Save Lives — Food Fortification Initiative

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<noscript><img src="https://web.archive.org/web/20230308151817im_/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1587238329801-BFZ56408C0XGP4DC4PWS/Wheat%252Bwith%252Bblue%252BskyFromCDC.jpg" alt="Wheat%2Bwith%2Bblue%2BskyFromCDC.jpg"/></noscript><img class="thumb-image" data-src="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1587238329801-BFZ56408C0XGP4DC4PWS/Wheat%252Bwith%252Bblue%252BskyFromCDC.jpg" data-image="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1587238329801-BFZ56408C0XGP4DC4PWS/Wheat%252Bwith%252Bblue%252BskyFromCDC.jpg" data-image-dimensions="2499x1406" data-image-focal-point="0.5,0.5" alt="Wheat%2Bwith%2Bblue%2BskyFromCDC.jpg" data-load="false" data-image-id="5e9b55b98bfd225caf98cdc9" data-type="image"/> </div> </div> </figure> </div> </div></div></div></div><div class="row sqs-row"><div class="col sqs-col-2 span-2"><div class="sqs-block spacer-block sqs-block-spacer sized vsize-1" data-block-type="21" id="block-fa50f2a3219a9286464c"><div class="sqs-block-content"> </div></div></div><div class="col sqs-col-8 span-8"><div class="sqs-block html-block sqs-block-html" data-block-type="2" id="block-4bea8f35e8c4c114db75"><div class="sqs-block-content"> <p class="" style="white-space:pre-wrap;">Countries add nutrients to flour and rice to help people and nations thrive. Iron, zinc, folic acid, and other B vitamins are commonly added to prevent anemia from nutritional deficiencies and reduce the risk of infants with severe brain and spine birth defects known as neural tube defects.</p><p class="" style="white-space:pre-wrap;">Fortification is a <a href="https://web.archive.org/web/20230308151817/https://static1.squarespace.com/static/5e1df234eef02705f5446453/t/614b92c48bb5f93a2b5b01fd/1632342726504/Safety_of_fortifying_with_folic_acid_Pachon_July2019+%281%29.pdf" target="_blank">safe nutrition intervention</a> proven to benefit individuals at every point in life—from <a href="/web/20230308151817/https://www.ffinetwork.org/mothers-and-babies" target="_blank">conception</a> to <a href="/web/20230308151817/https://www.ffinetwork.org/adults" target="_blank">aging.</a> Also, <a href="/web/20230308151817/https://www.ffinetwork.org/mothers-and-babies" target="_blank">breastfeeding</a> mothers, <a href="/web/20230308151817/https://www.ffinetwork.org/children" target="_blank">adolescents</a>, and adults in their reproductive years need the nutrients included in fortified grains.</p><p class="" style="white-space:pre-wrap;">Nationally, fortification improves <a href="/web/20230308151817/https://www.ffinetwork.org/adults" target="_blank">productivity</a> and reduces <a href="/web/20230308151817/https://www.ffinetwork.org/world" target="_blank">healthcare expenditures.</a> Globally, fortification addresses several of the <a href="/web/20230308151817/https://www.ffinetwork.org/world#sdg" target="_blank">Sustainable Development Goals</a> and can restore nutrients lost in crops as a result of <a href="/web/20230308151817/https://www.ffinetwork.org/world" target="_blank">climate change.</a></p> </div></div><div class="sqs-block video-block sqs-block-video" data-block-json="{"blockAnimation":"none","layout":"caption-hidden","overlay":true,"description":{"html":"82 countries have legislation that requires adding essential vitamins and minerals to wheat flour, maize flour, and/or rice. Watch this video to see what mot..."},"hSize":null,"floatDir":null,"isOldBlock":true,"customThumb":"5e9b85cf9da3a560e80eea11","html":"<iframe src=\"//www.youtube.com/embed/QburYS7A6tA?wmode=opaque&amp;enablejsapi=1\" height=\"480\" width=\"640\" scrolling=\"no\" frameborder=\"0\" allowfullscreen=\"\">\n</iframe>","url":"https://youtu.be/QburYS7A6tA","thumbnailUrl":"https://i.ytimg.com/vi/QburYS7A6tA/hqdefault.jpg","resolvedBy":"youtube"}" data-block-type="32" id="block-yui_3_17_2_1_1587237771113_14251"><div class="sqs-block-content"><div class="sqs-video-wrapper" data-provider-name="" data-html="<iframe src="//www.youtube.com/embed/QburYS7A6tA?wmode=opaque&enablejsapi=1" height="480" width="640" scrolling="no" frameborder="0" allowfullscreen=""><br/></iframe>"><div class="sqs-video-overlay" style="opacity: 0;"><img