- Food fortification does not change the characteristics of the food
- It is not a substitute for good quality diet required for optimal health
- Dietary diversity is the key to address micronutrient malnutrition: Mr Kar
New Delhi: Malnutrition is the primary reason behind 69 per cent of deaths of children below the age of five in India, according to a UNICEF’s The State of the World’s Children 2019 report. The report further states that every second child in India, under five years of age, is affected by some form of malnutrition. According to Mini Varghese, Country Director, Nutrition International, conditions arising from malnutrition can prevent brain development, body growth, immune systems from working effectively, and increases lifelong risk of disease and disability.
The control of micronutrient deficiencies is an essential part of the overall effort to fight hunger and malnutrition. India has been implementing a variety of strategies to address anaemia and micronutrient deficiencies which include iron-folic acid supplementation, vitamin A supplementation, nutrition health education to encourage dietary diversity, and others. However, the anaemia levels continue to be high. This, therefore, requires the introduction of strategies such as food fortification which are evidence based, tried and tested in other parts of the world, explained Bishow Parajuli, Country Director, World Food Programme.
The World Health Organization defines food fortification as the practice of deliberately increasing the content of an essential micronutrient (vitamins and minerals) in food so as to improve the nutritional quality of the food supply and to provide a public health benefit with minimal risk to health.
For example, adding iodine and iron to edible salt. Similarly, other vital micronutrients can be added to staples like rice, wheat flour, oil, and milk. The reason behind choosing staple items is to reach a larger population.
But is food fortification a good way of inculcating micronutrients in one’s diet and address the problem of malnutrition? Experts believe that just as there are two sides to coin, there are two sides to every strategy. In this report, we bring to you both pros and cons of fortified food.
Advantages Of Food Fortification
Does Not Require Behaviour Change
Fortification can make frequently consumed foods or daily staples more nutritious without any change in the dietary habits of the consumers. The demand and consumption of staples like wheat flour, rice, milk, oil, and salt usually remains uninterrupted in every scenario and they are consumed across the population – from low to high income groups. This makes food staples a great vehicle to add micronutrients to improve the nutritional status of the general population, said Ms Varghese.
Provides Nutrition Without Any Change In Characteristics Of Food
Though micronutrients are added, fortification does not cause any change in the taste, aroma, texture, or appearance of the food. For example, for the fortification of rice, Fortified Rice Kernels (FRK) are manufactured by combining rice flour with required nutrients. FRK resemble the sheen, transparency, consistency and flavour of rice. These kernels are simply mixed with ordinary rice.
Maintain Body Stores Of Nutrients
According to the ‘Guidelines on food fortification with micronutrients’ issued by the WHO and Food and Agricultural Organization of the United Nations, if consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittent supplements.
Fortified foods are also better at lowering the risk of the multiple deficiencies that can result from seasonal deficits in the food supply or a poor quality diet. This is an important advantage to growing children who need a sustained supply of micronutrients for growth and development, and to women of fertile age who need to enter periods of pregnancy and lactation with adequate nutrient stores. Fortification can be an excellent way of increasing the content of vitamins in breast milk and thus reducing the need for supplementation in postpartum women and infants, states the guidelines.
The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 per cent of the total food value.
Nutrition International and University of Toronto have developed the Encapsulated Ferrous Fumarate-Double Fortified Salt (EFF-DFS) which has both iron and iodine. According to Ms Varghese, the DFS comes with a minimal incremental cost of Rs. 0.02 per person per day.
Contain Natural Or Near Natural Levels Of Micronutrients
According to the WHO, fortification generally aims to supply micronutrients in amounts that approximate to those provided by a good, well-balanced diet. Consequently, fortified staple foods will contain natural or near natural levels of micronutrients, which may not necessarily be the case with supplements.
Disadvantages Of Food Fortification
Not A Substitute Of Good Nutrition
While fortified foods contain increased amounts of selected micronutrients, they are not a substitute for a good quality diet that supplies adequate amounts of energy, protein, essential fats and other food constituents required for optimal health.
Might Not Benefit Infants And Children
For the first six months of the life, exclusive breastfeeding is recommended. A child will get nutrition only if the lactating mother will be healthy and consumes adequate nutrition. After the six months, complementary feeding is initiated, wherein infants and children consume relatively small amounts of food.
They are less likely to be able to obtain their recommended intakes of all micronutrients from universally fortified staples or condiments alone. Fortified complementary foods may be appropriate for these age groups, recommended WHO.
Fails To Cater To The Poorest Segment of The Population
Poorest segments of the general population have restricted access to fortified foods in the open markets due to low purchasing power and an underdeveloped distribution channel. To address this, Mr Parajuli suggests government food safety nets like public distribution system (PDS) to adopt staple food fortification strategies.
This will help ensure delivery of adequate nutrients to all sections of the population as is being encouraged in India, said Mr Parajuli.
Not A Long Term Solution
Basanta Kumar Kar recipient of the Global Nutrition Leadership Award believes that food fortification is a short and medium term measure. For long term sustainability, dietary diversity is the key to address micronutrient malnutrition.
In its guidelines, FSSAI (Food Safety and Standards Authority of India) has also titled food fortification as a ‘complementary strategy’ rather than a ‘replacement of balanced, diversified diets’ to address malnutrition. As explained by FSSAI, fortification only bridges the gap between the need and actual consumption of required micronutrients through food.
Can Have Detrimental Effects
‘Excess of anything is bad’. The old proverb is a guide for doing anything in moderation. According to Mr Kar, fortified foods as a public health measure should be promoted after analysing the efficacies and micronutrient status of the population. Excess dosages of vitamins and minerals in some cases can have harmful effects.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.