Recent Advances in Dietary Sources, Health Benefits, Emerging Encapsulation Methods, Food Fortification, and New Sensor-Based Monitoring of Vitamin B12: A Critical Review

In this overview, the latest achievements in dietary origins, absorption mechanism, bioavailability assay, health advantages, cutting-edge encapsulation techniques, fortification approaches, and innovative highly sensitive sensor-based detection methods of vitamin B12 (VB12) were addressed. The cobalt-centered vitamin B is mainly found in animal products, posing challenges for strict vegetarians and vegans. Its bioavailability is highly influenced by intrinsic factor, absorption in the ileum, and liver reabsorption. VB12 mainly contributes to blood cell synthesis, cognitive function, and cardiovascular health, and potentially reduces anemia and optic neuropathy. Microencapsulation techniques improve the stability and controlled release of VB12. Co-microencapsulation of VB12 with other vitamins and bioactive compounds enhances bioavailability and controlled release, providing versatile initiatives for improving bio-functionality. Nanotechnology, including nanovesicles, nanoemulsions, and nanoparticles can enhance the delivery, stability, and bioavailability of VB12 in diverse applications, ranging from antimicrobial agents to skincare and oral insulin delivery. Staple food fortification with encapsulated and free VB12 emerges as a prominent strategy to combat deficiency and promote nutritional value. Biosensing technologies, such as electrochemical and optical biosensors, offer rapid, portable, and sensitive VB12 assessment. Carbon dot-based fluorescent nanosensors, nanocluster-based fluorescent probes, and electrochemical sensors show promise for precise detection, especially in pharmaceutical and biomedical applications.

Recent advances in iron encapsulation and its application in food fortification

Iron (Fe) is an important element for our body since it takes part in a huge variety of metabolic processes. However, the direct incorporation of Fe into food fortification causes a number of problems along with undesirable organoleptic properties. Thus, encapsulation has been suggested to alleviate this problem. This study first sheds more light on the Fe encapsulation strategies and comprehensively explains the results of Fe encapsulation studies in the last decade. Then, the latest attempts to use Fe (in free or encapsulated forms) to fortify foods such as bakery products, dairy products, rice, lipid-containing foods, salt, fruit/vegetable-based products, and infant formula are presented. Double emulsions are highly effective at keeping their Fe content and display encapsulation efficiency (EE) > 88% although it decreases upon storage. The encapsulation by gel beads possesses several advantages including high EE, as well as reduced and great Fe release in gastric and duodenal conditions, respectively. Cereals, particularly bread and wheat, are common staple foods globally; they are very suitable for food fortification by Fe derivatives. Nevertheless, the majority of Fe in flour is available as salts of phytic acid (IP6) and phytates, reducing Fe bioavailability in the human body. The sourdough process degrades IP6 completely while Chorleywood Bread Making Process and conventional processes decrease it by 75% in comparison with whole meal flour.

Improvement of vitamin D status through consumption of either fortified food products or supplement pills increased hemoglobin concentration in adult subjects: Analysis of pooled data from two randomized clinical trials

Background: It is documented that vitamin D may have a role in erythropoiesis as its deficiency is accompanied by an increased risk of anemia. Aim: This study aimed to examine whether improvement of vitamin D status through daily consumption of either fortified foods or supplements could impinge on certain hematologic parameters in adults. Methods: We pooled data from our two separate clinical trials and made five experimental groups. As part of their usual diet, one group consumed 500 mL/day of yogurt drink fortified with 1000 IU of vitamin D (D-yogurt, n = 27) whereas one group consumed 500 mL/day of the plain yogurt drink (P-yogurt, n = 27). In addition three other groups consumed either 50 g/day bread fortified with 1000 IU of vitamin D (D-bread) or supplement containing 1000 IU vitamin D (D-supplement, n = 27) or placebo (placebo, n = 27). Biochemical measurements were performed before and after the intervention. Results: In all three vitamin D-supplemented groups, serum 25(OH)D concentration increased after the intervention period, which was interestingly accompanied by a significant increment of hemoglobin (D-yogurt, p < 0.001, D-bread, p = 0.003, D-supplement, p < 0.001). Analyses indicated that among participants in vitamin D-intervention groups, being in D-yogurt group was more favourable predictor of improvement in hemoglobin concentrations compared with the placebo (p < 0.001), D-bread (p = 0.045) and P-yogurt (p = 0.001). Conclusion: Improvement of vitamin D status via regular intake of either vitamin D-fortified food products or supplements can result in a significant increment of hemoglobin in adult subjects. This finding has very important clinical as well as public health implications.

Aromatic Plant-Based Functional Foods: A Natural Approach to Manage Cardiovascular Diseases

Aromatic plants and their essential oils have shown beneficial effects on the cardiovascular system and, therefore, are potential raw materials in the development of functional foods. However, despite their undeniable potential, essential oils present several limitations that need to be addressed, such as stability, poor solubility, undesirable sensory effects, and low bioavailability. The present review provides a current state-of-the-art on the effects of volatile extracts obtained from aromatic plants on the cardiovascular system and focuses on major challenges that need to be addressed to increase their use in food products. Moreover, strategies underway to overcome these limitations are pointed out, thus anticipating a great appreciation of these extracts in the functional food industry.

