Fortification of food
Fortification is the practice of deliberately increasing the content of one or more micronutrients (i.e., vitamins and minerals) in food or condiment to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health. As well as increasing the nutritional content of staple foods, the addition of micronutrients can help to restore the micronutrient content lost during processing.
Fortification has been identified as one of the most cost-effective nutrition interventions available, particularly for low- and middle-income countries. Fortification of commonly used food vehicles provides an opportunity for increasing nutrient intake during infancy and for populations at risk of deficiencies without any side effects for the general population. It is a “win-win”.
Food fortification with multiple micronutrients may reduce anaemia, iron deficiency anaemia and micronutrient deficiencies (iron, vitamin A, vitamin B2 and vitamin B6) as well as some motor and cognitive outcomes. Micronutrient fortification may also improve child growth measures.
Fortification of wheat flour with folic acid may reduce the risk of neural tube defects and may increase erythrocyte and serum/plasma folate concentrations. Fortification of wheat flour with iron may reduce anaemia in the general population.
Staple foods may be fortified with vitamin D for the prevention and reduction of nutritional rickets.
Fortification of foods with zinc may improve the serum zinc status.
There are no reported side effects associated with single or micronutrient fortification.
Fortification should be part of a comprehensive micronutrient deficiency control strategy that sets clear and achievable goals to assess progress across the lifespan of the program and ensures complementarity with other programs if needed.
The most widely used vehicles for fortification are among the most commonly consumed foods, including oils and fats, milk, sugar, salt, rice, wheat, or maize flour. Some factors related to food fortification such as level of fortification; bioavailability of fortificants; and amount of fortified food consumed have a significant effect on health.
The choice of vehicle for fortification requires information on the consumption pattern (or potential consumption pattern) in diverse population groups, and particularly the proportion of the food vehicle consumed that is fortifiable.
Lessons from Food Fortification
Food fortification leads to rapid improvement in the micronutrient status of a population, and at a reasonable cost, especially if advantage is taken from existing technology and local distribution networks.
In many cases, when multiple deficiencies coexist, food fortification with multiple micronutrients appears relatively mor beneficial and should be considered.
Challenges such as choosing appropriate fortification vehicles, reaching target populations, avoiding overconsumption in nontarget groups, and monitoring nutritional status are relevant to all countries because they occur everywhere where there is an attempt to fortify foods to optimize intake and nutritional status.
Continuous production and monitoring of quality fortified foods are essential.
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