Fortification and formulation

FOOD FORTIFICATION
AND FORMULATION
Instructor : Aemiro Tadesse

Food Fortification
Nutrients
What is it?
Why fortify?
Who benefits?
History and
current progress
Evidence of impact
Cost and benefit
Program
implementation

Nutrients
1. Macronutrients:
 Proteins,
 Fats
 Carbohydrates
which are often
called
 “Proximate
Principals”
because they
form the main
bulk of food.
 Nutrients are organic & inorganic complexes contained in food .
2. Micronutrients:
 Vitamins
 Minerals.
 They are required in
small amounts which
may vary from a
fraction of a
 milligram to several
grams.
The absence of Nutrient in diet <-
Nutrient Deficiencies <- Diseases
Nutrient Deficiency
Micro-Nutrient Deficiency Macro-Nutrient Deficiency
• Kewashaker
• Marasmus

 Micronutrient deficiency (MND) is a lack of essential
vitamins and minerals required in small amounts by
the body for proper growth and development
 Uses of Vitamin and Mineral
• To improve the nutritional quality of the food
supply
• To provide a public health benefit with
minimal risk to health,“
• Since lack of Vitamin and Minerals
contribute significantly to high rates of
morbidity and mortality among
 infants,
 children,
 mothers in developing countries
• It leads to multiple significant consequences,
such as death during childbirth, mental
retardation, blindness, lower educational
attainment, decreased work capacity and
earning potential
Micronutrient Deficiencies
• Poverty
• Food insecurity
• Inadequate care or feeding practices
• Inadequate care or feeding practices
 Causes of Micronutrient deficiency

Determinants of Under nutrition (Micronutrient deficiency)
 Nutrient deficiency can be solved through
1. Fortification< -Micro-Nutrient deficiency
2. Enrichment <-Micro-Nutrient deficiency
3. Formulation <- Macro-nutrient deficiency

 Food fortification has been defined
as addition of one or more essential
nutrients (Micro) to a food,
 Whether or not it is normally
contained in the food,
• for the purpose of preventing
or correcting a demonstrated
deficiency of nutrient in the
population or specific
population groups (FAO/WHO
1994).
• Fortification focuses on
Micronutrient to micronutrient
deficiency prevention
 Enrichment is defined as "synonymous with
fortification and refers to the addition of
micronutrients to a food which are lost during
processing"
 When foods are processed, they often lose some
of the important nutrients such as vitamins and
minerals in the process.
 If the food is labeled “enriched” then the vitamins
and/or minerals which were lost have simply been
added back to restore it to it’s original nutritional
value
 Many consumers think that “enriched” means
that the food has extra nutrients added to it which
will make it more nutritious.
 That is not true. It has simply been restored to it’s
original state.
Fortification <- Micro-Nutrient deficiency
3. Fortification
2. Enrichment <- Micro-Nutrient deficiency

 Food
 Micronutrient
1. Iodine
2. Iron
3. Vitamin A
4. Folic acid
5. Zinc
6. Vitamin D
7. Calcium
8. Other micronutrients:
Vitamin B2, B6, B12
The five common
micronutrient deficiency
1. vitamin A
2. Iodine
3. Iron
4. Zinc
5. Folate
Potential Fortificant
OIL
Vitamin
A,
D, E
MILK
Vit A,D
Ca
CEREALS
Fe, Zn
Vit. B1, B2, B3, B6, B12
Folic acid
Vitamin A
SALT
Iodine
SUGAR
Vitamin A

• Nearly 800,000 deaths among
women and children
worldwide can be attributed to
V-AD
• 20% of maternal deaths
worldwide can be attributed to
V-AD
The impact of Common Five Deficiencies
• Vitamins are organic substances
are essential for several enzymatic
functions in human metabolism
• A compound is called vitamin when
it cannot be synthesized in
sufficient quantities by an
organism, and must be obtained
from the diet.
 Vitamin A Deficiency:
• This is the leading cause of
 blindness worldwide and
also
 Ocular change-Night blindness &
xerophthalmia
 impairs immune function
 cell differentiation
 Growth retardiation
Vitamin A Deficiency of world data

