{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T04:22:35Z","timestamp":1781065355150,"version":"3.54.1"},"reference-count":62,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2007,3,7]],"date-time":"2007-03-07T00:00:00Z","timestamp":1173225600000},"content-version":"unspecified","delay-in-days":856,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Proc. Nutr. Soc."],"published-print":{"date-parts":[[2004,11]]},"abstract":"<jats:p>Micronutrient malnutrition is widespread throughout the world, with important health and economic consequences. Tools to address this situation include food fortification, supplementation and dietary diversification, each having different and complementary roles. Fortification (mandatory and voluntary) has been practised over several decades in Western countries as well as in developing countries. Iodised salt was introduced in the USA in 1924 to reduce severe I deficiency. In 1938 voluntary enrichment of flours and breads with niacin and Fe was initiated to reduce the incidence of pellagra and Fe-deficiency anaemia respectively. Micronutrient intakes in European countries appear to be generally adequate for most nutrients. However, a number of population subgroups are at higher risk of suboptimal intakes (below the lower reference nutrient intake) for some micronutrients, e.g. folate, Fe, Zn and Ca in children, adolescents and young women. Dietary surveys indicate that fortified foods play a role in mitigating such risks for several important nutrients. The number of foods suited to fortification are considerably limited by several factors, including technological properties (notably moisture, pH and O<jats:sub>2<\/jats:sub>permeability), leading to unacceptable taste and appearance, as well as cost and consumer expectations. In countries in which voluntary fortification is widely practised micronutrient intakes are considerably below tolerable upper intake levels. Concerns about safety are addressed in relation to the potentially increased level or proportion of fortified foods (e.g. following potential EU legislation), for nutrients with relatively low tolerable upper intake levels and where the potential benefit and risks are in different subpopulations (e.g. folic acid). Recent models for assessing these issues are discussed.<\/jats:p>","DOI":"10.1079\/pns2004391","type":"journal-article","created":{"date-parts":[[2005,4,13]],"date-time":"2005-04-13T00:22:20Z","timestamp":1113351740000},"page":"605-614","source":"Crossref","is-referenced-by-count":71,"title":["Public health aspects of food fortification: a question of balance"],"prefix":"10.1017","volume":"63","author":[{"given":"Reginald J.","family":"Fletcher","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian P.","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet P.","family":"Lambert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2007,3,7]]},"reference":[{"key":"S0029665104000813_ref030","first-page":"314","article-title":"Results of surveys to assess iron status in Europe","volume":"11","author":"Hallberg","year":"1995","journal-title":"Nutrition Reviews"},{"key":"S0029665104000813_ref041","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.47.3.829"},{"key":"S0029665104000813_ref058","first-page":"95","volume-title":"Nutrients in Processed Foods","author":"Sebrell","year":"1974"},{"key":"S0029665104000813_ref004","doi-asserted-by":"publisher","DOI":"10.1093\/jn\/133.11.3875S"},{"key":"S0029665104000813_ref018","article-title":"Articles 28 and 30 of the Treaty establishing the European Community (TEC), consolidated version","volume":"C325","year":"2002","journal-title":"Official Journal of the European Communities"},{"key":"S0029665104000813_ref056","unstructured":"Scientific Committee on FoodScientific Committee on Food (2000) Guidelines of the Scientific Committee on Food for the development of tolerable upper intake levels for vitamins and minerals. SCF\/CS\/NUT\/UPPLEV\/11 Final, 28 November 2000. http:\/\/europa.eu.int\/comm\/food\/fs\/sc\/scf\/out80a_en.pdf"},{"key":"S0029665104000813_ref055","first-page":"116","article-title":"Vitamin intake and status in Germany","volume":"52","author":"Schneider","year":"1995","journal-title":"Bibliotheca Nutritio et Dieta"},{"key":"S0029665104000813_ref045","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1093\/ajcn\/77.6.1474","article-title":"Low vitamin B-12 concentrations in patients without anemia: the effect of folic acid fortification of grain","volume":"77","author":"Mills","year":"2003","journal-title":"American Journal of Clinical Nutrition"},{"key":"S0029665104000813_ref034","first-page":"3022","article-title":"Impact of folic acid fortification of the US food supply on the occurrence of neural tube defects","volume":"285","author":"Honein","year":"2001","journal-title":"Journal