Food Fortification: Benefits Extend Beyond Babies

Wednesday, October 10th, 2018

Physical changes, medications, hospitalisations, and social factors can put older adults at risk of malnutrition which makes other health problems worse. By the Food Fortification Initiative.

Fortifying food is often seen as a strategy to help young people because children and women in their child-bearing years require vitamins and minerals for healthy growth and development. Yet physical changes, medications, hospitalisations, and social factors can put older adults at risk of malnutrition which makes other health problems worse. Consequently, fortifying food is as important for the aging population as it is for children and women who may become pregnant.

The aging population is particularly noteworthy in Asia. With decreasing fertility rates and increasing life expectancy, the World Economic Forum notes that more than half the world’s people over age 60 years live in Asia and the Pacific. By 2050, “nearly two-thirds of the world’s older people—close to 1.3 billion—will live in Asia-Pacific, and one in four people across the region is expected to be over 60. In north-east and East Asia, this proportion will be more than one in three people.”

While an aging population has many implications for a country’s economy and health system, aging increases the likelihood of individuals having a chronic disease. Heart disease, diabetes, and osteoporosis are a few of the illnesses that people are more likely to experience as older adults than as youth. Proper nutrition plays a role in preventing diseases, and good nutrition contributes to quality of life and lessens the disease’s effects.

Fortification involves adding essential nutrients to foods as they are processed. A key advantage is that consumers do not have to change their shopping or eating habits to benefit. They simply continue to enjoy eating their favourite foods.

“Globally, we have emphasised good nutrition during the first 1,000 days of life, meaning from conception through a child’s second birthday. While that is a critical time, the need for nutrition does not stop at age 2,” said Scott J. Montgomery, Director of the Food Fortification Initiative. “Food fortification gives people of all ages additional vitamins and minerals to help them remain healthy through the life span.”


B Vitamins—Not Just For Babies

Folic acid (vitamin B9) reduces the risk of birth defects of the brain and spine. Consequently, women of childbearing age are encouraged to take 400 micrograms of folic acid every day. This amount of vitamin B9 is nearly impossible to consume daily from unfortified food alone, consequently flour and rice are often fortified with folic acid.

Yet the recommended daily intake (RDI) for adult men and women of all ages is 400 micrograms of folic acid. This nutrient helps people produce and maintain healthy cells and prevent anemia from vitamin B9 deficiency. One neurologist’s research shows that in older adults, “Vitamin B9 deficiency contributes to ageing brain processes, increases the risk of Alzheimer’s disease and vascular dementia and, if critically severe, can lead to a reversible dementia.”

Fortifying with folic acid has nearly eliminated anemia from vitamin B9 deficiency among older adults in the United States, where most of the wheat flour, maize flour, and rice is fortified with folic acid. In a geriatric healthcare facility in Japan, 28 of 68 residents were deficient in vitamin B9. They were given rice that was fortified with folic acid, and within 6 months, none of them had this deficiency.

Moreover, people need vitamins B9, B6 and B12 to lower homocysteine levels. This is important because elevated homocysteine levels are associated with dementia, heart disease, stroke, and osteoporosis. In Australia, homocysteine levels were significantly reduced among people older than 65 years after wheat flour was fortified with vitamin B9 (folic acid). Also, in Sakado City, Japan, rice fortified with folic acid resulted in decreased homocysteine levels and reduced medical costs by decreasing myocardial infarction, stroke, dementia, and fracture.

Other nutrients for which the RDI does not change as adults age include selenium, zinc, iron, iodine, thiamin, riboflavin, niacin, pantothenate, and vitamins B12, C, E, and K.

The four nutrients for which the RDI increases as adults age are calcium and vitamins A, B6, and D. The following information focuses on these four vitamins and minerals.



Calcium is needed for healthy bones. The mineral is also necessary for performing key tasks, such as transmitting nerve messages, enhancing muscle function, and clotting blood. The RDI for calcium remains at 1,300 micrograms per day for women from age 51 years through the rest of their lives. For men, the RDI increases from 1,000 micrograms per day from 19 to 65 years to 1,300 micrograms per day after 65 years.

Dairy products are natural sources of calcium, and some breakfast cereals, juices, and other foods are fortified with calcium. Adding calcium to flours can be challenging as the compounds do not flow well through milling equipment. Also, calcium is usually added to flour at higher levels than other nutrients. Together, this means calcium can clog the mill’s fortification equipment. Mills can solve this problem by having separate equipment for the calcium addition.


Vitamin A

Vitamin A deficiency is the leading cause of preventable childhood blindness. For adults, vitamin A is important for normal vision, immunity, reproduction, and proper functioning of the heart, lungs, kidneys, and other organs. Though too much vitamin A can be dangerous, the daily “recommended safe intake” for women increases from 500 micrograms of retinol equivalents per day from 50 to 65 years to 600 micrograms of retinol equivalents per day after 65 years. The recommended safe intake for men remains at 600 micrograms of retinol equivalents from age 19 years through the rest of the life span.

The Philippines includes vitamin A in its standard for wheat flour and cooking oil. It is typically less expensive to fortify edible oils or margarine with vitamin A than to fortify flours with vitamin A.


Vitamin B6

Vitamin B6 facilitates enzyme reactions involved in metabolism and assists with immune function. It is also one of the vitamins that prevents the accumulation of homocysteine. A woman’s RDI of vitamin B6 remains at 1.5 micrograms per day from 50 years of age throughout the rest of her life. For men, the RDI increases from 1.3 micrograms per day from 19 to 50 years to 1.7 micrograms per day after 50 years. Poultry, fish, potatoes, and non-citric fruit are good sources of vitamin B6. In countries where these foods are commonly consumed, vitamin B6 deficiency may be uncommon. People in countries where diverse foods are not accessible or affordable may have vitamin B6 deficiency and would benefit from foods being fortified with vitamin B6.


Vitamin D

Vitamin D is sometimes called the sunshine vitamin because people produce it when their skin is exposed to sunlight. People who mostly stay indoors, including some elderly people with limited mobility, are more likely to develop vitamin D deficiency. Women’s RDI for vitamin D increases from 10 micrograms per day from 50 to 65 years to 15 micrograms per day after 65 years. For men, the RDI for vitamin D increases from 5 micrograms per day from 19 to 50 years to 15 micrograms per day after 50 years.

Vitamin D is essential for bone health because it helps people absorb calcium. As a result, vitamin D deficiency in adults contributes to osteoporosis, which is marked by weak and brittle bones. This often leads to broken bones, most often of the wrist, spine, and hip. Women of Asian and Caucasian descent are more prone to osteoporosis than other ethnic groups, according to the International Osteoporosis Foundation.

To increase vitamin D intake in Canada, fortifying milk and margarine with vitamin D is mandatory. In the United States, including vitamin D in infant formula is mandatory, and fortifying other foods such as milk, orange juice, and breakfast cereals with vitamin D is voluntary.

Silver Market

Asia’s aging population has been called the “silver market”. The label implies that older adults have high disposable incomes and can afford to purchase expensive items. Other researchers conclude that several factors could make the economic impact of Asia’s aging population positive or negative.

A key benefit of mandatory food fortification is that if the mandate covers commonly consumed foods and it is well implemented, consumers benefit regardless of their age or economic status. Fortification adds nutritional value to food, whether the person is indulging at an expensive restaurant, making instant noodles at home, or eating a meal with other residents at a senior living facility.



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