Vitamin-A Deficiencies related data of the world

RICH DIETARY SOURCES
Animal Foods
 Cod liver oil
 Liver & kidney
 Egg
 Butter
 Milk & cheese
 Fish & meat
Plant Foods
 Sweet potato
 Carrot
 Cantaloupe
 Spinach
 Apricot
 Papaya
Life stage µg/day
Infant 300-400
Children 400-600
Adolescent 900M- 700F
Recommended Allowance

Nutrients
Amount in 1 medium, raw
carrot
Daily recommendation
for adults
Energy (calories) 25 1,600–3,200
Carbohydrate (g) 5.8 — including 2.9 g of sugar 130
Fiber (g) 1.7 22.4–33.6
Calcium (millgrams [mg]) 20.1 1,000–1,300
Phosphorus (mg) 21.4 700–1,250
Potassium (mg) 195 4,700
Vitamin C (mg) 3.6 65–90
Folate (mcg DFE) 11.6 400
Vitamin A (mcg RAE) 509 700–900
Beta carotene (mcg) 5,050 No data
Alpha carotene (mcg) 2,120 No data
Lutein & zeaxanthin (mcg) 156 No data
Vitamin E (mg) 0.4 15
Vitamin K (mcg) 8.1 75–120
Nutrition Fact of Carrot
Natalie Butler et al., 2019

Iron Deficiencies:
• The most common MND worldwide
 leads to microcytic anemia,
 Decreased capacity for work,
 Impaired immune and endocrine function
• It contributes to 18.4% of total maternal deaths and
(death of a woman while pregnant or within 42 days
of termination of pregnancy)
• 23.5% of perinatal deaths globally (still birth death in
the first week of life)
Iron Deficiencies:
In children:
• Iron deficiency impairs cognitive
development in children
• This mental capacity is never regained and in
turn limits academic performance and future
earnings potential.
• Childhood anemia globally is associated with
2.5% drop in wages in adulthood.

• In 10 developing countries,
 annual physical productivity
losses due to iron deficiency was
up to 3% of GDP
 Anaemia contributes to maternal
death
• In developing countries,
 one-fifth of perinatal mortality
 one-tenth of maternal mortality
are attributed to iron deficiency
Iron deficiency reduces productivity

Iodine Deficiencies:
It results in
 Goiter
 mental retardation,
 Reduced cognitive function
abortion, and still birth
• 28.5% of people are iodine deficient
 Iodine deficiency is the world’s
most prevalent, yet easily
preventable, cause of brain
damage.

• In Switzerland around the
1920’s, cretins were common
• Cretinism is a condition of
severe physical and mental
retardation due to iodine
deficiency

 Adequate zinc is necessary for
 optimal immune function,
 Zinc deficiency is associated with an
 increased incidence of
 diarrhea
 Acute respiratory infections,
 major causes of death in those younger 5
years of age
 The estimated global prevalence of zinc
deficiency is 31%
Zinc Deficiencies:

 Slow growth in
children
 Loss hair
 Skin lesion
 Peeling skin
 Slow healing of
wound

Folate is essential for
• DNA synthesis
• repair,
Deficiency results in
• macrocytic anemia,
• neural tube defects
It affects up to 5 babies per
1000 live births worldwide
(95% of pregnancy)
Folate Deficiency:

Who benefits
• Food fortification is
industrial process. The
industry ensures provision
of essential vitamins and
minerals according to
government standards and
regulations.
• Fortified foods reach all
those who have access to
the market and purchase
their staple food/ oil/ salt.
 Includes
 Urban poor
 Fast growing group
in many developing
countries in Africa
and Asia
• Those who do not have access to
 Fortified
 Packaged and commercially processed foods needs to
receive
o essential vitamins
o minerals through alternative mechanisms (“sprinkles”)
or supplements, as well as social safety net
approaches, which use fortified foods.
• 1940, Britain and USA started enriching flour as a means
 To improve health of their populations during WWII.
• While fortification of flour was never really embraced in
Europe
• Countries all around the world started flour fortification in the
late 20st and early 21st century.
• To date, more and more countries are adopting this measure.
History of fortification

