what are the 4 main methods of food fortification

Allen L.H., Haskell M. Estimating the potential for vitamin A toxicity in women and young children. Source: Irizarry, L, Prost, MA, Murillo, D, Lopez de Romaa Daniel et al. 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.[25]. Globally, mandatory regulations are most often applied to the fortification of food with micronutrients such as iodine, iron, vitamin A and folic acid. Examples of biofortification projects include iron biofortification of rice, beans, maize and sweet potato; zinc biofortification of wheat, rice, beans, sweet potato and corn; and Vitamin A biofortification of sweet potatoes, corn and cassava. 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". Despite ongoing debates globally and in some countries regarding the performance and . Despite the average intake of fortified flour detected by the study amounting to 100 g per day, the poor diets quality of children with low bioavailability of iron compromised the benefits of fortified flour [41]. These are dry mixing, drip feed addition, spray mixing and submersion. WHO has been working systematically in food fortification for decades and collaborates with different networks for fortification at regional, country and community levels. New approaches, bioavailability and the use of chelates as a promising method for food fortification. World Health Organization and Food and Agriculture Organization of the United Nations Guidelines on food fortification with micronutrients. Available online: Drewnowski A., Amanquah D., Gavin-Smith B. Ruel-Bergeron J.C., Stevens G., Sugimoto J.D., Roos F.R., Ezzati M., Black R.E., Kraemer K. Global Update and Trends of Hidden Hunger, 1995-2011: The Hidden Hunger Index. Civil society in particular can help improve accountability and commitment to standards, etc. The type of fortification that will be most appropriate and effective in a given country depends on several factors including: the prevalence of certain micronutrient deficiencies, the population(s) most affected, dietary compositions, available infrastructure, capacities for food processing and production systems, as well as national regulation and governmental leadership. A particularly widespread problem in LMICs is hidden hunger, or a chronic lack of essential vitamins and minerals in the diet [2]. [30] In many industrialized countries, the addition of folic acid to flour has prevented a significant number of NTDs in infants. By 1924, it became readily available in the US. Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: An agenda for action. Food fortification is the addition of one or more essential nutrients to a foodstufffood, food product, ingredient, or condimentto prevent micronutrient deficiencies of one or more nutrients at the population level (Allen et al. Public-private partnerships (PPPs) are important for food fortification programs as most/all programs have some link between the public and private sector, as well as engagement with consumers, civil society, donors, etc. The study consisted of four population-based surveys conducted over a four-year period, and it measured dietary intake and hemoglobin levels. Wheat flour fortification with iron for reducing anaemia and improving iron status in populations. This research received no external funding. provide a comprehensive analysis of regulatory monitoring on fortified foods. Furthermore, a systematic review performed in both HICs and LIMCs did not find any significant association between the effect of multiple micronutrient fortification on child growth outcomes such height/length-for-age z-score (HAZ/LAZ)) (MD 0.09, 95% CI 0.01 to 0.18; 8 studies, 2889 participants; low-quality evidence) and zinc deficiency (RR 0.84, 95% CI 0.65 to 1.08; 5 studies, 1490 participants; low-quality evidence) [20]. In India and Kenya, voluntary fortification initiative were drivers of more exhaustive legislation and a strong enabling environment [24]. Figure 1 shows the potential benefits of food fortification across the life cycle. United Nations Childrens Fund, Global Databases, 20152020. Others may include vascular or gastrointestinal diseases. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, fortification, micronutrients, micronutrient deficiencies, large-scale food fortification, biofortification, point-of-use fortification, micronutrient supplements, partnerships. Therefore, food fortification can be a crucial intervention to decrease the risk of malnutritionbefore, during, and after pandemic. Perspective: How to Develop Nutrient Profiling Models Intended for Global Use: A Manual. Guidelines for developing a Nutrient Profiling system in LMICs were [64]. [1], Fortification is present in common food items in two different ways: adding back and addition. Barkley J.S., Wheeler K.S., Pachon H. Anaemia prevalence may be reduced among countries that fortify flour. ORIGINAL RESEARCH article . Numerous country-level studies on the impact of food fortification on micronutrient status