Food Fortification Resource Centre; Food Fortification, Double Fortification

1. FORTIFICATION
Dr Paras Porwal
Assistant Professor (I)
AIB, AUUP, Lucknow
9889327441
pporwal@lko.amity.edu
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2. • In May 2017 the FSSAI had issued directions regarding
the operationalization of standards for fortification of
foods.
• Since then FSSAI has received a number of
representations from stakeholders about the use of the
fortification logo as specified in Schedule II of the Food
Safety and Standards (Fortification of Foods) Regulations
2017.
• The FSSAI has issued directions dated 11 August 2017
regarding the operationalization of the logo for fortified
food under the Food Safety and Standards (Fortification
of Foods) Regulations 2017.
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3. • Square represents completeness.
• + sign (shows addition of micronutrients) and
F surrounded by a circle (ring of protection of
good health) which indicates the addition of
extra nutrition and vitamins to daily meals.
• Blue colour signifies purity, health and active
life.
• SAMPOORNA POSHAN SWASTHA JEEVAN
is optional and it is not mandatory to have
that on the food label.
• However, if it is used then it must be placed
below the fortification logo as shown below.
• The Food Fortification logo is an identity mark to distinguish fortified products
from non-fortified ones as per the standards notified under FSS (Fortification of
Food) Regulation, 2018.
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4. India has a very high burden of micronutrient deficiencies caused by Vitamin
A, Iodine, Iron and Folic Acid leading to Night Blindness, Goitre, Anaemia and
various birth defects.
According to the National Family Health Survey (NFHS-4)
• 58.4 percent of children (6-59 months) are anaemic
• 53.1 percent women in the reproductive age group are anaemic
• 35.7 percent of children under 5 are underweight
Fortification is a globally proven intervention to address the much prevalent
micronutrient deficiencies in the population.
INTRODUCTION
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5. • Fortification is the addition of key vitamins and minerals such as
Iron, Iodine, Zinc, Vitamins A & D to staple foods such as rice,
wheat, oil, milk and salt to improve their nutritional content.
• These nutrients may or may not have been originally present in
the food before processing or may have been lost during
processing.
What is Food Fortification?
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6. • Deficiency of micronutrients or micronutrient malnutrition, also
known as hidden hunger, is a serious health risk.
• Access to safe and nutritious food is a must and sometimes due to lack
of consumption of a balanced diet, lack variety in the diet or
unavailability of food one does not get adequate micronutrients.
• Often, there is considerable loss of nutrients during the processing of
food as well.
• One of the strategies to address this problem is fortification of food.
• This method complements other ways to improve nutrition such as
such as diversification of diet and supplementation of food.
Why do we Need Fortification of Food?
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7. MICRONUTRIENTS
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8. • Vitamin A is required for vision and its deficiency leads to
night blindness in children below 5 years of age, prevalence
of bitots spot.
• 35-60 million people suffer from Vitamin A deficiency in
India.
• Vegetarian get vitamins from fruits & vegetables.
• Fruits & vegetables contains beta that does not get fully
converted into retinol & thus absorbed by our body.
• Deficiency can be addressed through food fortification.
Vitamin A
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9. • Vitamin D deficiency affects 70-90% of our population.
• It causes rickets, growth problems, bowlegs, knocked knees, etc.
• Indian diet is not rich in Vitamin D because it is mainly vegetarian.
• Adequate exposure of body surfaces to sunlight is required.
• Best time between 11 am-1 pm.
• Salmon is good source of Vitamin D.
• Milk & Edible Oil Fortification with Vitamin D provides 1/3 of an
individual's daily requirement of the nutrients.
Vitamin D
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10. • Anaemia is common among both undernourished and nourished
people.
• In initial period from 1960-2007, there was a low acceptability of
iodized salt (40-60%), however after mandatory legislation (2007),
the coverage increased to 92% now. However, only 78% receive
adequately iodised salt.
• Most of the maternal death in 1970s was due to anaemia.
• Most of the iron we need comes from meat, which gets absorbed
50% by our body.
• Through vegetables, there is limited intake and only 3%
absorption. This is the reason why iron deficiency is a major
problem in the country.
IRON
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11. • Fortification of iodized salt with iron (Double Fortified Salt) is a way to address iron
deficiency anaemia in addition to iron in wheat flour and rice. It is a cost effective way of
dealing with micronutrient deficiency.
• In 1970s NIN created iron fortified salt. Both the technology approved by FSSAI for
producing iron fortified salt has been shared with industry.