data-src="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1587250639100-9MWZQRCCZVUTVG4QFQNW/WhyFortify_AdolescentDevelopment_UNICEF%2BViet%2BNam%2Bgirl%2Breading.jpg" data-load="false" data-image-focal-point="0.5,0.5"/><div class="sqs-video-opaque"></div><div class="sqs-video-icon"></div></div></div></div></div><div class="sqs-block spacer-block sqs-block-spacer" data-aspect-ratio="2.1012416427889207" data-block-type="21" id="block-3305a4219ceaf7650b63"><div class="sqs-block-content"> </div></div><div class="sqs-block html-block sqs-block-html" data-block-type="2" id="block-yui_3_17_2_1_1587237771113_8942"><div class="sqs-block-content"> <h2 style="white-space:pre-wrap;">A Matter of Life and Death</h2><p class="" style="white-space:pre-wrap;">In 2016, an estimated <a href="https://web.archive.org/web/20230308151817/https://www.who.int/healthinfo/global_burden_disease/estimates/en/">107,000 deaths </a>were caused by iron deficiency anemia and other nutritional deficiencies. Pregnant women with severe anemia are <a href="https://web.archive.org/web/20230308151817/https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30185-2/fulltext">twice as likely to die</a> during or shortly after pregnancy than non-anemic women. About 75% of children with brain and spine birth defects <a href="https://web.archive.org/web/20230308151817/https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.13548">die before their fifth birthday</a>; many of these birth defects could be prevented with folic acid (vitamin B9).</p><p class="" style="white-space:pre-wrap;">Nutritional deficiencies also impact survivors. For example, <a href="https://web.archive.org/web/20230308151817/https://www.sciencedirect.com/science/article/abs/pii/S0306919202000702">iron deficiency in childhood</a> stunts cognitive development which hinders academic performance and future earnings potential. Spina bifida, a spinal birth defect, has varying degrees of severity, and often leads to life-long disability.</p><h2 style="white-space:pre-wrap;">FFI's Role</h2><p class="" style="white-space:pre-wrap;">Fortification is successful primarily because it does not require consumers to change their behaviors. Governments and industries, however, need to make systematic changes to maximize fortification’s health benefits. FFI helps country leaders promote, plan, implement, and monitor sustainable grain fortification programs.</p> </div></div><div class="sqs-block code-block sqs-block-code" data-block-type="23" id="block-yui_3_17_2_1_1605802244371_10388"><div class="sqs-block-content"><div id="micronutrients"></div></div></div><div class="sqs-block html-block sqs-block-html" data-block-type="2" id="block-yui_3_17_2_1_1605802244371_10453"><div class="sqs-block-content"> <h2 style="white-space:pre-wrap;">Vitamins and Minerals Added to Grains</h2><p class="" style="white-space:pre-wrap;">Each <a href="/web/20230308151817/https://www.ffinetwork.org/country-profiles" target="_blank">country</a> sets <a href="/web/20230308151817/https://www.ffinetwork.org/plan-standards-and-legislation" target="_blank">standards</a> to include the specific nutrients its population needs. The following vitamins and minerals are used in flour and rice fortification globally:</p><ul data-rte-list="default" style="margin-left:40px;"><li><p class="" style="white-space:pre-wrap;">Iron, riboflavin, folic acid, zinc, vitamin A, and vitamin B12 help <a href="https://web.archive.org/web/20230308151817/http://ernaehrungsdenkwerkstatt.de/fileadmin/user_upload/EDWText/TextElemente/Ernaehrungswissenschaft/Naehrstoffe/nutritional_anemia_book.pdf" target="_blank">prevent nutritional anemia</a> which improves productivity, maternal health, and cognitive development.</p></li><li><p class="" style="white-space:pre-wrap;">Folic acid (vitamin B9) reduces the risk of severe brain and spine birth defects. Fortifying with folic acid may also have a role in the child's <a href="https://web.archive.org/web/20230308151817/https://www.ajmc.com/newsroom/folic-acid-fortification-may-have-role-in-sustaining-mental-health" target="_blank">mental health</a>.</p></li><li><p class="" style="white-space:pre-wrap;"><a href="/web/20230308151817/https://www.ffinetwork.org/s/IZiNCG_Call-To-Action_13Sep2021-FINAL.pdf" target="">Zinc</a> helps children develop, strengthens immune systems, and lessens complications from diarrhea.