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Fortification of Food for Value
  Addition : Prospects and
          Constraints
       Dr. Yousef Elshrek
• Wheat and maize flours and rice are
  most commonly fortified with iron, folic
  acid, and other B vitamins.
• Iron improves your capacity for
  physical activity and productivity.
• Iron also facilitates children’s physical
  and mental development and improves
  the health of pregnant women.
• When iron deficiency causes severe
  anemia, it contributes to maternal
  deaths.
• Folic acid (vitamin B9) is needed
                             for the health production of cells.
                           • It reduces the prevalence of
                             neural tube defects such as
                             spina bifida and anencephaly.
                           • These birth defects are
                             permanently disabling or fatal.
                           • Severe vitamin B9 deficiency
                             also leads to anemia.




Spina bifida. (A) Normal spine. (B) Spina bifida occulta. (C) Spina
bifida with meningocele. (D) Spina bifida with myelomeningocele.
Anencephaly
• Other vitamins and minerals frequently used in
  fortification and their role in health include:
• Niacin (vitamin B3) prevents the skin disease known
  as pellagra. from diarrhea
• Riboflavin   (vitamin      B 2)   helps with
  metabolism of fats, carbohydrates and
  proteins.
• Note: Riboflavin cannot be added to rice as
  the orange color is too bright and will
  change the color of fortified rice.
• Thiamin (vitamin B1) prevents the
  nervous system disease called beriberi.
• Vitamin B12 maintains functions of the
  brain and nervous system.
• Vitamin D helps bodies absorb calcium
  which improves bone health.
• Vitamin A deficiency is the leading cause of
  childhood blindness. It also diminishes an
  individual’s ability to fight infections.




   Severe vitamin A deficiency leads to
   progressive keratinization of the
   cornea of the eye
• Zinc helps children develop, strengthens
  immune systems and lessens complications
  from diarrhea.




