ABSTRACT
The study aimed to evaluate the physicochemical and functional properties of liquid whole egg (LWE) with L-calcium lactate (L-Ca), zinc lactate (L-Zn), and sodium ferric EDTA (NaFeEDTA), and to compare with NaCl addition to determine the application potential of these mineral supplements. Results showed that salts addition significantly influenced the foaming, emulsifying, and gelling properties of LWE, which was possible through affecting the pH, particle size, surface hydrophobicity, apparent viscosity, and solubility. The addition of all the four salts reduced pH but increased the d4,3 diameter of LWE. Additionally, the addition of 200 mM L-Ca and 6 mM L-Zn significantly improved the emulsifying capacity by 41.73% and 13.6%, the foaming capacity by 26.57% and 10%, and the protein solubility by 13.89% and 12.70%, respectively. In the meantime, mineral supplements tend to produce lower hardness gel, especially with 25 mM L-Ca and 8 mM L-Zn, and the hardness was decreased from 2401.13 to 1138.29 and 1175.59 g, respectively. A relative decrease in hardness was desirable in gelled egg products. Moreover, the addition of NaCl and L-Ca showed a higher redness and yellowness, but the addition of NaFeEDTA showed an undesirable color in dark brown, which may be not accepted by the public. In summary, L-Ca and L-Zn had great potential for application in LWE, which was more appropriate than adding NaCl. This study provides a basis for improving the functional properties of LWE products in the future. PRACTICAL APPLICATION: The addition of L-Ca and L-Zn to liquid whole egg (LWE) could improve the foaming and emulsifying capacity of LWE as well as produce a lower hardness gel, which may be more conducive to the production of cake, custards, and meat products. Meantime, it is more in line with people's pursuit of a healthy diet.
Subject(s)
Calcium Compounds , Eggs , Ferric Compounds , Lactates , Calcium Compounds/pharmacology , Edetic Acid/pharmacology , Eggs/analysis , Ferric Compounds/pharmacology , Food, Fortified/standards , Humans , Lactates/pharmacology , Zinc/chemistryABSTRACT
Micronutrient malnutrition is a global health issue and needs immediate attention. Over two billion people across the globe suffer from micronutrient malnutrition. The widespread zinc (Zn) deficiency in soils, poor zinc intake by humans in their diet, low bioavailability, and health consequences has led the research community to think of an economic as well as sustainable strategy for the alleviation of zinc deficiency. Strategies like fortification and diet supplements, though effective, are not economical and most people in low-income countries cannot afford them, and they are the most vulnerable to Zn deficiency. In this regard, the biofortification of staple food crops with Zn has been considered a useful strategy. An agronomic biofortification approach that uses crop fertilization with Zn-based fertilizers at the appropriate time to ensure grain Zn enrichment has been found to be cost-effective, easy to practice, and efficient. Genetic biofortification, though time-consuming, is also highly effective. Moreover, a Zn-rich genotype once developed can also be used for many years without any recurring cost. Hence, both agronomic and genetic biofortification can be a very useful tool in alleviating Zn deficiency.
Subject(s)
Biofortification/methods , Crops, Agricultural/genetics , Fertilizers/analysis , Food, Fortified/standards , Malnutrition/diet therapy , Soil/chemistry , Zinc/chemistry , Humans , Malnutrition/physiopathology , Nutritional StatusABSTRACT
The bioavailability of iron from elemental iron powders, including hydrogen reduced iron powder (HRIP), is influenced by particle size and surface area. In the present study, we investigated the solubility, bioaccessibility, and bioavailability of iron from novel HRIPs (particle size ≤25 and 38 µm generated at low [LT] and high [HT] temperature), with porous morphology and high surface area, in intestinal Caco-2 cells and in rat models. The acceptability of fortified wheat flour was tested in human volunteers. The iron solubility and ferritin induction in Caco-2 cells were significantly higher from wheat flour fortified with HRIPs compared to electrolytic iron powder (EIP, ≤45 µm size) either in the absence or presence of ascorbic acid. Nevertheless, ferritin induction in Caco-2 cells was significantly higher with FeSO4 compared to HRIP or EIP. The relative biological value of HRIPs was significantly higher (≤38HT) or similar compared to EIP in rats. However, serum ferritin was significantly higher in rats fed HRIPs than EIP. Further, wheat flour fortified with HRIP was found to be acceptable for consumption. These findings demonstrate higher iron bioavailability from novel HRIPs compared to the reference EIP (≤45 µm) and merits further studies on toxicity and efficacy. PRACTICAL APPLICATION: The use of elemental iron powders for food fortification to alleviate iron deficiency is limited due to its poor bioavailability. The novel hydrogen-reduced elemental iron powders used in this study had higher bioaccessibility and bioavailability compared to reference EIP (≤45 µm) in in vitro and in vivo models, respectively. Further, there were no sensory differences between roti prepared with fortified or unfortified wheat flour. These results suggest that the novel hydrogen reduced elemental iron powders used in the present study are suitable for wheat flour fortification.
