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Food Fortification: Traditional and New Strategies to Combat Micronutrient Deficiencies

A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (1 June 2019) | Viewed by 37929

Special Issue Editors

Department of Food Science and Human Nutrition, University of Florida, Gainesville, FL 32611-0370, USA
Interests: food science and human nutrition; malnutrition; micronutrients deficiencies; global nutrition; iron deficiency anemia; vitamin A deficiency; protein deficiency; soy and dairy products; essential oils; antioxidants; intervention programs to address undernutrition; encapsulation technologies
Department of Food Science and Human Nutrition, Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA

Special Issue Information

Dear Colleagues,

Food fortification has been a nutrition-specific strategy heralded for its cost-effectiveness, reach, and feasibility to address nutrient gaps for vulnerable populations worldwide. It has evolved from the addition of micronutrients to staple foods to ameliorate deficiencies of public health importance to the addition of macronutrients and bioactive substances to reach optimal physical and mental performance. In general, food fortification can take several forms, such as mandatory mass fortification targeted at the whole population and market-driven voluntary fortification of foods aimed at satisfying consumer demand for specific population groups. Mass fortification has resulted in the eradication of old foes such as pellagra, scurvy, goiter and rickets in several countries, especially those with affluent economies. Nevertheless, the sequelae of some macro- and micronutrient deficiencies, such as lack of quality protein, iron, vitamin A, iodine and zinc are still present among people living in low- and middle-income countries (LMICs). Barriers to fortification in LMICs abound and can be invariably associated with poorly chosen ingredients and food vehicles, poorly designed programs, and limited advocacy, implementation, monitoring and evaluation of national fortification strategies. In the hope of reaching the Sustainable Development Goals by 2030, food fortification must be at the front and center of our development agenda.

This Special Issue invites original research and review articles describing clinical trials, epidemiological studies, and experiments conducted in cell, animal models or humans that examine potential barriers and solutions for effective and safe food fortification. Potential topics include, but are not limited to the following:

  • Technologies/processes aimed at the addition of vitamins and minerals, essential fatty acids, amino acids, phytochemicals and bioactives substances, probiotics/prebiotics and enzymes into foods
  • Application of micro and nanotechnologies for the encapsulation of nutrients
  • Sensory evaluations of fortified products
  • Efficacy of new methods for fortification
  • Efficacy of mainstream fortification strategies
  • New fortification strategies such as those of fortifying condiments and spices.
  • Biofortification of crops, their consumption, and efficacy
  • Technologies and processes aimed at enhancing the stability of nutrients in foods during storage and preparation
  • Technologies/processes to assert the quality of fortified foods
  • Policies and regulations aimed at promoting awareness of fortified food, establishing and strengthening food fortification programs, and at monitoring and evaluating the safety and quality of fortified foods

Dr. Juan E. Andrade
Dr. Luis A. Mejia
Guest Editors

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Published Papers (7 papers)

