With the current contention around further food fortification, this week's blog discusses what fortification is, what products in the UK have added nutrients and what's the debate surrounding it all.
Micronutrients are dietary components (such as vitamins and minerals) which are needed in minute quantities but are essential for normal growth, development, disease prevention and wellbeing. When a person consumes inadequate amounts of micronutrients, complications and adverse effects are likely to develop and can sometimes arise without showing any symptoms. Micronutrient deficiencies are a major concern worldwide as over two billion people are thought to be affected. This isn’t just a major concern in developing countries, there are a significant number of people in the UK who are suffering vitamin and mineral deficiencies. The most recent findings from the National Diet and Nutrition Survey (NDNS) suggest that UK males fell below dietary targets for five micronutrients (magnesium, potassium, zinc, selenium, and copper) whilst UK females fell short for seven micronutrients (calcium, iron, magnesium, potassium, selenium, iodine and copper). The most common being iron deficiency, which is prevalent in 5% of adult women.
In an attempt to reduce micronutrient deficiencies in a total population, manufacturers can add nutrients to foods to enhance their nutrient content. This is known as food fortification.
Food fortification is not used solely to improve the nutritional status of a population, it is also used to minimise the effects of processing and to give a substitute food a similar nutritional value to its replacement. Food fortification, depending on the country, micronutrient or product, can be mandatory or voluntary. In the UK, flour (all wheat flour except wholemeal) and margarine have to be fortified by law. If manufactures voluntarily fortify foods, only permitted vitamins and minerals which are in their bioavailable form can be added.
What foods are fortified in the UK?
Fortified foods can make an important contribution to some UK diets and are probably more common than you think. If we take a look at cupboard staples, all of the following can be fortified: breakfast cereals (contributing to 20% iron intake and 13-24% of Vitamin D in adults), margarine and spreads (add Vitamin A and D, so they’re comparable to butter), flour (except wholemeal is fortified by law with calcium, iron, niacin and thiamine), fruit juice (commonly add Vitamin C, calcium and omega-3), eggs (widely available enriched with Omega 3) and bread (widely available Omega 3 and newly Vitamin D).
Although food fortification is an effective way to increase total population micronutrient consumption - is it always a good thing? Some argue that without fortification policy certain sub-groups would be vulnerable to micronutrient deficiency and fortified foods are currently crucial for key nutrients in their diets. Others feel that fortifying food is ‘mass medication’ and concerns are raised about the safety of excessive nutrient intakes. For example, the possibility of fortifying flour with folic acid is currently an area of contention in the UK. Inadequate folate consumption during conception and early pregnancy have been shown to increase the risk of neural birth defects. The dispute lies within the ‘tolerable upper intake level’ set for folic acid at 1mg per day and fortification of flour could cause some individuals to exceed this limit.
Concerns about excessive micronutrient intakes are dependent on the impact the fortified foods have on the public’s health. The impact in which a fortified food has on an individual’s micronutrient intake will depend on the level of fortification, bioavailability, amount consumed and overall diet. For example, absorption of iron from fortified foods will vary greatly between consumers as it depends on overall dietary intake and the effect of dietary enhancers and inhibitors such as vitamin c and phytate.
Over or under consumption of any nutrient can be harmful to health. Opting for a dietary approach which emphasises the consumption of real food reduces the risk of micronutrient deficiencies. Concerns of inadequate vitamin and mineral intake should be initially addressed by eating a healthy, varied diet and added nutrients in foods or supplements should only be secondary to diet. Currently, vitamin D is the only dietary supplement which has been recommended by the government for the total population. Added vitamins and minerals in fortified foods shouldn’t be eaten to replace poor nutrition and a well-rounded, varied diet filled with vegetables and wholefoods should always be the first port of call.
On a population-based scale, food fortification can be an effective way to ensure certain subgroups consume micronutrients they might otherwise be deficient in. However, fortified foods shouldn’t be eaten to replace poor nutrition and a nutrient dense, varied diet should always be favoured. In terms of an overall public health concern, nutrition is multifactorial and therefore not one singular intervention (such as food fortification) will eliminate the poor dietary habits of the UK population.
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- World Health Organization. [no date]. Micronutrients. [Online]. [Accessed on 18 September 2018]. Available from: www.who.int/nutrition/topics/micronutrients/en
- Derbyshire, E. 2018. Micronutrient intakes of British adults across mid-life: a secondary analysis of the UK National Diet and Nutrition Survey. Frontiers in Nutrition. 5. p.55
- Food Standards Agency and Public Health England. 2018. NDNS: result from years 7 and 8 (combined). [Online]. [Accessed on 18 September 2018]. Available from: https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined
- Food Standards Agency. [no date]. Fortified Foods. [Online]. [Accessed on 18 September 2018]. Available from:http://labellingtraining.food.gov.uk/module7/overview_2.html
- Wald, N., Morris, J. and Blakemore, C. 2018. Public health failure in the prevention of neural tube defects: time to abandon the tolerable upper intake level of folate. Public Health Reviews. 39(2).
- World Health Organization and Food and Agricultural Organization of the United Nations. Guidelines on food fortification with micronutrients. [Online]. [Accessed 13 September 2018]. Available from: www.who.int/nutrition/publications/micronutrients/9241594012/en