Flour Millers Tool Kit

Definitions
Enrichment / Fortification
• Adding vitamins and minerals to flour during the milling process
• May include nutrients naturally in the grain or additional nutrients
• Addition may meet or exceed natural levels
• Designed for mass populations
Supplementation
• Nutrients provided in liquid or pill form
• Usually in doses higher than found in fortified food
• Designed for specific target groups (i.e. women or children)
 Section 1:

Introduction

 Why Fortify?

 Overview of Fortification Process

 Fortification’s Public Health Impact

 Minerals and Vitamins Used in Flour Fortification

Why Fortify?
Health and Economic Benefits
• Prevent iron deficiency, neural tube birth defects, and
other health concerns
• Improve the national economy by increasing productivity
and decreasing healthcare expenditures

FFI photo
Why Fortify?
Leverage Existing Infrastructure to Reach Population

Siemer flour mill

http://www.siemermilling.com/Locations/125/a/159
Overview: Wheat’s Natural Iron
• Bran contains 55% of wheat’s natural iron
• Germ contains 5% of wheat’s natural iron
Bran

The bran and germ are primarily used for animal

feed.
Endosperm

Germ

Percentages calculated from USDA Nutritional Database

Image courtesy of the Wheat Foods Council
Wheat’s Mineral Loss in Milling
Mineral loss at 75-80% extraction
Overview: Wheat’s Natural Vitamins

Found in Found in
Vitamin
Bran
Bran (%) Germ (%)
Folic Acid (B9) 33 12
Niacin (B3) 86 2
Endosperm Thiamine (B1) 33 64
Riboflavin (B2) 42 26
Pyridoxine (B6) 73 21
Pantothenic Acid (B5) 50 7

Germ

Percentages calculated from USDA Nutritional Database

Image courtesy of the Wheat Foods Council
Wheat’s Vitamin Loss in Milling
Vitamin loss at 75-80% extraction
Overview: Fortification Process
Powdered vitamins and minerals are added to flour during
the milling process using equipment called feeders.

A large mill may use a “feeder bank”

such as this set of four. One feeder Smaller mills may use a
is for fortification and three are for single feeder for
other flour improvers. fortification.
Photo courtesy of Research Products Company Photo copyright: David Snyder / CDC
Foundation 
Impact on Health: Iron
Burden of Deficiency Health Benefits
• Reduced productivity • Increased productivity
• Iron deficiency anemia • Fully developed mental
• Undeveloped mental skills
capacity • Improved maternal and
• Maternal mortality child health
• Pre-term births

“Iron deficiency affects more people than any other condition, constituting a
public health condition of epidemic proportions.”
-World Health Organization
http://www.who.int/nutrition/topics/ida/en/
 Each year of flour
fortification is
associated with a
2.4% decrease in
anemia.

Barkley, J., Wheeler, K., and Pachón, H. Anaemia prevalence may be reduced among countries that fortify flour. British Journal of Nutrition, 2015. 114, pp 265-
273. doi:10.1017/S0007114515001646.
 Results of Insufficient Folic Acid
(vitamin B9)

• Children born with neural tube

birth defects (NTDs) such as
spina bifida
• Permanently disabling or fatal
• More than 300,000 NTDs
occur every year globally*
Photo from the International Federation for Spina Bifida and
Hydrocephalus

* Global Report on Birth Defects, March of Dimes Birth Defects Foundation, 2006
Impact of Fortifying with Folic Acid
• Reduce risk of NTDs 31% to 78%
• Healthcare savings from averted
surgeries and therapy
• Annual net savings:
o 2.3 million international dollars in
Chile
o 40.6 million rand in South Africa
Photo from istock
o 603 million US dollars in the United
States
Risk reduction from Blencowe, H: Folic acid to reduce neonatal mortality form neural tube disorders. International Journal of Epidemiology. April
2010 (suppl_1):i110-i121
Cost benefit data from:
Llanos, A., et. al., Cost-effectiveness of a Folic Acid Fortification Program in Chile. Health Policy 83 2007:295-303.
Sayed, A., et.al., Decline in the Prevalence of Neural Tube Defects Following Folic Acid Fortifcation and Its Cost-Benefit in South Africa. Birth
Defects Research 82 2008:211-216.
Grosse, S., et. al., Retrospective Assessment of Cost Savings From Prevention. American Journal of Preventive Medicine , 2016
Minerals and Vitamins
Used in Flour Fortification

