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Serra-Majem, Lluís, Rosa Ortega, Javier Aranceta, Alfredo Entrala, and Angel Gil. "Fortified foods. Criteria for vitamin supplementation in Spain." Public Health Nutrition 4, no. 6a (April 1, 2001): 1331–34. http://dx.doi.org/10.1079/phn2001211.
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AbstractObjective:To review and analyse criteria for vitamin supplementation and fortification in Spain.Design:Systematic review of scientific literature and simulation analysis of food fortification.Methods:A simulation analysis using a fortified beverage was performed in a random sample of 2855 children aged 2 to 24 years in Spain.Results:High-risk groups for vitamin supplementation and fortification in Spain are highlighted, and target vitamins considered have been: folic acid, vitamin A, vitamin E, vitamin D and vitamin B12 (particularly in the elderly). A beverage fortified with vitamins C, A, B1 and B6 may contribute to improving the intake of all of these vitamins with the exception of vitamin A, since the Recommended Nutrient Intake is already covered with current consumption.Conclusions:A detailed knowledge of nutritional status helps to ensure the rationale and follow up of nutrient supplementation and fortification.
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Coad, Ross, and Lan Bui. "Stability of Vitamins B1, B2, B6 and E in a Fortified Military Freeze-Dried Meal During Extended Storage." Foods 9, no. 1 (January 2, 2020): 39. http://dx.doi.org/10.3390/foods9010039.
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Australian military ration packs contain a variety of processed foods, including some that are fortified with vitamins. In this study, freeze-dried meals, a key component of lightweight patrol ration packs, were fortified at the time of packing by direct addition of a vitamin premix containing vitamins B1, B2, B6 and E. Fortification was at three levels: 50%, 100% and 200% of the recommended vitamin content for military ration packs. Vitamin stability was determined following storage at temperatures of 1 °C, 30 °C and 40 °C for up to 24 months. HPLC methods were used to measure vitamin content; water activity and colour were also determined. Mean 24-month retention rates across all temperatures and fortification levels were 94%, 97%, 86% and 77% for vitamins B1, B2, B6 and E, respectively. Water activity increased with storage temperature, whereas colour changes due to fortification and storage temperature were at the threshold of visual detection. Fortification of freeze-dried meals would be an effective means of improving the quality of light weight military ration packs by addressing shortfalls in vitamin levels.
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Barclay, Denis. "Multiple Fortification of Beverages." Food and Nutrition Bulletin 19, no. 2 (January 1998): 168–71. http://dx.doi.org/10.1177/156482659801900213.
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Diet-related micronutrient deficiencies rarely occur in isolation; deficiencies of iodine and vitamin A or of iron and vitamin A or zinc are often observed in the same populations. In addition, widespread deficiencies of some micronutrients, for example, zinc and calcium, may often go undiagnosed because of the absence of specific and sensitive status indicators. Multiple micronutrient supplementation can be more effective in improving nutritional status than supplementation with single key micronutrients; therefore, the multiple fortification of appropriate food vectors, including beverages, is of interest from the nutritional standpoint. Beverages fortified with multiple micronutrients include dairy products, chocolate beverages, fruit juices, and soya-based drinks. As well as the documented or estimated micronutrient deficiencies and the requirements of the target population or consumer group, the conception of such a multiply fortified beverage must take into account a number of other important factors. The choice of the chemical form of the fortification micronutrients should be made with consideration of bioavailability, the effects on the organoleptic characteristics of the particular beverage, and cost. The initial calculation of the composition of the micronutrient premix should include the levels of micronutrients in the raw materials used and the estimated losses of specific micronutrients during processing and storage. Preliminary production and storage trials are then needed to determine the actual losses. The composition of the micronutrient premix may then be finalized. Interactions, both positive and negative, between fortification micronutrients may also need to be considered. For example, the bioavailability of iron may be enhanced by the addition of vitamin C, whereas mineral–vitamin and vitamin–vitamin interactions can accelerate the destruction of some vitamins. To render quality control procedures simple and cost-effective, only a limited number of fortification micronutrients, which are especially sensitive to losses and which are easy to measure, may be analysed. Simple, inexpensive, and rigorous analytical methods for such measurements are now available.
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Liberato, Selma Coelho, and Helena Maria Pinheiro-Sant'Ana. "Fortification of industrialized foods with vitamins." Revista de Nutrição 19, no. 2 (April 2006): 215–31. http://dx.doi.org/10.1590/s1415-52732006000200009.
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Vitamins are essential to life. Inadequate eating habits, high caloric intake and metabolic defects lead to micronutrient deficiencies, affecting more than two billion people worldwide. The increasing intake of industrialized foods, combined with low vitamin stability has led to the common practice of adding these nutrients to processed foods. This review discusses the terminology, availability, intake and risk of hypervitaminosis, due to the intake and nutritional importance of foods fortified with vitamins. The addition of nutrients should occur in foods that are effectively consumed by the target population and must meet the real needs of a significant segment of the population. In Brazil, a total of 166 products available in supermarkets are vitamin-enriched. A 10-year study involving children and adolescents in Germany showed that 90% of those surveyed used at least one fortified food. During this 10-year period, 472 fortified products were consumed. The enrichment of foods should be based on the needs of each country and, if possible, regional needs. For instance, in order to increase its intake, Vitamin D is added to foods in Denmark during the winter, mainly for the elderly. However, in Brazil, there is no evidence of the need to fortify food with this vitamin. A survey showed that of the 76 enriched dairy products, 37 contained vitamin D. Food-fortification is a very important strategy to solve nutritional deficiency problems, but it can also cause many health problems.
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de Lourdes Samaniego-Vaesken, Maria, Elena Alonso-Aperte, and Gregorio Varela-Moreiras. "Vitamin food fortification today." Food & Nutrition Research 56, no. 1 (January 2012): 5459. http://dx.doi.org/10.3402/fnr.v56i0.5459.
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Peregrin, Tony. "Expanding Vitamin D Fortification." Journal of the American Dietetic Association 102, no. 9 (September 2002): 1214–16. http://dx.doi.org/10.1016/s0002-8223(02)90265-8.
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Wilson, Louise R., Laura Tripkovic, Kathryn H. Hart, and Susan A. Lanham-New. "Vitamin D deficiency as a public health issue: using vitamin D2or vitamin D3in future fortification strategies." Proceedings of the Nutrition Society 76, no. 3 (March 28, 2017): 392–99. http://dx.doi.org/10.1017/s0029665117000349.
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The role of vitamin D in supporting the growth and maintenance of the skeleton is robust; with recent research also suggesting a beneficial link between vitamin D and other non-skeletal health outcomes, including immune function, cardiovascular health and cancer. Despite this, vitamin D deficiency remains a global public health issue, with a renewed focus in the UK following the publication of Public Health England's new Dietary Vitamin D Requirements. Natural sources of vitamin D (dietary and UVB exposure) are limited, and thus mechanisms are needed to allow individuals to achieve the new dietary recommendations. Mandatory or voluntary vitamin D food fortification may be one of the mechanisms to increase dietary vitamin D intakes and subsequently improve vitamin D status. However, for the food industry and public to make informed decisions, clarity is needed as to whether vitamins D2and D3are equally effective at raising total 25-hydroxyvitamin D (25(OH)D) concentrations as the evidence thus far is inconsistent. This review summarises the evidence to date behind the comparative efficacy of vitamins D2and D3at raising 25(OH)D concentrations, and the potential role of vitamin D food fortification as a public health policy to support attainment of dietary recommendations in the UK. The comparative efficacy of vitamins D2and D3has been investigated in several intervention trials, with most indicating that vitamin D3is more effective at raising 25(OH)D concentrations. However, flaws in study designs (predominantly under powering) mean there remains a need for a large, robust randomised-controlled trial to provide conclusive evidence, which the future publication of the D2–D3Study should provide (BBSRC DRINC funded: BB/I006192/1). This review also highlights outstanding questions and gaps in the research that need to be addressed to ensure the most efficacious and safe vitamin D food fortification practices are put in place. This further research, alongside cost, availability and ethical considerations (vitamin D3is not suitable for vegans), will be instrumental in supporting government, decision-makers, industry and consumers in making informed choices about potential future vitamin D policy and practice.
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Mehansho, Haile, Renee I. Mellican, Don L. Hughes, Don B. Compton, and Tomas Walter. "Multiple-Micronutrient Fortification Technology Development and Evaluation: From Lab to Market." Food and Nutrition Bulletin 24, no. 4_suppl_1 (January 2003): S111—S119. http://dx.doi.org/10.1177/15648265030244s108.