have shown very positive results. In Cameroon, the consumption of multiple Vitamin A fortified vehicles such as sugar or wheat flour with edible oil resulted in a possible excess of UL among children. Similarly, Pachon et al. Van den Wijngaart A., Bgin F., Codling K., Randall P., Johnson Q.W. The WHO proposed a methodology for calculating and defining the safe upper limit in the Guidelines on Food Fortification with Micronutrients, which vary depending on the local context. [] 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. These technologies have been extensively reviewed elsewhere. To strengthen these programs, Sight and Life, in collaboration with Tata Trust and the local Government, has instituted a promising, cost-effective blending process known as continuous blending. Food fortification, or enrichment, is a common practice to improve the nutritional value of food. Fortified complementary foods had a small effect on childrens anemia but had no impact on their growth and in some cases, they were associated with more diarrhea episodes [42]. Hoddinott J., Rosegrant M., Torero M. Hunger and malnutrition. Van Der Straeten D., Bhullar N.K., de Steur H., Gruissem W., MacKenzie D., Pfeiffer W., Qaim M., Slamet-Loedin I., Strobbe S., Tohme J., et al. [22], 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. Inclusion in an NLM database does not imply endorsement of, or agreement with, If you ask most people in the West, roasting, and baking are almost always the same method applied to different foods. Carducci B., Keats E.C., Ruel M., Haddad L., Osendarp S.J.M., Bhutta Z. (2018) reported a generally increased supply of micronutrients between 1980 and 2013, Ruel-Bergeron et al. Despite the enormous economic potential of food fortification, several barriers are not conducive to creating an enabling environment for global food fortification scale-up. Accra, Ghana: Jun, 2017. Voluntary Particularly in the context of the COVID-19 pandemic in which mandatory lockdowns and economic slowdowns are leading to increases in food insecurity and malnutrition. The global hidden hunger indices and maps: An advocacy tool for action. 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. Sustainable Development Goals Knowledge Platform Sustainable Development Goal 17: Strengthen the Means of Implementation and Revitalize the Global Partnership for Sustainable Development. Micronutrient deficiencies are due primarily to inadequate intake of nutrient dense foods and nutrient losses due to poor diets, infections and blood loss during menstruation (women of reproductive age). 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 caused by fluorosis (a condition caused by excessive fluoride intake). For our purposes, they are the same in terms of technique. Crude Fat Crude fat is the term used to refer to the crude mixture of fat-soluble material present in a sample. It was discovered in 1821 that goiters could be treated by the use of iodized salts. In the case of biofortification, the estimated health benefit-to-cost ratio was USD 17 of benefits for every USD 1 invested [11]. As such, combatting hunger and malnutrition in many countries is more than a moral duty but is a legally binding part of national law under human rights obligation. In Guatemala it was shown that the consumption of wheat flour fortified with acid folic varied massively among people from different socioeconomic status (women from wealthy groups consumed 15 times more than women from no wealthy groups) rising concerns on the safe limits [43]. 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. . As well as increasing the nutritional content of staple foods, the addition of micronutrients can help to restore the micronutrient content lost during processing. 2017. [9] The website is maintained by the Food Fortification Initiative, GAIN, Iodine Global Network, and the Micronutrient Forum. The global regulatory landscape regarding micronutrient fortification of condiments and seasonings. ; writingreview and editing, R.O. A 2019 review attempted to estimate the real-world impact of industrial food fortification on health and nutrition outcomes in LMICs, and found that it had a positive impact on some health outcomes, including goiter, anemia, and NTD prevalence [36]. A more comprehensive view is given by the online Global Fortification Data Exchange. There are also ongoing debates globally and in some countries regarding the performance and safety of fortification efforts (whether or not the consumption of micronutrient fortified foods may cause adverse health effects due to the accumulation of these nutrients in the human body). News releases; Multimedia content; Videos for the media; . A feasibility and cost-effectiveness study in the Philippines using fortified powdered milk to increase micronutrient intake amongst children found it as a cost-effective tool for addressing iron deficiency [54]. In North and South America, addition of folic acid to wheat flour is mandatory to lower the risk of birth