Health Benefits of Bread Fortification: A Systematic Review of Clinical Trials according to the PRISMA Statement
Abstract
:1. Introduction
2. Materials and Methods
3. Results
3.1. Influence of Fortified Bread on Human Health
3.1.1. Minerals
Jadad Scale | Participants | Fortificant/Substance/ Dose/Inhibitor | Duration | Methods/Analysis | Results | References/ Country |
---|---|---|---|---|---|---|
1 | Young male adults; N = 11; Age: 18–30 BMI: 23.8–28.6 | Potassium, Magnesium, Phosphorus; 3.6 g of MgCO3 and 12.5 g of KH2PO4/kg of flour; 7.2 g of MgCO3 and 25 g of KH2PO4/kg of flour | 30 days | Venous blood; PG; GR; IR; triacylglycerols; total P, Mg, and K; HOMA-IR | TG and GR after consumption of fortified bread maintained at a lower level compared to control. | [14] Lebanon |
3 | Mother–child pairs; N = 22; Age: 18–45, 2.5–5. | Iron; 2/4 mg of 57Fe as FeFum, 2/4 mg of NaFeEDTA (Na58FeEDTA and Na57FeEDTA); 2–4 mg/day (4 times during experiment) | 28 days | Venous blood, FIA, BIS | FIA from NaFeEDTA is 40% higher than from FeFum; combination of both fortificants does not lead to a significant increase in FIA. | [15] Haiti |
1 | Women; N = 46; Age: 18–49; Anemic: Hb < 12 g/dL, Non-anemic: Hb ≥ 12 g/dL; BMI: 20.4–25.4 | Iron; 6 mg of 57Fe as NaFeEDTA, 6 mg (3 mg/3 mg) of 58Fe/56Fe as NaFeEDTA; Tea | 17 days | Venous blood, FIA | Fe from NaFeEDTA increases by 17% in the anemia-free group and 33% in the iron-deficient group; tea consumption reduced iron absorption (>85%) in both groups. NaFeEDTA cannot overcome the inhibition of tea polyphenols. | [16] Morocco |
1 | Mother–child pairs; N = 17; Age: 18–40, 2–6 BMI: 21.7–22.11. | Iron; 2/4 mg of 58FeSO4, 2/4 mg of 57FeFum; Tea | 30 days | Venous blood, FAFe | Fe absorbed from FeSO4 was 8.85% higher than for FeFum in mothers, and 56.36% in children. Tea reduced FAFe by 44–65%. | [17] Senegal |
0 | Women; N = 12; Age: 33–42 BMI: 25.8–30.1 | Iron, Zinc; 58FeSO4, ZnSO4; Tea | 28 days | Venous blood, CI | Fe absorption from the bread fortified with iron was 19.8% (10.5–37.2%); for 30 mg of Zn/kg, it was 18.5% (10.2–33.4%); 17.7% (7.7–38.7%) for 60 mg of Zn/kg; and 11.2% (6.2–20.3%) for 90 mg of Zn/kg. | [18] Chile |
3 | Children; N = 82; Age: 2–5. | Iron, Processed amaranth | 6 months | Venous blood, hemoglobin, serum ferritin, CCR | Hemoglobin concentration in the amaranth group increased significantly from 112.1 to 120.3 compared to the control (106.9–113.2 g/L); anemia prevalence: CCR (CI:95%) decrease from 0.57 to 0.37 in amaranth group (μU/mL). | [19] Ethiopia |
0 | Healthy adults; N= 12; Age: 19.6–27.2 BMI: 19.9–24.7 | Chromium; Cr-enriched yeast 500 μg of Cr/50 g of available carbohydrates | 4 weeks | Venous blood, PG, IR, GR, GI | GR after fortified bread was 101.27 mg/dL and 117.82 mg/dL, compared to control (128.46 mg/dL); GI of enriched breads was 34.22 and 62.35 while the control bread had GI = 100. | [21] Greece |
3 | Type 2 diabetes adults; N= 30; Age: 40–65 BMI: 27.9–31.1 | Chromium; Cr-enriched yeast 99.0 μg of Cr/28 g of bread | 12 weeks | Venous blood, BMI, GR, IR | Reduction in BMI from 29.3 to 28.9; decreased fasting plasma glucose from 143.2 to 129.6 (mg/dL); decrease of the mean glycosylated hemoglobin from 6.9 to 6.3 (%); decrease in fasting insulin from 6.8 to 4.4 (μU/mL). | [22] Greece |
