Food fortification

Food fortification, introduction,

importance, advantages, types,
WHO/FAO guideline
 Food Fortification
• WHO – “The process whereby nutrients are added to foods (in
relatively small quantities) to maintain or improve the quality of the
diet of a group , a community or a population.”
• It is a public health measure to prevent or control some nutritional
disorders.
•  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.

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 History of Food Fortification

• Iodised Salt was used in the United States before World

War II
• Niacin has been added to bread in the USA since 1938

• Vitamin D was added to margarine in Denmark in early

50’s
• Vitamin A & D were added to Vanaspati (hydrogenated
Vegetable Oil) in India since 1954 as per mandate

7
 Cont.….

 Folic acid was added to bread for preventing neural

tube defects in infants in 60’s.
 Over the last 3 decades fortification of foods has
become a public health measure for preventing
deficiencies of Vitamin -A, Iron, Folic acid and Iodine.

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 Approaches For Arriving At Fortification Levels

• National RDA of nutrients

• Prevalence of deficiency in the region
• Per capita consumption of food vehicle to be fortified
• Current dietary habits of the population
• Stability of the nutrient in the food being fortified
• Chemical sources(avail)

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 Objective of Food fortification
• It is a effective public health measure.
• Its main aim is to prevent & control nutritional
disorder.
• To increase nutritional quality of manufactured
product that are used as sole of nourishment. eg.
infant formula, formulated liquid diets or
weaning foods.
• To correct demonstrated dietary deficiency of
those nutrients that are added.
• To restore nutrients initially present in
significant amount in food but lost as a result
of processing & manufacturing.
• To ensure nutritional equivalency of
manufactured food products substituting
other foods.eg fortified margarine as
substitute of butter.
 Criteria for Fortification

• Nutrient deficiency should be widespread.

• The vehicle food must be consumed by the target
group.
• The high consumption of fortified food will not lead to
toxicity.
• Addition of micronutrient should not change the taste,
colour, flavour, texture and shelf- life of the food item.

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 Cont..

• The item of food should be centrally controlled and

monitored
• The cost of fortification should be affordable.

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• Food fortification is an important tool for
improving the health of the population.
• Food fortification is the addition of one or
more nutrients to the food.
• The terms double fortification or multiple
fortification are used when more nutrients are
added to the foods.
• In Nepal, salt is fortified with iodine&
Vanaspatee ghee is fortified with Vitamin A&
D.
 Principles
of Food Fortification
a) Restore nutrients lost during processing of foods so that
the nutrient content is restored to the level originally
present in the raw food. This is often referred to as
restoration.eg.Addition of vit.C to the fruit juices & other
processed fruit products.
b) Addition of a nutrient to a staple or other widely
consumed primary foods deficient in one or more
nutrients,to improve its nutritional quality with a view
to ensuring an improvement in the nutrient intake of
the population. Eg. thaimine & other B vitamins enriched
highly polished rice.
 Principles
of Food Fortification
• c) Nutrient added to a food or an article of diet
widely consumed to improve quality of diet of a
group ,community or a population .This is an
accepted definition of fortification by the WHO ,&
can include the process of adding small nutrients
to improve the nutrient intake of a population.
food fortification can help to deliver a nutrient to
a population suffering from the defiency of that
nutrient so as to prevent the deficiency disease.
 Types of fortification
• Food fortification can take several forms.
• Mass fortification
• Targeted fortification
• Market driven fortification
 Mass fortification
• mass fortification is the term used to describe the
addition of one or more micronutrients to foods
commonly consumed by the general public, such as
cereals, condiments and milk. It is usually instigated,
mandated and regulated by the government sector.
• Mass fortification is generally the best option when
the majority of the population has an unacceptable
risk, in terms of public health, of being or becoming
deficient in specific micronutrients.
 Mass fortification…..contd
• The mandatory addition of folic acid to wheat
flour with a view to lowering the risk of birth
defects, a practice which has been introduced
in Canada and the United States, and also in
many Latin American countries, is one
example of the latter scenario.
 Targeted fortification
• In targeted food fortification programmes, foods
aimed at specific subgroups of the population are
fortified, thereby increasing the intake of that
particular group rather than that of the population
as a whole.
• Examples include complementary foods for infants
and young children, foods developed for school
feeding programmes, special biscuits for children
and pregnant women, and rations (blended foods)
for emergency feeding and displaced persons .
 Market-driven fortification
• The term “market-driven fortification” is applied to
situations whereby a food manufacturer takes a business-
oriented initiative to add specific amounts of one or more
micronutrients to processed foods. Examples include
certain minerals (e.g. iron,calcium) and sometimes selected
vitamins (e.g. vitamin C, vitamin B2).
• Market-driven fortification is more widespread in
industrialized countries, whereas in most developing
countries the public health impact of market-driven food
interventions is still rather limited. However, their
importance is likely to be greater in the future, because of
increasing urbanization and wider availability of such foods.
 Other types of fortification

