labeling regulations and
support nutritional rationale. From a food developer's point of view, they also need to
consider the costs associated with this new product and whether there will be a market
to support the change.[26]
The Food Fortification Initiative lists all countries in the world that conduct fortification
programs,[27] and within each country, what nutrients are added to which foods, and
whether those programs are voluntary or mandatory. Vitamin fortification programs exist
in one or more countries for folate, niacin, riboflavin, thiamine, vitamin A, vitamin B 6,
vitamin B12, vitamin D and vitamin E. Mineral fortification programs include calcium,
fluoride, iodine, iron, selenium and zinc. As of December 21, 2018, 81 countries
required food fortification with one or more vitamins. [28] The most commonly fortified
vitamin – as used in 62 countries – is folate; the most commonly fortified food is wheat
flour (enriched flour).[28] Examples of foods and beverages that have been fortified:
Iodized salt[edit]
Main article: Iodised salt
"Iodine deficiency disorder (IDD) is the single greatest cause of preventable mental
retardation. Severe deficiencies cause cretinism, stillbirth and miscarriage. But even
mild deficiency can significantly affect the learning ability of populations. […] Today over
1 billion people in the world suffer from iodine deficiency, and 38 million babies born
every year are not protected from brain damage due to IDD."—Kul Gautam, Deputy
Executive Director, UNICEF, October 2007[29]
Iodised salt has been used in the United States since before World War II. It was
discovered in 1821 that goiters could be treated by the use of iodized salts. However, it
was not until 1916 that the use of iodized salts could be tested in a research trial as a
preventative measure against goiters. By 1924, it became readily available in the
US.[30] Currently in Canada and the US, the RDA for iodine is as low as 90 µg/day for
children (4–8 years) and as high as 290 µg/day for breast-feeding mothers.[medical citation needed]
Diseases that are associated with an iodine deficiency include: mental
retardation, hypothyroidism, and goiter. There is also a risk of various other growth and
developmental abnormalities.[medical citation needed]
Folate[edit]
Folate (as a fortification ingredient, folic acid) functions in reducing blood homocysteine
levels, forming red blood cells, proper growth and division of cells and preventing neural
tube defects (NTDs).[31] In many industrialized countries, the addition of folic acid to flour
has prevented a significant number of NTDs in infants. Two common types of
NTDs, spina bifida and anencephaly, affect approximately 2500-3000 infants born in the
US annually. Research trials have shown the ability to reduce the incidence of NTDs by
supplementing pregnant mothers with folic acid by 72%.[32]
Niacin[edit]
Niacin (a form of vitamin B3) has been added to bread in the US since 1938 (when
voluntary addition started), a program which substantially reduced the incidence
of pellagra.[33] Pellagra was seen amongst poor families who used corn as their main
dietary staple. Although corn itself does contain niacin, it is not a bioavailable form
unless it undergoes nixtamalization (treatment with alkali, traditional in Native American
cultures) and therefore was not contributing to the overall intake of niacin. [medical citation needed]
Diseases associated with niacin deficiency include: pellagra which consisted of signs
and symptoms called the three D's-"dermatitis, dementia, and diarrhea." Others may
include vascular or gastrointestinal diseases.[34] Common diseases which present a high
frequency of niacin deficiency: alcoholism, anorexia nervosa, HIV infection,
gastrectomy, malabsorptive disorders, certain cancers and their associated
treatments.[34]
Vitamin D[edit]
Since Vitamin D is a fat-soluble vitamin, it cannot be added to a wide variety of foods.
Foods that it is commonly added to are margarine, vegetable oils and dairy
products.[35] During the late 1800s, after the discovery of curing conditions
of scurvy and beriberi had occurred, researchers were aiming to see if the disease, later
known as rickets, could also be cured by food. Their results showed that sunlight
exposure and cod liver oil were the cure. It was not until the 1930s that vitamin D was
actually linked to curing rickets.[36] This discovery led to the fortification of common foods
such as milk, margarine, and breakfast cereals. This took the astonishing statistics of
approximately 80–90% of children showing varying degrees of bone deformations due
to vitamin D deficiency to being a very rare condition. [37]
Diseases associated with a vitamin D deficiency include rickets, osteoporosis, and
certain types of cancer (breast, prostate, colon and ovaries). It has also been
associated with increased risks for fractures, heart disease, type 2 diabetes,
autoimmune and infectious diseases, asthma and other wheezing disorders, myocardial
infarction, hypertension, congestive heart failure, and peripheral vascular disease.[37]
Fluoride[edit]
Main article: Water fluoridation
Although fluoride is not considered an essential mineral, it is useful in prevention of
tooth decay and maintaining adequate dental health. [38][39] In the mid-1900s it was
discovered that towns with a high level of fluoride in their water supply was causing the
residents' teeth to have both brown spotting and a strange resistance to dental caries.
