Food fortification and micro nutrients

Food fortification
In the British Journal of Nutrition there is a commentary and an article on the benefits of this in Ireland.
Micronutrient malnutrition is a prime cause of ill health, iron , zinc and vitamin A and D , vitamin C and Vitamin B2 being prime examples.
Obviously a sufficient healthy diet is the answer which is not always seemingly possible. An alternative is food fortification. This ensures automatic delivery to the population. The poor are the most likely to benefit from this programme. It is sad to say often it is the less intellectually endowed who are the most at risk. This process has been applied for over 80 years.
The fortified food must be available to all parts of the population. , rich and poor
Where micro nutrient deficiency is extreme fortification is no substitute for the prime supplement in higher dosage
Supplements are less good when infection increases the need for the supplement.
The supplementation must be feasible in the local commonly eaten foods, e.g. flour, breakfast cereals and margarines
Supplementation may be given in foods eaten by particularly at risk populations e.g. children and the elderly.
Manufacturers might add supplements as part of the processing of the foods, within government regulatory limits.
Fortification is regarded as voluntary when the food industry freely chooses to supplement a micronutrient
It is important that the Government supervises the supplementation.
The range of foods which are allowed to be fortified may be quite narrow.
The stability of the micronutrient in that food during cooking is an important consideration
In Ireland of 3000 foods surveyed, 1.9% were fortified, mainly breakfast cereals. Fortification makes a significant contribution to the intakes of micronutrients for riboflavin, folate, vitamin D and iron. Calcium and vitamin D are worthy of consideration.
Rosenberg I 2007, Further evidence that food fortification improves micronutrient status Brit Journal of Nutrition 97, 1051-1052
Hannon EM et al 2007, The impact of voluntary fortification of foods on micronutrient intakes in Irish adults 97, 1177-1186

In the BMJ 2007 vol 334, pp 1252-3 the advisability of supplementing folic acid to foods is considered and whether this should be mandatory.
Wald NJ and Oakley GP argue for fortification. The less well off have the most to gain. The reduction in neural tube defects justifies the case. Supplementation must precede conception. There is a possible debatable reduction in cardiovascular disease and reducing the rate of cognitive decline with age. Maybe reduce the incidence of colon cancer . There is the threat of undiagnosed B12 deficiency and neurological consequences. This is unlikely at the dosages used. Synthetic folic acid is more biologically available than natural folic acid and is stable during cooking.
Hubner and his colleagues disagree. The metabolism and action of synthetic folic acid may not be similar to natural folic acid. They refute the protective effects of synthetic folic acid and suggest that the answer is natural folic acid.
They claim that there is an increased rather than a decreased risk of cancer with supplementation. The supplement promoting the growth of premalignant lesions and facilitating their conversion to a malignant process.
Which indicates that improving food intake is best and that governments should concentrate on nutrition

Martin Eastwood
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