Prevalence of Micronutrient Deficiency

Nutrient Number of countries that
include nutrient in wheat
flour
Iron 86
Folic acid (vitamin B9) 86
Thiamin (vitamin B1) 59
Niacin (vitamin B3) 57
Riboflavin (vitamin B2) 57
Zinc 25
Vitamin B12 15
Vitamin A 15
Vitamin B6 13
Calcium 5
Vitamin D 4
Cereal flours can be fortified with many vitamins and minerals
Current progress fortification
Afghanistan, Democratic Republic of Congo, Gambia, Lesotho,
Namibia, Qatar, Swaziland, and the United Arab Emirates fortify
more than half their industrially milled wheat flour even
though it is not mandatory.
86 countries have mandates to fortify
industrially milled wheat flour with at
least iron or folic acid.

Malnutrition or
undernourishment is a universal
problem
Cause and Impact of Micronutrient
deficiency

2018 Global Nutrition Report
• The global burden of malnutrition is
unacceptably high
Children under 5
1 in 5 stunted
15.9m stunted and wasted
8.23m stunted and overweight
Adolescents
Record
overweight
and obesity
Adults
1 in 3 either
overweight
or obese
Undernutrition explains around
45% of deaths among children
under five, mainly in low and
middle-income countries
34% of children in conflict states are
affected by stunting, compared with 20%
in non-conflict states
Impact

Stunting is declining (2000–2017)
0
50
100
150
200
250
2000 2004 2008 2012 2017
Source: NCD Risk Factor Collaboration
198.4
30.1
150.8
38.3
Children
affected,
millions
Stunting
Overwight
Most significant declines are in Asia and Latin America and the Caribbean

 48% of countries are on track for at least one nutrition target
TARGET 1:
40% reduction in the
number of children
under 5 who are stunted
TARGET 2:
50% reduction of
anaemia in women of
reproductive age
TARGET 3:
30% reduction
in low birth weight
TARGET 4:
No increase in childhood
overweight
TARGET 5:
Increase the rate of
exclusive breastfeeding in
the first 6 months to at least
50%
TARGET 6:
Reduce and maintain
childhood wasting to
less than 5%
TARGET 1:
30% relative reduction in
mean population intake of
salt
TARGET 2:
A 25% relative reduction in
the prevalence of raised
blood pressure
TARGET 3:
Halt the rise
in obesity and
diabetes
Global nutrition targets for 2025
Global non-communicable disease
targets for 2025 (diet-related)
GOAL to address MND

 Yet progress towards targets is too slow
49 138 7
24 27 16 127
31 13 20 130
37 12 24 121
38 23 133
No progress or worsening No data
Some progress
On course
Maternal, infant and young child nutrition targets
Anaemia
Exclusive breastfeeding
Childhood stunting
Childhood overweight
Childhood wasting
26 164 4
8 182 4
178 16
180 14
Obesity, men
Obesity, women
Diabetes, men
Diabetes, women
Nutrition-related NCD targets

 Rates of anaemia and women underweight have barely changed, while obesity is rising
Global prevalence of anaemia, overweight (including obesity) and underweight in
women, 2000–2016
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
2000 2004 2008 2012 2016
31.7%
11.6%
39.2%
Prevalence,
%
Prevalence of anaemia
among women of
reproductive age (15–49)
Prevalence of underweight
among women aged 20–
49
Prevalence of overweight
and obesity among adult
women (18+)
9.7%
31.6% 32.8%

1. Fortification
Strategies and Interventions to control MND
Supplementation
2. Dietary diversification
Several options
is generally for severe case
(Ex: India, Nigeria)
 Choice is determined depends on the cause, severity and
scope of MND
 Food-based approaches

Codex Commission
• Addition of Essential Nutrients to Foods or
synonymously “enrichment” whether or not it is
normally contained
 for the purpose of preventing or correcting a
demonstrated deficiency of one or more
nutrients in the population or specific population
groups”.
Codex General Principles
• States condition for the fulfillment of any fortification
programs “
 for increasing the intake of an essential nutrient
in one or more population groups.
Strategies and Interventions to control MND Conti…
1. Fortification
 Types of fortification
1. Mass fortification – foods consumed by the
general public
• Nearly always mandatory
2. Targeted fortification - specific population
or subgroups (e.g., CF)
• Mandatory or voluntary depending on
public health significance of the
problem
3. market-driven fortification - voluntary
fortification by manufacturers
• Always voluntary

