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Discretionary addition of vitamins and minerals to foods: implications for healthy eating

Abstract

Objectives:

Health Canada proposes to allow manufacturers to add vitamins and minerals to a wide variety of foods at their discretion, a practice that has long been permitted in the United States and Europe. With Health Canada's proposed exclusion of staple and standardized foods from discretionary fortification, questions arise about the nutritional quality of the foods that remain eligible for fortification. To better understand the implications of this policy for healthy eating, this study examined the contribution of foods eligible to be fortified to the dietary quality of Canadians.

Methods:

Using 24-h dietary recall data from the 2004 Canadian Community Health Survey, the relationship between intake of fortifiable foods and indicators of dietary quality was assessed.

Results:

The mean percentage contribution of fortifiable foods to usual energy intake ranged from 19% among men over the age of 70 years to 36% for girls aged 14–18 years. Fortifiable food (as a percentage of total energy) was inversely associated with intake of vegetables and fruit, meat and alternatives, milk products, fiber, vitamins A, B6, B12 and D, magnesium, potassium and zinc. Fortifiable food was positively associated with dietary energy density, total energy intake and grain products. Few relationships were found for folate, vitamin C, iron, calcium, sodium and saturated fat.

Conclusions:

Consumption of foods slated for discretionary fortification is associated with lower nutrient intakes and suboptimal food intake patterns. Insofar as adding nutrients to these foods reinforces their consumption, discretionary fortification might function to discourage healthier eating patterns.

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References

  • Barton BA, Eldridge AL, Thompson D, Affenito SG, Striegel-Moore RH, Franko DL et al. (2005). The relationship of breakfast and cereal consumption to nutrient intake and body mass index: the National Heart, Lung, and Blood Institute Growth and Health Study. J Am Diet Assoc 105, 1383–1389.

    Article  Google Scholar 

  • Beauchesne E, Kondro K (2009). Health Canada contemplates providing food industry with ‘discretionary’ authority to fortify junk foods. CMAJ 180, 1196.

    Article  Google Scholar 

  • Berner LA, Clydesdale FM, Douglass JS (2001). Fortification contributed greatly to vitamin and mineral intakes in the United States, 1989–1991. J Nutr 131, 2177.

    CAS  Article  Google Scholar 

  • Bes-Rastrollo M, van Dam RM, Martinez-Gonzalez MA, Li TY, Sampson LL, Hu FB (2008). Prospective study of dietary energy density and weight gain in women. Am J Clin Nutr 88, 769.

    CAS  Article  Google Scholar 

  • Codex Alimentarius Commission (2007). Discussion Paper on the Proposal for New Work to Amend the Codex General Principles for the Addition of Essential Nutrients to Foods. WHO and the FAO of the United Nations: Rome.

  • Colby SE, Johnson L, Scheett A, Hoverson B (2010). Nutrition marketing on food labels. J Nutr Educ Behav 42, 92–98.

    Article  Google Scholar 

  • Coppens P, da Silva MF, Pettman S (2006). European regulations on nutraceuticals, dietary supplements and functional foods: a framework based on safety. Toxicology 221, 59–74.

    CAS  Article  Google Scholar 

  • Dauchet L, Amouyel P, Dallongeville J (2009). Fruits, vegetables and coronary heart disease. Nat Rev Cardiol 6, 599–608.

    Article  Google Scholar 

  • Department of Justice Canada (2010). Food and Drugs Regulations. Breakfast Cereal B.13.060. (Cited 23 September 2010). Available from: http://laws.justice.gc.ca/PDF/Regulation/C/C.R.C.-c.870.pdf.

  • Elliott C (2008). Assessing ‘fun foods’: nutritional content and analysis of supermarket foods targeted at children. Obes Rev 9, 368–377.

    CAS  Article  Google Scholar 

  • European Parliament (2006). Regulation (EC) No 1925/2006 of the European Parliament and of the Council of 20 December 2006 on the addition of vitamins and minerals and of certain other substances to foods. Official Journal of the European Union 49, 26–38.