This led to the fortification of water supplies with fluoride in safe amounts (or reduction
of naturally occurring levels) to retain the properties of resistance to dental caries but
avoid the staining cause by fluorosis (a condition caused by excessive fluoride
intake).[40] The tolerable upper intake level (UL) set for fluoride ranges from 0.7 mg/day
for infants aged 0–6 months and 10 mg/day for adults over the age of 19.
See also[edit]
•
Food portal
•
•
•
•
•
Food additive
Food composition
Dietary supplement
Food processing
Nutraceutical
External links[edit]
•
Food fortification in the Philippines: Policies,
programmes, issues, and prospects
References[edit]
1.
2.
3.
4.
^ Jump up to:a b "Micronutrient Fortification and Biofortification
Challenge". Copenhagen Consensus Center. Retrieved 201706-14.
^ Jump up to:a b c d World Health Organization and Food and
Agriculture Organization of the United Nations Guidelines on
food fortification with micronutrients. Archived 26 December
2016 at the Wayback Machine 2006 [cited on 2011 Oct 30].
^ Micronutrient Fortification of Food: Technology and Quality
Control Archived 2 September 2016 at the Wayback Machine
^ Dwyer, Johanna T; Wiemer, Kathryn L; Dary, Omar; Keen,
Carl L; King, Janet C; Miller, Kevin B; Philbert, Martin A;
Tarasuk, Valerie; Taylor, Christine L; Gaine, P Courtney;
Jarvis, Ashley B (2015-01-07). "Fortification and Health:
Challenges and Opportunities1234". Advances in
Nutrition. 6 (1): 124–
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
131. doi:10.3945/an.114.007443. ISSN 21618313. PMC 4288271. PMID 25593151.
^ Jump up to:a b Liyanage, C.; Hettiarachchi, M. (2011). "Food
fortification". Ceylon Medical Journal. 56 (3): 124–
127. doi:10.4038/cmj.v56i3.3607. PMID 22164753.
^ Jump up to:a b Darnton-Hill E (1998). "Overview: Rationale
and elements of a successful food-fortification
programme". Food Nutr Bull (United Nations
University). 19 (2): 92–
100. doi:10.1177/156482659801900202.
^ "Recommendations on Wheat and Maize Flour Fortification
Meeting Report: Interim Consensus
Statement" (PDF). Who.int. Archived from the
original (PDF) on May 13, 2009. Retrieved 2016-03-30.
^ "Full GFDx Datasets – Global Fortification Data Exchange |
GFDx". Retrieved 2021-07-28.
^ "Country Fortification Dashboard – Global Fortification Data
Exchange | GFDx". Retrieved 2021-07-28.
^ "Global Fortification Data Exchange | GFDx – Providing
actionable food fortification data all in one place".
Retrieved 2021-07-28.
^ "Ley 25.630". Ministry of Justice and Human Rights
(Argentina). Retrieved 2021-07-27.
^ "Guías alimentarias para la población
Argentina" (PDF). Ministry of Health (Argentina).
2016. Archived (PDF) from the original on 2020-07-10.
Retrieved 2021-07-27.
^ "Derecho del Bienestar Familiar
[DECRETO_1944_1996]". www.icbf.gov.co. Retrieved 202107-28.
^ "Alimentos Fortificados". www.incap.int. Retrieved 2021-0728.
^ David. L, Jorge (2004). "FORTIFICACIÓN DE HARINA DE
TRIGO EN AMÉRICA LATINA Y REGIÓN DEL
CARIBE". Revista chilena de nutrición. 31 (3): 336–
347. doi:10.4067/S0717-75182004000300009. ISSN 07177518.