Natural Antioxidant Potential of Melon Peels for Fortified Foods

Agricultural and food waste recycling reduces natural resource losses, contributing significantly to the development of new green markets through the creation of redesigned products. In order to cycle valuable molecules, the peels from Italian cantaloupe (Cucumis melo L.) cultivars were studied and successfully characterized for high-added biomolecules to verify their possible exploitation as wealthy biomasses. Peels were investigated for their cell wall-modifying and browning enzymes, as well as for total polyphenols, ortho-diphenols, flavonoids, tannins, and antioxidant properties. The results of the analyses displayed great promise in one of the three cultivars investigated. Later on, a preliminary study using the best peel extract as a dietary supplement was carried out by preparing fortified seawater to enhance its antioxidant power. The effects of storage time (60 days) were examined at two temperatures through the determination of the stability of the polyphenol content. The kinetic parameters of degradation were also calculated. The "enriched sea water" retained great antioxidant activity in refrigerated conditions, demonstrating that there is good potential for melon by-products to add their natural compounds for food fortification. These findings may provide valuable data for scale-up, from the lab to the pilot or industrial application.

Vitamin B12 in Foods, Food Supplements, and Medicines-A Review of Its Role and Properties with a Focus on Its Stability

Vitamin B₁₂, also known as the anti-pernicious anemia factor, is an essential micronutrient totally dependent on dietary sources that is commonly integrated with food supplements. Four vitamin B₁₂ forms-cyanocobalamin, hydroxocobalamin, 5'-deoxyadenosylcobalamin, and methylcobalamin-are currently used for supplementation and, here, we provide an overview of their biochemical role, bioavailability, and efficacy in different dosage forms. Since the effective quantity of vitamin B₁₂ depends on the stability of the different forms, we further provide a review of their main reactivity and stability under exposure to various environmental factors (e.g., temperature, pH, light) and the presence of some typical interacting compounds (oxidants, reductants, and other water-soluble vitamins). Further, we explore how the manufacturing process and storage affect B₁₂ stability in foods, food supplements, and medicines and provide a summary of the data published to date on the content-related quality of vitamin B₁₂ products on the market. We also provide an overview of the approaches toward their stabilization, including minimization of the destabilizing factors, addition of proper stabilizers, or application of some (innovative) technological processes that could be implemented and contribute to the production of high-quality vitamin B₁₂ products.

Recent progress in fish oil-based emulsions by various food-grade stabilizers: Fabrication strategy, interfacial stability mechanism and potential application

Fish oil, rich in a variety of long-chain ω-3 PUFAs, is widely used in fortified foods due to its broad-spectrum health benefits. However, its undesired characteristics include oxidation sensitivity, poor water solubility, and fishy off-flavor greatly hinder its exploitation in food field. Over the past two decades, constructing fish oil emulsions to encapsulate ω-3 PUFAs for improving their physicochemical and functional properties has undergone great progress. This review mainly focuses on understanding the fabrication strategies, stabilization mechanism, and potential applications of fish oil emulsions, including fish oil microemulsions, nanoemulsions, double emulsions, Pickering emulsions and emulsion gels. Furthermore, the role of oil-water interfacial stabilizers in the fish oil emulsions stability will be discussed with a highlight on food-grade single emulsifiers and natural complex systems for achieving this purpose. Additionally, its roles and applications in food industry and nutrition field are delineated. Finally, possible innovative food trends and applications are highlighted, such as novel fish oil-based delivery systems construction (e.g., Janus emulsions and nutraceutical co-delivery systems), exploring digestion and absorption mechanisms and enhancing functional evaluation (e.g., nutritional supplement enhancer, and novel fortified/functional foods). This review provides a reference for the application of fish oil-based emulsion systems in future precision diet intervention implementations.

Filipino Children with High Usual Vitamin A Intakes and Exposure to Multiple Sources of Vitamin A Have Elevated Total Body Stores of Vitamin A But Do Not Show Clear Evidence of Vitamin A Toxicity

Background

Young children exposed to high-dose vitamin A supplements (VAS) and vitamin A (VA)-fortified foods may be at risk of high VA intake and high VA total body stores (TBS).

Objectives

TBS and estimated liver VA concentration were compared among children with adequate or high VA intake and different timing of exposure to VAS, and associations between estimated liver VA concentrations and biomarkers of VA toxicity were examined.

Methods

Children 12-18 mo of age (n = 123) were selected for 3 groups: 1) retinol intake >600 µg/d and VAS within the past mo, 2) retinol intake >600 µg/d and VAS in the past 3-6 mo, and 3) VA intake 200-500 µg retinol activity equivalents (RAE)/d and VAS in the past 3-6 mo. Dietary intake data were collected to measure VA intakes from complementary foods, breast milk, and low-dose, over-the-counter supplements. TBS were assessed by retinol isotope dilution, and VA toxicity biomarkers were measured. Main outcomes were compared by group.

Results

Mean (95% CI) VA intakes excluding VAS were 1184 (942, 1426), 980 (772, 1187), and 627 (530, 724) µg RAE/d, in groups 1-3, respectively; mean VA intake was higher in groups 1 and 2 compared with group 3 (P < 0.05). Geometric mean (GM) (95% CI) TBS were 589 (525, 661), 493 (435, 559), and 466 (411, 528) µmol, respectively. GM TBS and GM liver VA concentrations were higher in group 1 compared with group 3 (liver VA concentration: 1.62 vs. 1.33 µmol/g; P < 0.05). Plasma retinyl ester and 4-oxo-retinoic acid concentrations and serum markers of bone turnover and liver damage did not indicate VA toxicity.

Conclusions

In this sample, most children had retinol intakes above the Tolerable Upper Intake Level (UL) and liver VA concentrations above the proposed cutoff for "hypervitaminosis A" (>1 µmol/g liver). There was no evidence of chronic VA toxicity, suggesting that the liver VA cutoff value should be re-evaluated. This trial was registered at www.clinicaltrials.gov as NCT03030339.

