Fortification of industrialized foods with vitamins
Palabras clave:
food, fortified, food habitsResumen
Vitamins are essential to life. Inadequate eating habits, high caloric intake and metabolic defects lead to
micronutrient deficiencies, affecting more than two billion people worldwide. The increasing intake of
industrialized foods, combined with low vitamin stability has led to the common practice of adding these
nutrients to processed foods. This review discusses the terminology, availability, intake and risk of
hypervitaminosis, due to the intake and nutritional importance of foods fortified with vitamins. The addition
of nutrients should occur in foods that are effectively consumed by the target population and must meet the
real needs of a significant segment of the population. In Brazil, a total of 166 products available in supermarkets
are vitamin-enriched. A 10-year study involving children and adolescents in Germany showed that 90% of
those surveyed used at least one fortified food. During this 10-year period, 472 fortified products were
consumed. The enrichment of foods should be based on the needs of each country and, if possible, regional
needs. For instance, in order to increase its intake, Vitamin D is added to foods in Denmark during the winter,
mainly for the elderly. However, in Brazil, there is no evidence of the need to fortify food with this vitamin. A
survey showed that of the 76 enriched dairy products, 37 contained vitamin D. Food-fortification is a very
important strategy to solve nutritional deficiency problems, but it can also cause many health problems.
Citas
Food and Agriculture Organization. Human Vitamin and Mineral Requirements. Report of a joint FAO/WHO expert consultation. Food and Agriculture Organization of the United Nations, Rome, Italy. 1998; 286p. www.fao.org/HumanVitaminandMineralRequirements.htm
Wright AJA, Finglas PM, Southon S. Proposed mandatory fortification of the UK diet with folic acid: have potential risks been underestimated? Trends Food Sci Tech. 2001; 12:313-21.
Brody T. Nutritional Biochemistry. Academic Press: San Diego; 1993.
Park YK, Mcdowell MA, Hanson MS, Yetley EA. History of cereal-grain product fortification in the United States. Nutr. Today. 2001; 36:124-37.
Nilson A, Piza J. Food fortification: a tool for fighting hidden hunger. Food Nutr Bull. 1998; 19:49-60.
Ames BN. DNA damage from micronutrient deficiencies is likely to be a major cause of cancer. Mutat Res. 2001; 475:7-20.
Iyengar GV, Nair PP. Global outlook on nutrition and the environment: meeting the challenges of the next millennium. Sci Total Environ. 2000; 249:331-46.
O’Brien A, Roberton D. Vitamin fortification of foods (specific applications). In: Ottaway PB. The technology of vitamins in food. London: Blackie Academic & Professional; 1993. p.114-42.
Carvalho PRN. Enriquecimento de Alimentos. In: I Seminário Brasileiro de Alimentos Enriquecidos, 1994, Campinas, SP. Resumos. Campinas: Ital/Unicamp. p.1-7.
Richardson DP. The addition of nutrients to foods. Proc Nutr Soc. 1997; 56(3):807-25.
Food and Agriculture Organization/World Health Organization. Codex Alimentarius. Rome; 1995.
Food and Agriculture Organization. Annex 4 – Micronutrient fortification of food: technology and quality control. FAO Technical consultation on food fortification: Technology and Quality control Rome, Italy, 20 – 23 november, 1995. Available from: www.fao.org/docrep/w2840E/w2840E00htm
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária (ANVISA). Proposta de Regulamento técnico para fixação de identidade e qualidade de alimentos adicionados de nutrientes essenciais Portaria n. 31, 13 de janeiro de 1998.
Diário Oficial (da República Federativa do Brasil), Brasília, n.60-E, Seção 1, p.4-5, 30 mar.1998.
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária (ANVISA). Regulamento técnico para fixação de identidade e qualidade de suplementos vitamínicos e ou de minerais Portaria n. 32, 13 de janeiro de 1998. Diário Oficial (da República Federativa do Brasil). 1998; n.60-E, Seção 1, 30 mar.
Fortification Basics. Oils and Margarine. Available from: www.micronutrient.org/search.htm/aceites.pdf2002
United Nations Children’s Found. Current events and recent data. 1996. Fortification update, n.1, 1995. Available from: www.unicef.org.htm
Food and Agriculture Organization. Annex 7 – Legislartion pertaining to food fortification. FAO Technical consultation on food fortification: Technology and Quality control Rome, Italy, 20 – 23 november, 1995. Available from: www.fao.org/docrep/w2840E/w2840e0e.htm#top0fpage
United Nations Children’s Found. Nutrition. 18 nations fortify foods.1996. Available from: www.unicef.org/pon96/nutortif.htm
Layrisse M, Garcia-Casal M, Solano L, Barón MA, Arguello F, Llovera D, Ramírez J, Leets I, Tropper E. Vitamin A reduces the inhibition of iron absortion by phytates and polyphenols. Food Nutr Bull. 1998; 19:3-5.
