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Opinion: Fighting Hidden Hunger, Deficiency In Micronutrients With Food Fortification

Prime Minister Narendra Modi recently announced the fortification of rice provided under all government schemes by 2024. But can it help address micronutrient deficiency in any way?

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Opinion: Fighting Hidden Hunger, Deficiency In Micronutrients With Food Fortification

“Be it rice available at ration shop, rice available in mid-day meal, rice available through every scheme will be fortified by the year 2024”, said Prime Minister Narendra Modi while addressing the nation from the Red Fort in New Delhi on the occasion of India’s 75th Independence Day. The announcement by the PM is significant for the nation and futuristic approach as the government distributes over 300 lakh tonnes of rice under various schemes covered under the National Food Security Act, 2013 (NFSA). The Centre has allocated 328 lakh tonnes of rice for TPDS (Targeted Public Distribution System), MDM (Mid-day Meal) and ICDS (Integrated Child Development Services) under NFSA during 2021-22.

The fortification of rice will help address micronutrient deficiencies or ‘hidden hunger’ which leads to undernutrition, a form of malnutrition. But before we dwell on the pros of the said announcement, if implemented well, let’s understand what fortification is and why is it needed to tackle malnutrition in India.

Also Read: All About Food Fortification And How It Can Make India A Healthy Country

The Burden Of Malnutrition In India

India’s greatest national treasure is its children; however, child malnutrition remains a major threat to the survival, growth and development of children. In India, it has taken the magnitude of a silent emergency. India has ranked 94th out of the 107 assessed countries on the 2020 Global Hunger Index (GHI), with a level of hunger that is categorised as ‘serious’ with an overall score of 27.2. It further says that the prevalence of wasting among children under 5 in India is ‘very high’. GHI states that India, with 17.3 per cent, has the most wasted (low weight for their height) children out of the nations assessed.

India is also home to 14 per cent of undernourished children under the age of 5 and 34.7 per cent stunted children in the same age. India’s neighbouring countries, Pakistan, Nepal and Bangladesh have secured a better rank than India. While Nepal’s ranked 73, Bangladesh and Pakistan are ranked 75 and 88 respectively.

Also Read: COVID-19 Has Caused One Of The Biggest Increases In World Hunger, Malnutrition In Decades: United Nations

Hidden Hunger, One Of The Causes Of Malnutrition

Micronutrient deficiencies or hidden hunger and the negative consequences of a diet lacking in essential vitamins and minerals or trace elements continue to pose significant public health problems in Indian populations. This hidden hunger is more prevalent in vulnerable populations, including women of reproductive age and young children and adolescents.

Interest in micronutrient malnutrition has increased greatly over the last few years. One of the main reasons for the increased interest is the realisation that micronutrient malnutrition contributes substantially to the global burden of the disease. The public health implications of micronutrient malnutrition are potentially huge, and are especially significant when it comes to designing strategies for prevention and control.

Also Read: Poshan Maah 2021: Can India Become Malnutrition Free? Nutrition Expert Dipa Sinha Answers FAQs on Nutrition

These can be addressed through a combination of interventions that include, dietary diversification, supplementation targeted to those with or at high risk of deficiency and food fortification. These three strategies are complementary to each other and in most situations, more than one strategy is required.

The best way of preventing micronutrient malnutrition is to ensure the consumption of a balanced diet that is adequate for every nutrient. Unfortunately, given the financial reach of people, this is far from being achievable everywhere since it requires universal access to adequate food and appropriate dietary habits.

Also Read: Expert Blog: Nourishing The Tribal Food Systems

Going Back In Time, Decoding Food Fortification

Food fortification is the process of adding vital micronutrients – vitamins and minerals – in staple food items – milk, edible oil, rice, flour and salt – without changing its taste, aroma or texture. Fortification is not a novel concept that India has picked up. In fact, fortification has been used for more than 80 years in industrialised countries as a means of restoring micronutrients lost during food processing. It has aided in eliminating deficiency-related diseases in high-income countries. Even India has been promoting fortified food since the 50s; fortification of Vanaspati was mandated in 1953 and iodization of salt was mandated in 1962. The mandatory ‘Universal Salt Iodization’ has addressed the major public health challenge of iodine deficiency disorders especially goiter in the country.