Choice b/n mandatory or voluntary FF depends on national circumstances
Figure 1 The interrelationships between the levels of coverage, compliance and the different types of food
fortification

1. Mass fortification – foods consumed by the
general public
• The best option when the majority
population has an unacceptable public
health risk
2. Targeted fortification - specific population
or subgroups (e.g., CF)
• CF
• Foods developed for school feeding
programs,
• Special biscuits for children &
pregnant women,
• Rations (blended foods) for emergency
feeding & displaced persons
3. market-driven fortification - voluntary
• Fortification by manufacturers
• Business-oriented initiative
- Add specific micronutrient to processed
foods
• Play a positive role in public health -
reducing the risk of deficiency
• Improve the supply of micronutrients - M &V
• More widespread in industrialized countries
• Increase in availability of fortified processed
foods in developing countries
 Divert consumers from their usual
dietary pattern in increased
consumption of sugar or lower fiber

Other types of fortification
1. Household and community fortification
Efforts to develop & test practical ways of adding
micronutrients to foods at the household level
 in particular, for young children
 this approach is a combination of
supplementation & fortification
referred as “CF supplementation”
 The efficacy & effectiveness of Household and community
fortification using different products
 Soluble or crushable tablets
 Micronutrient-based powder (sprinkles) are currently
being evaluated
 Relatively expensive ways of increasing
micronutrient intakes and more costly than mass
fortification
 But useful
• For improving local foods fed to infants & young children
• where universal fortification is not possible
Foods for fortification at the household level
Product Comments
 Micronutrient powder
can be
 Sprinkled in to food
 Iron
 Soluble micronutrient
tablets can be
 Dissolved in water
and fed as a drink
 Suitable for young
children;
 Tested by WHO
 Crushable
micronutrient tablets
for adding to foods
 For infants and young
children
 Tested by UNICEF
 Fat-based spread
fortified with
micronutrient to
implement
 Popular with children
 Can be produced locally
as the technology
required is easy

 Major challenges to local-scale fortification programs
include
 Initial cost of the mixing equipment
 The price of premix (imported in most cases)
 Achieving & maintaining adequate standard
(uniformity of mixing)
 Sustaining monitoring & distribution systems
2. Bio-fortification of staple foods
 The breeding & genetic modification of plants
 to improve
 Nutrient content – crops (low phytate,
high M & V)
 Absorption
 Still needs to prove
 The efficacy & effectiveness of these
foods
 Safety
 Cost
 Impact on the environment
 Fortification based on Legal considerations
 FF parameters are established by law or
through cooperative arrangements in
developed nations
To ensure
 the safety of all consumers
 the maximum benefit to target groups
 Within the legal context, FF can be categorized
as either:
1. Mandatory
2. voluntary
o These terms refer to level of obligation
required of food producers to comply
with government intentions expressed in
law

1. Mandatory fortification (MF)
 Key characteristics
• Governments legally oblige food producers to
fortify particular foods with specified
micronutrient
• Delivers a high level of certainty of fortified food
in constant supply
 Governments are responsible for
 Ensuring the combination of food vehicle and
fortificants will be efficacious & effective for the
target group
 Safety of FF for target & non-target groups
 Mandatory regulations are most often applied
to the FF with
 iodine - most widely adopted
 iron
 vitamin A
 folic acid
 MF in relation to public health
 MF is usually prompted by evidence that a
given population is
 Deficient or inadequately nourished,
 Clinical or biochemical signs of
deficiency and/or
 Unacceptably low levels of
micronutrient intake
 a demonstrated public health benefit of
an increased consumption of a given
micronutrient even if the population is
not seriously at risk
 folic acid to flour to reduce the risk of birth
defects is a