0 | Healthy young adults; Type 2 diabetes adults; N= 10, 10; Age: 23–26, 43–65 BMI: 20–26.57 | Chromium, Magnesium, Selenium; Wheat varieties; Cr: 14.0–15.2 μg/100 g Mg: 32.9–85.6 mg/100 g Se: 1.6–5.5 μg/100 g Buckwheat; Mg: 172 mg/100 g Se: 3.5 μg/100 g | 2 h | Vein blood, GI, PG | Lower GI of Jizi439 by 19.67% and 10.78% (that of the mixture of white wheat and Chu20); the lowest PG in diabetes patients after Jizi439. | [23] China |
3.1.2. Vitamins
Jadad Scale | Participants | Fortificant/Substance/ Dose/Inhibitor | Duration | Methods/Analysis | Results | References/ Country |
---|---|---|---|---|---|---|
4 | Adults N = 45 Age: 18–45 BMI: 18.5–30 | Folic acid; Folate, Calcium L-5-methyltetrahydrofolic acid; 452 mg of L-5-MTHF/roll; 400 mg of folic acid/roll | 16 weeks | Venous blood, Plasma folate, Whole-blood folate concentrations | Increase in mean erythrocyte folate by 60% for L-5-MTHF, and by 44% for folic acid. | [24] Canada |
3 | Adult women N = 41 Age: 20–40 BMI: 19.9–24.5 | Vitamin D2, UV-treated baker’s yeast; 30.2 μg/100 g | 8 weeks | Venous blood sample, Serum 25-hydroxyvitamin D concentrations | Increase in S-25(OH)D2 concentration by 6.4 nmol/L. | [25] Finland |
4 | Adults N = 90 Age: 26–48 BMI: 21.7–31.2 | Vitamin D3, Vitamin premix, 25 μg/50 g | 8 weeks | Venous blood sample, serum 25-hydroxyvitamin D concentrations. | [26] Iran | |
0 | Young adults N = 27 Age: 20–29 BMI: 20–24 | Vitamin C; L-ascorbic acid; 5 ppm, 10 ppm, 15 ppm | 120 min (30, 60, 90, and 120 min) | Venous blood, GR, GI, GL | GR was the lowest for 5 ppm ascorbic acid brad: 85, 98, 101, 93, 92 for 72% flour extract, and 91, 90, 95, 91, 86 for 72% flour extract; lowest GI (83–90% flour extract) in variant fortified with 10 ppm ascorbic acid, lowest GL (42–90% flour extract) in variant fortified with 10 ppm ascorbic acid. | [27] Iraq |
3.1.3. Other Nutritional Compounds
Fiber
Protein
Jadad Scale | Participants | Fortificant/Substance/ Dose/Inhibitor | Duration | Methods/Analysis | Results | References/ Country |
---|---|---|---|---|---|---|
0 | Young adults N = 10 Age: 16–30 BMI: 27.6–36.6 | Fiber; pumpkin powder at 75 g/450 g of flour, corn powder at 20 g/450 g of flour | 3 days | Vein blood, SG, IR, SAS | SG after 120 min: enriched bread at 56.8 L vs. 75.9 mmol*min/L for control bread; MI after 120 min: 20,476 vs. 32,892 mmol*min/L; lower SAS | [28] New Zealand |
2 | Young adults N = 19 Age: 22–24 BMI: 22.2 | Fiber; arabinoxylan oligosaccharides: 8.9 g/portion, 18.4 g/portion; resistant starch: 6.6 g/portion, 15 g/portion | 3 h | Vein blood, GR, IR, ISI | GR decrease from 183.3 mmol min/L to 168.3 to 154.4 mmol min/L at 0–120 min; IR decreased from 0.050 nmol/l to 0.042 and 0.038 nmol/l; ISI increase from 478 to 512 and 551 | [29] Sweden |
5 | Adults N = 35 Age: 17–74 BMI: 18.5–29.99 | Fiber; VERSAFIBE™2470 at 16.5 g/portion | 3 weeks | Vein blood, GR, IR, PS, gastrointestinal tolerance | GR reduced by 43–45%, IR by 35–40%, reduced hunger | [30] USA |
4 | Adults N = 24 Age: 34–61 BMI: 22.1 | Fiber; arabinoxylan at 3.2 g/100 g | 7 days | Vein blood, PPG | PPG reduced by 20% | [31] Italy |
3 | Overweight or obese women with type 2 diabetes N = 48 Age: 25–55 BMI: 25–40 | Protein, whey protein at 20 g/portion | 12 weeks | Vein blood, GS, FGL, IL, LP, BP | FGL elevated from 154.50 to 178.50 mg/dL; IL increased from 22.45 to 44.30 μIU/mL and from 16.30 to 38.30 μIU/mL in experimental and placebo group, respectively | [32] Iran |
3 | Diabetes patients, women N = 30 Age: 30–50 BMI: 29.5 | Protein, soy flour | 8 weeks | Vein blood, metabolic profile (n > 30) | No statistically significant changes | [33] Iran |
