Food fortification or enrichment is the process of adding
micronutrients (essential trace elements and vitamins) to
food. It can be carried out by food manufacturers, or by governments as a
public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
policy which aims to reduce the number of people with dietary deficiencies within a population. The predominant diet within a region can lack particular nutrients due to the local soil or from inherent deficiencies within the staple foods; the addition of micronutrients to staples and condiments can prevent large-scale
deficiency disease
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
s in these cases.
As defined by the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO) and the
Food and Agricultural Organization of the United Nations
The Food and Agriculture Organization of the United Nations (FAO)french: link=no, Organisation des Nations unies pour l'alimentation et l'agriculture; it, Organizzazione delle Nazioni Unite per l'Alimentazione e l'Agricoltura is an intern ...
(FAO), fortification refers to "the practice of deliberately increasing the content of an essential micronutrient, i.e. vitamins and minerals (including trace elements) in a food, to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health", whereas enrichment is defined as "synonymous with fortification and refers to the addition of micronutrients to a food which are lost during processing".
[World Health Organization and Food and Agriculture Organization of the United Nations Guidelines on food fortification with micronutrients.](_blank)
2006 ited on 2011 Oct 30
Food fortification has been identified as the second strategy of four by the WHO and FAO to begin decreasing the incidence of nutrient deficiencies at the global level.
As outlined by the FAO, the most commonly fortified foods are
cereals and cereal-based products;
milk
Milk is a white liquid food produced by the mammary glands of mammals. It is the primary source of nutrition for young mammals (including breastfed human infants) before they are able to digest solid food. Immune factors and immune-modula ...
and dairy products;
fat
In nutrition, biology, and chemistry, fat usually means any ester of fatty acids, or a mixture of such compounds, most commonly those that occur in living beings or in food.
The term often refers specifically to triglycerides (triple est ...
s and
oil
An oil is any nonpolar chemical substance that is composed primarily of hydrocarbons and is hydrophobic (does not mix with water) & lipophilic (mixes with other oils). Oils are usually flammable and surface active. Most oils are unsaturated ...
s; accessory food items;
tea
Tea is an aromatic beverage prepared by pouring hot or boiling water over cured or fresh leaves of ''Camellia sinensis'', an evergreen shrub native to East Asia which probably originated in the borderlands of southwestern China and north ...
and other beverages; and
infant formula
Infant formula, baby formula, or simply formula (American English); or baby milk, infant milk or first milk (British English), is a manufactured food designed and marketed for feeding to babies and infants under 12 months of age, usually prepar ...
s. Undernutrition and nutrient deficiency is estimated globally to cause the deaths of between 3 and 5 million people per year.
Types
Fortification is present in common food items in two different ways: adding back and addition. Flour loses nutritional value due to the way grains are processed;
Enriched Flour has iron, folic acid, niacin, riboflavin, and thiamine added back to it. Conversely, other fortified foods have micronutrients added to them that don't naturally occur in those substances. An example of this is orange juice, which often is sold with added
calcium
Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...
.
Food fortification can also be categorized according to the stage of addition:
# Commercial and industrial fortification (wheat flour, corn meal, cooking oils)
#
Biofortification
Biofortification is the idea of breeding crops to increase their nutritional value. This can be done either through conventional selective breeding, or through genetic engineering. Biofortification differs from ordinary fortification because it ...
(breeding crops to increase their nutritional value, which can include both conventional selective breeding, and genetic engineering)
# Home fortification (example: vitamin D drops)
Rationale
Micronutrients serve an important role in bodily development and growth. Deficiencies of these micronutrients may cause improper development or even disease.
The WHO and FAO, among many other nationally recognized organizations, have recognized that there are over 2 billion people worldwide who have a variety of micronutrient deficiencies. In 1992, 159 countries pledged at the FAO/WHO International Conference on Nutrition to make efforts to help combat these issues of micronutrient deficiencies, highlighting the importance of decreasing the number of those with iodine, vitamin A, and iron deficiencies.
