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Nutrients
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The Impact of Food Fortification on Health and Nutrition Outcomes
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The Impact of Food Fortification on Health and Nutrition Outcomes

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Micronutrients and Human Health".

Deadline for manuscript submissions: closed (5 August 2024) | Viewed by 28326

Special Issue Editor

Dr. Andrew G. Hall

E-Mail Website
Guest Editor
1. Department of Nutritional Sciences & Toxicology, University of California, Berkeley, CA 94720, USA
2. Department of Nutrition, University of California, Davis, CA 95616, USA
Interests: micronutrient intake; zinc

Special Issue Information

Dear Colleagues,

Over recent decades, notable progress has been made towards the improvement of malnutrition on a global scale. Nutrition priorities to support health are likewise changing. In many settings, micronutrient deficiencies remain in parallel to, and may even exacerbate, growing epidemics of communicable and noncommunicable diseases.

Food fortification increases the micronutrient density of foods, supporting increases in immune and metabolic competence, improving health outcomes. Cost-effectiveness, applicability both to mass scale and targeted interventions, and efficacy, are major advantages supporting innovation in food fortification systems and expanded use of food fortification. To inform the best placement of these advancements, it is critical to effectively link the increased intakes of micronutrients of concern with related improvements in health outcomes.

This special issue of Nutrients welcomes original research and reviews covering food fortification impacts on nutrition and human health outcomes. The scope of this issue spans from preparatory research evaluating dietary patterns and current health issues towards selection of foods for fortification, to clinical and population-based studies of efficacy and effectiveness. It encompasses studies ranging from the evidence-based exploration of the potential health impacts of future fortification, to the direct quantification of micronutrient bioavailability and impacts on nutrition and health outcomes.

Dr. Andrew G. Hall
Guest Editor

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Keywords

  • food fortification
  • health outcomes
  • micronutrients
  • nutrition status
  • malnutrition
  • food systems

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Published Papers (6 papers)

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Research

Jump to: Review, Other

14 pages, 1466 KiB  
Article
Comparing Nutrient Profiles of Meat and Fish with Plant-Based Alternatives: Analysis of Nutrients, Ingredients, and Fortification Patterns
by Adam Drewnowski, Maaike J. Bruins and Julia J. F. Besselink
Nutrients 2024, 16(16), 2725; https://doi.org/10.3390/nu16162725 - 16 Aug 2024
Viewed by 2678
Abstract
Nutrient quality of plant-based meat and fish alternative (MFA) products has been reported as variable. The present objective was to compare the nutrient density of raw meat and fish with MFA products and to examine MFA ingredients and fortification patterns. Nutrient composition data [...] Read more.
Nutrient quality of plant-based meat and fish alternative (MFA) products has been reported as variable. The present objective was to compare the nutrient density of raw meat and fish with MFA products and to examine MFA ingredients and fortification patterns. Nutrient composition data for raw beef, pork, and chicken (n = 450) came from the USDA Standard Reference Legacy Reselase (SR28) nutrient composition database (n = 450). Data for plant-based meat alternatives (n = 118) came from the USDA Branded Food Products Database (BFPDB). Data for fish and seafood (n = 68) and alternatives (n = 12) came from the Danish Frida Database and Mintel (n = 503). Analyses compared macronutrient content and selected micronutrients per 100 g and percentage of US Daily Values. Nutrient density scores were based on the NRF5.3 algorithm. NRF5.3 scores were significantly lower for MFA products as compared to meat or fish. Saturated fat content was lower, but the mean MFA sodium content was 660 mg/100 g compared to 60 mg/100 g for beef. Mean protein content (17 g) was lower than for beef and pork (20 g). A search of ingredient lists found that fortification with most nutrients associated with animal source proteins (such as B vitamins, vitamin D, iodine, zinc, and omega-3 EPA and DHA) was minimal. Plant-based MFA products would benefit from nutrient standards and fortification guidelines to ensure that these products are not nutritionally inferior to the originals. Full article
(This article belongs to the Special Issue The Impact of Food Fortification on Health and Nutrition Outcomes)
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17 pages, 974 KiB  
Article
Effect of Nicotinamide Mononucleotide Concentration in Human Milk on Neurodevelopmental Outcome: The Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study
by Yoshie Saito, Keigo Sato, Shinji Jinno, Yoshitaka Nakamura, Takahiro Nobukuni, Soichi Ogishima, Satoshi Mizuno, Seizo Koshiba, Shinichi Kuriyama, Kinuko Ohneda and Masashi Morifuji
Nutrients 2024, 16(1), 145; https://doi.org/10.3390/nu16010145 - 31 Dec 2023
Cited by 2 | Viewed by 3177
Abstract
(1) Background: Breast milk is the only source of nutrition for breastfed infants, but few studies have examined the relationship between breast milk micronutrients and infant neurodevelopmental outcome in exclusively breastfed infants. The aim of this study was to characterize the association between [...] Read more.
(1) Background: Breast milk is the only source of nutrition for breastfed infants, but few studies have examined the relationship between breast milk micronutrients and infant neurodevelopmental outcome in exclusively breastfed infants. The aim of this study was to characterize the association between nicotinamide adenine dinucleotide (NAD)-related compounds in the breast milk of Japanese subjects and infant neurodevelopmental outcome. (2) Methods: A total of 150 mother–child pairs were randomly selected from the three-generation cohort of the Tohoku Medical Megabank in Japan. Infants were exclusively breastfed for up to 6 months. Breast milk was collected at 1 month postpartum, and the quantity of NAD-related substances in the breast milk was quantified. The mothers also completed developmental questionnaires at 6, 12, and 24 months. The relationship between the concentration of NAD-related substances in breast milk and developmental indicators was evaluated via ordinal logistic regression analysis. (3) Results: Nicotinamide mononucleotide (NMN) was quantified as the major NAD precursor in breast milk. The median amount of NMN in the breast milk was 9.2 μM. The NMN concentration in breast milk was the only NAD-related substance in breast milk that showed a significant positive correlation with neurodevelopmental outcome in infants at 24 months. (4) Conclusions: The results suggest that NMN in human milk may be an important nutrient for early childhood development. Full article
(This article belongs to the Special Issue The Impact of Food Fortification on Health and Nutrition Outcomes)
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Review