    Google Scholar 

  • Food and Drug Administration (1993). Code of Federal Regulations. Food and Drugs: Nutritional Quality Guidelines for Foods Fortification Policy: 21CFR104. (Updated 19 July 2010; cited 21 July 2010). Available from: http://ecfr.gpoaccess.gov/cgi/t/text/text-idx?c=ecfr&sid=aa52743aefe5a6a28353899288112e1&rgn=div6&view=text&node=21:2.0.1.1.4.2&idno=21.

  • Garriguet D (2007a). Sodium consumption at all ages. Health Rep 18, 47–52.

    PubMed  Google Scholar 

  • Garriguet D (2007b). Canadians' eating habits. Health Rep 18, 17–32.

    PubMed  Google Scholar 

  • Hannon EM, Kiely M, Flynn A (2007). The impact of voluntary fortification of foods on micronutrient intakes in Irish adults. Br J Nutr 97, 1177.

    CAS  Article  Google Scholar 

  • He FJ, Nowson CA, MacGregor GA (2006). Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet 367, 320–326.

    Article  Google Scholar 

  • He K, Hu FB, Colditz GA, Manson JE, Willett WC, Liu S (2004). Changes in intake of fruits and vegetables in relation to risk of obesity and weight gain among middle-aged women. Int J Obes Relat Metab Disord 28, 1569–1574.

    CAS  Article  Google Scholar 

  • Health Canada (2003). Addition of Vitamins and Minerals to Foods: Policy Review and Implementation. Food Vehicles for Discretionary Fortification, Summary report of stakeholder consultation. (Cited 14 July 2010). Available from:http://www.hc-scgc.ca/fn-an/nutrition/vitamin/index-eng.php.

  • Health Canada (2005). Addition of Vitamins and Minerals to Foods: Health Canada's Proposed Policy and Implementation Plans, (Cited 14 July 2010). Available from: http://www.hc-scgcca/fnan/nutrition/vitamin/fortification_final_doc_1-eng.php.

  • Health Canada (2007a). Canada's Food Guide, (cited 14 July 2010). Available from:http://www.hc-scgc.ca/fn-an/food-guide-aliment/index-eng.php.

  • Health Canada (2008a). Canadian Community Health Survey, Cycle 2.2, Nutrition (2004). Nutrient Intakes from Food: Provincial, Regional and National Summary Data Tables, Vol. 2. Health Canada: Ottawa (Report No.: H164-45/2-2008E-PDF).

  • Health Canada (2008b). Canada's Food and Drugs Act and Regulations, (Updated 19 July 2010; cited 21 July 2010). Available from: laws.justice.gc.ca/en/F-27/C.R.C.-c.870/index.html.

  • Health Canada, Office of Nutrition Policy and Promotion, Health Products and Food Branch (2006). Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition (2004): A Guide to Accessing and Interpreting the Data. Health Canada: Ottawa, Report No.:H164–20/2006E2006.

  • Health Canada (2007b). Canadian Community Health Survey, Cycle 2.2, Nutrition (2004). Nutrient Intakes from Food: Provincial, Regional and National Summary Data Tables, Volume 1 Health Canada: Ottawa. Report No.: H164-45/1-2007E-PDF.

  • Hung HC, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA et al. (2004). Fruit and vegetable intake and risk of major chronic disease. J Natl Cancer Inst 96, 1577–1584.

    Article  Google Scholar 

  • Institute of Medicine (IOM) (2005). Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein and Amino Acids (Macronutrients). National Academies Press: Washington, DC.

  • Joyce T, Hannon EM, Kiely M, Flynn A (2009). Analysis of the impact of fortified food consumption on overall dietary quality in Irish adults. Br J Nutr 101, 431–439.

    CAS  Article  Google Scholar 

  • Kant AK, Graubard BI (2005). Energy density of diets reported by American adults: association with food group intake, nutrient intake, and body weight. Int J Obes 29, 950–956.

    CAS  Article  Google Scholar 

  • Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC, et al. (2005). Dietary energy density determined by eight calculation methods in a nationally representative United States population. J Nutr 135, 273–278.

    CAS  Article  Google Scholar 

  • Ledikwe JH, Blanck HM, Khan LK, Serdula MK, Seymour JD, Tohill BC et al. (2006). Dietary energy density is associated with energy intake and weight status in US adults. Am J Clin Nutr 83, 1362–1368.

