Procedure to identify fortified foods in the Dutch branded food database

Introduction

Information on fortified foods is needed for multiple purposes, including food consumption research and dietary advice. Branded food databases are a valuable source of food label data. European labeling legislation prescribes that food fortification should be indicated in the ingredient list, and nutrient values should be declared under certain conditions. This creates the potential to identify fortified foods in branded food databases, though it is not straightforward and labor-intensive. The aim of our study was to develop an automated approach to identify fortified foods in the Dutch branded food database called LEDA.

Methods

An automated procedure, based on a stepwise approach conforming with European labeling legislation, using a list of rules and search terms, was developed to identify fortified foods. Fortification with calcium, folic acid, vitamin B12, and zinc was studied as an example. The results of a random stratified sample with fortified and not-fortified foods were validated by two experts.

Results

The automated approach resulted in identifying 1,817 foods fortified with one or more of the selected nutrients in the LEDA dataset (0.94%). The proportions of fortified foods per nutrient were below 0.7%. The classification of fortified/non-fortified foods matched manual validation by experts for the majority of the foods in the sample, i.e., sensitivity and specificity indicating the probability of correctly identifying fortified and non-fortified foods was high (>94.0%).

Conclusion

The automated approach is capable of easily and quickly identifying fortified foods in the Dutch branded food database with high accuracy, although some improvements to the automated procedure could be made. In addition, the completeness, correctness, and consistency of the LEDA database can be improved. To fully benefit from this automated approach, it needs to be expanded to cover all micronutrients that may be added to foods.

Consumption of Iron-Fortified Lentils Is Protective against Declining Iron Status among Adolescent Girls in Bangladesh: Evidence from a Community-Based Double-Blind, Cluster-Randomized Controlled Trial

BACKGROUND

In many low-income countries, iron deficiency (ID) and its anemia (IDA) pose significant health challenges, particularly among females and girls. Finding sustainable and effective solutions to address this issue is critical.

OBJECTIVES

This study aimed to evaluate the efficacy of incorporating iron-fortified lentils (IFLs) into the diets of rural Bangladeshi adolescent girls on their body iron (Fe) status.

METHODS

A community-based, double-blind, cluster-randomized controlled trial involved n = 1195 girls aged 10-17 y. A total of 48 adolescent clubs (n = ∼27 girls each) were randomized into 3 groups: 1) 200 g cooked IFLs, 2) 200 g cooked noniron-fortified lentils (NIFLs), and 3) a control group with no lentils (usual dietary intake). The intervention, administered 5 days a week for 85 feeding days, provided ∼8.625 mg Fe from each serving of IFLs and 2.625 mg from NIFLs. Blood samples collected at baseline, midpoint (42 feeding days), and endpoint (85 feeding days) assessed key Fe and inflammation biomarkers. Statistical analyses were filtered for inflammation.

RESULTS

Although all groups experienced a decline in Fe status over time, the IFL group exhibited a significantly reduced decline in serum ferritin (sFer -7.2 μg/L), and total body iron (TBI -0.48 mg/kg) level compared with NIFL (sFer -14.3 μg/L and TBI -1.36 mg/kg) and usual intake group (sFer -12.8 μg/L and TBI -1.33 mg/kg). Additionally, those in the IFL group had a 57% reduced risk of developing clinical ID (sFer <15 μg/L) compared with the usual intake group.

CONCLUSIONS

Our findings suggest that incorporating IFLs into the diet can help mitigate a decline in sFer, indicating a positive impact on the body Fe status of adolescent girls. This research underscores the potential role of fortified foods in addressing ID and IDA in vulnerable populations, emphasizing the significance of food-based interventions in public health.

TRIAL REGISTRATION NUMBER

This trial was registered at the clinicaltrials.gov on May 24, 2018 (https://clinicaltrials.gov/study/NCT03516734?locStr=Bangladesh&country=Bangladesh&distance=50&cond=Anemia&intr=Iron%20fortified%20lentils&rank=1) as NCT03516734.

Update on the impact of voluntary folic acid fortification of corn masa flour on red blood cell folate concentrations-National Health and Nutrition Examination Survey, 2011-March 2020

BACKGROUND

Folic acid is a micronutrient that is effective at preventing neural tube defects (NTDs). In 2016, the FDA authorized the voluntary fortification of corn masa flour (CMF) with folic acid to reduce disparities in NTDs among infants of women who do not regularly consume other fortified cereal grains, in particular Hispanic women of reproductive age (WRA).

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2011 to March 2020 assessing the impact of voluntary fortification of CMF on the folate status of Hispanic WRA. We analyzed folic acid usual intake and red blood cell (RBC) folate concentrations among non-pregnant, non-lactating Hispanic WRA, comparing pre-fortification (2011-2016) to post-fortification (2017-March 2020) data. RBC folate concentrations were used to create model-based estimation of NTD rates.

RESULTS

The proportion of Hispanic WRA with folic acid usual intakes <400 μg/d did not change (2011-2016: 86.1% [95% Confidence Interval, CI: 83.7-88.5]; 2017-March 2020: 87.8% [95% CI: 84.8-90.7]; p = .38) nor did the proportion of Hispanic WRA with RBC folate below optimal concentrations (<748 nmol/L, 2011-2016: 16.0% [95% CI: 13.7-18.2]; 2017-March 2020: 18.1% [95% CI: 12.1-24.0]; p = 0.49). Model-based estimates of NTD rates suggest further improvements in the folate status of Hispanic WRA might prevent an additional 157 (95% Uncertainty Interval: 0, 288) NTDs/year.

CONCLUSIONS

Voluntary fortification of CMF with folic acid has yet to have a significant impact on the folate status of WRA. Continued monitoring and further research into factors such as fortified product availability, community knowledge, and awareness of folic acid benefits would inform and improve future public health interventions.

Optimal omegas - barriers and novel methods to narrow omega-3 gaps. A narrative review

Dietary intakes of omega-3 long chain polyunsaturated fatty acids (O3LC-PUFAs) such as eicosapentaenoic and docosahexaenoic acid are central to development and health across the life course. O3LC-PUFAs have been linked to neurological development, maternal and child health and the etiology of certain non-communicable diseases including age-related cognitive decline, cardiovascular disease, and diabetes. However, dietary inadequacies exist in the United Kingdom and on a wider global scale. One predominant dietary source of O3LC-PUFAs is fish and fish oils. However, growing concerns about overfishing, oceanic contaminants such as dioxins and microplastics and the trend towards plant-based diets appear to be acting as cumulative barriers to O3LC-PUFAs from these food sources. Microalgae are an alternative provider of O3LC-PUFA-rich oils. The delivery of these into food systems is gaining interest. The present narrative review aims to discuss the present barriers to obtaining suitable levels of O3LC-PUFAs for health and wellbeing. It then discusses potential ways forward focusing on innovative delivery methods to utilize O3LC-PUFA-rich oils including the use of fortification strategies, bioengineered plants, microencapsulation, and microalgae.

A blueprint for fortification planning and programming: Lessons learned from an analytical review of existing fortification frameworks

With multiple food fortification frameworks, countries can find it challenging to determine optimal methods for planning and implementing food fortification programmes to combat vitamin and mineral deficiencies, especially without additional technical support. To address this challenge, this study aimed to review existing frameworks to determine consistencies, differences, strengths, and weaknesses across the frameworks, and based on the review findings, formulate an enhanced and streamlined fortification framework. Nineteen frameworks were ultimately examined following a comprehensive literature review and key informant interviews. Generally, the reviewed frameworks amply describe motives and methods for the determination of fortification need and feasibility, industry engagement/quality assurance and quality control, and impact evaluations/surveillance. However, there was limited inclusion or discussion throughout the reviewed frameworks around harmonization of fortification with existing micronutrient interventions; fortification policy and/or strategy; enforcement, incentives, and penalties to ensure producer compliance with industry standards; and periodic fortification programme review and reassessment. The findings were used to develop a comprehensive Fortification Blueprint that aims to provide structured guidance and a library of tools and resources to fortification programme managers and key stakeholders to ensure optimal and sustainable programme design.

