Accelerating action for staple food fortification crucial to combat micronutrient malnutrition: Experts

New Delhi: “It is evident from the recent NFHS-5 data that anaemia has increased among all age groups across the country. For proper health, diet-diversity is important; however, to overcome widespread micronutrient deficiency, we need complementary strategies. Food fortification perhaps is the easiest and most cost-effective way to tackle these issues,” says Inoshi Sharma, Executive Director, Food Safety and Standards Authority of India (FSSAI).

“Healthy diets must be promoted while recognizing the benefits of fortification when administered at scale. Collectively, we can make food fortification a reality. The vehicles chosen are staples consumed in daily diets and this would provide universal coverage. Food Fortification strategy must be monitored and reviewed periodically,” she added while sharing her thoughts at an International Webinar on ‘Large Scale Food Fortification’ on 26th April 2022.

Themed ‘Food Fortification: Accelerating action to reduce micronutrient malnutrition’, the webinar was organized by the Department of Foods and Nutrition, Faculty of Family and Community Sciences, The Maharaja Sayajirao University of Baroda (MS University), in partnership with the National Centre for Excellence and Advanced Research on Anaemia Control  (NCEAR-A)-AIIMS, New Delhi, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh and National Institute of Food Technology, Entrepreneurship and Management (NIFTEM)-Haryana.

The webinar was further divided into two key sessions. The first session, delivered by Dr. Georg Lietz and Dr. Helena Pachon, focused on current global experiences around how Large-Scale Food Fortification (LSFF) is working as a public health strategy to address key micronutrient deficiencies.

Speaking of reaching out to the vulnerable with Vitamin A fortification, Dr. Georg Lietz, shared insights from global studies and said, “Vitamin A deficiency remains a public health concern in South Asia and more so during the COVID-19 pandemic. Mandatory Vitamin A fortification across the world has shown effective results in reducing Vitamin A Deficiency (VAD). For instance, sugar fortification with vitamin A in Guatemala resulted in a successful reduction of VAD from 15.6% to 0.6% from the year 1995 to 2013.  Going forward, India can learn from such global experiences. However, regular monitoring of both dietary intake and biochemical indicators, documenting impact, effectiveness and safety, and strengthened industry motivation would be vital in implementing a safe Vitamin A fortification program.”

Highlighting insights from studies conducted in over 27 countries on fortification of staple foods, Dr. Helena Pachon said, “Currently, a majority of countries mandate or allow food fortification. Global experiences have shown that mandatory fortification is more effective than voluntary fortification in improving health and nutrition outcomes and addressing health inequities. This includes reducing the prevalence of iodine, iron and folate deficiencies as well as preventing goiter, nutritional anemia, and neural tube defects. Going forward, monitoring of food consumption patterns and quality control are key to ensuring sustainable fortification, along with countries complying with WHO fortification recommendations.”

The second session, delivered by Dr. Kapil Yadav and Dr. Mona Duggal, and moderated by Dr Seema Puri, Associate Professor, Institute of Home Economics, New Delhi, focused on the Indian perspective of how large-scale food fortification can be a crucial complementary strategy to address vitamin and mineral deficiencies.

Highlighting the importance of a continuous cycle of research, policy making, and programme implementation in public health, Dr. Kapil Yadav said, “Evidence-based decision making is key to moving successfully from research to policy to programme. Universal salt iodisation is India’s biggest success story in fortification, and continuous data, monitoring, and evaluation of quality coverage and consumption have been critical to this achievement. These learnings will be crucial to keep in mind as we implement iron, folic acid, Vitamin B12 fortification in public food programmes to prevent nutritional anemia as mandated under Anemia Mukt Bharat program.”

Speaking on the need for a 3C strategy – Convergence, Collaboration and Communication – to implement Large Scale Food Fortification in India, Dr. Mona Duggal said, “There are several Indian studies that have evaluated and are ongoing to evaluate the feasibility, affordability, sustainability, and scalability of fortifying staples. Evidence is pointing towards the efficacy of LSSF as an intervention in improving nutritional outcomes for the most vulnerable. India’s strong enabling environment to address micronutrient deficiencies, backed by political will and commitment at the highest level (PMO) along with FSSAI standards on five fortified staples (rice, oil, milk, salt and wheat) and awareness campaigns, will be pivotal in rolling out fortification programmes.”

Overall, the webinar emphasized that while staple food fortification might not be the ultimate panacea, it is needed as a complementary food system strategy to reduce vitamin and mineral deficiencies.