Fortification is the practice of deliberately increasing the content of one or more micronutrients (i.e., vitamins and minerals) in a food or condiment to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health. As well as increasing the nutritional content of staple foods, the addition of micronutrients can help to restore the micronutrient content lost during processing.
Fortification is an evidence-informed intervention that contributes to the prevention, reduction and control of micronutrient deficiencies. It can be used to correct a demonstrated micronutrient deficiency in the general population (mass or large-scale fortification) or in specific population groups (targeted fortification) such as children, pregnant women and the beneficiaries of social protection programmes. When the vitamins and minerals are not added to the foods during the processing but just before consumption at home or at schools or child‐care facilities, it is called point-of-use fortification.
In addition to the micronutrient deficiencies, policies and implementation programmes for fortification need to consider an alignment with policies for the reduction of diet-related noncommunicable diseases. Such is the case of salt iodization, which builds on sodium consumption and, as result, needs to consider strategies for sodium intake reduction.
The World Health Organization recommends large scale food fortification as a powerful evidence-informed and cost-effective intervention to fight vitamin and mineral deficiencies, including iodine deficiency disorders, anaemia and iron deficiency, among others.
Recommendations in all settings include:
- universal salt iodization
- fortification of maize flour, corn meal, wheat flour and rice with vitamins and minerals.
For children living in different settings:
- micronutrient powders containing iron for point-of-use fortification of foods for infants and young children 6–23 months old or children 2–12 years.
Mandatory food fortification occurs when governments legally oblige food producers to fortify particular foods or categories of foods with specified micronutrients, providing high certainty over time that they will contain a predetermined amount. Voluntary fortification occurs when a food manufacturer freely chooses to fortify particular foods in response to permission given in food law as a means to increase their brand value.
Globally, mandatory regulations are most often applied to the fortification of food with micronutrients such as iodine, iron, vitamin A and folic acid. Of these, the iodization of salt is the most widely implemented globally.
WHO has been working systematically in food fortification for decades and collaborates with different networks for fortification at regional, country and community levels.
WHO, the Food and Agriculture Organization of the United Nations and the Codex Alimentarius Commission developed the general principles for the addition of essential nutrients to foods with the intention to provide guidance and protect health, while supporting implementation among Member States.
WHO has organized and convened guideline development group meetings, technical consultations and working groups and has created implementation and monitoring tools in collaboration with country offices and external partners to help Member States to adapt and adopt WHO guidelines and technical documents on food fortification.
WHO also monitors and reports progress of several nutrition targets that are affected by fortification such as the reduction of anaemia in women and the reduction of stunting in children under 5 years of age.