Benefits and Harms of Edible Vegetable Oils and Fats Fortified with Vitamins A and D as a Public Health Intervention in the General Population: A Systematic Review of Interventions

This systematic review aims to assess whether edible vegetable oils and fats fortified with vitamin A and/or D are effective and safe in improving vitamin intake and ameliorating deficiency states in the general population. In November 2022, we systematically searched MEDLINE, Cochrane CENTRAL, Scopus, Global Index Medicus, ClinicalTrials.gov, and WHO ICTRP (International Clinical Trials Registry Platform) for randomized controlled trials (RCT) and non-randomized studies of interventions (NRSI) investigating the fortification of edible vegetable oils and fats with either vitamin A or vitamin D or both as compared to the same vegetable oils and/or fats without vitamin A and D fortification or no interventions, in the general population, without age restriction. We assessed the methodological quality of included RCTs using Cochrane's risk of bias tool 2.0 and of NRSIs using ROBINS-I tool. We performed random-effects meta-analysis and assessed certainty of evidence using GRADE. We included eight studies. Available evidence showed no significant effect of fortification with vitamin A on serum retinol levels (RCTs: MD 0.35 µmol/L, 95% CI -0.43 to 1.12; two trials; 514 participants; low-certainty evidence; CCTs: MD 0.31 µmol/L, 95% CI -0.18 to 0.80; two trials; 205 participants; very low-certainty evidence) and on subclinical vitamin A deficiency. Low-certainty evidence showed no effect of vitamin D fortification on serum 25-hydroxy vitamin D concentration (MD 6.59 nmol/L, 95% CI -6.89 to 20.07; one trial; 62 participants). In conclusion, vitamin A-fortified vegetable oils and fats may result in little to no difference in serum retinol levels in general populations. The dose of vitamin A used in the trials may be safe but may not be sufficient to reduce subclinical vitamin A deficiency. Further, the evidence suggests that vitamin D fortification results in little to no difference in serum 25-hydroxy vitamin D concentration. Several aspects of providing fortified oils and fats to the general population as a public health intervention should be further investigated, including optimal fortification dose, effects on vitamin D deficiency and its clinical symptoms and potential adverse effects.

Elevating Cereal-Based Nutrition: Moringa oleifera Supplemented Bread and Biscuits

Enhancing the nutritional value of commonly consumed, cost-effective staple foods, such as bread and biscuits, by fortifying them with Moringa oleifera leaf powder (MOLP) and its phenolic-rich extract holds substantial potential for addressing malnutrition. This study evaluated the phenolic extract from MOLP obtained through Soxhlet extraction, focusing on its antioxidant, antibacterial, and antidiabetic properties. The resulting extract exhibited a total phenolic content (TPC) of 138.2 mg of gallic acid equivalents/g. The ABTS and DPPH assays presented IC50 values of 115.2 mg/L and 544.0 mg/L, respectively. Furthermore, the extract displayed notable α-amylase inhibition and no cytotoxicity towards human fibroblasts. The primary phenolic compounds identified were catechin, epicatechin, and caffeic acid. Subsequently, MOLP and its extract were incorporated into bread and biscuits, replacing 5% of wheat flour, resulting in fortified functional foods. The fortified products exhibited improved TPC and antioxidant activity compared to the non-fortified foods. Furthermore, they displayed the ability to inhibit microbial growth, leading to an extended shelf life. Sensory analysis indicated that the products incorporated with the extract were preferred over those with MOLP. These results have demonstrated the viability of using MOLP and its phenolic-rich extract as an environmentally sustainable strategy for enhancing the quality of cereal-based products.

Properties and physiological effects of dietary fiber-enriched meat products: a review

Meat is a rich source of high biological proteins, vitamins, and minerals, but it is devoid of dietary fiber, an essential non-digestible carbohydrate component such as cellulose, hemicellulose, pectin, lignin, polysaccharides, and oligosaccharides. Dietary fibers are basically obtained from various cereals, legumes, fruits, vegetables, and their by-products and have numerous nutritional, functional, and health-benefiting properties. So, these fibers can be added to meat products to enhance their physicochemical properties, chemical composition, textural properties, and organoleptic qualities, as well as biological activities in controlling various lifestyle ailments such as obesity, certain cancers, type-II diabetes, cardiovascular diseases, and bowel disorders. These dietary fibers can also be used in meat products as an efficient extender/binder/filler to reduce the cost of production by increasing the cooking yield as well as by reducing the lean meat content and also as a fat replacer to minimize unhealthy fat content in the developed meat products. So, growing interest has been observed among meat processors, researchers, and scientists in exploring various new sources of dietary fibers for developing dietary fiber-enriched meat products in recent years. In the present review, various novel sources of dietary fibers, their physiological effects, their use in meat products, and their impact on various physicochemical, functional, and sensory attributes have been focused.

Bioactive Ingredients from Dairy-Based Lactic Acid Bacterial Fermentations for Functional Food Production and Their Health Effects

Lactic acid bacteria are traditionally applied in a variety of fermented food products, and they have the ability to produce a wide range of bioactive ingredients during fermentation, including vitamins, bacteriocins, bioactive peptides, and bioactive compounds. The bioactivity and health benefits associated with these ingredients have garnered interest in applications in the functional dairy market and have relevance both as components produced in situ and as functional additives. This review provides a brief description of the regulations regarding the functional food market in the European Union, as well as an overview of some of the functional dairy products currently available in the Irish and European markets. A better understanding of the production of these ingredients excreted by lactic acid bacteria can further drive the development and innovation of the continuously growing functional food market.

Treatment of vitamin D deficiency in children

INTRODUCTION

Vitamin D deficiency affects from 10% to 50% in various pediatric population groups and causes life-threatening hypocalcemia in infants, crippling rickets in infants and children, and increased risk of subsequent adult metabolic and neurologic problems.

AREAS COVERED

An English language literature search of PubMed was performed since 1940 as were the authors' personal literature collections. References identified in the reviewed literature are considered.

DIAGNOSIS

The diagnosis of vitamin D deficiency is based on serum 25-hydroxyvitamin D levels. Clinical features of rickets include bone deformities and elevated alkaline phosphatase. Most children and adolescents who are biochemically vitamin D deficient do not have specific symptoms or signs of deficiency.

PREVENTION

Prevention of vitamin D deficiency is via exposure to sunshine, food and beverage fortification, and dietary supplementation.

TREATMENT

Effective treatment of vitamin D deficiency is via oral or injectable administration of vitamin D. Dosing and duration of vitamin D therapy have been described for healthy children and for children with underlying medical conditions, but recommendations vary.

EXPERT OPINION

Further investigation is needed to determine long-term non-skeletal effects of childhood vitamin D deficiency, benefits of supplementation in asymptomatic individuals with biochemical vitamin D deficiency, and appropriate screening for vitamin D deficiency in asymptomatic children and adolescents.

Industry Self-Regulation of Food Fortification Compliance: Piloting the Micronutrient Fortification Index in Nigeria

Sustaining large-scale and good-quality food fortification requires strategies that incentivize food processors to invest in and consistently meet national food fortification standards where they exist. A standardized Micronutrient Fortification Index (MFI) piloted in Nigeria has provided a ranking of fortified branded products for each participating company, based on a score aggregating the effectiveness and efficiency of the company's systems and levels of product fortification. The MFI has demonstrated the significance of brands as a focal point for investment and industry accountability in food fortification and the power of harnessing the competitive nature of businesses to drive their food fortification performance. The initiative started with a pilot consisting of well-known brands of 4 companies and has since expanded participation to 15 companies, representing 31 brands, having completed the first entire ranking cycle. The publicly listed brands on the Index now cover approximately 80% of the flour milling market, 40% of the edible oils market, and 88% of the sugar market in Nigeria, reaching an estimated 134 million people in the country in 2022 according to analysis by TechnoServe Supporting African Processors of Fortified Foods (SAPFF) program in Nigeria. The data inputs are made through company-owned digital portals, and the results are published on a secure, web-based public portal which also serves as a gateway for stakeholders to access related information on micronutrient fortification and food quality (https://technoserve-mfi.web.app/). The ultimate aim of the MFI is to serve as a leverage for private sector efforts to both digitalize quality assurance and business processes linked to industrial automation and to harness their competitiveness through voluntary participation in the Index to drive improved food fortification performance based on industry best practices and quality benchmarks.

Implementing micronutrient fortification programs as a potential practical contribution to achieving sustainable diets

Due to sustainability concerns related to current diets and environmental challenges, it is crucial to have sound policies to protect human and planetary health. It is proposed that sustainable diets will improve public health and food security and decrease the food system's effect on the environment. Micronutrient deficiencies are a well-known major public health concern. One-third to half of the world's population suffers from nutrient deficiencies, which have a negative impact on society in terms of unrealised potential and lost economic productivity. Large-scale fortification with different micronutrients has been found to be a useful strategy to improve public health. As a cost-effective strategy to improve micronutrient deficiency, this review explores the role of micronutrient fortification programmes in ensuring the nutritional quality (and affordability) of diets that are adjusted to help ensure environmental sustainability in the face of climate change, for example by replacing some animal-sourced foods with nutrient-dense, plant-sourced foods fortified with the micronutrients commonly supplied by animal-sourced foods. Additionally, micronutrient fortification considers food preferences based on the dimensions of a culturally sustainable diet. Thus, we conclude that investing in micronutrient fortification could play a significant role in preventing and controlling micronutrient deficiencies, improving diets and being environmentally, culturally and economically sustainable.