Subject(s)
Biological Availability , Flour , Food, Fortified , Iron , Animals , Caco-2 Cells , Flour/analysis , Food, Fortified/analysis , Food, Fortified/standards , Humans , Hydrogen/chemistry , Iron/chemistry , Iron/metabolism , Powders/chemistry , RatsABSTRACT
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.
Subject(s)
Anemia/prevention & control , Food, Fortified/standards , Infant Food/standards , Iron, Dietary/administration & dosage , COVID-19/complications , Evidence-Based Medicine/methods , Global Health , Humans , InfantABSTRACT
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.
Subject(s)
Anencephaly/prevention & control , Folic Acid/administration & dosage , Food, Fortified/standards , Policy Making , Public Health/methods , Spinal Dysraphism/prevention & control , Adult , Female , Health Policy , Humans , Infant, Newborn , Male , PregnancyABSTRACT
Although mandatory fortification of oil with vitamin A is efficacious, its effectiveness can be compromised by suboptimal compliance to standards. In this study, we assessed (1) the availability of oil brands across the eight divisions of Bangladesh, (2) fortification quality (the extent to which vitamin A content is aligned with fortification standards) of oil brands and producers and (3) the market volume represented by available edible oil types. We visited different retail outlets in rural and urban market hubs to ascertain available oil brands and bulk oil types and collected samples. We used high-performance liquid chromatography to quantify average vitamin A content and compared them to the national oil fortification standards. Among the 66 packaged brands analyzed, 26 (39%) were not fortified, and 40 (61%) were fortified, with 28 (42%) fortified above the standard vitamin A minimum. Among the 41 bulk oil type composites analyzed, 24 (59%) were not fortified, and 17 (41%) were fortified, with 14 (34%) fortified below and 3 (7%) fortified above the standard minimum. Vitamin A fortification is high for packaged and branded edible oil but low for oil sold in unbranded, loose form. As bulk oil makes up a large proportion of the oil market volume, this means the majority of the oil volume available to the population is either not (25%) or fortified below the standard requirement (39%). Regulatory inspections of producers selling bulk oil should be prioritized to support and incentivize the industry to make all oil traceable and fortified to standard.
Subject(s)
Dietary Fats, Unsaturated/analysis , Food, Fortified/analysis , Vitamin A/analysis , Bangladesh , Dietary Fats, Unsaturated/classification , Food Labeling , Food Quality , Food, Fortified/standards , Humans , Supermarkets , Vitamin A/administration & dosageABSTRACT
Low dietary calcium is very common in many populations, contributing to nutritional rickets/osteomalacia in children/adults and increasing the risk of several health problems. Calcium is a nutrient of concern as the recommended nutrient requirements are difficult to meet in the absence of dairy products. The provision of culturally acceptable calcium-fortified foods may improve calcium intake when it is a feasible and cost-effective strategy in a particular setting. This landscape review was conducted in 2019 and describes current calcium fortification efforts and lessons learned from these experiences. Worldwide, the United Kingdom is the only country where calcium fortification of wheat flour is mandatory. It is estimated that this fortified staple ingredient contributes to 13-14% of calcium intake of the British population. Other items voluntary fortified with calcium include maize flour, rice, and water. Current calcium fortification programs may lack qualified personnel/training, clear guidelines on implementation, regulation, monitoring/evaluation, and functional indicators. Also, the cost of calcium premix is high and the target groups may be hard to reach. There is a lack of rigorous evaluation, particularly in settings with multiple micronutrient programs implemented simultaneously, with low quality of the evidence. Further research is needed to assess the impact of calcium fortification programs.
