. "3 Overview of Food Fortification in the United States and Canada." Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification. Washington, DC: The National Academies Press, 2003.
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Dietary Reference Intakes: Guiding Principles for Nutrition Labeling and Fortification
may be added, which micronutrients may be added, and the level to which they may be added. This is an example of a “positive listing” approach. These regulations apply to all food sold in Canada.
When vitamins became available for addition to food, no regulatory controls were in place. Concern about fraudulent practices in the addition of vitamins to food led the government to set minimum levels for this addition in 1942, followed in 1949 with maximum levels (Cheney and Lee, 1994). Newfoundland had required the enrichment of flour since 1944, and following the entry of Newfoundland into the Canadian Confederation, the standard for flour was amended to permit the same nutrient enrichment (Health Canada, 1999).
The Canadian government has used mandatory fortification to address documented deficiencies. Iodinization of salt, which became mandatory in 1949, virtually eliminated goiter throughout the country; a highly targeted approach to vitamin D fortification turned around a widespread problem with rickets (Cheney and Lee, 1994; Health Canada, 1999). In particular, Canada’s experience with a high incidence of severe rickets and death from vitamin D deficiency is cited as an example of how thoughtful, full-coverage fortification of a targeted food category can address a widespread deficiency. In the 1940s and 1950s all unstandardized food could be fortified within the specified minimum and maximum levels of vitamin D. While rickets continued to be documented in infants and young children, one survey indicated that some of the young children in Ontario were consuming very high levels of vitamin D from supplements and food (Broadfoot et al., 1966). Nationwide food-intake surveys had not been conducted at that time, but concern about the apparent contradictions related to vitamin D status (very high intakes at the same time as a continuing problem of rickets) led in 1964 to the present controls on the addition of vitamins and minerals to food (Cheney and Lee, 1994). Although the addition of vitamin D to evaporated and dried milks had been permitted since 1950, the change in the regulations in 1964, which led to cessation of vitamin D fortification of many food products, resulted in an increase in rickets (Cheney and Lee, 1994; Health Canada, 1999). Health Canada attributes this rise to its overlooking “a fundamental principle of food fortification—the selection of an appropriate vehicle to reach the target population” (Health Canada, 1999, p. 6). In the case of vitamin D, while evaporated and powdered milk was fortified, fluid milk was not. The regulations were amended in 1965 to include fluid milk, and rickets cases began to decline. Educational campaigns in the late 1960s, coupled with a further broadening of the