Public Health Nutrition

HOT TOPIC – Fortification

Food fortification improves the intake of all fortified nutrients, but fails to meet the estimated dietary requirements for vitamins A and B6, riboflavin and zinc, in lactating South African women

Peggy C Papathakisa1 c1 and Kerry E Pearsona1

a1 Department of Food Science and Nutrition, California Polytechnic State University, San Luis Obispo, CA 93407, USA


Objective To investigate the impact of fortification by comparing food records and selected biochemical indicators of nutritional status pre- and post-fortification.

Design Mean intake from 24 h recalls (n 142) was compared with the Estimated Average Requirement (EAR) to determine the proportion with inadequate intake. In a subsample (n 34), diet and serum retinol, folate, ferritin and Zn were compared pre- and post-fortification for fortified nutrients vitamin A, thiamin, riboflavin, niacin, folic acid, Fe and Zn.

Setting South Africa.

Subjects Breast-feeding women (ninety-four HIV-infected, forty eight HIV-uninfected) measured at ∼6, 14, 24 weeks, and 9 and 12 months postpartum.

Results Pre-fortification, >80 % of women did not meet the EAR for vitamins A, C, D, thiamin, riboflavin, niacin, B6, B12 and folate and minerals Zn, iodine and Ca. Dietary intake post-fortification increased for all fortified nutrients. In post-fortification food records, >70 % did not meet the EAR for Zn and vitamins A, riboflavin and B6. Serum folate and Zn increased significantly post-fortification (P < 0·001 for both), with no change in ferritin and a reduction in retinol. Post-fortification marginal/deficient folate status was reduced (73·5 % pre v. 3·0 % post; P < 0·001), as was Zn deficiency (26·5 % pre v. 5·9 % post; P < 0·05). Pre- and post-fortification, >93 % were retinol replete. There was no change in Fe deficiency (16·7 % pre v. 19·4 % post; P = 0·728).

Conclusions Micronutrient intake improved with fortification, but >70 % of lactating women did not meet the EAR for Zn, vitamins A, riboflavin and B6. Although 100 % exceeded the EAR for Fe after fortification, Fe status did not improve.

(Received January 04 2012)

(Revised May 03 2012)

(Accepted May 06 2012)

(Online publication July 05 2012)


c1 Corresponding author: Email