2. Voluntary fortification (VF)
 Key characteristics
 Voluntary when a food manufacturer freely
chooses to fortify particular foods in response to
permission given in food law
 Encouraged by government to do so
 Governments are responsible for
 Ensure that consumers are not misled by
fortification practices
 Regulate the range of foods eligible for VF and
on the permitted combinations of micronutrients
& foods
 Market promotion of fortified foods does not
conflict or compromise any national food &
nutrition policies on healthy eating
 VF in relation to public health
 VF tends to be used when there are
 lower order risks to public health
 Inadequate MN intakes that arise
because of changes in lifestyles
 changing social & economic
circumstances
 Inadequate intakes arising from a
significantly modified eating habits &
dietary behavior
 Criteria governing the selection of mandatory or
voluntary fortification
1. The significance of the public health need;
2. The size & scale of the food industry sector;
3. The level of awareness among the
population about nutritional needs;
4. The political environment; and
5. Food consumption patterns

1. The significance of the public health need or risk of
deficiency, as determined by severity of the problem
and its prevalence within a population group.
 Importance & should be determined
 at the country
 regional level
 Set criteria that describe the severity of the public
health problem
 evidence of clinical or subclinical deficiency,
 inadequate nutrient intake, or
 potential health benefit
 LEGAL CONSIDERATION
 MF is more suited to cases of serious public health
need or risk,
 VF to cases of lower order public health need or risk,
 VF can achieve similar public health impacts as MF
2. The features of food industry sector that will
responsible for the production of the proposed
food vehicle
 Food industry sector
 The number, capacity & geographical
distribution of the producers,
 The presence of any government support or
control
 The prevailing commercial environment
 In developing countries, MF is more likely to
succeed when the industry sector is either relatively
 Centralized
 Well organized
 If the industry consists numerous
• Small,
• Widely dispersed producers
 An indication that favors MF or VF regulatory mechanisms:

 MF is likely to be more effective option when
 Consumer knowledge is poor or
 Demand for voluntarily-fortified products is low
 Few opportunities for community nutrition
education
 VF generally relies on:
 Consumer interest and/or
 Demand for fortified foods
 MF will be more difficult to achieve
 Unless these small units have some form of collective
arrangement
 established industry association)
 VF does not need to take account
 Industry arrangements
 But where there is a monopoly or a government-
sponsored industry,
• the impact of voluntary arrangements can match
those achieved by MF
An indication that favors MF or VF regulatory mechanisms…..
3. The relevant population’s present level of knowledge
about the importance of consuming fortified foods or their
interest in consuming fortified foods
 The level of resources available for implementing &
sustaining specific nutrition education programs
 Choose the most suitable regulatory environment for
FF program
4. The political environment
 Significant factors that affecting regulatory
decisions:
 The acceptable level of government
intervention
 the value placed on informed consumer choice
 Where consumer choice is highly valued, both VF
& MF could be appropriate
 VF usually confers a higher level of consumer
choice
 Not the main issue in many developing countries
 poverty remains the limiting factor to access to
processed foods for the majority population

5. Food consumption patterns
 Food consumption
patterns - have a bearing
on the choice of MF or VF
 The issue of the technical
suitability of food vehicle
for fortification
 Foods considered for MF
should be
 Widely & regularly
consumed by the
population group –
benefit
 The likelihood of all at-risk
consumers increasing their
usual micronutrient intake
through VF is lower than with
MF
 Criteria for selection of food vehicles and premix for fortification
 Selection of food vehicle–fortificant combination is governed by range of
factors
• Technological
• Regulatory
 Foods well suited to mandatory mass fortification:
 cereals,
 oils,
 dairy products,
 beverages
 various condiments:
• salt
• sugar
 These foods share some or all of the following characteristics:
 Consumed by a large proportion of the population
• Including the groups at greatest risk of deficiency
 consumed on regular basis, in adequate & relatively consistent
amounts
 can be centrally processed
 Easy to add a nutrient premix using low-cost technology

 Foods purchased & used
within a short period of
time of processing
• Tend to have better
MN retention,
• Fewer sensorial
changes due to the
need for only small
coverage
 The choice of fortificant
compound is often a
compromise b/n:
 Reasonable cost,
 Bioavailability
from the diet,
 The acceptance of
any sensory
changes
 When selecting the most appropriate micronutrient (MN), the main
considerations & concerns are:
1. Sensory problems.
 Fortificants must not cause
 unacceptable sensory problems (color, flavor, odor, texture)
 segregate out from the food matrix,
 They must be stable within given limits
 In the case of iron fortificants, the two most common problems are
 increased rancidity due to oxidation of unsaturated lipids
 unwanted color changes.
• Include a green or bluish coloration in cereals,
• Graying of chocolate and cocoa,
• Darkening of salt to yellow or red/brown.
o Sensory changes are highly variable and not always predictable.
o Iron fortificant does not cause adverse sensory changes does not necessarily
mean that other fortificant will not cause a problem.
o Having selected potential fortificant, and effects on the sensory properties of
food to which it is to be added are determined prior to use.