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At the World Summit for Children (New York, 1990), a resolution was passed to eliminate vitamin A and iodine deficiencies and significantly reduce iron-deficiency anemia by the year 2000. In responding to this urgent call, we developed a unique multiple-micronutrient fortification delivery system called “GrowthPlus/CreciPlus®.” Using this technology, a fortified powder fruit drink has been formulated and extensively evaluated. One serving of the product delivers the following US recommended dietary allowances: 20–30% of iron; 10–35% of vitamin A; 25–35% of iodine; 100–120% of vitamin C; 25–35% of zinc; 15–35% of folate; and 10–50% of vitamins E, B2, B6, and B12. This was accomplished through (a) identifying and selecting the right fortificants, and (b) understanding their chemical and physical properties that contribute to multiple problems (product acceptability, stability, and bioavailability). Data from a home-use test showed fortification with the “Multiple-Fortification Technology” has no effect on the appearance and taste of the eventually consumed powder fruit drink. One-year stability studies demonstrated that iodine and the vitamins have adequate stability. Bioavailability evaluation by using double-isotope labeling technique showed that the iron from the fortified powder drink has excellent bioavailability (23.4% ± 6.7). In conclusion, a powder fruit drink has been clinically demonstrated to deliver multiple micronutrients, which include adequate levels of bioavailable iron, vitamin A, iodine, zinc, vitamin C, and B vitamins, without compromising taste, appearance, and bioavailability. The critical limiting step in the micronutrient fortification program is the production and distribution of the multiplemicronutrient-fortified product. The fortified powder drink was marketed in Venezuela under the brand name NutriStar®.
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Yeh, Eileen B., David M. Barbano, and MaryAnne Drake. "Vitamin Fortification of Fluid Milk." Journal of Food Science 82, no. 4 (March 2, 2017): 856–64. http://dx.doi.org/10.1111/1750-3841.13648.
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Mora, Jose O. "Proposed Vitamin A Fortification Levels." Journal of Nutrition 133, no. 9 (September 1, 2003): 2990S—2993S. http://dx.doi.org/10.1093/jn/133.9.2990s.
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Challis, Tessa. "Vitamin fortification of yellow fats." Food and Chemical Toxicology 29, no. 9 (January 1991): 649. http://dx.doi.org/10.1016/0278-6915(91)90153-x.
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Engle-Stone, Reina, Katherine Adams, Sika Kumordzie, Hanqi Luo, K. Ryan Wessells, Seth Adu-Afarwuah, Alex Ndjebayi, et al. "Analyses Using National Survey Data From Cameroon, Haiti, and Ghana Indicate the Potential for Bouillon Fortification to Help Fill Dietary Gaps for 5 Nutrients." Current Developments in Nutrition 5, Supplement_2 (June 2021): 640. http://dx.doi.org/10.1093/cdn/nzab045_022.
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Abstract Objectives We modeled the potential impacts of bouillon fortification with different levels of vitamin A, folic acid, vitamin B12, iron, and zinc on dietary micronutrient adequacy to inform multi-stakeholder discussions around bouillon fortification programs. Methods We used individual dietary intake data in Cameroon from women of reproductive age (WRA) and children 1–5 y (n = 902 and 872), and household (HH) survey data in Cameroon (n = 11,384 HH), Ghana (n = 11,870 HH), and Haiti (n = 4,951 HH) to estimate micronutrient (MN) intake. The Adult Male Equivalent method was applied to estimate “apparent intake” of WRA, children, and men from HH surveys. We examined intake of bouillon and calculated prevalence of inadequate (below the estimated average requirement) and high (above the tolerable upper intake level, UL) micronutrient intake. Analyses included the contributions of mandatory fortification of oil or wheat flour at estimated current micronutrient levels. We simulated the impacts of bouillon fortification with varying levels of vitamin A, folic acid, vitamin B12, iron, and zinc on inadequate and high intakes of each nutrient. Results Bouillon was commonly consumed in all countries, with any reported consumption ranging from 67–81% in Ghana to over 90% in Cameroon and Haiti. Median (apparent) bouillon consumption ranged from 1.6–2.1 g/d for women, 0.7–1.0 g/d for children, and 1.8–2.2 g/d for men. Bouillon fortification with vitamins was predicted to reduce dietary inadequacy (120 μg/g vitamin A: 15–33 percentage points, pp, depending on the country and target group; 80 μg/g folate: 11–33 pp; 1.2 μg/g B12: 12–67 pp) with minimal risk of high intake. In contrast, predicted effects on dietary iron inadequacy were modest (5–12 pp reduction at 5 mg iron/g, assuming 2% absorption). Simulated zinc fortification showed reductions in inadequate absorbable zinc intake (14–42 pp at 3 mg/g), but children's intakes commonly exceeded the UL. Conclusions Modeling suggests that bouillon fortification could reduce inadequate MN intakes in these countries. Further work is needed to identify fortification levels that will meet criteria for nutritional benefits, technical feasibility, and cost-effectiveness. Funding Sources This analysis was supported by a grant to UC Davis from Helen Keller International.
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Sandmann, Arne, Michael Amling, Florian Barvencik, Hans-Helmut König, and Florian Bleibler. "Economic evaluation of vitamin D and calcium food fortification for fracture prevention in Germany." Public Health Nutrition 20, no. 10 (November 16, 2015): 1874–83. http://dx.doi.org/10.1017/s1368980015003171.
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AbstractObjectiveThe study evaluates the economic benefit of population-wide vitamin D and Ca food fortification in Germany.DesignBased on a spreadsheet model, we compared the cost of a population-wide vitamin D and Ca food-fortification programme with the potential cost savings from prevented fractures in the German female population aged 65 years and older.SettingThe annual burden of disease and the intervention cost were assessed for two scenarios: (i) no food fortification; and (ii) voluntary food fortification with 20 µg (800 IU) of cholecalciferol (vitamin D3) and 200 mg of Ca. The analysis considered six types of fractures: hip, clinical vertebral, humerus, wrist, other femur and pelvis.SubjectsSubgroups of the German population defined by age and sex.ResultsThe implementation of a vitamin D and Ca food-fortification programme in Germany would lead to annual net cost savings of €315 million and prevention of 36 705 fractures in the target population.ConclusionsVitamin D and Ca food fortification is an economically beneficial preventive health strategy that has the potential to reduce the future health burden of osteoporotic fractures in Germany. The implementation of a vitamin D and Ca food-fortification programme should be a high priority for German health policy makers because it offers substantial cost-saving potential for the German health and social care systems.
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Itkonen, Suvi, Maijaliisa Erkkola, and Christel Lamberg-Allardt. "Vitamin D Fortification of Fluid Milk Products and Their Contribution to Vitamin D Intake and Vitamin D Status in Observational Studies—A Review." Nutrients 10, no. 8 (August 9, 2018): 1054. http://dx.doi.org/10.3390/nu10081054.
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Fluid milk products are systematically, either mandatorily or voluntarily, fortified with vitamin D in some countries but their overall contribution to vitamin D intake and status worldwide is not fully understood. We searched the PubMed database to evaluate the contribution of vitamin D-fortified fluid milk products (regular milk and fermented products) to vitamin D intake and serum or plasma 25-hydroxyvitamin D (25(OH)D) status in observational studies during 1993–2017. Twenty studies provided data on 25(OH)D status (n = 19,744), and 22 provided data on vitamin D intake (n = 99,023). Studies showed positive associations between the consumption of vitamin D-fortified milk and 25(OH)D status in different population groups. In countries with a national vitamin D fortification policy covering various fluid milk products (Finland, Canada, United States), milk products contributed 28–63% to vitamin D intake, while in countries without a fortification policy, or when the fortification covered only some dairy products (Sweden, Norway), the contribution was much lower or negligible. To conclude, based on the reviewed observational studies, vitamin D-fortified fluid milk products contribute to vitamin D intake and 25(OH)D status. However, their impact on vitamin D intake at the population level depends on whether vitamin D fortification is systematic and policy-based.
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Lazarevic, Konstansa, Maja Nikolic, and Vladimir Mitrovic. "Application and significance of fortification in prevention of micronutrient deficiency-induced diseases." Srpski arhiv za celokupno lekarstvo 134, Suppl. 2 (2006): 139–44. http://dx.doi.org/10.2298/sarh06s2139l.
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Fortification is defined as adding of one or more essential elements to food article, regardless of whether it has been already added to food or not, in order to prevent or correct deficiency of one or more nutrients in the general population or specific population group. Food fortification with minerals and vitamins helps eliminate diseases such as goiter, rickets, beriberi, and pellagra. Significant results have been also achieved in prevention of anemia and vitamin A deficiency. The aforementioned deficiencies can be prevented and eliminated by means of appropriate and diverse nutrition and supplementation of deficient micronutrients, but on the national level, food fortification is the best solution. Two basic conditions for the application of fortification are the following: that the food article is in wide use and that it is cheap (available). The purpose of our paper was to show the results achieved by means of fortification in various countries in order to build up the basis for similar propositions in our country (Serbia and Montenegro). Owing to fortification in Asia, the number of cretinism cases has been reduced by half while sugar fortification significantly reduced the number of children with vitamin A deficiency. For more than 50 years, flour fortification with iron in order to prevent its deficiency and anemia, has been successfully applied in the United States and Canada, and as of recently in some countries of Africa and South America. The analysis of the results leads to the conclusion that food fortification has had beneficial health effects in the communities where it has been applied.
