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Comparison of nutrient levels in national fortification standards with WHO guidelines

A GFDx analysis comparing the levels of nutrient compounds in national fortification standards against WHO recommended nutrient levels.

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Interpretation

Fortification aims to increase nutrient intake to address nutrient deficiencies. The amount of nutrient added through fortification should be sufficient to improve nutrient status of the population but not enough to cause excessive intake in any population group. To guide effective and safe nutrient addition levels in fortification, the World Health Organization (WHO) has issued guidelines for recommended nutrient levels for maize flour, salt, and wheat flour fortification. Fortification standards, including required nutrient levels, are generally indicated in national food fortification legislation or regulations and/or food standards for the food vehicle.

Using appropriate nutrient addition levels in fortification can have a significant impact on the success of a fortification program. WHO guidelines aim to provide “global, evidence-informed guidelines” to help member states make “informed decisions on the appropriate nutrition actions.” However, all guidelines are intended to be adapted to particular country contexts and countries may have valid programmatic reasons for not following WHO guidelines. The results of the GFDx analysis should be used as a starting point for policymakers to discuss whether national fortification standards are as safe and effective as possible.

GFDx has calculated how much the nutrient level in a fortification standard varies from the WHO-recommended level/range, taking into consideration the food intake/availability (grams per capita per day, g/c/d):

  • A nutrient level is 100% of the WHO-recommended level: the nutrient level in the fortification standard is the same as the WHO-recommended level or within the WHO-recommended range.
  • A nutrient level is >100% of the WHO-recommended level: the nutrient level in the fortification standard is greater than the WHO-recommended level. Countries may want to review if the nutrient level has the potential to cause excessive nutrient intakes.
    • For example, if the iron level in a country’s wheat flour fortification standard is 200% of the WHO-recommended level, this means that the iron level is double the WHO-recommended level.
  • A nutrient level is <100% of the WHO-recommended level: the nutrient level in the fortification standard is lower than the WHO-recommended level. Countries may want to review if the required nutrient level is adequate enough to increase nutrient intakes.
    • For example, if the iron level in a country’s wheat flour fortification standard is 50% of the WHO-recommended level, this means that the iron level is half of the WHO-recommended level.
  • Cannot be determined: WHO guidelines specify effective nutrient addition levels for different amounts of food intake/availability. If there is no food intake/availability information for a country, GFDx was not able to identify the recommended nutrient addition level for that country. WHO guidelines also take into consideration the nutrient compounds. If nutrient compounds are not specified in the fortification standards, GFDx was not able to identify the recommended nutrient level for that nutrient.
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 of nutrient levels or compounds specified in oil fortification requirements.
  • 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 of compounds specified in rice fortification requirements.
  • 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 standard.
    • 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, the combined availability of both grains was used to identify the WHO-recommended compounds.
  • Compare the nutrient compound(s) in a country’s 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 levels in national fortification standards with WHO guidelines. Accessed dd/month/yyyy. [http://www.fortificationdata.org.]