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Will fortification harmful to our health?
• It is highly unlikely that anyone will get an
  excess amount of vitamins and minerals
  from fortified foods.
• Studies and research in countries with long
  histories of fortification have established
  overwhelming evidence of the protective
  effect of fortification.
• A study published in 2004 found that the
  “prevalence of excessive micronutrient
  intakes in current European diets is non-
  existent or extremely low, even for
  consumers choosing higher amounts of
  fortified foods.
• Diet-based models indicate that future
  increases in the proportion of foods
  fortified at levels between 10 and 50%
  RDA (recommended daily allowance)
  would not be expected to lead to
  excessive intakes for the majority of
  vitamins and minerals.”
• In the United States, most wheat flour
  and many breakfast cereals are fortified
  with folic acid.
• Also, vitamin supplements containing
  folic acid are widely available.
• Yet a population-based study found
  that less than 3% of U.S. adults
  exceeded the recommended upper
  level of folic acid.
• None reached that level by eating
  fortified foods; they only exceeded the
  level if they consumed high-dose
  supplements
Will fortification add to the cost
   of flour, noodles, bread, rice,?
• The ongoing cost to fortify wheat and maize flour with
  quality iron, zinc, folic acid and other B vitamins
  ranges from US $1.50 to US $3 per metric ton of flour.
• If the miller passes that cost to the consumer, it
  amounts to only pennies per pound of flour.
• Reports from different countries all say the cost is
  less than 50 cents per person per year.
• When Uzbekistan        launched a flour fortification
  program in 2005, the cost was 120 Sums (around 10
  US cents) per person, per year.
• The total cost of adding mandatory nutrients to flour
  in the USA is $0.07 per person per year.
• The retail cost of rice may increase 1-4% depending
  on the fortification method used.
Purpose of fortification
• All agricultural raw materials are processed
  before they can be used as foods..
• In processing stages,, some portion of the
  nutrients is destroyed (some Vitamin an trace
  elements)
• Enrichment – addition of specific nutrients
• to a food (FDA, 1943)..
• Restoration – Replacement of nutrients loss in
  processing foods..
• Supplementation : any foods or nutrients or a
  mixture of both used to improve the nutritive
  value..
• Nitrification: Addition of nutrients to the
  food at such level as to make major
  contribution to food..
• Addiction of specific nutrients (milk or flour
• Excess amount to be added..
• Selection of appropriate carrier for
  nutrients..
Objectives
• To maintain the nutritional quality of foods..
• Keeping nutrients levels adequate to correct or
  prevent specific nutritional deficiencies in the
  population or in groups at risk of certain
  deficiencies..
• To increase the added nutritional value of a
  product (commercial view).
• To provide certain technological functions in
  food processing.
Advantage of fortification
• Food fortification does not require people to
  change their eating habits thus it is socially
  acceptable..
• The effect of fortification is both fast and broad..
• Fortification does not affect organoleptic
  properties..
• Food fortification is the safest strategy as the
• added nutrient is provided in the diet is low but
• constant amounts..
• Way to deliver necessary amounts of
  micronutrients..
• Fortification is the most cost effective
  approach to prevent nutrient deficiencies.
• It can be introduced quickly through existing
  marketing and distribution system.
• Benefits of fortification are readily visible.
• Food fortification is sustainable as it is
  socially acceptable.
• In addition, fortification will reach secondly
• target risk groups, such as the elderly, the all
  and those who have an unbalanced diet.
Limitations of fortification
• A thorough knowledge of dietary habits and
  nutrient intake in the target group(s).
• A complementary educational programme is
  required particularly when the fortification
  influences organoleptic characteristics of the
  food.
• Food fortification is not the ultimate solution
  of a nutritional deficiency
Fortification programme design
• Identification of the target group.
• Identification of the nutrient to be added.
• Selection of foods to reach the vulnerable
  i.e. target group.
• Level of nutrient to be added.
• Execution of test protocol – laboratory
  testing, bioavailability and pilot trials.
Criteria for selecting the vehicle for
               food fortification
• Food fortification is appropriate when there is demonstrated
  need for increasing the intake of essential nutrients in one or
  more population groups.
• The fortified food must be consumed by a large section of the
  population, especially those at greatest risk of deficiency.
• Relatively little inter and intra individual variations occurs in the
  amount of the fortified food conserved.
• This will ensure that nutrient intakes remain within a safe range.
• The essential nutrient(s) should be present in amounts that are
  whether excessive nor insignificant, taking into account intake
  from other dietary sources.
• The essential nutrient(s) should be present
  in amounts that are whether excessive nor
  insignificant, taking into account intake
  from other dietary sources.
• The nutrient(s) added should not
  adversely affect the metabolism of any
  other nutrient.
• The nutrient's added should be sufficiently
  stable in the food under customary
  conditions of packaging storage,
  distribution and use.
• The nutrient(s) added should be
  physiologically available from the food.
• The nutrients added should not impart
  undesirable characteristics to the food and
  should not unduly shorten shelf life.
• The fortified food must be through central
  processing in which nutrients can be added
  under controlled conditions and minimum
  cost.
• The additional cost of the fortification
  should be reasonable for the consumers.
Fortification Technology
•   Dry mixing : for foods like cereal flours and their
•   products, powder milk, beverage powder etc.
•   Dissolution in water : for liquid milk, drinks, fruit
•   juices, bread, pastas, cookies.
•   Spraying : for corn flakes and other processed
•   foods requiring cooking or extrusion steps that
•   would destroy vitamin activity.
•   Dissolution in oil : for oily products such as
•   margarine.
• Addition : For sugar fortification vitamin
  A in powder form is absorbed on to the
  surface of the sugar crystals when used
  with a vegetable oil.
• Coating : For rice. The vitamins sprayed
  over the grains must be coated to avoid
  losses when the grains are washed
  before cooking.
• Pelleting : for rice. The vitamins are
  incorporated into pellets reconstituted
  from broken kernels.
Constraints

• Vitamin A
•   Moisture contents
•   Repeated heating
•   Hygroscopic foods
•   Status of individual
•   Dietary composition
• Iron
•   Food rich in phytate
•   Suitable technologies
•   Tannins present in chocolate breakfast drinks
•   Fat based foods,, salt and sugars
•   Low acid content of food
•   Long term risk for male than female
•   Iodine
•   Iodine stability
•   Periodic checking
•   Mandatory certificatiion
• Vitamins are very sensitive to external factors such
• as humidity,, heat,, oxygen,, pH,, light,, oxidizing
  and reducing agents..
• Some losses must therefore be expected during
  food processing and storage..
• A part from using a process that causes minimal
  losses and packaging material that gives maximum
  protection
• The food industry must add extra amounts of the
  vitamins to compensate for those losses and to
  ensure that the finished products has at least the
  amounts declared on the labella during its normal
  shelf life.
Situation of fortification in Qatar
             Qatar Grain Practices (metric tons)