A significant statistic that led to these efforts was the discovery that approximately 1 in 3 people worldwide were at risk for either an iodine, vitamin A, or iron deficiency.
Although it is recognized that food fortification alone will not combat this deficiency, it is a step towards reducing the prevalence of these deficiencies and their associated health conditions.
In Canada, the Food and Drug Regulations have outlined specific criteria which justify food fortification:
# To replace nutrients which were lost during manufacturing of the product (e.g. the manufacturing of flour)
# To act as a
public health intervention
# To ensure the nutritional equivalence of substitute foods (e.g. to make butter and
margarine similar in content,
soy milk
Soy milk (simplified Chinese: 豆浆; traditional Chinese: 豆漿) also known as soya milk or soymilk, is a plant-based drink produced by soaking and grinding soybeans, boiling the mixture, and filtering out remaining particulates. It is a sta ...
and cow's milk, etc.)
# To ensure the appropriate vitamin and mineral nutrient composition of foods for special dietary purposes (e.g.,
gluten
Gluten is a structural protein naturally found in certain cereal grains. Although "gluten" often only refers to wheat proteins, in medical literature it refers to the combination of prolamin and glutelin proteins naturally occurring in all grai ...
-free products, low sodium, or any other products specifically designed for special dietary requirements from an individual).
There are also several advantages to approaching nutrient deficiencies among populations via food fortification as opposed to other methods. These may include, but are not limited to: treating a population without specific dietary interventions therefore not requiring a change in dietary patterns, continuous delivery of the nutrient, does not require individual compliance, and potential to maintain nutrient stores more efficiently if consumed regularly.
Around the world
The subsections below describe fortifications in some jurisdictions around the world. A more comprehensive view is given by the online ''Global Fortification Data Exchange.'' It indicates which of 197 countries worldwide have mandatory and voluntary food fortification in their datasets and country profiles. The website is maintained by the ''Food Fortification Initiative'',
GAIN,
Iodine Global Network, and the ''Micronutrient Forum''.
Argentina
In
Argentina
Argentina (), officially the Argentine Republic ( es, link=no, República Argentina), is a country in the southern half of South America. Argentina covers an area of , making it the second-largest country in South America after Brazil, th ...
, wheat flour must by law (''Ley 25.630'' of 2002) be fortified with iron, thiamine (vitamin B
1), riboflavin (B
2), niacin (B
3), and folic acid (B
9).
Colombia
Wheat flour sold in
Colombia must by law be fortified with vitamin B
1, vitamin B
2, niacin (B
3), folic acid (B
9) and iron (''Decreto 1944'' of 1996).
El Salvador, Guatemala, Honduras and Nicaragua
The four countries, also called the C-4, all legally require wheat flour to be fortified with vitamins B
1, B
2, B
3, B
9, and iron.
Philippines
The
Philippine
The Philippines (; fil, Pilipinas, links=no), officially the Republic of the Philippines ( fil, Republika ng Pilipinas, links=no),
* bik, Republika kan Filipinas
* ceb, Republika sa Pilipinas
* cbk, República de Filipinas
* hil, Republ ...
law on food fortification has two components: mandatory (covering select staples) and voluntary (under the ''Sangkap Pinoy'' program). The latter has been criticized for covering only low nutritional-value food, namely,
junk food
"Junk food" is a term used to describe food that is high in calories from sugar and/or fat, and possibly also sodium, but with little dietary fiber, protein, vitamins, minerals, or other important forms of nutritional value. It is also known as ...
, to enable them to be sold in schools.
United Kingdom
UK law (The Bread and Flour Regulations 1998) requires that all flour (except wholemeal and some self-raising flours) be fortified with
calcium
Calcium is a chemical element with the symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar t ...
. Wheat flour must also be fortified with iron,
thiamine
Thiamine, also known as thiamin and vitamin B1, is a vitamin, an essential micronutrient, that cannot be made in the body. It is found in food and commercially synthesized to be a dietary supplement or medication. Phosphorylated forms of thi ...
(vitamin B
1) and
vitamin B3.
