How Food Fortification can be an added supplement to combat Nutritional Deficiencies

Food fortification can help in addressing micronutrient deficiencies, improving health and productivity outcomes.

As India recently commemorated World Food Day, what Nu-Shakti terms the ‘Diet Paradox’ is worth noting. Titled India’s ‘Diet Paradox’, the report indicates that almost all respondents (98%) believe a nutritious diet is vital for a healthy lifestyle. Moreover, 73% of respondents understand the connection between healthy eating and weight loss while 97% are aware of the essential nutrients and micronutrients their bodies need. Yet, all this awareness does not necessarily result in them taking the right dietary action.

Significantly, while micronutrient malnutrition (MNM) is widespread in developed economies, it is more pronounced in the developing nations. Although it impacts all age groups, young children and women, especially those in the reproductive age, are among the most vulnerable. Besides adverse health effects, all of which may not be evident clinically, it impacts human functions. Consequently, MNM affects a nation’s economic development and productivity goals while imposing a higher cost burden on the healthcare system.

Globally, deficiencies in iron, vitamin A and iodine comprise the most common types of MNM. These three deficiencies affect at least a third of the global populace, the majority in developing geographies. The most prevalent is iron deficiency. As per estimates, this renders more than two billion people anaemic while a shade under two billion suffer from inadequate iodine intake and 254 million children in the preschool-age group have vitamin A deficiency.

What’s more worrisome is that MNM can cause higher rates of morbidity and mortality. According to estimates, around 7.3% of the global disease burden is due to micronutrient deficiencies. Here, deficiency of iron and vitamin A rank among the 15 biggest causes of the world’s disease burden. Going by WHO’s mortality data, about 0.8 million deaths – or 1.5% of the total numbers annually – are attributable to iron deficiency while vitamin A deficiency contributes to a similar number.

Against this backdrop, food fortification is gaining rising prominence. This refers to key vitamins and minerals – iron, iodine, vitamins A and D and zinc – being added to staple foods such as wheat, rice, milk, oil and salt, among others, to enhance their nutritional values. Food fortification is undertaken because these nutrients may not have been present in the food originally in the required quantities. Or, if present, may have been lost during the processing and refining of these foods.

Food fortification is now considered vital in addressing hidden hunger – a serious health condition caused by micronutrient malnutrition or deficiency in important nutrients and trace elements. In addressing the above conditions, food fortification is used to complement the diversification of diets and food supplementation for improving nutrition levels in the affected persons.

In India, deficiencies in vitamin A, iron, iodine and folic acid create a high disease burden causing anaemia, goitre, night blindness and numerous birth defects. The NFHS-4 (National Family Health Survey) reveals that anaemia afflicts 58.4% of children between 6 and 59 months and 53.1% of women from the reproductive age while 35.7% of children below five are underweight.

Today, food fortification is perceived as a proven intervention in combatting prevalent micronutrient deficiencies in populations globally. The Copenhagen Consensus notes that for every rupee spent on fortification, the economy benefits to the tune of Rs 9. Of course, an upfront investment is needed to buy both the equipment as well as the premix of vitamins and minerals. Nonetheless, the total costs of food fortification remain extremely low.

There are other benefits too. Since nutrients are added to widely-consumed staple foods, the health of a large section of the populace is improved simultaneously. Fortification is a safe means of improving people’s health because the quantities added are small and under the RDAs (recommended daily allowance), adhering to prescribed safe consumption standards. Apart from being cost-effective, it needs no change in eating patterns or people’s dietary habits. Furthermore, the characteristics of food such as aroma, taste and texture remain unaltered. However, foods like salt or oil should be used moderately as they are not individual foods which can be enjoyed as a meal, it only enhances the flavour and taste of the food. Also, because higher levels of iron intake can be risk factors for both coronary heart disease (CHD) and cancer.

Since staple grains such as wheat and rice are consumed regularly in substantial quantities, fortifying such foods is most effective. For instance, wheat flour is fortified with iron or other micronutrients. Similarly, more than half the country’s population consumes rice as a staple. Here, fortified rice kernels can help in augmenting people’s requisite micronutrient intake.

As the pandemic leads to rising cases of hidden hunger, food fortification may be an appropriate way to address the pan-India problem of nutritional deficiencies cost-effectively.

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