Lewis J. To fortify or not to fortify: benefits and risks - the principles behind fortification. P Nutr Soc New Zealand. 1999; 24:21-5.
Hendricks MK, Saitowitz R, Fiedler JL, Saghvi T, Roux I, Makan B, Hussey G, Maglagang H, Dary O. An assessment of the feasibility, coverage and cost of fortification maize meal and sugar with vitamin A in South Africa. South African Clin Nutr. 2001; 14:46-55.
Mokhtar N, Belhaldj H, Kress D, Zerrari A, Chaouki N, Aguenaou H. Food-fortification program in Morocco. Food Nutr Bull. 2001; 22:427-30.
Sichert-Hellert W, Kersting M, Schoech G. Consumption of fortified food between 1985 and 1996 in 2- to 14-year-old German children and adolescents. Int J Food Sci Nutr. 1999; 50(1): 65-72.
Avelar PS, Pinheiro-Sant’ana HM, Liberato SC. Alimentos Enriquecidos Com Vitaminas Comercializados Em Belo Horizonte – MG. In: Resumos do II Congresso Internacional de Nutrição, Longevidade e Qualidade de Vida/Alimentos Fortificados; 2001; São Paulo, São Paulo: Núcleo; 2001.
Mora JO, Gueri M, Mora OL. Vitamin A deficiency in Latin America and the Caribbean: an overview. Rev Pan Salud Publica. 1998; 4:178-85.
Krause VM, Delisle H, Solomons NW. Fortified foods contribute one half of recomended vitamin A intake in poor urban guatemalan toddlers. J Nutr. 1998; 128(5):860-4.
Alexy U, Kersting M, Sichert-Hellert W, Manz F, Schoech G. Vitamin intake of 3- to 36-month-old German infants and children - Results of the DONALD-Study. Int J Vitam Nutr Res. 1999; 69(4):285-91.
Sichert-Hellert W, Kersting M, Alexy U, Manz F. Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents. Eur J Clin Nutr. 2000; 54(1):81-6.
Sichert-Hellert W, Kersting M. Dortmund nutritional and anthropometric longi tudinally designed study significance of fortified beverages in the long-term diet of German children and adolescents: 15-year results of Donald Study. Int J Vitam Nutr Res. 2001; 71:356-63.
Wasserbacher B, Elmadfa I. Estimating the degree to which fortified foods meet the nutritional requirements in Austria. Ernahrung. 2001; 25: 57-61.
Siega-Riz AM, Bodnar LM, Savitz DA. What are pregnant women eating? Nutrient and food group differences by races. Am J Obstet Gynecol. 2002; 186(3):480-6.
Bazzano LA, He J, Ogden LG, Loria CM, Vupputuri S, Myers L, Whelto, PK. Agreement on nutrient intake between the databases of the First National Health and Nutrition Examination Survey and the ESHA Food Processor. Am J Epidemiol. 2002; 156(1):78-85.
Barclay D. Multiple fortification of beverages. Food Nutr Bull. 1998; 19:168-71.
Yates AA, Schilcker AS, Suitor CW. Dietary reference intake: The new basis for recommendations for calcium and related nutrients, B vitamins, and choline. J Am Diet Assoc. 1998; 98(6):699-706.
Wallach J. Interpretação de Exames de Laboratório. 6.ed. Rio de Janeiro: Medsi; 1999; 1098p.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteia and recommendations for vitamin C intake. JAMA. 1999; 281(15):1415-23.
Flynn A, Moreiras O, Stehle P, Fletcher RJ, Muller DJ, Rolland V. Vitamins and minerals: A model for safe addition to foods. Eur J Nutr. 2003; 42(2):118-30.
Scanlon KS, Blank S, Sinks T, Lett S, Mueller P, Freedman DS, et al. Subclinical health effects in a population exposed to excess vitamin D in milk. Am J Public Health. 1995; 85(10):1418-22.
Rasmussen LB, Hansen GL, Hansen E, Koch B, Mosekilde L, Molgaard C, et al. Vitamin D: should the supply in the Danish population be increased? Int J Food Sci Nutr. 2000; 51(3):209-15.