Regulatory Framework of Fortified Foods and Dietary Supplements for Athletes: An Interpretive Approach

A varied and well-planned diet can meet the nutritional needs of an athlete; however, in certain cases, it could be advisable to increase the intake of some vitamins, minerals or other components through the controlled intake of fortified foods or dietary supplements. In the European Union, a high number of sport foods and supplements are marketed; athletes could at times consume them indiscriminately or even choose products that have not been evaluated and approved by scientific evidence. In this sense, it is necessary to know and interpret the specific regulations for these products in order to make adequate use of them. The aim of this manuscript is to describe the current status of the European regulatory framework, focusing on: (1) regulation of the marketing and labelling of both fortified foods and supplements; (2) regulation of the use of substances used as ingredients in fortified foods; and (3) regulation of nutritional claims and/or health properties associated with nutrients, ingredients and other related substances. This review can facilitate knowledgeable decision making by sports nutrition professionals in order to counsel or manage adequate food choices as well as help consumers make better-informed food decisions. Other experts, such as producers who ensure food safety, might also be interested in this review.

Associations of atrophic gastritis and proton-pump inhibitor drug use with vitamin B-12 status, and the impact of fortified foods, in older adults

BACKGROUND

Atrophic gastritis (AG) and use of proton pump inhibitors (PPIs) result in gastric acid suppression that can impair the absorption of vitamin B-12 from foods. The crystalline vitamin B-12 form, found in fortified foods, does not require gastric acid for its absorption and could thus be beneficial for older adults with hypochlorhydria, but evidence is lacking.

OBJECTIVES

To investigate associations of AG and PPI use with vitamin B-12 status, and the potential protective role of fortified foods, in older adults.

METHODS

Eligible participants (n = 3299) not using vitamin B-12 supplements were drawn from the Trinity-Ulster and Department of Agriculture cohort, a study of noninstitutionalized adults aged ≥60 y and recruited in 2008-2012. Vitamin B-12 status was measured using 4 biomarkers, and vitamin B-12 deficiency was defined as a combined indicator value < -0.5. A pepsinogen I:II ratio <3 was considered indicative of AG.

RESULTS

AG was identified in 15% of participants and associated with significantly lower serum total vitamin B-12 (P < 0.001) and plasma holotranscobalamin (holoTC; P < 0.001), and higher prevalence of vitamin B-12 deficiency (38%), compared with PPI users (21%) and controls (without AG and nonusers of PPIs; 15%; P < 0.001). PPI drugs were used (≥6 mo) by 37% of participants and were associated with lower holoTC concentrations, but only in participants taking higher doses (≥30 mg/d). Regular, compared with nonregular, consumption of fortified foods (i.e., ≥5 and 0-4 portions/wk, respectively) was associated with higher vitamin B-12 biomarkers in all participants, but inadequate to restore normal vitamin B-12 status in those with AG.

CONCLUSIONS

Older adults who have AG and/or use higher doses of PPIs are more likely to have indicators of vitamin B-12 deficiency. Fortified foods, if consumed regularly, were associated with enhanced vitamin B-12 status, but higher levels of added vitamin B-12 than currently provided could be warranted to optimize status in people with AG.

Ingestion of supplements and fortified food with iodine on the breast milk iodine concentration in deficiency areas: a systematic review

Introduction

The level of iodine in breast milk may be inadequate and compromise the health of this, both due to excess and lack, some population groups remain deficient because of the low consumption of iodate salt, because there is an increase in consumption of other sources of iodine, such as supplements and fortified foods.

Objective

To evaluate the effect of the consumption of fortified foods and nutritional supplements with iodine on maternal milk levels.

Methodology

Systematic review based on the Prism method, using the descriptors provided by DeCS. The reading, selection and analysis of the methodological quality of the articles was done by two researchers independently.

Results

From 346 abstracts, 6 were eligible. The median iodination range between the studies ranged from 75 to 600 µg in supplements and 150 and 225 µg in fortified foods with effect on increased iodine concentration of breastmilk (BMIC), achieving the adequacy of the median BMIC in 4 of the 6 studies.

Conclusion

Iodine ingestion through supplements or fortified foods results in improved iodine levels in breast milk.

Role of food fortification with vitamin D and calcium in the bone remodeling process in postmenopausal women: a systematic review of randomized controlled trials

CONTEXT

Foods containing vitamin D reduce the deficiency of this vitamin and improve bone turnover.

OBJECTIVE

To discuss effects of the intake of vitamin D-fortified foods in isolated form or associated with calcium on bone remodeling in postmenopausal women.

DATA SOURCES

PubMed, Lilacs, Scopus, and Bireme databases. OpenThesis and Google Scholar were searched as "grey literature". Medical subject headings or similar terms related to food fortified with vitamin D and bone in postmenopausal women were used.

DATA EXTRACTION

Information was collected on study methodology and characteristics of studied populations; dosage; the food matrix used as the fortification vehicle; duration of intervention; dietary intake; 25-hydroxyvitamin D [25(OH)D] levels; serum parathyroid hormone (PTH) concentrations; bone resorption and/or formation markers (ie, carboxy terminal cross-linked telopeptide of type I collagen [CTX], tartrate-resistant acid phosphatase isoform 5b [TRAP5b], and procollagen type 1 N-terminal propeptide [P1NP]); main results; and study limitations.

DATA ANALYSIS

Five randomized controlled trials involving postmenopausal women were included. The mean ages of participants ranged from 56.1 to 86.9 years. Daily consumption of soft plain cheese fortified with 2.5 µg of vitamin D3 and 302 mg of calcium for 4 weeks resulted in a mean increase of 0.8 ng/mL in 25(OH)D and 15.9 ng/mL in P1NP levels compared with baseline, and decreased CTX, TRAP5b, and PTH values. A similar intervention for 6 weeks, using fortified cheese, showed a reduction only in TRAP5b values (-0.64 U/L). Yogurt fortified with 10 µg of vitamin D3 and 800 mg of calcium did not change P1NP values after 8 weeks of intervention, but was associated with decreases of 0.0286 ng/mL and 1.06 U/L in PTH and TRAP5b, respectively. After 12 weeks of eating the fortified yogurt, 25(OH)D levels increased by a mean of 8.8 ng/mL and PTH levels decreased in by a mean of 0.0167 ng/mL.