• Household and community fortification:

• Foods for fortification at the household level

Product Comments

Micronutrient powder (eg.Baal Vita) which Contain several micronutrients, including

can be sprinkled into food
iron, encapsulated to
which can be minimize adverse interactions
between micronutrients and sprinkled onto
food sensory changes to the food to which
they are added;
available in sachets

Soluble micronutrient Suitable for young children;

tablets which can be Tested by WHO
dissolved in water
and fed as a drink
Biofortification of staple foods
• Biofortification of staple foods means the breeding and
genetic modification of plants so as to improve their
nutrient content and/or absorption is another novel
approach that is currently being considered.
• Biofortification is the process by which the nutritional
quality of food crops is improved through agronomic
practices, conventional plant breeding, or modern
biotechnology
Examples of bio fortification projects include:
• iron-bio fortification of rice, beans, sweet potato, cassava
and legumes;
• zinc-bio fortification of wheat, rice, beans, sweet potato
and maize;
 public health benefits of fortification
• Prevention or minimization of the risk of occurrence of
micronutrient deficiency in a population or specific population
groups.
• • Contribution to the correction of a demonstrated micronutrient deficiency in
• a population or specific population groups.
• • A potential for an improvement in nutritional status and dietary intakes that
• may be, or may become, suboptimal as a result of changes in dietary
• habits/lifestyles.
• • Plausible beneficial effects of micronutrients consistent with maintaining or
• improving health (e.g. there is some evidence to suggest that a diet rich in
• selected anitoxidants might help to prevent cancer and other diseases).
 Advantage of food fortification
• If consumed on a regular and frequent basis, fortified foods will maintain
body stores of nutrients more efficiently and more effectively than will
intermittent supplements.
• Fortified foods are also better at lowering the risk of the multiple deficiencies
that can result from seasonal deficits in the food supply or a poor quality diet.
This is an important advantage to growing children who need a sustained
supply of micronutrients for growth and development, and to women of
fertile age who need to enter periods of pre lactation with adequate nutrient
stores.
• Fortification can be an excellent way of increasing the content of vitamins in
breast milk and thus reducing the need for supplementation in postpartum
women and infants.
 Advantage of food fortification

• Fortification generally aims to supply micronutrients in amounts that

approximate to those provided by a good, well-balanced diet.
Consequently, fortified staple foods will contain “natural” or near
natural levels of micronutrients, which may not necessarily be the case
with supplements.
• Fortification of widely distributed and widely consumed foods has the
potential to improve the nutritional status of a large proportion of the
population, both poor and wealthy.
• Multiple micronutrient deficiencies often coexist in a population that
has a poor diet. It follows that multiple micronutrient fortification is
frequently desirable. In most cases, it is feasible to fortify foods with
several micronutrients simultaneously.
 Limitation of food fortification
• While fortified foods contain increased amounts of selected micronutrients,
they are not a substitute for a good quality diet that supplies adequate
amounts of energy, protein, essential fats and other food constituents required
for optimal health.
• A specific fortified foodstuff might not be consumed by all members of a target
population. Conversely, everyone in the population is exposed to increased
levels of micronutrients in food, irrespective of whether or not they will
benefit from fortification
• Very low-income population groups are known to have coexisting multiple
micronutrient deficiencies, as a result of inadequate intakes of the traditional
diet. Although multiple micronutrient fortification is technically possible, the
reality is that the poor will be unable to obtain recommended intakes of all
micronutrients from fortified foods alone.
 Future Challenges of Food Fortification

1. Create community awareness about benefits of food

fortification.

2. Private Sector, Governments & International Agencies

need to make commitments for investing in food
fortification.

3. Ensure increased availability of fortified foods to the

vulnerable groups of populations.
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 Cont..

4. Governments & International Agencies should

encourage fortification by way of tax concessions or duty
rebates.
5. Regulatory authorities to recommend Uniform Food
Fortification Guidelines to the group countries.
6. Develop Technologies that will produce the Futuristic
food.

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 Food fortification in Nepal
• Iodization of salt- since 1973
• Vitamin A fortification of ghee-since 1983
• Vitamins & minerals fortification of blended
complementary foods(distributed by WFP)-
since 1993.
• Fortification of wheat flour with iron,folic acid
&vitamin A at some roller mills- since 2007.
• The Micronutrient Initiative began working with village millers in rural Nepal to
help them add essential vitamins and minerals to the cereal flour they produce.

