Fortification contributed greatly to vitamin and mineral intakes in the United States, 1989-1991

The objective of this work was to quantify the contribution of fortification (defined here as adding nutrients beyond traditional enrichment standards) to dietary nutrient intakes in the United States. A list of fortified foods was developed that was relevant at the time of the analyses, and prefortification (naturally occurring) nutrients in the fortified foods were determined from industry-supplied data. Using dietary data from the 1989-1991 Continuing Survey of Food Intakes by Individuals (CSFII), intakes of nine nutrients were determined both as reported in the CSFII (i.e., postfortification) and also by using prefortification nutrient levels for the identified fortified foods. We report data for the total population age >/= 1 y based on respondents (n = 11,710) with 3 d of dietary data, as well as select age/gender subgroups. All data were weighted. Fortification substantially increased the intakes of all nutrients examined except calcium, in all age/gender groups but especially in children. In numerous cases, fortification was responsible for boosting median or 25th percentile intakes from below to above the RDA. The breakfast cereal category was responsible for nearly all the intake of nutrients from fortified foods, except vitamin C for which juice-type beverages made as great or a greater contribution. These data from 1989 to 1991 serve as a useful baseline with which to compare contributions of fortification as the practice expands. The large contribution of fortification even in 1989-1991 suggests that continued monitoring of fortification practices, using methods such as those presented here, is important.     

Assessing the Nutrient Adequacy in China’s Food Supply from 1965 to 2018

Nutritional intake has important impacts on human health. A sufficient supply of nutrients is required to ensure high-level nutrition in a population. Assessment of nutrient supply adequacy can help to develop evidence-based policies and thereby promote public health. This study estimates the supply adequacy of nutrients in China’s food system from 1965 to 2018 at the national level, aiming to reveal whether the supply of nutrients meets the demand. The results show that the nutrient supply in China’s food system has experienced a sharp increase in the past five decades, and the deficiency in nutrient supply has been greatly mitigated. Although most nutrients such as potassium are already sufficiently supplied in China’s current food system, some nutrients, especially calcium and zinc, still need a further enlarged supply to improve the nutrition condition of the Chinese population. Besides encouraging a healthy diet, supply-side regulation, e.g., fortification and enrichment, is also needed to improve nutrient availability. This study helps people better understand the development and current situation of nutrient adequacy in China’s food supply, thereby providing information and implications for policymakers.     

Fortified Foods Are Major Contributors to Nutrient Intakes in Diets of US Children and Adolescents

BackgroundEven in an era of obesity and dietary excess, numerous shortfall micronutrients have been identified in the diets of US children and adolescents. To help tailor strategies for meeting recommendations, it is important to know what foods contribute greatly to micronutrient intakes. Data are lacking on specific contributions made by added nutrients.ObjectiveOur aims were to examine the impact of fortification on nutrient adequacy and excess among US children and adolescents and to rank food sources of added nutrient intake and compare rankings with those based on total nutrient intake from foods.Design and statistical analysesData were from 7,250 respondents 2 to 18 years old in the National Health and Nutrition Examination Survey 2003-2006. Datasets were developed that distinguished nutrient sources: intrinsic nutrients in foods; added nutrients in foods; foods (intrinsic plus added nutrients); and total diet (foods plus supplements). The National Cancer Institute method was used to determine usual intakes of micronutrients by source. The impact of fortification on the percentages of children having intakes less than the Estimated Average Requirement and more than the Upper Tolerable Intake Level was assessed by comparing intakes from intrinsic nutrients to intakes from intrinsic plus added nutrients. Specific food sources of micronutrients were determined as sample-weighted mean intakes of total and added nutrients contributed from 56 food groupings. The percentage of intake from each grouping was determined separately for total and added nutrients.ResultsWithout added nutrients, a high percentage of all children/adolescents had inadequate intakes of numerous micronutrients, with the greatest inadequacy among older girls. Fortification reduced the percentage less than the Estimated Average Requirement for many, although not all, micronutrients without resulting in excessive intakes. Data demonstrated the powerful influence of fortification on food-source rankings.ConclusionsKnowledge about nutrient intakes and sources can help put dietary advice into a practical context. Continued monitoring of top food sources of nutrients and nutrient contributions from fortification will be important.     

