Evaluating the effectiveness and risks of bread fortification programs in the middle eastern region: a comprehensive review

Abstract

Fortification of staple foods such as bread has been implemented as a public health strategy to address nutrient deficiencies. Currently, 11 out of 22 Middle Eastern countries have mandatory wheat flour fortification, primarily with iron and folic acid, while others have voluntary initiatives. Despite progress in bread fortification efforts across the Middle East the long-term effectiveness and safety of these programs remain unclear. We assess the historical context, existing policies, and standards of fortification, focusing on public health outcomes, implementation challenges, and potential risks. A comprehensive search in PubMed, MEDLINE, Cochrane, and ProQuest databases, and relevant studies from the inception of the fortification efforts till 2024 were selected. Our search included Bread or flour fortification and their effectiveness and potential risks specific to Middle Eastern Regions. Findings from the literature indicate that fortification was effective in combating micronutrient deficiencies without causing the harmful effects of overload. However, ongoing research is needed to monitor potential risks, such as micronutrient overload. Most studies are concentrated in Egypt and Iran, with limited data from Saudi Arabia, Turkey, and Jordan, and a notable absence of research from other Middle Eastern countries. This highlights the need for further studies across a wider range of countries to provide a more comprehensive understanding of the regional impact and effectiveness of fortification policies. Addressing the challenges of inadequate coverage, compliance issues, and infrastructure limitations could provide a more comprehensive understanding of the region's fortification policies and their effectiveness.