Definition

The main strategies to prevent and control micronutrient deficiencies include dietary improvement, through promoting the consumption of foods that are naturally rich in micronutrients and encouraging dietary diversification; food fortification—the practice of deliberately increasing the content of one or more micronutrients (i.e. vitamins and minerals) in a food or condiment to improve the nutritional quality of the food supply and provide a public health benefit with minimal risk to health; supplementation, which delivers key micronutrients (e.g. iron, folic acid, and vitamin A) to populations in need; and disease control measures implemented through improved public health services.

This Policy Instrument (PI) focuses on the prevention and control of micronutrient deficiencies through food fortification, as other key interventions to reduce micronutrient deficiencies are addressed in different Policy Instruments. Notably, dietary improvement is covered under the ‘Promotion and Access to Healthy Diets’ PI, while micronutrient supplementation is addressed in the ‘Maternal and Early Childhood Nutrition’ PI.”

Rationale

Large-scale food fortification (LSFF) and biofortification: These are cost-effective strategies for improving micronutrient intake and reducing micronutrient deficiencies among populations at large, including vulnerable population groups. LSFF has the potential to reach populations at large with essential micronutrients. Globally, 147 countries mandate or allow salt iodization virtually eliminating iodine deficiency and goitre in much of the world. Further, 92 countries have mandated cereal grain fortification programmes and more than 30 mandate fortification of edible oil, reducing the prevalence of deficiencies in essential micronutrients such as iodine, folate, iron, vitamin A, vitamin D and zinc, especially where the programmes are mandatory, well-implemented and enforced.

Key interventions

• Governments play an important role in creating an economically safe and supportive environment for fortification. This can be done by creating an adequate and enforceable legal framework for fortification and establishing effective fortification requirements that can be feasibly implemented by the food industry. Mandatory legislation for fortification also creates a level-playing field for the industry partners to fortify their produce.
• Regulatory standards for large-scale fortification of commonly-consumed staple foods and condiments (rice, wheat flour, maize flour, edible oil and salt) set out the regulatory framework, definition and scope of large-scale fortification, fortification levels, and labeling guidelines for producers of fortified foods. They also provide a guideline for Food and Drug Administrations and other enforcement agencies to monitor and ensure the quality of fortified foods produced and distributed/sold in the open market or through government-led programmes/social protection platforms. Depending on the context, this intervention can also include guidelines for enforcement agencies on how to handle non-conforming food commodities. Regulatory Standards for Fortification of commonly-consumed foods can be adopted by any government.
• Around 443 varieties of conventionally bred, “biofortified” crop varieties were released by December 2023 and most are grown in more than 40 countries. More than 20 million farmers are currently growing conventionally biofortified varieties, and more than 103 million people in these farms are benefitting from these nutrient-dense crops with an estimated additional 227 million consumers buying and eating these foods from the marketplace. Similarly to LSFF, biofortification requires legislation, standards (e.g. levels of micronutrients in Government set breeding policies), and strategies for biofortification (e.g. food labeling, nutrition and health claims regulations).
• Fortified commonly-consumed foods can be incorporated into social protection/social assistance programmes (including school feeding and food ration distribution programmes) that target populations who are at particularly high risk of micronutrient deficiencies as well as in humanitarian assistance. This will contribute to increased synergies between the health, food and social protection national systems. The adoption of Regulatory Standards for the Fortification of Staple Foods is an important pre-requisite to ensure social protection/social assistance programmes deliver quality and impactful support to populations at the highest risk. This includes ensuring that food rations and/or food provided through school meals are adequately fortified.
• Guaranteed demand and standards enforced by governments for foods distributed through social assistance (including school meals) will also stimulate the industry to start fortifying.