CONCLUSIONS

The interventions contributed toward the improvement of the bone resorption process but not to the bone formation process in postmenopausal women.

PROSPERO REGISTRATION NUMBER

CRD42019131976.

Acceptance of oat-based beverages tailored for patients with cancer

Oat-based beverages are a nutritious product with the potential to support increased nutrient intake of patients with cancer. The aim of this research was to evaluate the sensory acceptance of oat-based beverages and perceptions of oats among patients with cancer as future vehicles for nutrient delivery. In study 1, three flavors of oat-beverages were well accepted without significant difference in liking among flavors or serving temperature, or between patients with cancer and healthy participants. Patients with cancer more frequently rated the beverages as too sweet compared to healthy participants; flavor intensity was just about right for all participants. In the second study, one of two formulations fortified with protein and fish oil was not different in liking compared to the unfortified chocolate product. Patients associated oat food products with specific oat-based food products and oat health benefits in a free-word association task in the third study. Together, sensory acceptance and the perceived health benefits of oats indicate the potential for oats to be incorporated in fortified and unfortified products tailored for patients with cancer. PRACTICAL APPLICATION: The three studies presented here to assess the sensory acceptance of oat-based beverages and perceptions of oats among patients with cancer demonstrate that oats can be incorporated in fortified and unfortified products tailored for patients with cancer. Inadequate nutrition is highly prevalent among oncology patients and there is a lack of available products targeted to improve their nutritional intake. These findings can support product developers and sensory scientists in the development and evaluation of food products acceptable to this population.

Vitamins in Human and Donkey Milk: Functional and Nutritional Role

BACKGROUND

Whole milk is a good source of all the nutrients, and it also contains a sufficient number of vitamins to permit regular the growth of the neonate. Dairy cow milk can create allergy in infants less than 12 months old because of the high caseins and β-lactoglobulin content. In these circumstances, donkey milk can represent a good replacement for dairy cows' milk in children affected by Cow Milk Protein Allergy (CMPA) because of its close chemical composition with human milk, mainly due to its low protein and low mineral content. Milk vitamin content is highly variable among mammalian species and it is strictly correlated with the vitamin status and the diet administered to the mother. Fat-soluble vitamins content in donkey milk is, on average, lower compared to ruminants' milk, while vitamin C content determined in donkey milk is higher compared to dairy cows' milk, showing a great similarity with human milk. In donkey milk, the content of vitamins of the B-complex such as thiamine, riboflavin, niacin, pyridoxine, and folic acid is higher compared to human milk. The use of donkey milk as a new functional food must be further evaluated in interdisciplinary clinical trials in which pediatricians, dietitians, and food scientists must be involved to deepen the knowledge about the positive health impact of donkey milk in different sensitive people, especially children and the elderly.

Perspective: How to Develop Nutrient Profiling Models Intended for Global Use: A Manual

Nutrient profiling (NP) models aim to assess the nutritional quality of individual foods, according to their energy content and nutrient composition. NP models, initially created to prevent obesity in high-income countries, have tended to penalize dietary energy by giving lower ratings to foods containing excessive calories, fat, sugar, and salt. Energy-driven NP models may need to be reconceptualized for use in low- and middle-income countries (LMIC) where hunger, undernutrition, and micronutrient deficiencies continue to be issues of public health concern. Consistent with the position of the WHO that the purpose of NP methods is to address an identified public health problem, NP models intended for use in LMIC ought to address inadequate intakes of vitamin A, B vitamins, folate, calcium, iron, iodine, and zinc and the frequent lack of high-quality protein. Those models of nutrient density that feature beneficial nutrients (high-quality protein, vitamins, minerals, and trace elements) may be better suited to LMIC needs than are some current NP models that are wholly based around nutrients to limit. NP models intended for LMIC and global use will also need to take food fortification into account. The challenge for LMIC public health agencies is how to balance the future risk of excess "empty" calories against the continuing danger of inadequate nutrients and micronutrient deficiencies that persist at the population level.

Reducing the Burden of Anemia and Neural Tube Defects in Low- and Middle-Income Countries: An Analysis to Identify Countries with an Immediate Potential to Benefit from Large-Scale Mandatory Fortification of Wheat Flour and Rice

Using a predetermined set of criteria, including burden of anemia and neural tube defects (NTDs) and an enabling environment for large-scale fortification, this paper identifies 18 low- and middle-income countries with the highest and most immediate potential for large-scale wheat flour and/or rice fortification in terms of health impact and economic benefit. Adequately fortified staples, delivered at estimated coverage rates in these countries, have the potential to avert 72.1 million cases of anemia among non-pregnant women of reproductive age; 51,636 live births associated with folic acid-preventable NTDs (i.e., spina bifida, anencephaly); and 46,378 child deaths associated with NTDs annually. This equates to a 34% reduction in the number of cases of anemia and 38% reduction in the number of NTDs in the 18 countries identified. An estimated 5.4 million disability-adjusted life years (DALYs) could be averted annually, and an economic value of 31.8 billion United States dollars (USD) generated from 1 year of fortification at scale in women and children beneficiaries. This paper presents a missed opportunity and warrants an urgent call to action for the countries identified to potentially avert a significant number of preventable birth defects, anemia, and under-five child mortality and move closer to achieving health equity by 2030 for the Sustainable Development Goals.