    CAS  Article  Google Scholar 

  • Levy AS, Stokes RC (1987). Effects of a health promotion advertising campaign on sales of ready-to-eat cereals. Public Health Rep 102, 398–403.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Mendoza JA, Drewnowski A, Christakis DA (2007). Dietary energy density is associated with obesity and the metabolic syndrome in US adults. Diabetes Care 30, 974–979.

    Article  Google Scholar 

  • Moorman C (1998). Market-level effects of information: competitive responses and consumer dynamics. J Mark Res 35, 82–98.

    Article  Google Scholar 

  • Natural Health Products Directorate, Health Canada (2006). NHPD Monthly Communiqué Product licensing information: processing of food-like NHPs fortified with vitamins and minerals. [Updated 12 September 2006; cited 30 April 2009). Available from: http://www.hc-sc.gc.ca/dhpmps/prodnatur/bulletins/_communiques/communique_sept06-eng.php.

  • Natural Health Products Directorate and Food Directorate (2009). Health Canada: Ottawa. Report No.: H164–108/2009E-PDF.

  • Nestle M, Ludwig DS (2010). Front-of-package food labels: public health or propaganda? JAMA 303, 771–772.

    CAS  Article  Google Scholar 

  • Nicklas TA, Myers L, Berenson GS (1995). Total nutrient intake and ready-to-eat cereal consumption of children and young-adults in the Bogalusa Heart Study. Nutr Rev 53, S39.

    CAS  PubMed  Google Scholar 

  • Sacco JE, Tarasuk V (2009). Health Canada's proposed discretionary fortification policy is misaligned with the nutritional needs of Canadians. J Nutr 139, 1980–1986.

    CAS  Article  Google Scholar 

  • Savage JS, Marini M, Birch LL (2008). Dietary energy density predicts women's weight change over 6 y. Am J Clin Nutr 88, 677–684.

    CAS  Article  Google Scholar 

  • Sichert-Hellert W, Kersting M, Manz F (2001). Changes in time-trends of nutrient intake from fortified and non-fortified food in German children and adolescents - 15 year results of the DONALD Study. Eur J Nutr 40, 49.

    CAS  Article  Google Scholar 

  • Sichert-Hellert W, Kersting M, Alexy U, Manz F (2000). Ten-year trends in vitamin and mineral intake from fortified food in German children and adolescents. Eur J Clin Nutr 54, 81.

    CAS  Article  Google Scholar 

  • Song WO, Chun OK, Kerver J, Cho S, Chung CE, Chung SJ (2006). Ready-to-eat breakfast cereal consumption enhances milk and calcium intake in the US population. J Am Diet Assoc 106, 1783.

    Article  Google Scholar 

  • Statistics Canada (2008). Canadian Community Health Survey (CCHS) Cycle 2.2 (2004). Nutrition—General Health (Including Vitamin & Mineral Supplements) & 24-Hour Dietary Recall Components. User guide.

  • Subar AF, Bowering J (1988). The contribution of enrichment and fortification to nutrient intake of women. J Am Diet Assoc 88, 1237.

    CAS  PubMed  Google Scholar 

  • Wagner KH, Blauensteiner D, Schmid I, Elmadfa I (2005). The role of fortified foods—situation in Austria. Forum Nutr 57, 84–90.

    Article  Google Scholar 

  • Yan W (2010). Invitation letter to stakeholders: think-tank on expanded voluntary addition of vitamins and minerals to foods.

Download references

Acknowledgements

We gratefully acknowledge Dr George Beaton for his invaluable contributions to this paper. Jocelyn E Sacco holds a Canadian Institutes of Health Research (CIHR) Fellowship in Public Health Policy, and a CIHR Canada Graduate Scholarship Doctoral Award.

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Correspondence to V Tarasuk.

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Supplementary Information accompanies the paper on European Journal of Clinical Nutrition website

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Sacco, J., Tarasuk, V. Discretionary addition of vitamins and minerals to foods: implications for healthy eating. Eur J Clin Nutr 65, 313–320 (2011). https://doi.org/10.1038/ejcn.2010.261

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Keywords

  • food fortification
  • dietary quality
  • vitamins
  • minerals

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