Abdul Majeed Safa, Said Suad, Hassan Dana Ahmad, Sadiq Faaiza, Alhosani Maryam, Al-Jawaldeh Ayoub, El-Obeid Tahra, Tayyem Reema
Nutrition Sciences Department, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
Regional Office for the Eastern Mediterranean (EMRO), World Health Organization (WHO), Cairo, Egypt.
Front Public Health. 2025 Mar 11;13:1530380. doi: 10.3389/fpubh.2025.1530380. eCollection 2025.
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.
强化主食（如面包）已作为一项公共卫生战略来解决营养缺乏问题。目前，22个中东国家中有11个国家强制实行小麦粉强化，主要添加铁和叶酸，而其他国家则有自愿强化举措。尽管中东地区在面包强化方面取得了进展，但这些项目的长期有效性和安全性仍不明确。我们评估了强化的历史背景、现有政策和标准，重点关注公共卫生成果、实施挑战和潜在风险。我们在PubMed、MEDLINE、Cochrane和ProQuest数据库中进行了全面检索，并选取了从强化举措开始到2024年的相关研究。我们的检索包括面包或面粉强化及其对中东地区特有的有效性和潜在风险。文献研究结果表明，强化在对抗微量营养素缺乏方面是有效的，且不会造成过量摄入的有害影响。然而仍需要持续研究来监测潜在风险，如微量营养素过量。大多数研究集中在埃及和伊朗，沙特阿拉伯、土耳其和约旦的数据有限，其他中东国家则明显缺乏相关研究。这凸显了需要在更广泛的国家开展进一步研究，以更全面地了解强化政策的区域影响和有效性。应对覆盖不足、合规问题和基础设施限制等挑战，有助于更全面地了解该地区的强化政策及其有效性。