However, the success of fortified food in low-and-middle-income countries is somewhat limited due to barriers such as lack of political will, which often leads to under-prioritisation by governments; the food fortification industry’s lack of capacity and resources; ineffective and weak regulation and enforcement; limited consumer understanding of the benefits of consuming fortified foods. We are fortunate that there is political commitment to food fortification in our country and legislation exists to support it, there is effective implementation and monitoring also.

Also Read: POSHAN Maah 2021: Three Different Ways Of Food Fortification Explained

Weighing The Pros And Cons Of The Much Appreciated Concept

Food fortification is one of the simplest and most sustainable public health strategies to address the challenge of micronutrient deficiencies. It has the dual advantage of being able to deliver nutrients to large segments of the population without requiring radical changes in food consumption patterns. Not only is it a cost-effective, scientifically proven, and globally recognised complementary approach, but also makes it facile to reach wider, vulnerable populations through existing food delivery systems.

While we count on the benefits of introducing fortified food, we need to remember that food fortification alone cannot correct micronutrient deficiencies when large numbers of the targeted population, either because of poverty or locality, have little or no access to the fortified food, when the level of micronutrient deficiency is too severe, or when the concurrent presence of infections increases the metabolic demand for micronutrients.

Also Read: Pros And Cons Of Food Fortification, An Effective Way To Address Micronutrient Deficiency

It is also seen that various safety, technological and cost considerations can also place constraints on food fortification interventions. Thus, proper food fortification programme planning not only requires assessment of its potential impact on the nutritional status of the population but, also of its feasibility in a given context.

How Fortification Of Rice Can Help Address Malnutrition

According to the Food Safety and Standards Authority of India (FSSAI), rice fortified with the fortificant mix by dusting; or coated or extruded fortified kernels mixed with non-fortified rice in a ratio varying between 0.5 per cent to 2 per cent is fortified rice.

In extrusion technology, milled rice is pulverized and mixed with a premix containing vitamins and minerals. Fortified rice kernels (FRK) are produced from this mixture using an extruder machine. The kernels resemble rice grains. FRK is added to non-fortified rice in ratio ranging from 1:50 to 1: 200 (ideal being 1:100) resulting in fortified rice nearly identical to traditional rice in aroma, taste, and texture. It is then distributed for regular consumption, states FSSAI.

As per FSSAI norms, 1 kg of fortified rice will contain iron (28 mg-42.5 mg), folic acid (75-125 microgram) and Vitamin B-12 (0.75-1.25 microgram). In addition, rice may also be fortified with micronutrients, singly or in combination, with zinc (10 mg-15 mg), Vitamin A (500-750 microgram RE), Vitamin B1 (1 mg-1.5 mg), Vitamin B2 (1.25 mg-1.75 mg), Vitamin B3 (12.5 mg-20 mg) and Vitamin B6 (1.5 mg-2.5 mg) per kg.

Also Read: Can India Piggy Bank On Food Fortification To Achieve The Goal Of POSHAN Abhiyaan?

Rice has the highest uptake in government food safety net programmes such as the Public Distribution System (PDS), Mid-day Meal Scheme (MDM), Integrated Child Development Services (ICDS), among others. It has the potential to reach more than a million people, especially women and children making rice an ideal vehicle for fortification. It reaches the most vulnerable and poorer section with the highest uptake in the government safety net programmes.

Rice fortification may be considered as having the highest potential to fill the gap in current staple food fortification programs as 65 percent of the Indian population consumes rice on a daily basis.

Conclusion

The success of a fortification programme can be measured through its public health impact and sustainability. The latter implies an inter-sectoral approach where, in addition to competent public health authorities, research, trade, law, education, non-governmental organizations and the private sector are all involved in the planning and implementation of the programme. Food fortification can also be achieved by harnessing the expertise of the private sector to produce and distribute fortified foods.

In our country where a change in lifestyle is the need of the hour, food fortification is playing an important role in pushing boundaries, by providing more for less. The process is slowly but steadily changing food habits and is helping a nation widely devoid of nutritional food to tackle the micronutrient deficiencies for individuals and families.