Fortification of Foods with Vitamin D in India

Vitamin D deficiency is widely prevalent in India, despite abundant sunshine. Fortification of staple foods with vitamin D is a viable strategy to target an entire population. Vitamin D fortification programs implemented in the United States and Canada have improved the vitamin D status in these countries, but a significant proportion of the population is still vitamin D deficient. Before fortification programs are designed and implemented in India, it is necessary to study the efficacy of the American and Canadian vitamin D fortification programs and then improve upon them to suit the Indian scenario. This review explores potential strategies that could be used for the fortification of foods in the Indian context. These strategies have been proposed considering the diverse dietary practices necessitated by social, economic, cultural and religious practices and the diverse climatic conditions in India. Fortification of staple foods, such as chapati flour, maida, rice flour and rice, may be more viable strategies. Targeted fortification strategies to meet the special nutritional needs of children in India are discussed separately in a review entitled, “Fortification of foods with vitamin D in India: Strategies targeted at children”.     

The impact of folic acid fortification of enriched grains on an elderly population: the New Mexico Aging Process Study

Fortification of enriched grains with synthetic folic acid is a potential concern for the elderly population who is at higher risk for Vitamin B12 deficiency. Consuming excess amounts of naturally occurring folate or synthetic folic acid can precipitate a deficiency of Vitamin B12, resulting in neurological damage. The purpose of this study was to determine the increase in folate intake in an elderly population due to the fortification of enriched grains. Three-day diet records of 320 participants (average age 76.8 years) were evaluated for total folate intake from food and supplements before and after the fortification of enriched grains. There was a significant mean daily folate intake increase of 63.8 microg due to fortification (p < 0.0001), raising the intake of total folate to 359 microg (89.8% of RDA). Supplements containing folic acid were consumed by 66% of the participants, raising the average total folate intake of supplement users to 793 microg per day. Only 5 participants exceeded the UL of 1,000 microg folic acid per day, with all 5 of these individuals consuming more than 1,000 microg folic acid per day from supplements alone. Folic acid fortification of grains does not appear to have increased the risk of excess folic acid in this population.     

Vitamin D Deficiency in India: Prevalence,Causalities and Interventions

Vitamin D deficiency prevails in epidemic proportions all over the Indian subcontinent, with a prevalence of 70%–100% in the general population. In India, widely consumed food items such as dairy products are rarely fortified with vitamin D. Indian socioreligious and cultural practices do not facilitate adequate sun exposure, thereby negating potential benefits of plentiful sunshine. Consequently, subclinical vitamin D deficiency is highly prevalent in both urban and rural settings, and across all socioeconomic and geographic strata. Vitamin D deficiency is likely to play an important role in the very high prevalence of rickets, osteoporosis, cardiovascular diseases, diabetes, cancer and infections such as tuberculosis in India. Fortification of staple foods with vitamin D is the most viable population based strategy to achieve vitamin D sufficiency. Unfortunately, even in advanced countries like USA and Canada, food fortification strategies with vitamin D have been only partially effective and have largely failed to attain vitamin D sufficiency. This article reviews the status of vitamin D nutrition in the Indian subcontinent and also the underlying causes for this epidemic. Implementation of population based educational and interventional strategies to combat this scourge require recognition of vitamin D deficiency as a public health problem by the governing bodies so that healthcare funds can be allocated appropriately.     

Public health aspects of food fortification: a question of balance

Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O2 permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.     

New approaches for designing and evaluating food fortification programs

Historically, food fortification programs were often undertaken with little attention to issues such as micronutrient bioavailability, optimal levels of addition, or efficacy or to monitoring impact on nutritional status, health, and human function. Several developments in recent years have enabled substantial progress to be made in the design and evaluation of fortification programs. The methodology for estimating the prevalence of inadequate nutrient intakes in a population and tolerable upper intake levels has been established and can be used as the basis for estimating desirable amounts of nutrient addition. More attention is being paid to assessing the bioavailability of nutrients (especially minerals) using stable and radioactive isotopes, and bioavailability of iron compounds can be estimated from changes in total body iron calculated from the ratio of transferrin receptors to serum ferritin. Procedures for quality control of the fortification process have been established. New approaches to monitoring the impact of fortification over time include assessment of liver retinol stores using retinol isotope dilution. In summary, the design and evaluation of food fortification programs now requires a series of formative research procedures on the part of nutritionists, which were not often expected or conducted in the past.     