• Pregnant women are particularly vulnerable to anaemia. Any successful iron-
supplementation program should focus on pregnant women, their education and
awareness and regular monitoring of the implementation.
• Communication around fortification needs to be targeted correctly. Pregnant women are
more likely to adopt iron-fortified food for the health of their baby.
• If outreach of iron fortified food is increased, 50% reduction of anaemia by 2025 is an
achievable goal.
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12. • Cost Benefit Ratio – Every 1 rupee spent in iodized salt, provides benefit amounting
to almost 80 rupees.
• Linkage with GDP – contribute to 1.25% in GDP.
• The success of the salt iodization program in India rests on "Panchayat"-the five
major pillars, which are applicable large-scale food fortification of all five staples.
• Sound Scientific Research—Policy--Program and Political Commitment-- Private
Sector Participation -- Partnerships with development agencies for People.
• Today, 99 % of the iodized salt produced in the country is by the private sector.
• Private sector plays a crucial role in sensitizing the population about food
fortification through CSR (corporate social responsibility) initiatives.
• Fortification is one of the most scalable, sustainable and cost effective approach to
fight hidden hunger.
IODINE
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13. • Promotion of +F Logo as a key point for media workshop.
• 92% of the population has now access to iodine salt as per survey.
• Food with + F logo – Ask for it, look for it, use it and spread the word.
Daily intake of iodised salt-a healthy habit
आयोडीन युक्त नमक प्रतितिन, बुद्धि और स्वस्थ रखे सुरतिि हर तिन
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14. • Deficiency of folic acid in pregnant women
leads to Neural Tube Defects in the baby
such as Spina Bifida (spinal cord defect) and
anencephaly (brain defect) etc.
• Folic acid needs to be taken by pregnant
women before conception.
• India & South East Asia & some parts of
Africa have the highest cases of neural Tube
defects (4.7-9 per 1000 in Punjab &
Haryana). In developed world, it is less than
1 per 1000.
FOLIC ACID
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16. • Adding folic acid to food through fortification
can address this health issue.
• Fortification has high benefit to cost ratio.
• For every one rupee is spent on prevention,
Rs. 25 is saved on the healthcare of every
child.
• Consumption of the standard required by
pregnant may prevent up to 50,000 children
born every in India.
• The media plays a huge role in awareness
efforts to educate people about the
importance of folic acid fortification.
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17. • Vitamin B12, also known as cynocobalamin is synthesized by most bacteria and
algae with the help of enzymes.
• Vitamin B12 synthesized in microorganisms enters the human food chain
through incorporation into food of animal origin.
• Gastrointestinal fermentation supports the growth of these vitamin B12-
synthesising microorganisms, and subsequently the vitamin is absorbed and
incorporated into the animal tissues.
• Vitamin B-12 is crucial to the normal function of the brain and the nervous
system.
Vitamin B12
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18. • Deficiency of Vitamin B12 causes pernicious
anaemia. It is rarely caused due to lack of
Vitamin B12 in the diet but because of the
absence the intrinsic factor in the stomach
leading to failure of absorption of Vitamin
B12.
• The bone marrow is not able to produce
mature RBCs but releases a fewer number of
large cells called macrocytes into the blood
circulation.
• These are large cells and nucleated because
of which the capacity of RBCs to carry
haemoglobin is decreased.
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19. • Food Fortification has a high benefit-to-cost ratio.
• The Copenhagen Consensus estimates that every 1 Rupee spent on
fortification results in 9 Rupees in benefits to the economy.
• It requires an initial investment to purchase both the equipment and the
vitamin and mineral premix, but the overall costs of fortification are
extremely low.
• Even when all program costs are passed on to consumers, the price
increase is approximately by 1-2%, which is less than the normal price
variation.
What are the Benefits of Fortification?
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20. 1. Nutrients are added to staple foods since they are widely consumed. Thus, this
is an excellent method to improve the health of a large section of the population,
all at once.
2. It is a safe method of improving nutrition among people. The addition of
micronutrients to food does not pose a health risk to people. The quantity added is
small and well under the Recommended Daily Allowances (RDA) and are well
regulated as per prescribed standards for safe consumption.
3. It is a cost-effective intervention and does not require any changes in eating
patterns or food habits of people. It is a socio-culturally acceptable way to deliver
nutrients to people.
4. It does not alter the characteristics of the food like the taste, aroma or the
texture of the food.
Various benefits of fortification of foods:
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21. • The Food Fortification Resource Centre is a Resource and Support
Centre to promote large-scale fortification of food across India.