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Research

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14 pages, 1949 KiB  
Article
Stakeholder’s Perceptions of Mexico’s Federal Corn Flour Fortification Program: A Qualitative Study
by Anna W. Waller, Astrid Dominguez-Uscanga, Emely Lopez Barrera, Juan E. Andrade and Jeanette M. Andrade
Nutrients 2020, 12(2), 433; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12020433 - 08 Feb 2020
Viewed by 3170
Abstract
Background: In Mexico, the fortification of corn and wheat flours with iron, zinc, and folic acid and the restoration of B-vitamins is a mandatory program. However, the monitoring and evaluation (M&E) of this fortification process is not well understood. Thus, the purpose of [...] Read more.
Background: In Mexico, the fortification of corn and wheat flours with iron, zinc, and folic acid and the restoration of B-vitamins is a mandatory program. However, the monitoring and evaluation (M&E) of this fortification process is not well understood. Thus, the purpose of the study was to understand the M&E of the food fortification program in Mexico, with an emphasis on technology research and development. Methods: Open-ended exploratory interviews were conducted with food technology representatives (n = 9), food science academic faculty (n = 1), president of a private tortilla-making federation (n = 1), and representatives of the federal monitoring agency (n = 2). Interviews were transcribed and themes were identified using the content analysis methodology. Inter-rater reliability was assessed by calculating an intraclass correlation coefficient (ICC) between the raters (n = 3). Results: A total of 49 codes were identified that resulted in three overarching themes, manufacturing/processing, monitoring logistics, and nutrition. Overall, there is a need for more robust internal and external M&E with Mexico’s fortification program to improve the manufacturing/processing of fortifying the tortillas, the monitoring of this fortification program, and the impact the fortified tortillas have on the nutritional status of the Mexican population. The overall ICC was 0.87. Conclusions: The present study can be used to gain insight into Mexico’s fortification program and to inform food fortification policymakers of best practices. Full article
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14 pages, 1745 KiB  
Article
Development of a Paper-Based Sensor Compatible with a Mobile Phone for the Detection of Common Iron Formulas Used in Fortified Foods within Resource-Limited Settings
by Anna W. Waller, Marco Toc, Dylan J. Rigsby, Marcela Gaytán-Martínez and Juan E. Andrade
Nutrients 2019, 11(7), 1673; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071673 - 21 Jul 2019
Cited by 17 | Viewed by 6210
Abstract
A lack of quality control tools limits the enforcement of fortification policies. In alignment with the World Health Organization’s ASSURED criteria (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverable), a paper-based assay that interfaces with a smartphone application for the quantification [...] Read more.
A lack of quality control tools limits the enforcement of fortification policies. In alignment with the World Health Organization’s ASSURED criteria (affordable, sensitive, specific, user-friendly, rapid and robust, equipment-free, and deliverable), a paper-based assay that interfaces with a smartphone application for the quantification of iron fortificants is presented. The assay is based on the Ferrozine colorimetric method. The reaction started after deposition of the 5 µL aqueous sample and drying. After developing color, pixel intensity values were obtained using a smartphone camera and image processing software or a mobile application, Nu3px. From these values, the actual iron concentration from ferrous sulfate and ferrous fumarate was calculated. The limits of detection, quantification, linearity, range, and errors (systematic and random) were ascertained. The paper-based values from real samples (wheat flour, nixtamalized corn flour, and infant formula) were compared against atomic emission spectroscopy. The comparison of several concentrations of atomic iron between the spectrophotometric and paper-based assays showed a strong positive linear correlation (y = 47.01x + 126.18; R2 = 0.9932). The dynamic range (5.0–100 µg/mL) and limit of detection (3.691 µg/mL) of the paper-based assay are relevant for fortified food matrices. Random and systematic errors were 15.9% and + 8.65 µg/g food, respectively. The concept can be applied to limited-resource settings to measure iron in fortified foods. Full article
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14 pages, 2401 KiB  
Article
Iodine Biofortification of Four Brassica Genotypes is Effective Already at Low Rates of Potassium Iodate
by Maria Gonnella, Massimiliano Renna, Massimiliano D’Imperio, Pietro Santamaria and Francesco Serio
Nutrients 2019, 11(2), 451; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11020451 - 21 Feb 2019
Cited by 38 | Viewed by 4363
Abstract
The use of iodine-biofortified vegetables may be a health alternative instead of iodine-biofortified salt for preventing iodine (I) deficiency and related human disorders. In this study, four Brassica genotypes (broccoli raab, curly kale, mizuna, red mustard) were hydroponically grown with three I-IO3 [...] Read more.