Projected impact of mandatory food fortification with folic acid on neurosurgical capacity needed for treating spina bifida in Ethiopia

Spina bifida, also known as meningomyelocele, is a major birth defect mostly associated with folate deficiency in the mother early in pregnancy. The prevalence of spina bifida is disproportionately high in Ethiopia compared to the global average; about 10,500 liveborn are affected annually. Many affected infants do not receive timely repair surgery. There are a high number of stillbirths, and neonatal, infant, and under‐five deaths. Mandatory fortification of staple foods such as wheat and maize flour with folic acid, a B vitamin, is an effective primary prevention strategy for spina bifida. Survival in those with spina bifida increases if neurosurgical intervention is available soon after birth, along with continuous surgical and clinical aftercare throughout the lifespan. Currently, Ethiopia does not have mandatory food fortification for primary prevention or adequate neurosurgical capacity to meet the need to prevent adverse outcomes associated with spina bifida. We present in this paper two concurrent and complementary policy and practice solutions occurring in Ethiopia through global partnerships: (1) capacity‐building of neurosurgery care through training programs; and (2) promoting national mandatory folic acid fortification of staples for primary prevention of spina bifida. These two policy and practice interventions ensure all affected infants can receive timely pediatric neurosurgery and sustained surgical aftercare through required neurosurgeon availability, and ensure primary prevention of spina bifida. Primary prevention of spina bifida frees up significant neurosurgical capacity in resource‐poor settings that can then be directed to other critical neurosurgical needs thus lowering child mortality and morbidity.

Intake of Vitamins and Minerals From Voluntarily Fortified Foods and/or Dietary Supplements in School Adolescents in Central-Eastern Poland

Background: The key issue is whether voluntarily fortified foods and vitamin/mineral supplements available on the market serve public health needs. The study aim was to estimate nutrient intakes from voluntarily fortified foods and vitamin/mineral supplements in relation to the Dietary Reference Intake (DRI) in adolescents (n = 759) aged 13–19 who attended public secondary schools in Central-Eastern Poland.

Methods: Data on the consumption of voluntarily fortified foods were collected using a semi-quantitative food frequency questionnaire containing 58 food items. Data on the use of dietary supplements were assessed via an open-ended question. The content of nutrients was estimated using the producer's labeling declaration. The distribution of nutrient intakes according to the percentage of DRI categories (<20%, 20–39.9%, 40–59.9%, 60–79.9%, 80–99.9%, 100–119%, or >120%) was estimated.

Results: Consumption of voluntarily fortified foods was a common behavior in adolescents (86.7% of participants), while vitamin/mineral supplements were used by less than one-fifth of them (17.7%). The amounts of nutrient intakes from fortified foods and/or supplements were at different levels: (I) vitamins A, D, calcium, magnesium (>50% of adolescents did not exceed 20% of DRI); (II) vitamins E, B₁₂, iron (>50% of respondents consumed at least 20% of DRI); (III) niacin and pantothenic acid (>50% of respondents consumed at least 40% of DRI); IV) vitamins C, B₁, B₂, B₆, folate, biotin (>50% of participants consumed at least 60% of DRI). In a subgroup of respondents who used fortified foods and supplements simultaneously (n = 126), some nutrients (i.e., vitamins C, B₁, B₂, B₆, niacin, and biotin) were consumed in amounts ≥150% of DRI. Intake above the Tolerable Upper Intake Levels was observed for niacin, vitamin A, B₆ and folic acid in individual cases (up to 1.1% of respondents); a higher risk of overconsumption was associated with using vitamin/mineral supplements than voluntarily fortified foods.

Conclusion: Adolescents should be educated on how to reasonably use fortified foods and dietary supplements to help to overcome the potential deficiency of nutrients without causing excessive consumption.

Fortified Foods Are Major Contributors to Apparent Intakes of Vitamin A and Iodine, but Not Iron, in Diets of Women of Reproductive Age in 4 African Countries

BACKGROUND

Food fortification is implemented to increase intakes of specific nutrients in the diet, but contributions of fortified foods to nutrient intakes are rarely quantified.

OBJECTIVES

We quantified iron, vitamin A, and iodine intakes from fortified staple foods and condiments among women of reproductive age (WRA).

METHODS

In subnational (Nigeria, South Africa) and national (Tanzania, Uganda) cross-sectional, clustered household surveys, we assessed fortifiable food consumption. We estimated daily nutrient intakes from fortified foods among WRA by multiplying the daily apparent fortifiable food consumption (by adult male equivalent method) by a fortification content for the food. Two fortification contents were used: measured, based on the median amount quantified from individual food samples collected from households; and potential, based on the targeted amount in national fortification standards. Results for both approaches are reported as percentages of the estimated average requirement (EAR) and recommended nutrient intake (RNI).

RESULTS

Fortified foods made modest contributions to measured iron intakes (0%-13% RNI); potential intakes if standards are met were generally higher (0%-65% RNI). Fortified foods contributed substantially to measured vitamin A and iodine intakes (20%-125% and 88%-253% EAR, respectively); potential intakes were higher (53%-655% and 115%-377% EAR, respectively) and would exceed the tolerable upper intake level among 18%-56% of WRA for vitamin A in Nigeria and 1%-8% of WRA for iodine in Nigeria, Tanzania, and Uganda.

CONCLUSIONS

Fortified foods are major contributors to apparent intakes of vitamin A and iodine, but not iron, among WRA. Contributions to vitamin A and iodine are observed despite fortification standards not consistently being met and, if constraints to meeting standards are addressed, there is risk of excessive intakes in some countries. For all programs assessed, nutrient intakes from all dietary sources and fortification standards should be reviewed to inform adjustments where needed to avoid risk of low or excessive intakes.

