Forceful message in fortification study

by Josh Sosland
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Among the challenges faced by those defending the healthfulness of grain-based foods, none has proved more vexing than the absence of recent scientific research examining the category’s importance as a source of dietary nutrition. While the role of enrichment in eliminating diseases associated with inadequate nutrition, including beri beri and pellagra, may be thought of as long “settled science” by the industry, fortification and enrichment recently have come under fire by those worried micronutrient additions exceed current human needs. Even industry advocates in the scientific community, including members of the Grain Foods Foundation Scientific Advisory Board, have bemoaned an absence of studies looking at the healthfulness of enriched grain products.

Thus, the publication earlier this year of a study looking directly at the role of fortification/enrichment in micronutrient intake adequacy represents a major step toward filling this void. Titled “Fortified Foods are Major Contributors to Nutrient Intakes in Diets of U.S. Children and Adolescents,” the 22-page paper was published in the Journal of the Academy of Nutrition and Dietetics. Based on food and supplement consumption data gathered by the Centers for Disease Control and Prevention in its National Health and Nutrition Examination Survey (NHANES) from 7,250 subjects aged 2-18 during the early 2000s, the researchers identified which foods, beverages or supplements provide micronutrients for children, whether their nutrient intake is either insufficient or excessive and whether their intake would be insufficient if foods were not fortified or enriched.

For the most part, children in the United States are experiencing neither inadequate nor excessive intake of the 17 micronutrients they examined.

Of greatest interest to grain-based foods is the source of these micronutrients, and here the results represent a breathtaking affirmation for the industry. Enriched grain products were the leading source for the micronutrients in the case of 8 of the 11 for which the authors listed dietary sources (6 micronutrients were not broken out by source). But for enrichment, large swaths of the population of children in the United States would not be getting enough vitamins and minerals. Looking at thiamin as an example, only 10.2% of females 14 to 18 are consuming too little from food. Without fortification, though, the researchers estimated this figure would leap to 85.6%. Sixty-four per cent of thiamin in the diet of children aged 9-18 comes from grain-based foods. In the case of iron, 60% in the diets of children aged 9-18 comes from grain-based foods. Intake is deficient for only 11.5% of teenage females but would be 51.8% without fortification.

The figures on iron are not just an abstract statistical exercise. Globally, 30.2% of non-pregnant women and 41.8% of pregnant women are anemic, a condition, related to inadequate iron intake, in which the body does not have enough healthy red blood cells. With an incidence rate of 3.1%, the United States is the only country tracked in a 2008 World Health Organization study in which anemia incidence was below 5%.

Beyond the data, three aspects of the paper merit consideration. While funding for the research came from the International Life Sciences Institute, a non-profit research and education group sustained by the food and agribusiness industries, the organization is not a grain-based foods organization. Member companies in North America include Hillshire Brands, Kraft Foods, Mondelez and Unilever, companies with no particular tilt toward the sector — grain-based foods — that fared most favorably.

Second, additional research on this important topic is needed, and public health recommendations of dietary intake changes should more carefully weigh the potential effects such guidance could have on the adequacy of micronutrient intake. Off-hand calls or more deliberate recommendations for reductions in consumption of enriched grains must be recognized as irresponsible public health policy. Finally, the handful of micronutrients for which dietary inadequacy remains widespread in the United States, including vitamin D, should be vigorously but carefully explored as candidates for grains fortification so that the grain-based foods industry is able to build further on its proud role as a cornerstone of public health.

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