Food Fortification in Today’s World

This article is the second in a series on food fortification. The first article, “Is Food Fortification Necessary? A Historical Perspective” can be accessed on www.foodinsight.org.

To keep up in today’s busy world, people are becoming master multi-taskers, and when it comes to keeping up with their daily nutritional needs, they expect their foods to multi-task as well.  According to the 2009 International Food Information Council (IFIC) Functional Foods/Foods for Health Consumer Trending Survey, the great majority of Americans believe that food provides benefits beyond basic nutrition and are interested in how certain foods or food components can improve or maintain their health.  Today, many people can identify a specific food and/or food component and its associated health benefit. 

Historically, food fortification, such as iodized salt or vitamin D-fortified milk, served as a public health measure to address population-wide nutrient deficiencies.  Now, there are also calcium- and vitamin D-fortified juices, breads fortified with omega-3 fatty acids, and vegetable oil spreads with plant sterols available for health-conscious consumers searching for foods with additional health benefits. These types of foods contain added nutrients and ingredients that may promote or support overall health and wellness in a variety of ways across many different body systems including heart, bone, digestive, eye, and brain health; weight management; and increased energy and immune health, among others.

Foods not only must meet consumer needs and preferences but also address nutrition, regulatory, safety, and technical constraints.  The European Food Safety Authority (EFSA), World Health Organization (WHO) and several countries, including the United States, United Kingdom, Australia, New Zealand, and Canada, follow similar guiding principles when it comes to their fortification policies.   

Fortifying Our World
Fortification and enrichment are terms used to describe the addition of nutrients to foods but are two separate concepts.  Enrichment refers to the restoration of nutrients lost during the handling, processing, or storage of foods, and levels are generally based on Food and Drug Administration (FDA) standards of identity.  Fortification refers to the voluntary addition of nutrients at levels beyond those naturally occurring in the food.

Globally, the decision to fortify products is left up to individual food manufacturers.  Voluntary fortification is a common practice in many countries.  Additionally, 50 countries including the United States, Canada, and Australia require mandatory fortification of certain staple foods with specific nutrient(s) to improve public health, such as the fortification of enriched flour with folic acid to reduce the risk of neural tube birth defects, and restrict the fortification of foods with certain nutrients such as vitamin D.

What Types of Foods Can Be Fortified?
The indiscriminate addition of nutrients to foods and the fortification of fresh produce; meat, poultry, or fish products; is not allowed by the U.S. government and fortification of unprocessed foods is prohibited in European countries.   This is meant to help consumers understand the nutritional value of foods from each food group.  Also fortification of some types of foods such as sugars and some snack foods (e.g., candies and carbonated beverages) is discouraged, so that consumers are not encouraged to choose fortified foods that are inconsistent with achieving dietary guidelines.

How Much is Too Much?
All food ingredients must be safe at the level of use and for the intended use.  In some cases the FDA has established maximum levels of certain ingredients while in other cases, the laws and regulations in the US allow for a manufacturer to make a determination of the safety of the ingredient for a specific intended use based on the views of experts qualified by scientific training to evaluate the safety of substances added to food. Chronic excessive intake of some nutrients above upper limits set by the Institute of Medicine may be harmful so fortification levels are set low to ensure a wide margin of safety. Baseline levels and population intakes are continuously monitored through the National Health and Nutrition Examination Survey, which is a national study that evaluates the nutrition status of Americans, and through other clinical, biochemical, and functional indicators. 

Will It Pass the Taste Test? 
Food has to taste good and be appealing to consumers, so fortification is often self limiting.   When high levels of nutrients are added, this may change the flavor and appearance.  For example, depending on the form of iron used, foods with added iron may taste metallic, turn brown, or spoil faster.  If it does not taste the same or better than the unfortified version, then the product is probably not going to succeed in the marketplace. No matter how healthful a food is, ultimately, taste is often a major influencing factor in food and beverage purchasing decisions

Fast-Forward to the Future
The 2005 Dietary Guidelines for Americans is based on the premise that nutrients should be consumed through foods first. However, it also states that there are instances where dietary supplements and fortified foods can help people achieve recommended intakes of certain nutrients. These instances may occur when certain nutrients are present in food in low amounts, when the form of a nutrient is not easily absorbed, or where fortification addresses a specific public health need. 
  
While we still await the release of the 2010 Dietary Guidelines for Americans, it has become clear that foods with added benefits are an option that may help some people meet their daily nutritional needs. The story on fortification will continue to evolve.  Further advances in science may pave the way for more opportunities through which fortified foods can benefit the population at-large as well as a more personalized approach to nutrition advice or new nutrient delivery systems. Maintaining a balanced diet from a variety of sources, with plenty of fruits, vegetables, whole grains, lean meat, and low-fat dairy products, and participating in physical activity on most days, will all remain key to living a healthful lifestyle.