3.6 Food Fortification, Including Biofortification

Chapter 3.6 is dedicated to food fortification, which is widely acknowledged as an efficient and cost-effective approach to improve micronutrient supply. It is particularly suited for populations whose diets have a low diversity and contain a high proportion of staple foods and who have no good access to nutrient supplements. Fortification of salt or centrally produced staple foods like wheat or maize flour and rice allows reaching a large number of persons. To ensure the safety and efficiency of fortification, it should be government-led and ideally mandatory. Programme development and implementation have to be preceded by a situation analysis to determine the type, forms and amounts of nutrients to be added and the best food vehicle. Salt iodization has a long tradition and is nowadays practiced in most countries of the world, at least on a voluntary basis. The WHO Eastern Mediterranean Region has the highest proportion of countries with mandatory salt iodization and this is reflected in significant advances in goitre control. The region also has the second highest percentage of countries fortifying wheat flour, with three countries also adding vitamin D. While implementation and enforcement of fortification have improved, the access to and funding of the nutrient premix can be difficult in some countries affected by conflict and crisis. A newer approach to fortification is biofortification, whereby the content of micronutrients is already increased in the crop plant. This is achieved by different approaches, including the application of specific fertilizers with high solubility and bioavailability on the one hand, and, on the other, through conventional plant breeding or genetic engineering to increase the bioabsorption of minerals by the plant. In the latter case, the biosynthesis of vitamins and other organic compounds is also increased. The development and propagation of biofortified crops and the creation of enabling environments for their dissemination to disadvantaged population groups is the objective of global programmes like the Global Alliance for Improved Nutrition (GAIN) and HarvestPlus. Although the focus is on low-income countries from sub-Saharan Africa and South-East Asia, some countries of the WHO Eastern Mediterranean Region such as Pakistan, Egypt, and Syria also feature among the top-priority countries for investment in biofortification interventions.