United States
In the 1920s, food fortification emerged as a strategy in the United States to address and prevent the lack of micronutrients in the population's diet. Specifically, it was discovered in the 1930s and 1940s, that micronutrient deficiency is often linked to specific diseases and syndromes. Consequently, The Committee on Food and Nutrition suggested that micronutrients be added to flour. In 1980,
The Food and Drug Administration put into action its Food Fortification Policy which included six fundamental rules. In addition to establishing safety guidelines of food fortification, this policy aimed to ensure that food fortification was solely for when the supplemental micronutrient had a national deficiency and that the food chosen to provide that nutrient was consumed by enough of the population to make a change. This policy also emphasized the importance of clinical data, a shift from earlier policies which relied on dietary data alone. The
2002 farm bill
The Farm Security and Rural Investment Act of 2002, also known as the 2002 Farm Bill, includes ten titles, addressing a great variety of issues related to agriculture, ecology, energy, trade, and nutrition. This act has been superseded by the 2007 ...
(P.L. 107–171, Sec. 3013) requires the
Administrator of USAID
The administrator of the United States Agency for International Development is the head of the United States federal government's Agency for International Development (USAID).
The administrator is officially nominated by the President of the Un ...
, in consultation with the
Secretary of Agriculture, to establish micronutrient fortification programs under P.L. 480 food aid. Section 3013 replaces a pilot program similarly named and authorized in the
1996 farm bill (P.L. 104–127, Sec. 415). Under the programs, grains and other commodities made available to countries selected for participation will be fortified with micronutrients (e.g., iron, vitamin A, iodine, and
folic acid
Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
).
Criticism
The WHO states that limitations to food fortification may include human rights issues indicating that consumers have the right to choose if they want fortified products or not, the potential for insufficient demand of the fortified product, increased production costs leading to increased retail costs, the potential that the fortified products will still not be a solution to nutrient deficiencies among low-income populations who may not be able to afford the new product, and children who may not be able to consume adequate amounts thereof.
![Ad for](https://upload.wikimedia.org/wikipedia/commons/a/a9/Ad_for_%22Vitamin_Donut%22_%28FDA_168%29_%288212305596%29.jpg)
In addition to criticism of government-mandated fortification, food companies have been criticized for indiscriminate enrichment of foods for marketing purposes. Food safety worries led to legislation in
Denmark
)
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, song_type = National and royal anthem
, image_map = EU-Denmark.svg
, map_caption =
, subdivision_type = Sovereign state
, subdivision_name = Kingdom of Denmark
, establish ...
in 2004 restricting foods fortified with extra vitamins or minerals. Products banned include:
Rice Krispies,
Shreddies,
Horlicks
Horlicks is a sweet malted milk hot drink powder developed by founders James and William Horlick. It was first sold as "Horlick's Infant and Invalids Food", soon adding "aged and travellers" to their label. In the early 20th century, it was s ...
,
Ovaltine
Ovaltine (also known by its original name Ovomaltine) is a brand of milk flavoring product made with malt extract (except in the blue packaging in the United States), sugar (except in Switzerland), and whey. Some flavors also have cocoa. Ovalt ...
and
Marmite
Marmite ( ) is a British savoury food spread based on yeast extract, invented by the German scientist Justus von Liebig. It is made from by-products of beer brewing ( lees) and is produced by the British company Unilever. Marmite is a vegan ...
.
Limited absorption
One factor that limits the benefits of food fortification is that isolated nutrients added back into a processed food that has had many of its nutrients removed, does not always result in the added nutrients being as
bioavailable
In pharmacology, bioavailability is a subcategory of absorption and is the fraction (%) of an administered drug that reaches the systemic circulation.
By definition, when a medication is administered intravenously, its bioavailability is 100%. Ho ...
as they would be in the original, whole food. An example is
skim milk
Skimmed milk (British English), or skim milk (American English), is made when all the milkfat is removed from whole milk. It tends to contain around 0.1% fat.
