Abstract
Large-scale food fortification (LSFF) is a cost-effective intervention that is widely implemented, but there is scope to further increase its potential. To identify gaps and opportunities, we first accessed the Global Fortification Data Exchange (GFDx) to identify countries that could benefit from new fortification programs. Second, we aggregated Fortification Assessment Coverage Toolkit (FACT) survey data from 16 countries to ascertain LSFF coverage and gaps therein. Third, we extended our narrative review to assess current innovations. We identified 84 countries as good candidates for new LSFF programs. FACT data revealed that the potential of oil/ghee and salt fortification is not being met due mainly to low coverage of adequately fortified foods (quality). Wheat, rice and maize flour fortification have similar quality issues combined with lower coverage of the fortifiable food at population-level (<50%). A four-pronged strategy is needed to meet the unfinished agenda: first, establish new LSFF programs where warranted; second, systems innovations informed by implementation research to address coverage and quality gaps; third, advocacy to form new partnerships and resources, particularly with the private sector; and finally, exploration of new fortificants and vehicles (e.g. bouillon cubes; salt fortified with multiple nutrients) and other innovations that can address existing challenges.
Highlights
Food systems in many low- and middle-income countries (LMICs) are not delivering nutritionally adequate diets across all populations, resulting in deficiencies in essential micronutrients required for women and children to grow, develop, and thrive [1]
We provide a narrative review and discuss the progress made in large-scale food fortification (LSFF) relative to its role in preventing, reducing and controlling micronutrient deficiencies, identify the gaps that represent an unfinished agenda for LSFF, and reflect on the priorities in research, programming and advocacy that urgently need to be addressed to ensure fortification sustainably realizes its potential
Several factors are credited for the uptake by millers and bakers, including: (1) pressure from the nutritionist community applied through advocacy to the convention of the Millers National Federation; (2) appeals to the millers’ philanthropy by invoking the poor nutritional statistics from the South; (3) hints at the possibility of federal legislation that would result in more stringent outcomes if vitamin enrichment was not supported; and (4) the wartime climate, against a backdrop of decisions by the British to produce only enriched flour, elicited a patriotic incentive
Summary
Food systems in many low- and middle-income countries (LMICs) are not delivering nutritionally adequate diets across all populations, resulting in deficiencies in essential micronutrients required for women and children to grow, develop, and thrive [1]. (i.e., the consumption patterns of the fortifiable food vehicle and the nutrient intake and need) must be reassessed regularly to ensure that intended effects at the outcome and impact levels are sustained over time. This latter point is further underscored by the fact that dietary patterns are changing at a rapid pace across Africa and Asia as populations and food systems experience demographic, technological and urbanization shifts, and food choice evolves concomitant with these changes. We provide a narrative review and discuss the progress made in LSFF relative to its role in preventing, reducing and controlling micronutrient deficiencies, identify the gaps that represent an unfinished agenda for LSFF, and reflect on the priorities in research, programming and advocacy that urgently need to be addressed to ensure fortification sustainably realizes its potential
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