FFA Issue 20 -
Fortifying Against the Hidden Hunger
March 2004
t_Articles
Asia truly is a land of contrasts. On the
one hand, over-nutrition has led to growing obesity and weight problems
among Asians, yet aid agencies simultaneously point to the continuing
challenge of hidden hunger deficiency of essential micro-nutrients –
that still affects the health of many.
According to the Asian Development Bank,
vitamin A, iodine and iron deficiencies are still prevalent all over
Asia. While clinical vitamin A deficiency (the level of deficiency that
causes blindness) has declined, sub-clinical vitamin A deficiency is
still common.
In areas where iodised salt programmes
are not present, there are still many people who suffer from iodine
deficiency disorders which may be apparent as goitre in adults and
mental retardation amongst children.
Iron deficiency anaemia is probably the
most common form of micronutrient deficiency in Asia and affects as many
as 600 million women and children in South East Asia alone. The effects
of iron deficiency anaemia include increased maternal and infant
mortality, limited learning capability and reduced immunity against
diseases as well as reduced ability to work and function.
Fighting micronutrient deficiencies
requires a multi-prong approach. One of them is by fortifying food that
is commonly eaten as staples by a large section of the population. The
strategy has been found to work in developed countries earlier last
century. Europe and the United States saw their rates of micronutrient
deficiencies fall after mandatory fortification of staple foods like
bread flour and wheat products.
Unlike mineral and vitamin supplements,
food fortification is unlikely to result in over-consumption of
nutrients, because the amount of food required to be eaten is too large
to pose a risk of overdose. In addition, estimates by international
agencies have shown that food fortification is often one of the cheapest
solutions. For example, it is estimated that fortifying soy sauce with
iron only costs about 0.03 USD per litre of sauce.
Asia fortifies
Because of the potential benefits, Asian
governments have used many innovative ways of delivering micronutrients
to the population via food fortification. Each country uses a different
food as the vehicle for fortification based on the population’s dietary
habits.
Malaysia has a mandatory programme to
fortify margarine with vitamins A and D to ensure the butter substitute
provides consumers with adequate amounts of these vitamins. In addition,
condensed milk, which is consumed by a large segment of the population
in beverages is mandatorily fortified with vitamin A as well.
After surveys of rural communities in
Sarawak in the 1970s and 1980s revealed worrying levels of iodine
deficiency disorders, the government mandated the import of iodised salt
to Sarawak in 1982. The legislation increased the availability of
iodised salt in affected communities from 28% in 1988 to 65% in 1995.
In Thailand, there has been a programme
to fortify the seasoning in instant noodles with vitamin A, iodine and
iron since 1996. The fortified seasoning provides 1/3 of the recommended
daily allowance for these three micro-nutrients. Currently 80% of
instant noodles in Thailand are participating in this fortification
programme with the government’s encouragement .
The voluntary fortification of margarine
with vitamin A in the Philippines, together with extensive government
support and consumer awareness campaigns have led to an increase in the
consumption of fortified margarine, even among low-income groups (who
stand to benefit most from the fortification). Studies among affected
communities showed that consumption of the margarine increased the
amount of vitamin A levels in children. Manufacturers also reduced the
package size, thus ensuring that it remains affordable to those in the
low income groups.
The Philippines also has another
programme to fortify rice with iron which is intended to reduce the
severity of iron deficiency anaemia in the country.
China has chosen a different vehicle to
reduce iron deficiency anaemia. Following on from research led by Dr
Junshi Chen of the Chinese Acadmy for Preventive Medicine and the
International Life Sciences Instititute Focal Point China, China has
embarked on a largescale programme in collaboration with soy sauce
manufacturers and with support from the GAIN project, to make
iron-enriched soy sauce readily available to Chinese citizens. Already
the project has begun to show promise. A pilot study conducted in an
area with high prevalence of anaemia showed that anaemic school children
given iron fortified soy sauce had significantly better iron profiles
than those who did not.
Innovative fortification
However, adding micro-nutrients to food
during milling and processing is not the only way to fortify food. Food
may be fortified from the inside via biofortification. One of these
methods uses biotechnology tools to create crop varieties with built-in
nutrients. One of the most advanced projects is Golden Rice, which is
rice with vitamin A. In development are also other crops like mustard,
canola, sweet potato, millet and cassava that are biofortified with
vitamin A, as well as rice and common legumes with zinc and iron.
The International Food Policy Research
Institute recently launched an ambitious programme to encourage plant
breeders (people who develop new crop varieties) working with staple
crops to breed for varieties with more vitamins and minerals. The
targeted crops are wheat, maize, cassava and beans and the targeted
micronutrients are iron, zinc, vitamin A and for cassava, iodine.
Conclusion
It is estimated that more than 2 billion
people or one third of the world’s population suffer from a
micronutrient deficiency. Government pledges in 1990 and 1992 to
eliminate iodine and vitamin A deficiency by 2000 have not met their
targets. Fighting micronutrient deficiency requires government
commitment, the cooperation of the private food industry and proper
consumer awareness.
In addition to nutrient supplementation
programmes with tablets and dietary modification to increase the intake
of nutrient-rich foods, there are indications from cases worldwide that
food fortification plays an important role in combatting micronutrient
deficiencies.
More Reasons to Fortify
Adding essential nutrients to foods to
correct or prevent micro-nutrient deficiencies is not the only reason to
fortify food.
Many types of food are fortified with
nutrients to replace those that were lost during the processing,
manufacturing and storage process in order to restore the level of these
nutrients to their original level, or in some cases even higher levels.
Examples include the restoration of B vitamins in grains because of
losses during the milling and extrusion processes, and replacement of
vitamin C in orange juice.
Foods may also be fortified to ensure
nutrient levels are similar to another food they may replace. For
example, soymilk is fortified with calcium and vitamin D to approximate
the nutrients found in cow’s milk and margarine is fortified with
vitamins A and D, as these nutrients are found in butter.
