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Nutrients
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The Benefits of Food Fortification
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The Benefits of Food Fortification

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

Deadline for manuscript submissions: closed (30 November 2020) | Viewed by 46671

Special Issue Editor

Dr. Ganmaa Davaasambuu

E-Mail Website
Guest Editor
Harvard University | Harvard Department of Nutrition

Special Issue Information

Dear Colleagues,

This Special Issue of Nutrients will be addressed to the benefits of food fortification. Micronutrient deficiencies are one of the biggest causes of inequality between the developed and the developing word. At the individual level, micronutrient deficiencies cause human physical and cognitive developmental delays and are responsible for increased risk of morbidity and mortality. At the population level, such deficiencies are responsible for the impairment of cultures, human capital, and national economies.

As the winners of the 2019 Nobel Prize in Economics put it: “providing more calories would often not work and help little for the poor to eat better because the main problem was not calories, but other nutrients…... Nutrition is a conundrum in developing countries” https://www.bbc.com/news/world-asia-india-50048519.

Food fortification has the potential to provide unquestionable benefits in terms of human development, protection against acute and chronic disease, and economic growth. The price of inaction in this area is enormous. The scientific evidence is robust and consistent in showing the benefits of food fortification. However, the route from science to policy, and from policy to action is not straightforward.

In this Special Issue we hope to bring together papers dealing with the effects of food fortification on physical and mental health and on social and economic development. We hope to focus particularly on comparing the experiences of the countries that have implemented food fortification with those that have not. As a direct outcome of the Special Issue, we would like to have a “call to action” statement for countries following the recommendations with some concrete advice to national governments around how they can more effectively take advantage of this potentially powerful and relatively cheap intervention and addressing how fortification fits within other nutrition interventions. We hope that our authors will address many questions concerning the crucial role of food fortification on health, and that they will also work to elucidate the causes of implementation challenges and delays that plague the adoption of readily available food fortification strategies.

We welcome different types of manuscript submissions, including original research articles and up-to-date reviews. Potential topics may include, but are not limited to: associations between food fortification and anthropometric measures, cognitive development, communicable disease, chronic inflammation, quality of life, reproductive health, and economic impact.

Prof. Ganmaa Davaasambuu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • nutrition
  • health
  • food fortification
  • food fortification policy
  • food fortification implementation
  • call for action

Published Papers (6 papers)

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Research

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13 pages, 660 KiB  
Article
Prevalence and Determinants of Vitamin D Deficiency in 9595 Mongolian Schoolchildren: A Cross-Sectional Study
by Jorick Bater, Sabri Bromage, Tuyatsetseg Jambal, Enkhjargal Tsendjav, Enkhsaikhan Lkhagvasuren, Yanjmaa Jutmann, Adrian R. Martineau and Davaasambuu Ganmaa
Nutrients 2021, 13(11), 4175; https://doi.org/10.3390/nu13114175 - 21 Nov 2021
Cited by 5 | Viewed by 2909
Abstract
Population-based data relating to vitamin D status of children in Northeast Asia are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 9595 schoolchildren aged 6–13 years in Ulaanbaatar (UB), the capital city of Mongolia. [...] Read more.
Population-based data relating to vitamin D status of children in Northeast Asia are lacking. We conducted a cross-sectional study to determine the prevalence and determinants of vitamin D deficiency in 9595 schoolchildren aged 6–13 years in Ulaanbaatar (UB), the capital city of Mongolia. Risk factors for vitamin D deficiency were collected by questionnaire, and serum 25-hydroxyvitamin D (25[OH]D) concentrations were measured using an enzyme-linked fluorescent assay, standardized and categorized as deficient (25[OH]D <10 ng/mL) or not. Odds ratios for associations between independent variables and risk of vitamin D deficiency were calculated using multivariate analysis with adjustment for potential confounders. The prevalence of vitamins D deficiency was 40.6% (95% CI 39.7% to 41.6%). It was independently associated with female gender (adjusted odds ratio [aOR] for girls vs. boys 1.23, 95% CI 1.11–1.35), month of sampling (aORs for December–February vs. June–November 5.28 [4.53–6.15], March–May vs. June–November 14.85 [12.46–17.74]), lower levels of parental education (P for trend <0.001), lower frequency of egg consumption (P for trend <0.001), active tuberculosis (aOR 1.40 [1.03–1.94]), household smoking (aOR 1.13 [1.02 to1.25]), and shorter time outdoors (P for trend <0.001). We report a very high prevalence of vitamin D deficiency among Mongolian schoolchildren, which requires addressing as a public health priority. Full article
(This article belongs to the Special Issue The Benefits of Food Fortification)
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13 pages, 2233 KiB  
Article
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
by Svenja M. Jungjohann, Gulshan Ara, Catia Pedro, Valerie M. Friesen, Mansura Khanam, Tahmeed Ahmed, Lynnette M. Neufeld and Mduduzi N. N. Mbuya
Nutrients 2021, 13(3), 794; https://doi.org/10.3390/nu13030794 - 28 Feb 2021
Cited by 3 | Viewed by 2784
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue The Benefits of Food Fortification)
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14 pages, 899 KiB  
Article
The Potential Contribution of Fortified Maize Flour, Oil, Rice, Salt, and Wheat Flour to Estimated Average Requirements and Tolerable Upper Intake Levels for 15 Nutrients in 153 Countries
by Helena Pachón, Bethany Reynolds, Michelle Duong, Becky L. Tsang, Lana Childs, Corey L. Luthringer, Yunhee Kang, Florencia C. Vasta and Karen Codling
Nutrients 2021, 13(2), 579; https://doi.org/10.3390/nu13020579 - 9 Feb 2021
Cited by 7 | Viewed by 3655
Abstract
Food fortification is designed to improve the nutritional profile of diets. The purpose of this research was to estimate the potential nutrient contribution of fortified maize flour, oil, rice, salt, and wheat flour in 153 countries, using the national intake (or availability) of [...] Read more.
Food fortification is designed to improve the nutritional profile of diets. The purpose of this research was to estimate the potential nutrient contribution of fortified maize flour, oil, rice, salt, and wheat flour in 153 countries, using the national intake (or availability) of the food and the nutrient levels required for fortification. This was done under two scenarios—maximum, where 100% of the food is assumed to be industrially processed and fortified, and realistic, where the maximum value is adjusted based on the percent of the food that is industrially processed and fortified. Under the maximum scenario, the median Estimated Average Requirements (EARs) met ranged from 22–75% for 14 nutrients (vitamins A, B1, B2, B3, B6, B12, D, E, folic acid and calcium, fluoride, iron, selenium and zinc), and 338% for iodine. In the realistic scenario, the median EARs met were 181% for iodine and <35% for the other nutrients. In both scenarios, the median Tolerable Upper Intake Levels (ULs) met were <55% for all nutrients. Under the realistic scenario, no country exceeded 100% of the UL for any nutrient. Current fortification practices of the five foods of interest have the global potential to contribute up to 15 nutrients to the diets of people, with minimal risk of exceeding ULs. Full article
(This article belongs to the Special Issue The Benefits of Food Fortification)
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18 pages, 793 KiB  
Article
Got Mylk? The Emerging Role of Australian Plant-Based Milk Alternatives as A Cow’s Milk Substitute
by Yianna Y. Zhang, Jaimee Hughes and Sara Grafenauer
Nutrients 2020, 12(5), 1254; https://doi.org/10.3390/nu12051254 - 28 Apr 2020
Cited by 34 | Viewed by 12532
Abstract
Growing ethical, environmental and health concerns have encouraged demand for novel plant-based milk alternatives, yet it remains nebulous whether these products are nutritionally adequate as cow’s milk replacements. The aim of this study was to conduct a cross-sectional survey of plant-based milk alternatives [...] Read more.
Growing ethical, environmental and health concerns have encouraged demand for novel plant-based milk alternatives, yet it remains nebulous whether these products are nutritionally adequate as cow’s milk replacements. The aim of this study was to conduct a cross-sectional survey of plant-based milk alternatives available in major Australian supermarkets and selected niche food retailers from November 2019 to January 2020 and assess two dietary scenarios (adolescents and older women) where dairy serves were substituted for plant-based alternatives against Australian Estimated Average Requirements (EAR). We collected compositional data from nutrition panels in juxtaposition with derivatives from the Australian Food Composition database, with a total of 115 products, including tree nuts and seeds (n = 48), legumes (n = 27), coconut (n = 10), grains (n = 19) and mixed sources (n = 10). Just over 50% of products were fortified, but only 1/3 contained similar calcium content to cow’s milk. Indiscriminate substitutions might reduce intakes of protein and micronutrients, particularly vitamin A, B2, B12, iodine and zinc, and lead to reductions >50% of the EARs for protein, zinc and calcium in the chosen dietary scenarios. To avoid unintended dietary outcomes, it is vital that consumers make pragmatic decisions regarding dietary replacements for cow’s milk. Full article
(This article belongs to the Special Issue The Benefits of Food Fortification)
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Review