Dietary Intake of Vitamin D from Dairy Products Reduces the Risk of Osteoporosis

Background: Vitamin D and calcium are important dietary compounds that affect bone mass, even if other minerals (potassium, zinc, etc.) and vitamins (A, C and K) are also involved. Vitamin D and certain minerals, in fact, play an important role in calcium homeostasis and calcium absorption. Hip fracture incidence is higher in Europe and the United States, where calcium is frequently included in the human diet; while the occurrence of these fractures is lower in developing countries, where diets are often poor in calcium. This condition is named the “calcium paradox”, and may be partially explained by phosphate toxicity, which can negatively affect mineral metabolism. It is important to maintain correct dietary calcium-phosphate balance in order to have a healthy life, reducing the risk of osteoporotic fractures in older people. Vitamin D can also act as a hormone; vitamin D2 (ergocalciferol) is derived from the UV-B radiation of ergosterol, the natural vitamin D precursor detected in plants, fungi, and invertebrates. Vitamin D3 (cholecalciferol) is synthesized by sunlight exposure from 7-dehydrocholesterol, a precursor of cholesterol that can also act as provitamin D3. Dietary intake of vitamin D3 is essential when the skin is exposed for short periods to ultraviolet B light (UV-B), a category of invisible light rays such as UV-A and UV-C. This can be considered the usual situation in northern latitudes during the winter season, or the typical lifestyle for older people and/or for people with very white delicate skin. The actual recommended daily intake of dietary vitamin D is strictly correlated with age, ranging from 5 μg for infants, children, teenagers, and adults—including pregnant and lactating women—to 15 μg for people over 65 years.

Iron and folic acid: natural, enriched, fortified, and supplements. Analysis of food sources in the Autonomous City of Buenos Aires

INTRODUCTION

Fortification and supplementation are two strategies for micronutrient deficiency prevention. The objective of this study was to describe the source of iron and folic acid intake throughout the life cycle in the population of the Autonomous City of Buenos Aires.

POULATION AND METHODS

Analysis of the information collected in the First Survey on Nutritional Food Intake of the Autonomous City of Buenos Aires (2011), which had a probability cluster sampling design. Consumption was assessed by means of a 24-hour recall. Iron and folic acid intake was estimated and categorized into natural content, enriched wheat flour, milk from the Maternal and Child Plan, fortified foods, and supplements.

RESULTS

Out of the 5369 studied individuals, practically all got iron and folic acid from natural contents (58 % and 29 % of intake, respectively). More than 90 % consumed enriched wheat flour, which provided 28 % of iron and 54 % of folic acid. Fortified food consumption and intake varied greatly. Milk intake from the Maternal and Child Plan was small, even in specific groups. Intake from supplements was low, except in children < 2 years old (30 % consumed iron supplements, which accounted for 38 % of iron).

CONCLUSION

In addition to natural intake from foods, enriched wheat flour accounted for a major source of folic acid and iron in this population; intake from fortified foods and supplements varied by age group.

Impact of behaviour change communication interventions on sales of fortified sunflower oil in Tanzania: A spatial-temporal analysis and association study

The Masava project was implemented in Manyara and Shinyanga regions in Tanzania to improve vitamin A intake by making available vitamin A-fortified sunflower oil with a subsidy through a mobile phone-based e-Voucher system. This study was conducted to assess the impact of the behaviour change communication (BCC) campaign of the project on volume of sales of vitamin A-fortified sunflower oil. The e-Voucher system provides real-time data on the number of e-Vouchers redeemed. The number, type, and locations of BCC events were obtained from the implementation agency. Multivariate linear regression was used to examine the associations between (a) the number and type of BCC events conducted in a ward and the volume of subsequent fortified oil redeemed in the ward and (b) distance of clinic shows, a component of the BCC campaign, from participating retailers and the volume of fortified oil redeemed in the store. After 1 year of the campaign, the volume of fortified oil redeemed monthly increased by more than 5 times in Manyara and by more than three times in Shinyanga. Among the different types of BCC events conducted, only clinic shows and cooking shows were significantly associated with the volume of redemptions (p < .05). Compared with retailers where at least one clinic show was conducted within 0.5 km from its location, the volume of redemptions was significantly lower at retailers where no clinic show conducted within 3.0 km from its location (p < .05). These findings suggest that future health promotion interventions in rural Africa should involve health clinics.

Nutraceuticals' Novel Formulations: The Good, the Bad, the Unknown and Patents Involved

Traditional nutraceuticals and cosmeceuticals hold pragmatic nature with respect to their definitions, claims, purposes and marketing strategies. Their definitions are not well established worldwide. They also have different regulatory definitions and registration regulatory processes in different parts of the world. Global prevalence of nutraceuticals and cosmeceuticals is noticeably high with large market share with minimal regulation compared to traditional drugs. The global market is flooded with nutraceuticals and cosmeceuticals claiming to be of natural origin and sold with a therapeutic claim by major online retail stores such as Amazon and eBay. Apart from the traditional formulations, many manufacturers and researchers use novel formulation technologies in nutraceutical and cosmeceutical formulations for different reasons and objectives. Manufacturers tend to differentiate their products with novel formulations to increase market appeal and sales. On the other hand, researchers use novel strategies to enhance nutraceuticals and cosmeceuticals activity and safety. The objective of this review is to assess the current patents and research adopting novel formulation strategies in nutraceuticals and cosmeceuticals. Patents and research papers investigating nutraceutical and cosmeceutical novel formulations were surveyed for the past 15 years. Various nanosystems and advanced biotechnology systems have been introduced to improve the therapeutic efficacy, safety and market appeal of nutraceuticals and cosmeceuticals, including liposomes, polymeric micelles, quantum dots, nanoparticles, and dendrimers. This review provides an overview of nutraceuticals and cosmeceuticals current technologies, highlighting their pros, cons, misconceptions, regulatory definitions and market. This review also aims in separating the science from fiction in the nutraceuticals and cosmeceuticals development, research and marketing.

Do Current Fortification and Supplementation Programs Assure Adequate Intake of Fat-Soluble Vitamins in Belgian Infants, Toddlers, Pregnant Women, and Lactating Women?