Fortification of Staple Foods for Household Use with Vitamin D: An Overview of Systematic Reviews

Vitamin D deficiency is a global public health concern with significant implications for bone health and chronic disease prevention. Our aim was to summarize the evidence from Cochrane and other systematic reviews evaluating the benefits or harms of vitamin D fortification of staple foods for household use. In April 2023, we systematically searched Ovid MEDLINE, Embase, Epistemonikos and the Cochrane Database of Systematic Reviews for systematic reviews investigating the effects of vitamin D fortification of food in general populations of any age. We used Cochrane methodology and assessed the methodological quality of included studies using AMSTAR (A MeaSurement Tool to Assess Systematic Reviews). We assessed the degree of overlap among reviews. All outcomes included in systematic reviews were assessed. The protocol is registered in PROSPERO (registration number: CRD42023420991). We included 27 systematic reviews out of 5028 records for analysis. Overall, 11 out of 12 systematic reviews calculating pooled estimates reported a significant increase in serum 25(OH)D concentrations. The mean change in serum 25(OH)D concentrations per additional 100 units of vitamin D ranged from 0.7 to 10.8 nmol/L. Fortification of food with vitamin D showed a reduction in the prevalence of vitamin D deficiency based on high-certainty evidence. Parathormone (PTH) levels were described to decrease, bone mineral density to increase, while the effects on other bone turnover markers were inconsistent. Fortification did not significantly impact most anthropometric parameters, but it seemed to positively influence lipid profiles. In summary, fortification of food with vitamin D results in a reduction of vitamin D deficiency and might increase serum 25(OH)D concentrations, to varying extents depending on the fortified vehicle and population characteristics. Additionally, fortification may have a positive impact on bone turnover and lipid metabolism but may only have a limited effect on anthropometric parameters.

Innovative Approaches for Food: Using Natural Phenolic-Rich Extracts to Produce Value-Added Fresh Pasta

Cereal-based products, which are rich in carbohydrates, are widely consumed worldwide; however, this type of food lacks other nutrients. Phenolic compounds from natural sources, such as Moringa oleifera, can be incorporated into these products to increase their nutritional and biological value. In this study, a phenolic-rich extract was obtained from M. oleifera leaf powder using a Soxhlet extractor. The extract obtained presented a total phenolic content of 79.0 mg of gallic acid equivalents/g and the ABTS and DPPH assays showed that the extract can act as an anti-oxidant agent, with IC50 values of 205.2 mg/L and 636.0 mg/L, respectively. Afterwards, fresh pasta was produced and the extract was incorporated into the pasta to improve its biological properties and extend its shelf-life. The results demonstrated that the addition of M. oleifera to the fresh pasta increased its anti-oxidant capacity and did not interfere with the cooking properties of the product. Moreover, the fortified pasta presented an increased shelf-life, since the extract conferred protection against microbial contamination for longer periods of time. Therefore, these findings showed that the incorporation of phenolic-rich extracts from natural sources (such as M. oleifera) is a feasible sustainable biotechnological approach to produce value-added cereal-based products.

Trends in Micronutrient Interventions, Anemia, and Iron Deficiency among Women and Children in Guatemala, 2009-2019

Background

Food fortification and micronutrient supplementation are public health strategies to improve micronutrient status in Guatemala; their population effectiveness has not been evaluated in recent years.

Objective

We evaluated trends in food fortification, micronutrient supplementation, anemia, and iron deficiency among nonpregnant women aged 15-49 y [women of reproductive age (WRA)] and children 6-59 aged mo [preschool age children (PSC)].

Method

Nationally representative serial cross-sectional surveys were used to assess changes in hemoglobin, anemia, ferritin, iron deficiency, iron deficiency anemia, and self-reported consumption of fortifiable foods and micronutrient supplements during 2008/2009, 2013, 2015, 2016, 2017/2018, and 2018/2019. Predictors of hemoglobin and ferritin were assessed using generalized linear mixed models adjusted for survey year as random effects, and the consumption of fortifiable foods, supplements, and other potential confounders were fixed effects.

Results

Multiple micronutrient powder consumption among PSC during the previous 3 mo was 53.3% (95% CI: 49.4, 57.2) in 2013 and 33.6% (28.8, 38.4) in 2018/2019. Anemia among PSC was 11.3% (8.0, 14.5) in 2008/2009 and 6.1% (3.6, 8.6) in 2018/2019. Anemia among WRA was 10.7% (7.2, 14.2) in 2008/2009 and 3.9% (2.7, 5.2) in 2018/2019. Iron deficiency among PSC was 15.5% (12.1, 19.0) in 2008/2009 and 10.9% (7.4, 14.5) in 2016 (lowest), but 17.1 (13.3, 21.0) in 2017/2018 (highest). Iron deficiency among WRA was 14.9% (11.6, 18.2) in 2008/2009, 13.8% (11.8, 15.8) in 2013 (lowest), and 18.9% (16.3, 21.6) in 2017/2018 (highest). Wheat flour/bread consumption was positively associated with hemoglobin among PSC, and sugar consumption was positively associated with hemoglobin among WRA. The reported consumption of fortifiable foods was not associated with ferritin among PSC or WRA.

Conclusions

Guatemala has implemented multiple food fortification strategies, and anemia has declined. Increases in iron deficiency in 2017-2019 warrant further attention. Secular trends toward poverty alleviation, education, and development might be responsible for changes not explained by the micronutrient interventions evaluated.

Wolffia globosa-Based Nutritious Snack Formulation with High Protein and Dietary Fiber Contents

Wolffia globosa (W. globosa) or duckweed is a small aquatic plant with high protein, dietary fiber, and lipid contents that can be combined with food products to develop nutritious snacks as one strategy to mitigate malnutrition. Here, response surface methodology (RSM) with mixture design was used to develop snacks from W. globosa freeze-dried powder (WP). The physical properties, proximate analysis, amino acid profiles, sensory evaluation, phytochemical analysis, antioxidant properties, and genotoxicity (Ames test) of the snacks were evaluated. The optimal W. globosa snack formula was 64% glutinous rice flour, 10% tapioca flour, and 26% WP, giving a highly desirable liking score of 1.00. Addition of WP increased crude protein, essential amino acids, and dietary fiber compared with the control snack by 51%, 147%, and 83%, respectively. According to the Thai recommended daily intakes, the developed W. globosa snack had high protein and dietary fiber. Phytochemical contents and antioxidant activities of the W. globosa snack such as total phenolic contents (TPCs), total flavonoid contents (TFCs), ferric ion reducing antioxidant power (FRAP) activity, and oxygen radical absorbance capacity (ORAC) activity were significantly higher than the control snack. The novel combination of WP with snack product ingredients greatly enhanced nutritional value.

Women in Selected Communities of Punjab, India Have a High Prevalence of Iron, Zinc, Vitamin B12, and Folate Deficiencies: Implications for a Multiply-Fortified Salt Intervention

Dietary intake and biomarkers of micronutrient status of 100 non-pregnant women of reproductive age (NPWRA) were assessed to determine optimal levels of iron, zinc, vitamin B12, and folic acid to include in multiply-fortified salt (MFS) that will be evaluated in an upcoming trial. Weighed food records were obtained from participants to measure intake of micronutrients and discretionary salt, and to assess adequacy using Indian Nutrient Reference Values (NRVs). Statistical modeling was used to determine optimal fortification levels to reduce inadequate micronutrient intake while limiting intake above the upper limit. Fasting blood samples were obtained to assess iron, zinc, vitamin B12, and folate status. In usual diets, inadequate intake of iron (46%), zinc (95%), vitamin B12 (83%), and folate (36%) was high. Mean intake of discretionary salt was 4.7 g/day. Prevalence estimates of anemia (37%), iron deficiency (67%), zinc deficiency (34%), vitamin B12 insufficiency (37%), and folate insufficiency (70%) were also high. Simulating the addition of optimized MFS to usual diets resulted in percentage point (pp) reductions in inadequate intake by 29 pp for iron, 76 pp for zinc, 81 pp for vitamin B12, and 36 pp for folate. MFS holds potential to reduce the burden of micronutrient deficiencies in this setting.