</p></li><li><p class="" style="white-space:pre-wrap;">Niacin (vitamin B3) prevents the skin disease known as pellagra.</p></li><li><p class="" style="white-space:pre-wrap;">Riboflavin (vitamin B2) helps with metabolism of fats, carbohydrates, and proteins.</p></li><li><p class="" style="white-space:pre-wrap;">Thiamin (vitamin B1) prevents the nervous system disease called beriberi.</p></li><li><p class="" style="white-space:pre-wrap;">Vitamin B12 maintains functions of the brain and nervous system.</p></li><li><p class="" style="white-space:pre-wrap;">Vitamin D helps bodies absorb calcium which improves bone health.</p></li><li><p class="" style="white-space:pre-wrap;">Vitamin A helps individuals fight infections and helps prevent childhood blindness. It is often added to rice, cooking oils, margarine, or sugar instead of flour.</p></li><li><p class="" style="white-space:pre-wrap;">Calcium builds strong bones, helps transmit nerve messages and assists with muscle function and blood clotting. A few countries add calcium to flour, but it is more commonly added to other foods.</p></li><li><p class="" style="white-space:pre-wrap;"><a href="https://web.archive.org/web/20230308151817/https://sightandlife.org/blog/introducing-selenium/" target="_blank">Selenium</a> helps with reproduction and thyroid gland function.</p></li><li><p class="" style="white-space:pre-wrap;">Vitamin B6 is needed for enzyme reactions involved in metabolism.</p></li><li><p class="" style="white-space:pre-wrap;">Folic acid, vitamin B6 and vitamin B12 lower <a href="https://web.archive.org/web/20230308151817/https://www.sciencedirect.com/science/article/pii/S2352385917300038" target="_blank">homocysteine</a> levels.</p></li></ul><p class="" style="white-space:pre-wrap;">Fortification as part of a country’s nutrition strategy is supported by global organizations such as UNICEF, the World Health Organization (WHO), the World Food Programme (WFP), the U.S. Centers for Disease Control and Prevention (CDC), the Global Alliance for Improved Nutrition (GAIN), and Nutrition International. For the latest evidence and guidance on nutrition interventions, see the WHO <a href="https://web.archive.org/web/20230308151817/http://www.who.int/elena/en/" target="_blank">e-Library of Evidence for Nutrition Actions (eLENA).</a></p> </div></div><div class="sqs-block code-block sqs-block-code" data-block-type="23" id="block-yui_3_17_2_1_1604694465180_24614"><div class="sqs-block-content"><div id="mthfr"></div> </div></div><div class="sqs-block html-block sqs-block-html" data-block-type="2" id="block-yui_3_17_2_1_1604694465180_24679"><div class="sqs-block-content"> <h2 style="white-space:pre-wrap;">MTHFR Genetic Variant</h2><p class="" style="white-space:pre-wrap;">Everyone with the methylenetetrahydrofolate reductase (<em>MTHFR</em>) C677T genetic variant, even people who have a homozygous genotype (<em>MTHFR</em> 677 TT), can process all forms of folate, including folic acid. [<a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/21508090/" target="_blank">1</a>, <a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/25788000/" target="_blank">2</a>] For women who are pregnant or who could become pregnant, <a href="https://web.archive.org/web/20230308151817/https://www.cdc.gov/ncbddd/folicacid/faqs/faqs-general-info.html" target="_blank">blood folate concentration</a> is important to help prevent a neural tube defect in a developing baby. [<a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/25073783/">3</a>] When compared to the C allele, the T allele on the <em>MTHFR</em> <a href="https://web.archive.org/web/20230308151817/https://www.cdc.gov/genomics/about/basics.htm#genes">gene</a> is associated with lower blood folate concentrations because it produces an enzyme with a reduced capacity to process folate. [<a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/25073783/">3</a>]</p><p class="" style="white-space:pre-wrap;">However, no matter which <em>MTHFR</em> genotype (CC, CT, or TT) a woman has, she can increase her blood folate concentration to a level to help prevent a neural tube defect by consuming 400 mcg of folic acid each day before and during early pregnancy, in addition to food with folate from a varied diet. [<a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/30609688/" target="_blank">4</a>]</p><p class="" data-rte-preserve-empty="true" style="white-space:pre-wrap;"></p><p class="" style="white-space:pre-wrap;">[1] Crider KS, Zhu JH, Hao L, et al. <a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/21508090/" target="_blank">MTHFR 677C->T genotype is associated with folate and homocysteine concentrations in a large, population-based, double-blind trial of folic acid supplementation.