Vitamin Bullets : Fortify shellfish to tackle human nutrient deficiencies


Cambridge scientists have developed a new way to fortify shellfish to tackle human nutrient deficiencies which cause severe health problems across the world.

The team is now working with major seafood manufacturers to further test their microencapsulation technology, or “Vitamin Bullets”.

Over two billion people worldwide are nutrient deficient, leading to a wide range of serious health problems.

Fortifying food with micronutrients is already an industry standard for enhancing public health but now scientists at Cambridge’s Department of Zoology have teamed up with Cambridge-based company BioBullets to supercharge one of the world’s most healthy and sustainable sources of animal protein: bivalve shellfish such as oysters, clams and mussels.

Dr. David Aldridge and Ph.D. student David Willer have produced the world’s first microcapsule specially designed to deliver nutrients to bivalves which are beneficial to human health.

These “Vitamin Bullets” – manufactured under patent by Aldridge’s company, BioBullets – are tailored for optimal size, shape, buoyancy and to appeal to shellfish.

This breakthrough, described in a study published today in the journal ‘Frontiers in Nutrition’, is particularly valuable because when we eat bivalves, we consume the entire organism including its gut, meaning that we digest the nutrients which the animals consumed towards the end of their lives. This makes bivalve shellfish the ideal target for nutritional fortification.

In their Cambridge laboratory, the scientists trialled Vitamin A and D fortified microcapsules on over 100 oysters to identify the optimal dose. They also established that this should be fed for 8 hours towards the end of “depuration”, the period in which bivalves are held in cleansing tanks after being harvested.

The team found that fortified oysters delivered around 100 times more Vitamin A, and over 150 times more Vitamin D, than natural oysters. Even more importantly, they dramatically outperformed salmon, one of the best natural sources of these vitamins.

The fortified oysters provided more than 26 times more Vitamin A and over 4 times more Vitamin D than salmon.

The scientists found that a serving of just two of their supercharged shellfish provided enough Vitamin A and D to meet human Recommended Dietary Allowance (RDAs).

Vitamin A and D deficiencies pose a particularly serious public health challenge – in Ghana more than 76% of children are Vitamin A deficient, causing widespread mortality and blindness.

In India, 85% of the population is Vitamin D deficient, which causes cardiovascular diseases, osteoporosis, and rickets. Even in the US, over 40% of people are Vitamin D deficient.

David Willer said: “We have demonstrated a cheap and effective way to get micronutrients into a sustainable and delicious source of protein. Targeted use of this technology in regions worst affected by nutrient deficiencies, using carefully selected bivalve species and micronutrients, could help improve the health of millions, while also reducing the harm that meat production is doing to the environment”.

David Aldridge said: “We are very excited about BioBullets’ potential. We are now establishing links with some of the world’s biggest seafood manufacturers to drive a step change in the sustainability and nutritional value of the seafood that we consume.”

Bivalves have a higher protein content than beef, are a rich source of omega-3 fatty acids, and have some of the highest levels of key minerals of all animal foods.

Nevertheless, the nutrients that they deliver naturally is unlikely to solve global deficiencies.

These shellfish are also highly sustainable to farm, having a far lower environmental footprint than animal meat or fish, and lower even than many plant crops such as wheat, soya, and rice.

Bivalves are a highly affordable food source when produced at large scale and the global market is rapidly expanding. Production in China alone has grown 1000-fold since 1980 and there is great potential to sustainably expand bivalve aquaculture worldwide, with over 1,500,000 km2 available for sustainable low-cost industry development, particularly around the west coast of Africa and India.

The researchers point out that consumers in poorer regions where vitamin deficiencies are most prevalent are more likely to buy slightly more expensive fortified food than to make additional purchases to take supplement pills.

They calculate that fortification adds just $0.0056 to the cost of producing a single oyster.

Micronutrient deficiencies often cause malnutrition that is a crucial public health problem, especially in developing countries (Ramakrishnan, Goldenberg, & Allen, 2011). Indeed, they generate several diseases either infectious or chronic and therefore impacts the life’s quality and epidemiological parameters such as morbidity and mortality (Verma, 2015).

As a consequence, this type of malnutrition leads to premature death, disability, and reduced work capacity (Black et al., 2013) and more often reaches children and women of reproductive age (Method & Tulchinsky, 2015).

Food fortification is considered as the most appropriate preventive approach against malnutrition caused by micronutrient deficiencies (Bhagwat, Gulati, Sachdeva, & Sankar, 2014). For many years, food fortification has been used as a cost‐effective means to prevent micronutrient malnutrition (Method & Tulchinsky, 2015).