A generic theory of change-based framework with core indicators for monitoring the effectiveness of large-scale food fortification programs in low- and middle-income countries

Large-scale food fortification (LSFF) programs are widely implemented in low- and middle-income countries (LMIC) to alleviate micronutrient deficiencies. However, these programs may not achieve the desired impact due to poor design or bottlenecks in program implementation. Monitoring and evaluation (M&E) frameworks and a set of agreed indicators can help to benchmark progress and to strengthen the evidence-base of effectiveness in a standardized way. We aimed to formulate recommendations towards core indicators for evaluating the effectiveness of LSFF programs with their associated metrics, methods, and tools (IMMT). For this, we used a multi-method iterative approach, including a mapping review of the literature, semi-structured interviews with international experts, compilation of a generic Theory of Change (ToC) framework for LSFF program delivery, and selection of IMMT for M&E of LSFF programs at key stages along the ToC delivery framework. Lastly, we conducted exploratory, qualitative interviews with key informants in Nigeria to explore experiences and perceptions related to the implementation of LSFF programs in Nigeria's context, and their opinion towards the proposed set of core IMMT. The literature search resulted in 14 published and 15 grey literature documents, from which we extracted a total of 41 indicators. Based on the available literature and interviews with international experts, we mapped a ToC delivery framework and selected nine core indicators at the output, outcome and impact level for M&E of the effectiveness of LSFF programs. Key informants in Nigeria revealed that the main bottlenecks for implementation of the proposed IMMT are related to the lack of technical capacity, equipment, laboratory infrastructure, and financial resources. In conclusion, we propose a set of nine core indicators for enabling comprehensive M&E of the effectiveness of LSFF programs in LMIC. This proposed set of core indicators can be used for further evaluation, harmonization and integration in national and international protocols for M&E of LSFF programs.

Contribution of Vitamin D Metabolites to Vitamin D Concentrations of Families Residing in Pune City

The objective was to explore the patterns of contribution from vitamin D metabolites (D2 and D3) to total vitamin D concentrations in Indian families. This cross-sectional study was carried out in slum-dwelling families residing in Pune city. Data on demography, socio-economic status, sunlight exposure, anthropometry, and biochemical parameters (serum 25OHD2, 25OHD3) via the liquid chromatography-tandem mass spectrometry method were collected. The results are presented for 437 participants (5 to 80 years). One-third were vitamin-D-deficient. Intake of foods containing vitamin D2 or D3 was rarely reported. Irrespective of gender, age, and vitamin D status, the contribution of D3 to total 25OHD concentrations far exceeded that of D2 (p < 0.05). The contribution of D2 ranged from 8% to 33% while that of D3 to 25OHD concentrations ranged from 67% to 92%. 25OHD3 is a major contributor to overall vitamin D concentrations, and the contribution of 25OHD2 was found to be negligible. This implies that sunlight and not diet is currently the major source of vitamin D. Considering that lifestyle and cultural practices may lead to insufficient sunlight exposure for large sections of the society, especially women, dietary contribution to vitamin D concentrations through fortification may play an important role in improving the vitamin D status of Indians.

The Chemical, Rheological, and Sensorial Characteristics of Arabic Bread Prepared from Wheat-Orange Sweet Potatoes Flour or Peel

The current study investigates the feasibility of preparing Arabic bread from wheat flour, sweet potato flour, or peeled sweet potatoes based on the nutritional values, technological characteristics, and sensory properties of the final products. First, we analyzed the proximate, elemental, total and individual phytochemical compositions of the raw materials and bread samples. The analysis showed that potassium, calcium, and phosphorus were higher in peels than pulp, in the same manner to the total phenolics, flavonoids, and anti-radical scavenging activities. Phenolic acids and flavonols were quantified, where p-coumaric, feruloyl-D-glucose, eucomic, gallic, and ferulic acids were measured as major phenolic acids in either peels or pulp flours, and their quantities were higher in the peels. Furthermore, we evaluated the effects of wheat substitution on the properties of the dough blends and their final bakery. The results indicated that the fortified samples' nutritional and rheological properties were significantly improved, while their sensory qualities were comparable to those of the control. Thereby, the fortified dough blends presented higher dough stabilities, indicating a wider range of applications. Additionally, after the heat treatment, the fortified breads maintained significantly higher total phenolic, flavonoid, anthocyanin, and carotenoid contents, and total antioxidant activities, implying their accessibility for humans upon consumption.

Comparing two simplified questionnaire-based methods with 24-h recalls for estimating fortifiable wheat flour and oil consumption in Mandaluyong City, Philippines

Information on fortifiable food consumption is essential to design, monitor and evaluate fortification programmes, yet detailed methods like 24-h recalls (24HRs) that provide such data are rarely conducted. Simplified questionnaire-based methods exist but their validity compared with 24HRs has not been shown. We compared two simplified methods (i.e., a household food acquisition and purchase questionnaire [FAPQ] and a 7-day semiquantitative food frequency questionnaire [SQ-FFQ]) against 24HRs for estimating fortifiable food consumption. We assessed the consumption of fortifiable wheat flour and oil using a FAPQ and, for wheat flour only, a 7-day SQ-FFQ and compared the results against 24HRs. The participants included children 12-18 months (n = 123) and their mothers 18-49 years selected for a study assessing child vitamin A intake and status in Mandaluyong City, Philippines. For fortifiable wheat flour, the FAPQ estimated considerably lower mean intakes compared to 24HRs for children and mothers (2.2 vs. 14.1 g/day and 5.1 vs. 42.3 g/day, respectively), while the SQ-FFQ estimated slightly higher mean intakes (15.7 vs. 14.1 g/day and 51.5 vs. 42.3 g/day, respectively). For fortifiable oil, the FAPQ estimated considerably higher mean intakes compared to 24HRs for children and mothers (4.6 vs. 1.8 g/day and 12.5 vs. 6.1 g/day, respectively). The SQ-FFQ, but not the FAPQ, generated useful information on fortifiable food consumption that can inform fortification programme design and monitoring decisions in the absence of more detailed individual-level data. Potential adaptations to improve the FAPQ, such as additional questions on foods prepared away from home and usage patterns, merit further research.

Valorization of Fruit Waste for Bioactive Compounds and Their Applications in the Food Industry

The fruit production and processing sectors produce tremendous amounts of by-products and waste that cause significant economic losses and an undesirable impact on the environment. The effective utilization of these fruit wastes can help to reduce the carbon footprint and greenhouse gas emissions, thereby achieving sustainable development goals. These by-products contain a variety of bioactive compounds, such as dietary fiber, flavonoids, phenolic compounds, antioxidants, polysaccharides, and several other health-promoting nutrients and phytochemicals. These bioactive compounds can be extracted and used as value-added products in different industrial applications. The bioactive components extracted can be used in developing nutraceutical products, functional foods, or food additives. This review provides a comprehensive review of the recent developments in fruit waste valorization techniques and their application in food industries. The various extraction techniques, including conventional and emerging methods, have been discussed. The antioxidant and antimicrobial activities of the active compounds extracted and isolated from fruit waste have been described. The most important food industrial application of bioactive compounds extracted from fruit waste (FW) has been provided. Finally, challenges, future direction, and concluding remarks on the topic are summarized.

The One-Hundred-Year Anniversary of the Discovery of the Sunshine Vitamin D3: Historical, Personal Experience and Evidence-Based Perspectives

The discovery of a fat-soluble nutrient that had antirachitic activity and no vitamin A activity by McCollum has had far reaching health benefits for children and adults. He named this nutrient vitamin D. The goal of this review and personal experiences is to give the reader a broad perspective almost from the beginning of time for how vitamin D evolved to became intimately involved in the evolution of land vertebrates. It was the deficiency of sunlight causing the devastating skeletal disease known as English disease and rickets that provided the first insight as to the relationship of sunlight and the cutaneous production of vitamin D₃. The initial appreciation that vitamin D could be obtained from ultraviolet exposure of ergosterol in yeast to produce vitamin D₂ resulted in the fortification of foods with vitamin D₂ and the eradication of rickets. Vitamin D₃ and vitamin D₂ (represented as D) are equally effective in humans. They undergo sequential metabolism to produce the active form of vitamin D, 1,25-dihydroxyvitamin D. It is now also recognized that essentially every tissue and cell in the body not only has a vitamin D receptor but can produce 1,25-dihydroxyvitamin D. This could explain why vitamin D deficiency has now been related to many acute and chronic illnesses, including COVID-19.

Application of Iron Nanoparticle-Based Materials in the Food Industry

Due to their different properties compared to other materials, nanoparticles of iron and iron oxides are increasingly used in the food industry. Food technologists have especially paid attention to their ease of separation by magnetic fields and biocompatibility. Unfortunately, the consumption of increasing amounts of nanoparticles has raised concerns about their biotoxicity. Hence, knowledge about the applicability of iron nanoparticle-based materials in the food industry is needed not only among scientists, but also among all individuals who are involved in food production. The first part of this article describes typical methods of obtaining iron nanoparticles using chemical synthesis and so-called green chemistry. The second part of this article describes the use of iron nanoparticles and iron nanoparticle-based materials for active packaging, including the ability to eliminate oxygen and antimicrobial activity. Then, the possibilities of using the magnetic properties of iron nano-oxides for enzyme immobilization, food analysis, protein purification and mycotoxin and histamine removal from food are described. Other described applications of materials based on iron nanoparticles are the production of artificial enzymes, process control, food fortification and preserving food in a supercooled state. The third part of the article analyzes the biocompatibility of iron nanoparticles, their impact on the human body and the safety of their use.

