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Review
. 2018 Jun;39(2):315-331.
doi: 10.1177/0379572118774229.

Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

Saskia J M Osendarp  1   2 , Homero Martinez  2   3 , Greg S Garrett  4 , Lynnette M Neufeld  4 , Luz Maria De-Regil  3 , Marieke Vossenaar  2 , Ian Darnton-Hill  5   6
Affiliations
Review

Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

Saskia J M Osendarp et al. Food Nutr Bull. 2018 Jun.

Abstract

Background: Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance.

Objective: To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC).

Methods: A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a "snowball" process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact.

Results: The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry.

Conclusions: In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.

Keywords: biofortification; compliance; economics; large-scale food fortification; low- and middle-income countries.

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Figures

Figure 1.
Figure 1.. Countries with mandatory or voluntary cereal grain fortification in 2017. Yellow countries have mandatory legislation for wheat flour; green countries have mandatory or voluntary fortification of wheat and maize flour.
Figure 2.
Figure 2.. Low–middle–high income countries with mandatory or voluntary oil fortification in 2017. Green countries have mandatory or voluntary oil fortification.
Figure 3.
Figure 3.. Impact model for staple food fortification.
See this image and copyright information in PMC

References

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