Fortification,supplementation, and nutrient balance

Efforts to combat nutrient deficiencies have centered on supplemental nutrient administration and addition of selected nutrients to the food chain in the form of food fortification. Over the past several decades, and as the association between diet and chronic diseases became apparent, supplementation and fortification were also targeted at healthy individuals, with the aim of reducing their risk of future diseases such as cardiovascular diseases, diabetes, and cancer. While supplementation strategies are playing a major role in reducing micronutrient deficiencies around the world, there is less compelling evidence for their role in reducing risk of chronic diseases in healthy individuals, perhaps with the exception of folic acid and reduction of neural tube defects. Nevertheless, with our increasing understanding of the genetic heterogeneity of human nutrient requirements, it is likely that certain groups or populations may clearly benefit from higher intakes of certain nutrients. In addition to supplementation or fortification with specific nutrients, the consumption of certain dietary patterns (such as the Mediterranean diet) is associated with a reduced risk of chronic diseases, particularly cardiovascular diseases.     

Recommendations for folate intake in women: implications for public health strategies

Folate deficiency has been associated with anemia and other adverse outcomes in pregnancy such as neural tube defects. The current recommendations for prevention of such outcomes are difficult to achieve through diet only, and folic acid supplementation and food fortification are feasible public health strategies. However, it is necessary to determine the usual diet and supplement use among women of reproductive age, including an accurate assessment of other dietary micronutrients. In addition to the beneficial effects observed in randomized clinical trials, health risks to the population have also been widely evaluated and discussed in the scientific community: for a minority to benefit from fortification programs, many are exposed to high folic acid intake levels.     

广东省城市居民食物和营养素摄入现状及变化趋势

目的 描述广东省城市居民食物消费及营养素摄入现状及变化趋势。方法 在广东省5个城市调查点选取3 154户7 421 人进行调查,膳食调查采用连续3 d 24 h回顾法,调味品消费量采用称重法。结果 广东省城市居民平均每标准人日粮谷类食物摄入量为240.1 g,蔬菜为302.1 g,水果为58.4 g,畜禽肉类为157.3 g,水产品类为50.4 g,蛋类及其制品为25.0 g,奶类及其制品为44.3 g,豆类及其制品为7.9 g,食用油摄入量为30.2 g,食盐为 7.6 g,酱及酱油为10.2 g;城市居民每标准人日能量平均摄入量为7 173.7 kJ,蛋白质为69.4 g,脂肪为74.4 g,碳水化合物为196.0 g,视黄醇当量为176.7 μg,核黄素为0.9 mg,硫胺素为0.9 mg,钙为415.5 mg;与1992年比较,能量、脂肪、蛋白质、碳水化合物摄入呈下降趋势。结论 广东省处于经济转型升级时期,城市居民食物消费及营养素摄入发生变化,需加强合理营养、平衡膳食的宣传教育。     

北京市50岁以上中老年人膳食营养状况调查

目的为了解北京市50岁及以上中老年人的膳食营养状况，对2002年“中国居民营养与健康状况调查”北京地区的结果进行分析。方法采用连续3d的称重法和24h回顾法，收集样本人群的食物消费种类及数量，获得个体每日食物和营养素的摄入量。结果北京市中老年人群的膳食以谷类为主，城郊区在膳食比例上存在差异。虽然人群的营养素平均摄入水平已接近或超过每日营养素供给量(RNI)，但个体之间存在较大差异。人群中仍有相当比例的个体能量、蛋白质、脂溶性维生素和B组维生素以及锌、钾等营养素的摄入达不到RNI。结论北京市中老年人群膳食结构仍欠合理；应增加维生索和矿物质丰富的蔬菜、水果和豆类制品的摄入；控制脂肪和钠的摄取；并需努力减少个体之间的差异。     

