Why Fortify? Prevent Nutritional Anemia
Anemia occurs when people lack hemoglobin to carry oxygen to tissues and muscles. Anemia causes debilitating fatigue, impairs a child’s mental development, and contributes to maternal deaths.
Nutritional anemia is caused by vitamin and mineral deficiencies . Adding iron, riboflavin, folic acid, zinc, and vitamin B12 to flour and rice during the milling process helps reduce the risk of nutritional anemia.
In Costa Rica for example, anemia declined in women and children, and iron status in children improved after fortification . Also, each year of flour fortification is associated with a 2.4% decrease in anemia prevalence among non-pregnant women . In the United States, fortifying with folic acid has nearly eliminated folic acid deficiency anemia .
Iron deficiency is the most common nutritional cause of anemia. All people need iron as it improves their capacity for physical activity and productivity. Iron helps children develop physically and mentally, and it improves the health of pregnant women.
Yet iron deficiency is “one of the most prevalent nutrient deficiencies in the world, affecting an estimated 2 billion people. In total, 800,000 (1.5%) of deaths worldwide are attributable to iron deficiency,” according to the World Health Organization (WHO) .
The latest WHO report estimates that 243,187,000 non-pregnant women of child-bearing age have anemia related to iron deficiency . Assume each woman is 1.65 meters tall (5.41 feet). If they stood head to toe, they would extend 401,259 kilometers – enough to reach the moon and circle it.
Animal foods are the best natural source of iron . Vitamin C can help people absorb iron. In contrast, several dietary factors limit iron absorption. Iron inhibitors include:
- Tannins in tea
- Polyphenols in honey, legumes and many fruits
- Phytates in legumes and whole grains .
Fortifying food with iron helps consumers avoid the consequences of iron deficiency with "remarkably little risk of adverse health effects."  See a two-page summary of fortification and iron deficiency.
 Nutritional Anemia. Sight and Life Press; 2007
 Martorell, R., et al. Effectiveness evaluation of the food fortification program of Costa Rica: impact on anemia prevalence and hemoglobin concentrations in women and children. American Journal of Clinical Nutrition, first published November 5, 2014.
 Barkley, J., Wheeler, K., and Pachón, H. Anaemia prevalence may be reduced among countries that fortify flour. British Journal of Nutrition, available on CJO2015. doi:10.1017/S0007114515001646.
 Odewole, O., et al. Near-elimination of folate-deficiency anemia by mandatory folic acid fortification in older US adults: Reasons for geographic and racial differences in stroke study 2003-2007. American Journal of Clinical Nutrition, published online 14 August 2013.
 The World Health Report 2002 -- Reducing Risks, Promoting Healthy Life. World Health Organization.
 Dietary Supplement Fact Sheet; National Institutes of Health
 Brittenham, Gary, The Safety of Flour Fortification with Iron, Columbia University, paper presented at 2004 workshop for the Flour Fortification Initiative, now the Food Fortification Initiative.