Food fortification or enrichment is the process of adding micronutrients (essential trace elements and vitamins) to food. It can be purely a commercial choice to provide extra nutrients in a food, or sometimes it is a public health policy which aims to reduce numbers of people with dietary deficiencies in a population. Diets that lack variety can be deficient in certain nutrients. Sometimes the staple foods of a region can lack particular nutrients, due to the soil of a region, or because of the inherent inadequacy of the normal diet. Addition of micronutrients to staples and condiments can prevent large-scale deficiency diseases in these cases.[1] While it is true that both fortification and enrichment refer to the addition of nutrients to food, the true definitions do slightly vary. As defined by the World Health Organization (WHO) and the Food and Agricultural Organization of the United Nations (FAO), fortification refers to "the practice of deliberately increasing the content of an essential micronutrient, ie. vitamins and minerals (including trace elements) in a food irrespective of whether the nutrients were originally in the food before processing or not, so as to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health," whereas enrichment is defined as "synonymous with fortification and refers to the addition of micronutrients to a food which are lost during processing."[2] Food fortification was identified as the second strategy of four by the WHO and FAO to begin decreasing the incidence of nutrient deficiencies at the global level.[2] As outlined by the FAO, the most common fortified foods are: Cereals and cereal based products Milk and Milk products Fats and oils Accessory food items Tea and other beverages Infant formulas[3] The 4 main methods of food fortification (named as to indicate the procedure that is used in order to fortify the food): Biofortification (i.e. breeding crops to increase their nutritional value, which can include both conventional selective breeding, and modern genetic modification) Microbial biofortification and synthetic biology (i.e. addition of probiotic bacteria to foods) Commercial and industrial fortification (i.e. flour, rice, oils (common cooking foods)) Home fortification (e.g. vitamin D drops)[4] [edit]Rationale The WHO and FAO, among many other nationally recognized organizations, have recognized that there are over 2 billion people worldwide who suffer from a variety of micronutrient deficiencies. In 1992, 159 countries pledged at the FAO/WHO International Conference on Nutrition to make efforts to help combat these issues of micronutrient deficiencies, highlighting the importance of decreasing the number of those with iodine, vitamin A, and iron deficiencies.[2] A significant statistic that led to these efforts was the discovery that approximately 1 in 3 people worldwide were at risk for either an iodine, vitamin A, or iron deficiency. Although it is recognized that food fortification alone will not combat this deficiency, it is a step towards reducing the prevalence of these deficiencies and their associated health conditions[5] In Canada, The Food and Drug Regulations have outlined specific criterion which justifies food fortification: To replace nutrients which were lost during manufacturing of the product (i.e. the manufacturing of flour[6]) To act as a public health intervention To ensure the nutritional equivalence of substitute foods (i.e. to make butter and margarine similar in content, soy milk and cow's milk, etc.) To ensure the appropriate vitamin and mineral nutrient composition of foods for special dietary purposes (i.e. Boost, gluten-free products, low sodium, or any other products specifically designed for special dietary requirements from an individual).[7] There are also several advantages to approaching nutrient deficiencies among populations via food fortification as opposed to other methods. These may include, but are not limited to: treating a population without specific dietary interventions therefore not requiring a change in dietary patterns, continuous delivery of the nutrient, does not require individual compliance, and potential to maintain nutrient stores more efficiently if consumed on a regular basis.[4] [edit]Criticism Several organizations such as the WHO, FAO, Health Canada, and the Nestle Research Center acknowledge that there are limitations to food fortification. Within the discussion of nutrient deficiencies the topic of nutrient toxicities can also be immediately questioned. Fortification of nutrients in foods may deliver toxic amounts of nutrients to an individual and also cause its associated side effects. As seen with the case of fluoride toxicity below, the result can be irreversible staining to the teeth. Although this may be a minor toxic effect to health, there are several that are more severe.[8] The WHO states that limitations to food fortification may include: human rights issues indicating that consumers have the right to choose if they want fortified products or not, the potential for insufficient demand of the fortified product, increased production costs leading to increased retail costs, the potential that the fortified products will still not be a solution to nutrient deficiencies amongst low income populations who may not be able to afford the new product, and children who may not be able to consume adequate amounts thereof.[2] Food safety worries led to legislation in Denmark in 2004 restricting foods fortified with extra vitamins or minerals. Products banned include: Rice Crispies, Shreddies, Horlicks, Ovaltine and Marmite