3 | Overweight/obese women N = 30 Age: 19–35 BMI: 25–30 | Protein, soy flour | 15 weeks | Vein blood, LP, BP, anthropometric parameters, CVD factors, BMI, weight | Weight reduction by 4.8 kg; BMI reduction by 0.6 | [34] Iran |
3.1.4. Physiological Compounds
Jadad Scale | Participants | Fortificant/Substance/ Dose/Inhibitor | Duration | Methods/Analysis | Results | References/ Country |
---|---|---|---|---|---|---|
3 | Diabetes patients N = 122 Age: 19–50+ BMI: 22.7–38.3 | Phytochemicals/polyphenols; Borassus powder: (wheat flour: BRP; m:m) 2:1; 5:1; 10:1; 20:1 | 3 months | Venous blood, Physical parameters Visceral fat, Metabolic age SBP, DBP, TC | waste reduction from 98.3 ± 14.6 cm to 95.9 ± 15.8 cm; BMI reduction by 3.4; visceral fat reduction from 10.4 ± 3.2 to 9.9 ± 3.0; metabolic age reduced from 61:6 ± 13:4 to 59:3 ± 13:0; SBP reduced from 161.2 ± 25.5 to 137.6 ± 22.9; DBP reduced from 99.2 ± 13.6 to 85.1 ± 10.8; TC reduced from 5.9 to 4.9; LDL reduced from 3.4 to 2.8; HDL reduced from 2.2 to 1.5 | [35] Ghana |
0 | Diabetes patients Women N = 72 Age: 46–51 BMI: 35–37 | Polyphenols; Turmeric powder: 10/100 g Ginger powder: 10/100 g | 8 weeks | Vein blood, Physical parameters (>10), CVD risk factors | BMI reduction from 37 to 36, 35 to 34; BF reduction of 1–1.5%; TG reduction from 139.28 to 118 mg/dL, 135 to 102 mg/dL; TC from 234 to 205, 218 to 183; CVDrf decreased from 5.17 to 3.99, 4.73–3.63 | [36] Egypt |
0 | Healthy adults N = 15 Age: 35–65 BMI: 21–32 | Phenolic acids, Native ray bran: Ferulic acid—134 mg/portion; Sinapic acid—31 mg/portion; 4-Coumaric acid—4.7 mg/portion; Bioprocessed rye bran: Ferulic acid—117 mg/portion; Sinapic acid—28 mg/portion; 4-Coumaric acid—5 mg/portion | 24 h | Vein blood, Urine samples; Postprandial phenolic acid excretions, GR | Bioprocessing of rye bran increased FA absorption by 14% vs. native rye bran | [37] Finland |
5 | Healthy adults N = 36, 39 Age: 18–70 BMI: <40 kg | Phytosterols; Vegapure® 67WDP (BASF): 2.3g/2 slices; Curcumin: 228 mg/2 slices | 4 weeks | Venous blood, TC, LDL, CVD risk | TC decrease of 0.52 mmol/L; LDL decrease of 0.49 mmol/L–124.33 nmol/L; CVD risk decreased from 1.1 to 12.7% | [38] Australia |
1 | Healthy adults N = 13 Age: 20–46 BMI: 19.4–29.7 | Polyphenols; Green tea extract powder: 0.4% of loaf weight in g; Baobab fruit extract powder: 1.88% of loaf weight in g | 6 days | Vein blood, GR, IR, Satiety | No statistically significant changes | [39] Australia |
5 | CVD risk patients N = 30 Age: 18–65 BMI: 23–31 | Neurotransmitters, Enzyme inhibitors, γ-Aminobutyric acid: 22.8 mg/100 g; Angiotensin-converting enzyme inhibitor: 7.23 mg/g (LSBþG) | 112 days | Vein blood, Urine samples, BP, GM, Endothelial function | BP decreased for 2.12 mmHg for LSBþG | [40] Spain |
3.2. Health Benefits of Consumption of Fortified Bread
4. Discussion
5. Strength
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Kaim, U.; Goluch, Z.S. Health Benefits of Bread Fortification: A Systematic Review of Clinical Trials according to the PRISMA Statement. Nutrients 2023, 15, 4459. https://doi.org/10.3390/nu15204459
Kaim U, Goluch ZS. Health Benefits of Bread Fortification: A Systematic Review of Clinical Trials according to the PRISMA Statement. Nutrients. 2023; 15(20):4459. https://doi.org/10.3390/nu15204459
Chicago/Turabian StyleKaim, Urszula, and Zuzanna Sabina Goluch. 2023. "Health Benefits of Bread Fortification: A Systematic Review of Clinical Trials according to the PRISMA Statement" Nutrients 15, no. 20: 4459. https://doi.org/10.3390/nu15204459