Subject(s)
Calcium, Dietary , Calcium/metabolism , Food, Fortified/standards , Nutritional Requirements , Calcium/chemistry , Cost-Benefit Analysis , Flour/standards , Humans , Oryza/chemistry , Triticum/chemistry , United Kingdom/epidemiology , Water/chemistry , Zea mays/chemistryABSTRACT
Zinc deficiency is a major public health problem in vulnerable populations of Latin America and the Caribbean. Biofortification of rice (Oryza sativa L.) with zinc has the potential to alleviate zinc deficiencies. However, as plant breeding processes can alter grain culinary quality and favorable sensory attributes, grain quality and consumer acceptability need to be assessed prior to releasing a variety to the public. A grain quality characterization and a sensory acceptability analysis were carried out with two varieties of zinc biofortified rice and a local control both in Bolivia and Colombia. The aim of this study was to evaluate the physicochemical parameters that are significant in consumer acceptance and to determine the acceptability of zinc biofortified rice by consumers. Results of physicochemical parameters were analyzed using ANOVA. The sensory acceptability was evaluated in 243 adults utilizing a 7-point hedonic scale and a Wilcoxon's signed rank test was used to determine the overall acceptability of the varieties. Biofortified rice variety T2-11 and MAC-18 -control 1- were equally accepted by consumers in Bolivia with no significant differences (p<0.05). The grain quality analysis reported that both presented long and slender rice grains (L>7.5 mm and L/B>3), an intermediate to high amylose content (>25%) and a similar level of chalkiness. In Colombia, the biofortified variety 035 presented a higher score in overall acceptance in comparison to biofortified variety 021 and the local variety CICA4 -control 2-. However, no significant differences were observed (p<0.05). Conversely to the other two varieties, the biofortified variety 035 presented the largest size grain (L/B = 2.97), a lower chalkiness and an amylose content above 25%. This study shows that the grain quality properties of rice have an influence on acceptability and that zinc biofortified rice varieties are accepted by consumers.
Subject(s)
Biofortification , Consumer Behavior , Edible Grain/standards , Oryza/chemistry , Taste Perception , Zinc/analysis , Adolescent , Adult , Attitude , Bolivia , Colombia , Edible Grain/chemistry , Female , Food, Fortified/standards , Humans , Male , Middle AgedABSTRACT
Few studies have examined the role of maternal diet in relation to development of coeliac disease (CD). In Denmark, cancellation of mandatory vitamin D fortification of margarine in June 1985 provided this opportunity. This study examined if season of birth or prenatal exposure to extra vitamin D from food fortification were associated with developing CD later in life. A strength of this study is the distinctly longer follow-up of patients (30 years). This register-based study has a semi-ecological design. Logistic regression analysis was used to estimate odds ratios and to calculate 95% confidence intervals. The odds ratio for developing CD was 0.81 (95% CI 0.66; 1.00 p = 0.054), comparing those with fetal exposure to mandatory vitamin D fortification policy of margarine to those without after adjusting for gender and season of birth. There was a statistically significant season effect particularly for children born in autumn (OR 1.6 95% CI 1.16; 2.21) and born in summer (OR 1.5 95% CI 1.1; 2.1) when compared to children born in winter. Although this study did not find evidence to support the premise that prenatal exposure to small extra amounts of vitamin D from a mandatory food fortification policy lowered risk of developing CD, the small number of CD cases and observed association between season of birth and CD suggest that environmental exposure ought to be further explored.