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13 pages, 1123 KiB  
Review
The Importance of Vitamin K and the Combination of Vitamins K and D for Calcium Metabolism and Bone Health: A Review
by Jan O. Aaseth, Trine Elisabeth Finnes, Merete Askim and Jan Alexander
Nutrients 2024, 16(15), 2420; https://doi.org/10.3390/nu16152420 - 25 Jul 2024
Viewed by 5146
Abstract
The aim of the present review is to discuss the roles of vitamin K (phylloquinone or menaquinones) and vitamin K-dependent proteins, and the combined action of the vitamins K and D, for the maintenance of bone health. The most relevant vitamin K-dependent proteins [...] Read more.
The aim of the present review is to discuss the roles of vitamin K (phylloquinone or menaquinones) and vitamin K-dependent proteins, and the combined action of the vitamins K and D, for the maintenance of bone health. The most relevant vitamin K-dependent proteins in this respect are osteocalcin and matrix Gla-protein (MGP). When carboxylated, these proteins appear to have the ability to chelate and import calcium from the blood to the bone, thereby reducing the risk of osteoporosis. Carboxylated osteocalcin appears to contribute directly to bone quality and strength. An adequate vitamin K status is required for the carboxylation of MGP and osteocalcin. In addition, vitamin K acts on bone metabolism by other mechanisms, such as menaquinone 4 acting as a ligand for the nuclear steroid and xenobiotic receptor (SXR). In this narrative review, we examine the evidence for increased bone mineralization through the dietary adequacy of vitamin K. Summarizing the evidence for a synergistic effect of vitamin K and vitamin D3, we find that an adequate supply of vitamin K, on top of an optimal vitamin D status, seems to add to the benefit of maintaining bone health. More research related to synergism and the possible mechanisms of vitamins D3 and K interaction in bone health is needed. Full article
(This article belongs to the Special Issue The Impact of Food Fortification on Health and Nutrition Outcomes)
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16 pages, 1148 KiB  
Review
Nutritional Value of Yogurt as a Protein Source: Digestibility/Absorbability and Effects on Skeletal Muscle
by Koichiro Sumi, Ryoichi Tagawa, Kae Yamazaki, Kyosuke Nakayama, Takefumi Ichimura, Chiaki Sanbongi and Koichi Nakazato
Nutrients 2023, 15(20), 4366; https://doi.org/10.3390/nu15204366 - 14 Oct 2023
Cited by 5 | Viewed by 9485
Abstract
Yogurt is a traditional fermented food that is accepted worldwide for its high palatability and various health values. The milk protein contained in yogurt exhibits different physical and biological properties from those of non-fermented milk protein due to the fermentation and manufacturing processes. [...] Read more.
Yogurt is a traditional fermented food that is accepted worldwide for its high palatability and various health values. The milk protein contained in yogurt exhibits different physical and biological properties from those of non-fermented milk protein due to the fermentation and manufacturing processes. These differences are suggested to affect the time it takes to digest and absorb milk protein, which in turn will influence the blood levels of amino acids and/or hormones, such as insulin, and thereby, the rate of skeletal muscle protein synthesis via the activation of intracellular signaling, such as the mTORC1 pathway. In addition, based on the relationship between gut microbiota and skeletal muscle conditions, yogurt, including lactic acid bacteria and its metabolites, has been evaluated for its role as a protein source. However, the substantial value of yogurt as a protein source and the additional health benefits on skeletal muscle are not fully understood. The purpose of this review is to summarize the research to date on the digestion and absorption characteristics of yogurt protein, its effect on skeletal muscle, and the contribution of lactic acid bacterial fermentation to these effects. Full article
(This article belongs to the Special Issue The Impact of Food Fortification on Health and Nutrition Outcomes)
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Other

