El Khoury et al. demonstrated the influence of bread fortification with potassium (K), magnesium (Mg), and phosphorus (P) on human health outcomes. Volunteers were given white pita bread (control) and pita bread fortified with different mineral doses. After 12 h of fasting, volunteers’ blood samples were taken, and they were given 90 g of the tested pita bread (containing 50 g of carbohydrates, and P, K, and Mg, respectively, at 11.6; 12.2; and 2.7 g/kg) with 200 cm³ of water. Vein blood samples were collected at 15, 30, 45, 60, 90, and 120 min after meal consumption. Tests with each bread variant were conducted 10 days apart. Glucose, insulin, triacylglycerols, and total P, Mg, and K were determined in the obtained blood serum. Baseline levels of glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), TG, and fasting serum total P, K, and Mg were within normal ranges and were found to be similar between the different experimental sessions for each type of bread. However, it was found that enrichment of white wheat flour with macronutrients (P, Mg, and K) had an effect on lowering postprandial glucose and TG concentrations. The study suggests that fortification of prefilled bread with P, K, and Mg may be a way to improve glycemic response [14].

Direct fortification of bread and bakery products with iron (Fe) was presented in three of the included trials [15,16,17,18], one in compilation with zinc [17] and one as undirect fortification with the use of Fe-rich raw material [19]. Fe is the most challenging food fortificant, providing optimal bioabsorption because water-soluble Fe compounds often cause unacceptable color and flavor changes in the food matrix. Moreover, insoluble compounds like elemental Fe powders do not provide sensory changes but are generally characterized by low bioabsorption. Selecting a suitable Fe compound is only a part of the problem. The other difficulty is the presence of its inhibitors in natural food products, such as phytic acid, present in cereal/pseudocereal grains and vegetable seeds or polyphenols in beverages often consumed with meals. The presence of inhibitors can decrease Fe absorption even in its most bioavailable forms [20].

The validity of the first boundary was assessed using the fortification level proposed to be mediatorial in Herter-Aeberli et al.’s trial. The prevalence of anemia is high in Haiti, with 62% of children and 37% of women of a reproductive age. Twenty-two healthy mother–child pairs of preschool age in Haiti received stable Fe isotopes such as FeFum or NaFeEDT in wheat flour bread rolls consumed by all participants in a randomized cross-over design. FeFum + NaFeEDTA was administered in the final identical meal, eaten only by the women. Fe absorption was measured by incorporating stable isotopes into erythrocytes 14 days after each meal, and Fe status, inflammatory markers, and Helicobacter pylori infection were determined. In tested groups, fractional Fe absorption (FIA) was considerably higher in meals fortified with NaFeEDTA compared to FeFum. However, FIA from a combination of both additives was not significantly different from the bread with NaFeEDTA. At the same time, the total amount of absorbed Fe was substantially higher for preschoolers when NaFeEDTA was added. All participants were with 40% better absorbed NaFeEDTA compared to FeFum. In considerations, authors suggested optimal amounts of the fortificant in an assumption of a daily intake of 120 g of wheat flour in adults, that the level of fortification should be 30 mg of Fe/kg of flour, and the predicted amount of absorbed Fe would be 0.47 mg/d from NaFeEDTA and 0.33 mg/d from FeFum. Thus, 120 g of such fortified bread would cover 33% of the daily intake of Fe using NaFeEDTA and 24% using FeFum as a fortificant. The authors noted that in Haiti, where the high costs of NaFeEDTA may not be affordable, using FeFum at 60 mg Fe/kg flour may be a preferable, cost-effective fortification strategy [15].

Three studies in these reports corroborate that a potential Fe inhibitor commonly consumed with a meal containing high polyphenol fractions can reduce its absorption [16,17,18]. Results of FIA achieved with assessment of blood samples to measure the incorporation of Fe isotopes in erythrocytes show that iron from NaFeEDTA increases by 17% in the anemia-free group (9.2–24.2%) and 33% in the iron-deficient group (24.2–39.8%) after consumption of bread made from wheat flour fortified with NaFeEDTA. However, rich-in-polyphenol-inhibitors tea consumed within fortified bread drastically reduces FIA (by 85%), showing that NaFeEDTA used as an Fe fortifier cannot overcome the inhibition of tea polyphenols on iron absorption, even in the anemia group, where iron absorption is strongly increased. These results may be valuable for a national Fe fortification strategy [16].