Considerable studies have been carried out to develop food fortification in developing countries (Akhtar, Anjum, & Anjum, 2010; Bhagwat et al., 2014; Mishra, 2011). However, effectiveness of food fortification approaches to improve nutritional status has to be coherently analyzed and evidenced.

In order to evaluate the most important global trends and historical patterns in food fortification, large databases are required to study the different types of fortification. Indeed, data relevant to the history, impacts, and challenges of food fortification are scattered across literature and existing reviews concern a few countries.

Therefore, though information on food fortification successes and failures may be difficult to assess and compare, key factors of success or failure of interventions need to be identified to inform policymakers and assist countries in the design and implementation of appropriate fortification programs.

Prevalence of undernutrition and micronutrient deficiencies in the world

Malnutrition (overnutrition, undernutrition, and micronutrient deficiencies) is a physiological state characterized by a low or high quantity of macronutrients, micronutrients, or both in human’s organism (Ortiz‐Andrellucchi, Ngo, & Serra‐Majem, 2016).

Currently, several cases of obesity and overweight due to overnutrition are recorded worldwide (IFPRI, 2016). Meanwhile, undernutrition and micronutrient deficiencies are recurrent and have significant negative effects on public health (Lopez, Mathers, Ezzati, Jamison, & Murray, 2006).

The prevalence of undernutrition varies considerably according to countries. In developing countries, rural people are the most subjected to undernutrition (Shetty, 2009). Indeed, micronutrient deficiencies are often associated with low income and poor access to nutritious foods, situations that are frequent in rural areas (Shetty, 2009).

According to recent estimations, about two billion people suffer from micronutrient deficiencies (Allen, de Benoist, Dary, & Hurrell, 2006). Micronutrient deficiencies account for about 7.3% of the global burden of disease, with iron and vitamin A deficiencies among the 15 leading causes of the global disease burden (WHO, 2000).

Animal foods are important sources of protein and of micronutrients such as iron, zinc, vitamin A, and vitamin B12. Unfortunately, in developing countries most people cannot afford these foods in their daily diet.

As a result, they suffer from micronutrient deficiencies. Folic acid, vitamin D, selenium, and zinc deficiencies, although less recognized, are important as well. A lack of those micronutrients represents a major threat to the health and development of populations in particular in developing countries (Bain et al., 2013; Müller & Krawinkel, 2005).

Many children worldwide suffer from nutritional deficiencies, which can negatively affect their physical and mental development and increase susceptibility to infections. Moreover, undernutrition amplifies the effect of every disease, including measles and malaria. Undernutrition (53%) causes as much mortality of children younger than 5 years as diarrhea (61%), malaria (57%), pneumonia (52%), and measles (45%; Black, Morris, & Bryce, 2003; Bryce, Boschi‐Pinto, Shibuya, & Black, 2005).

In addition, according to Black et al. (2008), women and children are the major targets suffering from consequences of micronutrient deficiency such as poor pregnancy outcomes, children’s impaired mental, and physical development.

Up to 3.1–3.5 million of children under 5 years old die every year and women of reproductive age living in low‐ and middle‐income countries because of undernutrition (fetal growth restriction, suboptimum breastfeeding, stunting, wasting, and deficiencies of vitamin A, iodine, zinc, iron, vitamin D deficiency, rickets, osteomalacia, and thyroid deficiency) (Black et al., 2008, 2003; Mandelbaum, 2004; Method & Tulchinsky, 2015).

Zinc deficiency is a risk factor with adverse long‐term effects on growth, immunity, and metabolic status of surviving offspring (Harika et al., 2017). Therefore, elimination of these deficiencies is essential, not only to improve health, but also for sustained economic growth and national development (Mishra, 2011).

Classical food fortification: definition and importance

The nutrient intake of basic foods, seasonings, or condiments may be enhanced through a fortification that increases the content of essential micronutrients, such as vitamins and minerals (Mannar & Gallego, 2002).

One way to fortify foods is to incorporate synthetic micronutrients to it (Zimmermann, Muthayya, Moretti, Kurpad, & Hurrell, 2006). In many developing countries, the most widely used vehicles for fortification are among the most commonly consumed foods, including oils and fats, milk, sugar, salt, rice, wheat, or maize flour.

Some factors related to food fortification such as level of fortification; bioavailability of fortificants; and amount of fortified food consumed have a significant effect on health (Verma, 2015; see Das, Salam, Kumar, & Bhutta, 2013 for more information).