Minerals Vitamins
• Iron • Folic Acid (B9)
• Zinc • Thiamine (B1)
• Riboflavin (B2)
• Niacin (B3)
• B12
• Vitamin A
• Vitamin D
Types of Iron Used In Fortification

Elemental Iron Ferrous Sulfate

(reduced iron or electrolytic iron)

Ferrous Fumarate Sodium Iron EDTA (NaFeEDTA)

Factors for Choosing Iron Compound
• Bioavailability (absorption)
o Water soluble compounds have the highest relative bioavailability
because they are very soluble in gastric juices.
o The size, shape and surface area of the iron particle affects
bioavailability, as does composition of food made with fortified
flour.
• Sensory changes
o High levels of some iron compounds could cause coloration or
rancidity of the flour.
• Cost:
o Highly bioavailable forms of iron are more expensive, but less is
needed per metric ton of flour for fortification to have a health
impact.
• Magnets:
o Iron salts (ferrous sulfate, ferrous fumarate and iron EDTA) will not
be attracted to magnets that may be used in milling process
Other Minerals in Flour Fortification
Zinc
• Zinc oxide is most
commonly used
• Inexpensive
• No sensory concerns
• Use higher levels in high-
extraction flours due to
higher phytic acid content
Calcium
• Calcium sulfate and
calcium carbonate are
both used
• No sensory concerns
• Not included in premix
with other nutrients
because levels are far
higher than other nutrient
additions
• Not usually included in
fortification standards
B Vitamins in Flour Fortification
Folic Acid (B9)
• Folic acid is preferred
source
• No sensory concerns
• Relatively stable with
some loss from exposure
to light and food
preparation
• More bioavailable than B9
in natural food sources
Thiamine (B1)
• Thiamine mononitrate is
preferred source
• No sensory concerns
• Susceptible to losses
from exposure to light
and heat and alkaline
conditions (pH over 7)
B Vitamins in Flour Fortification
Riboflavin (B2) Niacin (B3)
• Orange crystalline • Commonly used source:
powder nicotinic acid (commonly
just called niacin) and
• Use only food grade
nicotinamide.
material exceeding 97%
• No sensory concerns
purity
• Nicotinic acid can cause
• Unstable in light
reddening in the skin on
exposure
• Both niacin compounds are
very stable in heat and light
B Vitamins in Flour Fortification
Pyrodoxine (B6) Cobalamin (B12)
• Pyrodoxine • Cyanocobalamin is common
hydrochloride is source
preferred source • No sensory concerns
• No sensory • Relatively stable in heat, but
concerns unstable in alkali and strong
• Stable to heat, but acidic environments
sensitive to UV • Difficult and expensive to test
light. for the small amounts used in
fortification
• More bioavailable than B12 in
natural food sources
Other Vitamins in Flour Fortification
Vitamin A
•Retinyl acetate and retinyl palmitate are recommended.
•Beta-carotene’s yellow color makes it undesirable for flour.
•Available in encapsulated forms that do not cause sensory
concerns
•Significant losses can occur on storage if the
encapsulation and antioxidant protection system is poor. A
standard stability test at 45°C on the raw material should
show losses no greater than 20% after 21 days.
•Countries often fortify edible oil or sugar rather than flour
with vitamin A.
Other Vitamins in Flour Fortification
Vitamin D
•Form used in fortification: D3 Cholecalciferol
•Countries often fortify dairy products with vitamin D in
combination with vitamin A
•Currently only a few countries fortify flour with vitamin D
More Information
• Health, productivity and economic benefits of flour fortification:
http://www.ffinetwork.org/why_fortify/index.html

• World Health Organization recommendations for wheat and maize

flour fortification:
http://www.who.int/nutrition/publications/micronutrients/wheat_maize
_fortification/en/