Abstracts: Adequate intakes of fat-soluble vitamins are essential to support the growth and development of the foetus, the neonate, and the young child. By means of an online self-administered frequency questionnaire, this study aimed to evaluate the intake of vitamins A, D, E, and K in Belgian infants (n = 455), toddlers (n = 265), pregnant women (n = 161), and lactating women (n = 165). The contribution of foods, fortified foods, and supplements on the total intake was quantified. 5% of toddlers, 16% of pregnant women, and 35% of lactating women had an inadequate vitamin A intake. Conversely, excessive vitamin A intakes were associated with consumption of liver (products). Furthermore, 22% of infants were at risk for inadequate vitamin D intake due to the lack of prophylaxis, while consumption of highly dosed supplements posed a risk for excessive intakes in 6%-26% of infants. Vitamin D intake in pregnant women and lactating women was inadequate (median of 51%, respectively, 60% of the adequate intake). In all groups, the risk for inadequate intake of vitamin E and K was low. Contribution of fortified foods to vitamin A, D, E, and K intake was minor, except in toddlers. National fortification strategies should be investigated as an alternative or additional strategy to prevent vitamin D and A deficiency. There is a need to revise and set uniform supplement recommendations. Finally, non-users of vitamin D prophylaxis need to be identified for targeted treatment.

Intake of Fat-Soluble Vitamins in the Belgian Population: Adequacy and Contribution of Foods, Fortified Foods and Supplements

A key challenge of public health nutrition is to provide the majority of the population with a sufficient level of micronutrients while preventing high-consumers from exceeding the tolerable upper intake level. Data of the 2014 Belgian food consumption survey (n = 3200) were used to assess fat-soluble vitamin (vitamins A, D, E and K) intake from the consumption of foods, fortified foods and supplements. This study revealed inadequate intakes for vitamin A, from all sources, in the entire Belgian population and possible inadequacies for vitamin D. The prevalence of inadequate intake of vitamin A was lowest in children aged 3-6 (6-7%) and highest in adolescents (girls, 26%; boys, 34-37%). Except for women aged 60-64 years, more than 95% of the subjects had vitamin D intake from all sources below the adequate intake (AI) of 15 μg/day. The risk for inadequate intake of vitamins K and E was low (median > AI). Belgian fortification and supplementation practices are currently inadequate to eradicate suboptimal intakes of vitamins A and D, but increase median vitamin E intake close to the adequate intake. For vitamin A, a small proportion (1-4%) of young children were at risk of exceeding the upper intake level (UL), while for vitamin D, inclusion of supplements slightly increased the risk for excessive intakes (% > UL) in adult women and young children. The results may guide health authorities when developing population health interventions and regulations to ensure adequate intake of fat-soluble vitamins in Belgium.

[Experimental and scientific formulation development of a specialized (sport) product, enriched with probiotic microorganisms]

The aim of the work is to scientifically justify the formulation of a probiotic food product for sports nutrition using a functional food ingredient. As a functional food ingredient, the association of probiotics (Lactobacillus and bifidobacteria) immobilized in a gel of biopolymers was studied. The main raw material used was cow's fat-free milk; as components that regulated the protein-carbohydrate composition of a multicomponent product, the whey protein isolate, natural honey and maltodextrin were chosen. A complex containing defibrated blood and an extract of reindeer antlers was used as an adaptogen of animal origin. In order to complement the qualitative and quantitative composition of vitamins and minerals, a premix containing 7 vitamins, calcium and iron was used. The process of obtaining a functional ingredient for fermenting a normalized mixture and enriching the product with viable probiotic cells is outlined. To protect them in the aggressive conditions of the technological process, as well as in the stomach and intestine, the process of immobilization by incorporating the association of probiotics into the gel of biopolymers was studied. The effectiveness of the delivery of the association of probiotic microorganisms immobilized in the gel of biopolymers was proved by carrying out studies in simulated conditions of the stomach and intestine. The functional food ingredient obtained experimentally was used for fermentation of a normalized mixture of components in the technology of a fermented (sour-milk) product for sport's nutrition.

[Modern state and prospects of the development of production of specialized foodstuffs for athletes]

Nutrition is a very important element in the training of athletes - both professionals and amateurs. Sports exercises accompanied by significant energy expenditure, hypoxia, large neuro-psychological stress that caused the body's increased need for energy and certain nutrients. It is almost impossible to provide athletes' needs through the regular diet, so during the training cycle they used specifically developed nutrition' systems. Modern methodology of athletes' nutrition makes provisions of using special diet, including not only conventional, but also fortified foods and dietary supplements, to compensate the comparative deficiency of any essential body' substratum and biologically active substances. Analytical researches indicate that lately generally in Russia, there is a tendency of increasing the number of people engaged in physical culture and sports, who needs specialized foodstuffs. Nowadays food and beverages intended for athletes of different specializations, widely represented in the Russian market, are mainly imported; the percentage of domestic specialized foodstuffs and beverages is small. In the last decade, native scientists developed a wide range of specialized foodstuffs for sportsmen's nutrition, that creates the prospect of the development of production of Russian foodstuffs with assured quality in order to achieve the best results in professional and amateur sports.

