More support needed by countries to maximize the benefits of mandatory food fortification

Farmers thresh wheat during a harvest in the Fateh Jang district of Punjab Province, Pakistan. Photographer: Asad Zaidi

By Dr. Noor Khan, Senior Technical Advisor for Nutrition in Food Systems

Fortifying food staples and/or condiments with essential micronutrients has been identified by the World Health Organization, the Copenhagen Consensus[1] and the Food and Agriculture Organization as an effective and sustainable solution to some of the most common micronutrient deficiencies globally.

These deficiencies can have devastating public health impacts. Iron deficiency anaemia in pregnant women, for example, can lead to significant defects in the development of their babies’ central nervous system[2],[3] which can affect their social development and productivity as adults. Folic acid deficiency can also cause serious birth defects[4] such as spina bifida in newborn babies ― and iodine deficiency can lead to a spectrum of mental and physical disorders among women and children particularly.

In an effort to solve this problem, 87 countries have adopted legislation to mandate fortification of at least one industrially milled cereal grain with iron and/or folic acid.[5]

However, support is still needed by many of these countries in order to ensure sustained enforcement of these legislations as well as quality control ― and that the programs and policies they have put in place are as effective as they can be.

This was the conclusion of a recent review of grain fortification monitoring documents from 68 countries led by the Food Fortification Initiative ― to which I had the pleasure of contributing as an author, alongside Dr. Luz María De-Regil, Nutrition International’s Vice-President of Global Technical Services, and six other fortification experts from around the world.

In reviewing grain fortification legislations, standards, and monitoring documents for each of the studied countries in Asia, Africa, South America, Europe, the Middle East and the Pacific, we found that most have documented technical specifications for fortification and systems for monitoring. However, documentation of other important items that would influence product compliance to national standards ― such as roles and responsibilities between agencies, the cost of regulating fortification, and enforcement strategies ― are often lacking.

This means that the resultant food products may not adequately fortified to the prescribed levels and hence unable to achieve the desired benefits of overcoming target micronutrient deficiencies and improved nutrition status of population in need.

To help countries revise their documentation or establish new programs, the study team created a 44-point checklist with sample text for food fortification legislation, standards, and monitoring policies. This checklist includes sections for vitamins and minerals, costs, labeling, roles of laboratories, reporting results and internal, external, commercial and import monitoring, with examples for each item for countries to consider as they create or modify protocols for fortification programs.

Evidence has shown that mandatory food fortification works. Large scale food fortification programs can make a major contribution towards improving the quality of diets at the population level resulting in better nutrition which directly contributes to the achievement of some of the key Sustainable Development Goals[6].

However, in order for a country to reap all its health, social and economic benefits, government must create an enabling environment, which includes strong legislation, evidence-based standards and sustainable quality control/quality assurance and enforcement systems.

The hope is that the checklist (which can be used for grain and other food fortification programs) will provide countries with the information and guidance they need to create or strengthen this enabling environment.

This is how we will ensure that we maximize the power of mandatory food fortification, so that more people can thrive.

 

[1] http://www.copenhagenconsensus.com/publication/second-copenhagen-consensus-micronutrient-fortification-best-practice-horton-et-al (accessed FEb 07, 2018)

[2] Greminger, AR. et al. Gestational Iron Deficiency Differentially Alters the Structure and Function of White and Gray Matter Brain Regions of Developing Rates, American Society of Nutrition, Online April 17, 2014: doi:10.3945/jn.113.187732

[3] http://en.wikipedia.org/wiki/Iron-deficiency_anemia (accessed on March 24, 2015)

[4] http://www.webmd.com/a-to-z-guides/folic-acid-deficiency-anemia-topic-overview (accessed, March 24, 2015)

[5] Food Fortification Initiative (FFI). Say Hello to a Fortified Future: 2016 Year in Review. Atlanta, GA: FFI;2017. http://ffinetwork.org/ about/stay_informed/publications/documents/FFI2016Review.pdf . Accessed October 03, 2018

[6] http://scalingupnutrition.org/nutrition/nutrition-and-the-sustainable-development-goals/  (accessed February 06, 2018)

Noor Khan headshot

Dr. Noor Khan

Senior Technical Advisor, Nutrition in Food Systems

Dr. Noor Khan is Nutrition International's Senior Technical Advisor for Nutrition in Food Systems, including food fortification and universal salt iodization.

Noor helps Nutrition International to achieve and maintain it’s role as a leading global technical agency in research and programming for the cost effective scale-up of food-system interventions that improve the nutrition and health of children and adults – particularly adolescent girls and women of reproductive age. He has an MD, an MSc in Community Health & Health Management in Developing Countries and a Commonwealth of Learning Executive MBA. Noor joined Nutrition International in 2000.

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