Chen TC, Shao A, Heath H3rd, Holick MF. An update on the Vitamin D content of fortified milk from the United States and Canada. N Engl J Med. 1993; 329(20):1507.
Nestel P, Melara A, Rosado J, Mora JO. Vitamin A deficiency and anemia among children 12–71 months old in Honduras. Rev Pan Salud Publica. 1999; 6(1):34-43.
Mills JL. Fortification of foods with folic acid. New Engl. J Med. 2000; 343:970-2
Mills JL. Fortification of foods with folic acid: how much is enough? New Engl J Med. 2000; 342(19):1442-5.
Marinho Há, Castro JS, Donadio MG, Roncada MJ. Prevalência de hipovitaminose A em pré-escolares de Manaus-AM. In: Programa do XVII Congresso Brasileiro de Nutrição; 2002, Porto Alegre. Porto Alegre; Associação Brasileira de Nutrição,
Sociedade Brasileira de Nutrição Clínica, Associação Gaúcha de Nutrição; 2002 p.50. Resumo n.A01/077.
Thu BD, Schultin KW, Dillon D, Gross R, Leswara ND, Khoi HH. Effect of daily and weekly micronutrient supplementation on micronutrient deficiencies and growth in young Vietnamese children. Am J Clin Nutr. 1999; 69(1):80-6.
Ramakrishnan U, Martorell R. The role of vitamin A in reducing child mortality and morbidity and improving growth. Salud Publica Mex. 1998; 40(2):189-98.
Casanueva E, Valdez-Ramos R, Pefeffer R, Ricalde-Moreno A, Garcia Villegas E, Meza C. Retinol sérico en mujeres mexicanas urbanas durante el periodo perinatal. Salud Publica Mex. 1999; 41:317-21.
Ramalho RA, Anjos LA, Flores H. Hipovitaminose A em recém-nascidos em duas maternidades públicas no Rio de Janeiro, Brasil. Cad Saúde Pública. 1998; 14(4):821-7.
Denke MA. Dietary retinol: a double-edged sword. JAMA. 2002; 287(1):102-4.
Saunders C, Accioly E, Baião Santos MMAS, Ramalho RA, Silva CB, Natalizi DA, et al. Ingestão de vitamina A de criança de 4 a 8 anos dos municípios do Rio de Janeiro e São Paulo. In: Programa do XVII Congresso Brasileiro de Nutrição; 2002, Porto Alegre. Porto Alegre; Associação Brasileira de Nutrição, Sociedade Brasileira de Nutrição Clínica, Associação Gaúcha de Nutrição; 2002. p.45 Resumo n.A01/058.
Phillips M, Sanghvi T, Suárez R, McKegney J, Fiedler J. The costs and effectiveness of three vitamin A interventions in Guatemala. Soc Sci Med. 1996; 42:1661-8.
Assis AM, Santos LM, Prado MS, Martins MC, Barreto ML. Tolerância à aplicação de megadoses de vitamina A associada à vacinação em crianças no Nordeste do Brasil. Cad Saúde Pública. 2000; 16(1):51-7.
Englberger L, Elymore J, Ngaden V, Ishmael H, Neupane, S. Vitamin A Deficiency Among Children - Federated States of Micronesia, 2000 [From the Centers for Disease Control and Prevention (CDC): morb mortal wkey Rep.]. JAMA. 2001; 286:667-8.
Robles-Sardin AE, Astiazarán-García H, DávalosNavarro R, Quihui-Cota L, Cabrera-Pacheco RM, Valencia ME. Efecto de la suplementación con una dosis masiva de vitamina A en niños de 6 a 36 meses de edad. Salud Publica Mex. 1998; 40(4):309-15.
Barba CVC, Feliciano EA. Micronutrient deficiency and its alleviation: the Philippine experience. Asia Pac Clin Nutr. 2002; 11:S371-6.
Hendricks MK, Fiedler JL. Food fortification: a feasible, cost-effective option in the fight against vitamin A deficiency in South Africa. S Afr Med J. 2001; 91(9):753-5.
Dary O, Guamuch M, Nestel P. Recovery of Retinol in Soft-Drink Beverages Made with Fortified Unrefined and Refined Sugar: Implications for National Fortification Programs. J Food Compos Anal. 1998; 11:212–20.
Benadé AJ. The potential of red palm oil-based shortining as a food fortificant for vitamin A in the baking industry. Food Nutr Bull. 2001; 22:416-8.