• It is a resource hub which provides information and inputs on
standards and food safety, technology and processes, premix and
equipment procurement and manufacture, quality assurance and
quality control for fortification of foods.
• FFRC's approach is to motivate, nudge and facilitate the food industry
to adopt Food Fortification as a norm.
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22. • This initiative follows the Joint Declaration by all stakeholders to fight
micronutrient malnutrition through fortification of food at the National
Summit for Fortification of Food, held on October 16-17, 2016 at Vigyan
Bhawan, New Delhi after which 5 national level workshops were held to
build consensus amongst the country.
• The initiative is being headed by a team of Coordinators at the Centre
who are driving the effort nationwide.
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23. Online Portal of the Food Fortification Resource Centre has been set up to aid in
realisation of these objectives.
The portal serves 02 very important purpose:
1. To serve as a platform for interaction between all stakeholders, such as Central
Ministries, Development Partners and particularly food manufacturers, processers
and fortification pre-mix makers.
2. Providing all information pertaining to fortification of food such as scientific
evidence, latest fortification technology, national and international experience,
government circulars and orders along with the success stories of various states
and the food industry.
FFRC VISION
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24. • The primary goal of FFRC is to address the deficiency of vitamins and
minerals for a healthy nation.
• For the same, a two-pronged strategy has been adopted by scaling up
fortification both in the safety net programmes and making it available
in the open market for all.
• For this aligning the demand and supply of fortified food in the country
is being worked towards at the earliest.
FFRC MISSION
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25. 1. To educate people about the benefits of fortified foods.
2. Sensitise states about fortification of food and promote them in the
Safety Net Programmes to curb the incidence of micronutrient deficiencies.
3. Provide technical support especially to small scale food manufacturers to
enable them to produce fortified foods.
4. To train and build capacity for large-scale fortification of foods and
provide tools for to provide communication material, technical, scientific
and financial support to promote large-scale fortification of food.
Objectives of FFRC
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26. Salt Fortification
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27. Iron and iodine fortified salt - the next breakthrough for tackling iodine and iron
deficiency in the country.
• Double Fortified Salt (DFS) is an innovative new fortified food product - delivering
small but crucial amounts of iodine and iron to human beings through their diet.
• In general, DFS formulations are intended to provide 100% of daily dietary iodine
requirement, and ~30 to 60% of daily dietary iron requirement.
• Dual fortification of salt with iodine and iron could be a sustainable approach to
combat iodine and iron deficiencies.
• India's National Institute of Nutrition (NIN) has pioneered the development of double
fortified salt (DFS).
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28. • NIN has also taken the initiative to transfer the technology to iodized salt
manufacturers in the country and provides continuous quality control support.
• The Micronutrient Initiative has developed DFS with encapsulated iron.
• In 2009, the Ministry of Health and Family Welfare has endorsed the addition of iron
in double fortified salt at 0.8-1.1 ppm (mg/g of salt).
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29. • Every year nine million pregnant women and eight million newborns are at risk of
iodine deficiency disorders (IDD) in India.
• IDDs are linked to iodine deficient soil.
• Due to glaciations, flooding, rivers changing course and deforestation the iodine
present in the top soil is constantly leached.
• This, in turn, leads to deficiency of iodine in crops grown on iodine deficient soil
with consequently low iodine in the diet for livestock and humans.
• This deficiency of iodine in the diet can be addressed by fortification of salt i.e.
adding iodine to salt.
• Salt has been identified as an effective vehicle for iodine because it is consumed
almost daily and universally.
Fortification of Salt with Iodine
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30. • Iodine deficiency disorders (IDD) comprise of a range of disorders including goitre,
hypothyroidism, cretinism, brain damage, intellectual disability, psychomotor defects,
hearing and speech impairment, abortion and stillbirths.
• Intelligent Quotient (IQ) Children born in iodine deficient areas have 13.5 IQ points
less than those in Iodine sufficient areas.
• A majority of the consequences of IDD are invisible and irreversible, but at the same
time, are totally preventable.
• IDD constitute the single largest cause of preventable brain damage worldwide.
• In India, due to lack of iodine in the soil and therefore in the diet.
• 2 billion people are at risk of IDD and around 264 million people are at high risk.
• India has the largest number of children born vulnerable to IDD.
• Currently, 92% of the population consumes iodised salt in India.
• Adequate salt iodisation in India has saved 4 billion IQ points in the last two decades.
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31. Standards
• Double Fortified Salt (DFS) is an innovative new fortified food product - delivering
small but crucial amounts of iodine and iron to human beings through their diet.
