Based on a large national dietary survey, the
researchers found that without fortification, the diets of a large
number of children and teens would be nutritionally inadequate. With
fortification the picture is better, but not perfect.
"Foods with added nutrients (most notably breakfast cereals,
enriched grain foods, fluid milks) supplied important amounts of
many but not all vitamins and minerals in diets of U.S. children and
adolescents," Louise Berner told Reuters Health in an email.
Berner is a food science and nutrition researcher at Cal Poly State
University in San Luis Obispo, California.
Currently, the U.S. Food and Drug Administration requires some
fortification of food, such as enriching refined flour with vitamins
and iron and adding vitamin A to low- and non-fat milk.
Food manufacturers may also add nutrients to food voluntarily — some
brands of orange juice, for example, are fortified with added
Berner and colleagues wanted to find out both how much of an impact
fortification has on kids' nutrition and determine which foods were
providing the added nutrients.
The researchers used data from the National Health and Nutrition
Examination Survey to analyze the diets of 7,250 children and
adolescents ages 2 to 18 years old.
Berner's team looked at the types of food eaten and any supplements
taken and assessed the nutrient content of each food. Then they
assessed how nutritionally adequate each kid's diet was by seeing
whether it met Estimated Average Requirements (EAR).
The EAR is the average daily nutrient intake level estimated to meet
the requirement of half the healthy individuals in a particular
group based on age or gender.
On average, girls ages 14 to 18 years old were most likely to fall
short of the EAR for their age, while boys and girls 2 to 8 years
old had the lowest rates of inadequate nutrient intakes.
The study team found that fortified foods contributed half or more
of the intakes of vitamin D, thiamin, and folate to children's
diets; 20 to 47 percent of the intakes of vitamin A, vitamin C,
riboflavin, niacin, B-6, B-12, and iron; 12 to 18 percent of the
intake of zinc; but only 4.5 to 6.6 percent of calcium.
Even with the increased nutrients from fortified sources, a
substantial percentage of kids still had intakes of vitamins A, C
and D that were less than the EAR for their age and sex.
The fortified foods also did not appear to lead to excessive intakes
of any nutrients, which is a concern others have expressed in the
past, Berner and her colleagues note in the Journal of the Academy
of Nutrition and Dietetics.
The fortified foods that provided the most nutrients were breakfast
cereals, milk and milk drinks, breads, rolls and other products made
with enriched grains.
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"This research study provides a good picture of the contribution
of fortified foods to kids' diets in the U.S.," Berner said, "but,
it should not be misinterpreted as a dietary recommendation to
consumers — that was not the intent of the research."
So many unfortified foods, including fruits, vegetables, meats,
fish and so forth, are critically important parts of healthful diets
yet are often under-consumed, Berner said.
"But, selectively, I think it makes sense — for example, choosing a
fortified breakfast cereal instead of an unfortified one," she said.
Berner and her coauthors advise consumers to obtain nutrients
primarily from foods that are naturally nutrient-dense. And, they
point out, not all fortified foods are healthy foods.
"The trouble with fortification is that while it can increase the
'good,' it doesn't necessarily do anything to decrease the 'bad',"
Dr. David Katz told Reuters Health in an email.
Katz is the founding director of the Prevention Research Center
at Yale University School of Medicine and medical director for the
Integrative Medicine Center at Griffin Hospital in Derby, CT. He was
not involved in the new study.
Katz said there are examples of fortification that are very
important no matter what the diet is like. Vitamin D in a population
that doesn't get a lot of sun exposure is perhaps the best example.
Katz said the paper demonstrates that in a culture that eats very
poorly, we need fortification to have adequate nutrient intake.
"But what this paper does not address at all is: what would happen
if we actually ate well," he added.
Katz said it's a mistake to think that preventing nutrient
deficiencies with fortified "junk" foods is in any way the same as
eating truly good foods.
"Eating a variety of wholesome foods would provide those same
nutrients, along with many others, and without the sugar, salt,
refined starch, unhealthy oils, excess calories and so on," Katz
Journal of the Academy of Nutrition and Dietetics. Online Jan.
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