In Ndiaye et al.’s trial, Senegalese mother–child pairs were randomly assigned to receive, in a 2 × 2 factorial design, bread fortified with ⁵⁸FeSO₄ or ⁵⁷FeFum consumed with water or herbal tea of Combretum micranthum (Tisane Kinkéliba, TK). The mean fractional iron absorption (FAFe/FIA) was assessed by measuring erythrocyte incorporation of stable iron isotopes 14 days after administration. In the results, FAFe from both breads was comparable, but the mean FAFe from fortified-with-FeSO₄ bread was higher than for FeFum in children but not mothers. Introducing polyphenol-rich herbal tea additives into tested meals reduced FAFe in mothers by 55.7% and 50.1% from FeSO₄ and FeFum, respectively, and similar observations were made in children. FAFe decreased by 65.3% from bread fortified with ⁵⁸FeSO₄ and 72.4% (both p < 0.0001) in meals with ⁵⁷FeFum, consuming with a polyphenol inhibitor. Moreover, these results showed that Fe absorption from FeFum is significantly lower than FeSO₄ in children but not adults [17].

The evaluation of the effect of Fe absorption in the presence of zinc (Zn) and tea was described in Olivares et al.’s trial. In the study, French-type wheat buns enriched with FeSO₄ were offered to female participants in approx. 100 g portions consumed with 200 cm³ of black tea. On 4 different days and after an overnight fast, the participants were given buns enriched with Fe alone or co-fortified with varying levels of ZnSO₄ from 30 mg/kg to 90 mg/kg. Radioisotopes with high specific activity (⁵⁹Fe and ⁵⁵Fe) measured by incorporating radioactive iron into erythrocytes were used as markers of iron absorption. The results indicate that the two variants of fortification with zinc levels of 30 and 60 mg/kg did not inhibit Fe absorption. However, Fe absorption significantly decreased at a Zn presence (≥60 mg/kg) when bread was consumed with black tea [18].

In one of the clinical trials, bread was fortified in Fe by using its natural source of a plant origin to determine the possibility of its use in preventing anemia in children. Two-to-five-year-old children without chronic illnesses and with hemoglobin levels from 70 to <110 g/L were included in the study. The intervention and the control group received 150 g of bread daily for 6 months. The intervention–amaranth group was supplied with bread containing 70% amaranth grain and 30% mass of mashed chickpea. The control–maize group was provided with the same portion of bread containing 100% maize. Amaranth grains were processed to reduce phytate availability. At the baseline, 29% of children were diagnosed with anemia, and 71% were mildly anemic. Children with moderate anemia were 38% in the interventional group and 20% in the control group. Fe deficiency constituted 30% of the total anemia cases and was distributed as 35% in the amaranth group and 24% in the maize group. Seven-day food frequency recall shows that 59% of children had not consumed Fe-rich food at least once for 6 consecutive months. There were no significant differences between groups on Fe-rich food consumption. After 6 months, anemia prevalence decreased by 44% compared to 100% at baseline. Children consuming bread enriched with processed amaranth grains showed a 61% reduced risk of anemia and had significantly higher hemoglobin concentrations than the control group [19].

The impact of consuming bread fortified with chromium (Cr)-enriched yeasts on health benefits was analyzed in two included studies. One study was conducted in general healthy young adults [21] and the other in patients with type 2 diabetes [22].

