Chapter 1 - Food Fortification: Past Experience, Current Status, and Potential for Globalization

Abstract

In the first half of the 20th century, food fortification programs in Europe and the United States were highly successful in virtually eliminating micronutrient deficiency diseases such as goiter, cretinism, pellagra, rickets, and xerophthalmia which had caused high levels of morbidity and mortality particularly in children. This success gave the impetus to further fortify staple foods, including cereal flours, milk products, condiments, fats and oils in many other countries worldwide, the development of targeted fortified foods particularly for infants and young children, and the introduction of fortified manufactured foods such as breakfast cereals that are market driven as well as public health driven. The efficacy of these programs in improving intake and status of iodine, iron, folate, vitamin D, and vitamin A is proven. However widespread micronutrient deficiencies still occur particularly in low and middle-income countries. While large-scale fortification of staple foods is on the rise the overall coverage is still at a relatively low level. While the scientific and technical issues of fortification are well known, the implementation science for scaling up new national programs in low- and middle-income countries is still under development.