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Jensen, Camilla B., Tina L. Berentzen, Michael Gamborg, Thorkild I. A. Sørensen, and Berit L. Heitmann. "Does prenatal exposure to vitamin D-fortified margarine and milk alter birth weight? A societal experiment." British Journal of Nutrition 112, no. 5 (June 17, 2014): 785–93. http://dx.doi.org/10.1017/s0007114514001330.
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The present study examined whether exposure to vitamin D from fortified margarine and milk during prenatal life influenced mean birth weight and the risk of high or low birth weight. The study was based on the Danish vitamin D fortification programme, which was a societal intervention with mandatory fortification of margarine during 1961–1985 and voluntary fortification of low-fat milk between 1972 and 1976. The influence of prenatal vitamin D exposure on birth weight was investigated among 51 883 Danish children, by comparing birth weight among individuals born during 2 years before or after the initiation and termination of vitamin D fortification programmes. In total, four sets of analyses were performed. Information on birth weight was available in the Copenhagen School Health Record Register for all school children in Copenhagen. The mean birth weight was lower among the exposed than non-exposed children during all study periods (milk initiation − 20·3 (95 % CI − 39·2, − 1·4) g; milk termination − 25·9 (95 % CI − 46·0, − 5·7) g; margarine termination − 45·7 (95 % CI − 66·6, − 24·8) g), except during the period around the initiation of margarine fortification, where exposed children were heavier than non-exposed children (margarine initiation 27·4 (95 % CI 10·8, 44·0) g). No differences in the odds of high (>4000 g) or low ( < 2500 g) birth weight were observed between the children exposed and non-exposed to vitamin D fortification prenatally. Prenatal exposure to vitamin D from fortified margarine and milk altered birth weight, but the effect was small and inconsistent, reaching the conclusion that vitamin D fortification seems to be clinically irrelevant in relation to fetal growth.
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Moyersoen, Isabelle, Brecht Devleesschauwer, Arnold Dekkers, Janneke Verkaik-Kloosterman, Karin De Ridder, Stefanie Vandevijvere, Jean Tafforeau, Herman Van Oyen, Carl Lachat, and John Van Camp. "A Novel Approach to Optimize Vitamin D Intake in Belgium through Fortification Based on Representative Food Consumption Data." Journal of Nutrition 149, no. 10 (June 17, 2019): 1852–62. http://dx.doi.org/10.1093/jn/nxz119.
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ABSTRACT Background Food fortification is a promising means to improve vitamin D intake of a population. Careful selection of food vehicles is needed to ensure that nearly all individuals within the population benefit from the fortification program. Objectives The aim of the study was to develop and apply a model that simultaneously selects the optimal combination of food vehicles and defines the optimal fortification level that adequately increases vitamin D intake in the population without compromising safety. Methods Food consumption data from the Belgian Food Consumption Survey 2014 (n = 3200; age 3–64 y) were used. The optimization model included 63 combinations of 6 potential vehicles for food fortification, namely “bread,” “breakfast cereals,” “fats and oils,” “fruit juices,” “milk and milk beverages,” and “yogurt and cream cheese.” The optimization procedure was designed to minimize inadequate or excessive vitamin D intake in each of the food combinations. This allowed the relative ranking of the different combinations according to their fortification utility. The estimated average requirement and upper intake level were used as thresholds. An age-specific and population-based approach enabled the sensitivity of the population subgroups to adverse health effects to be taken into account. Feasibility, technical aspects, and healthiness of the food vehicles were used to select the optimal combination. Results Multiple combinations of food vehicles significantly reduced the prevalence of inadequate vitamin D intake within the Belgian population (from 92–96% to <2%). Taking other aforementioned criteria into account, the fortification of “milk and milk beverages” and “bread” with 6.9 μg vitamin D/100 kcal was proposed as an optimal fortification scenario. Conclusions The optimization model allows identification of an effective fortification scenario to improve vitamin D intake within the Belgian population based on acceptable risks of inadequate and excessive intake. The model can be extended to other micronutrients and other populations.
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Pineda, Oscar. "Fortification of Sugar with Vitamin A." Food and Nutrition Bulletin 19, no. 2 (January 1998): 131–36. http://dx.doi.org/10.1177/156482659801900207.
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The technology for fortifying sugar with vitamin A was developed in Guatemala in the mid-1970s, and the Guatemalan government enacted legislation to make fortification mandatory in June 1974. This action was copied by other Central American governments. The fortification programme in Guatemala developed in two stages. In the first (1975–77), the fortification programme was evaluated four times at six-month intervals and was shown to be effective. The sugar industry was responsible for carrying out the programme, but the programme was suspended, mainly because of economic arguments. After 10 years of effort, the programme was restarted in 1989. At this time the programme was combined with an initial mass distribution of vitamin A capsules to pre-school children, which began the first successful social mobilization effort in the area. The programme was evaluated for six months and was shown to be effective in improving the vitamin A status of the Guatemalan population. This sec- ond stage has been active continuously since 1989. With improvements in the technology of fortification, new approaches have been tested, and now it is possible to obtain an excellent sugar doubly fortified with vitamin A and iron, using new iron products of high bioavailability that do not alter the organoleptic characteristics of the sugar and do not produce unwanted colour changes during processing. To avoid the rancidity of premixes, new processes of dry mixing have been developed in which no oil is used, This opens a real possibility for the fortification of sugar with other nutrients. Sugar fortified with vitamin A, iron, and zinc, either alone or in any combination, is commercially available in Brazil, where, under the guidance of the Latin American Centre of Nutrition and Metabolic Studies (CELANEM), the procedures have been developed using iron amino acid chelated minerals.
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Moulas, Anargyros N. "Fortification of foods with vitamin D." Journal of Biotechnology 256 (August 2017): S13. http://dx.doi.org/10.1016/j.jbiotec.2017.06.045.
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Papathakis, Peggy C., and Kerry E. Pearson. "Food fortification improves the intake of all fortified nutrients, but fails to meet the estimated dietary requirements for vitamins A and B6, riboflavin and zinc, in lactating South African women." Public Health Nutrition 15, no. 10 (July 5, 2012): 1810–17. http://dx.doi.org/10.1017/s1368980012003072.
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AbstractObjectiveTo investigate the impact of fortification by comparing food records and selected biochemical indicators of nutritional status pre- and post-fortification.DesignMean intake from 24 h recalls (n 142) was compared with the Estimated Average Requirement (EAR) to determine the proportion with inadequate intake. In a subsample (n 34), diet and serum retinol, folate, ferritin and Zn were compared pre- and post-fortification for fortified nutrients vitamin A, thiamin, riboflavin, niacin, folic acid, Fe and Zn.SettingSouth Africa.SubjectsBreast-feeding women (ninety-four HIV-infected, forty eight HIV-uninfected) measured at ∼6, 14, 24 weeks, and 9 and 12 months postpartum.ResultsPre-fortification, >80 % of women did not meet the EAR for vitamins A, C, D, thiamin, riboflavin, niacin, B6, B12 and folate and minerals Zn, iodine and Ca. Dietary intake post-fortification increased for all fortified nutrients. In post-fortification food records, >70 % did not meet the EAR for Zn and vitamins A, riboflavin and B6. Serum folate and Zn increased significantly post-fortification (P < 0·001 for both), with no change in ferritin and a reduction in retinol. Post-fortification marginal/deficient folate status was reduced (73·5 % pre v. 3·0 % post; P < 0·001), as was Zn deficiency (26·5 % pre v. 5·9 % post; P < 0·05). Pre- and post-fortification, >93 % were retinol replete. There was no change in Fe deficiency (16·7 % pre v. 19·4 % post; P = 0·728).ConclusionsMicronutrient intake improved with fortification, but >70 % of lactating women did not meet the EAR for Zn, vitamins A, riboflavin and B6. Although 100 % exceeded the EAR for Fe after fortification, Fe status did not improve.
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Shikh, Evgenia V., Anna A. Makhova, and Ekaterina I. Alekseeva. "Vitamins А, С and D — Essential Trio for Infants." Current Pediatrics 18, no. 3 (September 18, 2019): 152–59. http://dx.doi.org/10.15690/vsp.v18i3.2031.