In the first included study, generally, healthy participants were provided with white bread (WB, reference food), whole wheat bread with Cr-enriched yeast (WWCrB, rich in insoluble fiber), white wheat bread with Cr-enriched yeast (WCrB, poor in fiber), or whole-wheat–rye–barley bread enriched with oat beta glucans (BGB, rich in soluble fiber) with 1-week intervals. Of the assayed bread variants, each furnished 50 g of readily available carbohydrates. Blood samples for tests were taken before meals compounded with 100 to 166 g of fortified bread and 250 cm³ of water. Subsequent blood samples were taken at 15, 30, 45, 60, 90, 120, and 180 min postprandially. In the results, the glucose response after 180 min of consumption of fortified bread showed significantly lower values, by 8–21% compared to the control, depending on bread variant. The results indicate that consumption of Cr-enriched whole grain bread caused a milder glycemic response and resulted in a significantly lower glycemic index (GI) value than the control bread. The enriched bread had GI values of 38–66% lower than the control. The white wheat bread supplemented with Cr-enriched yeast exhibited the most favorable outcomes regarding postprandial glucose response. Those differences between the bread variants are related fiber content, which may inhibit Cr absorption [21].

The second clinical trial concerning Cr fortification included diabetes participants with a fasting glucose level (FPG) > 125 mg/dL and glycosylated hemoglobin (HBA1c) < 8.5% for 3 months before the study. Disease-related biochemical parameters, inflammatory markers, body weight, and energy balance were studied. After dietary education, groups of participants were given whole wheat bread with Cr-enriched yeast or a placebo in the same daily amount of 112 g of slices of bread. At the end of the experiment, the group consuming fortified bread had lower body weight and lower BMI and decreased FPG, fasting insulin levels, and mean HbA1c. Moreover, the concentration of total Cr in the blood remained within optimal values with a median of 2.1 μg/L, comparable with the values shown in the control group. The study’s results indicate that including Cr-enriched bread in the daily diet of patients with type 2 diabetes can improve glucose tolerance and insulin resistance. Furthermore, it results in a significant reduction in body weight and a significant reduction in systolic blood pressure. No differences were found in oxidative stress and inflammation-related parameters [22].

A study aimed to evaluate the effectiveness of folic acid fortification of wheat rolls and was the first study to use microencapsulated calcium L-5-methyltetrahydrofolic acid as a food fortifier, which should not mask a B₁₂ deficiency and may be safer than folic acid. Its influence and an equivalent of folic acid on blood folate levels in study participants was detected. The results were compared to wheat rolls without folate. Both sexes of participants were assigned to three groups and received a wheat roll containing L-5-MTHF, folic acid, or a placebo. After an overnight fast, participants’ blood samples were taken at weeks 8 and 16. In the results, the mean erythrocyte folate was significantly higher in subjects who consumed fortified bread compared to baseline results. The plasma folate was approx. 23 nmol/L higher in the L-5-MTHF and folic acid wheat roll groups than in the placebo group. However, there were no significant differences in blood folate levels between the groups consuming the fortified bread. Results showed that fortified-with-microencapsulated-L-5-MTHF wheat rolls increased erythrocyte and plasma folate concentrations relative to a placebo bread in a healthy population [24].

Investigation of potential benefits related to the consumption of bread fortified with D₂-fortified yeast to prevent vitamin deficiency was conducted in endogenous subjects in late winter/early spring when UVB sunlight was insufficient. Female participants were divided into four study groups and received regular wheat bread with a placebo pill, a daily D₂ supplement, a D₃ supplement, or D₂-biofortified wheat bread with a placebo pill. The average daily serving of bread weighed 87 g. The average increase in the D₂ supplement group was 9.6 nmol/L (+14.7%); for the D3 supplement group, it was 17.0 nmol/L (+26.2%). D₂-enriched bread groups showed a modest increase in the total S-25(OH)D, while it remained stable regarding the placebo. The study found that the D₂ form used to fortify the bread did not have good bioavailability to humans, probably due to conditions during the baking process or its potentially indigestible form [25].