Background
Historically, skimmed milk was used for fattening pigs, and was recommended ...
that has had the fat removed, and then had
vitamin A
Vitamin A is a fat-soluble vitamin and an essential nutrient for humans. It is a group of organic compounds that includes retinol, retinal (also known as retinaldehyde), retinoic acid, and several provitamin A carotenoids (most notably ...
and
vitamin D
Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (c ...
added back. Vitamins A and D are both fat-soluble and non-water-soluble, so a person consuming skim milk without fats may not be able to absorb as much of these vitamins as one would be able to absorb from drinking whole milk. On the other hand, the nutrient added as a fortificant may have a higher bioavailability than from foods, which is the case with folic acid used to increase folate intakes.
Phytochemicals such as
phytic acid in cereal grains can also impact nutrient absorption, limiting the bioavailability of intrinsic and additional nutrients, and reducing the effectiveness of fortification programs.
Different forms of micronutrients
There is a concern that micronutrients are legally defined in such a way that does not distinguish between different forms, and that fortified foods often have nutrients in a balance that would not occur naturally. For example, in the U.S., food is fortified with folic acid, which is one of the many naturally-occurring forms of folate, and which only contributes a minor amount to the folates occurring in natural foods.
[A. David Smith, "Folic acid fortification: the good, the bad, and the puzzle of vitamin", ''American Society for Clinical Nutrition'', Vol. 85, No. 1, 3-5. January 2007.](_blank)
In many cases, such as with folate, it is an open question of whether or not there are any benefits or risks to consuming folic acid in this form.
In many cases, the micronutrients added to foods in fortification are synthetic.
Certain forms of micronutrients can be actively toxic in a sufficiently high dose, even if other forms are safe at the same or much higher doses. There are examples of such toxicity in both synthetic and naturally occurring forms of vitamins.
Retinol
Retinol, also called vitamin A1, is a fat-soluble vitamin in the vitamin A family found in food and used as a dietary supplement. As a supplement it is used to treat and prevent vitamin A deficiency, especially that which results in xeroph ...
, the active form of Vitamin A, is toxic in a much lower dose than other forms, such as beta carotene.
Menadione
Menadione is a natural organic compound with the formula C6H4(CO)2C2H(CH3). It is an analog of 1,4-naphthoquinone with a methyl group in the 2-position. It is sometimes called vitamin K3. Use is allowed as a nutritional supplement in animal feed ...
, a phased-out synthetic form of
Vitamin K
Vitamin K refers to structurally similar, fat-soluble vitamers found in foods and marketed as dietary supplements. The human body requires vitamin K for post-synthesis modification of certain proteins that are required for blood coagulation ...
, is also known to be toxic.
Examples of fortification in foods
Many foods and beverages worldwide have been fortified, whether a voluntary action by the product developers or by law. Although some may view these additions as strategic marketing schemes to sell their product, there is a lot of work that must go into a product before simply fortifying it. To fortify a product, it must first be proven that the addition of this vitamin or mineral is beneficial to health, safe, and an effective method of delivery. The addition must also abide by all food and labeling regulations and support nutritional rationale. From a food developer's point of view, they also need to consider the costs associated with this new product and whether there will be a market to support the change.
The Food Fortification Initiative lists all countries in the world that conduct fortification programs,
and within each country, what nutrients are added to which foods, and whether those programs are voluntary or mandatory. Vitamin fortification programs exist in one or more countries for folate, niacin, riboflavin, thiamine, vitamin A, vitamin B
6, vitamin B
12, vitamin D and vitamin E. Mineral fortification programs include calcium, fluoride, iodine, iron, selenium and zinc. As of December 21, 2018, 81 countries required food fortification with one or more vitamins.