of the American Medical Association"},{"key":"S0029665104000813_ref051","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.1999.10718846"},{"key":"S0029665104000813_ref048","doi-asserted-by":"publisher","DOI":"10.1159\/000177908"},{"key":"S0029665104000813_ref011","article-title":"Folate status: effects on pathways of colorectal carcinogenesis","volume":"135","author":"Choi","year":"2002","journal-title":"Journal of Nutrition"},{"key":"S0029665104000813_ref035","volume-title":"Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride","year":"1997"},{"key":"S0029665104000813_ref062","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/S0140-6736(95)91266-5","article-title":"Serum vitamin D concentrations among elderly people in Europe","volume":"346","author":"Van","year":"1995","journal-title":"Lancet"},{"key":"S0029665104000813_ref019","doi-asserted-by":"publisher","DOI":"10.1080\/07315724.2000.10718936"},{"key":"S0029665104000813_ref032","unstructured":"Henderson L , Irving K , Gregory J (2003) The National Diet and Nutrition Survey: Adults Aged 19 to 64 Years3 London: The Stationery Office"},{"key":"S0029665104000813_ref039","volume-title":"Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc","year":"2001"},{"key":"S0029665104000813_ref050","doi-asserted-by":"publisher","DOI":"10.1079\/PNS2003297"},{"key":"S0029665104000813_ref025","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2002441"},{"key":"S0029665104000813_ref003","unstructured":"ACC\/SCN (2000) Fourth Report on the World Nutrition Situation. Geneva:WHO."},{"key":"S0029665104000813_ref016","first-page":"185","article-title":"Nutrition and health of elderly people in Europe: the EURONUT-SENECA Study","volume":"50","author":"De","year":"1992","journal-title":"Nutrition Reviews"},{"key":"S0029665104000813_ref008","unstructured":"Blum M (1997) Status Paper: Food Fortification, a Key Strategy to End Micronutrient Malnutrition. NUTRIVIEW 97\/Special Issue Basel, Switzerland: Vitamin Division, F. Hoffmann-La Roche Ltd"},{"key":"S0029665104000813_ref031","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2001189"},{"key":"S0029665104000813_ref014","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)91205-2"},{"key":"S0029665104000813_ref005","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0002-8223(01)00026-8","article-title":"Position of the American Dietetic Association: Food fortification and dietary supplements","volume":"101","author":"American","year":"2001","journal-title":"Journal of the American Dietetic Association"},{"key":"S0029665104000813_ref059","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2000104"},{"key":"S0029665104000813_ref013","unstructured":"Confederation of, the Food and, Drink Industries, of the, European Union (1999) Addition of Nutrients to Food Brussels, Belgium: CIAA"},{"key":"S0029665104000813_ref044","doi-asserted-by":"crossref","DOI":"10.1177\/156482659401500413","article-title":"Fortification of foods: Historical development and current practices","volume":"15","author":"Mejia","year":"1994","journal-title":"Food and Nutrition Bulletin"},{"key":"S0029665104000813_ref046","volume-title":"National Food Survey 1999 (Annual Report on Food Expenditure, Consumption and Nutrient Intakes)","year":"2000"},{"key":"S0029665104000813_ref028","volume-title":"Report of the Diet and Nutrition Survey","volume":"1","author":"Gregory","year":"2000"},{"key":"S0029665104000813_ref049","unstructured":"Ottaway B (1995) The Technology of Vitamins in Food Glasgow Blackie Academic and Professional"},{"key":"S0029665104000813_ref036","volume-title":"Dietary Reference Intakes: Folate, Other B Vitamins, and Choline","year":"1998"},{"key":"S0029665104000813_ref022","doi-asserted-by":"publisher","DOI":"10.1007\/s00394-003-0391-9"},{"key":"S0029665104000813_ref010","first-page":"S1","article-title":"Nutritional status among adults with special reference to micronutrients","volume":"51","author":"Brussaard","year":"1997","journal-title":"European Journal of Clinical Nutrition"},{"key":"S0029665104000813_ref026","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2003493"},{"key":"S0029665104000813_ref001","volume-title":"Statutory Instrument 1995 no. 3116 The Spreadable Fats (Marketing Standards) Regulations 1995","year":"1995"},{"key":"S0029665104000813_ref027","doi-asserted-by":"publisher","DOI":"10.1177\/146642409511500608"},{"key":"S0029665104000813_ref002","volume-title":"Statutory Instrument 1998 no. 141. Bread and Flour Regulations 1998","year":"1998"},{"key":"S0029665104000813_ref012","unstructured":"Commission of, the European Communities (2003) COM 671, Proposal for a Regulation of the European Parliament and of the Council, on the Addition of Vitamins and Minerals and of Certain Other Substances to Foods Brussels, Belgium