defects. This was the case in urban settings due to the high consumption of such foods [44]. Global and national experiences show that food fortification accomplishments are most promising when partnerships are formed not only between the public and private sectors, but also with parties/organizations that can contribute in the following critical areas: advocacy, management, capacity building, implementation and regulatory monitoring. [17], 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. Supply chain and technical feasibility Evidence from 10 years of implementation around the world Rice Fortification Table of Contents ImprintNow is the right time to scale up rice fortification |06 Filling the nutrient gap | 08 Improving the nutritional value of rice through post-harvest fortification | 10 Scaling Up Rice Fortification in Latin America and the Caribbean. Unfortunately, guaranteeing the right to food and nutrition is a complex and often overwhelming challenge in many LMICs. The authors declare no conflict of interest. Furthermore, the national production of salt is carried out by producers without a license, thereby avoiding any official controls; and the absence of high-quality laboratories prevent control and monitoring to assess the quality of fortified food [55]. Which Choice of Delivery Model(s) Works Best to Deliver Fortified Foods? fortification of maize flour, corn meal, wheat flour and rice with vitamins and minerals. Among the various staples available in Andhra Pradesh, rice is the most effective vehicle to reach the poorest and only one of two staples, which when fortified well, can carry a range of minerals and vitamins. Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. The Food Safety and Standards Authority of India (FSSAI) developed specifications for fortified rice after expert consultations which included strong clinical evidence from leading academic institutions in India. An example of this is Olam in Ghana who is fortifying long-grain rice with micronutrients including iron, zinc, and B-complex vitamins, providing more than 15% of the minimum RDA (recommended dietary allowance) per serving [23]. (2015) found limited evidence to support the reduction of anemia with large-scale flour fortification [16]. Criteria for Effective Food Fortification: Other Criteria For Fortification: Types of Food Fortification: Advantages of Food Fortification: Limitations of Food Fortification: This is the first time that this type of approach has been implement in India for fortify rice under large-scale government programs. Fortification is an evidence-informed intervention that contributes to the prevention, reduction and control of micronutrient deficiencies. government site. Global Problems, Smart Solutions: Costs and Benefits. which were established based on daily food intake. Food fortification - enhancing the micronutrient content of commonly eaten foods - provides a cost-effective and life-changing solution. A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a "snowball" process of citation searching. For example, Field et al. The World Health Organization (WHO) and the United Nations Food and Agriculture Organization (FAO) have adopted four main strategies for improving dietary intake: food fortification, micronutrient supplementation, nutrition education, and disease control measures. Fortification programs implemented population-wide were associated with a 34% reduction in anemia from improved iron stores, with greater benefits realized by those most at risk of deficiency; 74% reduction in the odds of goiter; and a 41% reduction in the odds of NTDs [14]. Conceptualization, R.O. [(accessed on 12 August 2020)]; Lalani B., Bechoff A., Bennett B. Methods: The current study examined 5,396 Iranian adults (2,627 males and 2,769 females) aged 35 years and older, who participated in a 10-year . Guidelines on Food Fortification with Micronutrients. Food fortification is a cost-effective strategy to improve the nutrition status of populations [47,48,49], and it associated with high economic benefits [50,51,52,53]. Ghana Micronutrient Survey 2017. However, challenges can arise in case of large consumption of the fortified food among the same population and utilization of multiple food vehicles [41]. Evidence of the effectiveness of flour fortification programs on iron status and anemia: A systematic review. the contents by NLM or the National Institutes of Health. De Pee S., Irizarry L., Kraemer K., Jefferds M.E.D. Large-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. 2 Food processing also includes adding ingredients to food, for example to extend shelf life. Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Publishers Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. New WHA resolution to accelerate efforts on food micronutrient fortification, New coalitions announced at the UN Food Systems Summit to increase access to healthy diets from sustainable food systems, Monitoring flour fortification to maximize health benefits: a manual for millers, regulators, and programme managers, New electronic survey manual supports countries to combat micronutrient deficiencies, Establishing global nutrient requirements, Strengthening national food control systems, Using Digital Technologies in Food Fortification for Improved Nutrition Outcomes, From Nutrition commitments to action: The Importance of a Coalition for Action on Healthy Diets from Sustainable Food Systems for Children and All in this the Decade of Action on Nutrition, Menu for Action: Spoilage mechanisms expiration dates See all videos for this article The latter has been criticized for covering only low nutritional-value food, namely, junk food, to enable them to be sold in schools. While some evidence suggests that while multiple exposures of micronutrients including fortified foods for a long period of time may result in adverse effects, when properly regulated, fortification carries a minimal risk of toxicity [45]. The main strengths of the work presented here include (1) the use of a generic ToC framework for LSFF programming grounded in the available literature . (fe)male equivalent method 4. . It is the dominant staple food crop of around three billion people. garine) as a vehicle for food fortification is a valid 1.2 Food Fortification Program and Suitable Methods. fortification. ; writingoriginal draft preparation, R.O. [4] The 2002 farm bill (P.L. Skip to main content. Back. Such is the case of salt iodization, which builds on sodium consumption and, as result, needs to consider strategies for sodium intake reduction. Food fortification and oralsupplements Global Fortification Data Exchange [(accessed on 7 July 2019)]; FAAPA Olam Launches Ghanas First Brand of Fortified Rice for Good Health. [citation needed], 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. While mandatory food fortification has been used as a strategy to prevent micronutrient deficiencies in high-income countries (HIC)dating as far back as the 1920s in Europe and North America when the first salt was iodizedit is still less common in LMICs where food systems are not delivering nutritionally adequate diets due the production and consumption of just a few major starchy food crops (maize, rice, wheat) with low micronutrient content and/or bioavailability (phytate). Food fortification can also be categorized according to the stage of addition: Micronutrients serve an important role in bodily development and growth. The findings showed an unexpected increase in anemia among children. 104127, Sec. As a library, NLM provides access to scientific literature. ; investigation, R.O. ; methodology, R.O. Sangkap Pinoy part 1 / 2 food fortification - Emir's Balik Tanaw / In Hindsight". Malnutrition in all its forms affects millions of women worldwide, but women in LMICs are particularly vulnerable to deficiencies in essential vitamins and minerals such as iron, folic acid, zinc and iodine due to poor quality diets. and C.F. The results indicated that for iron deficiency, food fortification was the most cost-effective method with a cost of USD 66 per disability adjusted life years (DALY), whereas supplementation and dietary diversification had estimated costs of USD 179 and 103 per DALY, respectively. and K.K. Sustainable Elimination of Iodine Deficiency: Progress since the 1990 World Summit for Children. Mandatory fortification programs are increasingly common, especially when it comes to fortified flour and iodized salt. Mandatory wheat flour fortification was first introduced in 1942 and currently 85 countries have since mandated its use. Federal government websites often end in .gov or .mil. For children living in different settings: Mandatory food fortification occurs when governments legally oblige food producers to fortify particular foods or categories of foods with specified micronutrients, providing high certainty over time that they will contain a predetermined amount. While Schmidhuber et al. 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 large-scale deficiency diseases in these cases. For example, through the Rwanda National Fortification Alliance, members identified VAT taxation as one of their biggest challenges, and key stakeholder groups such as the private sector, CSOs and NGOs supported discussions with the Ministry of Finance to reduce or wave VAT taxes on fortified flour as a key fortification incentive. There have been four major technologies used in the addition of iodine to salt. A significant body of literature shows that LSFF can have public health impacts in HICs as well as in LMICs. The main forms of micronutrient deficiencies in Kenya include vitamin A, iron . But even mild deficiency can significantly affect the learning ability of populations. . In Costa Rica, an evaluation of the impact of iron fortification on anemia prevalence found a significant decrease at the national level in the prevalence of anemia among children aged 17 years and women of reproductive age.

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