Nutrition Facts - Diet And Nutrition - Free Diet Plans

The Role of Food Fortification

July 5th, 2005

Food fortification of commonly consumed foods may be a reliable and effective way to attain health benefits by increasing the nutrient intake of a population without relying on individual supplementation practices. However, fortification of the food supply must be moderated to benefit people who need to increase their nutrient intakes without increasing the risk of excessive intakes to others. For instance, because increasing folic acid consumption by either dietary selections or supplementation depends on personal behavioral change, food fortification with folic acid is an effective way to moderately increase folate intake for the entire population. New fortification standards for cereal grain products have increased folate intakes of the population, such that median folate intakes from all sources (expressed as dietary folate equivalents) are now estimated to exceed 400µg/d. However, women capable of becoming pregnant must use additional specific supplemental or fortification sources to meet the new recommendations of 400µg of folic acid from synthetic sources in addition to food folate from a varied diet. This recommendation cannot be met by general fortification of bread and cereal products without risking excessive folate intake that may mask or exacerbate vitamin B-12 deficiency or adversely interact with anticonvulsant or methotrexate medications in other population groups, especially children. From national food survey data, the Food and Drug Administration (PDA) estimates that 20–30% of young children (ages 1–8 y) may exceed the UL for folic acid, because of the frequent use of fortified breakfast cereals, fortified grain products, and dietary supplements. In some instances the preponderance of many products fortified with the same nutrient may make supplementation unnecessary or undesirable.

The US government sets standards of identity for enrichment or fortification of designated foods with specific amounts of nutrients such as thiamin, niacin, riboflavin, folic acid, and iron in grain products; vitamins A and D in milk; and iodine in salt. Fortification following these standards has made important contributions to nutrient intakes in the United States. The FDA food fortification policy warns that random fortification of foods could result in over- or underfortification and nutrient imbalances. The FDA indicates that it is not appropriate to fortify fresh produce, meat, poultry or fish products, sugars, or snack foods such as candies and carbonated beverages.

Food producers often initiate voluntary food fortification. In many instances, such as the fortification of some nondairy foods with calcium, or of vegetable-based meat substitutes with nutrients commonly supplied by meat, this voluntary food fortification can expand the food choices available to consumers to meet dietary recommendations. However, supplier-initiated food fortification should not reduce consumer choices by limiting access to unfortified foods. It is currently difficult for people concerned about excessive dietary iron to choose a breakfast cereal unfortified with iron. Similar difficulties may arise with the increasingly extensive calcium fortification of foods. Some foods seem to be fortified without an explicit public health rationale. The nutrients provided by both fortified foods and supplements change rapidly, and dietetics professionals must be aware of the changing market when assessing the total dietary intake of clients. Nutrient databases must be updated regularly to reflect these changes. In giving dietary advice, dietetics professionals should present clients with a number of options regarding food selection choices, including fortified foods, as well as supplementation choices. Again, the goal should be to meet dietary recommendations without exceeding the UL, and clients should be aware that there is no known benefit to exceeding the dietary recommendation.

For example, it is possible to meet the new calcium recommendations with regular use of (low-fat) dairy products. But for clients who, for whatever reason, limit their use of dairy products, dietetics professionals can help them determine whether the use of calcium-fortified orange juice and bread, or use of a calcium supplement can best fit their lifestyle to meet their calcium needs. For some people, a combination of using dairy products, fortified foods, and supplements would cause them to exceed the UL of 2500mg calcium daily. Dietetics professionals should help educate clients and the general public on the variety of fortified and supplemental products that would promote adequate without excessive intakes.

Marketplace fortification can substantially change the nutrient content of the food supply. For example, high iron enrichment standards in effect in the mid-to-late 70s were reduced because of concerns about efficacy and safety and have not changed since 1983. Yet the iron content of the food supply has continued to rise, because of an increased percentage of white flour that is enriched, an increased iron-fortification of breakfast cereals, and an increased use of grains.

Use of iron compounds for enrichment and fortification increased considerably in the last quarter of the century, with greater use of more bioavailable forms than in the past. This increase in food iron may pose a health risk for persons with a genetic risk of high iron stores. Fortification is commonly used to sell new food products. FDA’s fortification policy encourages and supports the rational addition of nutrients to foods. However, unlike the standards for iron enrichment of flour, bread or cereal (originally intended to replace nutrients lost in refinement of flour), there is currently no regulatory limitation on the amount of iron that can be added to many food products that do not have standards of identity.

The Canadian government has developed policy recommendations for the addition of vitamins and minerals to foods that suggest the use of mandatory food fortification programs for nutritional problems of public health significance that cannot be addressed through voluntary means. An additional recommendation would expand the range of food products that are fortified. It is further recommended that the addition of vitamins and minerals to foods not be permitted when no adequate nutritional rationale is provided.

Entry Filed under: Foods

General Multivitamin-Mineral Supplements Toxicities, Adverse Nutrient Interactions, and Safety