             Domestic Grain            Grain        Flour        Flour
             Production Imports        Exports      Imports      Exports


Wheat        32           100487       23           37489        111


Maize        1270         18022        13           262          79


Rice                      100633       163          78           2

Source: Food and Agriculture Organization (FAO) of the United Nations
Fortification Status

                                        Number of
                           Available in
                                        Industrial   % produced
             Legislation   food supply
                                        mills (>20   in industrial
             Status        (grams/capit
                                        metric       mills
                           a/day)
                                        tons/day)

Wheat        Voluntary                  1            100

Maize

Rice

Source: FFI database
nutrients Added (parts per million)

             Type
                  Folic                  Vitam
        Iron of         Zinc      B12
                  Acid                   in A
             Iron

             Electr
Wheat 60            1.5
             olytic
Maize
Rice
Neural Tube Defects

       Neural tube defects per 10,000 births1

                                              12
      1Source:   Calculated from March of Dimes statistics, 21-March-2012



Note: This figure may not include pregnancy loss or
terminations of pregnancies due to pre-natal diagnosis of a
neural tube defect.
Countries that fortify flour with folic acid often report a
neural tube defect prevalence of less than 10 per 10,000
births.
indicators of Iron and Zinc Deficiency
% Anemia in                                 % Proportion of
non-pregnant          % Anemia in           population at
women of              pre-school            risk of
reproductive          children3             inadequate zinc
age2                                        intake4
                      26.2
2Source:  -
Note: Anemia can be caused by many things. Fortifying flour with iron
can reduce the risk of anemia caused by iron deficiency. The
classification of anemia as a public health problem, according to the
World Health Organization, is:
                     ≤4.9% No public health problem
                     5.0-19.9 Mild public health problem
                    20.0-39.9 Moderate public health problem
                    ≥40.0 Severe public health problem
3Source: -
 WHO, Worldwide Prevalence of Anemia, 1993-2005.
Country estimates of anemia prevalence in
preschool-age children. WHO global database on
anemia. Geneva, World Health Organization, 2008.
Note: Iron is essential for a child’s physical and
mental development. Pre-school children are
usually defined as ages 6-59 months.

4Source:  -
Note: Zinc is needed for optimal child health and
physical growth and normal pregnancy outcomes.
If the probability of inadequate zinc intake is
greater than 25 percent, it is considered an
elevated public health concern, according to the
World Health Organization

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Fortification of Foods for Improved Nutrition