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Administration of essential vitamins A, C and D in vitamin-mineral complex in common dosage is efficient for immunity formation, harmonious physical and neuropsychic development, rickets prevention. Dosage of components at the physiological daily maintenance in basic vitamin complexes for infants is integral for nursing mother supplementation and fortification of the food used for infant weaning. If necessary, and specifically in immature infants, the basic vitamin complex (vitamins A, C and D) can be extended with other required micronutrients (vitamin D, for example, can be extended up to 1000 ME). It depends on feeding type, intake of vitamin-mineral complexes for nursing mothers, seasonal prevalence, region and many other factors.
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Darnton-Hill, Ian, and Ritu Nalubola. "Fortification strategies to meet micronutrient needs: sucesses and failures." Proceedings of the Nutrition Society 61, no. 2 (May 2002): 231–41. http://dx.doi.org/10.1079/pns2002150.
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Food fortification is likely to have played an important role in the current nutritional health and well-being of populations in industrialized countries. Starting in the early part of the 20th century, fortification was used to target specific health conditions: goitre with iodized salt; rickets with vitamin D-fortified milk; beriberi, pellagra and anaemia with B-vitamins and Fe-enriched cereals; more recently, in the USA, risk of pregnancy affected by neural-tube defects with folic acid-fortified cereals. A relative lack of appropriate centrally-processed food vehicles, less-developed commercial markets and relatively low consumer awareness and demand, means it has taken about another 50 years for fortification to be seen as a viable option for the less-developed countries. The present paper reviews selected fortification initiatives in developing countries to identify different factors that contributed to their successful implementation, as well as the challenges that continually threaten the future of the se programmes. Ultimately, the long-term sustainability of fortification programmes is ensured when consumers are willing and able to bear the additional cost of fortified foods. There has been an enormous increase in fortification programmes over the last couple of decades in developing countries. Considerable progress has been made in reducing vitamin A and I deficiencies, although less so with Fe, even as Zn and folic acid deficiencies are emerging as important public health problems. Food fortification based on sound principles and supported by clear policies and regulations can play an increasingly large role in this progress towards prevention and control of micronutrient malnutrition.
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Fiedler, John L., Keith Lividini, and Odilia I. Bermudez. "Estimating the impact of vitamin A-fortified vegetable oil in Bangladesh in the absence of dietary assessment data." Public Health Nutrition 18, no. 3 (April 24, 2014): 414–20. http://dx.doi.org/10.1017/s1368980014000640.
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AbstractObjectiveVitamin A deficiency is a serious health problem in Bangladesh. The 2011–12 Bangladesh Micronutrient Survey found 76·8 % of children of pre-school age were vitamin A deficient. In the absence of nationally representative, individual dietary assessment data, we use an alternative – household income and expenditure survey data – to estimate the potential impact of the introduction of vitamin A-fortified vegetable oil in Bangladesh.DesignItems in the household income and expenditure survey were matched to food composition tables to estimate households’ usual vitamin A intakes. Then, assuming (i) the intra-household distribution of food is in direct proportion to household members’ share of the household’s total adult male consumption equivalents, (ii) all vegetable oil that is made from other-than mustard seed and that is purchased is fortifiable and (iii) oil fortification standards are implemented, we modelled the additional vitamin A intake due to the new fortification initiative.SettingNationwide in Bangladesh.SubjectsA weighted sample of 12240 households comprised of 55580 individuals.ResultsNinety-nine per cent of the Bangladesh population consumes vegetable oil. The quantities consumed are sufficiently large and, varying little by socio-economic status, are able to provide an important, large-scale impact. At full implementation, vegetable oil fortification will reduce the number of persons with inadequate vitamin A intake from 115 million to 86 million and decrease the prevalence of inadequate vitamin A intake from 80 % to 60 %.ConclusionsVegetable oil is an ideal fortification vehicle in Bangladesh. Its fortification with vitamin A is an important public health intervention.
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Stougaard, Maria, Peter Damm, Peder Frederiksen, Ramune Jacobsen, and Berit L. Heitmann. "Exposure to vitamin D from fortified margarine during fetal life and later risk of pre-eclampsia: the D-tect Study." Public Health Nutrition 21, no. 4 (December 20, 2017): 721–31. http://dx.doi.org/10.1017/s1368980017003135.
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AbstractObjectiveTo examine if fetal exposure to a small dosage of extra vitamin D from food fortification was associated with a decrease in the risk of pre-eclampsia later in life.DesignCancellation of the mandatory vitamin D fortification of margarine in 1985 created a societal experiment, with entire adjacent birth cohorts exposed or unexposed to extra vitamin D during fetal development. The Danish national medical health registries allowed the identification of pre-eclampsia cases later in life among all exposed and unexposed female individuals.SettingDenmark.SubjectsWomen born between June 1983 and August 1988, who gave birth to their first child at age 14·5–27·5 years (n 32 621).ResultsOR (95 % CI) for pre-eclampsia among women exposed v. unexposed to extra vitamin D from fortification during fetal development was 0·86 (0·76, 0·97). Exposure to extra vitamin D was associated with further reduced odds of pre-eclampsia (0·49 (0·34, 0·72)) among current smokers, but not among former smokers and non-smokers.ConclusionsAdditional vitamin D in fetal life from food fortification seems to reduce the risk of pre-eclampsia later in life. The risk reduction may be particularly strong among women who smoke during pregnancy.
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Doets, Esmée L., Per M. Ueland, Grethe S. Tell, Stein Emil Vollset, Ottar K. Nygård, Pieter van't Veer, Lisette C. P. G. M. de Groot, et al. "Interactions between plasma concentrations of folate and markers of vitamin B12status with cognitive performance in elderly people not exposed to folic acid fortification: the Hordaland Health Study." British Journal of Nutrition 111, no. 6 (November 11, 2013): 1085–95. http://dx.doi.org/10.1017/s000711451300336x.
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A combination of high folate with low vitamin B12plasma status has been associated with cognitive impairment in a population exposed to mandatory folic acid fortification. The objective of the present study was to examine the interactions between plasma concentrations of folate and vitamin B12markers in relation to cognitive performance in Norwegian elderly who were unexposed to mandatory or voluntary folic acid fortification. Cognitive performance was assessed by six cognitive tests in 2203 individuals aged 72–74 years. A combined score was calculated using principal component analysis. The associations of folate concentrations, vitamin B12markers (total vitamin B12, holotranscobalamin (holoTC) and methylmalonic acid (MMA)) and their interactions in relation to cognitive performance were evaluated by quantile regression and least-squares regression, adjusted for sex, education, apo-ɛ4 genotype, history of CVD/hypertension and creatinine. Cross-sectional analyses revealed an interaction (P= 0·009) between plasma concentrations of folate and vitamin B12in relation to cognitive performance. Plasma vitamin B12concentrations in the lowest quartile ( < 274 pmol/l) combined with plasma folate concentrations in the highest quartile (>18·5 nmol/l) were associated with a reduced risk of cognitive impairment compared with plasma concentrations in the middle quartiles of both vitamins (OR 0·22, 95 % CI 0·05, 0·92). The interaction between folate and holoTC or MMA in relation to cognitive performance was not significant. In conclusion, this large study population unexposed to mandatory folic acid fortification showed that plasma folate, but not plasma vitamin B12, was associated with cognitive performance. Among the elderly participants with vitamin B12concentrations in the lower range, the association between plasma folate and cognitive performance was strongest.
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Yusufali, Rizwan, Nigel Sunley, Maude de Hoop, and Dora Panagides. "Flour Fortification in South Africa: Post-Implementation Survey of Micronutrient Levels at Point of Retail." Food and Nutrition Bulletin 33, no. 4_suppl3 (December 2012): S321—S329. http://dx.doi.org/10.1177/15648265120334s308.
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Background Fortification of staple foods is an effective strategy to deliver and increase the intake of micronutrients in the diet and can reduce micronutrient deficiencies. It is important to ensure that the food vehicle consistently contains adequate amounts of nutrients at the point of consumption for effective impact. Objective This survey aimed to gauge the level of fortification of maize and wheat flour at the retail level compared with staple food fortification regulations in South Africa to better understand the current obstacles to effective delivery of micronutrients through flour fortification and consider approaches to strengthening the program. Methods White bread flour and maize meal samples were collected from retail points across all provinces and analyzed for vitamin A, iron, and nicotinamide, and a database capturing the origins of the sample was populated. Nicotinamide and vitamin A results were compared against each other and evaluated against food regulations. Results The level of compliance with statutory fortification requirements was low, both for bread flour and for maize meal. There is evidence of insufficient addition of premix as opposed to losses due to vitamin A stability as seen from the strong correlation between vitamin A and nicotinamide in maize meal. Conclusions The current levels of micronutrients added to maize meal and bread flour are unsatisfactory. This is likely to be because of insufficient addition of premix at the mills. This affects the availability and intake by consumers of fortified product and potentially prevents the desired reduction in vitamin and mineral deficiencies expected from the flour fortification program.
