About Food Fortification
Vitamins and minerals are an essential part of the human diet, but people worldwide do not get enough of the essential vitamins and minerals they need for healthy growth and development.
Diets low in vitamins and minerals can lead to poor health outcomes, serious birth defects of the brain and spine, and poor cognitive development. These irreversible damages adversely affect communities and the economies of entire nations. Children do not develop fully, adults cannot work productively, and excessive resources are spent to treat a variety of nutrition-related health problems.
An Integral Part of a Nutrition Strategy: Food Fortification
Food fortification is one of the most cost-effective, proven interventions that is readily available to address vitamin and mineral deficiencies. Food fortification adds essential vitamins and minerals to commonly consumed foods such as maize flour, edible oil, rice, salt, and wheat flour. Food fortification is a complementary intervention to preventing and treating vitamin and mineral deficiencies and should be considered as part of a broader nutrition strategy that includes other nutrition-specific and nutrition-sensitive interventions.
Food fortification, as an intervention is unique, in that it spreads the burden of intervention and cost between the public and private sector and the consumer. While it is the private sector that fortifes the food, government can create a more enabling environment for industry, by passing and enforcing legislation making it a mandatory requirement (which creates an even playing field for industry) and by setting standards to ensure adequate and safe levels of nutrients are added. Moreover, when fortification is mandatory, no behavior change or even knowledge on the part of the consumer is required; they will benefit simply by continuing to eat the foods they normally buy. Voluntary fortification is undertaken at the discretion of the private sector, although preferably based on standards set by government. Mandatory fortification is more likely to have a public health benefit because there is no need for the consumer to actively identify and choose to purchase the fortified food.
Links to fortification resources are categorized in sections below. Select a section to reveal its resources.
- WHO & FAO guidelines on food fortification with micronutrients (2006)
- WHO recommendations for wheat and maize flour fortification (2009)
- WHO recommendations for salt fortification (2014)
- WHO recommendations for maize flour fortification (2016)
- WHO guideline for fortification of rice with vitamins and minerals in public health (2018)
Fortification Program Best Practices
- Regulatory Monitoring of National Food Fortification Programs: A Policy Guidance Document
- Evidence, status and lessons learned in grain fortification
Tsang BT, Pachón H. Sight and Life, Rice Fortification in Latin America. 150-157. 2017
Public Health Evidence for Fortification
- Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses
Aburto N, Abudou M, Candeias V, Wu T. Effect and safety of salt iodization to prevent iodine deficiency disorders: a systematic review with meta-analyses. WHO eLibrary of Evidence for Nutrition Actions (eLENA). Geneva: World Health Organization; 2014.
- Evidence of the effectiveness of flour fortification programs on iron status and anemia: a systematic review
Pachón H, Spohrer R, Mei Z, Serdula M. Nutr Rev. 2015 Nov;73(11):780-95.
- Folic acid to reduce neonatal mortality form neural tube disorders
Blencowe H, Cousens S, Modell B, Lawn J. International Journal of Epidemiology. April 2010 (suppl_1):i110-i121.
- Impact of folic acid fortification of flour on neural tube defects: a systematic review
Castillo-Lancellotti C, Tur JA, Uauy R. Public Health Nutr. 2013 May;16(5):901-11. doi: 10.1017/S1368980012003576. Review. Erratum in: Public Health Nutr. 2013 Aug;16(8):1527
- Summary: Fortifying Flour with Folic Acid to Prevent Neural Tube Defects
Food Fortification Initiative (FFI). Atlanta, USA. 2017.
- Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis
Keats EC, Neufeld LM, Garrett GS, Mbuya MNN, Bhutta ZA. Improved micronutrient status and health outcomes in low- and middle-income countries following large-scale fortification: evidence from a systematic review and meta-analysis. Am J Clin Nutr. 2019 Jun 1;109(6):1696-1708. Doi: 10.1093/ajcn/nqz023.
Fortification Advocacy and Endorsements
- International Association of Operative Millers: A Resolution in Support of the Flour Fortification Initiative, 2003
- World Food Programme Executive Board policy regarding fortification, Rome, 24–26 May 2004
- European Commission Food Fortification Global Mapping Study 2016
- The Arusha Statement on Food Fortification
- The Lagos Statement on Nigeria Food Fortification
- Large Scale Food Fortification in India: The Journey So Far and Road Ahead
- The #FutureFortified Global Summit on Food Fortification: Event Proceedings and Recommendations for Food Fortification Programs
- Second Copenhagen Consensus (2008): Micronutrient Fortification Best Practice
Horton S, Mannar V, Wesley A. Micronutrient Fortification (Iron and Salt Iodization). Best Practice Paper: New Advice from CC08. 2008.
- Third Copenhagen Consensus (2012): Challenge Paper on Hunger and Malnutrition
Hoddinott J, Rosegrant M, Torero M. Investments to reduce hunger and undernutrition. April 9, 2012.
- Grain Fortification to Address the Sustainable Development Goals
- North American Teratology Society resolution on folic acid fortification (2014)
- FAO policy statement: Fortification of food with micronutrients. (2003)