FOOD FORTIFICATION : A sustainable solution to improve nutritional status

Food fortification or enrichment is the process of adding micronutrients to food. It can be carried out by food manufacturers, or by governments as a public health policy which aims to reduce the number of people with dietary deficiencies within a population.

Need of fortification :

In 2016, an estimated 107,000 deaths were caused by iron deficiency anemia and other nutritional deficiencies. Pregnant women who were severe anemic are twice as like to die during or shortly after pregnancy than non-anemic women. About 75% of children with brain and spine birth defect die before their fifth birthday; many of these birth defects could be prevented with folic acid (vitamin B9). Nutritional deficiencies also impact survivors. For example, iron deficiency in childhood stunts cognitive development which hinders academic performance and future earnings potential. Spina bifida, a spinal birth defect, has varying degrees of severity, and often leads to life-long disability. Fortification is successful primarily because it does not require consumers to change their behaviors. Governments and industries, however, need to make systematic changes to increase fortification’s health benefits.

Fortified foods are healthy or not :

Fortifying foods has been widely successful in the United States. Common diseases that are caused by nutrient deficiencies, like rickets and pellagra have been almost eliminated.

Even fortification has maximise the vitamin and mineral consumption in the United States, there haven’t been studies on nutrients other than folic acid that show that fortified foods are improving their health. There are also concerns that fortified and enriched foods may be causing people to get harmful amounts of certain vitamins and minerals. Fortified and enriched foods can be a part of a healthy, nutrient-rich diet. But whether or not they’re beneficial depends on age and a few other factors. If the amount of fortified nutrients is exceed, then it could be dangerous for health.

Safety and technical consideration during fortification :

Consumption of relatively large amounts of some nutrients can be harmful to health. Therefore it is important that decisions on the addition of nutrients to foods consider:

• the intakes of the nutrients from unfortified foods • the anticipated consumption of the food to be fortified • the physiological availability (bioavailability) of the added nutrients • the likely impact of fortification on overall intake of the nutrient(s) • the risk of excessive intakes of the added nutrients by ‘extreme’ consumers of a food.

The potential effects of fortification (and enhanced nutrient intake) on other nutrient and health indicators must also be considered, for example high intakes of folic acid from fortified foods (or supplements) may mask vitamin B12 deficiency. Also, high intakes of some micronutrients can interfere with the absorption of others, triggering new problems. Additionally, thought must be given to aspects such as the stability of the added nutrients and the effect on the sensory qualities of a food (taste, colour, texture). If the colour, smell and texture have been change, then many people don't want to accept the food.

Fortified foods :

Ø Skim milk - Most skim milk is fortified with vitamin D and A. Vitamin D and A, however, are fat soluble vitamins that need the presence of fat for maximum absorption, which is a problem since skim milk by definition has all of the fat removed from it.

Ø Whole grain bread - the B vitamin folic acid has been added to many breads in order to prevent neural tube defect in infants and low birth weight.

Ø Eggs - eggs are now being fortified—namely with omega 3 fatty acids . Eggs can be fortified with two different omega-3 fatty acids( DHA and ALA ). DHA is found in oily fish like salmon, sardines, and trout; it's vital for proper development and maintenance of brain function and can guard against heart disease, while ALA is found in flaxseeds, flaxseed oils, chia seeds, hemp seeds, and walnuts—which also may protect against heart disease.

Ø Grains & rice - About 20 percent of all women, 50 percent of pregnant woman, and 3 percent of men are iron deficient. Iron deficiency anemia is the most common nutritional deficiency and the leading cause of anemia in India. Symptoms include fatigue, pale skin and fingernails, dizziness, and headaches. If you are vegetarian/vegan, you must try to combine your food with vitamin C-rich foods so that your body can better absorb the iron. These include foods like citrus fruit, orange juice, bell peppers, dark leafy greens, kiwi fruit, broccoli, berries, tomatoes, peas, and papayas. Also look for fortified grains and rice to help increase your iron stores make you feel more energized.

Ø High quality salt - Although salt is a necessary part of a healthy diet, it's very sneaky and found in very high quantities in many foods, particularly packaged ones. You should make a conscious effort to consume a restrained amount, as well as making sure it's quality salt when you do consume it. When adding it to your foods, opt for fortified salt that contains iodine, an essential nutrient that helps prevent developmental disabilities, cognitive impairment, and goiter. Salt in processed foods does not contain iodine (in case you needed another reason to avoid processed junk!), and iodine deficiency is the leading cause of preventable brain damage in the world. Having salt with iodine is especially important if you don't consume seafood.

Ø Unsweetend oatmeal - Fortified whole grain oatmeal may help lower your risk for heart disease and type 2 diabetes (especially if you use it as a replacement for refined grains), but many of these benefits go out the window if you opt for sweetened fortified oatmeals. Fortified oatmeals are high in B vitamins, folic acid, vitamin A, and iron. Some also have added calcium, so make sure to carefully read nutrition labels to avoid unnecessary added sugars, chemicals, and preservatives! And to make the most of your oats, check out these

Ø Fortified oil - Oil fortification, i.e. the process of adding micronutrients to edible oil to increase its nutritional value, is expected to achieve almost 99% penetration of the Indian population due to the widespread use of cooking oil. All kinds of edible oils (soybean, palmolein, groundnut, cotton seed, mustard, etc.) can be fortified. At an individual level, fortified oil can help a person meet 25-30% of the recommended dietary intake for vitamins A and D, according to FSSAI.

Ø Wheat flour - Fortified flour is made by adding nutrients in excess to quantities lost during milling, or additional nutrients are added to improve its nutritive value.

Benefits : -

- Eliminates malnutrition and nutritional deficiencies.

- Provides extra nutrition at affordable costs.

- The inherent characteristics of the food remain the same even after fortification. This means that the original taste, texture, and appearance are unchanged.

- Wide scale production of fortified foods can help improve the overall nutritional problem of a country, by catering to both, the poor and the wealthy.

- The process of fortification is cost effective.

Awareness around food fortification :

For scaling up food fortification, large scale awareness of fortification is needed. This will help in the supply & demand alingnment andalso provide the required demand pull for people to adopt fortification. Currently, mass communication around increasing the visibility of +F logo is also being undertaken to generate awareness & help in the adoption of fortified products.

Reference:

1. Liyanage, C.; Hettiarachchi, M. (2011). "Food fortification"(PDF). Ceylon Medical Journal. 56 (3): 124–127. doi:10.4038/cmj.v56i3.3607. PMID 22164753. Archived from the original (PDF) on 13 May 2012.

2. http://www.ffinetwork.org/why_fortify/index.html

3. https://www.nutritionintl.org/what-we-do/by-programs/fortification/

4. https://www.healthline.com/health/food-nutrition/fortified-and-enriched-foods