Subject(s)
Celiac Disease/etiology , Diet/adverse effects , Dietary Supplements , Food, Fortified/adverse effects , Margarine/adverse effects , Nutrition Policy , Nutritional Requirements , Prenatal Exposure Delayed Effects , Seasons , Vitamin D/administration & dosage , Vitamin D/adverse effects , Celiac Disease/epidemiology , Celiac Disease/prevention & control , Denmark/epidemiology , Female , Follow-Up Studies , Food, Fortified/standards , Humans , Male , Margarine/standards , PregnancyABSTRACT
Daily calcium intake is well below current recommendations in most low- and middle-income countries (LMICs). Calcium intake is usually related to bone health, however an adequate calcium intake has also been shown to reduce hypertensive disorders of pregnancy, lower blood pressure and cholesterol values, and to prevent recurrent colorectal adenomas. Food fortification of foods has been identified as a cost-effective strategy to overcome micronutrient gaps in public health. This review summarizes regulatory aspects of fortification of commonly consumed foods with micronutrients, with an emphasis on calcium. We selected a convenient sample of 15 countries from different WHO regions and described the regulatory framework related to calcium fortification of staple foods. We assessed the relevant policies in electronic databases including the WHO Global database on the Implementation of Nutrition Action (GINA) for fortification policies and the Global Fortification Data Exchange Database, a fortification database developed and maintained by Food Fortification Initiative (FFI), Global Alliance for Improved Nutrition (GAIN), Iodine Global Network (IGN), and Micronutrient Forum. Food fortification with micronutrients is widely used in many of the selected countries. Most countries had national legislation for the addition of micronutrients to staple foods, especially wheat flour. These national legislations, that includes regulations and standards, can provide the framework to consider the implementation of adding calcium to the fortification strategies, including the selection of the adequate food vehicle to reach the targeted population at risk safely. The strategy to include calcium in the fortification mix in fortified staple foods seems promising in these countries. However, potential undesired changes on the organoleptic characteristics of fortified foods and products thereof, and operational feasibility at the manufacturing site should be evaluated by the stakeholders during the planning stage. Codex Alimentarius standards should be considered by regulators in order to assure adherence to international standards. While the selected countries already have established national regulations and/or standards for fortification of key staple food vehicles, and there are experiences in the implementation of fortification of some staple foods, national food intake surveys can help plan, design, and modify existing fortification programs as well as monitor food and nutrient consumption to assess risk and benefits.
Subject(s)
Calcium, Dietary/standards , Food, Fortified/standards , Micronutrients/standards , Nutrition Policy/legislation & jurisprudence , Developing Countries , Health Plan Implementation , HumansABSTRACT
Large-scale food fortification is an effective, sustainable, and scalable intervention to address vitamin and mineral deficiencies, however, pressing gaps exist globally around ensuring the quality of fortified foods. This paper summarizes the global challenges and gaps faced in monitoring the quality of fortified foods, the guidance produced in response to these challenges, where we are today in terms of effective implementation, and what approaches and opportunities may be usefully applied to enhance the quality of fortified foods moving forward.
Subject(s)
Food, Fortified/standards , Food/economics , Micronutrients/administration & dosage , Global Health , Health Policy , Humans , Nutritional StatusABSTRACT
Currently, there is an increase in the resistance of microorganisms to the available arsenal of antimicrobial drugs, which makes it necessary to maintain and stimulate the body's own immune-protective properties. The main extraskeletal effect of vitamin D activity is associated with the homeostasis of the immune system. The role of vitamin D in reducing the risk of infection with infectious agents has been studied for a long time. Literature search on the effective use of vitamin D for immunoprophylaxis was carried out in Scopus, Web of Science, PubMed, clinicaltrials.gov databases over the past 10 years for related keywords: vitamin D, immunoprophylaxis. Vitamin D stimulates the synthesis of antimicrobial peptides, cathelicidins and defensins, which exhibit broad-spectrum activity against viruses, bacteria and fungal infections; reduces the concentration of pro-inflammatory cytokines; increases the concentration of anti-inflammatory cytokines. Vitamin D is also involved in cell differentiation, maturation and proliferation of immune cells. The article presents the literature review in order to justify additional intake of vitamin D in case of diagnosis of its deficiency and insufficiency for the purpose of immunoprophylaxis in children and adults, especially in risk groups (elderly age, pregnant women, patients with chronic diseases of respiratory, endocrine and urinary systems, gastrointestinal tract, and infectious diseases). Inclusion of vitamin D in the diet as a dietary supplement, as well as fortification of products with it, can be an effective measure to reduce the risk of both morbidity and mortality, especially during the period of quarantine measures.
