Fortification review highlights overwhelming benefits
effective methods to improve health and prevent nutritional
deficiencies, say researchers in a new study, which reviews
fortification programmes carried out in the US. However yesterday's
report on vitamin A, and its link to higher risk of fractures in
the elderly suggests, that some caution may be required in
fortifying foods for public consumption.
Food fortification with vitamins and minerals is one of the most effective methods to improve health and prevent nutritional deficiencies, say researchers in a new study.
Fortification is greatly responsible for the virtual eradication of disease such as goiter, rickets, beriberi, and pellagra in the United States, say researchers from the Johns Hopkins Bloomberg School of Public Health, who suggest that developing nations could implement successful food fortification programmes by requiring fortified foods for their military personnel.
Their conclusions are based on a detailed review of the history of food fortification programs in the US, published in the 22 January 2003 edition of Economic Development and Cultural Change.
"Food fortification in the US was accomplished with a great deal of co-operation between the food industry and public forces. Historically, food producers have been eager to supply fortified food once it was proven it could be profitable," said Dr David Bishai, co-author of the review and assistant professor of population and family health sciences at the Johns Hopkins Bloomberg School of Public Health.
"Many of the industrial and market forces in the US do not apply to developing nations, but our research shows that governments can take steps to encourage manufacturers to fortify food for the public. One way may be to have military purchasers demand only fortified products."
Dr. Bishai and co-author Ritu Nalubola, examined the major waves of food fortification in the United States, which include the iodisation of salt in the 1920s, fortification of milk with vitamin D in the 1930s, enrichment of flour and bread in the 1940s, and the wide spread addition of calcium to a variety of products beginning in the 1980s.
For salt, milk, and bread, food fortification was accomplished by establishing the health benefits through scientific research and enlisting the support of food manufacturers. In most cases, manufacturers found the measures to be profitable after appealing to consumers with advertising and public service campaigns, claim the researchers. Widespread compliance was often achieved through market demand rather than through government mandates. Governments are often large food purchasers and can influence industry, they added.
However, the researchers noted that efforts to enrich bread and flour were particularly slow because there was little public interest or economic incentive. The situation did not change significantly until World War II, when Britain began to manufacture only enriched flour and started a public campaign to improve the nation's health during wartime. Despite similar patriotic campaigns in the US, only 40 per cent of the nation's manufactured flour was enriched, because smaller companies continued to produce cheaper unenriched flour to compete with larger manufacturers.
The authors write that the decision in 1942, by the US army to purchase only enriched flour encouraged many more manufacturers to produce enriched flour, but 100 per cent compliance was not reached until 1943 when the War Foods Administration temporarily required enriched bread. Today, the Food and Drug Administration does not restrict the sale of unenriched products as long they are properly labelled, but most flour remains enriched with B vitamins, iron, and folate because of consumer demand.
"The flour enrichment efforts during World War II can be an important model for developing nations attempting to build successful food fortification programmes," said Dr Bishai.
However recent research suggests that while fortification programmes may be necessary in developing countries, in the developed world they may be posing problems with implications that we are as yet not fully aware of.
Yesterday, we reported on a study that suggested many people are getting too much vitamin A through their diets, which has been associated with an increased risk of fractures in the elderly. The research shows the need for continual reassessment of fortification for specific populations.
The research was funded by the Hopkins Population Center at the Johns Hopkins Bloomberg School of Public Health.