Defining 'nutraceuticals': neither nutritious nor pharmaceutical

There are widespread inconsistencies and contradictions in the many published definitions of 'nutraceuticals' and 'functional foods', demonstrating wholesale uncertainty about what they actually are. Furthermore, in a 2014 lecture, the inventor of the term 'nutraceutical', confessing that nutraceuticals do not work, said that 'the quest to demonstrate whether … long-term supplementation [with nutraceuticals] can prevent serious diseases … has come to an end'. Definitions of 'nutraceuticals' and related terms, still widely used, should therefore be explored systematically. There are no internationally agreed definitions of 'nutraceuticals' and 'functional foods', or of similar terms, such as 'health foods', or of terms related to herbal products, which are sometimes referred to as 'nutraceuticals', compounding the confusion. 'Nutraceuticals' and 'functional foods' are vague, nondiscriminatory, unhelpful terms; the evidence suggests that they should be abandoned in favour of more precise terms. The term 'dietary supplement' is widely used to designate formulations that are also called 'nutraceuticals' but it would be better restricted to individual compounds used to treat or prevent deficiencies. 'Fortified foods', sometimes called 'designer foods', are foods to which compounds of proven therapeutic or preventive efficacy (e.g. folic acid) have been added. Other terms, such as 'food', 'foodstuffs', 'eat', 'drink', and 'nutrition', are well defined, as are 'medicinal products' and 'pharmaceutical formulations'. Dietary regimens, such as Mediterranean or nitrate-rich diets or vegetarianism, can affect health. A dietary regimen of this kind can be defined as a programme of food, of a defined kind and/or quantity, prescribed or adopted for the restoration or preservation of health.

Use of Highly Fortified Products among US Adults

It is complicated to ascertain the composition and prevalence of the use of highly fortified food and supplement products (HFPs) because HFP foods and HFP supplements have different labeling requirements. However, HFPs (energy bars, energy drinks, sports drinks, protein bars, energy shots, and fortified foods/beverages) are popular in the United States. A web-based survey balanced to reflect US census data was used to describe their use in a sample of 2,355 US adults >18 yr in 2011 and trends in their use from 2005. In 2011, 33% of adults reported using HFP; use was significantly higher among males, African Americans, Hispanics, and more highly educated individuals (e.g. some college or more) and those <45 yr compared to non-users. Multiple product use was common. Of users, 46% consumed sports drinks, 37% fortified foods/beverages, 32% protein bars, 27% energy drinks, 24% energy bars, and 12% energy shots. For those HFP products as a group, prevalence of use was 36% (n=2039) in 2005, 35% in 2009 (n=2010), and 30% in 2011 (n=2355). Although use was significantly lower in 2011 than in 2005 especially among females, non-Hispanics, and those with high school education or less (P≤0.05). HFP, particularly energy and sports drinks, continue to be widely used by many U.S. adults.

Beyond the 'raw' and the 'cooked': a history of fortified blended foods

This paper offers a history of fortified blended foods, a humanitarian product that first emerged in the middle of the twentieth century. Tracing its emergence and development, the paper argues that this food was the product of four key historical trends: (i) the search for a compact and efficient diet in the wake of the Second World War; (ii) the high modernist movement that saw science and technology as a way to improve on traditional foods; (iii) the state-led industrialisation of the development decades oriented around the notion of a worldwide 'protein gap'; and (iv) the legacy of 'productivist' agriculture in the United States, generating massive surpluses in certain crops that had to be adapted creatively for a multitude of uses. The paper positions fortified blended foods in these broader historical processes, and asserts that humanitarian techniques are very much rooted in cultural, political, and social conditions.

Novel strategies for capturing health-protective mango phytochemicals in shelf stable food matrices

Cost-effective methods for concentration and stabilization of otherwise perishable mango fruit phytoactives into shelf stable high protein ingredients were developed to combat stunting (malnutrition) in rural Africa. Mango juices complexed with sunflower oil and protein-rich legume flours yielded carotenoid-enriched oils and pelleted polyphenol-enriched flour matrices. Carotenoids from juices were concentrated 9-10 times in the fortified sunflower oil. Protein-rich soy and peanut flours captured 2.2-3.2 mg/g polyphenols from the juices. Alternatively, mango juice was sorbed and co-dried with flours, which stably bound the polyphenols, carotenoids, and natural sugars in soy or peanut protein-rich matrices. The concentration of provitamin A carotenoids was almost doubled and total polyphenols were enriched 4-5 times higher in the matrices compared to fresh pureed juice. Both strategies require minimal instrumentation, are compatible with rural village dietary practices; and capture the benefits of otherwise perishable seasonal resources by complexing healthful proteins together with phytoactive compounds.

Effectiveness of the National Program of Complementary Feeding for older adults in Chile on vitamin B12 status in older adults; secondary outcome analysis from the CENEX Study (ISRCTN48153354)

BACKGROUND

Older people are at increased risk of vitamin B12 deficiency and the provision of fortified foods may be an effective way to ensure good vitamin B12 status in later life.

AIM

To evaluate the effectiveness of a vitamin B12 fortified food provided by a national program of complementary food for older people on plasma vitamin B12 levels.

SUBJECTS AND METHODS

A random sub-sample of 351 subjects aged 65-67 y from a large cluster randomised controlled trial provided blood samples at baseline and after 24 months of intervention. The intervention arm (10 clusters 186 participants) received a vitamin B12 fortified food designed to deliver 1.4 μg/day, while the control arm did not receive complementary food (10 clusters, 165 participants). Serum vitamin B12 and folate levels determined by radioimmunoassay were used to estimate the effect of intervention on vitamin B12 levels, adjusting for baseline levels and sex.

RESULTS

Attrition at 24 months was 16.7% and 23.6% in the intervention and control arms respectively (p = 0.07). Over 24 months of intervention, mean (95% CI) serum vitamin B12 decreased from 392 (359-425) pmol/dL to 357 (300-414) pmol/dL (p < 0.07) in the intervention arm and from 395 (350-440) pmol/dL to 351 (308-395) pmol/dL in the control arm. There was no significant effect of the intervention on folate status.

DISCUSSION

Our findings suggest that foods fortified with 1.4 μg/daily vitamin B12 as provided by Chile's national programme for older people are insufficient to ensure adequate vitamin B12 levels in this population. Chile has a long and successful experience with nutrition intervention programs; however, the country's changing demographic and nutritional profiles require a constant adjustment of the programs.