EC Nutrition

In Brazil, the mandatory fortification of wheat and corn flours with iron and folic acid was established by Resolution RDC No. 344/2002 and updated by RDC No. 150/2017 and RDC No. 604/2022. This public health strategy, led by the Ministry of Health, aims to reduce neural tube defects and prevent iron-deficiency anemia. This study assessed iron concentrations in enriched wheat and corn flour samples commercially available in Minas Gerais, evaluating their compliance with current legislation and discussing the need for regulatory adjustments and ongoing monitoring. A total of 391 flour samples were analyzed, revealing that 29.9% were non-compliant with the legislation, which mandates an iron concentration between 4 mg and 9 mg/100g. The average iron content found was 6.31 mg/100g for wheat flour and 5.28 mg/100g for corn flour, with values ranging from 1.13 mg/100g to 31.80 mg/100g in wheat flour and from 0.71 mg/100g to 29.75 mg/100g in corn flour. The findings raise significant concerns about the efficacy and consistency of the fortification process. The non-compliance of nearly 30% of samples points to potential gaps in the fortification process and quality control during production and distribution. The wide variability in iron content suggests inconsistencies in fortification, leading to both under- and over-fortification. These discrepancies could undermine the public health objectives of the fortification program and pose health risks, including inadequate protection against anemia and potential harm from excessive iron intake. The study underscores the need for stricter enforcement of fortification guidelines and enhanced quality control measures across the food production chain. Regulatory authorities, such as ANVISA, should intensify monitoring to ensure compliance. Additionally, revisiting and refining current fortification policies may be necessary to address these issues. Continuous public health surveillance and research are essential to assess the long-term impacts of the fortification program and ensure its effectiveness.

 Keywords: Iron Fortification; Wheat and Corn Flour; Public Health; Neural Tube Defects; Iron-Deficiency Anemia; Compliance Monitoring

1. Tola FS. “The concept of folic acid supplementation and its role in prevention of neural tube defect among pregnant women: PRISMA”. Medicine 19 (2024): e38154.
2. World Health Organization. “Guideline on haemoglobin cutoffs to define anaemia in individuals and populations”. World Health Organization (2024).
3. Santos LMP and Pereira MZ. “The effect of folic acid fortification on the reduction of neural tube defects”. Cadernos de Saúde Pública1 (2007): 17-24.
4. Lowe NM. “Fortification or biofortification: Complimentary strategies or duplication of effort?” Proceedings of the Nutrition Society (2024): 1-10.
5. Martins AC., et al. “Market-driven fortification of vitamins and minerals in packaged foods targeted at children in Brazil”. Nutrition Bulletin2 (2024): 209-219.
6. Kaur N., et al. “Food fortification strategies to deliver nutrients for the management of iron deficiency anemia”. Current Research in Food Science 5 (2022): 2094-2107.
7. Fernando L. “Impact of food processing techniques on nutritional content in Brazil”. International Journal of Food Sciences1 (2024): 55-65.
8. São Paulo. “Normas analíticas do Instituto Adolfo Lutz: Métodos físicos e químicos para análise de alimentos (No. 4)”. São Paulo (2008).
9. Chevallier E., et al. “Simultaneous determination of 31 elements in foodstuffs by ICP-MS after closed-vessel microwave digestion: Method validation based on the accuracy profile”. Journal of Food Composition and Analysis 41 (2015): 35-41.
10. National Health Surveillance Agency. Resolution RDC No. 344: Approves the technical regulation for the mandatory fortification of wheat and corn flours with iron and folic acid. Official Gazette of the Union, Section 1 (2002): 81.
11. National Health Surveillance Agency. Resolution RDC No. 150: Technical regulation for the fortification of wheat flour and cornmeal with iron and folic acid. Official Gazette of the Union, Brasília (2017).
12. National Health Surveillance Agency. Resolution RDC No. 604: Provides for the enrichment of mandatory salt with iodine and wheat and corn flour with iron and folic acid intended for human consumption. Official Gazette of the Union, Brasília Brazil (2022): 3-8.
13. Ministry of Health. Ordinance No. 31, of January 13, 1998: Technical Regulation Regarding Foods with Added Essential Nutrients. Official Gazette of the Federative Republic of Brazil, Brasília (DF); 03/30/1998; Section 1 (60-E) (1998).
14. Boen TR., et al. “Folic acid and iron evaluation in Brazilian enriched corn and wheat flours”. Journal of the Brazilian Chemical Society 1 (2008): 53-59.
15. Buzzo ML., et al. “Monitoramento de farinha de trigo e de milho fortificadas com ferro”. Revista do Instituto Adolfo Lutz4 (2012): 645-649.
16. Ministry of Health. II Ordinary Meeting of the Interinstitutional Commission for the Implementation, Monitoring, and Evaluation of the Actions of Fortification of Wheat and Corn Flour and Their By-products (2012).
17. Ferreira ALA and Matsubara LS. “Radicais livres: Conceitos, doenças relacionadas, sistema de defesa e estresse oxidative”. Revista da Associação Médica Brasileira1 (1997): 45-50.
18. Manzoor MF., et al. “Bioaccessibility mechanisms, fortification strategies, processing impact on bioavailability, and therapeutic potentials of minerals in cereals”. Future Foods 10 (2024): 100425.
19. Cardoso MA., et al. “Prevalência e preditores de anemia na infância no estudo de coorte de nascimentos MINA-Brasil”. Revista de Saúde Pública 57 (2024): 6s.
20. Olson R., et al. “Food fortification: The advantages, disadvantages and lessons from sight and life programs”. Nutrients 4 (2021): 1118.