Subject(s)
Dietary Supplements/standards , Food, Fortified/standards , Immunomodulation , Vitamin D/therapeutic use , Adult , Animals , Child , Chronic Disease , Endocrine System Diseases/diagnosis , Endocrine System Diseases/diet therapy , Endocrine System Diseases/immunology , Female , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/diet therapy , Gastrointestinal Diseases/immunology , Humans , Infections/diagnosis , Infections/diet therapy , Infections/immunology , Male , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/diet therapy , Pregnancy Complications/immunology , Respiratory Tract Diseases/diagnosis , Respiratory Tract Diseases/diet therapy , Respiratory Tract Diseases/immunology , Vitamin D/immunologyABSTRACT
Child malnutrition remains persistently high in Rwanda. Complementary foods play a key role in young child nutrition. This study explores the quality and safety of complementary food products available in the Rwandan market. Ten of the most consumed porridge-type complementary food products in Rwanda have been analysed. Mean values of macronutrient and micronutrient contents were compared against three international standards and evaluated against label claims. Mean mycotoxin, microbiological, and pesticide contamination were compared with maximum tolerable limits. Mean energy density (385 kcal/100 g) and total fat content (7.9 g/100 g) were lower than all three international benchmarks. The mean fibre content of 8.5 g/100 g was above the maximum recommended amount of Codex Alimentarius and more than double the amount claimed on labels. Mean levels of vitamin A (retinyl palmitate, 0.54 mg/100 g) and vitamin E (α-tocopherol, 3.7 mg/100 g) fell significantly short of all three standards, whereas calcium and zinc requirements were only partially met. Average iron content was 12.1 mg/100 g. The analysis revealed a mean aflatoxin contamination of 61 µg/kg, and high mold and yeast infestation. Escherichia coli and pesticide residues were found, whereas no heavy metals could be quantitated. Overall, complementary food products in Rwanda show inadequate nutrient contents and high aflatoxin and microbial contamination levels. Improved regulation and monitoring of both local and imported products are needed to improve the quality and safety of complementary foods in Rwanda.
Subject(s)
Food Contamination , Food, Fortified/analysis , Food, Fortified/standards , Infant Nutritional Physiological Phenomena , Nutritive Value , Escherichia coli , Food Labeling/standards , Food, Fortified/microbiology , Fungi , Humans , Infant , Micronutrients/analysis , Mycotoxins/analysis , Nutrients/analysis , Nutritional Requirements , Pesticides , Rwanda , YeastsABSTRACT
Commercially produced complementary foods (CPCF) that are iron fortified can help improve iron status of young children. We conducted a review of 217 CPCF sold in 42 stores in Bandung, Indonesia, in 2017. There were 95 (44%) infant cereals, 71 (33%) snacks or finger foods (biscuits or cookies, puffs, and noodles or crackers), 35 (16%) purees, and 16 (7%) other foods for which we obtained label information. Nearly 70% of CPCF reported iron content on their labels, but only 58% of products were reported to be fortified with iron according to ingredient lists. Among iron-fortified products, only one fifth indicated a specific type of iron used as the fortificant, but all of these were recommended by the World Health Organization for fortifying complementary foods. Infant cereal was more likely to contain added iron (81%) compared with snacks or finger food (58%) and purees (14%) and had higher iron content per median serving size (cereal = 3.8 mg, snacks or finger food = 1.3 mg, mixed meals = 2.7 mg, and purees = 0.9 mg). Infant cereal was most likely to meet the recommended daily intakes for iron (41% for infants 6-12 months of age and 66% for children 12-36 months) compared with snacks or finger food (infants = 14%, children = 22%), mixed meals (infants = 28%, children = 46%), or purees (infants = 9%, children = 15%). Regulations on fortification of complementary foods need to specify minimum levels and forms of iron and require reporting in relation to requirements by child age and serving size. Monitoring and enforcement of regulations will be essential to ensure compliance.