Classical food fortification with zinc is very common; in case, the vehicle is cereal flour at a recommended level (100 mg zinc/kg for wheat flour; Brown, Hambidge, Ranum, & Zinc, 2010) of zinc fortification, of which a lower level may have no significant effect on the nutrient improvement of the cereal (Brown, Peerson, Baker, & Sonja, 2009).

Food fortification leads to rapid improvement in the micronutrient status of a population, and at a reasonable cost, especially if advantage is taken from existing technology and local distribution networks.

Rice fortification has an advantage to benefit to almost half of the world’s population (>3 billion people consumed rice as their main staple worldwide; de Pee, Tsang, Zimmerman, & Montgomery, 2018).

Thus, rice can be considered as one of the best staple food vehicles for food fortification in developing counties regarding a population‐level intervention (Moench‐Pfanner, Laillou, & Berger, 2012).

Fortification of rice flour with iron, zinc, and folate allows children under 5 years old, having a rapid iron and zinc absorption, to improve their growth and micronutrient status (Hettiarachchi, Hillmers, Liyanage, & Abrams, 2004).

Fortifying flour is much simpler because the nutrients that are available in powdered form can successfully be mixed into the flour. As such, rice flour was recommended as a suitable vehicle for fortification.

Long‐term measures have been implemented to combat vitamin A and iron deficiencies, in particular, fortification of cotton oil with vitamin A and of wheat flour with iron, zinc, folic acid, and vitamin B.

Multiple micronutrient fortification appears relatively more beneficial and should be considered because multiple micronutrient deficiencies coexist in many cases (Table ​1).

This consideration justifies why many fortification programs are oriented toward multi‐micronutrients and vehicles chosen adequately for a good acceptability of fortified foods by the target group. Food fortification can take several forms, and different techniques and procedures can be used (Liyanage & Hettiarachchi, 2011).