针对老年人群的中国膳食平衡指数尝试性调整与应用

目的建立适合中国老年人群的膳食平衡指数(DBI),为综合评价该人群的膳食质量提供评价工具,并初步验证其有效性。方法根据老年人的营养需要特点,调整2005年中国DBI的部分单项指标定义和计分取值而成,并利用建立的评分系统对177名住养老机构60岁以上老年人的3天膳食质量进行评价。结果该DBI评价系统总体上可反映绝大多数食物种类和营养成分摄入的实际状况,并可综合反映膳食中各营养素摄入不足、过量和不平衡状况的方向和程度。样本人群膳食总体摄入不足,性别、年龄和伙食费对膳食质量均有影响,影响该人群膳食质量的食物种类主要是奶类豆类、蔬菜水果、食用油和动物性食物。结论采用该针对老年人群的中国膳食平衡指数基本能反映老年人群的膳食质量,并能发现存在的主要问题。     

风险分析在食品强化管理中的应用

目的为完善我国食品强化政策法规,修订食品营养强化剂标准提供参考和依据。方法研究风险分析在国际及国外一些国家食品强化管理中的应用状况,按照风险分析的3个组成部分分别阐述食品强化管理中风险评估、风险管理和风险交流的特征及关键因素。结果营养素风险评估需同时考虑改善营养不足及防止营养过量,应根据营养素安全范围间距划分风险等级,进行分类管理。制定食品强化法规标准时,不应局限于针对单一营养素的评价,还要评估食品强化对膳食及疾病模式的影响。结论鉴于我国居民营养状况、膳食结构十分复杂,建议根据国情按照风险分析方法调整和完善食品强化政策和标准,指导食品工业界的研发,提高消费者的营养认知水平。     

Appropriate calcium fortification of the food supply presents a challenge

Fortification with calcium to increase dietary intakes of this mineral is currently under evaluation in Canada. To model the potential dietary consequences of food fortification, data from a large national survey of Canadians (n = 1543) were used. Food fortification scenarios were based on reference amounts for labeling requirements. Consumption of milk, cheese and other dairy products was associated with high calcium intakes, and there was a low prevalence of inadequacy in men < 50 y old; however, other age-sex groups had lower intakes. The aim of the fortification modeling was to determine which scenario would most effectively reduce the proportion of the population with low intakes of calcium while minimizing the proportion of individuals who exceeded the tolerable upper intake level (UL). Given the correlation between energy and calcium (r = 0.60, P < 0.01), it appeared that any fortification scenario sufficient to increase the mean intake for women to near the adequate intake led to 6-7% of the men having calcium intakes above the UL. The results suggest that fortification of widely consumed foods is not a realistic way to address the issue of low calcium intakes and illustrate the need for concern about the growing use of fortification practices.     

Enablers and Barriers of Zinc Fortification; Experience from 10 Low- and Middle-Income Countries with Mandatory Large-Scale Food Fortification

Adequate zinc nutrition is important for child growth, neurodevelopment, immune function, and normal pregnancy outcomes. Seventeen percent of the global population is estimated to be at risk for inadequate zinc intake. However, zinc is not included in the fortification standards of several low- and middle-income countries with mandatory fortification programs, despite data suggesting a zinc deficiency public health problem. To guide policy decisions, we investigated the factors enabling and impeding the inclusion of zinc as a fortificant by conducting in-depth interviews with 17 key informants from 10 countries. Findings revealed the decision to include zinc was influenced by guidance from international development partners and enabled by the assessment of zinc deficiency, mandatory regional food fortification standards which included zinc, the World Health Organization (WHO) guidelines for zinc fortification, and the low cost of zinc compound commonly used. Barriers included the absence of zinc from regional fortification standards, limited available data on the efficacy and effectiveness of zinc fortification, and the absence of national objectives related to the prevention of zinc deficiency. To promote zinc fortification there is a need to put the prevention of zinc deficiency higher on the international nutrition agenda and to promote large-scale food fortification as a key deficiency mitigation strategy.     