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Steyn, Nelia P., Petro Wolmarans, Johanna H. Nel, and Lesley T. Bourne. "National fortification of staple foods can make a significant contribution to micronutrient intake of South African adults." Public Health Nutrition 11, no. 3 (March 2008): 307–13. http://dx.doi.org/10.1017/s136898000700033x.
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AbstractBackgroundA national survey found that micronutrient deficiencies are prevalent in South African children, particularly calcium, iron, zinc, riboflavin, niacin, vitamin B6, folate, vitamin A, E and C. Mandatory fortification of maize meal and wheat flour were introduced in 2003 to combat some of the deficiencies found in children. To date however, there has not been a national survey on dietary intake in adults.ObjectivesThe main objectives of this study were to evaluate the micronutrient intake of the diet consumed by the average adult South African by means of secondary data analyses and secondly to evaluate the effects of fortification on selected nutrient intakes.Study designSecondary data analysis was carried out with numerous dietary surveys on adults to create a database that included sampling (and weighting) according to ethnic/urban–rural residence in line with the population census, of which 79% were black Africans and the majority resided in rural areas. The effect of fortification was evaluated by substituting fortified foods in the diet for the unfortified products.SubjectsThe combined database used in this study comprised 3229 adults.ResultsMean calcium, iron, folate and vitamin B6 intakes were very low particularly in women. Mean intakes of most micronutrients were lower in rural areas. Fortification of maize meal and wheat flour (bread) raised mean levels of thiamine, riboflavin, niacin, vitamin B6 and folate above the recommended nutrient intakes (RNIs). In women, despite fortification, mean iron intakes remained below the RNIs, as did calcium since it was not in the fortification mix.ConclusionThe average dietary intake of adults was of poor nutrient density, particularly in rural areas. Fortification of maize meal and wheat flour (bread) considerably improved mean vitamin B6, thiamine, riboflavin, niacin, folate and iron intakes as well as the overall mean adequacy ratio of the diet.
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Papastoyiannidis, G., A. Polychroniadou, A. M. Michaelidou, and E. Alichanidis. "Fermented Milks Fortified with B-group Vitamins: Vitamin Stability and Effect on Resulting Products." Food Science and Technology International 12, no. 6 (December 2006): 521–29. http://dx.doi.org/10.1177/1082013206073274.
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Four fermented milks were made from cow's milk fortified with B-group vitamins (thiamine (B1), riboflavin (B2), pyridoxine, pyridoxal, pyridoxamine and folic acid) inoculated with different mixed probiotic cultures. Fermented milks made from non-fortified milk were used as controls. Some vitamins were partly lost during heating of the milk and fermentation but the level of all vitamins remained stable during storage for 16 days at 4°C. Species and strain of the culture were clearly found to affect the vitamin level throughout fermentation and storage of the products. Fortification was observed as having no impact on the composition or sensory properties of the products, attributes that were found to be mainly dependent on the culture. At the fortification level applied, fermented products could be a good alternative to dietary supplements, because they are readily consumed and combine the beneficial effects of probiotic microorganisms with important amounts of valuable vitamins.
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Greene, Matthew D., Gladys Kabaghe, Mofu Musonda, and Amanda C. Palmer. "Retail Sugar From One Zambian Community Does Not Meet Statutory Requirements for Vitamin A Fortification." Food and Nutrition Bulletin 38, no. 4 (October 4, 2017): 594–98. http://dx.doi.org/10.1177/0379572117733841.
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Background: Industrial food fortification is a major strategy to improve dietary micronutrient intakes and prevent deficiencies. Zambia introduced mandatory sugar fortification with vitamin A, at a target of 10 mg/kg, in 1998. Representative surveys conducted since that time do not support marked improvement in vitamin A status. Objective: To describe vitamin A concentrations in retail sugar, as well as vendor practices, perceptions of fortified foods, and sugar use practices. Methods: We conducted a census of sugar vendors in one Zambian community, capturing information on vendors, available brands and packaging options, and storage conditions. We purchased all brands and package types of sugar available at each vendor. In a 15% subsample, we conducted semi-structured interviews with vendor–consumer pairs. We tested 50% of sugar samples at random for vitamin A using an iCheck portable fluorimeter. Results: The distribution of vitamin A in sugar in market samples was highly skewed, with a median of 3.1 mg/kg (25th-75th percentiles: 1.8-5.5) and a range from 0.2 to 29.9 mg/kg. Only 11.3% of samples met the 10 mg/kg statutory requirement. Sugar was primarily repackaged and sold in small quantities, with rapid turnover of stocks. Perceptions of fortification by vendors and consumers were generally positive. Conclusions: Vitamin A in fortified sugar fell well below statutory requirements. Our data point to challenges at regional depot and/or poor adherence to fortification standards at the factory level. A renewed commitment to monitoring and enforcement will be required for Zambia to benefit from a food fortification strategy.
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Meltzer, Helle M., Antti Aro, Niels Lyhne Andersen, Bente Koch, and Jan Alexander. "Risk analysis applied to food fortification." Public Health Nutrition 6, no. 3 (June 2003): 281–90. http://dx.doi.org/10.1079/phn2002444.
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Abstract:Objective:To describe how a risk analysis can be applied to food fortification, with emphasis on voluntary fortification and intake levels that might exceed usual dietary levels.Design:Use of the risk analysis model as a frame to classify nutrients according to the risk of exceeding upper safe intake levels. Furthermore, to apply the model when discussing possible consequences of liberal fortification practices on eating behaviour and disease patterns.Setting:The discussion on food fortification presently going on internationally.Results:Micronutrients can be classified according to their safety margin, i.e. the size of the interval between the recommended intake and the upper safe level of intake. We suggest that nutrients with a small safety margin, i.e. for which the upper safe level is less than five times the recommended intake, be placed in a category A and should be handled with care (retinol, vitamin D, niacin, folate and all minerals). Category B comprises nutrients with an intermediate safety margin (vitamins E, B6, B12 and C), while nutrients that according to present knowledge are harmless even at 100 times the recommendation (vitamin K, thiamin, riboflavin, pantothenic acid and biotin) are categorised as C.Discussion:The risk analysis model is a useful tool when assessing the risk of both too low and excess intakes of single micronutrients, but can also be applied to analyse the consequences of fortification practices on eating behaviour and disease patterns. Liberal fortification regulations may, for example, distort the conception of what is healthy food, and drive consumption towards a more unhealthy diet, contributing to the plague of overweight and concomitant increased risk of degenerative diseases.Conclusion:The impact of fortification practices on the total eating pattern of a population should become an integrated part of the discussions and regulations connected to the issue.
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Smith, Jessica D., Neha Jain, and Regan L. Bailey. "Ready-to-eat cereal fortification: a modelling study on the impact of changing ready-to-eat cereal fortification levels on population intake of nutrients." Public Health Nutrition 23, no. 12 (January 20, 2020): 2165–78. http://dx.doi.org/10.1017/s1368980019003690.
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AbstractObjective:Ready-to-eat (RTE) cereal is an important source of nutrients in the American diet. Recent regulatory changes to labelling requirements may impact the fortification of RTE cereal. We used an evidence-based approach to optimize the fortification of RTE cereal considering current dietary patterns and nutrition policy.Design:A US modelling study of cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2013–2014. The percentage of the population below the Estimated Average Requirement (EAR) and above the Upper Tolerable Intake Level (UL) was modelled under three scenarios: baseline, zero fortification and optimized fortification.Setting:USA.Participants:Toddlers aged 1–3 years, n 559; children aged 4–12 years, n 1540; adolescents aged 13–18 years, n 992; and adults aged ≥19 years, n 576.Results:Comparing current with optimized fortification, nutrient/100 g RTE cereal decreased for vitamin A, thiamin, riboflavin, niacin, vitamin B6, folic acid, vitamin B12, Ca and Fe (by 2–82 %). The amount of vitamins C and D increased (by 13 and 50 %, respectively). Among RTE cereal eaters, these changes resulted in modest increases in the percentage of the population aged ≥1 year below the EAR (+0·5 to +11·5 percentage points). Decreases were observed in the percentage of the population above the UL.Conclusions:Fortification of RTE cereal can be optimized to provide key nutrients and minimize the percentage of the population below the EAR and above the UL. Dietary intake modelling is useful to ensure that RTE cereal continues to help the population meet their nutrient needs.
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Friesen, Valerie M., Mduduzi N. N. Mbuya, Grant J. Aaron, Helena Pachón, Olufemi Adegoke, Ramadhani A. Noor, Rina Swart, Archileo Kaaya, Frank T. Wieringa, and Lynnette M. Neufeld. "Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries." Journal of Nutrition 150, no. 8 (June 13, 2020): 2183–90. http://dx.doi.org/10.1093/jn/nxaa167.
