Fortified wheat flour and micronutrient deficiencies worldwide
What it found
Fortifying wheat flour and other cereal flours can help reduce vitamin and mineral deficiencies, especially in children and women.
The evidence comes from studies in people and from country programmes.
What they found
Studies in people
Deficiencies are widespread
The authors report that billions of people lack vitamins and minerals. About 19.1 million pregnant women are deficient in vitamin A, 190 million pre-school children are deficient in vitamin A, and about 1.62 billion people are anaemic.
Health benefits reported
The authors cite studies showing that folic acid fortification programmes in Chile led to significant declines in pregnancies affected by neural tube defects. Iron fortification in Iran is described as a strategy to combat iron deficiency.
Other findings
Fortification reaches populations
Adding micronutrients to foods eaten daily, like flour, reaches target populations without major changes to eating habits. The authors describe this as a cost-effective public health strategy.
Wheat flour is widely fortified
Wheat flour was the first cereal product to be largely fortified. By early 2015, 83 countries required wheat flour fortification, most with at least iron and folic acid.
Nutrients used in flour
Wheat flour has been fortified with iron, folic acid, B-complex vitamins, vitamin A, D and C, zinc, and calcium among others. Maize flour is fortified with iron, folic acid, vitamin A and B, and zinc.
Legislation varies by country
For wheat flour, 82 countries have mandatory fortification and 10 have voluntary fortification. For maize flour, 16 countries have mandatory fortification and 4 have voluntary fortification.
What the authors conclude
- They conclude that food fortification programmes are extremely important to overcome and ensure the correct intake of micronutrients.
- They state that flours are a potential vehicle for fortification because of their high consumption worldwide.
How it was done
Billions of people worldwide are deficient in vitamins and minerals, and these deficiencies cause illnesses especially in children and women. Governments and world organisations have focused efforts on addressing these shortcomings.
The authors reviewed studies and country experiences on flour fortification, including wheat, maize and rice flours. They looked at which nutrients are added, health benefits, and legislation around the world.
What it can’t tell you
- This is a review of existing studies and country programmes, not a single experiment. It cannot show cause and effect for any one nutrient or health outcome.
- The authors describe benefits reported in the studies they reviewed, but they did not run new trials in people.
Who paid
- Authors work at
- Instituto Politécnico de Bragança, Portugal
The paper
- Title
- Flour fortification for nutritional and health improvement: A review
- Type
- ReviewThe authors read earlier studies and describe what they found. It isn’t a new study.
- Evidence
- Studies in people
- Summarised from
- Full text
- Cite
- Cardoso RVC, Fernandes Â, Gonzaléz-Paramás AM, Barros L, Ferreira ICFR (2019). Flour fortification for nutritional and health improvement: A review. Food research international (Ottawa, Ont.). doi:10.1016/j.foodres.2019.108576Free full textPubMed 31554122DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error