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17 pages, 774 KiB  
Systematic Review
Benefits and Harms of Edible Vegetable Oils and Fats Fortified with Vitamins A and D as a Public Health Intervention in the General Population: A Systematic Review of Interventions
by Éva Szabó, Ildikó Csölle, Regina Felső, Daniela Kuellenberg de Gaudry, Patrick Nyamemba Nyakundi, Kazahyet Ibrahim, Maria-Inti Metzendorf, Tamás Ferenci and Szimonetta Lohner
Nutrients 2023, 15(24), 5135; https://doi.org/10.3390/nu15245135 - 18 Dec 2023
Cited by 3 | Viewed by 4394
Abstract
This systematic review aims to assess whether edible vegetable oils and fats fortified with vitamin A and/or D are effective and safe in improving vitamin intake and ameliorating deficiency states in the general population. In November 2022, we systematically searched MEDLINE, Cochrane CENTRAL, [...] Read more.
This systematic review aims to assess whether edible vegetable oils and fats fortified with vitamin A and/or D are effective and safe in improving vitamin intake and ameliorating deficiency states in the general population. In November 2022, we systematically searched MEDLINE, Cochrane CENTRAL, Scopus, Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP (International Clinical Trials Registry Platform) for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSI) investigating the fortification of edible vegetable oils and fats with either vitamin A or vitamin D or both as compared to the same vegetable oils and/or fats without vitamin A and D fortification or no interventions, in the general population, without age restriction. We assessed the methodological quality of included RCTs using Cochrane’s risk of bias tool 2.0 and of NRSIs using ROBINS-I tool. We performed random-effects meta-analysis and assessed certainty of evidence using GRADE. We included eight studies. Available evidence showed no significant effect of fortification with vitamin A on serum retinol levels (RCTs: MD 0.35 µmol/L, 95% CI −0.43 to 1.12; two trials; 514 participants; low-certainty evidence; CCTs: MD 0.31 µmol/L, 95% CI −0.18 to 0.80; two trials; 205 participants; very low-certainty evidence) and on subclinical vitamin A deficiency. Low-certainty evidence showed no effect of vitamin D fortification on serum 25-hydroxy vitamin D concentration (MD 6.59 nmol/L, 95% CI −6.89 to 20.07; one trial; 62 participants). In conclusion, vitamin A-fortified vegetable oils and fats may result in little to no difference in serum retinol levels in general populations. The dose of vitamin A used in the trials may be safe but may not be sufficient to reduce subclinical vitamin A deficiency. Further, the evidence suggests that vitamin D fortification results in little to no difference in serum 25-hydroxy vitamin D concentration. Several aspects of providing fortified oils and fats to the general population as a public health intervention should be further investigated, including optimal fortification dose, effects on vitamin D deficiency and its clinical symptoms and potential adverse effects. Full article
(This article belongs to the Special Issue The Impact of Food Fortification on Health and Nutrition Outcomes)
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29 pages, 1522 KiB  
Systematic Review
Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews
by Patrick Nyamemba Nyakundi, Zsuzsanna Némethné Kontár, Attila Kovács, Luca Járomi, Afshin Zand and Szimonetta Lohner
Nutrients 2023, 15(17), 3742; https://doi.org/10.3390/nu15173742 - 26 Aug 2023
Cited by 3 | Viewed by 2369
Abstract
Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple [...] Read more.
Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple foods for household use. In April 2023, we systematically searched Ovid MEDLINE, Embase, Epistemonikos and the Cochrane Database of Systematic Reviews for systematic reviews investigating the effects of vitamin D fortification of food in general populations of any age. We used Cochrane methodology and assessed the methodological quality of included studies using AMSTAR (A MeaSurement Tool to Assess Systematic Reviews). We assessed the degree of overlap among reviews. All outcomes included in systematic reviews were assessed. The protocol is registered in PROSPERO (registration number: CRD42023420991). We included 27 systematic reviews out of 5028 records for analysis. Overall, 11 out of 12 systematic reviews calculating pooled estimates reported a significant increase in serum 25(OH)D concentrations. The mean change in serum 25(OH)D concentrations per additional 100 units of vitamin D ranged from 0.7 to 10.8 nmol/L. Fortification of food with vitamin D showed a reduction in the prevalence of vitamin D deficiency based on high-certainty evidence. Parathormone (PTH) levels were described to decrease, bone mineral density to increase, while the effects on other bone turnover markers were inconsistent. Fortification did not significantly impact most anthropometric parameters, but it seemed to positively influence lipid profiles. In summary, fortification of food with vitamin D results in a reduction of vitamin D deficiency and might increase serum 25(OH)D concentrations, to varying extents depending on the fortified vehicle and population characteristics. Additionally, fortification may have a positive impact on bone turnover and lipid metabolism but may only have a limited effect on anthropometric parameters. Full article
(This article belongs to the Special Issue The Impact of Food Fortification on Health and Nutrition Outcomes)
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