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12 pages, 633 KiB  
Review
Food Fortification: The Advantages, Disadvantages and Lessons from Sight and Life Programs
by Rebecca Olson, Breda Gavin-Smith, Chiara Ferraboschi and Klaus Kraemer
Nutrients 2021, 13(4), 1118; https://doi.org/10.3390/nu13041118 - 29 Mar 2021
Cited by 91 | Viewed by 19210
Abstract
Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social [...] Read more.
Deficiencies in one or more micronutrients such as iron, zinc, and vitamin A are widespread in low- and middle-income countries and compromise the physical and cognitive capacity of millions of people. Food fortification is a cost-effective strategy with demonstrated health, economic and social benefits. Despite ongoing debates globally and in some countries regarding the performance and safety of food fortification, the practice offers significant benefits across each of the main vehicles for food fortification (large-scale food fortification, biofortification and point-of-use or home fortification) ranging from reducing the prevalence of nutritional deficiencies and economic benefits to societies and economies. Using Sight and Life’s global and national experiences in implementing food fortification efforts, we demonstrate how different programs in LMICs have successfully addressed challenges with food fortification and in doing so, find that these efforts are most successful when partnerships are formed that include the public and private sector as well as other parties that can provide support in key areas such as advocacy, management, capacity building, implementation and regulatory monitoring. Full article
(This article belongs to the Special Issue The Benefits of Food Fortification)
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17 pages, 1629 KiB  
Review
Addressing the Fortification Quality Gap: A Proposed Way Forward
by Laura A. Rowe
Nutrients 2020, 12(12), 3899; https://doi.org/10.3390/nu12123899 - 20 Dec 2020
Cited by 7 | Viewed by 4455
Abstract
Large-scale food fortification is an effective, sustainable, and scalable intervention to address vitamin and mineral deficiencies, however, pressing gaps exist globally around ensuring the quality of fortified foods. This paper summarizes the global challenges and gaps faced in monitoring the quality of fortified [...] Read more.
Large-scale food fortification is an effective, sustainable, and scalable intervention to address vitamin and mineral deficiencies, however, pressing gaps exist globally around ensuring the quality of fortified foods. This paper summarizes the global challenges and gaps faced in monitoring the quality of fortified foods, the guidance produced in response to these challenges, where we are today in terms of effective implementation, and what approaches and opportunities may be usefully applied to enhance the quality of fortified foods moving forward. Full article
(This article belongs to the Special Issue The Benefits of Food Fortification)
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