A study by Nikooyeh et al. detected the bioavailability of vitamin D from fortified bread and the effects of its daily consumption on health aspects. A premix containing 100,000 IU/g of flour with vitamin D₃ was added to the Lavash bread formulation to provide a dose comparable to a 1000-IU vitamin D supplement. Both sexes of participants were assigned into three groups consuming 50 g of bread fortified with 25 g of vitamin D₃ and a placebo supplement daily; another group consumed plain bread and 25 g of a vitamin D₃ supplement; the control group consumed plain bread and a placebo pill. After 8 weeks of intervention, the within-group change in serum 25(OH)D concentrations was significantly higher in the enriched-bread-eating group than in the supplement group and placebo group. Results indicated that vitamin-D-fortified bread could effectively raise the population’s circulating 5-hydroxyvitamin D levels to nearly optimal. There were no significant differences in laboratory and anthropometric parameters between the study groups [26].

The effect of L-ascorbic acid addition to Iraqi flatbread on the blood glucose response and glycemic index was detected by Thannoun and Al-Arajy. The study was conducted with generally healthy young adults divided into three groups who received two types of fortified wheat bread (72% or 90% flour extract) with different concentrations of ascorbic acid. Blood glucose response was determined at 0, 30, 60, 90, and 120 min after the meal. Bread fortification with ascorbic acid resulted in a reduction in the glycemic index and glycemic load. These findings were more significant in bread made from flour with 90% extraction than 72%, probably due to the higher amount of dietary fiber. The glucose response was the weakest after eating bread enriched with 5 ppm ascorbic acid, made from the 72% flour extract. However, the glycemic index and load have the lowest values in the bread made with the 90% flour extract in the variant fortified with 10 ppm ascorbic acid and were lower than in whole grain bread. The study shows that the analyzed parameters are more influenced by the degree of flour milling than by the amount of fortificant added, as the results of the measured parameters did not differ significantly [27].

The influence of fiber fortification of bread with vegetable powder on serum glucose levels, insulin response, and subjective appetite suppression was investigated by Amoah et al. The bread was fortified with pumpkin and sweet corn powder. Participants were tested three times after an overnight fast and consumed 75 g of vegetable-enriched bread, with pumpkin powder or sweet corn powder, or white control bread. The vegetable-enriched bread was formulated from the following ingredients: strong white wheat flour, wholemeal wheat flour, whole flaxseed, sprouted wheat flour, pumpkin flour, sweet corn flour, fresh yeast, and salt (descending order by weight). Participants assessed their subjective sensations of hunger, fullness, satisfaction, and desire to eat using a Likert scale. Venous blood samples were taken at 0, 15, 30, 45, 60, 90, and 120 min after bread consumption and were analyzed for glucose and insulin levels. After 120 min of consumption, serum glucose levels were 19.1 mmol*min/L lower for enriched bread compared to the control. Moreover, the mean AUC of insulin for the fortified bread was significantly lower, with a difference of 12.415 pmol/L*min. In addition, consuming enriched bread was associated with greater feelings of fullness in participants over 120 min due to the presence of hydrophilic fiber pectin, cellulose, and β-glucan; flaxseed and whole grain flour suppressed postprandial appetite and improved the glycemic response; and sprouted wheat lowered the glycemic index [28].

Boll et al.’s trial investigated the metabolic benefits of adding probiotic arabinoxylan oligosaccharides and resistant starch to white wheat bread on overnight glucose tolerance, intestinal fermentation, and changes in gut-derived hormones. The study involved healthy young adults consuming three test products or control bread in equal carbohydrate portions of 50 g of available starch. Breads were consumed late at night with 250–300 cm³ of water. The fortification was carried out using a wheat bran extract rich in arabinoxylan oligosaccharides, resistant corn starch, or a combination of both. The amount of additives in the bread recipe was 120 g of starch (Hi-Maize™ 260) and 90 g of the wheat bran extract (Brana Vita™ 200) or 165 g of the same wheat bran extract or 270 g of high-amylose corn starch in the mixed bread. On four occasions, fasting blood samples were collected to measure blood glucose, serum insulin, plasma GLP-1, H2 respiration, and subjective appetite sensation that were monitored before breakfast and at 15, 30, 45, 60, 90, 120, and 180 min afterwards. The overall postprandial fasting glucose response was not statistically different for the bread variants. However, a significant dose-dependent decrease in glucose response was observed with increased wheat bran extract content for fortified breads. A similar observation was made for fasting insulin. With a higher dose of the wheat bran extract, insulin levels decreased in fortified breads. The amount of high-resistivity corn starch did not cause significant decreases. In addition, the insulin sensitivity index improved with a similar trend after consuming bread enriched with the compilation of additives [29].

