Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

Osendarp, Saskia; Martı́nez, Homero; Garrett, Greg S.; Neufeld, Lynnette M.; De-Regil, Luz María; Vossenaar, Marieke; Darnton‐Hill, Ian

doi:10.1177/0379572118774229

Cited by 134 publications

(148 citation statements)

References 66 publications

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“…Despite the documented successes of food fortification globally, an unfinished agenda persists, that limits its potential for impact at a global scale. Previous reviews on the state of LSFF [6,8,78,79] have focused on efficacy and effectiveness, coverage and equity, and costs and cost effectiveness. In this review, we (1) identified, based on pre-determined criteria, 84 LMICs that stand to benefit from fortification programs suggesting a need for action; (2) quantified bottlenecks (gaps) to achieving potential to benefit and link these with design and implementation issues; and (3) suggest new areas for innovations across the fortification ecosystem, including some that already hold great promise and others that warrant further research.…”

Section: Discussionmentioning

confidence: 99%

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

et al. 2020

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Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (<50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.

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Section: Discussionmentioning

confidence: 99%

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

et al. 2020

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“…The process of implementation of micronutrient food fortification programs is challenging, as there are several steps involved in the process of monitoring and evaluation. A review of available documents about lessons learned from various micronutrient food fortification programs identified the following challenges and barriers: [64][65][66][67][68][69][70] (1) Lack of qualified personnel and lack of training; (2) Lack of clear guidelines at the country level on implementation, regulatory frameworks, and monitoring and evaluation; (3) Lack of clarity in the structure and roles of government authorities in regulatory monitoring; (4) Lack of enforcement of standards by the regulatory agents or political instability, which may be related to perceived political risk in doing so; • Mandatory fortification of staple foods (salt with iodine, wheat flour and maize meal with iron, zinc, vitamin A, folic acid, and other B-complex vitamins, sugar and oil with vitamin A and skimmed milk powder with vitamins A and D) • Supplementation programs (mega doses of vitamin A to children and iron and folic acid to pregnant women) and biofortification (sweet potato with β-carotene) Philippines…”

Section: Challenges and Barriersmentioning

confidence: 99%

Current calcium fortification experiences: a review

Palacios

Hofmeyr

Cormick

et al. 2020

Annals of the New York Academy of Sciences

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Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.

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“…In this sense, several agencies worldwide are focusing their attention on the fight against micronutrient deficiencies, since they are a short-term resolution (FAO, 2017;Prentice et al, 2008). Some challenges, such as choosing appropriate fortification vehicles, having a good policy, targeting populations, avoiding excessive consumption in non-target groups, and monitoring nutritional status, are among relevant factors in improving health and will have the possibility to save billions of lives (Dwyer et al, 2015;Osendarp et al, 2018;Prentice et al, 2008;WHO & FAO, 2006).…”

Section: Issues and Challenges Of Nutrient Deficienciesmentioning

confidence: 99%

Flour fortification for nutritional and health improvement: A review

Cardoso

Fernandes

Gonzaléz-Paramás

et al. 2019

Food Research International

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Deficiencies of micronutrients, essentially vitamins and minerals, have mainly cause several illnesses, especially in children and women worldwide. Governments and world organizations have focused great efforts to address these shortcomings and improve the health of the populations. This malnutrition can be combated by fortifying basic foods that are consumed daily. Thus, flours, especially wheat, maize and rice, are a popular and common food in the world's populations diet and are gaining considerable attention as a suitable vehicle for micronutrient fortification. There are some studies that show the effectiveness of flour fortification in combating micronutrient deficiencies and several diseases and the flour fortification strategies are directed to meet nutritional and health needs of the populations. The main points discussed in this review are food fortification, with great focus in flour fortification, health benefits, and legislative issues. This review also highlights multifaceted issues related to flour fortification to meet nutritional needs and to improve the health of vulnerable populations.

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Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

Cited by 134 publications

References 66 publications

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

The Unfinished Agenda for Food Fortification in Low- and Middle-Income Countries: Quantifying Progress, Gaps and Potential Opportunities

Current calcium fortification experiences: a review

Flour fortification for nutritional and health improvement: A review

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