Milk Fortification History

The history of milk fortification is deeply intertwined with the evolution of nutritional science and public health initiatives. Beginning in the early 20th century, the recognition of widespread health issues such as rickets, particularly among urban populations, spurred efforts to fortify milk with essential vitamins and minerals.

One of the earliest instances of milk fortification dates back to 1923 in the United Kingdom, where vitamin D was first added to milk. This practice was a response to the alarming prevalence of rickets, a debilitating condition caused by vitamin D deficiency, especially among children living in inner-city areas. As medical understanding of nutrition progressed, the fortification of milk with additional vitamins, such as vitamins A and D, became common practice, albeit on a voluntary basis.

In the United States, the fortification of milk gained traction as a strategy to combat serious nutritional deficiencies. The American Medical Association's Council on Foods and Nutrition recommended the addition of vitamin D to milk in 1933, aiming to eradicate rickets, which was particularly rampant among underprivileged children in northern cities. This recommendation was supported by medical professionals who recognized the urgent need to address the public health crisis posed by rickets.

Following these recommendations, the fortification of milk with vitamin D became widespread, with guidelines established to ensure the safety and efficacy of the process. By fortifying milk with vitamin D, the incidence of rickets drastically declined, marking a significant public health achievement within a few years of implementation.

Internationally, various countries have implemented milk fortification programs to address specific nutritional deficiencies among their populations. For instance, Chile introduced iron-fortified milk powder over 20 years ago as part of complementary feeding programs for children. Similarly, Argentina successfully fortified liquid milk with iron, utilizing innovative techniques such as microencapsulation to ensure both efficacy and product quality.

However, the history of milk fortification also includes challenges and lessons learned. In the early 1950s, an outbreak of hypercalcemia in infants in Great Britain raised concerns about the over-fortification of milk with vitamin D. This incident prompted several European countries to restrict the fortification of dairy and food products, except for specific items like breakfast cereals and margarine, to prevent vitamin D intoxication in neonates.

Despite occasional setbacks, the practice of milk fortification continues to be recognized as a vital strategy in addressing nutritional deficiencies and promoting public health. By enriching milk with essential vitamins and minerals, fortification not only improves the nutritional quality of dairy products but also contributes to the overall well-being of consumers, particularly vulnerable populations such as children and pregnant women. Moreover, milk fortification presents opportunities for the dairy industry to enhance product value and meet evolving consumer preferences for healthier food options.
Milk Fortification History

Essential micronutrient fortification in dairy products

Milk in its natural form is almost unique as a balanced source of man's dietary need. The various steps in processing and storage have a measurable impact on some specific nutrients.

Fortification is defined as the practice of deliberately increasing the content of an essential micronutrients such as essential vitamins and minerals to food. The fortification of food products has been practiced for more than 80 years.

The micronutrients which are commonly used in the fortification of the food products such as milk and its products are:
• Vitamins and co-vitamins
• Essential minerals
• Essential fatty acids
• Essential amino acids
• Phytonutrients
• Enzymes

Vitamins are compounds which play a role as cofactors in the body. Fermented milk products such as yogurt can be thought as vitamin sources. Vitamin concentrates with vitamins A and D are used for fortification of fluid milk.

Vitamin fortification has a long history in fluid milk in the United States to reduce rickets in children, and the FDA mandated in the 1990s that fortified fluid milks must be within 100% to 150% of label claims to address documented variability in vitamin amounts.

Iron-fortified yogurt has a relatively high iron bioavailability. Iron fortification of milk and dairy product is considered as a potential approach to prevent the iron deficiency disorder , since dairy foods are an important part of the daily diet in most parts of the world.

Iron fortification of milk or dairy products induces several bio physicochemical modifications with important consequences. Iron fortification of food is regarded as the most cost-effective method for reducing the prevalence of nutritional iron deficiency. Iron deficiency induces anemia, alters mental development, decreases immunity, impairs cognitive scores in children and leads to poor pregnancy outcome.
Essential micronutrient fortification in dairy products

Adding vitamin D in milk

Milk normally contains vitamin D, but the amount varies with cow’s diet, and with her exposure to sunlight.

Milk has a relatively low content of vitamin D particularly in the winter. Summer milk may have approximately 30 IU in each quart but in winter, the content falls very much below this level. The vitamin D level in milk may be raised by simply adding the milk a dispersible preparation of the vitamin.

This generally is accomplished by adding a concentrate to the milk, prior to pasteurization, to increase the potency to at least 400 IU of vitamin D per quart of milk.

Pasteurization of milk and sterilization of evaporate milk do not destroy vitamin D. Most of the milk consumed in the United States contains added vitamin D.
Adding vitamin D in milk

Vitamin fortification in milk

The term fortification is usually used to designated the addition of nutrients not naturally present in a food, whereas the term enrichment generally means the addition of nutrients already present in a food. Often the terms are used interchangeably.

Many milks are fortified with vitamins A and D. Vitamin D is found naturally in very few foods and was initially added to milk, a staple food, to reduce the incidence of rickets, a bone softening condition in children that was at one time endemic in North America.

The fortification of milk and infant milk with 400 IU of vitamin D2 or vitamin D3 has eliminated rickets as a health problem in the United States and Canada.

Because vitamins A and D are fat soluble they are found in the milk fat of whole milk. For this reason, whole milk is not required to be fortified with either vitamin, although many milk manufacturers add both.

Vitamin A and carotene are in the fat portion of the milk, the vitamin A activity is removed in reduced fat (2% fat) and fat free milks, dried whole milk and evaporated skim milk, so vitamin A fortification is required.

The fortification of dried skim milk with vitamin A is viewed by WHO and FAO as an important measure to combat vitamin A deficiency in developing countries.

Fortification with vitamin D in reduced fat and fat free milks is optional. Vitamin D fortification is required for evaporated whole and fat free milks.
Vitamin fortification in milk