^ Documentary on the mandatory food fortification program of
the Philippine government
^ Documentary on Sangkap Pinoy
^ "The Bread and Flour Regulations 1998". UK Legislation.
The National Archives (UK).
^ "Nutritional Contribution Of Flour". UK Flour Millers.
Retrieved 2021-05-10.
^ "Fortification - Page 3". British Nutrition Foundation.
Retrieved 2021-05-10.
^ Labeling, Institute of Medicine (US) Committee on Use of
Dietary Reference Intakes in Nutrition (2003). Overview of
Food Fortification in the United States and Canada. National
Academies Press (US).
^ Dwyer, Johanna T; Wiemer, Kathryn L; Dary, Omar; Keen,
Carl L; King, Janet C; Miller, Kevin B; Philbert, Martin A;
Tarasuk, Valerie; Taylor, Christine L; Gaine, P Courtney;
Jarvis, Ashley B (2015-01-07). "Fortification and Health:
Challenges and Opportunities1234". Advances in
Nutrition. 6 (1): 124–
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
131. doi:10.3945/an.114.007443. ISSN 21618313. PMC 4288271. PMID 25593151.
^ Bruno Waterfield (24 May 2011). "Marmite made illegal in
Denmark".
^ McNulty, Helene; Pentieva, Kristina (2007). "Folate
bioavailability". Proceedings of the Nutrition Society. 63 (4):
529–536. doi:10.1079/PNS2004383. ISSN 00296651. PMID 15831124.
^ A. David Smith, "Folic acid fortification: the good, the bad,
and the puzzle of vitamin", American Society for Clinical
Nutrition, Vol. 85, No. 1, 3-5. January 2007. Archived 18
December 2015 at the Wayback Machine
^ Richardson, D. P. (28 February 2007). "Food
Fortification". Proceedings of the Nutrition Society. 49 (1): 39–
50. doi:10.1079/PNS19900007. PMID 2190226.
^ "Why fortify?". Food Fortification Initiative. 2017. Retrieved 3
February 2019.
^ Jump up to:a b "Map: Count of Nutrients In Fortification
Standards". Global Fortification Data Exchange. Retrieved 4
February 2019.
^ Salt, The (13 July 2013). "Iodized Salt". Salt Institute.
Archived from the original on 14 February 2013.
Retrieved 2016-03-30.
^ "Archived copy". Archived from the original on 21 January
2012. Retrieved 30 October 2011.
^ "Site | Ohioline" (PDF). Archived from the original (PDF) on
2005-10-26.
^ Honein MA, Paulozzi LJ, Mathews TJ, Erickson JD, Wong
LY (2001). "Impact of folic acid fortification of the US food
supply on the occurrence of neural tube
defects". JAMA. 285 (23): 2981–
2986. doi:10.1001/jama.285.23.2981. PMID 11410096.
^ Park YK, Sempos CT, Barton CN, Vanderveen JE, Yetley
EA (2000). "Effectiveness of food fortification in the United
States: the case of pellagra". American Journal of Public
Health. 90 (5): 727–
738. doi:10.2105/AJPH.90.5.727. PMC 1446222. PMID 10800
421.
^ Jump up to:a b Prousky J, Millman CG, Kirkland JB (2001).
"Pharmacologic Use of Niacin". Journal of Evidence-Based
Complementary & Alternative Medicine. 16 (2): 91–
101. doi:10.1177/2156587211399579. S2CID 71468175.
^ "Food Fortification Technology". Fao.org. Retrieved 201603-30.
^ "A dose of vitamin D history". Nature Structural
Biology. 9 (2): 77. 2002. doi:10.1038/nsb020277. PMID 11813006.
^ Jump up to:a b Holick MF (2010). "The Vitamin D Deficiency
Pandemic: a Forgotten Hormone Important for Health". Health
Reviews. 32: 267–283. doi:10.1007/bf03391602.
^ "Community Water Fluoridation | Division of Oral Health |
CDC". www.cdc.gov. 2018-02-21. Retrieved 2018-05-01.
^ "Medical Testimonials about Fluoridation". www.ada.org.
Retrieved 2018-05-01.
^ "The Story of Fluoridation". National Institute of Dental and
Craniofacial Research. Retrieved 30 March 2016.
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