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Comparison of nutrient compounds in national fortification standards with WHO guidelines

A GFDx analysis comparing nutrient compounds in fortification standards against WHO recommended nutrient compounds.

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Interpretation

Nutrients are available in different chemical forms, referred to as compounds, which may differ in bioavailability or suitability for use in fortification. The World Health Organization (WHO) has recommended compounds for maize flour, salt, and wheat flour fortification. Fortification standards, including permitted compounds, are generally indicated in national food fortification legislation or regulations and/or food standards for the food vehicle.

Using recommended (or non-recommended) compounds in fortification can have a significant impact on the success of a fortification program. GFDx has classified the compound information from a country’s fortification standard as follows:

  • All of the nutrient compounds (in the fortification standard) are recommended by WHO: the fortification standard specifies effective compound(s) to fortify maize flour, salt, or wheat flour.
  • There are both WHO recommended and non-WHO recommended compounds: the fortification standard specifies both WHO-recommended and non WHO-recommended compounds for use in fortification. Countries may want to review why non WHO-recommended compounds are included in their fortification standard.
  • None of the nutrient compounds (in the fortification standard) are recommended by WHO: the fortification standard does not specify any WHO-recommended compounds. Countries may want to review the effectiveness of fortification and the compounds included in their fortification standard, and consider amending their fortified standards to specify WHO-recommended compounds.
  • Unspecified: the country’s fortification standard does not specify which compounds can be used in fortification. For instance, it only states the nutrient “iron” but no compounds such as “ferrous fumarate.” Ideally, permitted compounds should be specified in a fortification standard so that only effective ones are in use
Indicator and term descriptions

Mandatory fortification: The country has legal documentation that has the effect of currently mandating fortification of the food vehicle in question with one or more vitamins or minerals i.e. the documentation indicates that fortification of all or some of the food is compulsory or required.

Voluntary fortification: The country has a fortification standard that provides guidance on levels and nutrient compounds for fortification but does not have the effect of mandating or requiring fortification. If a country has mandatory fortification for that food vehicle, it will be categorized by GFDx as not having voluntary fortification, even if some types of the food vehicle or some nutrients may be fortified on a voluntary basis.

Fortification standard: Legal or official documentation indicating the micronutrients and the forms and levels of these micronutrients that must be added to fortification vehicles at the production level. Fortification standards are generally indicated in national food fortification legislation or regulations and/or food standards for the food vehicle.

Nutrient levels: The level of each nutrient expressed in milligrams per kilogram (mg/kg) that is listed in the current fortification standard at the point of production / import for the food vehicle in question.

Nutrient compound: The chemical form of a nutrient. The compound(s) which are permitted to be used in fortification (at the point of production / import), as specified in a country’s fortification standard.

Additional information about this indicator
How to download data

Follow these steps to download data from the visualization as an Excel or CSV file:

  • Click on the “Data” tab at the bottom of the visualization window.
  • Hover over the header row of the table until an ellipses (three dots […]) appears.
  • Click on “more options” and a drop-down menu will appear. Select “Export data.”
  • In the new window, select the export format that best supports your needs and click the “Export” button.
Considerations
  • There are no WHO guidelines for oil fortification. As a result, no analysis could be conducted for nutrient levels or compounds specified in oil fortification standards.
  • Although WHO guidelines for rice fortification exist, they do not make specific recommendations for the compounds used in rice fortification. As a result, no analysis could be conducted on compounds specified in rice fortification standards.
  • GFDx uses availability data from FAO for maize flour, oil, rice, and wheat flour. Food availability is not the same as food intake and may overestimate food intake if there is significant waste or loss of that food. Food availability that is higher than food intake in reality could have resulted in GFDx comparing the wrong recommended nutrient compound for a specified intake/availability.
  • If a country does not have food intake/availability data, GFDx was not able to identify WHO-recommended iron compounds for that country.
Methodology
  • Extract the nutrient compound(s) stated in a country’s fortification standards.
    • In some cases, vitamin A compounds may have multiple names but are chemically considered the same. For comparison, GFDx has standardized the reference to vitamin A compounds as:
      • Beta-carotene;
      • Retinyl acetate (also known as retinol acetate, vitamin A acetate, or acetyl-retinol); and
      • Retinyl palmitate (also known as retinol palmitate and vitamin A palmitate).
  • For each nutrient in WHO guidelines for fortification, extract the recommended compounds.
    • For wheat and maize flour, recommended compounds for iron vary depending on the country’s food intake/availability (g/c/d) and flour extraction rate. For example, if wheat flour intake is very high (>150 g/c/d), recommended compounds include electrolytic iron, a lower bioavailability compound. Where intake is <150 g/c/d, only higher-bioavailability compounds (i.e., ferrous fumarate, ferrous sulfate, NaFeEDTA) are recommended.
    • Where a country has mandatory fortification for both maize and wheat flour fortification, the combined availability of both grains was used to identify the WHO-recommended compounds.
  • Compare the nutrient compound(s) in country fortification standards to the WHO recommendations for compounds used in maize flour, wheat flour, or salt fortification, classifying the specified nutrient compound(s) as “All,” “Some,” “None,” or “Unspecified” (see Interpretation section above).

For more information about GFDx methodology and indicators: GFDx Data Dictionary.

Data sources
Other resources
Suggested citation

Global Fortification Data Exchange. Map: Comparison of nutrient compounds in national fortification standards with WHO guidelines. Accessed dd/month/yyyy. [http://www.fortificationdata.org.]