  • 1. Fortification of Food for Value Addition : Prospects and Constraints Dr. Yousef Elshrek
  • 2. • Wheat and maize flours and rice are most commonly fortified with iron, folic acid, and other B vitamins. • Iron improves your capacity for physical activity and productivity. • Iron also facilitates children’s physical and mental development and improves the health of pregnant women. • When iron deficiency causes severe anemia, it contributes to maternal deaths.
  • 3. • Folic acid (vitamin B9) is needed for the health production of cells. • It reduces the prevalence of neural tube defects such as spina bifida and anencephaly. • These birth defects are permanently disabling or fatal. • Severe vitamin B9 deficiency also leads to anemia. Spina bifida. (A) Normal spine. (B) Spina bifida occulta. (C) Spina bifida with meningocele. (D) Spina bifida with myelomeningocele.
  • 5. • Other vitamins and minerals frequently used in fortification and their role in health include: • Niacin (vitamin B3) prevents the skin disease known as pellagra. from diarrhea
  • 6. • Riboflavin (vitamin B 2) helps with metabolism of fats, carbohydrates and proteins. • Note: Riboflavin cannot be added to rice as the orange color is too bright and will change the color of fortified rice.
  • 7. • Thiamin (vitamin B1) prevents the nervous system disease called beriberi.
  • 8. • Vitamin B12 maintains functions of the brain and nervous system.
  • 9. • Vitamin D helps bodies absorb calcium which improves bone health.
  • 10. • Vitamin A deficiency is the leading cause of childhood blindness. It also diminishes an individual’s ability to fight infections. Severe vitamin A deficiency leads to progressive keratinization of the cornea of the eye
  • 11. • Zinc helps children develop, strengthens immune systems and lessens complications from diarrhea. Oysters may be renowned for boosting the sex drive, but these slimy molluscs are also ideal if you're looking to improve your immune system. Oysters are crammed with zinc, which can really enhance your immunity by helping white blood cells reproduce more quickly. Zinc also strengthens antibodies, making them more efficient at warding off infectio
  • 12. Will fortification harmful to our health? • It is highly unlikely that anyone will get an excess amount of vitamins and minerals from fortified foods. • Studies and research in countries with long histories of fortification have established overwhelming evidence of the protective effect of fortification. • A study published in 2004 found that the “prevalence of excessive micronutrient intakes in current European diets is non- existent or extremely low, even for consumers choosing higher amounts of fortified foods.
  • 13. • Diet-based models indicate that future increases in the proportion of foods fortified at levels between 10 and 50% RDA (recommended daily allowance) would not be expected to lead to excessive intakes for the majority of vitamins and minerals.” • In the United States, most wheat flour and many breakfast cereals are fortified with folic acid.
  • 14. • Also, vitamin supplements containing folic acid are widely available. • Yet a population-based study found that less than 3% of U.S. adults exceeded the recommended upper level of folic acid. • None reached that level by eating fortified foods; they only exceeded the level if they consumed high-dose supplements
  • 15. Will fortification add to the cost of flour, noodles, bread, rice,? • The ongoing cost to fortify wheat and maize flour with quality iron, zinc, folic acid and other B vitamins ranges from US $1.50 to US $3 per metric ton of flour. • If the miller passes that cost to the consumer, it amounts to only pennies per pound of flour. • Reports from different countries all say the cost is less than 50 cents per person per year. • When Uzbekistan launched a flour fortification program in 2005, the cost was 120 Sums (around 10 US cents) per person, per year. • The total cost of adding mandatory nutrients to flour in the USA is $0.07 per person per year. • The retail cost of rice may increase 1-4% depending on the fortification method used.
  • 16. Purpose of fortification • All agricultural raw materials are processed before they can be used as foods.. • In processing stages,, some portion of the nutrients is destroyed (some Vitamin an trace elements) • Enrichment – addition of specific nutrients • to a food (FDA, 1943).. • Restoration – Replacement of nutrients loss in processing foods..
  • 17. • Supplementation : any foods or nutrients or a mixture of both used to improve the nutritive value.. • Nitrification: Addition of nutrients to the food at such level as to make major contribution to food.. • Addiction of specific nutrients (milk or flour • Excess amount to be added.. • Selection of appropriate carrier for nutrients..
  • 18. Objectives • To maintain the nutritional quality of foods.. • Keeping nutrients levels adequate to correct or prevent specific nutritional deficiencies in the population or in groups at risk of certain deficiencies.. • To increase the added nutritional value of a product (commercial view). • To provide certain technological functions in food processing.
  • 19. Advantage of fortification • Food fortification does not require people to change their eating habits thus it is socially acceptable.. • The effect of fortification is both fast and broad.. • Fortification does not affect organoleptic properties.. • Food fortification is the safest strategy as the • added nutrient is provided in the diet is low but • constant amounts.. • Way to deliver necessary amounts of micronutrients..
  • 20. • Fortification is the most cost effective approach to prevent nutrient deficiencies. • It can be introduced quickly through existing marketing and distribution system. • Benefits of fortification are readily visible. • Food fortification is sustainable as it is socially acceptable. • In addition, fortification will reach secondly • target risk groups, such as the elderly, the all and those who have an unbalanced diet.