Subject(s)
Fast Foods/standards , Food Labeling/standards , Food, Fortified/standards , Infant Food/standards , Iron/administration & dosage , Recommended Dietary Allowances , Child, Preschool , Humans , Indonesia , Infant , Nutrition Policy , Nutritive Value , Serving SizeABSTRACT
PURPOSE: Oral nutritional supplements and fortified foods, here considered supplemented food products (SFP), are recommended as part of nutrition therapy guidelines to treat malnutrition among cancer patients. However, their successful use is limited by patients' failure to meet recommended intakes. This systematic review aimed to identify sensory preferences for SFP among cancer patients and evaluate the methodologies employed in sensory preference assessment. METHODS: A systematic search was conducted in several relevant databases yielding 1056 papers of which 19 met the inclusion criteria. Two authors independently selected papers and extracted findings. The included papers were categorized according to the focus of the preference assessment. RESULTS: Studies comparing sensory preferences for SFP of cancer patients with those of a control group suggested that the liking for SFP by cancer patients differs from healthy participants. Patient heterogeneity in site and stage of tumor, variation in study methodologies, and type of treatment complicated a conclusion regarding the effects of cancer treatment and taste changes on taste preferences. However, some general results were observed among the studies, such as the preference for fresh milk-based supplements when compared with other supplement types. CONCLUSION: This review highlighted the need for consistent reporting and control of variables that influence the sensory characteristics of SFP when sensory preferences are assessed in the clinical setting. Attention to these methodological details will enhance the reliability and accuracy of sensory preference assessment among cancer patients for realistic evaluation of SFP targeted to their nutritional needs.
Subject(s)
Dietary Supplements/standards , Food Preferences/psychology , Food, Fortified/standards , Neoplasms/diet therapy , HumansABSTRACT
BACKGROUND: There is an opportunity to reduce child mortality by preventing folic acid-preventable spina bifida and anencephaly (FAP SBA) in developing countries. We estimated reductions in FAP SBA-associated child mortality in 69 countries with an immediate potential for mandatory fortification of wheat flour. METHODS: Using data from multiple sources, we estimated the percent reductions in neonatal, infant, and under-five mortality that would have occurred by preventing FAP SBA; and the contributions of these reductions toward each country's Sustainable Development Goals (SDG) for child mortality reduction. We used the combined prevalence of spina bifida and anencephaly in selected countries before fortification, and estimated preventable child mortality associated with FAP SBA, assuming 0.5 per 1,000 live births as minimum achievable prevalence from mandatory fortification. RESULTS: Annually, 56,785 live births with FAP SBA occurred in the 69 countries examined. Of these, about 49,680 (87%) would have resulted in deaths under age 5 years, and are preventable through mandatory folic acid fortification. On average, compared to current rates, prevention of FAP SBA would have reduced the neonatal, infant, and under-five mortality by 19% (95% uncertainty interval [UI]: 16-24%), 15% (UI: 13-17%), and 14%, (95% UI: 13-17%), respectively. Prevention of FAP SBA seemed to contribute toward achieving SDG on neonatal and under-five mortality in developing countries. CONCLUSIONS: Prevention of FAP SBA will lead to notable and immediate reductions in child mortality. Many countries have an opportunity to effectively move toward child mortality-related SDG targets with existing milling infrastructure for food fortification.