3. Cost. The cost of fortification must not affect
 the affordability of the food
 its competitively with the unfortified alternative
4. Bioavailability. The fortificant must be
 sufficiently well absorbed from the food vehicle
 able to improve the MN status of the target
population
5. Safety consideration.
 The level of consumption that is required for
fortification to be effective must be compatible with a
healthy diet
2. Interactions.
 The likelihood or potential for interactions b/n the
added MN & the food vehicle,
 Other nutrients (added or naturally present) that might
interfere
 with the metabolic utilization of the fortificant,
needs to assess & check prior to implementing a
FF program
 Food fortification for control of micronutrient
deficiency in Ethiopia
 The 1° aim of NNP is to
 Improve the nutritional status of the
population, especially
• children,
• pregnant and lactating women
• PL-HIV,
 through cost effective, sustainable &
harmonized interventions primarily at
the community level
 The NNP has in cooperated MN interventions
as one of the NN strategies to reduce MNM
burden in the Country
 Ethiopia has already taken significant steps in
this direction with
 enactment of mandatory, food
vehicles have been identified,
 progressing to undertake FF as one of the
MN intervention

 The four main MNs of interest are
 iodine,
 Vitamin A,
 iron
 zinc
 Selected food vehicles are:
 wheat flour - in progress & waiting for standard
approval,
 vegetable (cooking) oil - in progress & waiting for
standard approval,
 salt – implemented
 Fortification of commonly consumed foods is a
relatively inexpensive & effective means of
increasing MN intake.
 Adequate consumption of FFs shown improvement
MN status
 The choice of a food vehicle depends on a series of
factors:
 the target group,
 food consumption patterns,
Food fortification for control of micronutrient deficiency in Ethiopia …
 Fortified foods include:
 Salt with iodine to prevent Iodine Deficiency
Disorders (IDD).
 Cereals products (wheat, maize, teff,
oats/ryes, breakfast cereals, with multi-mix
of vitamins and minerals).
 Sugar, vegetable oil & fats with vitamin A
 Beverages like milk, water, soda/alcohol etc
with multi-vitamin
Micronutrients found in the fortified staples are;
 Vegetable oil & sugar: Vitamins A & D
 Wheat flour: Vitamin A, Folic Acid, Vitamin B12,
Vitamin B1, Vitamin B2, Vitamin B6, Niacin, Zinc,
Iron.
 Maize flour: Vitamin A, folic acid, vitamin B12,
vitamin B1, vitamin B2, vitamin B6, niacin, Zinc,
Iron.
 Salt: Iodine
 industry structure,
 technological factors of the food

2. Dietary diversification Formulation
Strategies 2…
Formulation of diets for target groups along
the lifecycle
1. Infant
2. Pre-school children
3. School going children
4. Adolescents
5. Pregnant women
6. Lactating women
7. Adults
8. Old age people
1. Healthy Diet for Infants 0 to 12 Months
 Making sure your baby has good nutrition can
protect him against disease.
 Every infant is different.
 Your baby may need more or less of the items in
each food group and may also need a special
diet.
 The amounts of breast milk, formula, and food that
most infants up to 1 year of age need. This feeding
plan provides:
 8 to 15% protein,
 35 to 55% fat, and
 30 to 50% carbohydrate
 This also gives the right amount of calories and
protein that your baby needs.
 Giving one new food to the baby only once every
2-3 days.
 Trying new foods that are dry or chewy, such as
peanut butter, cheese, or dried beans,
 Watch your infant closely to make sure they don't
choke.
 Normal Diet for Infants - 0 to 12 Months
 What is it?
 Infant nutrition making sure your baby is getting
enough nutrients during his first year.
 Nutrients are calories, protein, fat, vitamins,
and minerals.

Fortification and formulation

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Fortification and formulation