  • 21. Limitations of fortification • A thorough knowledge of dietary habits and nutrient intake in the target group(s). • A complementary educational programme is required particularly when the fortification influences organoleptic characteristics of the food. • Food fortification is not the ultimate solution of a nutritional deficiency
  • 22. Fortification programme design • Identification of the target group. • Identification of the nutrient to be added. • Selection of foods to reach the vulnerable i.e. target group. • Level of nutrient to be added. • Execution of test protocol – laboratory testing, bioavailability and pilot trials.
  • 23. Criteria for selecting the vehicle for food fortification • Food fortification is appropriate when there is demonstrated need for increasing the intake of essential nutrients in one or more population groups. • The fortified food must be consumed by a large section of the population, especially those at greatest risk of deficiency. • Relatively little inter and intra individual variations occurs in the amount of the fortified food conserved. • This will ensure that nutrient intakes remain within a safe range. • The essential nutrient(s) should be present in amounts that are whether excessive nor insignificant, taking into account intake from other dietary sources.
  • 24. • The essential nutrient(s) should be present in amounts that are whether excessive nor insignificant, taking into account intake from other dietary sources. • The nutrient(s) added should not adversely affect the metabolism of any other nutrient. • The nutrient's added should be sufficiently stable in the food under customary conditions of packaging storage, distribution and use.
  • 25. • The nutrient(s) added should be physiologically available from the food. • The nutrients added should not impart undesirable characteristics to the food and should not unduly shorten shelf life. • The fortified food must be through central processing in which nutrients can be added under controlled conditions and minimum cost. • The additional cost of the fortification should be reasonable for the consumers.
  • 26. Fortification Technology • Dry mixing : for foods like cereal flours and their • products, powder milk, beverage powder etc. • Dissolution in water : for liquid milk, drinks, fruit • juices, bread, pastas, cookies. • Spraying : for corn flakes and other processed • foods requiring cooking or extrusion steps that • would destroy vitamin activity. • Dissolution in oil : for oily products such as • margarine.
  • 27. • Addition : For sugar fortification vitamin A in powder form is absorbed on to the surface of the sugar crystals when used with a vegetable oil. • Coating : For rice. The vitamins sprayed over the grains must be coated to avoid losses when the grains are washed before cooking. • Pelleting : for rice. The vitamins are incorporated into pellets reconstituted from broken kernels.
  • 28. Constraints • Vitamin A • Moisture contents • Repeated heating • Hygroscopic foods • Status of individual • Dietary composition
  • 29. • Iron • Food rich in phytate • Suitable technologies • Tannins present in chocolate breakfast drinks • Fat based foods,, salt and sugars • Low acid content of food • Long term risk for male than female • Iodine • Iodine stability • Periodic checking • Mandatory certificatiion
  • 30. • Vitamins are very sensitive to external factors such • as humidity,, heat,, oxygen,, pH,, light,, oxidizing and reducing agents.. • Some losses must therefore be expected during food processing and storage.. • A part from using a process that causes minimal losses and packaging material that gives maximum protection • The food industry must add extra amounts of the vitamins to compensate for those losses and to ensure that the finished products has at least the amounts declared on the labella during its normal shelf life.
  • 31. Situation of fortification in Qatar Qatar Grain Practices (metric tons) Domestic Grain Grain Flour Flour Production Imports Exports Imports Exports Wheat 32 100487 23 37489 111 Maize 1270 18022 13 262 79 Rice 100633 163 78 2 Source: Food and Agriculture Organization (FAO) of the United Nations
  • 32. Fortification Status Number of Available in Industrial % produced Legislation food supply mills (>20 in industrial Status (grams/capit metric mills a/day) tons/day) Wheat Voluntary 1 100 Maize Rice Source: FFI database
  • 33. nutrients Added (parts per million) Type Folic Vitam Iron of Zinc B12 Acid in A Iron Electr Wheat 60 1.5 olytic Maize Rice
  • 34. Neural Tube Defects Neural tube defects per 10,000 births1 12 1Source: Calculated from March of Dimes statistics, 21-March-2012 Note: This figure may not include pregnancy loss or terminations of pregnancies due to pre-natal diagnosis of a neural tube defect. Countries that fortify flour with folic acid often report a neural tube defect prevalence of less than 10 per 10,000 births.
  • 35. indicators of Iron and Zinc Deficiency % Anemia in % Proportion of non-pregnant % Anemia in population at women of pre-school risk of reproductive children3 inadequate zinc age2 intake4 26.2 2Source: - Note: Anemia can be caused by many things. Fortifying flour with iron can reduce the risk of anemia caused by iron deficiency. The classification of anemia as a public health problem, according to the World Health Organization, is: ≤4.9% No public health problem 5.0-19.9 Mild public health problem 20.0-39.9 Moderate public health problem ≥40.0 Severe public health problem
  • 36. 3Source: - WHO, Worldwide Prevalence of Anemia, 1993-2005. Country estimates of anemia prevalence in preschool-age children. WHO global database on anemia. Geneva, World Health Organization, 2008. Note: Iron is essential for a child’s physical and mental development. Pre-school children are usually defined as ages 6-59 months. 4Source: - Note: Zinc is needed for optimal child health and physical growth and normal pregnancy outcomes. If the probability of inadequate zinc intake is greater than 25 percent, it is considered an elevated public health concern, according to the World Health Organization