Subject(s)
Anencephaly/mortality , Spinal Dysraphism/epidemiology , Spinal Dysraphism/mortality , Anencephaly/epidemiology , Anencephaly/prevention & control , Child , Child Mortality , Developing Countries , Female , Flour , Folic Acid/metabolism , Folic Acid Deficiency/mortality , Folic Acid Deficiency/prevention & control , Food, Fortified/economics , Food, Fortified/standards , Genetic Diseases, X-Linked , Goals , Humans , Infant , Male , Neural Tube Defects , Pregnancy , Prevalence , Spinal Dysraphism/prevention & control , Sustainable Development , TriticumSubject(s)
Congenital Hypothyroidism/prevention & control , Goiter, Endemic/prevention & control , Iodine/deficiency , Sodium Chloride, Dietary/administration & dosage , Animal Feed/standards , Commerce/legislation & jurisprudence , Congenital Hypothyroidism/epidemiology , Congenital Hypothyroidism/etiology , Europe/epidemiology , European Union , Food Industry/legislation & jurisprudence , Food Industry/standards , Food, Fortified/standards , Goiter, Endemic/epidemiology , Health Promotion/organization & administration , Humans , Information Dissemination , Iodine/administration & dosage , Public Health Administration , SpainABSTRACT
OBJECTIVE: Analyze the content of documents used to guide mandatory fortification programs for cereal grains. METHODS: Legislation, standards, and monitoring documents, which are used to mandate, provide specifications for, and confirm fortification, respectively, were collected from countries with mandatory wheat flour (n=80), maize flour (n=11), and/or rice (n=6) fortification as of January 31, 2015, yielding 97 possible country-grain combinations (e.g., Philippines-wheat flour, Philippines-rice) for the analysis. After excluding countries with limited or no documentation, 72 reviews were completed, representing 84 country-grain combinations. Based on best practices, a criteria checklist was created with 44 items that should be included in fortification documents. Two reviewers independently scored each available document set for a given country and food vehicle (a country-grain combination) using the checklist, and then reached consensus on the scoring. We calculated the percentage of country-grain combinations containing each checklist item and examined differences in scores by grain, region, and income level. RESULTS: Of the 72 country-grain combinations, the majority of documentation came from countries in the Americas (46%) and Africa (32%), and most were from upper and lower middle-income countries (73%). The majority of country-grain combinations had documentation stating the food vehicle(s) to be fortified (97%) and the micronutrients (e.g., iron) (100%), fortificants (e.g., ferrous fumarate) (88%), and fortification levels required (96%). Most (78%) stated that labeling is required to indicate a product is fortified. Many country-grain combinations described systems for external (64%) monitoring, and stated that industry is required to follow quality assurance/quality control (64%), though detailed protocols (33%) and roles and responsibilities (45%) were frequently not described. CONCLUSIONS: Most country-grain combinations have systems in place for internal, external, and import monitoring. However, documentation of other important items that would influence product compliance to national standard, such as roles and responsibilities between agencies, the cost of regulating fortification, and enforcement strategies, are often lacking. Countries with existing mandatory fortification can improve upon these items in revisions to their documentation while countries that are beginning fortification can use the checklist to assist in developing new policies and programs.
Subject(s)
Documentation/statistics & numerical data , Edible Grain , Food, Fortified/standards , Legislation, Food , Mandatory Programs , HumansABSTRACT
3D printing technology was employed to obtain snacks with a designed cylindrical geometry from wheat flour dough enriched by ground larvae of Yellow mealworms (Tenebrio molitor) as novel source of proteins. The main microstructural features, overall quality, and nutritional attributes were studied as a function of formulation, time and temperature of baking. The addition of ground insects up to 20â¯g/100â¯g (d.b.) resulted in softer dough. This caused an overflow in dough deposition producing the increase in diameter, height and weight of snacks. Baking conditions did not alter the overall aspect of the snacks, but modification of the main dimensional and microstructure attributes were observed due to the better water evaporation. The optimization of baking conditions found that 22â¯min and 200⯰C allowed obtaining a maximum desirability of 0.693. Baked in these conditions, the printed snacks enriched with 10 and 20% of ground insects significantly increased the total essential amino acid, from 32.5 (0% insects) to 38.2 and 41.3â¯g/100â¯g protein, respectively. The protein digestibility corrected amino acid score increased from 41.6 to 65.2 from 0 to 20% insect enrichment, with lysine and methionineâ¯+â¯cysteine being the respective limiting amino acid. Our results evidenced the rational promotion of insects based on nutritional arguments and validated the use of 3D printing as technology to manufacture innovative printed snacks without adverse impact on technological quality.