Incorporation of Solid Lipid Nanoparticles into Stirred Yogurt: Effects in Physicochemical and Rheological Properties during Shelf-Life

The aim of this work was to develop a yogurt fortified with curcumin. Curcumin is a lipophilic compound with a wide range of biological activities; however, it presents low water solubility and low bioavailability, and therefore it was the first to be encapsulated in solid lipid nanoparticles (SLNs). Then the influence of the incorporation of curcumin-loaded SLNs on the physicochemical (i.e., pH, titratable acidity, syneresis and color) and rheological properties of yogurt during its shelf-life (30 days at 4 °C) was evaluated. SLN incorporation into yogurt did not affect pH and titratable acidity compared to the control (i.e., plain yogurt) during shelf-life, even though the yogurt with SLNs presented lower values of pH (4.25 and 4.34) and acidity (0.74% lactic acid and 0.84% lactic acid) than the control in the end, respectively. Furthermore, the yogurt with SLNs presented slightly higher values of syneresis than the control during the shelf-life; however, it did not present visual differences in whey separation. Relative to the color, the incorporation of SLNs into the yogurt imparted a strong yellow color to the sample but did not affect color stability during shelf-life. Both samples showed flow curves with yield stress and shear-thinning behavior during shelf-life, and, regarding the viscoelastic behavior, both showed a typical weak viscoelastic gel with an elastic structure. Overall, curcumin-loaded SLNs incorporation did not affect the physicochemical and rheological stability of yogurt during shelf-life, showing a promising application for the development of new functional foods.

Enhanced stability and clinical absorption of a form of encapsulated vitamin A for food fortification

Food fortification is an effective strategy to address vitamin A (VitA) deficiency, which is the leading cause of childhood blindness and drastically increases mortality from severe infections. However, VitA food fortification remains challenging due to significant degradation during storage and cooking. We utilized an FDA-approved, thermostable, and pH-responsive basic methacrylate copolymer (BMC) to encapsulate and stabilize VitA in microparticles (MPs). Encapsulation of VitA in VitA-BMC MPs greatly improved stability during simulated cooking conditions and long-term storage. VitA absorption was nine times greater from cooked MPs than from cooked free VitA in rats. In a randomized controlled cross-over study in healthy premenopausal women, VitA was readily released from MPs after consumption and had a similar absorption profile to free VitA. This VitA encapsulation technology will enable global food fortification strategies toward eliminating VitA deficiency.

The Prevalence of Vitamin and Mineral Deficiencies and High Levels of Non-Essential Heavy Metals in Saudi Arabian Adults

Although the micronutrient status of a population is of high national priority, as it critically impacts public health, limited data is available for quantifying the micronutrient status in Saudi Arabia. We aimed to provide comprehensive, epidemiological, descriptive data regarding micronutrient levels in Saudi adults. This cross-sectional study included 3432 adults aged ≥18 years (mean age, 37.7 ± 11.7 years; women, 51.2%) across all 13 Saudi administrative regions (March 2019-November 2021). Laboratory data for 14 micronutrients (8 vitamins, 4 minerals, and 2 nonessential heavy metals) were characterized using descriptive analysis. Vitamin D deficiency (64.3%) was the most prevalent, followed by vitamin B2 (44.9%) and A (9.6%) deficiencies. Among minerals, iron deficiency was the most prevalent (23.2%), followed by zinc (15.3%) and copper (8.7%) deficiencies. Most Saudi adults exhibited normal arsenic (99.7%) and mercury (99.9%) levels. Men exhibited significantly higher vitamin B2, B9, and D deficiencies than women, while women exhibited higher vitamin A, B12, iron, and zinc deficiencies than men. Younger adults demonstrated a significantly higher prevalence of vitamin D and iron deficiencies, whereas older adults exhibited a higher prevalence of vitamin B1 and magnesium deficiencies. As micronutrient deficiencies are a public health concern, health policies and programs need to be developed and implemented to address them.

Small and Medium Enterprises' Perspectives on Food Fortification Amid the Growing Burden of Malnutrition

The need for a profound food system transformation has never been greater. The growing burden of malnutrition has become the new normal, with two billion people who are overweight, over 140 million children under five who are stunted and over two billion people affected by hidden hunger. Food fortification has been recognized as a cost-effective strategy to address micronutrient deficiencies. Small and medium enterprises (SMEs) play a strategic role in the food supply chain in low- and middle-income countries, accounting for over 80% of food sales. It is therefore critical to create an enabling environment to facilitate SMEs' involvement in food fortification practices as a potential solution to tackle all forms of malnutrition. This review highlights SMEs' relevance as agents of change in the food system through food fortification practices and their indirect yet key role in producing nutritious, tasty and affordable foods. It discusses their challenges (e.g., access to long-term finance, sustainable technical assistance, limited capacity), presents solutions and discusses how different actors can help SMEs to overcome these challenges. Furthermore, it presents a relevant public-private partnership case study to demonstrate how SMEs can address the growing burden of malnutrition through food fortification practices, nutrient profiling schemes and demand generation.

Lactic Acid Bacteria (LAB): Autochthonous and Probiotic Microbes for Meat Preservation and Fortification

The enhanced concern of the consumers regarding the safety, quality of the food products, and avoidance of the use of chemical food preservatives has resulted in a breakthrough in biopreservation. This has resulted in the use of beneficial microbial species, including bacteria and their secondary metabolites, to enhance the shelf-life and quality of the food products. Meat preservation and fortification are among the biggest concerns, as they are relevant to the majority of food products. The chemical preservatives conventionally used in preserving meat and meat products possess several detrimental effects on the consumers. Thus, alternative strategies are needed to combat strategically in facilitating the shelf-life and quality. Lactic acid bacteria (LAB) are considered the safest organism and have a profound role in food and food-processing industries. The biofilm developed by the bacteria prevents the growth of various undesirable microorganisms on meat and meat products. Various studies depicted that LAB produces various antimicrobial metabolites that can act effectively on the food-degrading pathogens, rendering it safe and enhancing shelf-life. This review, thus, deals with the use of LAB as biopreservatives for enhancing the shelf-life of meat and meat products and helping its fortification.

Tachysterol2 increases the synthesis of fibroblast growth factor 23 in bone cells

Tachysterol₂ (T₂) is a photoisomer of the previtamin D₂ found in UV-B-irradiated foods such as mushrooms or baker’s yeast. Due to its structural similarity to vitamin D, we hypothesized that T₂ can affect vitamin D metabolism and in turn, fibroblast growth factor 23 (FGF23), a bone-derived phosphaturic hormone that is transcriptionally regulated by the vitamin D receptor (VDR). Initially, a mouse study was conducted to investigate the bioavailability of T₂ and its impact on vitamin D metabolism and Fgf23 expression. UMR106 and IDG-SW3 bone cell lines were used to elucidate the effect of T₂ on FGF23 synthesis and the corresponding mechanisms. LC-MS/MS analysis found high concentrations of T₂ in tissues and plasma of mice fed 4 vs. 0 mg/kg T₂ for 2 weeks, accompanied by a significant decrease in plasma 1,25(OH)₂D and increased renal Cyp24a1 mRNA abundance. The Fgf23 mRNA abundance in bones of mice fed T₂ was moderately higher than that in control mice. The expression of Fgf23 strongly increased in UMR106 cells treated with T₂. After Vdr silencing, the T₂ effect on Fgf23 diminished. This effect is presumably mediated by single-hydroxylated T₂-derivatives, since siRNA-mediated silencing of Cyp27a1, but not Cyp27b1, resulted in a marked reduction in T₂-induced Fgf23 gene expression. To conclude, T₂ is a potent regulator of Fgf23 synthesis in bone and activates Vdr. This effect depends, at least in part, on the action of Cyp27a1. The potential of oral T₂ to modulate vitamin D metabolism and FGF23 synthesis raises questions about the safety of UV-B-treated foods.

Update on Analytical Methods and Research Gaps in the Use of Household Consumption and Expenditure Survey Data to Inform the Design of Food-Fortification Programs

The lack of nationally representative, individual-level dietary intake data has led researchers to increasingly turn to household-level data on food acquisitions and/or consumption to inform the design of food-fortification programs in low- and middle-income countries (LMICs). These nationally representative, household-level data come from household consumption and expenditure surveys (HCESs), which are collected regularly in many LMICs and are often made publicly available. Our objectives were to examine the utility of HCES data to inform the design of food-fortification programs and to identify best-practice methods for analyzing HCES data for this purpose. To this end, we summarized information needed to design fortification programs and assessed the extent to which HCES data can provide corresponding indicators. We concluded that HCES data are well suited to guide the selection of appropriate food vehicles, but because individual-level estimates of apparent nutrient intakes rely on assumptions about the intrahousehold distribution of food, more caution is advised when using HCES data to select the target micronutrient content of fortified foods. We also developed a checklist to guide analysts through the use of HCES data and, where possible, identified research-based, best-practice analytical methods for analyzing HCES data, including selecting the number of days of recall data to include in the analysis and converting reported units to standard units. More research is needed on how best to deal with composite foods, foods consumed away from home, and extreme values, as well as the best methods for assessing the adequacy of apparent intakes. Ultimately, we recommend sensitivity analyses around key model parameters, and the continual triangulation of HCES-based results with other national and subnational data on food availability, dietary intake, and nutritional status when designing food-fortification programs.