Also Read: Opinion: Public Health Nutrition Priorities- Disrupted But Not Defeated By COVID-19

Dr Sujeet Ranjan

Dr Sujeet Ranjan is a Public Health Nutrition Expert. Dr Ranjan has been associated with the Public Health Nutrition sector for more than two decades. He is the former Executive Director at The Coalition for Food and Nutrition Security (CFNS). He holds a Doctorate degree in Public Health and is a Visionary Leadership (VLP) fellow in Population & Development by International Council on Management of Population Programmes (ICOM), Malaysia.

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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World

22,95,44,435Cases
19,20,52,504Active
3,27,83,741Recovered
47,08,190Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 22,95,44,435 and 47,08,190 have died; 19,20,52,504 are active cases and 3,27,83,741 have recovered as on September 22, 2021 at 3:49 am.

India

3,35,31,498 26,964Cases
3,01,9897,586Active
3,27,83,741 34,167Recovered
4,45,768 383Deaths
In India, there are 3,35,31,498 confirmed cases including 4,45,768 deaths. The number of active cases is 3,01,989 and 3,27,83,741 have recovered as on September 22, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,27,629 3,131

44,269 960

63,44,744 4,021

1,38,616 70

Kerala

45,39,926 15,768

1,61,765 5,813

43,54,264 21,367

23,897 214

Karnataka

29,69,361 818

13,769 617

29,17,944 1,414

37,648 21

Tamil Nadu

26,48,688 1,647

16,993 9

25,96,316 1,619

35,379 19

Andhra Pradesh

20,40,708 1,179

13,905 483

20,12,714 1,651

14,089 11

Uttar Pradesh

17,09,693 13

194 0

16,86,612 13

22,887

West Bengal

15,62,710 537

7,741 69

15,36,291 592

18,678 14

Delhi

14,38,556 39

400 21

14,13,071 18

25,085

Odisha

10,21,216 462

4,844 103

10,08,226 560

8,146 5

Chhattisgarh

10,05,120 26

297 0

9,91,260 26

13,563

Rajasthan

9,54,275 12

99 8

9,45,222 4

8,954

Gujarat

8,25,751 14

133 0

8,15,536 14

10,082

Madhya Pradesh

7,92,410 8

90 6

7,81,803 14

10,517

Haryana

7,70,754 8

328 12

7,60,618 20

9,808

Bihar

7,25,907 6

60 9

7,16,188 15

9,659

Telangana

6,63,906 244

4,938 53

6,55,061 296

3,907 1

Punjab

6,01,359 36

304 3

5,84,554 37

16,501 2

Assam

5,98,864 441

5,081 97

5,87,970 338

5,813 6

Jharkhand

3,48,139 14

65 10

3,42,941 4

5,133

Uttarakhand

3,43,405 12

249 18

3,35,765 29

7,391 1

Jammu And Kashmir

3,28,214 145

1,450 11

3,22,345 154

4,419 2

Himachal Pradesh

2,17,403 263

1,715 99

2,12,033 162

3,655 2

Goa

1,75,690 107

886 76

1,71,507 29

3,297 2

Puducherry

1,25,618 101

922 55

1,22,864 46

1,832

Manipur

1,18,870 197

2,174 9

1,14,861 203

1,835 3

Tripura

83,956 51

353 7

82,794 44

809

Mizoram

82,815 1,355

15,363 223

67,184 1,127

268 5

Meghalaya

79,817 150

1,878 18

76,558 167

1,381 1

Chandigarh

65,195 7

44 3

64,333 4

818

Arunachal Pradesh

54,190 64

413 3

53,504 60

273 1

Sikkim

31,014 43

627 27

30,007 70

380

Nagaland

30,959 52

470 3

29,832 46

657 3

Ladakh

20,743 6

144 6

20,392

207

Dadra And Nagar Haveli

10,670

0 0

10,666

4

Lakshadweep

10,360 1

9 1

10,300

51

Andaman And Nicobar Islands

7,607 7

17 4

7,461 3

129

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