PADMASHREE INSTITUTE OF MANAGEMENT AND

SCIENCES

SUBJECT CODE: CND-204

TOPIC: FOOD FORTIFICATION
SUBMITTED BY: Dr. REKHA G.
REG.NO:18YYHS8010
MSC. CLINICAL NUTRITION AND DIETETICS
2ND SEMESTER

SUBMITTED TO: CHARISHMA

DEPARTMENT OF FOOD AND NUTRITION
DATE OF SUBMISSION:30/04/2019
FOOD FORTIFICATION

Food fortification is usually regarded as the deliberate addition of one

or more micronutrients to particular foods, so as to increase the intake
of these micro-nutrient(s) in order to correct or prevent a
demonstrated deficiency and provide a health benefit. The extent to
which a national or regional food supply is for- tified varies
considerably. The concentration of just one micronutrient might be
increased in a single foodstuff (e.g. the iodization of salt), or, at the
other end of the scale, there might be a whole range of food–
micronutrient combinations. The public health impact of food
fortification depends on a number of parameters, but predominantly
the level of fortification, the bioavailability of the fortificants, and the
amount of fortified food consumed. As a general rule, however, the
more widely and regularly a fortified food is consumed, the greater the
pro-portion of the population likely to benefit from food fortification.

Definition

Food fortification is defined as the practice of deliberately increasing

the content of essential1 micronutrients – that is to say, vitamins and
minerals (including trace elements) – in a food so as to improve the
nutritional quality of the food supply and to provide a public health
benefit with minimal risk to health.

TYPES OF FORTIFICATIONS

Food fortification can take several forms. It is possible to fortify foods

that are widely consumed by the general population (mass
fortification), to fortify foods designed for specific population
subgroups, such as complementary foods for young children or rations
for displaced populations (targeted fortification) and/or to allow food
manufacturers to voluntarily fortify foods available in the Food
fortification can take several forms. It is possible to fortify foods that
are widely consumed by the general population (mass fortification), to
fortify foods designed for specific population subgroups, such as
complementary foods for young children or rations for displaced
populations (targeted fortification) and/or to allow food manufacturers
to voluntarily fortify foods available in the market place.

1. Mass fortification

As indicated above, 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.

2.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.

3.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. Although voluntary, this type of food
fortification usually takes place within government-set regulatory
limits

Other types of fortification

1. Household and community fortification

Efforts are under way in a number of countries to develop and
test practical ways of adding micronutrients to foods at the
household level, in particular, to complementary foods for young
children. In effect, this approach is a combination of
supplementation and fortification, and has been referred to by
some as “complementary food supplementation”.

2. Biofortification of staple foods

The biofortification of staple foods, i.e. 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. The potential for plant breeding
to increase the micronutrient content of various cereals, legumes
and tubers certainly exists; for instance, it is possible to select
certain cereals (such as rice) and legumes for their high iron
content, various varieties of carrots and sweet potatoes for their
favourable β-carotene levels, and maizes for their low phytate
content (which improves the absorption of iron and zinc).
However, much more work still needs to be done before the
efficacy and effectiveness of these foods are proven, and current
concerns about their safety, cost and impact on the environment
are alleviated.
Fortification strategy to reduce micronutrients deficiency

Food fortification has lowered the incidence of

micronutrient deficiencies (MNDs) that were previously
common, and has, improved the health status (and also
other key indicators, such as economic and educational
status) of a large proportion of the population(s) involved
. In 2002 the World Health Report identified iodine,
iron, vitamin A and zinc deficiencies as being among the
world's most serious health risk factors [5]. The four key
strategies identified to address MNDs are: dietary
improvement, supplementation.

Complementary feeding with fortified food products

While fortified complementary foods are widely

used in industrialised countries, they are beyond the
reach of the poor in developing countries. The challenge
is to increase the density of complementary foods with
multiple fortifications of essential micronutrients at
affordable prices. Three types of fortified products
(precooked or instant) have been developed for infants
and young children: fortified blended foods (FBF),
complementary food supplements (CFS), and
micronutrient powders (MNP). FBFs and CFSs have
been formulated to be prepared as semisolids or solids
(not liquids) that can replace traditional porridges so
that they are less likely to interfere with breastfeeding
and complying with local and international regulations,
including the International Code on Marketing of Breast-
Milk Substitutes and many relevant Codex Alimentarius
standards, including hygiene, additives, forms of added
micronutrients, and protein quality [7, 8]. The MNPs have
been developed to be used as “point-of-use fortificants”
or “home fortificants” [9]. Feasibility of iron sprinkles
as a point-of-use fortificant on homemade complementary
foods has shown to increase absorption of iron [10].
Some other types of fortified complementary foods, such
as cookies or biscuits and compressed bars, also have
been used in emergency feeding programmes for young children.

General principles of FF and quality control

A technical consultation on FF convened by the FAO

in 1995 focused on technology and quality control, and in
addition, the Codex Alimentarius Commission (1995) has adopted
the general principles for the addition of essential nutrients to
Foods [6]. Although these general principles of FF are recognised
internationally, incorporating them into domestic law requires a
clear understanding of the nutrition problem involved [3, 5].
While its effectiveness is not in doubt, FF needs to be controlled
by appropriate legislation. Adherence to legislation will ensure
that the objectives of a food-fortification programme are achieved
and that the levels of micronutrients are controlled within safe
and acceptable limits.

Problem identification

In order to successfully develop and implement a FF

programme, a country needs to have a clear understanding
of the nature of the nutrition problem (5) by collecting
information on extent and severity of the problem, whether
it affects different demographic groups, implications,
commitment of government and producers for addressing
the problem, major causes and resources available.

Bioavailability of fortificants

Absorption of added nutrients, particularly iron and

zinc, varies widely depending on the fortificant used. The
nature of the food vehicle, and/or the fortificant, may limit
the amount of fortificant that can be successfully added.
Selection of the form of micronutrient to be used as a
fortifying agent requires consideration of the bio-
availability, chemical and physical properties of both
the fortifying agent and the food to be fortified.

Advantages and limitations of food fortifications

Being a food based approach FF has several

advantages over other interventions as it does not
necessitate a change in dietary patterns of the population,
can deliver a significant proportion of the recommended
dietary allowances for a number of micronutrients on a
continuous basis, and does not call for individual
compliance. It could often be dovetailed into the existing
food production and distribution system, and therefore,
can be sustained over a long period of time.
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, 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 pregnancy and lactation
with adequate nutrient stores.
The limitations of FF are also well known: FF alone
cannot correct micronutrient deficiencies when large
numbers of the targeted population, either because of
poverty or locality, have little or no access to the fortified
food, when the level of micronutrient deficiency is too
severe, or when the concurrent presence of infections
increases the metabolic demand for micronutrients. In
addition, various safety, technological and cost consi-
derations can also place constraints on FF interventions.
Thus proper FF programme planning not only requires
assessment of its potential impact on the nutritional status
of the population but also of its feasibility in a given
context. Further, it needs to be controlled by appropriate
legislation [5]. Table 1 further illustrates the pros and
cons of different types of FF programmes that can be
implemented.
References

1. Codex Alimentarius. (1991) General Principles for the Addition

of Essential Nutrients to Foods – CAC/GL 09-1987

2. Health Organization World Health Report. Geneva,

WHO, 2000.

3. International Life Sciences Institute Preventing micronutrient-

malnutrition: a guide to food-based approaches. Why policy
makers should give priority to food-based strategies
1997. Available at: http://www.fao.org