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ABSTRACT Background Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified. Objectives We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA). Methods In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI). Results Fortified foods made modest contributions to measured iron intakes (0%–13% RNI); potential intakes if standards are met were generally higher (0%–65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%–125% and 88%–253% EAR, respectively); potential intakes were higher (53%–655% and 115%–377% EAR, respectively) and would exceed the tolerable upper intake level among 18%–56% of WRA for vitamin A in Nigeria and 1%–8% of WRA for iodine in Nigeria, Tanzania, and Uganda. Conclusions Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.
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Webb, Geoffrey P. "Vitamin fortification of foods: a critical review." Food Science & Technology Bulletin: Functional Foods 8, no. 1 (March 2011): 1–11. http://dx.doi.org/10.1616/1476-2137.1605.
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Leskauskaite, Daiva, Ina Jasutiene, Ernesta Malinauskyte, Milda Kersiene, and Paulius Matusevicius. "Fortification of dairy products with vitamin D3." International Journal of Dairy Technology 69, no. 2 (November 12, 2015): 177–83. http://dx.doi.org/10.1111/1471-0307.12242.
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Buttriss, J. L., and S. A. Lanham‐New. "Is a vitamin D fortification strategy needed?" Nutrition Bulletin 45, no. 2 (May 18, 2020): 115–22. http://dx.doi.org/10.1111/nbu.12430.
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Jungjohann, Svenja M., Gulshan Ara, Catia Pedro, Valerie M. Friesen, Mansura Khanam, Tahmeed Ahmed, Lynnette M. Neufeld, and Mduduzi N. N. Mbuya. "Vitamin A Fortification Quality Is High for Packaged and Branded Edible Oil but Low for Oil Sold in Unbranded, Loose Form: Findings from a Market Assessment in Bangladesh." Nutrients 13, no. 3 (February 28, 2021): 794. http://dx.doi.org/10.3390/nu13030794.
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Although mandatory fortification of oil with vitamin A is efficacious, its effectiveness can be compromised by suboptimal compliance to standards. In this study, we assessed (1) the availability of oil brands across the eight divisions of Bangladesh, (2) fortification quality (the extent to which vitamin A content is aligned with fortification standards) of oil brands and producers and (3) the market volume represented by available edible oil types. We visited different retail outlets in rural and urban market hubs to ascertain available oil brands and bulk oil types and collected samples. We used high-performance liquid chromatography to quantify average vitamin A content and compared them to the national oil fortification standards. Among the 66 packaged brands analyzed, 26 (39%) were not fortified, and 40 (61%) were fortified, with 28 (42%) fortified above the standard vitamin A minimum. Among the 41 bulk oil type composites analyzed, 24 (59%) were not fortified, and 17 (41%) were fortified, with 14 (34%) fortified below and 3 (7%) fortified above the standard minimum. Vitamin A fortification is high for packaged and branded edible oil but low for oil sold in unbranded, loose form. As bulk oil makes up a large proportion of the oil market volume, this means the majority of the oil volume available to the population is either not (25%) or fortified below the standard requirement (39%). Regulatory inspections of producers selling bulk oil should be prioritized to support and incentivize the industry to make all oil traceable and fortified to standard.
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Lehtonen-Veromaa, Marjo, Timo Möttönen, Aila Leino, Olli J. Heinonen, Essi Rautava, and Jorma Viikari. "Prospective study on food fortification with vitamin D among adolescent females in Finland: minor effects." British Journal of Nutrition 100, no. 2 (August 2008): 418–23. http://dx.doi.org/10.1017/s0007114508894469.
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Vitamin D insufficiency is common particularly during wintertime. After the recommendation by the Ministry of Social Affairs and Health, Finnish fluid milks and margarines have been fortified with vitamin D since February 2003. The aims of the present study were to examine the impact of vitamin D fortification of food supplies on serum 25-hydroxyvitamin D (S-25(OH)D) concentrations and on daily dietary vitamin D intake among adolescent females. One hundred and forty-two girls of Caucasian ethnicity aged 12–18 years completed semi-quantitative FFQ from which the dietary vitamin D and Ca intakes were calculated. S-25(OH)D was measured by radioimmunoassay. The study was performed from February–March 2000 to February–March 2004, one year after the initiation of fortification. The mean dietary intake of vitamin D was < 7·5 μg in 91·5 % of the adolescent girls in 2000 and 83·8 % in 2004. The midwinter mean S-25(OH)D concentration did not change significantly during the follow-up period (48·3 v. 48·1 nmol/l, NS). The proportion of participants who had S-25(OH)D concentration < 50 nmol/l was 60·6 % in 2000 and 65·5 % in 2004. Only 7·0 % of the participants had an adequate S-25(OH)D ( ≥ 75 nmol/l) level in 2000 or 4 years later. The vitamin D fortification of fluid milks and margarines was inadequate to prevent vitamin D insufficiency. There are numerous adolescent girls and women who are not reached by the current fortification policy. Therefore new innovative and feasible ways of improving vitamin D nutrition are urged.
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Jacobsen, R., M. Moldovan, A. A. Vaag, E. Hypponen, and B. L. Heitmann. "Vitamin D fortification and seasonality of birth in type 1 diabetic cases: D-tect study." Journal of Developmental Origins of Health and Disease 7, no. 1 (October 27, 2015): 114–19. http://dx.doi.org/10.1017/s2040174415007849.
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Fortification of margarine with vitamin D was mandatory in Denmark during 1961–1985. The aim of the study was to assess whether gestational and early infancy exposure to margarine fortification was associated with seasonality of birth in Danish type 1 diabetes (T1D) patients. The risks of T1D in Danes born during various exposure periods around margarine fortification termination in 1985 were analyzed. As expected, the T1D hazards in males unexposed to margarine fortification and born in spring were higher than in males born in autumn: relevant hazard ratios (95% confidence intervals) in various exposure groups ranged from 1.74 (1.112/2.708) to 37.43 (1.804/776.558). There were no indications of seasonality of birth in males exposed to fortification, nor in both exposed and unexposed females. The study suggests that early life exposure to low-dose vitamin D from fortified food eliminates seasonality of birth in T1D male patients. Further studies are required to investigate the identified gender differences.
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Clark, Beth, Julie Doyle, Owen Bull, Sophie McClean, and Tom Hill. "Knowledge and attitudes towards vitamin D food fortification." Nutrition & Food Science 49, no. 3 (May 13, 2019): 346–58. http://dx.doi.org/10.1108/nfs-04-2018-0121.
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Purpose Vitamin D deficiency is a well-recognised public health problem within the UK, with specific population groups more vulnerable to deficiency. Two pilot studies were used to explore awareness of vitamin D deficiency and attitudes towards food fortification. Design/methodology/approach A survey of 120 participants from five at-risk groups (South Asians, Blacks, Middle Eastern, Far Eastern and Caucasian older adults over 65 years) plus a group of British Caucasians who do not avoid sun exposure explored awareness of vitamin D, sun exposure knowledge and behaviour and attitudes towards food fortification. The latter group was included to provide a comparison group who were at a reduced risk of deficiency. χ2 was used to test associations between categorical variables and the study groups. The second study used three focus groups and two interviews, conducted on young South Asian females and examined knowledge and awareness of vitamin D and vitamin D-fortified foods. Findings A lack of knowledge and misconceptions were highlighted by both studies in relation to at-risk factors, including sunlight exposure (p = 0.037), dietary intakes (p = 0.0174) and darker skin pigmentation (p = 0.023), sources of vitamin D and the health benefits associated with optimal consumption. Attitudes to mandatory fortification of some foods varied significantly (p = 0.004) between the groups with acceptance rates for Blacks (68 per cent), those over 65 years (50 per cent), Middle Eastern (67 per cent) and Far Eastern (73 per cent), whereas the control (71 per cent) showed no acceptance, and South Asians gave a mixed response (48 per cent No). Focus group findings highlighted positive views towards fortification, although this was less for mandatory as opposed to voluntary fortification. Both pilot studies highlight the need for more research into this area, to create more effective public health policies. Originality/value The research presents novel insights into a topical area where there is limited research.
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Serra-Majem, Lluís. "Vitamin and mineral intakes in European children. Is food fortification needed?" Public Health Nutrition 4, no. 1a (February 2001): 101–7. http://dx.doi.org/10.1079/phn2000104.