Table 1

Examples and outcomes of classical food fortification

Fortified foodImproved nutrient(s)Consumption of the fortified foodsSubjectsOutcomesLimitationsReferences
Food fortification with a micronutrient
Fish sauceIronConsumption of 10 ml per day of a sauce that was fortified with 100 mg of iron (as NaFeEDTA) per 100 mlThe subjects were nonpregnant anemic female factory workers in VietnamIt significantly reduces iron deficiency and iron‐deficiency anemia after 6 months in the group receiving the fortified sauce compared to the placebo control group FAO and OMS (2006)
Rice mealIronIron‐fortified rice meal (15 mg of iron per day as ferric pyrophosphate)Young children (5–9 years)The prevalence of iron deficiency was significantly reducedThere was a significant decrease in median blood lead concentrationThe prevalence of blood lead levels 10 g/dl was significantly reduced.The study was of short duration (16 weeks) and blood lead was only measured twiceZimmermann et al. (2006)
Wheat flour and maize mealIronThe iron compound (sodium iron ethylenediaminetetraacetate[NaFeEDTA], ferrous fumarate, or ferrous sulfate) was varied and dosed at rates according to the WHO guidelines for consumption of 75–149 g/day of wheat flour and >300 g/day of maize meal and tested again for 150–300 g/day for bothThree countries were selected for the trials: Kenya, South Africa, and TanzaniaThe levels of iron compounds used, in accordance with the WHO guidelines, do not lead to changes in the baking and cooking properties of the wheat flour and maize mealThis trial has not covered all the possible dosage levels of the WHO guidelines, nor by any means all of the possible end‐use products of wheat flour and maize mealRandall, Johnson, & Verster (2012)
Soy sauceIron (as NaFeEDTA)Daily consumption of 5 mg or 20 mg iron in the fortified sauceChildrenVery effective in the treatment of iron‐deficiency anemia in children; positive effects were seen within 3 months of the start of the interventionFAO and OMS (2006)
RiceIronRice is fortified at a level likely to lead to approximately equal supplemental iron absorption in both groups. A 10‐kg child in the control group would receive ~10 mg Fe/d (a dose of 20 drops of iron solution thrice weekly)Infants and young children (6–24 months old)Fortifying rice with iron may improve iron status at least as well as providing free iron dropsBeinner, Velasquez‐Melendez, Pessoa & Greiner (2010)
Porridge cerealsZincA 30 g dry weight of an iron‐fortified cereal porridge and a separate dose of an aqueous multivitamin (MV) supplement between meals (control group), the same porridge and MV with 3 mg Zn added to the supplement dose (ZnSuppl group), or the porridge with added zinc (150 mg/kg dry weight) and MV without zinc (ZnFort group)6‐ to 8‐month‐old Peruvian childrenIncrease linear growth and weight gain by a small, but highly significant, amountA fortified porridge did not significantly affect the children’s physical growthBrown et al. (2009)
Cereals flourZincThe recommended maximum level of zinc fortification is 100 mg zinc/kg wheat flour (100 ppm)Young children and pregnant and lactating women and adult menZinc fortification of cereal flour is a safe and appropriate strategy for enhancing the zinc status of population subgroups who consume adequate amounts of fortified cereal flourGreater levels of fortification may adversely affect the sensory properties of food items prepared with such flour. Fermentation of flour reduces the level of zinc fortification that is required to meet the theoretical needs for absorbed zinc.Brown et al. (2010)
MargarineVitamin AConsumption of 27 g of vitamin A‐fortified margarine per day for a period of 6 monthPreschool‐aged childrenReduction in the prevalence of low serum retinol concentrations from 26% to 10% FAO and OMS (2006)
Wheat flour bun (pandesal)Vitamin AA 60‐g vitamin A‐fortified pandesal was consumed by the children 5 day/week for 30 weeksChildren aged 6–13 years attending for rural schools in the PhilippinesVitamin A fortification modified significantly serum retinol effectDaily consumption of vitamin A‐fortified pandesal improved the vitamin A status of Filipino school‐age children with marginal‐to‐low initial serum retinol concentrations.Solon et al. (2000)
MilkVitamin DA 710 ml of vitamin D‐fortified (total 300 IU or 7.5 µg) milk dailyMongolian school‐age children (22 girls and 24 boys) aged 9–11 yearsAfter one month of drinking milk, all children had an increase in height and weightGanmaa et al. (2008)
Multiple micronutrient food fortification
Dairy products such as natural low‐fat cheese and lactose‐reduced yogurtCalcium and vitamin DConsumption of calcium (1,000 mg) and 200 IU (5 µg) vitamin D daily during 2 yearsGirls (10−12 years)Increasing calcium intake by consuming cheese appears to be more beneficial for cortical bone mass accrual than the consumption of tablets containing a similar amount of calcium. Cheng et al. (2005)
Maize grainIron and vitamin AMaize grain was milled and fortified in two custom‐designed mills installed at a central location in the camp, and a daily ration of 400 g per person was distributed twice monthly to households as part of the routine food aid ration. Micronutrient fortificant added to 1 kg of maize meal (Vitamin A [mg RE] 2,100
Thiamin (mg) 4.4
Riboflavin (mg) 2.6
Nicotinamide (mg) 35.0
Vitamin B 6 (mg) 2.5
Vitamin B 12 (mg) 10.0
Folic acid (mg) 1.5
Fe (mg) 35.0
Zn (mg) 20.0
Adolescents (10–19 years), children (6–59 months) and women (20–49 years)During the intervention period, mean Hb increased in children and adolescents Anemia decreased in children by 23.4%Serum transferring receptor indicating an improvement in the Fe status of adolescentsIn adolescents, serum retinol increased and vitamin A deficiency decreased by 26.1%Hb did not increase in womenAnemia was not significant change in adolescents or women.Seal et al. (2007)
Staples, condiment, and processed foodsSingle, dual, or multiple micronutrients (iron, folic acid, zinc, vitamin A, iodine, vitamin D, and calcium)Children, adolescents (all age) preschool children (ages 2–5 years), school‐going children (ages of above 5 years) and adolescents till 18Fortification is potentially an effective strategy but evidence from the developing world is scarceThe techniques of fortification are not mentionedDas et al. (2013)
Wheat flourIron, vitamin A,Fortification level for wheat flour is as follows: iron (as NaFeEDTA) 5 ppm, iron (as Electrolytic iron) 50 ppm, folic acid (as folic acid) 1.3 ppm, vitamin B12 (as cyanocobalamin) 0.01 ppm, and vitamin A (as vitamin A palmitate) 1.5 ppmChildren aged 6–59 month and womenBhagwat et al. (2014)
Soybean oilIron, vitamin DSoybean oil fortification level is as follows: vitamin A (as retinyl palmitate) 25,000 IU/kg of oil; vitamin D2 2,000 IU/kg of oilChildren aged 6–59 monthsWomenBhagwat et al. (2014)
MilkIron, vitamin DMilk Fortification level is: Vitamin A (as Retinyl acetate, water miscible) 2,000 IU/L of milk, Vitamin D−2,400 IU/L of milk

Historical trends and impacts of food fortification

For fixing the iodine deficiency (cause of goiter) that happened early in the 20th century, public health opted for the first time to food fortification (Backstrand, Allen, Black, de Mata, & Pelto, 2002; Mannar & Hurrell, 2018).