Fiedler JL, Dado DR, Maglalang H, Juban N, Capistrano M, Magpantay MV. Cost analysis as a vitamin A program design and evaluation tool: a case study of the Philippines. Soc Sci Med. 2000; 51(2):223-42.
Arroyave G, Mejia LA, Aguilar JR. The effect of vitamin A fortification of sugar on the serum vitamin A levels of preschool Guatemalan children: a longitudinal evaluation. Am J Clin Nutr. 1981; 34(1):41-9.
Solon FS, Klemm RDW, Sanchez L, Darnton-Hill I, Craft NE, Christian P, West KP Jr. Efficacy of a vitamin A-fortified wheat-flour bun on the vitamin A status of Filipino schoolchildren. Am J Clin Nutr. 2000; 72(3):738-44.
Van Stuijvenberg ME, Dhansay MA, Smuts CM, Lombard CJ, Jogessar VB, Benadé AJ. Long-term evaluation of a micronutrient-fortified biscuits used for addressing micronutrient deficiencies in primary school children. Public Health Nutr. 2001; 4(6):1201-9.
Van Stuijvenberg ME, Kvalsvig JD, Faber M, Kruger M, Kenoyer DG, Benadé AJ. Effect of iron-, iodine-, and b-carotenoo fortified biscuits on the micronutrient status of primary school children: a randomized controlled trial. Am J Clin Nutr. 1999;
(3):457-503.
Fillardi S, Guerreiro CA, Magna LA, Marques Neto JF. Bone mineral density, vitamin D and anticonvulsant therapy. Arq Neuropsiquiar. 2000; 58(3A):616-20.
Liu BA, Gordon M, Labranche JM, Murray TM, Vieth R, Shear NH. Seasonal Prevalence of Vitamin D deficiency in institutionalized older adults. J Am Geriatr Soc. 1997; 45(5):598-603.
Nesby O’Dell S, Scanlon KS, Cogswell ME, Gillespie C, Hollis BW, Looker AC, et al. Hypovitaminosis D prevalence and determinants among African American and white women of reproductive age: third National Health and Nutrition Examination Survey, 1988–1994. Am J Clin Nutr. 2002; 76(1):187–92.
Holick MF. Too little vitamin D in premenopausal women: why should we care? Am J Clin Nutr. 2002; 76(1):3-4
McKenna MJ, Freaney R, Byrne P, McBrinn Y, Murray B, Kelly M, Donne B, O’Brien M. Milk fortified with vitamin D3
and calcium: safety and efficacy in young adults. Bone. 1996; 16:679-95 (abstract P30).
Neuhouser ML, Beresford SA. Folic acid: Are current fortification levels adequate? Nutrition. 2001; 17(10):868-72.
Reynolds EH. Benefits and risks of folic acid to nervous system. J Neurol Neurosurg Psychiatry. 2002; 72(5):567-71.
French MR, Barr SI, Levy-Milne Y. Folate intakes and awareness of folate to prevent neural tube defects: a survey of women living in Vancouver, Canada. J Am Diet Assoc. 2003; 103(2):181-5.
Becker GL. Folic acid and food fortification. Food Processing. 1994; 55:41-4.
Gregory JF 3rd, Willeamson J, Bailey LB, Toth JP. Urinary excretion of [2H4] folate by nonpregnant women following a single oral dose of [2H4] folic acid is a functional index of folate nutritional status. J Nutr. 1998; 128(11):1907-12.
Schorah CJ, Devitt H, Lucock M, Dowell AC. The responsiveness of plasma homocysteine to small increases in dietary folic acid: a primary care study. Eur J Clin Nutr. 1998; 52(6):407-11.
Lawrence JM, Petitti DB, Watkins M, Umekubo MA. Trends in serum folate after food fortification. Lancet. 1999; 354(9182):915-6.
Choumenkovitch SF, Jacques PF, Nadeau MR, Wilson PW, Rosenberg IH, Selhub J. Folic acid fortification increases red blood cell folate concentrations in the Framingham study. J Nutr. 2001; 131(12): 3277-80.
Boushey CJ, Edmonds JW, Welshimer KJ. Estimates of the effects of folic-acid fortification and folicacid bioavailability for women. Nutrition. 2001; 17(10):873-9.
Lima HT, Sunders C, Ramalho RA. Ingestão dietética de folato em gestantes do município do Rio de Janeiro. In: Programa do XVII Congresso Brasileiro de Nutrição; 2002, Porto Alegre. Porto Alegre; Associação Brasileira de Nutrição, Sociedade Brasileira de Nutrição Clínica, Associação Gaúcha de Nutrição; 2002. p.59. Resumo n.A01/113.
