Glossary

Term · Pregnancy: Eating

fortification

Also: food fortification, fortified foods, milk fortifier, folic acid fortification

Adding vitamins or minerals to foods, such as folic acid in flour, or to breast milk for babies born early. It comes up in folate advice and in hospital feeds.

In plain words

Fortification means adding vitamins or minerals to a food that does not naturally have enough of them. In the United States, enriched grain products have carried added since 1998. The step was aimed at lowering the risk of , such as spina bifida. Those defects form in the first weeks of pregnancy, often before a mother knows she is pregnant. Fortification also describes the nutrients added to breast milk for babies born early, to help them meet growth needs. It is different from a supplement. It works across a whole food supply rather than through one person's daily pill. A mother may see folic acid on a cereal label, or hear that a milk fortifier is being added to her baby's feeds in the hospital.

The deeper version

Fortification adds micronutrients to a widely eaten vehicle food at population scale, or to a single infant's milk at the bedside. Mandatory folic acid fortification of enriched cereal grains took effect in the United States in January 1998. Honein and colleagues (JAMA, 2001) estimated about a 19 percent decline in neural tube defect prevalence in the years after implementation. Human milk fortifiers, usually protein and mineral concentrates added to expressed milk for preterm infants, are a separate use with its own evidence base. The ESPGHAN committee on nutrition (Agostoni and colleagues, 2010) describes individualized fortification guided by growth and blood measures rather than fixed routine dosing. The main debates concern whether broader mandatory fortification is warranted, how much of any population benefit comes from folic acid alone, and how to match fortifier amounts to each preterm infant's growth.

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Sources

  • CDC (Honein MA and colleagues) — Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects. JAMA, 2001
  • ESPGHAN Committee on Nutrition (Agostoni C and colleagues) — Enteral nutrient supply for preterm infants: commentary from the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 2010

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