Food fortification

22 Jan 2021

Summary

Food fortification involves the addition of vitamins and minerals to foods as part of manufacture or processing. In some cases, it is required by law, in others it is voluntary. It can play an important part in improving the micronutrient intake of the population as a whole, particularly when targeted appropriately.

Fortification may carry negative connotations for some consumers. There are some market trends, including organic food, which support the removal of additives, including fortificants, from foods.

The BDA believes

Fortification plays an important role in ensuring a healthy diet, especially to certain population groups who may struggle to access the necessary range of micronutrients from normal food for a variety of reasons.
Government should consider mandating fortification of specific micronutrients where population level deficiencies exist and fortification would be effective, such as the fortification of flour with folic acid.
Industry should consider wider voluntary fortification of foods where appropriate, especially where their product seeks to replace a food that would normally contain those micronutrients. They should ensure consumers are informed of the benefits to health of such fortification.
Accurate labelling of products is vital, and manufacturers should be clear which of their products are fortified and which are not, to avoid consumer confusion or misinformation.

Background

Food fortification is the addition of vitamins and minerals to increase the micronutrient density in a food to support people in achieving their daily requirements. It is a common practice in UK foods, either to replace nutrients lost as a result of other forms of processing, or as an addition to improve the nutritional quality of a food. The fortification of white flour with Iron, Niacin and Thiamin is an example of the former, where these nutrients are added to replace those that are lost as a result of milling. The addition of Calcium and Iodine to plant-based milk-alternatives is an example of the latter, where companies add micronutrients that would be found in milk.

There is evidence that fortification provides a significant proportion of dietary intake of some key micronutrients. For example, studies have found fortified breakfast cereals to be a significant contributor of dietary iron in the UK diet. This is despite the fact such cereals are not recommended as good sources of iron by NHS Choices and consumers may be unaware of their role².

One form of fortification of particular interest to the BDA is the fortification of flour with folic acid. This is commonplace in many other countries, where it was introduced to reduce the rates of still births as a consequence of neural tube defects (to include spina bifida). Figures show that the prevalence of NTD pregnancies in the UK is 1.28 per 1000 total births (19% live births, 81% terminations)³. Evidence suggests that 200-300 NTD pregnancies could be prevented annually in the UK if folic acid status of women was improved via fortification⁴. See the BDA’s campaign pages on folic acid fortification for more information.

Fortification and specific diets

For people following restrictive diets for health, ethical or sustainability reasons, such as vegan diets or some allergy diets, fortification (or supplementation) may be necessary to ensure sufficient micronutrient intake. For example, meat, fish and dairy are important sources of protein, calcium, iodine, B vitamins and essential fatty acids. Reducing or ceasing the consumption of such foods could place individuals at risk of deficiency, if they do not obtain other sources of these nutrients. Fortification of meat, fish and dairy alternatives can play a role in ensuring adequate intakes of particular nutrients needed for health.

Processed foods and other concerns

Adding vitamins and minerals to such products, may lead to a product being described as “Processed” or “Ultra Processed”, depending on the number of ingredients and classification system used. This can have negative connotations, even when there are clear health benefits from the fortification. For more information on the BDA’s position on processed foods, please see our Process Food Position Statement.

Some consumers are anxious about the inclusion of specific nutrients, and there are concerns that artificial fortification could lead to over-consumption, or certain nutrients where high quantities can have a negative health effect, for example of iodine. These concerns are unfounded, but of course it is important that any proposed fortification levels are well below upper safe limits.

“Clean label” and organic products

Given fortification’s important role, there is a concerning market trend for “clean label” foods that contain no additives, even when this would include fortification with beneficial micronutrients. Consumer surveys report anxiety in relation to preservatives, artificial sweeteners and other additives in foods^5,6. While consumer choice is important, it may not be clear to consumers that they may be missing out on micronutrients that may be difficult to obtain from elsewhere in the diet.

Organic product codes do not allow the use of fortificants or additives that are not required by law[1], which means many organic products will not contain micronutrients that a non-organic equivalent may have added. There is concern that consumers may not realise this difference, leaving them at greater risk of deficiency of some particular nutrients.