Food fortification is the addition of micronutrients (essential trace elements and vitamins) to food products.
Food enrichment means adding back nutrients lost during food processing, while fortification includes adding nutrients not naturally present.
Food fortification is the process of deliberately adding essential vitamins and minerals to food products during their industrial processing to improve the nutritional quality of the food supply and address nutrient deficiencies in the population.
Food fortification aims to enhance the intake of specific micronutrients, such as iron, iodine, vitamin A, and folic acid, which are often lacking in the diets of certain populations.
Food fortification can be implemented in various forms: large-scale fortification of staple foods (e.g., wheat flour, maize flour, rice), biofortification (breeding crops to increase their nutrient content), and point-of-use or home fortification, adding nutrient powders to foods at the time of consumption).
The World Health Organization (WHO) has developed guidelines for the fortification of staple foods to ensure that these interventions are safe and effective.
Food fortification has been successful in reducing the prevalence of nutrient deficiency diseases: goiter (iodine deficiency), rickets (vitamin D deficiency), and neural tube defects (folic acid deficiency).
The most commonly fortified foods are cereals and cereal-based products; milk and dairy products; fats and oils; accessory food items; tea and other beverages; and infant formulas.
Undernutrition and nutrient deficiency is estimated globally to cause the deaths of between 3 and 5 million people per year.
Fortification is present in common food items in two different ways: adding back and addition.
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.
Other fortified foods have micronutrients added to them that don’t naturally occur in those substances: orange juice, which often is sold with added calcium.
Food fortification can also be categorized according to the stage of their addition:
Commercial and industrial fortification of wheat flour, corn meal, and cooking oils.
Biofortification-the breeding of crops to increase their nutritional value, which can include both conventional selective breeding, and genetic engineering.
Approximately 1 in 3 people worldwide are at risk for either an iodine, vitamin A, or iron deficiency.
Criteria which justify food fortification:
To replace nutrients which were lost during manufacturing of the
To ensure the nutritional equivalence of substitute foods (to make butter and margarine similar in content, soy milk and cow’s milk).
To ensure the appropriate vitamin and mineral nutrient composition of foods for special dietary purposes (gluten-free products, low sodium, or any other products specifically designed for special dietary requirements from an individual).
Advantages for food fortification: treating a population without specific dietary interventions therefore not requiring a change in dietary patterns, continuous delivery of the nutrient, does not require individual compliance, and potential to maintain nutrient stores more efficiently if consumed regularly.
Food fortification emerged as a strategy in the United States to address and prevent the lack of micronutrients in the population’s diet.
Phytochemicals such as phytic acid in cereal grains can impact nutrient absorption, limiting the bioavailability of intrinsic and additional nutrients, and reducing the effectiveness of fortification programs.
In many cases, the micronutrients added to foods in fortification are synthetic.
To fortify a product, it must first be proven that the addition of this vitamin or mineral is beneficial to health, safe, and an effective method of delivery.
The addition must also abide by all food and labeling regulations and support nutritional rationale.
Vitamin fortification programs exist in one or more countries for folate, niacin, riboflavin, thiamine, vitamin A, vitamin B6, vitamin B12, vitamin D and vitamin E.
Mineral fortification programs include calcium, fluoride, iodine, iron, selenium and zinc.
The most commonly fortified vitamin is folate; the most commonly fortified food is wheat flour (enriched flour).
Examples of foods and beverages that have been fortified:
Iodized salt
Iodine deficiency disorder (IDD) is the single greatest cause of preventable mental retardation.
Severe deficiencies cause cretinism, stillbirth and miscarriage.
Even mild deficiency can significantly affect the learning ability of populations.
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 iodine deficiency.
Diseases that are associated with an iodine deficiency include: intellectual disabilities, hypothyroidism, and goiter.
Folate, a fortification ingredient, folic acid, functions in reducing blood homocysteine levels, forming red blood cells, proper growth and division of cells and preventing neural tube defects (NTDs).
The addition of folic acid to flour has prevented a significant number of NTDs in infants.
Two common types of NTDs, spina bifida and anencephaly, affect approximately 2500-3000 infants born in the US annually.
By supplementing pregnant mothers with folic acid the incidence of NTD’s is reduced by 72%.
Niacin (a form of vitamin B3) has been added to bread in the US and substantially reduced the incidence of pellagra.
Pellagra was seen amongst poor families who used corn as their main dietary staple.
Corn itself does contain niacin, it is not a bioavailable form unless it undergoes nixtamalization.
Diseases associated with niacin deficiency include pellagra which consisted of signs and symptoms called the three D’s-dermatitis, dementia, and diarrhea.
Others disease processes may include vascular or gastrointestinal diseases.
Common diseases which present a high frequency of niacin deficiency include alcoholism, anorexia nervosa, HIV infection, gastrectomy, malabsorptive disorders, certain cancers and their associated treatments.
Since Vitamin D is a fat-soluble vitamin, it cannot be added to a wide variety of foods.
Foods that it is commonly added to are margarine, vegetable oils and dairy products.
Diseases associated with a vitamin D deficiency include rickets, osteoporosis, and certain types of cancer (breast, prostate, colon and ovaries).
It has also been associated with increased risks for fractures, heart disease, type 2 diabetes, autoimmune and infectious diseases, asthma and other wheezing disorders, myocardial infarction, hypertension, congestive heart failure, and peripheral vascular disease.
Fluoride is not considered an essential mineral, it is useful in prevention of tooth decay and maintaining adequate dental health.
A high level of fluoride in their water supply was causing the residents’ teeth to have both brown spotting and a strange resistance to dental caries.
The tolerable upper intake level (UL) set for fluoride ranges from 0.7 mg/day for infants aged 0–6 months and 10 mg/day for adults over the age of 19.