Food Fortification and Enrichment

• Module: FST3221 Nutrition through lifecycle and dietetics
• Unit: Food fortification and enrichment

Introduction

• Micronutrient deficiencies are major public health challenges globally, affecting both developing and developed countries
• Micronutrient deficiencies are more serious in developing countries
• Common deficiencies in developing countries include iron, iodine, vitamin A, and zinc, especially among women and children
• Health consequences of micronutrient deficiencies include impaired brain development, poor pregnancy outcomes, weakened immunity, poor growth, blindness, and death
• Diets based primarily on plant foods with limited or no animal sources contribute to micronutrient deficiencies in developing countries
• Micronutrient deficiencies negatively impact a country's economic development
• Strategies to improve micronutrient consumption:
  • Fortification of staple foods, infant foods, condiments, and industrial processed foods
  • Biofortification of locally grown foods through plant breeding, especially useful for developing countries
  • Dietary diversification, easily applied in well-off economies that can afford animal-source foods
  • Supplementation with dietary supplements for specific populations like children (vitamin A) or pregnant women (iron and folic acid)

Food Fortification

• Food fortification/enrichment involves adding one or more essential nutrients to a food, whether or not it naturally contains them
• Purpose is to prevent or correct demonstrated nutrient deficiencies in a population or specific groups
• National fortification programs add a nutrient-rich "premix" with measured micronutrients to commonly eaten foods during processing
• Foods chosen for fortification must be commonly consumed by the population, and centrally processed to integrate into the food production system
• Examples of foods used for fortification: salt, cereals, fats and oils, and sugar
• Micronutrients used for fortification: vitamin A, vitamin D, folic acid, B-complex vitamins, iron, iodine, and zinc

Types of Food Fortification

• Food fortification programs encompass mass, targeted, and market-driven approaches

Mass Fortification

• Addition of one or more micronutrients to staple foods or condiments widely consumed by a population with an unacceptable public health risk of deficiency
• Examples: flour fortification with iron and folic acid, and salt iodization
• Advantage: reaches all population segments, including the most vulnerable
• Limitation: uncontrolled fortification can lead to excessive micronutrient intake in some population segments already consuming enough
• Limitation: premix preparation costs may be a limitation in low and middle-income countries

Targeted Fortification

• Fortified foods designed for specific population groups like infants, young children, adolescents, young women, pregnant women, and displaced people.
• Usually involves a wide range of micronutrients for populations at risk of deficiency
• Complementary foods processed for young children and infant formulas with strictly regulated nutrient content are examples

Market-Driven Fortification

• Fortification of manufactured foods for marketing advantage and consumer benefit
• Food processing companies use added nutrient content for product marketing, complying with nutrient regulations
• Examples: breakfast cereals and chocolate drink powders
• Cost is often a barrier for most people in developing countries

Selection of Fortification Vehicles

• First step of a national program implementation: select appropriate foods to use as vehicles
• Conduct a dietary survey to determine micronutrient intake and vehicle food consumption levels
• Consider food consumption variability among the population to ensure safety and significant impact
• The micronutrient vehicle food should:
  • Be commonly consumed by the target population
  • Have a constant consumption pattern with low risk of excess
  • Have good stability during storage
  • Be relatively low in cost
  • Be centrally processed with minimal fortificant stratification
  • Have no interaction between the fortificant and the carrier food
  • Be contained in most meals with availability unrelated to socioeconomic status
  • Be linked to energy intake
• Common food vehicles for fortification include maize, wheat products, cooking oils, milk products, sugar, rice, salt, and condiments

Biofortification

• Aims to increase nutrient levels in crops during plant growth rather than postharvest processing
• Achieved through agronomic practices, conventional plant breeding, or modern biotechnology
• Examples of biofortification projects:
  • Iron-biofortification of rice, beans, sweet potato, cassava, and legumes
  • Zinc-biofortification of wheat, rice, beans, sweet potato, and maize
  • Provitamin A carotenoid-biofortification of sweet potato, maize, and cassava

Fortification Vehicles

• Wheat and maize flour fortification
  • Wheat and maize are the most important food crops for human consumption worldwide (according to the FAO, 2015)
  • Wheat flour is used to make pasta, bread, noodles, biscuits, and cakes
  • Corn is consumed as corn on the cob, cornbread, beverages, and snack foods
  • In 2009, the WHO released "Recommendations on wheat and maize flour fortification"
  • Iron, folate, vitamin B12, vitamin A, and zinc were five nutrients considered
  • In 2016, the WHO maize flour recommendations added 5 more nutrients (thiamine, riboflavin, niacin, pyridoxine, and pantothenic acid)
  • Some countries have mandatory/voluntary legislation concerning wheat and maize flour fortification
  • Wheat and maize flours are under mandatory fortification in Rwanda as of 2020 via Regulation No. CBD/TRG/003 Rev. No. 1
  • Health Impact: flour fortification reduces the prevalence of conditions like neural tube defects (folic acid) and anemia (iron fortification)

Rice Fortification

• Involves multiple methods to increase micronutrient content:
  • Parboiling: transfers micronutrients (like vitamin B1) from bran to the grain
  • Breeding techniques: improves micronutrients such as Zinc
  • Dusting: mixing rice with a micronutrient premix
  • Coating rice grains: using liquid waxes containing fortificants
  • Extrusion technique: Rice flour is mixed with micronutrients, then extruded to form fortified rice-like grains.
    • The fortified grains are mixed with normal rice at ratios between 0.5 to 2% for the target nutrient
• Fortified rice is better accepted if there are no changes in appearance, smell, or flavor
• Fortified rice color and shape should be as close as possible to non-fortified rice
• Some fortificants (Riboflavin, beta-carotene, and some forms of iron) should not be used; they cause discoloration, leading consumers to discard the blend