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AbstractObjective:To provide an overview of vitamin and mineral intakes among children and adolescents in European countries and to present results from studies showing the impact of food fortification.Design:Comparative analysis of a number of nutritional studies among children and adolescents performed during the last decade in certain European countries.Setting:Spain, France, UK, North Ireland, Portugal, Germany.Subjects:Europeans aged 6 to 18.Results:Dietary surveys across Europe showed that varying levels of nutrient adequacy existed from one country to another, and that even within the same country, there were important nutritional gaps between different regions. In general, studies are difficult to compare, and information for many countries was missing. The results suggest that children and adolescents are the population group most likely to have higher risk of nutritional deficiencies, particularly for iron, vitamins C, E, B6and folates. In France, Ireland, UK and Spain, food fortification, and particularly of breakfast cereals, has positively contributed to increasing vitamin and mineral intakes in childhood and adolescence.Conclusions:Information on vitamin and mineral intakes in European children is less available than in adults. Fortified foods may contribute to reducing nutrient inadequacy in European children and adolescents, but should not replace nutrition education.
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Cuskelly, Geraldine J., Kathleen M. Mooney, and Ian S. Young. "Folate and vitamin B12: friendly or enemy nutrients for the elderly." Proceedings of the Nutrition Society 66, no. 4 (October 25, 2007): 548–58. http://dx.doi.org/10.1017/s0029665107005873.
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In the UK vitamin B12deficiency occurs in approximately 20% of adults aged >65 years. This incidence is significantly higher than that among the general population. The reported incidence invariably depends on the criteria of deficiency used, and in fact estimates rise to 24% and 46% among free-living and institutionalised elderly respectively when methylmalonic acid is used as a marker of vitamin B12status. The incidence of, and the criteria for diagnosis of, deficiency have drawn much attention recently in the wake of the implementation of folic acid fortification of flour in the USA. This fortification strategy has proved to be extremely successful in increasing folic acid intakes pre-conceptually and thereby reducing the incidence of neural-tube defects among babies born in the USA since 1998. However, in successfully delivering additional folic acid to pregnant women fortification also increases the consumption of folic acid of everyone who consumes products containing flour, including the elderly. It is argued that consuming additional folic acid (as ‘synthetic’ pteroylglutamic acid) from fortified foods increases the risk of ‘masking’ megaloblastic anaemia caused by vitamin B12deficiency. Thus, a number of issues arise for discussion. Are clinicians forced to rely on megaloblastic anaemia as the only sign of possible vitamin B12deficiency? Is serum vitamin B12alone adequate to confirm vitamin B12deficiency or should other diagnostic markers be used routinely in clinical practice? Is the level of intake of folic acid among the elderly (post-fortification) likely to be so high as to cure or ‘mask’ the anaemia associated with vitamin B12deficiency?
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Keller, Amélie, Lars Ängquist, Ramune Jacobsen, Allan Vaag, and Berit L. Heitmann. "A retrospective analysis of a societal experiment among the Danish population suggests that exposure to extra doses of vitamin A during fetal development may lower type 2 diabetes mellitus (T2DM) risk later in life." British Journal of Nutrition 117, no. 5 (March 14, 2017): 731–36. http://dx.doi.org/10.1017/s000711451700037x.
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AbstractVitamin A deficiency has been associated with impaired fetal pancreatic development and increased risk of developing type 2 diabetes mellitus (T2DM). In 1962, mandatory margarine fortification with vitamin A was increased by 25 % in Denmark. We aimed to determine whether offspring of mothers who had been exposed to the extra vitamin A from fortification during pregnancy had a lower risk of developing T2DM in adult life, compared with offspring of mothers exposed to less vitamin A. Individuals from birth cohorts with the higher prenatal vitamin A exposure (born 1 December 1962–31 March 1964) and those with lower prenatal exposure (born 1 September 1959–31 December 1960) were followed up with regard to development of T2DM before 31 December 2012 in the Danish National Diabetes Registry and National Patient Register. Logistic and Cox regression analyses were performed to determine the risk of T2DM by vitamin A exposure level. A total of 193 803 individuals were followed up until midlife. Our results showed that individuals exposed prenatally to extra vitamin A from fortified margarine had a lower risk of developing T2DM than those exposed to lower levels: OR 0·88; 95 % CI 0·81, 0·95, P=0·001, after adjustment for sex. Fetal exposure to small, extra amounts of vitamin A from food fortification may reduce the risk of T2DM. These results may have public health relevance, as they demonstrate that one of the most costly chronic diseases may be prevented by food fortification – a simple and affordable public health nutrition intervention.
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Duus, Katrine S., Caroline Moos, Peder Frederiksen, Vibeke Andersen, and Berit L. Heitmann. "Prenatal and Early Life Exposure to the Danish Mandatory Vitamin D Fortification Policy Might Prevent Inflammatory Bowel Disease Later in Life: A Societal Experiment." Nutrients 13, no. 4 (April 19, 2021): 1367. http://dx.doi.org/10.3390/nu13041367.
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This register-based national cohort study of 206,900 individuals investigated whether prenatal exposure to small extra doses of vitamin D from fortified margarine prevented inflammatory bowel disease (IBD) later in life; whether the risk of IBD varied according to month or season of birth; and finally, whether there was an interaction between exposure to extra D vitamin and month or season of birth. Fortification of margarine with vitamin D was mandatory in Denmark from the mid-1930s until 1st June 1985, when it was abolished. Two entire birth cohorts, each including two years, were defined: one exposed and one unexposed to the fortification policy for the entire gestation. All individuals were followed for 30 years from the day of birth for an IBD diagnosis in Danish hospital registers. Logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI). Odds for IBD was lower among those exposed to extra D vitamin compared to those unexposed, OR = 0.87 (95% CI: 0.79; 0.95). No association with month or season of birth was found. However, estimates suggested that particularly children born during autumn may have benefitted from the effect of small extra doses of vitamin D. This is, to our knowledge, the first study to explore if prenatal exposure to vitamin D from fortification influenced the risk of IBD. Our results suggest that prenatal exposure to small amounts of extra vitamin D from food fortification may protect against the development of IBD before 30 years of age.
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Abdeen, Ziad, Asa’d Ramlawi, Radwan Qaswari, Ala’ Abu Alrub, Omar Dary, Zo Rambeloson, Setareh Shahab-Ferdows, et al. "Predicted efficacy of the Palestinian wheat flour fortification programme: complementary analysis of biochemical and dietary data." Public Health Nutrition 18, no. 8 (August 29, 2014): 1358–68. http://dx.doi.org/10.1017/s1368980014001554.
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AbstractObjectiveTo utilize complementary biochemical and dietary data collected before the initiation of national flour fortification to (i) identify micronutrient insufficiencies or deficiencies and dietary inadequacies in Palestinian women and children in vulnerable communities and (ii) assess the suitability of the current wheat flour fortification formula.DesignQuantitative dietary intake questionnaires were administered and fasting venous blood samples collected in randomly selected households in Gaza City and Hebron. The impact of fortification was simulated by estimating the additional micronutrient content of fortified wheat flour.SettingHouseholds in Gaza City and Hebron that were not receiving food aid from social programmes.SubjectsNon-pregnant women (18–49 years) and children aged 36–83 months.ResultsThe micronutrients with highest prevalence of insufficiency were vitamin D in women (84–97 % with serum 25-hydroxyvitamin D <50 nmol/l) and vitamin B12 in women and children (43–82 % with serum B12 <221 pmol/l). Deficiencies of vitamin A, Fe and Zn were also of public health concern. Current levels of wheat flour fortificants were predicted to improve, but not eliminate, micronutrient intake inadequacies. Modification of fortificant concentrations of vitamin D, thiamin, vitamin B12, Zn and folic acid may be indicated.ConclusionsMicronutrient insufficiencies or deficiencies and intake inadequacies were prevalent based on either biochemical or dietary intake criteria. Adjustments to the current fortification formula for wheat flour are necessary to better meet the nutrient needs of Palestinian women and children.
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Saville, Naomi M., Macharaja Maharjan, Dharma S. Manandhar, and Helen A. Harris-Fry. "Equity implications of rice fortification: a modelling study from Nepal." Public Health Nutrition 23, no. 15 (July 6, 2020): 2824–39. http://dx.doi.org/10.1017/s1368980020001020.