Advocacy Organizations and Nutrition Policy in Nigeria: Identifying Metrics for Enhanced Efficacy

Advocacy organizations have played a significant role in the field of nutrition in recent years. However, why are some advocates viewed as more effective than others? This paper derives metrics for assessing advocacy efficacy by first drawing on key insights from the nutrition and public policy scholarship. A set of metrics is proposed to capture the constitutive elements of three concepts that often emerge as critical from that literature: organizational capacity, strong networks, and external outreach. Based on a survey of 66 nutrition stakeholders in Nigeria, including at the federal level and within the states of Kaduna and Kano, the metrics are then applied to a set of advocacy organizations within the country. We show that the metrics can provide insights into why some advocacy organizations are perceived as more effective than others by policymakers. Specifically, we find that geographical reach, share of budget allocated to advocacy, action plans with clear objectives, large networks that include government and non-governmental policy champions, multiple media and dissemination outputs, and numerous training events collectively increase nutrition advocates' visibility to, and influence on, policymakers. Although the metrics are subject to further testing in other country settings and need to be interpreted based on a country's underlying policy system, they offer a useful starting point for more systematic, comparative advocacy analysis and learning within the nutrition field and beyond.

Experiences and Lessons Learned in Developing and Implementing a Population-Based Nutrition and Health Surveillance System in Guatemala 2011-2021

Background

Practice-based experiences documenting development and implementation of nutrition and health surveillance systems are needed.

Objectives

To describe processes, methods, and lessons learned from developing and implementing a population-based household nutrition and health surveillance system in Guatemala.

Methods

The phases and methods for the design and implementation of the surveillance system are described. Efforts to institutionalize the system in government institutions are described, and illustrative examples describing different data uses, and lessons learned are provided.

Results

After initial assessments of data needs and consultations with officials in government institutions and partners in the country, a population-based nutrition surveillance system prototype with complex sampling was designed and tested in 5 Guatemalan Highland departments in 2011. After dissemination of the prototype, government and partners expanded the content, and multitopic nutrition and health surveillance cycles were collected in 2013, 2015, 2016, 2017/18, and 2018/19 providing nationally representative data for households, women of reproductive age (15-49 y), and children aged 0-59 mo. For each cycle, data were to be collected from 100 clusters, 30 households in each, and 1 woman and 1 child per household. Content covered ∼25 health and nutrition topics, including coverage of all large-scale nutrition-specific interventions; the micronutrient content of fortifiable sugar, salt, and bread samples; anthropometry; and biomarkers to assess annually, or at least once, ∼25 indicators of micronutrient status and chronic disease. Data were collected by 3-5 highly trained field teams. The design was flexible and revised each cycle allowing potential changes to questionnaires, population groups, biomarkers, survey design, or other changes. Data were used to change national guidelines for vitamin A and B-12 interventions, among others, and evaluate interventions. Barriers included frequent changes of high-level government officials and heavy dependence on US funding.

Conclusions

This system provides high-quality data, fills critical data gaps, and can serve as a useful model for others.

Ozone Layer Depletion and Emerging Public Health Concerns - An Update on Epidemiological Perspective of the Ambivalent Effects of Ultraviolet Radiation Exposure

Solar ultraviolet (UV) radiation exposure is the primary etiological agent responsible for developing cutaneous malignancies. Avoiding excessive radiation exposure, especially by high-risk groups, is recommended to prevent UV-induced photo-pathologies. However, optimal sun exposure is essential for the healthy synthesis of about 90% of vitamin D levels in the body. Insufficient exposure to UV-B is linked to vitamin D deficiency in humans. Therefore, optimal sun exposure is necessary for maintaining a normal state of homeostasis in the skin. Humans worldwide face a major existential threat because of climate change which has already shown its effects in several ways. Over the last 4 to 5 decades, increased incidences in skin cancer cases have led international health organizations to develop strong sun protection measures. However, at the same time, a growing concern about vitamin D deficiency is creating a kind of exposure dilemma. Current knowledge of UV exposure to skin outweighs the adverse effects than the beneficial roles it offers to the body, necessitating a correct public health recommendation on optimal sun exposure. Following an appropriate recommendation on optimal sun exposure will lead to positive outcomes in protecting humans against the adverse effects of strict recommendations on sun protection measures. In this short review, we spotlight the ambivalent health effects of UV exposure and how ozone layer depletion has influenced these effects of UVR. Further, our aim remains to explore how to lead towards a balanced recommendation on sun protection measures to prevent the spurt of diseases due to inadequate exposure to UV-B.

Decisions to Start, Strengthen, and Sustain Food Fortification Programs: An Application of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence to Decision (EtD) Framework in Nigeria

Background

Although the potential impact of food fortification to improve the micronutrient status of populations has been demonstrated beyond a doubt, it is constrained in practice by critical gaps in program design and implementation. These are partly linked to suboptimal decision making.

Objectives

We aimed to demonstrate how the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Evidence to Decision (EtD) framework for health system and public health decisions can be applied to formulate recommendations and make decisions in national food fortification programming.

Methods

Following a program impact pathway, we reviewed the literature to define the key decision types and identify the corresponding decision makers necessary for designing and implementing effective food fortification programs. We then applied the GRADE EtD framework to the Nigerian fortification program to illustrate how evidence-informed assessments and conclusions can be made.

Results

Fortification program decisions were classified into 5 types: 1) program initiation; 2) program design; 3) program delivery; 4) program impact; and 5) program continuation. Policymakers, food processors, and (in cases dependent on or considering external funding) development partners are the main decision makers in a fortification program, whereas technical partners play important roles in translating evidence into contextualized recommendations. The availability and certainty of evidence for fortification programs are often low (e.g., quality and coverage data are not routinely collected and there are challenges evaluating impact in such population-based programs using randomized controlled trials) yet decisions must still be made, underscoring the importance of using available evidence. Furthermore, when making program initiation and continuation decisions, coordination with overlapping micronutrient interventions is needed where they coexist.

Conclusions

This framework is a practical tool to strengthen decision-making processes in fortification programs. Using evidence in a systematic and transparent way for decision making can improve fortification program design, delivery, and ultimately health impacts.

Minor tropical fruits as a potential source of bioactive and functional foods

Tropical fruits are defined as fruits that are grown in hot and humid regions within the Tropic of Cancer and Tropic of Capricorn, covering most of the tropical and subtropical areas of Asia, Africa, Central America, South America, the Caribbean and Oceania. Depending on the cultivation area covered, economic value and popularity these tropical fruits are divided into major and minor tropical fruits. There is an annual increment of 3.8% in terms of commercialization of the tropical fruits. In total 26 minor tropical fruits (Kiwifruit, Lutqua, Carambola, Tree Tomato, Elephant apple, Rambutan, Bay berry, Mangosteen, Bhawa, Loquat, Silver berry, Durian, Persimon, Longan, Passion fruit, Water apple, Pulasan, Indian gooseberry, Guava, Lychee, Annona, Pitaya, Sapodilla, Pepino, Jaboticaba, Jackfruit) have been covered in this work. The nutritional composition, phytochemical composition, health benefits, traditional use of these minor tropical fruits and their role in food fortification have been portrayed.

Interventions to improve calcium intake through foods in populations with low intake

Calcium intake remains inadequate in many low- and middle-income countries, especially in Africa and South Asia, where average intakes can be below 400 mg/day. Given the vital role of calcium in bone health, metabolism, and cell signaling, countries with low calcium intake may want to consider food-based approaches to improve calcium consumption and bioavailability within their population. This is especially true for those with low calcium intake who would benefit the most, including pregnant women (by reducing the risk of preeclampsia) and children (by reducing calcium-deficiency rickets). Specifically, some animal-source foods that are naturally high in bioavailable calcium and plant foods that can contribute to calcium intake could be promoted either through policies or educational materials. Some food processing techniques can improve the calcium content in food or increase calcium bioavailability. Staple-food fortification with calcium can also be a cost-effective method to increase intake with minimal behavior change required. Lastly, biofortification is currently being investigated to improve calcium content, either through genetic screening and breeding of high-calcium varieties or through the application of calcium-rich fertilizers. These mechanisms can be used alone or in combination based on the local context to improve calcium intake within a population.

