Food fortification in aged care and in community-dwelling older adults: A review of strategies and issues

Miss Danielle Cave1, Dr Karen Abbey1, Prof Sandra Capra1

1School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University Of Queensland, St Lucia, Australia

Fortification is the addition of ingredients to foods or beverages, to make them more energy and nutrient-dense, without increasing the portion size. This food-first approach is commonly used as a nutrition support strategy in aged care homes, for residents who are malnourished or at risk of malnutrition. The aim of this study was to determine the scope and strength of published works exploring relationships between food fortification strategies, mode of delivery and sustainability in aged care and community-dwelling older adults. A narrative review was conducted. Literature from PubMed, Embase, CINAHL, Scopus and relevant grey literature was searched. All dates and study designs were included. Joanna Briggs Institute methodology was used to assess the quality of studies. Of 3152 records screened, twenty-two studies were included. Five studies were rated moderate and 17 studies were rated high quality. The majority of studies used pre-made food fortification, rather than fortifying foods on-site. Additionally, the majority of studies fortified foods with either micronutrients or macronutrients, not both. There was heterogeneity across studies, including the mode of delivery and ingredients used for food fortification. No studies identified strategies to embed food fortification within the foodservice system, or identified staffing needs or concerns and only 2 studies measured any aspect of the costs associated with food fortification. The literature is silent on comprehensive costs. No clear sustainable strategies for implementing food fortification in these settings could be identified. We expect that costs are of importance in the aged care sector and future research should include intervention costs of food fortification, as well as other strategies to support embedding food fortification within the foodservice system. Malnutrition is a critical issue in aged care and is the business of all staff. Research is required to provide further insight into the acceptability and sustainability of food fortification interventions.


Danielle Cave is a Dietitian and PhD Candidate at The University of Queensland, under the supervision of Professor Sandra Capra and Dr Karen Abbey. She has previously worked as a Dietitian for Encara, providing services to aged care homes across South-East Queensland. Danielle holds a Master of Dietetics Studies from the University of Queensland and Bachelor of Nutrition Science from Queensland University of Technology.

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