</a> <em>The American Journal of Clinical Nutrition. </em>2011;93(6):1365-1372.</p><p class="" style="white-space:pre-wrap;">[2] Tsang BL, Devine OJ, Cordero AM, et al. <a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/25788000/" target="_blank">Assessing the association between the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism and blood folate concentrations: a systematic review and meta-analysis of trials and observational studies</a>. <em>The American Journal of Clinical Nutrition. </em>2015;101(6):1286-1294.</p><p class="" style="white-space:pre-wrap;">[3] Crider KS, Devine O, Hao L, et al. <a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/25073783/" target="_blank">Population red blood cell folate concentrations for prevention of neural tube defects: Bayesian model</a>. <em>BMJ (Clinical Research Ed). </em>2014;349:g4554.</p><p class="" style="white-space:pre-wrap;">[4] Crider KS, Devine O, Qi YP, et al. <a href="https://web.archive.org/web/20230308151817/https://pubmed.ncbi.nlm.nih.gov/30609688/" target="_blank">Systematic Review and Bayesian Meta-analysis of the Dose-response Relationship between Folic Acid Intake and Changes in Blood Folate Concentrations</a>. <em>Nutrients. </em>2019;11(1).</p> </div></div><div class="sqs-block spacer-block sqs-block-spacer" data-aspect-ratio="2.1012416427889207" data-block-type="21" id="block-yui_3_17_2_1_1587237771113_17402"><div class="sqs-block-content"> </div></div><div class="sqs-block html-block sqs-block-html" data-block-type="2" id="block-yui_3_17_2_1_1587237771113_19563"><div class="sqs-block-content"> <h2 style="text-align:center;white-space:pre-wrap;"><strong>Resources</strong></h2> </div></div><div class="sqs-block summary-v2-block sqs-block-summary-v2" data-block-json="{"hSize":null,"floatDir":null,"collectionId":"5e9b6678aae6d36c0eefe27a","design":"carousel","headerText":"","textSize":"small","pageSize":30,"imageAspectRatio":"1","columnWidth":150,"gutter":50,"listImageSize":20,"listImageAlignment":"left","slidesPerRow":5,"textAlignment":"center","showTitle":true,"showThumbnail":true,"showExcerpt":false,"showReadMoreLink":false,"showPrice":true,"productQuickViewEnabled":false,"showPastOrUpcomingEvents":"upcoming","metadataPosition":"below-content","primaryMetadata":"none","secondaryMetadata":"none","filter":{"category":null,"tag":null},"autoCrop":true,"lightbox":true,"mixedContent":true,"blockId":"7953332562512c1afde5"}" data-block-type="55" id="block-yui_3_17_2_1_1587242141587_76315"><div class="sqs-block-content"> <div class=" summary-block-wrapper summary-block-collection-type-gallery summary-block-setting-text-size-small summary-block-setting-text-align-center summary-block-setting-design-carousel summary-block-setting-design-list-thumbnail-left summary-block-setting-metadata-position-below-content summary-block-setting-primary-metadata-none summary-block-setting-secondary-metadata-none summary-block-setting-show-thumbnail summary-block-setting-show-title summary-block-setting-show-price summary-block-setting-hide-excerpt sqs-gallery-design-carousel "> <div class="summary-item-list-container sqs-gallery-container"> <header class="summary-block-header"> <div class="summary-heading" data-animation-role="content"> <span class="summary-collection-title">Why Fortify Intro Publications</span> </div> <div class="summary-carousel-pager sqs-gallery-controls" data-animation-role="content"> <span class="summary-carousel-pager-prev previous" tabindex="0" role="button" aria-label="Previous"></span> <span class="summary-carousel-pager-next next" tabindex="0" role="button" aria-label="Next"></span> </div> </header> <div class="summary-item-list sqs-gallery"> <div class=" summary-item summary-item-record-type-image sqs-gallery-design-carousel-slide summary-item-has-thumbnail summary-item-has-tags summary-item-has-author " data-click-through-url="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00367-9/fulltext"> <div