Stewart et al. aimed to assess postprandial glucose, insulin responses, postprandial satiety, and gastrointestinal tolerance after consuming wheat scones with high dietary fiber content and resistant starch (RS). The bread was fortified with VERSAFIBE™2470 resistance starch containing 70% dietary fiber from high-amylose corn starch. Healthy subjects with fasting blood glucose above 5.55 mmol/L participated in three trials, and baseline satiety was assessed 30 min before consuming the bread with 240 cm³ of water and 15 min after the first blood sample was taken, followed by 180 min to measure blood glucose and insulin concentrations. Moreover, respondents completed the Satiety Visual Analog Scales (VAS), Gastrointestinal (GI) Tolerability Questionnaire, and palatability questionnaire. The results showed that consuming the fiber-enriched scones significantly reduced postprandial glucose and insulin incremental areas under the curves (43–45% reduction and 35–40% reduction, respectively) and postprandial glucose and insulin maximum concentrations (8–10% and 22% reduction, respectively). The fiber scone significantly reduced hunger and desire to eat during the 180 min following consumption. In addition, no gastrointestinal side effects were observed [30].

Investigating the effect of adding whey protein to bread in overweight or obese women with type 2 diabetes on the glycemic status, lipid profile, and blood pressure was the aim of a 12-week study by Nouri et al. In the trial, patients were assigned to a group consuming bread fortified with 20 g of a whey protein concentrate or to a placebo group. At baseline, parameters such as glucose, serum insulin, lipid profile, blood pressure, glycosylated hemoglobin HBA1C, physical activity, and dietary intake were determined. Insulin resistance was determined by evaluating the homeostatic model for insulin resistance HOMA-IR. In the results, except for the HbA1C value, which was higher in the experimental group, there were no significant differences in glycemic parameters. In addition, fasting glucose levels were significantly elevated in the experimental group. Insulin levels in both groups also increased. However, no significant differences were observed between the groups in the participants’ lipid profiles and blood pressure [32].

The study conducted by Moghaddam et al. aimed to assess the impact of bread fortified with soybean flour on the metabolic profile of women with type 2 diabetes. Initially, a 2-week run-in period was implemented, followed by random assignment of participants to either the intervention or control group. During the intervention phase, participants in the intervention group were instructed to replace an equivalent portion (120 g) of their regular bread or cereal intake with soybean-flour-fortified bread for 6 weeks. After a 4-week washout, the participants crossed to the alternative regimen for another 6 weeks. The study results revealed no statistically significant effects of soybean-flour-fortified bread on the metabolic profile of participants. While specific metabolic parameters, such as serum triglycerides, serum low-density lipoprotein cholesterol, insulin, and homeostatic model assessment of insulin resistance, decreased after 6 weeks, these changes did not reach statistical significance. Additionally, no significant alterations were observed in anthropometric indices, blood pressure, fasting blood sugar, glycated hemoglobin, high-density lipoproteins, and total cholesterol levels after consuming soybean-flour-fortified bread [33].

The study of Apprey et al. aimed to assess the impact of Borassus aethiopum-fortified bread on metabolic risk factors in outpatients with CVD. Borassus fruit pulp contains phytochemicals, including flavonoids, alkaloids, triterpenes, steroids and sterols (cardiac glycosides), saponins, and phenols, as well as substantial antioxidant levels. The 122 patients with CVD were given either Borassus-fortified bread (150 g) or an indistinguishable placebo (150 g of white flour bread) daily for 90 days. Body composition, blood pressure, and biochemical parameters were measured before and after the intervention. Following the intervention, there was a significant reduction in mean waist circumference, BMI, and visceral fat. Additionally, systolic blood pressure, diastolic blood pressure, serum total cholesterol (TC), LDL, and HDL levels within the experimental group showed significant reductions regarding both before and after measurements. According to the authors, the potential of Borassus aethiopum in treating cardiovascular and other metabolic diseases should be examined [35].