[ The most commonly fortified vitamin – as used in 62 countries – is folate; the most commonly fortified food is wheat flour ( enriched flour).] Examples of foods and beverages that have been fortified:
Iodized salt
Iodised salt
Iodised salt ( also spelled iodized salt) is table salt mixed with a minute amount of various salts of the element iodine. The ingestion of iodine prevents iodine deficiency. Worldwide, iodine deficiency affects about two billion people and is t ...
has been used in the United States
The United States of America (U.S.A. or USA), commonly known as the United States (U.S. or US) or America, is a country primarily located in North America. It consists of 50 states, a federal district, five major unincorporated territori ...
since before World War II
World War II or the Second World War, often abbreviated as WWII or WW2, was a world war that lasted from 1939 to 1945. It involved the vast majority of the world's countries—including all of the great powers—forming two opposing ...
. It was discovered in 1821 that goiters
A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
could be treated by the use of iodized salts. However, it was not until 1916 that the use of iodized salts could be tested in a research trial as a preventative measure against goiters
A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
. By 1924, it became readily available in the US. Currently in Canada and the US, the RDA for iodine is as low as 90 µg/day for children (4–8 years) and as high as 290 µg/day for breast-feeding mothers.
Diseases that are associated with an iodine deficiency
Iodine deficiency is a lack of the trace element iodine, an essential nutrient in the diet. It may result in metabolic problems such as goiter, sometimes as an endemic goiter as well as congenital iodine deficiency syndrome due to untreated cong ...
include: intellectual disabilities
Intellectual disability (ID), also known as general learning disability in the United Kingdom and formerly mental retardation, Rosa's Law, Pub. L. 111-256124 Stat. 2643(2010). is a generalized neurodevelopmental disorder characterized by signif ...
, hypothyroidism, and goiter
A goitre, or goiter, is a swelling in the neck resulting from an enlarged thyroid gland. A goitre can be associated with a thyroid that is not functioning properly.
Worldwide, over 90% of goitre cases are caused by iodine deficiency. The term is ...
. There is also a risk of various other growth and developmental abnormalities.
Folate
Folate
Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing an ...
(as a fortification ingredient, folic acid) functions in reducing blood homocysteine levels, forming red blood cells, proper growth and division of cells and preventing neural tube defects
Neural tube defects (NTDs) are a group of birth defects in which an opening in the spine or cranium remains from early in human development. In the third week of pregnancy called gastrulation, specialized cells on the dorsal side of the embryo b ...
(NTDs). In many industrialized countries, the addition of folic acid to flour has prevented a significant number of NTDs in infants. Two common types of NTDs, spina bifida
Spina bifida (Latin for 'split spine'; SB) is a birth defect in which there is incomplete closing of the spine and the membranes around the spinal cord during early development in pregnancy. There are three main types: spina bifida occulta, men ...
and anencephaly
Anencephaly is the absence of a major portion of the brain, skull, and scalp that occurs during embryonic development. It is a cephalic disorder that results from a neural tube defect that occurs when the rostral (head) end of the neural tube ...
, affect approximately 2500-3000 infants born in the US annually. Research trials have shown the ability to reduce the incidence of NTDs by supplementing pregnant mothers with folic acid
Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
by 72%.
Niacin
Niacin
Niacin, also known as nicotinic acid, is an organic compound and a form of vitamin B3, an essential human nutrient. It can be manufactured by plants and animals from the amino acid tryptophan. Niacin is obtained in the diet from a variet ...
(a form of vitamin B3) has been added to bread in the US since 1938 (when voluntary addition started), a program which substantially reduced the incidence of pellagra
Pellagra is a disease caused by a lack of the vitamin niacin (vitamin B3). Symptoms include inflamed skin, diarrhea, dementia, and sores in the mouth. Areas of the skin exposed to either sunlight or friction are typically affected first. Over t ...
. Pellagra was seen amongst poor families who used corn as their main dietary staple. Although corn itself does contain niacin, it is not a bioavailable form unless it undergoes nixtamalization
Nixtamalization () is a process for the preparation of corn, or other grain, in which the grain is soaked and cooked in an alkaline solution, usually limewater (but sometimes aqueous alkali metal carbonates), washed, and then hulled. The ter ...
(treatment with alkali, traditional in Native American cultures) and therefore was not contributing to the overall intake of niacin.