class="summary-thumbnail-outer-container"> <a href="https://web.archive.org/web/20230308151817/https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00367-9/fulltext" class=" summary-thumbnail-container sqs-gallery-image-container js-gallery-lightbox-opener " data-title="Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide" data-description=""> <div class="summary-thumbnail img-wrapper" data-animation-role="image">  <img data-src="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1587250001759-LHVYG7PF2FPHJ954UHC8/Article.png" data-image="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1587250001759-LHVYG7PF2FPHJ954UHC8/Article.png" data-image-dimensions="521x521" data-image-focal-point="0.5,0.5" alt="Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide" data-load="false" class="summary-thumbnail-image"/> </div> </a>  </div> <div class="summary-content sqs-gallery-meta-container" data-animation-role="content"> <div class="summary-metadata-container summary-metadata-container--above-title"> <div class="summary-metadata summary-metadata--primary"> </div> <div class="summary-metadata summary-metadata--secondary"> </div> </div> <div class="summary-title"> <a href="https://web.archive.org/web/20230308151817/https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(22)00367-9/fulltext" class="summary-title-link">Micronutrient deficiencies among preschool-aged children and women of reproductive age worldwide</a></div> <div class="summary-metadata-container summary-metadata-container--below-title"> <div class="summary-metadata summary-metadata--primary"> </div> <div class="summary-metadata summary-metadata--secondary"> </div> </div> <div class="summary-metadata-container summary-metadata-container--below-content"> <div class="summary-metadata summary-metadata--primary"> </div> <div class="summary-metadata summary-metadata--secondary"> </div> </div> </div> </div> <div class=" summary-item summary-item-record-type-image sqs-gallery-design-carousel-slide summary-item-has-thumbnail summary-item-has-tags summary-item-has-author " data-click-through-url="/s/NTD_Summary_June_2021.pdf"> <div class="summary-thumbnail-outer-container"> <a href="/web/20230308151817/https://www.ffinetwork.org/s/NTD_Summary_June_2021.pdf" class=" summary-thumbnail-container sqs-gallery-image-container js-gallery-lightbox-opener " data-title="Fortifying flour with folic acid to prevent neural tube defects" data-description=""> <div class="summary-thumbnail img-wrapper" data-animation-role="image">  <img data-src="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1624884955507-28ZPWUET9OU9XPWXXU85/Report.png" data-image="https://web.archive.org/web/20230308151817/https://images.squarespace-cdn.com/content/v1/5e1df234eef02705f5446453/1624884955507-28ZPWUET9OU9XPWXXU85/Report.png" data-image-dimensions="521x521" data-image-focal-point="0.5,0.5" alt="Fortifying flour with folic acid to prevent neural tube defects" data-load="false" class="summary-thumbnail-image"/> </div> </a>  </div> <div class="summary-content sqs-gallery-meta-container" data-animation-role="content"> <div class="summary-metadata-container summary-metadata-container--above-title"> <div class="summary-metadata summary-metadata--primary"> </div> <div class="summary-metadata summary-metadata--secondary"> </div> </div> <div class="summary-title"> <a href="/web/20230308151817/https://www.ffinetwork.org/s/NTD_Summary_June_2021.pdf" class="summary-title-link">Fortifying flour with folic acid to prevent neural tube defects</a></div> <div class="summary-metadata-container summary-metadata-container--below-title"> <div class="summary-metadata summary-metadata--primary"> </div> <div class="summary-metadata summary-metadata--secondary"> </div> </div> <div class="summary-metadata-container summary-metadata-container--below-content"> <div class="summary-metadata summary-metadata--primary"> </div> <div class="summary-metadata summary-metadata--secondary"> </div> </div> </div> </div> <div class=" summary-item summary-item-record-type-image sqs-gallery-design-carousel-slide summary-item-has-thumbnail summary-item-has-tags summary-item-has-author " data-click-through-url="/s/FFI_neuraltubedefectstudies_June2021-9pea.xlsx"> <div class="summary-thumbnail-outer-container"> <a 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