Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Fortification, supplementation, and nutrient balance


Efforts to combat nutrient deficiencies have centered on supplemental nutrient administration and addition of selected nutrients to the food chain in the form of food fortification. Over the past several decades, and as the association between diet and chronic diseases became apparent, supplementation and fortification were also targeted at healthy individuals, with the aim of reducing their risk of future diseases such as cardiovascular diseases, diabetes, and cancer. While supplementation strategies are playing a major role in reducing micronutrient deficiencies around the world, there is less compelling evidence for their role in reducing risk of chronic diseases in healthy individuals, perhaps with the exception of folic acid and reduction of neural tube defects. Nevertheless, with our increasing understanding of the genetic heterogeneity of human nutrient requirements, it is likely that certain groups or populations may clearly benefit from higher intakes of certain nutrients. In addition to supplementation or fortification with specific nutrients, the consumption of certain dietary patterns (such as the Mediterranean diet) is associated with a reduced risk of chronic diseases, particularly cardiovascular diseases.

This is a preview of subscription content, access via your institution

Access options

Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.

Figure 1
Figure 2


  • Appel LJ, Moore TJ, Obarzanek E, Vollmer WM, Svetkey LP, Sacks FM, Bray GA, Vogt TM, Cutler JA, Windhauser MM, Lin PH & Karanja N (1997): A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. New Engl. J. Med. 336, 1117–1124.

    Article  CAS  Google Scholar 

  • Bhutta ZA, Black RE, Brown KH, Gardner JM, Gore S, Hidayat A, Khatun F, Martorell R, Ninh NX, Penny ME, Rosado JL, Roy SK, Ruel M, Sazawal S & Shankar A (1999): Prevention of diarrhea and pneumonia by zinc supplementation in children in developing countries: pooled analysis of randomized controlled trials. Zinc Investigators' Collaborative Group. J. Pediatr. 135, 689–697.

    Article  CAS  Google Scholar 

  • Bron D & Asmis R (2001): Vitamin E and the prevention of atherosclerosis. Int. J. Vitam. Nutr. Res. 71, 18–24.

    Article  CAS  Google Scholar 

  • Eichholzer M, Luthy J, Gutzwiller F & Stahelin HB (2001): The role of folate, antioxidant vitamins and other constituents in fruit and vegetables in the prevention of cardiovascular disease: the epidemiological evidence. Int. J. Vitam. Nutr. Res. 71, 5–17.

    Article  CAS  Google Scholar 

  • Feinleib M, Beresford SA, Bowman BA, Mills JL, Rader JI, Selhub J & Yetley EA (2001): Folate fortification for the prevention of birth defects: case study. Am. J. Epidemiol. 154(Suppl), S60–S69.

    Article  CAS  Google Scholar 

  • Harsha DW, Lin PH, Obarzanek E, Karanja N, Moore TJ & Caballero B (1999): Dietary approaches to stop hypertension: a summary of study results. J. Am. Diet. Assoc. 99, 35–39.

    Article  Google Scholar 

  • Institute of Medicine (1998): Standing Committee on the Scientific Evaluation of Dietary Reference Intakes: Proposed Definition and Plan for Review of Dietary Antioxidants and Related Compounds. Washington, DC: National Academy Press.

  • McGee DL, Reed DM, Yano K, Kagan A & Tillotson J (1984): Ten-year incidence of coronary heart disease in the Honolulu heart program: relationship to nutrient intake. Am. J. Epidemiol. 119, 667–676.

    Article  CAS  Google Scholar 

  • MRFIT Research Group (1982): Multiple risk factor intervention trial: risk factor changes and mortality results. JAMA 248, 1465–1477.

  • Shekelle RB, Shryock AM, Paul O, Lepper M, Stamler J, Liu S & Raynor Jr WJ (1981): Diet, serum cholesterol, and death from coronary heart disease: the Western Electric Study. New Engl. J. Med. 304, 65–70.

    Article  CAS  Google Scholar 

  • Sommer A, Tarwotjo I, Djunaedi E, West KP, Loeden AA & Tilden R (1986): Impact of vitamin A supplementation on childhood mortality. Lancet 1, 1169–1173.

    Article  CAS  Google Scholar 

  • Watkins ML, Erickson JD, Thun JD, Mulinare J & Heath Jr CW (2000): Multivitamin use and mortality in a large prospective study. Am. J. Epidemiol. 152, 149–162.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations



Guarantor: B Caballero.

Corresponding author

Correspondence to B Caballero.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Caballero, B. Fortification, supplementation, and nutrient balance. Eur J Clin Nutr 57 (Suppl 1), S76–S78 (2003).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • fortification
  • supplementation
  • dietary patterns
  • chronic disease
  • prevention interventions
  • dietary supplements

This article is cited by


Quick links