Evaluating the Effectiveness and Risks of Bread Fortification Programs in the Middle Eastern Region: A Comprehensive Review

Safa Abdul Majeed ¹ Suad Osman Said ¹ Dana Ahmad Hassan ¹ Faaiza Sadiq ¹ Maryam Alhosani ¹ Ayoub Al Jawaldeh ² Tahra ElObeid ¹ Reema Fayez Tayyem ^1*

• ¹ Qatar University, Doha, Qatar
• ² WHO, Cairo, Beni Suef, Egypt

Fortification of staple foods such as bread has been implemented as a public health strategy to address nutrient deficiencies, particularly in low-and middle-income countries. While these programs have shown positive outcomes in reducing neural tube defects (NTDs) and nutritional deficiencies, there is growing concern about the potential health impacts of overnutrition, particularly regarding excessive intake of certain fortified nutrients. Therefore, this study aims to evaluate the effectiveness of bread fortification programs in Middle Eastern region, focusing on both the positive outcomes and potential risks associated with over nutrition. We conducted a comprehensive search in PubMed, MEDLINE, Cochrane, and ProQuest databases and more than 80 articles were finally selected. Our findings indicate that fortification was effective in combating micronutrient deficiencies without causing harmful effects of overload, although ongoing research is monitoring for potential micronutrient overload. However, studies are mostly centered on countries such as Egypt and Iran. This suggests a gap in research coverage for other countries in the region, highlighting the need for more studies to evaluate fortification programs of bread in a wider range of Middle Eastern countries. This would provide a more comprehensive understanding of the impact and effectiveness of fortification policies across the region.