The influence of soy bread fortified with plant powders, turmeric (5%), and ginger (5%) on metabolic parameters of obese and type 2 diabetes patients was the focus of the Fouad et al. trial. In the first phase of the experiment, one group of participants followed a low-calorie balanced diet (1000–1200 kcal), consuming traditional Syrian bread fortified with soy flour and 5% turmeric powder in two portions per day, and the second group consumed soy bread fortified with 5% ginger powder and followed the exact instructions. Phase 2 lasted for 4 weeks, during which participants continued the low-calorie diet without consuming any food containing soy products. Study results demonstrated that curcumin exhibited more significant hypolipidemic benefits compared to ginger, while ginger showed superior antidiabetic properties compared to curcumin. However, both curcumin and ginger exhibited antiobesity effects. The inclusion of curcumin in bread resulted in a significant reduction in anthropometric parameters such as BMI, mean body weight, waist circumference, WHtR, and WHR and lipid profiles, including a decrease in total cholesterol, non-HDL-C, LDL, and TG, and an increase in HDL levels. On the other hand, ginger, a natural antidiabetic agent, demonstrated a more significant reduction in the change in insulin sensitivity, fasting blood glucose levels, and hemoglobin HbA1c compared to curcumin [36].

Bioprocessing techniques involving enzymes and yeast were employed to release the phenolic acids from the fiber complex. The study involves subjects consuming different types of bread, such as wheat bread fortified with either bioprocessed or native rye bran and whole grain rye bread or wheat bread as a control. Urine samples were collected at various time points (basal state, and 4, 8, and 12 h) over 24 h to measure phenolic acids and their metabolites. Additionally, blood samples were taken six times over 4 h to assess postprandial glucose and insulin responses following bread ingestion. The results showed that bioprocessing of rye bran increased the proportion of free ferulic acid (FA) and soluble arabinoxylan in the bread. Consumption of white wheat bread fortified with bioprocessed rye bran led to a significant increase in the urinary excretion of FA, particularly within the first 4 h. This finding suggests an enhanced absorption of FA from the small intestine due to bioprocessing. However, the bread types had no significant differences in postprandial glucose and insulin responses. Additionally, the bioprocessing of rye bran did not affect the excretion of benzoic, phenylpropionic, and phenylacetic acid metabolites. In conclusion, compared to native rye bran, the bioprocessing of rye bran increased the absorption of ferulic acid from the small intestine in healthy individuals [37].

The influence of the incorporation of polyphenol-rich extracts into wheat bread on the glycemic and insulin responses in healthy individuals was detected in the Coe et al. [39] study. To determine the optimal dosage of different extracts (including baobab fruit extract, green tea extract, grape seed extract, and resveratrol) for reducing rapidly digestible starch in white bread, an in vitro dose–response analysis was conducted. Two extracts demonstrating the highest potential for reducing sugar were selected for a trial involving both sexes of volunteers in a crossover study featuring three different meal conditions. On separate occasions, the participants consumed 250 cm³ of water and control white bread, white bread fortified with the green tea extract in the amount of 104.16 g, bread with a total of 96.33 mg of added polyphenols, and white bread fortified with the baobab fruit extract in the amount of 106.97 g with 61.24 mg of total added polyphenols. The glycemic response, insulin response, and satiety levels were measured 3 h after the meals. Although the enriched bread did not lead to a significant reduction in glycemic response or hunger, the white bread supplemented with the baobab fruit extract exhibited a noteworthy decrease in the total (0–180 min) and segmental insulin area under the curve at 0 to 90, 0 to 120, and 0 to 150 min. However, there was a nonsignificant trend for fortified bread to have a lower peak in detected parameters than control bread and no differences in satiety [39].