Indeed, the first fortified food was the iodized salt to prevent goiter (Mannar & Hurrell, 2018) that was introduced in Switzerland and Michigan (United States) in 1923 and 1924, respectively (Abdullahi, Zainab, Pedavoah, Sumayya, & Ibrahim, 2014; Mannar & Hurrell, 2018; Marine & Kimball, 1920).

In the same period, many vitamins were isolated and their molecular structures elucidated. As a result, it was possible to produce vitamins for fortifying foods at a large scale. In the 1930s, iron was mainly used to fortify cereal flours and products for a large population such as fish sauce (Vietnam), soy sauce (China), and rice (Philippines; Mannar & Gallego, 2002).

Since 1938, niacin had been added to bread in the United States. From the early 1940s onwards, fortification of cereal products with thiamine, riboflavin, and niacin (Kyritsi, Tzia, & Karathanos, 2011) became a common practice.

Meanwhile, rice fortification received considerable attention due to the great importance of rice in children’s nutrition. Margarine was fortified with vitamin A (FAO & OMS, 2006) in Denmark and milk with vitamin D in the United States (Laforest et al., 2007).

The fortification of sugar with vitamin A has been introduced for the first time during the 1970s in Guatemala, followed by other Costa Rica, Honduras, and El Salvador, for reaching up to 80% (Honduras) and 95% (Guatemala and El Salvador) of households (Mora, Dary, Chinchilla, & Arroyave, 2000).

The success of this fortification allowed many countries to effectively combat micronutrient deficiencies in populations. Enriching flour and cereal products moved from the use of iron, niacin, riboflavin, and thiamin to the use of folic acid in 1996 (Food and Drug Administration, United States) for enriching breads, flours, corn meals, and rice in order to address neural tube defects in newborns (Backstrand et al., 2002).

Therefore, folic acid fortification of wheat became widespread, a strategy adopted by Canada and the United States and about 20 Latin American countries (Samaniego‐Vaesken, Alonso‐Aperte, & Varela‐Moreiras, 2010).

Thus, folic acid was added to flour on a mandatory basis in over 60 countries to prevent neural tube birth defects (Liyanage & Zlotkin, 2002; Oakley & Tulchinsky, 2010).

Other food vehicles fortified with vitamin A, besides sugar, include fats and oils, tea, cereals, flour, monosodium glutamate, and instant noodles, as well as milk or milk powder, whole wheat, rice, salt, soybean oil, and infant formulas (Lotfi, Venkatesh Mannar, Merx, & Heuvel, 1996).

In Asia, the red palm oil was used as a vitamin A fortificant added to other edible oils (Solomons, 1998). Currently, fortifying foods with vitamin A are common in 29 developing countries (Mason et al., 2014).

The huge success of salt iodization was likely a critical factor in generating support for other fortification initiatives. In Ghana, food fortification began in 1996 when legislation was passed to enforce salt iodization. Salt iodization has been ongoing with the target of covering at least 90% of the population (Nyumuah et al., 2012).

Through Africa, maize meal and bread were shown to be the most commonly consumed staples; hence, vitamin A, iron, zinc, folic acid, thiamin, niacin, vitamin B, and riboflavin have been added to maize meal and wheat flour with the aim of improving the growth and micronutrient status of undernourished children (Steyn, Nel, & Labadarios, 2008).

Technical limits to the practice of food fortification

Technical fortification challenges rely on

(a) nonappropriateness of fortification causing nutrients’ loss,

(b) sunlight exposure of fortified foods by retailers,

(c) nonregular monitoring and unreliable quality control procedures by companies.

The most important challenge is to ensure a regulatory monitoring that aims at meeting fortified foods to national fortification standards (Method & Tulchinsky, 2015). Governments in developing countries may not have the resources to effectively monitor compliance, especially when there are many small processing companies operating.

As Luthringer, Rowe, Vossenaar, and Garrett (2015) showed, financial inputs for monitoring have a proportional significant effect on the effectiveness of detection and enforcement of noncompliant and under fortified products.

