Food fortification: Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins) to food.

It can be purely a commercial choice to provide extra nutrients in a food, or sometimes it is a public health policy which aims to reduce numbers of people with dietary deficiencies in a population. Diets that lack variety can be deficient in certain nutrients. Sometimes the staple foods of a region can lack particular nutrients, due to the soil of a region, or because of the inherent inadequacy of the diet. Addition of micronutrients to staples and condiments can prevent largescale deficiency diseases in these cases.[

Types of Food Fortification

The 4 main methods of food fortification (named as to indicate the procedure that is used in order to fortify the food): 1. Biofortification (i.e. creating new crops using genetically modified breeding techniques) 2. Microbial biofortification and synthetic biology (i.e. addition of probiotic bacteria to foods) 3. Commercial and industrial fortification (i.e. flour, rice, oils (common cooking foods)) 4. Home fortification (i.e. vitamin D drops)[4]

General principles for food fortification

There are a number of general principles that must be considered in introducing a food fortification regime. In 1995, the FAO convened a technical consultation on food fortification, focusing on technology and quality control. The consultation agreed that, ideally, fortified food should: Be commonly consumed by the target population Have constant consumption patterns with a low risk of excess consumption Have good stability during storage Be relatively low in cost Be centrally processed with minimal stratification of the fortificant Have no interaction between the fortificant and the carrier food Be contained in most meals, with the availability unrelated to socio-economic status Be linked to energy intake In addition, the Codex Alimentarius Commission has adopted the General Principles for the Addition of Essential Nutrients to Foods which state: The essential nutrient should not result in an adverse effect on the metabolism of any other nutrient Addition of essential nutrients should not be used to mislead or deceive the consumer as to the

nutritional benefit of the food Methods of controlling, measuring and/or enforcing the levels of added essential nutrients in foods should be available Food standards, regulations or guidelines for fortification should identify the effectual nutrients which are to be required, and the levels at which they should be present in the food to achieve their intended purpose. The last bullet point above highlights that safe and effective fortification programmes must be based on up-to-date and accurate information about the deficiencies in a population, and the likely resultant health effects of fortified food. The FAO and WHO have recommended that the following principles should be considered when developing legislation for food fortification: Fortification should always be in the best interests of the selected population There should be input from interested parties in the development of the law and regulations Fortification must be supported by appropriate food safety and quality standards.

General recommendations
The Consultation agreed upon the following general recommendations regarding food fortification: 1. Where foodstuffs cannot provide naturally occurring essential nutrients to population groups, the use of fortification, following the principles outlined in Codex Alimentarius, should be given serious consideration as a means of achieving ICN goals. 2. A multi-sectoral approach must be adopted in the establishment of any food fortification programme, encompassing participation of relevant governmental organizations, food industry, trade organizations, consumers, academic and research facilities, marketing specialists and any involved international organizations and agencies. 3. Efforts should continue to harmonize national legislation concerning fortified foods, with the international standards of the Codex Alimentarius. 4. International guidelines to advise food aid donors on acceptable and safe fortification practices should be developed; guidelines should not be so restrictive as to impede the provision of high quality food aid commodities nor hinder communication on fortification between relevant parties. 5. There should be appropriate fortification of foods used in food aid programmes, with donors being required to provide relevant nutritional information particularly through adequate labelling. 6. Levels of fortification should be evaluated and adjusted according to bioavailability of the nutrient(s) in the diets of target populations.

7. It is important to evaluate the potential of local food industries to become involved in the production of high quality fortified food products, including those destined for use in food aid programmes, in areas where problems of micronutrient deficiency are likely to occur. 8. Food control systems based on HACCP principles, risk-based inspection procedures and internationally accepted analytical methods should be developed in support of fortification programmes. 9. The impact of food fortification on the nutritional status of target populations should be monitored so that appropriate corrective action can take place as required.

