{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T23:00:32Z","timestamp":1771023632363,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T00:00:00Z","timestamp":1623715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV007767"],"award-info":[{"award-number":["INV007767"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Adequate zinc nutrition is important for child growth, neurodevelopment, immune function, and normal pregnancy outcomes. Seventeen percent of the global population is estimated to be at risk for inadequate zinc intake. However, zinc is not included in the fortification standards of several low- and middle-income countries with mandatory fortification programs, despite data suggesting a zinc deficiency public health problem. To guide policy decisions, we investigated the factors enabling and impeding the inclusion of zinc as a fortificant by conducting in-depth interviews with 17 key informants from 10 countries. Findings revealed the decision to include zinc was influenced by guidance from international development partners and enabled by the assessment of zinc deficiency, mandatory regional food fortification standards which included zinc, the World Health Organization (WHO) guidelines for zinc fortification, and the low cost of zinc compound commonly used. Barriers included the absence of zinc from regional fortification standards, limited available data on the efficacy and effectiveness of zinc fortification, and the absence of national objectives related to the prevention of zinc deficiency. To promote zinc fortification there is a need to put the prevention of zinc deficiency higher on the international nutrition agenda and to promote large-scale food fortification as a key deficiency mitigation strategy.<\/jats:p>","DOI":"10.3390\/nu13062051","type":"journal-article","created":{"date-parts":[[2021,6,15]],"date-time":"2021-06-15T21:24:29Z","timestamp":1623792269000},"page":"2051","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Enablers and Barriers of Zinc Fortification; Experience from 10 Low- and Middle-Income Countries with Mandatory Large-Scale Food Fortification"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2538-8016","authenticated-orcid":false,"given":"Ann","family":"Tarini","sequence":"first","affiliation":[{"name":"Independent Consultant, Laval, QC H7G 3Z5, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mari S.","family":"Manger","sequence":"additional","affiliation":[{"name":"International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA"},{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth H.","family":"Brown","sequence":"additional","affiliation":[{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"},{"name":"Department of Nutrition, Institute for Global Nutrition, University of California, Davis, CA 95616, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1230-2367","authenticated-orcid":false,"given":"Mduduzi N. N.","family":"Mbuya","sequence":"additional","affiliation":[{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"},{"name":"Global Alliance for Improved Nutrition, Washington, DC 20036, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"Rowe","sequence":"additional","affiliation":[{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"},{"name":"Food Fortification Initiative, Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frederick","family":"Grant","sequence":"additional","affiliation":[{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"},{"name":"Helen Keller International, New York, NY 10017, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert E.","family":"Black","sequence":"additional","affiliation":[{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"},{"name":"Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine M.","family":"McDonald","sequence":"additional","affiliation":[{"name":"International Zinc Nutrition Consultative Group, University of California, San Francisco, CA 94143, USA"},{"name":"IZiNCG Fortification Task Force, San Francisco, CA 94143, USA"},{"name":"Department of Pediatrics, San Francisco School of Medicine, University of California, San Francisco, CA 94143, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,6,15]]},"reference":[{"key":"ref_1","first-page":"S99","article-title":"International Zinc Nutrition Consultative Group (IZiNCG) Technical Document #1. 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