• DFS is produced by mixing iodized salt with either/or ferrous sulphate/
encapsulated ferrous fumarate.
• While producing DFS with ferrous sulphate, sodium hexametaphosphate (SHMP)
is used as a stabilizer, ferrous fumarate has been encapsulated with soya stearin
to prevent interaction between iodine and iron.
• DFS as a product is stable in both formulations, is indistinguishable in taste,
color, and smell from regular salt and has been proved efficacious in addressing
IDA (Iron Deficiency Anemia) and IDD (Iodine Deficiency Disorder).
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32. • The salt iodization process involves very little technology of using a drip feed
equipment to dose potassium iodate (KIO3) solution to the raw salt to a very
sophisticated dewatering, drying and packing system.
• DFS technology can be easily integrated with little modifications in existing iodized
salt processing facilities by adding a ribbon blender to blend the iron compound to
iodized salt to produce DFS.
• Given limited commercialization of the product, the incremental cost per kilogram
of salt on account of addition of iron remains unclear.
• However it is anticipated that the increase in cost of DFS could be 20-50% higher
than iodized salt per kilogram.
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34. Vitamin D Fortification
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35. • Milk is a rich source of high quality protein, calcium and of fat-soluble vitamins
A and D.
• Vitamins A and D are lost when milk fat is removed during processing.
• Many countries have a mandatory provision to add back the vitamins removed
as it is easily doable.
• It is called replenishment as the nutrients lost during processing are added
back.
• Fortification of milk with Vitamin A and Vitamin D is required in India because
of the widespread deficiencies present in the population.
• A Recent National Nutrition Monitoring Bureau (NNMB) survey and a Report of
the expert group of ICMR in 2012 has stated that India has very high burden of
Vitamin A and D deficiencies, amongst both young children and adults
particularly in urban areas are physically less active and have a very limited
exposure to sunlight.
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36. • Since milk is consumed by all population groups, fortification of milk
with certain micronutrients is a good strategy to address micronutrient
malnutrition.
• India is the largest producer of milk in the world with 146.3 million
tonnes of production and per capita availability of 322 grams per day .
• The dairy industry in India has progressed from a situation of scarcity to
that of plenty.
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37. • Milk is one of the most nutritious foods.
• Vitamins A and D though important for various bodily functions and naturally
present in milk are removed along with fat when the milk is processed to
produce toned, double-toned and skimmed milk.
At the processing level, four types of fluid milk are commonly produced in India:
1. Fortifying standardized (Fat - 4.5%),
2. toned (Fat - 3%),
3. double toned (Fat - 1.5%) and
4. skimmed milk (Fat < 0.5%)
• Milk with vitamin A and vitamin D will ensure that these will also reach
consumers who purchase low-fat milk and provide them with significant
amounts of their daily needs of these vitamins.
Standards
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38. • The technology to fortify milk is simple. All the vitamins and minerals that
can be added to milk are available in dry powder form as well as in the liquid
form.
• The fat-soluble vitamins are also available in an oily form as well as in the
water soluble form.
• The fortification process does not require any sophisticated equipment.
Liquid milk fortification: Liquid milk is fortified just prior to pasteurization or
ultra-heat treatment, and it is essential to ensure a good distribution of the
nutrients in milk prior to any heat treatment.
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40. Edible oil Fortification
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41. • Multiple micronutrient deficiencies are rampant in India, and continue
to be significant public health problems, which adversely impact the
health and productivity of all the population groups.
• More than 57% of children suffer from vitamin A deficiency, which may
be symptomatic or present at the sub-clinical level.
• In addition, a high proportion of pregnant women and their new-borns
suffer from Vitamin D deficiency.
• Vitamin D is also considered to play an important role in decreasing the
risk of many chronic illnesses, including common cancers, autoimmune
diseases, infectious diseases, diabetes and cardiovascular disease.
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42. • Thus public health problems warrant public health intervention.
• As per Household Consumer Expenditure (HCE) Survey in India, NSSO
report 2011, consumption of oil is reasonably high, about 20-30g /
person / day and is consumed by all population groups.
• Since vitamin A and D are fat-soluble vitamins, fortification of edible
oils and fats with vitamin A and D is a good strategy to address
micronutrient malnutrition and fortified oil is known to provide 25%-
30% of the recommended dietary allowances for vitamins A&D.
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43. Rice Fortification
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44. • Rice fortification is a cost effective, culturally appropriate strategy to address
micronutrient deficiency in countries with high per capita rice consumption.