Use of Branded Food Composition Databases for the Exploitation of Food Fortification Practices: A Case Study on Vitamin D in the Slovenian Food Supply

Vitamin D deficiency is a worldwide public health concern, which can be addressed with voluntary or mandatory food fortification. The aim of this study was to determine if branded food composition databases can be used to investigate voluntary fortification practices. A case study was conducted using two nationally representative cross-sectional datasets of branded foods in Slovenia, collected in 2017 and 2020, and yearly sales data. Using food labeling data we investigated prevalence of fortification and average vitamin D content, while nutrient profiling was used to investigate overall nutritional quality of the foods. In both datasets, the highest prevalence of vitamin D fortification was observed in meal replacements (78% in 2017; 100% in 2020) and in margarine, corresponding to high market share. Other food categories commonly fortified with vitamin D are breakfast cereals (5% in 2017; 6% in 2020), yogurts and their imitates (5% in 2017; 4% in 2020), and baby foods (18% in both years). The highest declared average content of vitamin D was observed in margarine and foods for specific dietary use (7-8 μg/100g), followed by breakfast cereals (4 μg/100g), while the average content in other foods was below 2 μg/100g. Only minor differences were observed between 2017 and 2020. Major food-category differences were also observed in comparison of the overall nutritional quality of the fortified foods; higher overall nutritional quality was only observed in fortified margarine. Our study showed that branded food composition databases are extremely useful resources for the investigation and monitoring of fortification practices, particularly if sales data can also be used. In the absence of mandatory or recommended fortification in Slovenia, very few manufacturers decide to add vitamin D, and even when this is the case, such products are commonly niche foods with lower market shares. We observed exceptions in imported foods, which can be subject to fortification policies introduced in other countries.

Characterization of Moringa oleifera Leaf Powder Extract Encapsulated in Maltodextrin and/or Gum Arabic Coatings

The encapsulation of bioactive-rich plant extracts is an effective method of preventing their damage or loss of activity during processing and storage. Here, the techno-functional properties of microcapsules developed from Moringa oleifera leaf powder (MoLP) extract (core) with maltodextrin (MD), gum Arabic (GA), and a combination (MDGA) (coatings) were assessed. The bulk and tap density were 0.177, 0.325 and 0.297 g/mL and 0.13, 0.295 and 0.259 g/mL for GA, MD and MDGA microcapsules, respectively. Flowability properties of microcapsules indicated an intermediate flow except for GA which had a poor flow. The moisture content of the microcapsules ranged from 1.47% to 1.77% with no significant differences (p > 0.05) observed. All the microcapsules had high water solubility (86.35% for GA to 98.74% for MD and 90.51% for MDGA). Thermogravimetric analyses revealed that encapsulation enhanced the thermal stability of the core material. The X-ray diffraction analysis revealed that the microcapsules and extracts have an amorphous nature, which was validated by the surface morphology analysis that showed amorphous, irregular, and flake-like attributes except for MDGA microcapsules which had slightly spherical and agglomerated surfaces. The Fourier Transform Infra-Red spectra of the microcapsules showed the presence of C-O and O-H aromatic rings as well as amine groups. New spectra were observed at 1177, 1382 and 1411 cm⁻¹ for MDGA, MD and GA, respectively, after encapsulation, which connotes a slight modification in the chemical structural pattern after encapsulation. Storage stability tests (28 days at 4, 25 and 40 °C) showed that the microcapsules were most stable at 4 °C and the stability differs significantly (p ≤ 0.05) with coating material type and temperature with MDGA showing better storage stability than others. Altogether, the attributes of the MDGA microcapsules were comparatively better than either MD or GA alone. The present data, therefore, demonstrate an effective encapsulation process for MoLP extract that can serve as fortificants in processed food products where MoLP may be used.

Applications of bioactive compounds extracted from olive industry wastes: A review

The wastes generated during the olive oil extraction process, even if presenting a negative impact for the environment, contain several bioactive compounds that have considerable health benefits. After suitable extraction and purification, these compounds can be used as food antioxidants or as active ingredients in nutraceutical and cosmetic products due to their interesting technological and pharmaceutical properties. The aim of this review, after presenting general applications of the different types of wastes generated from this industry, is to focus on the olive pomace produced by the two-phase system and to explore the challenging applications of the main individual compounds present in this waste. Hydroxytyrosol, tyrosol, oleuropein, oleuropein aglycone, and verbascoside are the most abundant bioactive compounds present in olive pomace. Besides their antioxidant activity, these compounds also demonstrated other biological properties such as antimicrobial, anticancer, or anti-inflammatory, thus being used in formulations to produce pharmaceutical and cosmetic products or in the fortification of food. Nevertheless, it is mandatory to involve both industries and researchers to create strategies to valorize these byproducts while maintaining environmental sustainability.

Food and Nutrition Champions in Residential Aged Care Homes Are Key for Sustainable Systems Change within Foodservices; Results from a Qualitative Study of Stakeholders

The role of foodservices in aged care is difficult to understand, and strategies to improve the nutritional care of residents are often unsustainable. In particular, food-first strategies such as food fortification are poorly executed in everyday practice and its execution relies upon the foodservice system in aged care homes. The aim of this study was to explore the perspective of staff on the role of foodservices in aged care and gauge the level of skills, education, access, time, and ability to deliver food fortification. Semi-structured interviews were conducted with foodservice managers, foodservice workers, dietitians, carers, and other managers who work in aged care homes across Australia. Participants were recruited purposively through email and through snowballing. Interviews (n = 21) were recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Three themes and six sub-themes were identified. The three themes include the role of foodservices being more than just serving food, teamwork between all staff to champion nutrition, and workplace culture that values continuous improvement. These themes identify how staff perceive the role of foodservices in aged care and provide an important perspective on the long-term sustainability of food fortification strategies and how to improve current practice.

Postprandial 25-hydroxyvitamin D response varies according to the lipid composition of a vitamin D3 fortified dairy drink

In-vitro evidence suggests that the lipid component of foods alters vitamin D absorption. This single-blinded, cross-over postprandial study examined the effect of changing the lipid component of a 20 µg vitamin D₃ fortified dairy drink on postprandial 25(OH)D concentrations. Participants consumed one dairy drink per visit: a non-lipid, a pre-formed oleic acid micelle, an olive oil and a fish oil dairy drink. There was a significant time*drink*baseline status effect on 25(OH)D concentrations (p = 0.039). There were no time*drink, time or drink effects on 25(OH)D in vitamin D sufficient participants (>50nmol/L). However, there was an effect of time on changes in 25(OH)D concentrations after the olive oil dairy drink (p = 0.034) in vitamin D insufficient participants (<50nmol/L). There were no effects after the other diary drinks. Olive oil may improve vitamin D absorption from fortified foods. Further research is needed to examine the practical implications of changing the lipid component of fortified foods.

Food Fortification With Folic Acid for Prevention of Spina Bifida and Anencephaly: The Need for a Paradigm Shift in Evidence Evaluation for Policy-Making

Context-specific evidence evaluation is advocated in modern epidemiology to support public health policy decisions, avoiding excessive reliance on experimental study designs. Here we present the rationale for a paradigm shift in evaluation of the evidence derived from independent studies, as well as systematic reviews and meta-analyses of observational studies, applying Hill's criteria (including coherence, plausibility, temporality, consistency, magnitude of effect, and dose-response) to evaluate food fortification as an effective public health intervention against folic acid-preventable (FAP) spina bifida and anencephaly (SBA). A critical appraisal of evidence published between 1983 and 2020 supports the conclusion that food fortification with folic acid prevents FAP SBA. Policy-makers should be confident that with mandatory legislation, effective implementation, and periodic evaluation, food fortification assures that women of reproductive age will safely receive daily folic acid to significantly reduce the risk of FAP SBA. Current evidence should suffice to generate the political will to implement programs that will save thousands of lives each year in over 100 countries.

Examining the Prevalence, Nutritional Quality and Marketing of Foods with Voluntary Nutrient Additions in the Canadian Food Supply

Foods with voluntary nutritional additions are a fast-growing sector of the global food industry. In Canada, while the addition of nutrients to foods has been regulated through fortification regulations, parallel policies which aim to encourage product innovation have also allowed for the voluntary addition of nutrients and other novel ingredients to ‘supplemented’ and ‘functional’ foods. Concerns have been raised that the consumption of these products may have negative repercussions on population health, such as high nutrient intakes inappropriate for certain population subgroups (e.g., children) and the shifting of dietary patterns to include more unhealthy foods. The aim of this study was to evaluate the prevalence, nutritional quality, and marketing characteristics of foods with added nutrients in the Canadian market. We found many nutritionally-enhanced foods contained high levels of nutrients beyond recommended intakes, despite these nutrients having no evidence of inadequacy in the Canadian population. Additionally, a large proportion of foods with added nutrients had poor nutrient profiles (were deemed ‘less healthy’ than their non-enhanced counterparts) and carried heavy marketing on their labels, regardless of their nutritional quality. Taken together these findings raise concerns about foods with voluntary nutrient additions and suggest the need to further investigate consumer attitudes and decision-making towards these foods.

