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With soaring rates of nutrient deficiency worldwide, there is an urgent need to improve the health outcomes of the world’s population through innovative and cost-effective means.

MICRONUTRIENT DEFICIENCY

Micronutrient malnutrition affects high and low to middle income countries alike. Women and children are most vulnerable to this problem, which refers to diseases caused by a dietary deficiency of vitamins or minerals. As the implications of micronutrient deficiency are not always visible, it is termed as ‘hidden hunger’. According to the World Health Organization, more than two billion people in the world suffer from this problem.

Although varied foods are crucial for a balanced diet, this option is not economically viable for many. Hence, we urgently require public health nutritional interventions in the form of food fortification efforts address micronutrient deficiency.

WHAT IS FOOD FORTIFICATION?

Food fortification is the process of purposefully adding micronutrients to processed food. This may be done to restore nutrients lost during food processing or more importantly, supplement the food product with essential micronutrients. This is meant to improve the nutritional status of targeted populations. It can significantly impact malnutrition rates by helping prevent vitamin and mineral deficiencies.

Food fortification has been identified as one of the top four methods for reducing micronutrient malnutrition globally. As a technique, food fortification was first implemented in the 1920’s when Switzerland began iodising salt. This led to a significant decline in goitre rates in the country by 1922. Currently, food fortification has gained momentum in the nutrition world, with various successful interventions implemented across the globe.

For food fortification to generate favourable results, it is essential to have strong links between the government and public as well as private organisations involved in food production and distribution. Moreover, appropriate policy with effective implementation, regulation and responsible marketing is crucial.

LOCAL APPROACH

A major challenge in food fortification and distribution is selecting the commodity to be fortified. Identifying a commodity which is commonly and regularly consumed by the targeted population is essential. Therefore, it is important to understand the local context and the staple diet of the targeted population so that the fortified food can effectively reach consumers. Research suggest that fortifying staple food can have a significant impact on rates of malnutrition.

Once a commodity is selected for fortification, consumer education programmes must be conducted. It is also important to inform targeted populations about the benefits of the specific fortification. In addition, these programmes should explain possible side-effects in case a person suffers from a particular condition.

As a public policy initiative, food fortification is a process that requires constant attention. Authorities must examine changing population trends, changes in food supply and demand as well as innovations in technology to constantly improve the efficiency of food fortification programmes.

COST-EFFECTIVENESS

Food fortification can be a very economical venture, if implemented effectively. Along with selecting a staple, the commodity should be such that it can be easily distributed through local networks. Identifying an existing local production and distribution network is necessary. This helps widen the reach of the fortified commodity at a low cost. Additionally, if the networks already have the necessary technology to fortify the selected commodity, costs can be reduced further.

TACKLING IRON DEFICIENCY

Iron deficiency is the most widespread nutritional disorder, affecting about 30% of the world’s population. Anaemia can lead to reduced learning ability and decreased work capacity. It also adversely affects the mortality rates of pregnant women and infants.

In 2000, a randomised trial was conducted in Vietnam, providing iron-fortified fish sauce to 152 anaemic women. Fish sauce is consumed by more than 80% of the Vietnamese population, making it an ideal vehicle to deliver fortification.  Moreover, the Ministry of Fishery supervised a network of fish sauce factories. This made it easy to implement and regulate the process. Lastly, fish sauce could be fortified with iron with only minor modifications to the production process. This effective cooperation resulted in a decrease in the prevalence of anaemia among the women from 23% to 4% in a matter of six months.

Similarly, wheat flour fortified with iron in Jordan dramatically decreased iron deficiency rates among children. In 1966, Oman fortified wheat flour with iron, which reduced permanent defects at birth. Currently, at least one major food grain is fortified in 79 countries. Food fortification is gaining momentum as a method to address nutrient deficiencies and for improvement of health outcomes.

THE NEED OF THE HOUR

The selection of a staple commodity with existing distribution networks can make food fortification a success in reducing micronutrient deficiencies. Thus, there is a need for rigorous research in this direction supplemented by government subsidies so that the benefits from fortification can effectively reach those at the bottom of the pyramid.

Sharvari Patwardhan recently completed an MSc in Development Economics at LIDC core member, SOAS University of London.