• The cost of fortification is determined by a multitude of context specific variables
such as the structure and capacity of the rice industry, the complexity of the
supply chain, the policy and regulatory environment and the scale of the relevant
programme.
• As per Department of Agriculture Cooperation and Farmers Welfare, India's rice
production has increased at Compound Annual Growth Rate (CAGR) of 1.43
percent during 2005-06 and 2016-17.
• India was the second leading rice producer followed by Indonesia and Bangladesh
in 2015-16.
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45. • Fortifying rice makes it more nutritious by adding vitamins and minerals in
the post - harvest phase; many of which are lost during the milling and
polishing process.
• Rice fortification may be considered as having the highest potential to fill
the gap in current staple food fortification programs as it is the staple food
of 65 percent of the Indian population and reaches the most vulnerable
and poorer section - with the highest uptake in the government safety net
programmes.
• The food and civil supplies department of each state empanels a number of
rice millers in each district for regular supply of rice to the FCI, from which
it is distributed to the social safety net schemes.
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46. Wheat Fortification
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47. • As per National Nutrition Monitoring Bureau (NNMB) survey (2012), the average
intake of cereals and millets was 375g/CU/day providing >=70% of
Recommended Dietary Intake (RDI).
• Wheat is the staple food for most Indians in the wheat growing areas (North,
West and Central India) and is consumed in the form of homemade chapattis or
rotis (unleavened flat bread) using custom milled atta (whole wheat flour).
• For the year 2018-19 (as per India-Grain and Feed Annual, 2017), wheat
consumption is forecasted at 93 MMT.
• Therefore, wheat flour is selected as a suitable vehicle for fortification to improve
the nutritional status of the mass population.
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48. Advantages of Fortifying Wheat Flour
(1) Wheat flour fortification is a safe and effective means of improving public
health.
(2) Fortified wheat flour is an excellent vehicle for adding nutrients to the diet
as wheat flour is commonly consumed by all people.
(3) Cost effective method to prevent nutritional deficiencies.
(4) During milling of wheat, nutrient losses take place. Fortification helps in
adding back these nutrients.
(5) Iron, Folic acid and Vitamin B12 when added to wheat flour is important
for fighting anaemia and blood formation.
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49. • Fortification of wheat flour is a cost-effective public health intervention that can reduce
Micro Nutrient Deficiencies (MNDs) and prevent birth defects such as Neural Tube
Defects (NTDs) due to folic acid deficiency.
• Wheat flour fortification can potentially reduce iron deficiency and iron deficiency
anaemia.
• Iron helps children develop physically and mentally, and improves the health of
pregnant women.
• Adequate intake of vitamin B12 through fortified flour can improve mental growth and
development of children.
• Therefore, the health impact of fortifying wheat flour with iron, folic acid and vitamin
B12 is immense.
Standards
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50. • Wheat flour fortified as per the recommendations from FSSAI will provide one third of
the recommended dietary allowance (RDA) of various essential vitamins and
minerals.
• The technology for fortifying wheat flour is simple and cost effective.
• This would require a premix feeder to add vitamins and minerals into flour and a
blender to ensure uniform mixing of the micronutrients.
• Mills planning to undertake wheat flour fortification must also ensure adherence to
internal and external quality control systems.
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52. Fortification in Public Distribution System (PDS)
• PDS is the key channel of the Government's food security system in India.
• PDS is operated under the joint responsibility of the Central and the State Governments.
• The present food basket of PDS includes wheat, rice, sugar and kerosene.
• Many States/UTs also permit sale of food items such as pulses, iodized salt, spices, and
edible oil, through the PDS outlets.
• Under NFSA (National Food Security Act), 2013 total coverage under PDS has gone up to
75% for the rural population and upto 50% for the urban population at the all India level.
• Beneficiaries under AAY (ANTYODAYA ANNA YOJANA) are allocated 35 kg per family per
month; Non AAY card holders are allocated 5 kgs per person per month at Rs 3 per kg rice
and Rs 2 kg for wheat.
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53. • FCI procures the grain from the farmers, and transports in to central warehouses.
• From central warehouses the grains are transported to state warehouses.
• The grains are transported from state warehouses to the Fair Price Shops.
• As per the supply chain, fortification in PDS for rice needs to be done at the FCI stage right
after rice is procured and sent for milling.
• For wheat flour, fortification needs to be done at the state godown level where state tenders
the millers to convert the wheat grain into wheat and fortifying wheat as per FSSAI standards.
• A directive has been issued by the Department of Food and Public Distribution, advising all
the states to give wheat flour/fortified wheat flour in place of wheat grains to the beneficiaries.
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