Diseases associated with niacin deficiency include pellagra which consisted of signs and symptoms called the three D's-"dermatitis, dementia, and diarrhea." Others may include vascular or gastrointestinal diseases. Common diseases which present a high frequency of niacin deficiency include alcoholism, anorexia nervosa, HIV infection, gastrectomy, malabsorptive disorders, certain cancers and their associated treatments.
Vitamin D
Since Vitamin D
Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (c ...
is a fat-soluble vitamin
A vitamin is an organic molecule (or a set of molecules closely related chemically, i.e. vitamers) that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism. Essential nutri ...
, it cannot be added to a wide variety of foods. Foods that it is commonly added to are margarine, vegetable oils and dairy products. During the late 1800s, after the discovery of curing conditions of scurvy
Scurvy is a disease resulting from a lack of vitamin C (ascorbic acid). Early symptoms of deficiency include weakness, feeling tired and sore arms and legs. Without treatment, decreased red blood cells, gum disease, changes to hair, and bleeding ...
and beriberi
Thiamine deficiency is a medical condition of low levels of thiamine (Vitamin B1). A severe and chronic form is known as beriberi. The two main types in adults are wet beriberi and dry beriberi. Wet beriberi affects the cardiovascular system, ...
had occurred, researchers were aiming to see if the disease, later known as rickets
Rickets is a condition that results in weak or soft bones in children, and is caused by either dietary deficiency or genetic causes. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications ma ...
, could also be cured by food. Their results showed that sunlight exposure and cod liver oil were the cure. It was not until the 1930s that vitamin D
Vitamin D is a group of fat-soluble secosteroids responsible for increasing intestinal absorption of calcium, magnesium, and phosphate, and many other biological effects. In humans, the most important compounds in this group are vitamin D3 (c ...
was actually linked to curing rickets
Rickets is a condition that results in weak or soft bones in children, and is caused by either dietary deficiency or genetic causes. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications ma ...
. This discovery led to the fortification of common foods such as milk, margarine, and breakfast cereals. This took the astonishing statistics of approximately 80–90% of children showing varying degrees of bone deformations due to vitamin D deficiency to being a very rare condition.
Diseases associated with a vitamin D deficiency include rickets
Rickets is a condition that results in weak or soft bones in children, and is caused by either dietary deficiency or genetic causes. Symptoms include bowed legs, stunted growth, bone pain, large forehead, and trouble sleeping. Complications ma ...
, osteoporosis, and certain types of cancer (breast, prostate, colon and ovaries). It has also been associated with increased risks for fractures, heart disease, type 2 diabetes
Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
, autoimmune and infectious diseases, asthma
Asthma is a long-term inflammatory disease of the airways of the lungs. It is characterized by variable and recurring symptoms, reversible airflow obstruction, and easily triggered bronchospasms. Symptoms include episodes of wheezing, co ...
and other wheezing disorders, myocardial infarction
A myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may ...
, hypertension, congestive heart failure
Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
, and peripheral vascular disease
Peripheral artery disease (PAD) is an abnormal narrowing of arteries other than those that supply the heart or brain. When narrowing occurs in the heart, it is called coronary artery disease, and in the brain, it is called cerebrovascular dise ...
.
Fluoride
Although fluoride is not considered an essential mineral, it is useful in prevention of tooth decay and maintaining adequate dental health. In the mid-1900s it was discovered that towns with a high level of fluoride in their water supply was causing the residents' teeth to have both brown spotting and a strange resistance to dental caries. This led to the fortification of water supplies with fluoride in safe amounts (or reduction of naturally occurring levels) to retain the properties of resistance to dental caries but avoid the staining caused by fluorosis (a condition caused by excessive fluoride intake). The tolerable upper intake level (UL) set for fluoride ranges from 0.7 mg/day for infants aged 0–6 months and 10 mg/day for adults over the age of 19.
See also
* Food additive
* Food composition
* Dietary supplement
* Food processing
* Nutraceutical
External links
Food fortification in the Philippines: Policies, programmes, issues, and prospects
References
{{DEFAULTSORT:Food Fortification
Food additives