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AbstractObjective:To model the potential impact and equity impact of fortifying rice on nutritional adequacy of different subpopulations in Nepal.Design:Using 24-h dietary recall data and a household consumption survey, we estimated: rice intakes; probability of adequacy (PA) of eight micronutrients commonly fortified in rice (vitamin A, niacin (B3), pyridoxine (B6), cobalamin (B12), thiamin (B1), folate (B9), Fe and Zn) plus riboflavin (B2), vitamin C and Ca and mean probability of adequacy (MPA) of these micronutrients. We modelled: no fortification; fortification of purchased rice, averaged across all households and in rice-buying households only. We compared adequacy increases between population subgroups.Setting:(i) Dhanusha and Mahottari districts of Nepal (24-h recall) and (ii) all agro-ecological zones of Nepal (consumption data).Participants:(i) Pregnant women (n 128), mothers-in-law and male household heads; (ii) households (n 4360).Results:Unfortified diets were especially inadequate in vitamins B12, A, B9, Zn and Fe. Fortification of purchased rice in rice-purchasing households increased PA > 0·9 for thiamin, niacin, B6, folate and Zn, but B12 and Fe remained inadequate even after fortification (PA range 0·3–0·9). Pregnant women’s increases exceeded men’s for thiamin, niacin, B6, folate and MPA; men had larger gains in vitamin A, B12 and Zn. Adequacy improved more in the hills (coefficient 0·08 (95 % CI 0·05, 0·10)) and mountains (coefficient 0·07 (95 % CI 0·01, 0·14)) but less in rural areas (coefficient −0·05 (95 % CI −0·09, −0·01)).Conclusions:Consumption of purchased fortified rice improves adequacy and gender equity of nutrient intake, especially in non-rice-growing areas.
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Krolevets, A. A., N. I. Myachikova, O. V. Binkovskaya, S. G. Glotova, K. M. Semichev, E. M. Mamaeva, and E. A. Shkondin. "Fortification of food products with nanostructured vitamin D." Tovaroved prodovolstvennykh tovarov (Commodity specialist of food products), no. 3 (February 25, 2021): 166 (240)—173 (245). http://dx.doi.org/10.33920/igt-01-2103-01.
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The paper provides information on the real possibility of using nanostructured vitamin D for enriching food products, it is illustrated through the examples of marmalade, yoghurt, ice cream and the production of bakery products. English version of the article on pp. 240-245 at URL: https://panor.ru/articles/fortification-of-food-products-with-nanostructured-vitamin-d/65958.html
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Calame, Wim, Laura Street, and Toine Hulshof. "Vitamin D Serum Levels in the UK Population, including a Mathematical Approach to Evaluate the Impact of Vitamin D Fortified Ready-to-Eat Breakfast Cereals: Application of the NDNS Database." Nutrients 12, no. 6 (June 23, 2020): 1868. http://dx.doi.org/10.3390/nu12061868.
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Vitamin D status is relatively poor in the general population, potentially leading to various conditions. The present study evaluates the relationship between vitamin D status and intake in the UK population and the impact of vitamin D fortified ready-to-eat cereals (RTEC) on this status via data from the National Diet and Nutrition Survey (NDNS: 2008–2012). Four cohorts were addressed: ages 4–10 (n = 803), ages 11–18 (n = 884), ages 19–64 (n = 1655) and ages 65 and higher (n = 428). The impact of fortification by 4.2 μg vitamin D per 100 g of RTEC on vitamin D intake and status was mathematically modelled. Average vitamin D daily intake was age-dependent, ranging from ~2.6 (age range 4–18 years) to ~5.0 μg (older than 64 years). Average 25(OH)D concentration ranged from 43 to 51 nmol/L, the highest in children. The relationship between vitamin D intake and status followed an asymptotic curve with a predicted plateau concentration ranging from 52 in children to 83 nmol/L in elderly. The fortification model showed that serum concentrations increased with ~1.0 in children to ~6.5 nmol/L in the elderly. This study revealed that vitamin D intake in the UK population is low with 25(OH)D concentrations being suboptimal for general health. Fortification of breakfast cereals can contribute to improve overall vitamin D status.
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Akkam, Yazan, Taha Rababah, Rui Costa, Ali Almajwal, Hao Feng, Juan E. Andrade Laborde, Mahmoud M. Abulmeaty, and Suhail Razak. "Pea Protein Nanoemulsion Effectively Stabilizes Vitamin D in Food Products: A Potential Supplementation during the COVID-19 Pandemic." Nanomaterials 11, no. 4 (March 31, 2021): 887. http://dx.doi.org/10.3390/nano11040887.
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Vitamin D deficiency is a global issue which has been exacerbated by the COVID-19 pandemic-related lockdowns. Fortification of food staples with vitamin D provides a solution to alleviate this problem. This research explored the use of pea protein nanoemulsion (PPN) to improve the stability of vitamin D in various food products. PPN was created using a pH-shifting and ultrasonication combined method. The physicochemical properties were studied, including particle size, foaming ability, water holding capacity, antioxidant activity, and total phenolic contents. The fortification of several food formulations (non-fat cow milk, canned orange juice, orange juice powder, banana milk, and infant formula) with vitamin D–PPN was investigated and compared to raw untreated pea protein (UPP) regarding their color, viscosity, moisture content, chemical composition, vitamin D stability, antioxidant activity, and morphology. Finally, a sensory evaluation (quantitative descriptive analysis, and consumer testing) was conducted. The results show that PPN with a size of 21.8 nm protected the vitamin D in all tested products. PPN may serve as a potential carrier and stabilizer of vitamin D in food products with minimum effects on the taste and color. Hence, PPN may serve as a green and safe method for food fortification during the COVID-19 pandemic.
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Sablah, Mawuli, Jennifer Klopp, Douglas Steinberg, Zaoro Touaoro, Arnaud Laillou, and Shawn Baker. "Thriving Public—Private Partnership to Fortify Cooking Oil in the West African Economic and Monetary Union (UEMOA) to Control Vitamin A Deficiency: Faire Tache d'Huile en Afrique de l'Ouest." Food and Nutrition Bulletin 33, no. 4_suppl3 (December 2012): S310—S320. http://dx.doi.org/10.1177/15648265120334s307.
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Background In sub-Saharan Africa, more than 42% of children are at risk for vitamin A deficiency, and control of vitamin A deficiency will prevent more than 600,000 child deaths annually. In the West African Economic and Monetary Union (UEMOA), an estimated 54.3% of preschool-age children are vitamin A deficient and 13% of pregnant women have night blindness. Objective To project the achievements of this West African coalition. Methods This article documents the achievements, challenges, and lessons learned associated with the development of a public—private partnership to fortify vegetable oil in West Africa through project reports and industry assessments. Results National-level food consumption surveys identified cooking oil as a key vehicle for vitamin A. Stakeholders therefore advocated for the production of fortified vegetable oil at large scale, supported industrial assessments, and reinforced the capacity of cooking oil industries to implement vitamin A fortification through effective coordination of public and private partnerships tied with standards, regulations, and social marketing. Strong alliances for food fortification were established at the regional and national levels. Stakeholders also developed policies, adopted directives, built capacity, implemented social marketing, and monitored quality enforcement systems to sustain fortification for maximum public health impact. The synergy created resulted from the unique and complementary core competencies of all the partners under effective coordination. The initiative began with the 8 UEMOA member countries and now includes all 15 countries of the Economic Community of West African States (ECOWAS), plus Cameroon, Tanzania, and Mozambique, forming a sub-Saharan Africa-wide initiative on food fortification. All members of the Professional Association of Cooking Oil Industries of the West African Economic and Monetary Union (AIFO-UEMOA) now fortify edible oil with vitamin A. Through multisector cooperation, an estimated 70% of the population has access to vitamin A–fortified edible oil in participating countries. Conclusions Sustainable fortification of cooking oil is now a reality in all UEMOA countries.
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Brandão-Lima, Paula Nascimento, Beatriz da Cruz Santos, Concepción Maria Aguilera, Analícia Rocha Santos Freire, Paulo Ricardo Saquete Martins-Filho, and Liliane Viana Pires. "Vitamin D Food Fortification and Nutritional Status in Children: A Systematic Review of Randomized Controlled Trials." Nutrients 11, no. 11 (November 14, 2019): 2766. http://dx.doi.org/10.3390/nu11112766.
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Children are in the risk group for developing hypovitaminosis D. Several strategies are used to reduce this risk. Among these, fortification of foods with vitamin D (25(OH)D) has contributed to the achievement of nutritional needs. This systematic review aims to discuss food fortification as a strategy for maintenance or recovery of nutritional status related to vitamin D in children. The work was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered in the International prospective register of systematic reviews (PROSPERO) database (CRD42018052974). Randomized clinical trials with children up to 11 years old, who were offered vitamin D-fortified foods, and who presented 25(OH)D concentrations were used as eligibility criteria. After the selection stages, five studies were included, totaling 792 children of both sexes and aged between two and 11 years. Interventions offered 300–880 IU of vitamin D per day, for a period of 1.6–9 months, using fortified dairy products. In four of the five studies, there was an increase in the serum concentrations of 25(OH)D with the consumption of these foods; additionally, most children reached or maintained sufficiency status. Moreover, the consumption of vitamin D-fortified foods proved to be safe, with no concentrations of 25(OH)D > 250 nmol/L. Based on the above, the fortification of foods with vitamin D can help maintain or recover the nutritional status of this vitamin in children aged 2–11 years. However, it is necessary to perform additional randomized clinical trials in order to establish optimal doses of fortification, according to the peculiarities of each region.