Commission of the European Communities"},{"key":"S0029665104000813_ref007","doi-asserted-by":"publisher","DOI":"10.1159\/000046692"},{"key":"S0029665104000813_ref040","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1079\/PHN2001190","article-title":"The efficacy and safety of nutritional supplement use in a representative sample of adults in North\/South Ireland Food Consumption Survey","volume":"4","author":"Kiely","year":"2001","journal-title":"Public Health Nutrition"},{"key":"S0029665104000813_ref042","doi-asserted-by":"publisher","DOI":"10.1111\/j.1753-4887.1999.tb06940.x"},{"key":"S0029665104000813_ref060","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2001211"},{"key":"S0029665104000813_ref047","doi-asserted-by":"publisher","DOI":"10.1079\/PHN2001188"},{"key":"S0029665104000813_ref009","first-page":"211","article-title":"Politics and pellagra: the epidemic of pellagra in the U.S. in the early twentieth century","volume":"65","author":"Bollet","year":"1992","journal-title":"Yale Journal of Biological Medicine"},{"key":"S0029665104000813_ref054","doi-asserted-by":"publisher","DOI":"10.1079\/PNS19970089"},{"key":"S0029665104000813_ref033","unstructured":"Hercberg S , Preziosi P , Galan P , Yacoub N , Kara G , Deheeger M (1996) La consommation du petit d\u00e9jeuner dans l\u2018\u00e9tude du Val-de-Marne 3. La valeur nutritionnelle du petit d\u00e9jeuner et ses relations avec l\u2019\u00e9quilibre nutritionnel global et le statut min\u00e9ral et vitaminique (Consumption at breakfast in the Val-de-Marne Study 3. The nutritional value of breakfast and its relationship with the overall nutritional balance and the mineral and vitamin status) Cahiers de Nutrition et de Dietetique Suppl. 1 18\u201325"},{"key":"S0029665104000813_ref017","volume-title":"Dietary Reference Values for Food Energy and Nutrients for the United Kingdom","year":"1991"},{"key":"S0029665104000813_ref053","doi-asserted-by":"publisher","DOI":"10.1079\/PNS19900007"},{"key":"S0029665104000813_ref020","volume-title":"Safe Upper Limits for Vitamins and Minerals","year":"2003"},{"key":"S0029665104000813_ref024","first-page":"8781","article-title":"Food standards: amendment of standards of identity for enriched grain products to require addition of folic acid","volume":"61","year":"1996","journal-title":"Federal Register"},{"key":"S0029665104000813_ref037","volume-title":"Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline","year":"2000"},{"key":"S0029665104000813_ref061","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/79.5.805"},{"key":"S0029665104000813_ref015","doi-asserted-by":"publisher","DOI":"10.1079\/PNS2002150"},{"key":"S0029665104000813_ref023","volume-title":"Food Fortification: Technology and Quality Control","year":"1996"},{"key":"S0029665104000813_ref043","doi-asserted-by":"publisher","DOI":"10.1136\/adc.75.6.474"},{"key":"S0029665104000813_ref029","volume-title":"Report of the Diet and Nutrition Survey","volume":"1","author":"Gregory","year":"1995"},{"key":"S0029665104000813_ref038","volume-title":"Dietary Reference Intakes for Vitamin C, Selenium, and Carotenoids","year":"2000"},{"key":"S0029665104000813_ref006","unstructured":"Bernier JJ (1995) Rapport sur les Limites de S\u00e9curit\u00e9 dans les Consommations Alimentaires des Vitamines et Mineraux (Report on the Safe Limits for Food Intakes of Vitamins and Minerals) Paris, France: Conseil Sup\u00e9rieur d'Hygi\u00e8ne Publique de France"},{"key":"S0029665104000813_ref021","unstructured":"Finch S , Doyle W , Lowe C , Bates CJ , Prentice A , Smithers G , Clarke PC (1998) National Diet and Nutrition Survey: People Aged 65 Years and Over. 1: Report of the Diet and Nutrition Survey London The Stationery Office"},{"key":"S0029665104000813_ref052","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2004.07.013"},{"key":"S0029665104000813_ref057","unstructured":"SCOOP Task, 7.1.1 Working Group (1997) Scientific Considerations for Development of Measures on the Addition of Vitamins and Minerals to Foodstuffs Zeist, The Netherlands: TNO Food and Nutrition Research"}],"container-title":["Proceedings of the Nutrition Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0029665104000813","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,6]],"date-time":"2020-04-06T20:15:13Z","timestamp":1586204113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0029665104000813\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2004,11]]},"references-count":62,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2004,11]]}},"alternative-id":["S0029665104000813"],"URL":"https:\/\/doi.org\/10.1079\/pns2004391","relation":{},"ISSN":["0029-6651","1475-2719"],"issn-type":[{"value":"0029-6651","type":"print"},{"value":"1475-2719","type":"electronic"}],"subject":[],"published":{"date-parts":[[2004,11]]}}}