Specific recommendations and areas for future work

The Consultation made the following specific recommendations and suggestions for future work:

Food Fortification Technology Iodine: 1. Determine iodine stability in traditional food processing as very little information on this is currently available. 2. Evaluate efficacy of iodine resins added to water as an iodine source, as findings regarding the effectiveness of this practice are inconclusive. 3. Evaluate iodine interaction with various goitrogens so as to better understand the influence of diet on the effectiveness of iodine fortification. Iron: 1. Use methodologies which are accurate and reliable in the presence or absence of recent infection, to define iron status in different population groups. 2. Develop convenient models of iron bioavailability (non-human or in-vitro models) as current methodologies for the evaluation of bioavailability are problematic. 3. Determine the necessity to revise levels of iron fortification in some products because of improved iron bioavailability of new fortificants. 4. Explore the use of new iron fortificants such as liposome micro-encapsulated iron compounds and amino acid chelates. Their bioavailability, long-term safety, regulation of absorption and retention need to be studied.

5. Evaluate long-term risks of iron intake for adult male populations as their iron requirement is lower than that for adult females and children, and iron fortification of foods generally does not allow for preferential targeting among these groups. 6. Assess the contribution of iron fortification, in combination with other strategies, for the control of iron deficiency in specific age/sex groups. 7. Assess issues of multiple fortification (iron/vitamin A; iron/iodine; iron/zinc; iron/calcium, etc) in terms of their practicality, nutrient interaction, stability and bioavailability. Vitamins A, B, C and D: 1. Identify other potential food vehicles for vitamin A and evaluate suitability of currently available technologies for these new vehicles. Develop new vitamin A forms, if necessary. 2. Develop reliable, accurate, simple and rapid methodology for the assessment of vitamin D status as current methods of assessment are difficult. 3. Develop and evaluate the use of more stable vitamin C compounds for the purpose of fortification. 4. Develop improved methodologies for assessment of B-vitamin status as this is currently difficult to determine. 5. The reported association between plasma homocysteine levels and the roles of vitamin B6, folic acid and vitamin B12 in this relationship should be further investigated. Practical Problems in Food Fortification: 1. Establishment and maintenance of a database documenting existing food fortification practices in developed and developing countries. Widespread and ready access to such information could reduce time wasted in establishing 'new' fortification procedures globally. 2. Surveys are required in many countries to establish dietary patterns and habits which are critical inputs in determining appropriate vehicles for use in food fortification. Legislation and international standards 1. Establishment, at an international level, of an advisory list of nutrients for use in food fortification. 2 Determination of the need for additional regulations, at the national level, pertaining to fortified foods according to specific regional, national or even local situations. 3. Further consideration of evidence indicating undesirable effects of excessive intakes of essential micronutrients in order to establish maximum levels of fortification where necessary.

4. The Codex work on Nutrition and Health Claims should be expedited as this is directly related to labelling requirements and allowable claims for fortified foods. Aims of food fortification : Nutritional surveys in several countries worldwide showed an inadequate intake of some micronutrients. A possibility to challenge this development is the fortification of selected foods with micronutrients. The aim of this study was to evaluate the situation of food fortification in Austria and to elucidate to what extent added nutrients contribute to the daily nutrient intake. Methods: The amount of fortification was observed by inspections of supermarkets and retail outlets over a period of 4 months. The intake and contribution to the daily nutrient intake of fortified nutrients of Austrian adults (n = 1,700) was evaluated with 24-hour recalls (together with a food frequency questionnaire). Results: Altogether 470 fortified products have been found and classified into baby products, beverages, sweets, cereals, milk products, edible fats, and salt. Highest frequency of nutrient added was found for vitamin C (73%), B6 (43%) and niacin (37%). Calcium (23%) was the most added mineral and trace element. The contribution of fortified foods to the daily micronutrient intake was up to 40 and 10% for vitamins and minerals, respectively, for the total group. When only considering the subgroup of people who are buying fortified foods (users; n = 934) the contribution increases up to 74 and 19% for vitamins and minerals, respectively. No risk of an overdose of nutrients has been observed through food fortification. Conclusion: Food fortification is commonly used in Austria, although not selectively. The only one mandatory is the fortification of salt with iodine. Fortified nutrients contribute variably to the daily nutrient intake, in particular, for users of fortified products, a risk of an overdosed intake was not found.

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