It’s estimated that approximately two billion people worldwide are deficient in one more micronutrient, particularly iron, iodine, vitamin A, zinc, and folate. Micronutrient deficiencies have significant health and economic consequences with devastating short- and long-term impacts.1
Since the 1920s, food fortification has been used globally as a cost-effective and efficient tool to enhance the nutritional value of staple food products and improve the nutritional status of people across the lifespan.1,2
Food fortification is the process of adding nutrients – namely vitamins and minerals – not normally present or present in small amounts to staple foods. This process is slightly different from food enrichment, which is the process of adding nutrients back to food products that were lost during processing.
However, the terms “enriched” and “fortified” are commonly used interchangeably to indicate that one or more nutrients were added to food unless regulations require otherwise.
In either case, food fortification has proven to be effective in reducing the prevalence of many diseases and conditions caused by nutrient deficiencies, including goiter (iodine), rickets (vitamin D), anemia (iron), xerophthalmia (vitamin A), and neural tube defects (folate).1,2
Food fortification in the United States and globally
Although voluntary food fortification in the United States has occurred since 1924 with the iodization of salt, it wasn’t until 1980 that the United States Food and Drug Administration (FDA) established a fortification policy that discouraged the indiscriminate addition of nutrients to foods.3
The policy, which does not apply to infant formula or dietary supplements, established four principles for the rational addition of nutrients to foods. The principles are to:
- Correct a dietary insufficiency
- Restore a nutrient level to those prior to storage, handling, and processing
- Provide a balance of vitamins, minerals, and protein in proportion to the total caloric value of the food
- Prevent nutrient inferiority in a food that replaces a traditional food in the diet
In the fortification policy, the FDA states that it is inappropriate to fortify certain foods such as cookies, candies, cakes, chips, and carbonated beverages. Fortification of these foods could mislead consumers to believe that substituting naturally nutrient-dense foods like fruits, vegetable, low-fat dairy, and lean meats with fortified snack foods would allow for a nutritionally adequate diet.4
With the exception of certain standardized foods, fortification is not mandatory in the United States. Many manufacturers, however, voluntary choose to fortify certain products.
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Examples of foods that are commonly fortified voluntarily include:
- Milk, optional addition of vitamins A and D
- Margarine, optional addition of vitamin D
- Orange juice, optional addition of calcium
- Salt, optional addition of iodine
The fortification policy applies to all essential vitamins and minerals. Nutrients that do not have a recommended dietary intake (RDI) or an established reference value – such as lycopene or lutein – are not covered under the fortification policy.4
Like the FDA, other countries and organizations, such as the Codex Alimentarius of the Food and Agriculture Organization (FAO) and the World Health Organization (WHO), have established guidelines and general principals on food fortification with micronutrients. However, each country determines its own policy or regulations, resulting in varied fortification approaches throughout the world.
The most common food vehicles for food fortification, include:5
- Maize flour: 16 countries have mandatory fortification
- Oil: 26 countries have mandatory fortification
- Rice: 7 countries have mandatory fortification
- Salt: 128 countries have mandatory fortification
- Wheat flour: 83 countries have mandatory fortification
Aside from the differences in fortification legislation, the number of food vehicles with fortification standards and the amount of each nutrient required in food vehicles also varies among countries.5
Food fortification as a marketing strategy
Food fortification may be used as a tool by regulatory agencies and industry to correct or prevent widespread nutrient deficiencies, but it’s also used by manufacturers to make food products more appealing to consumers.
Increasingly, the food industry has taken full advantage of voluntary food fortification by producing products that appeal to the health-conscious consumer.
From vitamin D and calcium fortified dairy alternatives to omega-3 fatty acid fortified breads to probiotic fortified granola, there is no shortage of novel fortified foods and beverages that appeal to consumers looking to manage specific health concerns.
In either case, manufacturers and marketers should be aware of the appropriate guidance for fortifying foods, especially when making labeling claims.
The bioavailability and purity of the nutrient fortificant as well as the food vehicle are also important considerations to keep in mind with product development.
References
- Chadare FJ, Idohou R, Nago E, et al. Conventional and food-to-food fortification: An appraisal of past practices and lessons learned. Food Sci Nutr. 2019; 7(9):2781-2795.
- Eichler K, Hess S, Twerenbold C. Health effects of micronutrient fortified dairy products and cereal food for children and adolescents: A systematic review. PLoS One. 2019; 14(1):e0210899.
- CFR – Code of Federal Regulations Title 21. Accessdata.fda.gov. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=104.20. Updated September 19, 2019. Accessed February 15, 2020.
- Center for Food Safety and Applied Nutrition. Questions and Answers on FDAs Fortification Policy. U.S. Food and Drug Administration. https://www.fda.gov/regulatory-information/search-fda-guidance-documents/guidance-industry-questions-and-answers-fdas-fortification-policy. Published November 2015. Accessed February 15, 2020.
- Providing actionable food fortification data. Global Fortification Data Exchange | GFDx. https://fortificationdata.org/. Accessed February 15, 2020.
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Gavin
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