Regulatory frameworks for copper considering chronic exposures of the population

Copper is an essential nutrient that is toxic in excess. Copper intakes from a balanced diet appear to meet the needs of most healthy individuals, because overt deficiency and toxicity are rare. Some uncertainty, however, persists because of limitations in currently available biomarkers used to assess copper status and the paucity of data available to establish tolerable upper levels of intake. Current policies and regulations pertaining to food fortification, nutritional supplements, and drinking water appear to be effective in providing for adequate copper intakes in many populations, although high levels of exposure, through overzealous fortification, supplementation, or drinking water exposure, may be possible under some circumstances. Surveillance and monitoring programs to evaluate copper exposures of human populations should continue and should be refined as new biomarkers become available.     

Iodine and Iodine Deficiency: A Comprehensive Review of a Re-Emerging Issue

Iodine is a mineral nutrient essential for the regulation of a variety of key physiological functions including metabolism and brain development and function in children and adults. As such, iodine intake and status within populations is an area of concern and research focus. This paper will review recently published studies that focus on the re-emerging issue of iodine deficiency as a global concern and declining intake among populations in developed countries. Historically, the implementation of salt-iodization programs worldwide has reduced the incidence of iodine deficiency, but 30% of the world’s population is still at risk. Iodine nutrition is a growing issue within industrialized countries including the U.S. as a result of declining iodine intake, in part due to changing dietary patterns and food manufacturing practices. Few countries mandate universal salt iodization policies, and differing agriculture and industry practices and regulations among countries have resulted in inconsistencies in supplementation practices. In the U.S., in spite of salt-iodization policies, mild-to-moderate iodine deficiency is common and appears to be increasing. European countries with the highest incidence of deficiency lack iodization programs. Monitoring the iodine status of at-risk populations and, when appropriate, public health initiatives, appear to be warranted.     

Food group categories used in dietary analysis can misrepresent the amount and type of fat present in foods

Objective: To determine whether analysis of food intake data using different food group classification systems changes the apparent contribution of defined food groups to total daily fat intake. Design: Three food classification systems were used to assess dietary intake of male omnivore subjects from a food frequency questionnaire. Setting: RMIT University, Melbourne, Australia. Subjects: A total of 78 healthy men aged 20–55 years, divided by meat consumption into moderate meat‐eaters (n = 60) and high meat‐eaters (n = 18). Methods: Dietary intake data were collected as semi‐quantitative food frequency questionnaires and analysed using the NUTTAB 95 database. The contribution of food groups to nutrient intakes was determined using three food classification systems. Results: When red meat was grouped with meat, poultry and game products and dishes, ‘meat’ contributed 19.8% of total fat to a diet typical of an adult Australian man. When lean meat cuts were distinguished from meat products or dishes and fast foods, ‘red meat cuts’ provided only 4.3% of the total fat in this diet, whereas ‘fast foods’ provided 18.7%. Conclusions: Food classification systems have a profound impact on the apparent nutrient content of defined food groups, particularly the fat content attributed to meats. Less precise systems may result in provision of misleading dietary advice. Meats such as lean beef and lamb can be a valuable part of a healthy diet by providing important nutrients, especially iron, zinc and vitamin B12, but relatively little fat.     

海宁市农村居民膳食结构与营养素摄入情况分析

目的了解我市农村居民的膳食结构和制定与之相关的营养卫生政策。方法采用3日称重、24h膳食回顾和食物频率问卷相结合的膳食调查方法，由专业人员入户进行食品称重，问卷询问和记录。结果我市调查人群的膳食结构中存在着核黄素、钙、钾、镁、锌、硒、膳食纤维等营养素摄入量不足；钠等超过参考摄入量：蔬菜、水果、蛋、奶类和豆类的摄入偏低，油脂、盐等摄入过量等问题。结论应加强营养干预和膳食指南的健康教育，加快制定改善农村居民膳食结构和营养的相关政策，促进农村居民形成健康的饮食习惯，提高健康水平和生活质量。