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Nutrition During Early Life: Findings From Conception and Early Life (Poster Theater Flash Session 6)

(PTFS06-05-25) Impact of Fortified Milk​ on Diet, Nutritional Status, and Functional Outcomes: A Systematic Review

Sunday, June 1, 2025
2:24 PM – 2:28 PM ET
Location: South Hall B (The Hub) - Poster Theater / Poster Board Number PT-6
Emerging Leaders in Nutrition Science Poster Competition

    Presenting Author(s)

  • Selin Sergin, BS (she/her/hers)

    Graduate Student
    Emory University
    Somerset, Kentucky, United States

    Disclosure(s): No relevant financial relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • MR

    Manju Reddy

    Food Fortification Initiative
    Atlanta, Georgia, United States

  • WQ

    Wilhemina Quarpong

    Emory University
    Atlanta, Georgia, United States

  • Helena Pachon, PhD, MPH

    Research Director / Research Professor
    Food Fortification Initiative / Emory University
    Rollins School of Public Health
    Atlanta, Georgia, United States

Objectives: The World Health Organization has fortification guidelines for several food-nutrient combinations such as for salt fortified with iodine. However, there are many food vehicles, like milk, without such guidelines. The objective of this study was to review the impact of micronutrient-fortified cow's milk on dietary intake (D), nutritional status (S), and functional (F) outcomes to facilitate setting priorities for milk fortification.

Methods: A systematic review was conducted by searching in PubMed (Aug 2023), Web of Science (Aug 2023), and Embase (Apr 2024) with no language or date restrictions. Peer-reviewed efficacy, effectiveness, or modeling studies that assessed the effect of cow’s milk fortification on D, S, and F outcomes in any population were included. Study, dose, and outcome information was extracted; outcomes were categorized as positive, no change, or negative to represent changes after milk fortification. Risk of bias was assessed at the study level with Cochrane tools for efficacy and effectiveness studies. Risk of bias for modeling studies will be assessed with a piloted tool. Two independent researchers completed all steps.

Results: The search identified 89 articles including 37 efficacy (41%), 39 effectiveness (44%), and 13 modeling studies (15%). Thirty-five countries, a wide range of ages, and both sexes were included, but pregnant and lactating women and vulnerable groups were underrepresented. A variety of fortification formulations were reported. Overall, 352 unique outcomes were reported 1348 times across studies (positive, 584 (43%); no change, 656 (49%); negative, 108 (8%)). Most D and S outcomes improved, while most F outcomes did not change. Results were consistent across study types, nutrient formulations, fortification compounds, ages, and vulnerabilities. Most efficacy studies had low or some concerns of risk of bias. Most effectiveness studies were at a serious risk of bias, limiting the interpretation of this evidence.

Conclusions: There is consistent evidence that milk fortification improves diet and nutritional status outcomes, but the evidence for functional outcomes is mixed due to the wide variation in reported outcomes that were not necessarily nutrient-specific.

Funding Sources: Bill and Melinda Gates Foundation, Food Fortification Initiative, and Emory University