The use of iodine-biofortified vegetables may be a health alternative instead of iodine-biofortified salt for preventing iodine (I) deficiency and related human disorders. In this study, four Brassica genotypes (broccoli raab, curly kale, mizuna, red mustard) were hydroponically grown with three I-IO3 rates (0, 0.75 and 1.5 mg/L) to produce iodine-biofortified vegetables. Crop performances and quality traits were analyzed; iodine content was measured on raw, boiled, and steamed vegetables. The highest I rate generally increased I content in all Brassica genotypes, without plants toxicity effects in terms of reduced growth or morphological symptoms. After 21 day-iodine biofortification, the highest I content (49.5 µg/100 g Fresh Weight (FW)) was reached in broccoli raab shoots, while after 43 day-iodine biofortification, genotype differences were flattened and the highest I content (66 µg/100 g FW, on average) was obtained using 1.5 mg I-IO3/L. Nitrate content (ranging from 1800 to 4575 mg/kg FW) was generally higher with 0.75 mg I-IO3/L, although it depended on genotypes. Generally, boiling reduced iodine content, while steaming increased or left it unchanged, depending on genotypes. Applying low levels of I proved to be suitable, since it could contribute to the partial intake of the recommended dose of 150 µg/day: A serving size of 100 g may supply on average 24% of the recommended dose. Cooking method should be chosen in order to preserve and/or enhance the final I amount. Full article
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13 pages, 256 KiB  
Article
Awareness and Attitudes Regarding Industrial Food Fortification in Mongolia and Harbin
by Sabri Bromage, Enkhmaa Gonchigsumlaa, Margaret Traeger, Bayarbat Magsar, Qifan Wang, Jorick Bater, Hewei Li and Davaasambuu Ganmaa
Nutrients 2019, 11(1), 201; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010201 - 19 Jan 2019
Cited by 9 | Viewed by 5628
Abstract
This study assessed awareness and attitudes regarding industrial food fortification among adults in urban and rural Mongolia, and the city of Harbin, China. Between 2014 and 2017, surveys were collected from healthy men and women aged ≥18 years (182 Harbin residents and 129 [...] Read more.
This study assessed awareness and attitudes regarding industrial food fortification among adults in urban and rural Mongolia, and the city of Harbin, China. Between 2014 and 2017, surveys were collected from healthy men and women aged ≥18 years (182 Harbin residents and 129 urban and rural Mongolians participating in a nationwide nutrition survey in Mongolia). Survey reproducibility was assessed among 69 Mongolian participants to whom it was administered twice (summer and winter). Findings revealed that only 19% of rural and 30% of urban Mongolians, and 48% of Harbin residents were aware that industrial fortification is practiced in their countries. For most food groups evaluated, at least half of Mongolians and less than half of Harbin residents thought fortification was government-mandated (only the addition of iodine with salt is actually mandated in both countries). Fifty-five percent of rural and urban Mongolians favored mandatory fortification of foods, 14% disapproved of it, and 31% were uncertain (compared with 25%, 38%, and 37% respectively in Harbin). Upon learning that the primary purpose of adding vitamin D to milk is to prevent rickets, 75% of Mongolians but only 18% of Harbin residents favored mandatory fortification, while 42% of Harbin residents favored voluntary fortification (compared with <10% of Mongolians). In conclusion, in Mongolia and Harbin, awareness and understanding of food fortification is low, as is receptivity toward mandatory fortification. Health promotion and social marketing should be designed to create an enabling environment for increasing supply and demand of fortified foods, in support of upcoming program implementation in Mongolia and potential future legislation in northeern China. Full article
13 pages, 2829 KiB  
Article
Stabilization of Vitamin D in Pea Protein Isolate Nanoemulsions Increases Its Bioefficacy in Rats
by Ali M. Almajwal, Mahmoud M. A. Abulmeaty, Hao Feng, Nawaf W. Alruwaili, Astrid Dominguez-Uscanga, Juan E. Andrade, Suhail Razak and Mohamed F. ElSadek
Nutrients 2019, 11(1), 75; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11010075 - 02 Jan 2019
Cited by 20 | Viewed by 4960
Abstract
Micronutrient delivery formulations based on nanoemulsions can enhance the absorption of nutrients and bioactives, and thus, are of great potential for food fortification and supplementation strategies. The aim was to evaluate the bioefficacy of vitamin D (VitD) encapsulated in nanoemulsions developed by sonication [...] Read more.
Micronutrient delivery formulations based on nanoemulsions can enhance the absorption of nutrients and bioactives, and thus, are of great potential for food fortification and supplementation strategies. The aim was to evaluate the bioefficacy of vitamin D (VitD) encapsulated in nanoemulsions developed by sonication and pH-shifting of pea protein isolate (PPI) in restoring VitD status in VitD-deficient rats. Weaned male albino rats (n = 35) were fed either normal diet AIN-93G (VitD 1000 IU/kg) (control group; n = 7) or a VitD-deficient diet (<50 IU/kg) for six weeks (VitD-deficient group; n = 28). VitD-deficient rats were divided into four subgroups (n = 7/group). Nano-VitD and Oil-VitD groups received a dose of VitD (81 µg) dispersed in either PPI-nanoemulsions or in canola oil, respectively, every other day for one week. Their control groups, Nano-control and Oil-control, received the respective delivery vehicles without VitD. Serum 25-hydroxyvitamin D [25(OH)VitD], parathyroid hormone (PTH), Ca, P, and alkaline phosphatase (ALP) activity were measured. After one week of treatment, the VitD-deficient rats consuming Nano-VitD recovered from Vitamin D deficiency (VDD) as compared against baseline and had serum 25(OH)VitD higher than the Nano-control. Enhancement in VitD status was followed with expected changes in serum PTH, Ca, P, and ALP levels, as compared against the controls. Stabilization of VitD within PPI-based nanoemulsions enhances its absorption and restores its status and biomarkers of bone resorption in VitD-deficient rats. Full article
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Review