Angelis RC. Importância de alimentos enriquecidos com ácido fólico. Prevenção de Enfermidades Cardiovasculares. Nutr Clin. 2001; 9: 28-37.74.
Pena GG, Dutra MM, Freitas SN, Cintra IP. Perfil do consumo alimentar de adolescentes de 10 a 18 anos de escolas públicas e privadas do Ouro Preto-MG. In: Programa do XVII Congresso Brasileiro de Nutrição; 2002, Porto Alegre. Porto
Alegre; Associação Brasileira de Nutrição, Sociedade Brasileira de Nutrição Clínica, Associação Gaúcha de Nutrição; 2002. p.144 Resumo n.A12/076.
Ray JG, Vermeulen MJ, Boss SC, Cole DE. Declining rate of folate insufficiency among adults following increased folic acid food fortification in Canada. Can J Public Health. 2002; 93(4):249-53.
Persad VL, van den Hof MC, Dube JA, Zimmer P. Incidence of open neural tube defects in Nova Scotia after folic acid fortification. CMAJ. 2002; 167(3):241-5.
Wald NJ, Law MR, Morris JK, Wald DS. Quantifying the effect of folic acid. Lancet. 2001; 358(9298):2069-73.
Murphy M, Whiteman D, Stone D, Botting B, Schorah C, Wild J. Dietary folate and the prevalence of neural tube defects in the British Isles: the past two decades. Brit J Obstet Gynaec. 2000; 107(7):885-9.
Mckay DL, Perrone G, Rasmussen H, Dallal G, Blumberg JB. Multivitamin/Mineral supplementation improves plasma B-Vitamin status and homocysteine concentration in healthy older adults consuming a folate-fortified diet. J Nutr. 2000; 130(12):3090-6.
Bostom AG, Gohh RY, Liaugaudas G, Beaulieu AJ, Han H, Jacques PF. Prevalence of mild fasting hyperhomocysteinemia in renal transplant versus coronary artery disease patients after fortification of cereal grain flour with folic acid. Atherosclerosis. 1999; 145(1):221-4.
Tice JA, Ross E, Coxson PG, Rosenberg I, Weinstein MC, Hunink MG, et al. Cost-effectiveness of vitamin therapy to lower plasma homocysteine levels for the prevention of coronary heart disease: effect of grain fortification and beyond. JAMA.
; 286(8):936-43.
Bazzano LA, He J, Ogden LG, Loria C, Vupputuri S, Myers L, Whelton PK. Dietary intake of folate and risk of stroke in US men and women: NHANES I Epidemiologic Follow-up Study. Stroke. 2002; 33(5):1183-8.
Samuels N. Screening for homocysteine levels in Israel in primary care clinics: a need for guidelines. Prev Med. 2003; 37(6 Pt 1):668–71.
Grunwald HW, Rosner FMD. Letters. Folic Acid Fortification of Food. J Am Med Assoc. 1992; 275:682.
Tucker KL, Rich S, Rosenberg I, Jacques P, Dallal G, Wilson PWF, et al. Plasma vitamin B-12 concentrations relate to intake source in the Framingham Offspring Study. Am J Clin Nutr. 2000; 71(2):514-22.
Ray JG, Cole DE, Boss SC. An Ontario-wide study of vitamin B12, serum folate, and red cell folate levels in relation to plasma homocysteine: is a preventable public health issue on the rise? Clin Biochem. 2000; 33(5):337-43.
Quinlivan EP, McPartlin J, McNulty H, Ward M, Strain JJ, Weir DG, et al. Importance of both folic acid and vitamin B12 in reduction of risk of vascular disease. Lancet. 2002; 359(9302):227-8.
Hirsch S, de la Maza P, Barrera G, Gattas V, Petermann M, Bunout D. The Chilean flour folic acid fortification program reduces serum homocysteine levels and masks vitamin B-12 deficiency in elderly people. J Nutr. 2002; 132(2):289-91.
Venn BJ, Green TJ, Moser R, Mann JI. Comparison of the effect of low-dose supplementation with L5-methyltetrahydrofolate or folic acid on plasma homocysteine: a randomized placebo-controlled study. Am J Clin Nutr. 2003; 77(3):658-62.
Cho S, Johnson G, Song WO. Folate content of foods: Comparison between databases compiled before and after new FDA fortification requirements. J Food Comp Anal. 2002; 15: 293-307.
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Derechos de autor 2023 Selma Coelho LIBERATO, Helena Maria PINHEIRO-SANT’ANA
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