The impact of voluntary food fortification on micronutrient intakes and status in European countries: a review

This review aims to assess the efficacy and safety of voluntary fortification as an option to address the occurrence of inadequate micronutrient intakes in population subgroups in Europe. Although legislation is harmonised across the European Union, fortification practices and patterns of consumption of fortified foods vary considerably between countries. While the proportion of children consuming fortified foods is greater than adults, the proportion of dietary energy obtained from fortified foods is generally low (<10% in Ireland, where fortified foods are widely consumed). There are a few systematic studies on the overall nutritional impact of voluntary fortification, but there are several studies on the impact of fortified ready-to-eat breakfast cereals. The available evidence indicates that voluntary fortification can reduce the risk of sub-optimal intakes of a range of micronutrients at a population level and can also improve status for selected micronutrients (e.g. folate, vitamin D and riboflavin) in children and adults. Although concerns have been raised regarding the potential of food fortification to lead to unacceptably high micronutrient intakes, particularly for those consuming higher amounts of fortified foods, data from national surveys on total micronutrient intakes (including fortified foods) in Europe show that small proportions of the population, particularly children, may exceed the upper intake level (UL) for some micronutrients. The risk of adverse effects occurring in these individuals exceeding the UL by modest amounts is low. In conclusion, voluntary fortification practices have been shown to improve intake and status of key micronutrients in European Union population groups and do not contribute appreciably to risk of adverse effects.