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25 pages, 1662 KiB  
Review
Performance Factors Influencing Efficacy and Effectiveness of Iron Fortification Programs of Condiments for Improving Anemia Prevalence and Iron Status in Populations: A Systematic Review
by Anna W. Waller, Juan E. Andrade and Luis A. Mejia
Nutrients 2020, 12(2), 275; https://0-doi-org.brum.beds.ac.uk/10.3390/nu12020275 - 21 Jan 2020
Cited by 11 | Viewed by 3719
Abstract
Iron fortification of staple foods is a common practice around the world to reduce the prevalence of iron-deficiency anemia. More recently, fortified condiments, including salts, sauces, and powders, have been tested in various efficacy trials. However, there is limited information on how nutritional, [...] Read more.
Iron fortification of staple foods is a common practice around the world to reduce the prevalence of iron-deficiency anemia. More recently, fortified condiments, including salts, sauces, and powders, have been tested in various efficacy trials. However, there is limited information on how nutritional, environmental, and experimental factors affect their efficacy and effectiveness. The purpose of the present work was to systematically review performance factors affecting the efficacy of condiment fortification trials. Three databases were searched using a standardized keyword search and included based on four-point inclusion criteria. Studies were evaluated against a quality assessment tool and effect sizes were calculated. Studies were ranked as low or high performing, based on whether or not they significantly improved iron-deficiency outcomes (hemoglobin, anemia prevalence, and ferritin levels). Of the 955 retrieved studies, 23 were included—of which, nine performed poorly, eight performed highly, and six were classified as neither because they did not meet the criteria of assessing the three iron outcomes. Results showed that unsuccessful trials did not consider environmental factors such as parasitic infections, nutritional factors such as micronutrient deficiencies other than iron, consumer acceptability of the product or experimental factors such as monitoring and adherence to the trials. Two common performing factors identified among those studies performing highly vs. those that did not were the control of sensory changes and monitoring of consumption compliance (i.e., dose delivery). The present work can be used as decision-making support for nutrition policy makers when determining the appropriate implementation of condiment fortification programs. Full article
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27 pages, 1816 KiB  
Review
Which Choice of Delivery Model(s) Works Best to Deliver Fortified Foods?
by Baqir Lalani, Aurélie Bechoff and Ben Bennett
Nutrients 2019, 11(7), 1594; https://0-doi-org.brum.beds.ac.uk/10.3390/nu11071594 - 14 Jul 2019
Cited by 20 | Viewed by 7696
Abstract
Micronutrient deficiencies (MNDs) occur as a result of insufficient intake of minerals and vitamins that are critical for body growth, physical/mental development, and activity. These deficiencies are particularly prevalent in lower-and middle-income countries (LMICs), falling disproportionately on the poorest and most vulnerable segments [...] Read more.
Micronutrient deficiencies (MNDs) occur as a result of insufficient intake of minerals and vitamins that are critical for body growth, physical/mental development, and activity. These deficiencies are particularly prevalent in lower-and middle-income countries (LMICs), falling disproportionately on the poorest and most vulnerable segments of the society. Dietary diversity is considered the most effective method in reducing this deficiency but is often a major constraint as most foods rich in micronutrients are also expensive and thereby inaccessible to poorer members of society. In recent years, affordable commodities such as staple foods (e.g., cereals, roots, and tubers) and condiments (e.g., salt and oil) have been targeted as “vehicles” for fortification and biofortification. Despite efforts by many countries to support such initiatives, there have been mixed experiences with delivery and coverage. An important but little understood driver of success and failure for food fortification has been the range of business models and approaches adopted to promote uptake. This review examines the different models used in the delivery of fortified food including complementary foods and biofortified crops. Using a keyword search and pearl growing techniques, the review located 11,897 texts of which 106 were considered relevant. Evidence was found of a range of business forms and models that attempt to optimise uptake, use, and impact of food fortification which are specific to the ‘food vehicle’ and environment. We characterise the current business models and business parameters that drive successful food fortification and we propose an initial structure for understanding different fortification business cases that will offer assistance to future designers and implementors of food fortification programmes. Full article
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