Chromium fortification in bread can optimize glucose metabolism and mitigate the risk of insulin resistance and type 2 diabetes. Fortification of bread with Cr-enriched yeast presents a new strategy for managing the glycemic response to bread [21,22]. Natural rich-in-Cr wheat varieties could provide medication and nutritional values, which create a source to prevent diabetes and cardiovascular diseases and enhance immunity [23]. Furthermore, fortification with other minerals such as P, Mg, and K may reduce postprandial glucose and TG levels, which supports the benefit of increasing the consumption of whole grain wheat since it retains most of its mineral content. These findings may significantly ameliorate simple carbohydrates’ detrimental potential effect [14].

Moreover, the addition of vitamin C to 90% extracted flour (wholemeal) can improve GI, GR, and GL in healthy participants. Vitamin C fortification can provide an additional quencher to enhance the natural processes of glucose metabolism and help reduce the rapid release of post-meal glucose [27].

Fortification of bread with vegetable powders and fiber is also associated with a postprandial reduction in postprandial serum glucose and insulin release. Moreover, its consumption increases the feeling of fullness compared with traditional bread [28,31,36]; thus, it can be used in diabetic and obese patient diets. Those results are also achievable by using resistant starch as a fortificant [29] or bioprocessed rye bran [37].

Replacement of traditional bread with bread fortified with polyphenol-rich fruit powder results in improvement in the lipid profile in CVD patients with a significant reduction in SBP, DBP, TC, LDL, and HDL [35,36].

Furthermore, fortification of bread with neurotransmitters and enzyme inhibitors reveals a positive effect on the lipid profile in CVD-risk patients by decreasing BP [40].

Additional protein in bread fortified with soy flour can decrease the BMI index and weight in overweight and obese patients after 15 weeks of replacement of traditional bread [34]. Fortification of bread with polyphenol-rich powder results in reduction in waste, BMI reduction, and visceral and body fat reduction (what can be used in obesity). Its consumption also influences metabolic age by statistically decreasing it [35,36].

Fe fortification of bread effectively addresses Fe deficiency, particularly in populations with inadequate dietary intake of this mineral. Depending on the region, a higher fortification level with the selected fortificant or native raw materials rich in Fe might result in optimal mineral absorption and, therefore, be more cost-effective. However, the strong inhibitory effect of polyphenol-rich beverages commonly consumed with meals reduces the amount of absorbed Fe from the fortified flour. Thus, those drinks should be replaced during meals with beverages with a good source of ascorbic acid to improve the impact of the national iron-fortification program. Because of the above, nutrition education should be conducted to ensure proper nutritional health in countries where tea is often consumed with meals that include products made from refined flour [15,16,17,19].

Regarding health benefits, adequate folic acid intake is paramount in improving cardiovascular health by reducing homocysteine levels and potentially lowering the risk of related diseases [24].

Regarding vitamin D, fortifying bread offers a valuable opportunity to prevent bone-related disorders like rickets in children and osteomalacia in adults [25]. Fortification of staple foods, including bread, with vitamin D becomes an effective strategy to ensure sufficient intake, especially among populations at risk of deficiency [26].

Including protein fortification in health policy initiatives can positively impact public health by addressing protein deficiencies and promoting better nutrition for populations. In the realm of physiological compounds, fortification with polyphenols, phytosterols, phenolic acids, and neurotransmitter precursors presents an opportunity to augment nutritional value and improve health outcomes. Fortifying foods with these bioactive compounds can contribute to nutrient enrichment and elevate the nutritional quality of the food supply, addressing nutrient deficiencies and enhancing public health [41]. Moreover, integrating these compounds into health policies can bolster disease prevention initiatives, targeting specific health conditions and reducing the burden of chronic illnesses [42]. Fortification initiatives can promote healthy dietary habits, encouraging consumers to select foods with supplementary health benefits and fostering balanced diets, thus creating a sustainable health approach.