Micronutrient fortification of cereal

flours at water mills in rural Nepal

• MI developed an innovative cereal flour fortification with

iron,folic acid& Vit A device for the small traditional
watermills in the Lalitpur district of Nepal. The device,
which does not require electricity or significant additional
workload, automatically adds correct doses of iron, folic
acid, and vitamin A to grains being milled and is powered
solely by gravity- since few years ago.
 Strategies to combat micronutrient
deficiencies in Nepal
IDD VAD IDA

Fortification of salt Fortification of flour, Fortification of flour

Injection/capsule blended food& edible oil Blended food
supplement (1979-1988) Supplementation Supplementation
Dietary diversification Dietary diversification
Public health measure Public health measure
• Social marketing of blended complementary
food targeting children aged 6-24 months –
since 2008/2009
Major fortification activities carried out in Nepal
Food Vehicle Micronutrients Target age group Area of distribution
fortified
Wheat flour Iron.FA,VA PSC children School Urban, semi urban&
produced at roller aged children, rural area to some
mills women of children extent
bearing age,
economically active
males
Cereal flour (such as Iron.FA,VA PSC children School Rural areas
maize flour) aged children,
produced at water women of children
mills bearing age,
economically active
males

Wheat & soy bend Iron & other 10 6-24 months Urban, semi urban&
micronutrients children rural area to some
extent
Salt Iron & Iodine Pregnant women Household level
children & people
of all agegroup
• Government Certified ‘Two Child Logo’ with
adequate iodine content (>= 15 ppm)
Prevention of vitamin A deficiency by fortification of sugar. A
field study.
Toro O, de Pablo S, Aguayo M, Gattán V, Contreras I, Monckeberg F.

Abstract
The small amount of vitamin A in the diet of people living in some
regions of Chile can be increased by adding this vitamin to sugar. In
order to evaluate the effectiveness of a sugar fortification program,
vitamin A fortified sugar was distributed to four indian villages in the
mountainous region of Africa, whose inhabitants showed a severe
vitamin A deficiency. The results of this study demonstrate that
sugar fortification program is able to correct vitamin A deficiency by
elevating the vitamin intake and consequently improve the circulating
retinol, without substantially increasing the cost or modigying the
organoleptic characteristics of sugar.
• THANK you
 Government controls
• Only certain additives are allowed to use
• amounts are controlled & must be indicated on
lables.
• Maximum amounts used are small & must
serve a useful purpose
• Are Safety tested by industry & these testes are
monitored by health protection branch of can.
• Monitoring usage of additives is ongoing.
 Classification by numeric range :
 E numbers are also encountered on food labelling 

• 4.1E100–E199 (colours)
• 4.2E200–E299 (preservatives)
• 4.3E300–E399 (antioxidants, acidity regulators)
• 4.4E400–E499 (thickeners, stabilisers, emulsifiers)
• 4.5E500–E599 (acidity regulators, anti-caking agents)
• 4.6E600–E699 (flavour enhancer)
• 4.7E700–E799 (antibiotics)
• 4.8E900–E999 (glazing agents, gases and sweeteners
)
• 4.9E1000–E1599 (additional additives)
 Few Fortified Foods

• EX:
• Milk
• Milk is high in calcium, protein, fat and it has a
moderate amount of carbs. It is often fortified with
vitamins A and D. Milk is fortified for bone health.
Calcium promotes bone strength, and vitamin D
helps the body absorb calcium. Vitamin D is released
naturally in the body when it is exposed to sun, but if
you get inadequate sun exposure, you can get
vitamin D from fortified milk.
Cereals
Cereal tends to be high in carbohydrates, and some varieties are
high in fiber. Cereals are also commonly fortified with B vitamins.
According to a team from the Jean Mayer USDA Human Nutrition
Research Center on Aging at Tufts University and Michigan State
University, 1 cup of fortified breakfast cereal daily significantly
increased B vitamin levels and decreased homocysteine
concentrations in a group of volunteers. These benefits can lower
your risk of stroke, vascular disease and dementia as you age

Salt
Salt is high in sodium and is used on many different foods to add
flavor. It is also fortified with iodine. "Iodized" salt benefits
thyroid function.
Bread
• Bread is composed of whole grains or white flour and it is often
fortified with folic acid, a B vitamin also known as "folate.“

Soy Milk
Soy milk is derived from soy beans and it is used as an alternative
to regular milk by people who have allergies or are strict
vegetarians. It is high in protein and is often fortified with calcium

• Fluoridation of drinking water in endemic areas to prevent

dental caries

• Iodization of salt to prevent IDD

•Vitamin A fortification in Vanaspathi or edible oils ( rice bran,

sunflower) or sugar

• Iron to salt or Flour

 Task for students
• Role of fortification in controlling
micronutrient deficiencies.
 Points to remember…..
• Enrichment is synonymous with fortification and refers to the
addition ofmicronutrients to a food irrespective of whether
the nutrients were originally in the food before processing or
not. When foods are refined, some of their nutrients are lost
and then put back in. These foods are then called "enriched."
• Currently, the two words are often used interchangeably,
which is wrong from a historical standpoint. However, taking
into consideration the fact that the aim in both cases is to
improve the nutritional value of foods, the term nutrification
was suggested, which would include both enrichment and
fortification [2].