Cooperative working relationships between regulatory agencies and food producers will be a useful strategy for successful fortification programs. Challenges such as choosing appropriate fortification vehicles, reaching target populations, avoiding overconsumption in nontarget groups, and monitoring nutritional status are relevant to all countries because they occur everywhere where there is an attempt to fortify foods to optimize intake and nutritional status (Dwyer et al., 2015). In Sub‐Saharan Africa, dietary diversification can be used effectively to enrich indigenous and traditional foods.

Practices and benefits of food‐to‐food fortification

Practices and benefits
Food‐to‐food fortification often uses foods that are available in the area of the target population to enhance nutrient intake. This approach consists of selecting and associating foods (a common staple and a fortifying food) in such a way to optimize the bioavailability of interesting micronutrients to consumers.

For example, in Nigeria, ogi, a fermented cereal‐based dough produced mostly from maize, is fortified with baobab fruit powder (rich in vitamins A, C, E, and F; proteins; fiber; carbohydrates; iron; zinc; calcium; and potassium; Adejuyitan, Abioye, Otunola, & Oyewole, 2012), and tapioca made from cassava tubers is fortified with soybean flour (carbohydrates, fiber; Kolapo & Sanni, 2015).

Worldwide, food‐to‐food fortification was studied for fighting against malnutrition (Abdullahi et al., 2014; Abioye & Aka, 2015; Adejuyitan et al., 2012; Adenuga, 2010; Ajanaku, Ogunniran, Ajani, James, & Nwinyi, 2010; De Brito, Garruti, & Silva, 2007; Giwa & Ibrahim, 2012; Kolapo & Sanni, 2015; Lelana, Purnomosari, & Husni, 2003; Meite, Kouame, Amanii, Katii‐Coulibaly, & Offoumou, 2008; Nadeem, Javid, Abdullah, Arif, & Mahmood, 2012; Okafor, Okafor, Ozumba, & Elemo, 2012; Oluwamukomi & Jolayemi, 2012; Onuoha & Ene‐Obong, 2005; Salem, Salama, Hassanein, & El Ghandour, 2013; Samuel, Otegbayo, & Alalade, 2012).

In Benin, it is common to see the association of local food resources, such as leaves (moringa), fruit (pawpaw, mango, plantain), seeds (from watermelon), legumes (soybean), and even edible mushrooms, as fortifying food to improve nutrient intake of some deficient foods (gari, tapioca, and wheat flour bread).

The main role of a fortifying food is to fill nutritional, sensory, biological, and physical gaps. Food‐to‐food fortification usually provides energy, proteins, fat, fiber, carbohydrates, phosphorus, iron, zinc, potassium, manganese, sodium, calcium, and vitamin C.

Table ​Table2 summarizes the evidence on the effectiveness of food‐to‐food fortification interventions. Examples of food‐to‐food fortification are also presented by Vuong (2000) for traditional rice dishes in Vietnam, liver chips as a snack in southern Thailand (Wasantwisut, Chittchang, & Sinawat, 2000), and red palm oil incorporated into biscuits in child‐feeding programs in South Africa (van Stuijvenberg & Benadé, 2000).

In Northeast Brazil, the pulp from the buriti fruit (Mauritia vinifera Mart.) is used daily as a dietary supplement to children at high risk (12 g containing ~800 µg β‐carotene or 134 µg retinol) to resolve or attenuate clinical signs of vitamin A deficiency (Mariath, Lima, & Santos, 1989).

In South India, the β‐carotene‐rich blue‐green alga Spirulina, prepared as a sweetened product suitable as a snack, improved vitamin A status of preschoolers attending daycare centers (Annapuma, Deosthale, & Bamji, 1999).

Odinakachukwu, Nwosu, Ngozi, Ngozi, and Aloysius (2014) revealed that Moringa oleifera fortification of infant complementary food improved its nutritional quality. Incorporation of pulverized M. oleifera leaves in infant foods could diversify food intake and ensure food and nutrition security.

An assessment of iron absorption was conducted by Cercamondi et al. (2014) in Burkina Faso and indicated any change in the iron quantity absorbed by young women when they ate a meal constituted of a maize paste accompanied by iron‐improved leaf‐based and traditional amaranth sauce.

Therefore, increasing leafy vegetables in a meal could not be enough to provide additional bioavailable iron. Steyn et al. (2008) examined dietary intake of children at population level who consume fortified staple foods in South Africa.

Results indicate that the addition of micronutrients to staple foods made a significant difference to the intake of vitamin A, thiamine, niacin, vitamin B, folic acid, and iron. These improvements were particularly important in rural areas where children had the lowest mean dietary micronutrient intake.