Vitamin B12 (Cobalamin) and Micronutrient Fortification in Food Crops Using Nanoparticle Technology

It is necessary to develop a resilient food supply that will withstand unexpected future shocks and deliver the required amounts of nutrients to consumers. By increasing the sustainability of food and agriculture, the food system will be able to handle challenges such as climate change, declining agricultural resources, growing population/urbanization, pandemics, and recessions/shortages. Micronutrient deficiency, otherwise called hidden hunger, is one of the major malnutrition consequences worldwide, particularly in middle- or low- income countries. Unlike essential mineral or nutrient compounds, micronutrients could be less of a priority due to their small levels of requirement. However, insufficient micronutrients caused critical adverse health symptoms and are excessively vital for young children's development. Therefore, there have been numerous attempts to enhance minerals and nutrients in food crops, including biofortification, food fortification, and supplementation. Based on several interventions involving micronutrients, modern technology, such as nanotechnology, can be applied to enhance sustainability and to reduce the food system's environmental impact. Previous studies have addressed various strategies or interventions to mitigate major micronutrient deficiency including iron, iodine, zinc, and vitamin A. Comparably small amounts of studies have addressed vitamin B12 deficiency and its fortification in food crops. Vitamin B12 deficiency causes serious adverse health effects, including in the nervous or blood systems, and occurs along with other micronutrient deficiencies, such as folate, iron, and zinc, worldwide, particularly in middle- and low-income countries. Mitigation for B12 deficiency has mainly focused on developing pharmacological and medical treatments such as vitamin B12 serum or supplements. Further studies are required to undertake a sustainable approach to fortify vitamin B12 in plant-based food sources for public health worldwide. This review paper highlights nanoparticle application as a promising technology for enhancing vitamin B12 without conventional genetic modification requirements. The nanoparticle can efficiently deliver the mineral/nutrient using coating techniques to targeted sites into the plant. This is mainly because nanoparticles have better solubility and permeability due to their nano size with high surface exposure. Vitamin B12-coated nanoparticles would be absorbed, translocated, and accumulated by the plant and eventually enhance the bioavailability in food crops. Furthermore, by reducing adverse environmental effects, such as leaching issues that mainly occur with conventional fertilizer usage, it would be possible to develop more sustainable food fortification.

Revalorization of Almond By-Products for the Design of Novel Functional Foods: An Updated Review

The search for waste minimization and the valorization of by-products are key to good management and improved sustainability in the food industry. The great production of almonds, based on their high nutritional value as food, especially almond kernels, generates tons of waste yearly. The remaining parts (skin, shell, hulls, etc.) are still little explored, even though they have been used as fuel by burning or as livestock feed. The interest in these by-products has been increasing, as they possess beneficial properties, caused by the presence of different bioactive compounds, and can be used as promising sources of new ingredients for the food, cosmetic and pharmaceutical industry. Additionally, the use of almond by-products is being increasingly applied for the fortification of already-existing food products, but there are some limitations, including the presence of allergens and mycotoxins that harden their applicability. This review focuses on the extraction technologies applied to the valorization of almond by-products for the development of new value-added products that would contribute to the reduction of environmental impact and an improvement in the sustainability and competitiveness of the almond industry.

Perspective: Putting the youngest among us into the nutrition "call for action" for food fortification strategies

Adequate iron intake is essential for optimal child development, but iron deficiency and anemia among infants and young children are widespread in low- and middle-income countries. Large-scale food fortification strategies hold great promise for reducing micronutrient deficiencies; however, for children <2 y of age, the impact of such strategies is limited because their intake of staple foods is relatively low and fortification levels are targeted at the adult population. Iron supplementation, iron fortification of foods targeted to infants, and point-of-use fortification with iron-containing products such as multiple micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements are evidence-based approaches recommended to reduce anemia among infants and young children when used in the right context. Since 2003, the WHO, with support from UNICEF, has recommended the use of MNPs to control iron deficiency. However, the percentage of children with anemia has changed very little over the past 10 y. Five years ago the UN declared a decade of action on nutrition, including World Health Assembly (WHA) targets for maternal, infant, and young child nutrition, yet the WHA set no anemia targets for children. In July 2020 the leaders of 4 UN agencies issued a call for action to protect children's right to nutrition in the face of the COVID-19 pandemic and beyond. Given persistently high rates of anemia among young children, the negative developmental impact, the challenge of meeting iron needs from typical complementary food diets, and the availability of successful evidence-based fortification strategies for this age group, we encourage planners, speakers, and donors at this year's UN Food Systems Summit and the Tokyo Nutrition for Growth Summit to 1) call for the WHA to set anemia targets for infants and young children and 2) promote investment in evidence-based interventions to improve the iron status of young children.

Marketing Healthy Food in an African City: Consumer Motivations for Adopting Orange-Fleshed Sweet Potato in Maputo, Mozambique

Since the late 1990s, the International Potato Center has promoted orange-fleshed sweet potato (OFSP) cultivars in Mozambique as a healthy food, emphasizing its capacity to reduce the prevalence of vitamin A deficiency among mothers and young children. This article seeks to reveal why consumers in Maputo, the capital city of Mozambique, adopt or reject OFSP looking at the role of food systems and consumer characteristics in access and acceptance of healthy food and at the positioning OFSP on the market in terms of lifestyle and need satisfaction.The results of 255 street interviews confirm that OFSP is widely known. Information reaches people mainly via informal channels (relatives and retailers). Nonadoption is the result of the positioning of OFSP as food for young children and sick people. The OFSP appeals most to the hedonistic and conservative lifestyle segments. Adoption is associated with the perception of OFSP as a source of vitamins that builds up muscles and improves physical appearance and self-fulfillment. While women are typically responsible for domestic tasks, male adopters emphasize the role of OFSP in family health and well-being more than female adopters. This first attempt to understand the marketing of healthy food in Mozambique exposes many similarities between the urban consumers in Maputo and those in developed countries. The results indicate that future marketing should exploit informal channels such as vendors and emphasize its nutritious value for all consumers instead of focusing on mothers and young children.

Impact of Voluntary Folic Acid Fortification of Corn Masa Flour on RBC Folate Concentrations in the U.S. (NHANES 2011-2018)

Surveillance data have highlighted continued disparities in neural tube defects (NTDs) by race-ethnicity in the United States. Starting in 2016, the Food and Drug Administration (FDA) authorized voluntary folic acid fortification of corn masa flour to reduce the risk of neural tube defects (NTDs) among infants of Hispanic women of reproductive age. To assess the impact of voluntary corn masa fortification, cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) 2011-2018 for Hispanic women of reproductive age with available red blood cell (RBC) folate concentrations were analyzed, with additional analyses conducted among Hispanic women whose sole source of folic acid intake was fortified foods (enriched cereal grain products (ECGP) only), excluding ready-to-eat cereals and supplements. RBC folate concentration (adjusted geometric mean) among Hispanic women of reproductive age did not differ between 2011-2016 and 2017-2018, though RBC folate concentration increased significantly among lesser acculturated Hispanic women consuming ECGP only. Concentrations of RBC folate for those born outside the U.S and residing in the U.S <15 years increased from 894 nmol/L (95% CI: 844-946) in 2011-2016 to 1018 nmol/L (95% CI: 982-1162; p < 0.001) in 2017-2018. Primarily Spanish-speaking Hispanic women of reproductive age who only consumed ECGP saw an increase from 941 nmol/L (95% CI: 895-990) in 2011-2016 to 1034 nmol/L (95% CI: 966-1107; p = 0.03) in 2017-2018. By subpopulation, we observed no significant changes in the proportion at risk of NTDs (<748 nmol/L) and no changes in the model-based estimated NTD rates following voluntary corn masa fortification. This analysis suggests that there is a remaining risk among Hispanics for folate sensitive NTDs, though continued monitoring of folate status in future NHANES data cycles will help inform the long-term efficacy of voluntary fortification of corn masa flour.

Green extraction techniques from fruit and vegetable waste to obtain bioactive compounds-A review

Food wastes imply significant greenhouse gas emissions, that increase the challenge of climate change and impact food security. According to FAO (2019), one of the main food wastes come from fruit and vegetables, representing 0.5 billion tons per year, of the 1.3 billion tons of total waste. The wastes obtained from fruit and vegetables have plenty of valuable components, known as bioactive compounds, with many properties that impact positively in human health. Some bioactive compounds hold antioxidant, anti-inflammatory, and anti-cancer properties and they have the capacity of modulating metabolic processes. Currently, the use of fruit and vegetable waste is studied to obtain bioactive compounds, through non-conventional techniques, also known as green extraction techniques. These extraction techniques report higher yields, reduce the use of solvents, employ less extraction time, and improve the efficiency of the process for obtaining bioactive compounds. Once extracted, these compounds can be used in the cosmetic, pharmaceutical, or food industry, the last one being focused on improving food quality.