Food Fortification & Malnutrition

Malnutrition, in the form of undernutrition remains very prevalent in New Zealand, especially in the older population (1). It is a problem that is often under-recognised and under-treated with grave consequences (2).

Malnutrition is described as ‘a state of nutrition in which a deficiency, excess or imbalance of a wide range of nutrients results in measurable adverse effects on body composition, function and clinical outcome.’(2,3).

It can lead to risk of poorer health outcomes such as poor wound healing, an increased risk of pressure injuries and loss of muscle mass which can affect balance and lead to falls and an overall reduced quality of life (2).

There are several indicators of malnutrition, these include decrease in food intake in recent months, significant weight loss, presence of chronic disease or conditions (e.g. dysphagia), low BMI, low muscle tone and any limitations in function and mobility (2,4).

In extreme cases of undernutrition, individuals need to be referred to a nutrition professional, such as a Dietitian, for a more in depth nutritional assessment or seek help from a medical doctor.

Fortunately, in many cases, malnutrition can be treated. Fortifying foods is an effective strategy that nutritionally replenishes the nutrients in an under-nourished individual. As described in the previous blog 'Food Fortification', fortifying foods is the addition of nutrients, such as macro-nutrients (carbohydrate, protein and fat) and/or micro-nutrients (vitamins and minerals) to an everyday food or meal to improve nutritional quality and provide a health benefit (5).

People requiring a fortified diet to treat under-nutrition may be surprised that they are encouraged to have foods [which for many years] they have avoided.

Fortifying foods (a strategy in the ‘High Energy, High Protein Diet’) can be done during the cooking phase or even after meals are prepared.

Here are some tips to get the most out of every mouthful;

  • Add cream, oil, butter or margarine, coconut cream, milk, grated cheese, milk powder, sauces and gravies to food items during cooking or just before service
  • Include full fat dairy products
  • Try liquid nutritional supplements
  • Consume fortified ready made food products found in the supermarket or from commercially prepared options such as The Pure Food Company’s range of fortified meals  

Breakfast Ideas:

  • Fortified cereal and milk
  • Bread/toast/bagel with butter/jam/peanut butter/honey/baked beans or cheese
  • Scone with butter and jam (honey or golden syrup)
  • Coffee or Tea with full cream milk and sugar
  • Scrambled eggs with grated cheese

Lunch and Dinner Ideas:

  • Sandwiches with egg/tuna/salmon/chicken/ham with avocado/cheese/hummus and dressings (e.g. mayonnaise/butter/margarine)
  • Roast chicken with mashed potatoes and gravy
  • Pasta meals with meat, chicken and creamy sauces
  • Takeaway meals such as Fish and Chips ( enjoy these once a week)
  • Roast vegetables with dressing and butter
  • Commercially available foods such as The Pure Food Company’s product range

Snack Ideas:

  • Nutritious drinks – milkshakes, yogurt drinks, fortified soya milk drinks
  • Crackers with cheese
  • Full fat yogurt
  • Cake/slice
  • Ice-cream or custard (choose the full fat options) with stewed fruit or sweet sauces

The main aims of a fortified diet is to build or maintain body weight, increase strength and energy, increase ability to fight infection, increase the ability to participate in rehabilitation and improve overall health.

Good nutrition plays an essential role in your well-being. If you require any guidance around a fortified diet it is best to seek help from a dietitian or a medical doctor to determine the adequacy of the diet to meet your current health needs.  

Kaye Dennison


  1. Wham C. et al. Malnutrition risk of older people across District Health Board community, hospital and residential care settings in New Zealand. Australasian Journal of Ageing 2017 May 25 (Epub ahead of print)
  2. Saunders J, Smith T, Stroud M. Malnutrition and undernutrition. Medicine 2010;39:45-50
  3. British Association for Parenteral and Enteral Nutrition. Introduction to Malnutrition. Available Online:
  4. Kondrup J, Allison SP, Alia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening. Clinical Nutrition 2002;22:415-421
  5. WHO and FAO. Guidelines on Food Fortification with Micronutrients. 2006. Geneva, Switzerland.



Very nice Article, thank you for sharing this information with us.
We do also write article on the same topic do visit-

Maria Woodward

Very interesting and educational topic with great ideas. Thanks

Leave a comment