Table 2

Examples on effectiveness of food‐to‐food fortification

Food used for fortification (fortificant)Vehicles (basic food)FortifierTechnique of fortificationAdvantagesLimitsReferences
Flour of Citrullus lanatus seedsBread from wheat flourProteins, fat, and ashWheat flour is substituted for 5%, 15%, and 20% by defatted seeds of C. lanatus. The substitution rate until 20% of the wheat flour by the seeds of C. lanatus was acceptable in terms of sensorial and physical properties with improvement of nutritional qualities The carbohydrate content in fortified bread is lower than the one in bread made by 100% of wheat flourMeite et al. (2008)
Soybean (Glycine max) and melon seed (Citrullus vulgaris): soybean–melon protein supplements“Gari,” a fermented and toasted cassava granuleProtein“Gari,” a fermented and toasted cassava granule, was enriched with 10% of full fat soy–melon protein supplements, at different processing stages (after toasting and before toasting)The gari enriched prior to toasting was better in most of the pasting properties, bulk density, and gel strengthThe enriched “gari” sample exhibited high setback and breakdown viscosity values of indicating that its paste will have lower stability against retrogradation than the un‐enriched gari samplesOluwamukomi and Jolayemi (2012)
Java tilapia flour (Fish)Plain crackerProteinPlain cracker was fortified with varying proportions of Java tilapia flour 5%, 10%, 15%, and 20%Fortification of plain cracker with Java tilapia flour increase protein content of plain cracker.
Fortification of cracker with 5% of Java tilapia is acceptable
Fortification of Plain cracker with Java tilapia flour decreases relative volumetric expansion and sensory properties of the crackerLelana et al. (2003)
SoybeanGari from the tubers of cassava (Manihot esculenta)Crude proteins, phosphorus, fat, and ash, manganese, iron, copper, zinc, and potassiumGari was fortified with soybean flour or soybean residue at 25% of dry weightSoybean flour increased the macronutrient and micronutrient content of the fortified gariDifficulty in processing soybean residue‐fortified productsKolapo and Sanni (2015)
Tapioca from cassava tubers (Manihot esculenta)Crude protein, phosphorus, fat, and ash, manganese, iron, copper, zinc, and potassiumTapioca was fortified with soybean flour or soybean residue at 25% of dry weightSoybean flour increased the macronutrient and micronutrient content of the fortified tapiocaDifficulty in processing soybean residue‐fortified productsKolapo and Sanni (2015)
Acerola (Malpighia emarginata), mango fruit pulps, or soy extractTapiocaVitamin C and proteinThe products were formulated with dried tapioca starch (63%) supplemented by acerola or mango fruit pulps or by soy extract in selected combinations (37%)This study indicated that the developed tapioca products had good sensory acceptance with increase in nutritional valueDe Brito et al. (2007)
Soybean flour (full fat)TapiocaCrude protein, crude fat, crude fiber, ash, energy, sodium, potassium, calcium, and phosphorusTapioca was enriched with varying proportions of soybean flour (0, 85%–15%, 75%–25%, 50%–50%) to produce soy‐tapiocaSoy fortification resulted in improvement of the nutrient composition in terms of protein, fat, energy, and mineral contents. Soy enhanced tapioca samples had a low level of antinutritional components, making them safe for consumption. There was a decrease in the cyanogenic potential and an increase in the level of trypsin inhibitor as soy‐substitution increasedSamuel et al. (2012)
Pawpaw fruit slurrySorghum‐ogiProtein, ash, fat, vitamins c, and sugarA 100 g of ogi (dry basis) was mixed with 0, 20, 40, 60, 80, and 100 g of papaw slurries (dry basis)Blends with 40% pawpaw addition and beyond were acceptable in improving the nutritive value of ogiThere was no apparent effect in pawpaw addition on the pH and titrable acidity of ogiAjanaku et al. (2010)
Cowpea and peanutSweet potato‐based infant weaning foodProtein, ash, fat, crude fiber, and carbohydratesThe flours were combined in specific ratios (sweet potato: 60%, 65%, and 70%; cowpea: 25%, and 15%, 15%; and peanut 15%, 25%, and 15%)Fortification 60% sweet potato, and less than 25% cowpea and 15% peanut flour was acceptable in terms of sensory property with increase in nutritional values.Infant weaning food developed using sweet potato, cowpea, and peanut showed a decrease in the sensory quality of the weaning foodAdenuga (2010)