Salt

• A universal carrier of nutrients for fortification
• Universally consumed worldwide, irrespective of socioeconomic status
• Used at the household level and added into industrial processed products
• Production and processing are centralized, making it an excellent vector for fortifying nutrients

Iodization of Salt

• Iodine is an important mineral in human and animal nutrition
• The body requires iodine to make thyroid hormones, playing an important role in the metabolism and bodily functions
• Iodine is crucial for normal bone and brain development during fetal growth and infancy
• The Universal Salt Iodization (USI) program was established by the United Nations World Summit in 1980
• USI Goal: eliminate iodine deficiency worldwide; program targets all salt consumed, including household, processed foods, and animal consumption
• Iodine is added as potassium iodate to salt after refining and before drying/packing
• Two salt iodization methods:
  • Wet method: Concentrated potassium iodate solution is added to salt
  • Dry method: Dry potassium iodate/iodide powder is mixed with a filler (calcium carbonate and/or dry salt) and added to dry salt
• Iodine deficiency can lead to congenital abnormalities, stillbirths, impaired brain development, delayed sexual development, and goiter; cretinism results from iron deficiency during pregnancy

Condiments

• Substances added in small quantities during food preparation or consumption to enhance flavor

Condiments as Fortification Vehicles

• Sugar and salt are the most used condiments worldwide and form the basis for many others
• Condiments improve food flavor, safety, and storage quality
• Condiments are affordable and widely consumed across all socioeconomic levels in predictable amounts
• Colors in many condiments can mask undesirable changes from fortification
• Contribute to high consumption of salt/added sugar, linked to increased risk of non-communicable diseases (NCDs)
• Need for policies that balance between limiting salt/sugar through intake and providing adequate nutrition through fortifying condiments
• The physical form determines the technology used for fortification
  • Solid: Sugar, salt, mustard, pepper
  • Semisolid: Tomato paste, mayonnaise, chutney
  • Liquid: Vinegar, Soy sauce, Chili oil
• A condiment can be made of only one ingredient or a mixture

Bouillon Cubes

• Seasoning products are made up of kitchen salt (40-70%), hydrolysed vegetable proteins, hardened vegetable fat, herbs, starch, flavorings, and spices
• Products are processed/distributed by private companies who may voluntarily fortify them through "market-driven" fortification
• Commonly used in Western/Central Africa, are low cost but also have limited use
• Bouillon cubes have been used for micronutrient fortification, such as iodine and iron
  • Iodine is added indirectly by using iodized salt during product processing
  • The contribution of iodine depends on the consumer level of intake and iodine content in the cube
  • Iron is generally added in the form of ferric pyrophosphate (FPP)
  • FPP is less soluble in water and has a lower absorption rate
• Research is on going for improvement of bioavailability of iron consumed through iron-fortified cubes by adding sodium pyrophosphate (NaPP) to make soluble complexes with FPP

Edible Oils

• Important role is to provide a source of energy, absorption and transport of fat-soluble vitamins, improve food flavor and palatability, and reducing hunger
• The fortification of edible oils is justified through several criteria:

Technical Feasibility

• Vegetable oils are good vehicles for fortification with fat-soluble vitamins because of centralized production and refining systems
• Vitamins form a true solution with oils, and mixing can be done easily without sophisticated equipment
• Vitamin A does not change the taste, color, or shelf life of the oil at low concentrations
• Stabilized vitamin A remains active even when the oil is used for frying
• Vitamin A can be protected from UV light through proper packaging

Human Consumption Levels

• Vegetable oils are widely consumed in the communities
• Fat-soluble vitamins fortification is good
• Consistent usage across many countries

Domestic Production

• Governments requirements for producers promoting fortification
• Oil producers subject to quality control

Industry Concentration

• Centralized oil milling industry limits small-scale community production
• This makes it easier to control fortification

Low incremental cost

• Fortification with vitamin A increases costs by only 0.1%-0.3% of retail price
• Lowers burden on producers to use technology

Cost Effectiveness

• Fat-soluble vitamins can be added in a concentrated and stable form
• Requires moderate cost equipment
• In order to protect the oil, take these technological aspects into consideration:
  • Add appropriate amounts of vitamin A and D concentrate is added to clarified, degassed oil at 45 to 50°C
  • High solubility of vitamin A and D in vegetable oils
  • To prevent oil and vitamin oxidation, add vitamin E (α-tocopherol) or Butylated hydroxyanisol (BHA)/Butylated hydroxytoluene (BHT)
  • The mixing ensures that vitamins are evenly distributed
  • Necessary to use light/protectedand sealed to hold vitamin A activity
  • Production/fortification happen in batches or continuously
  • Batch process is when premeasured vitamin blend is mixed into warm oil to form the premix
  • This premix is added into the oil before the emulsifying process
  • A mild 30 minutes is sufficient enough for the vitamins to be mixed well in oil.
• Intense agitation must be avoided to lower the risk of oxidation, packaging of fortified oil must be done immediately after to lower air-contact