Food fortification

Food fortification is a proven cost-effective and complementary strategy to address India’s malnutrition burden
Considering the diverse populations in India, there is an urgent need to address the maladies that poor nutrition can inflict on the masses, especially when it comes to micronutrient malnutrition.

Malnutrition, India’s most serious challenge is also a concern which exacerbates the magnitude of the public health crises.
According to National Family Health Survey data, every second Indian woman is anemic, every third child is stunted and malnourished, and every fifth child is wasted.
India ranks 101 out of 116 countries in the Global Hunger Index 2021 says FAO’s Food Security Report for 2021, with a 15.3% undernourished population, the highest proportion of stunted children (30%), and wasted children (17.3%).
As per the Global Nutrition Report 2021 the cause for concern of stunting among children in India is significantly higher than the Asian average of 21.8%

Since the 1920s, developed countries and high-income countries have successfully tackled the issue of malnutrition through food fortification.
Late, low and middle-income countries like India have pursued food fortification as one of the strategies to tackle micronutrient malnutrition.
Food fortification is the process of adding nutrients to the food. For instance, rice and wheat are fortified with iron, folic acid, and vitamin B12 also salt is fortified with iron and iodine. Iodized salt has been in use for the past few decades
The Rice Programme and Anemia Pilot projects on the distribution of fortified rice have been taken up in selected States like Maharashtra as part of a targeted Public Distribution programme for the masses.
The programme has been a success in terms of preventing cases of anemia from 58.9% to 29.5% within a span of two years, prompting the central government to declare the scaling up of the distribution of fortified rice as the major staple diet of 65% of the population through the existing platform of social safety networks such as the PDS, ICDS and PM-POSHAN.

Results from the fortified rice project of different States so far tally with the results of global programmes that use fortified food as a cost-effective strategy.

The health benefits accruing from food fortification have made 80 countries frame laws for the fortification of cereal flour and 130 countries with iodised salt, whereas 13 countries have mandated rice fortification.

The encouraging results of the Anemia Pilot Programme in Maharashtra have prompted the proposed large scale food fortification programme, which includes fortified rice in all safety net government schemes.

Results from Maharashtra found a promising reduction (29.5%) in the prevalence of anemia among women, adolescent girls, and children.

In the state, an eight-month-long study on multiple micronutrients fortified rice intervention for school children (6-12 years) in 2018-2019, as part of the Mid-day Meal Scheme, found increased hemoglobin concentration, 10% reduction scores (by 11.3%).
Anemia due to iron deficiency is a major public health concern because it is responsible for 3.6% of disability adjusted life years (DALY) according to theWorld Health Organization (WHO); i.e., a loss of 47 million DALYs or years of healthy life lost due to illness, disability, or premature death (2016).
According to NITI Aayog, a rice fortification budget of around ₹ 2,800 crores per year can save 35% of the total or 16.6 million DALYs per year with no known risk of toxicity.
In India, the cost of one DALY lost due to Iron Deficiency Anemia (IDA) is approximately ₹ 30,000, while the cost of averting an IDA-related DALY is only ₹ 1,545, resulting in a cost-benefit ratio of 1:18. Rice fortification, which costs less than 1% of the food subsidy bill (201819), has the potential to prevent 94.1 million anemia cases, saving ₹ 8,098 crore over five years.

Considering the per capita intake of a three membered family with a rice consumption of approximately 60 grams per person, the additional intake is 2.45 mg of iron. This compensates for the daily loss of iron from the body, which is 1 mg2 mg per day.
As per the FSSAI standards, the iron levels in fortified rice range from 28 mg to 42.5 mg, folic acid levels from 75 mcg125 mcg, and vitamin B12 levels from 0.75 mcg to 1.2 mcg .
According to stalwarts of nutrition, food fortification is a cost-effective complementary strategy to address multiple micronutrient deficiencies.Thus the proven efficacy and cost-effectiveness of food fortification can help us in reducing micronutrient deficiencies and address overall health benefits.

Regardless of the proven efficacy of the programme, activists have expressed

concern that excess iron overload from fortified rice has been dangerous for

Jharkhand’s tribal population suffers from sickle cell anemia and thalassaemia.

However the intervention, carried out with precautions, is the key to the malnutrition

issue which the nation continues to grapple with.

Pic Courtesy: The Hindu

Content Source: The Hindu