Defatted Soy FlourTapioca mealProtein and ashThe cassava starch and defatted soy flour were mixed in the ratio 100:0, 95:5, 90:10, 85:15, and 80:20 to produce tapioca mealThe sample with 80:20 cassava starch and defatted soy flour had the highest protein content and the least moisture content. It was also rated highest in terms of overall acceptability from the sensory evaluationBalogun, Karim, Kolawole, & Solarin (2012)
Mushroom flour and spices (Alllium sativum)Cookies from wheat flourWheat flour was used to substitute mushroom flour at the ratio of 70:30, 50:50, 30:70 and with spices (A. sativum) which concentration range from 5, 10, and 15 g, respectivelyProduce a significant effect on the physical properties as the diameter, thickness, and spread factor varies significantly at the probability level less than 0.05 as the concentration of spice (A. sativum) increases.Giwa and Ibrahim (2012)
Oyster Mushroom (Pleurotus plumonarius) PowderBread from wheat flourCrude Proteins, ash, and crude fiberBread containing graded levels of mushroom powder were produced by replacement of wheat flour with 0, 5%, 10%, 15%, 20%, and 25% mushroom powderThe substitution rate of 15% of the wheat flour by the mushroom powder was acceptable in terms of, sensorial and physical properties with increase in nutritional valueThe acceptability decreased with increase in inclusion of mushroom powder. Bread with 25% mushroom powder was the least acceptableOkafor et al. (2012)
Baobab (Adansonia digitata) fruit
Pulp powder
Yoghurt from milklipid, fiber, protein, and mineralA. digitata fruit
Pulp powder was used to fortified yoghurt production in ratios of 4:1, 3:2, 2:3, 1:4, and 5:0. Incorporation of A. digitata fruit pulp increased the bioavailability of nutrients, minerals, and a volatile metabolite with medicinal properties.
Increase in nutritional valueAbdullahi et al. (2014)
African locust bean (Parkia biglobosa) pulpFunctional bread products from wheat flourProtein, fat, ash, and fiberThe functional bread produced from wheat flour was fortified with 0, 5%, 10%, 15%, 20%, 30%, and 40% of Parkia flourThe investigation shows that there was significant improvement in the bread‐resistant starch content and nutritional quality on addition of Parkia flour. The sensory evaluation also indicated that 5%, 10%, and 15% Parkia flour bread was the most acceptable bread.Bread with 40% Parkia flour addition had significantly poor appearance, texture, and pronounced Parkia taste and aromaSankhon et al. (2013)
Baobab fruit pulp“Ogi” powder produced from maizeMinerals and vitamin particularly vitamin C“Ogi” produced from maize was fortified with baobab fruit powder at substitution levels of 0, 10, 20, and 50%.All the fortified samples were acceptable.
Ogi supplemented with baobab fruit powder had higher minerals and vitamin contents particularly vitamin C
Decrease of protein, crude fiber, fat, and carbohydrateAdejuyitan et al. (2012)
Moringa oleifera leaf powderButtermilkThe protein, ash, total solids, calcium, iron, and vitamins of B‐groupDry leaves of Moringa oleifera were incorporated into buttermilk at three different concentrations 1%, 2%, and 3%Dry leaves of Moringa oleifera can be used at T3 level (3% addition) to formulate fortified buttermilk with increased nutritional value and acceptable sensory attributes.The low color score was observedNadeem et al. (2012)
Dry leaves of Moringa oleiferaLabneh cheeseCa, Fe, Zn and Si, vitamins A, B1, B2, and EDry leaves of M. oleifera were added to Labneh cheese at concentration 1%, 2%, or 3%.Labneh fortified with dry leaves of M. oleifera characterized with high biological value (BV), true protein digestibility (TD), and net protein utilization (NPU) and acceptable up to 2%.The addition of dry leaves of M. oleifera tended to make the color (appearance) greenerSalem et al. (2013)
Moringa leaf powderMaize‐ogiProtein, fat, ash, crude fiber, calcium, magnesium, iron, potassium, zinc, and copperThe “ogi” produced from maize was fortified with moringa leaves at substitution levels of 0, 10%, and 15%.The ogi sample with 10% moringa leaves substitution was rated close to the unfortified ogi sample.
Improvement of the nutritional and sensory qualities
The swelling capacity decreased with increase in the level of moringa leaves substitutionAbioye and Aka (2015)

More information: David F. Willer et al, Vitamin Bullets. Microencapsulated Feeds to Fortify Shellfish and Tackle Human Nutrient Deficiencies, Frontiers in Nutrition (2020). DOI: 10.3389/fnut.2020.00102


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