ARS | Publication request: Considering the case for vitamin B12 fortification of flour

Submitted to: Food and Nutrition Bulletin
Publication Type: Review Article
Publication Acceptance Date: November 20, 2009
Publication Date: March 20, 2010
Citation: Allen, L.H., Rosenberg, I.H., Oakley, G.P., Omenn, G.S. 2010. Considering the case for vitamin B12 fortification of flour. Food and Nutrition Bulletin. 31(1):S36-46.

Technical Abstract: Reasons to fortify flour with vitamin B12 are considered, which include the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in elderly in wealthier countries, as well as the adverse functional consequences of poor vitamin B12 status. From a global perspective, the main cause of inadequate intake and status is a low intake of animal-source foods. Even lacto-ovo vegetarians have lower serum vitamin B12 concentrations than omnivores; and for various reasons many populations have limited consumption of animal-source foods. Infants are vitamin B12-depleted from early infancy if their mothers’ vitamin B12 status and intake are poor during pregnancy and lactation. Even in the United States, more than 20% of the elderly have serum vitamin B12 concentrations that indicate depletion and an additional 6% have deficiency, primarily due to gastric atrophy, which impairs the absorption of the vitamin from food but usually not from supplements or fortified foods. Although evidence is limited, it shows that fortified flour, consumed as bread, can improve vitamin B12 status. Where vitamin B12 fortification is implemented, the recommendation is to add 20 kg of flour, assuming consumption of 75 to 100 g flour per day, to provide 75% to 100% of the Estimated Average Requirement; the amount added is limited by its cost. The effectiveness of this level of addition for improving vitamin B12 status in programs needs to be determined and monitored. In addition, further research should evaluate the bioavailability of the vitamin from fortified flour by elderly people with food cobalamin malabsorption and gastric atrophy.