Fortified wheat flour and four other foods in 153 countries
What it found
In an analysis of 153 countries, fortified wheat flour, maize flour, oil, rice and salt together could add up to 15 nutrients to the diet.
The authors say the amounts stayed below the upper limits in nearly all countries.
What they found
Nutrients contributed
Under the maximum scenario, fortified foods could contribute up to 15 nutrients. The median contribution ranged from 22 to 75 percent of Estimated Average Requirements for 14 nutrients, and 338 percent for iodine.
Realistic scenario
When adjusted for actual processing and fortification rates, the median contribution was 181 percent for iodine and less than 35 percent for the other nutrients.
Upper limits
In both scenarios, the median Tolerable Upper Intake Level met was less than 55 percent for all nutrients. Under the realistic scenario, no country exceeded 100 percent of the upper limit for any nutrient.
Iodine from salt
In the maximum scenario, iodine contribution exceeded the upper limit in 8 of 137 countries, by 2 to 30 percent above the limit. In the realistic scenario, no country exceeded the upper limit.
Wheat flour contribution
Among the five foods, salt and wheat flour had the highest percentages of nutrient contribution, while maize flour and rice had the lowest, and oil was intermediate.
What the authors conclude
“Current fortification practices of the five foods of interest have the global potential to contribute up to 15 nutrients to the diets of people, with minimal risk of exceeding ULs.”
Also in their conclusions
- They conclude that current fortification practices for these foods have the potential to contribute up to 15 nutrients to the diet, with little risk of contributing excess nutrients.
- They advise that continuous monitoring of the nutrient contribution of fortified foods is warranted to ensure that effective and safe amounts of nutrients are delivered through fortification.
How it was done
Micronutrient deficiencies are a global public health problem, and food fortification is one strategy to prevent them. The authors wanted to estimate how much fortified foods could contribute to nutrient needs.
They used country-level data from the Global Fortification Data Exchange for 153 countries that set nutrient levels for fortifying maize flour, oil, rice, salt or wheat flour. They calculated potential nutrient contributions under two scenarios: maximum (100% of food processed and fortified) and realistic (adjusted for actual processing and fortification rates).
What it can’t tell you
- The analysis used one average food intake value per country, not surveys of individuals, so it cannot show how many people are below or above nutrient limits.
- It only looked at nutrients added through fortification of these five foods and did not include other foods, supplements, or naturally occurring nutrients in the diet.
Who paid
- Funding
- Funded by Bill and Melinda Gates Foundation (from the PubMed record).
- Conflicts
- Co-authors are employed with the Food Fortification Initiative, Emory University, Johns Hopkins University, the Global Alliance for Improved Nutrition, and the Iodine Global Network. All these organizations help country leaders promote, plan, implement, monitor, or evaluate food fortification. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.
- Authors work at
- Emory University, USA; Johns Hopkins Bloomberg School of Public Health, USA
The paper
- Title
- The Potential Contribution of Fortified Maize Flour, Oil, Rice, Salt, and Wheat Flour to Estimated Average Requirements and Tolerable Upper Intake Levels for 15 Nutrients in 153 Countries
- Type
- Study
- Summarised from
- Full text
- Cite
- Pachón H, Reynolds B, Duong M, et al (2021). The Potential Contribution of Fortified Maize Flour, Oil, Rice, Salt, and Wheat Flour to Estimated Average Requirements and Tolerable Upper Intake Levels for 15 Nutrients in 153 Countries. Nutrients. doi:10.3390/nu13020579Free full textPubMed 33572488DOI
Summary written 26 Sep 2026. Check it against the paper before it changes what you eat. How we summarise papers · Report an error