Food Fortification-Health is wealth and nutrition plays an important role in earning this wealth Nutrition helps to keep the body healthy and in good shape. However, the food that is available is not nutritious and does not eradicate hunger. India suffers from malnutrition, both undernutrition and overnutrition, which leads to deficiency diseases and obesity respectively. India is ranked 102 out of 117 countries in the Global Hunger Index 2019, behind its neighbours Nepal, Pakistan and Bangladesh. Indian diets are rich in staples, provide calories but not nourishment. Food quality, safety and security are of paramount importance as malnutrition is responsible for numerous deaths.
Definition of Food Fortification
Food fortification is the process of adding micronutrients (essential trace elements and vitamins) to food. It can be carried out by food manufacturers, or by governments as a public health policy to reduce the number of people with dietary deficiencies within the population.
According to the definition of World Health Organisation (WHO) and Food and Agricultural Organisation (FAO), fortification refers to “the practice of deliberately increasing the content of an essential micronutrients like vitamins and minerals (including trace elements) in a food, so as to improve the nutritional quality of food supply and to provide a public health benefit with minimal risk to health”
Need for Food Fortification
To push for development, growth and productivity, a country needs to have population that has food consisting of nutrients. This will help in reducing morbidity and injecting positive health trends in population. India has made grea progress while dealing with the prevailing hunger and malnutrition. India has a very high burden of micronutrient deficiencies caused by vitamin A, iodine, iror and folic acid leading to night blindness, goitre, anaemia and various birth defe Over 70% of the Indian population still consumes less than half of the Recommended Dietary Allowance (RDA) endorsed micronutrients. This is a majo contributing factor to prevalent health concerns such as stunting, low immunity cognitive losses and physical impairments.
According to the National Family Health Survey (NFHS-4) 58.4% of children (6-59 months) are anaemic, 53.1% women in the reproductive age group are anaemic and 35.7% of children under 5 are underweight. Food fortification can help to address the issue of these micronutrient deficiencies. It is a scientifically proven, scalable and cost-effective strategy to improve the health and nutritional status of the most vulnerable sections of our society.
Types of Food Fortification
There are mainly three types of food fortification. They are
• Commercial and industrial fortification like wheat, flour, corn, meat, cooking oils.
• Biofortification i.e breeding crops to increase their nutritional value.
• Home fortification i.e an innovation aimed at improving diet quality of nutritionally vulnerable groups such as children. For example, vitamin D drops.
Benefits of Food Fortification
Food fortification is considered an efficient public health strategy because it can reach wider susceptible populations through existing food delivery systems without requiring major changes in existing consumption patterns. It acts as an effective short-term approach to address the nutrition gaps within a population. The long-term, sustainable approach would be to diversify people’s dietary patterns by encouraging higher consumption of locally produced, seasonal food.
Compared to other nutrition interventions, food fortification is more cost-effective, if it is coupled with existing technology and large-scale distribution systems such as the MDM Scheme, ICDS, PDS, etc. The food fortification also help us to reduce the health care costs related to nutritional disorders. Thus it becomes necessary to move in a direction where fortified food is available and easy to access by all. It helps to improve the health of a large section of the population, all at once as the nutrients are added to the widely consumed staple foods.
Steps Taken By Government
Article 47 of Indian Constitution directs the state to raise the level of nutrition and standard of living in people and improve public health as among its primary duties. Thus, India has launched nutrition security measures such as the Public Distribution System (PDS), Mid-Day Meal (MDM) Scheme, Integrated Child Development Scheme (ICDS) etc. The National Nutrition Policy, 1993 has identified and placed fortification of essential food as a short term direct nutrient intervention and states that essential food items shall be fortified with appropriate nutrients. Some of the measures taken by the government are
• National Policy on Salt Iodisation
India is one of the first countries in the world to start a public health programme to address iodine deficiency disorders based on salt iodisation. A national policy of universal salt iodisation was started in India in 1986 which prohibits the sale of non-iodised salt for human consumption. Later, in order to combat iron and iodine deficiencies, India implemented double fortification of salt, iron and iodine.
• Five Year Plans
Promoting food fortification has been part of 10th, 11th and 12th Five Year National Plans of the country. To keep up the spirit to achieve nutritional security, India has secured micronutrients for beneficiaries by including fortified foods as an additional supplement to nutritious meals for which it has launched Food Fortification Initiative.
Food Safety and Standards Authority of India (FSSAI) has been authorised for setting the standard for fortification of food articles like wheat, flour, rice, milk, edible oil and salts with vitamins and minerals. At present, all the major oil producers in the country are voluntarily fortifying at least one brand in their product portfolios.
The Draft Food and Standards (fortification of food) Regulations, 2016 stipulate that FSSAI may from time to time mandate fortification of any food article. It can be done on the direction of government of India or recommendations of the states/UTs. Under Food Safety and Standards (prohibition and restrictions on sales), sale of only iodised salt is permitted for direct human consumption. It also provides that Vanaspati shall contain synthetic vitamin A. FSSAI has established Food Fortification Resource Centre (FFRC) in collaboration with Tata trusts to promote large scale fortification of food.
• Efforts of Central Government Ministries
Ministry of Women and Child Development and Ministry of Human Resource Development have advised the use of double fortified salt (Iron and Iodine), wheat flour (with Iron, folic acid and vitamin B-12) and edible oil (with vitamin A and D) under their schemes.
• Movements for Behavioural Change
India has set its pace to end all forms of malnutrition by 2030 for which it has started “The Eat Right Movement. This movement brings together three ongoing initiatives of FSSAI i.e. “Safe and Nutritious Food Initiative’, which focused on social and behavioural change around food safety and nutrition at home, school, workplace and ‘The Eat Healthy Campaign’, which focused on reduction of high fat, sugar and salt foods in the diet and ‘Food Fortification’, which focused on promoting five staple foods i.e. wheat flour, rice, oil, milk and salt that are added with key vitamins and minerals to improve their nutritional content.
Issues and Challenges
here is a need to create a policy environment for making compulsory fortification national agenda. The other issue is the partnership with industry to set up the anslatable technologies. Behavioural change communication is required to mitigate akeholder’s reluctance to change. Shelf life and packaging for fortified rice tored rice) is also a great challenge. Effective monitoring is required for the areful consideration of the effect of other fortified foods and supplements. Several Eganisations like WHO, FAO have acknowledged that there are limitations to food rtification. Fortification of nutrients in food may deliver excessive amount of Eitrients to some individual with side effects. For example, Flouride can cause reversible staining to the teeth. Iron might be beneficial for women but it might esult into over consumption in case of men. Besides, there are several human ghts issue like consumers right to choose if they want fortified products or not.
Actions Required to Overcome the Challenges ome of the future course of action are given below
•There is a need to engage stakeholders to understand the importance of more comprehensive and up to date databases on food and nutrient intakes.
• There is a need for better tracking/reporting systems to look for potential adverse effects of excessive nutrient exposures.
•More research is needed to quantify the nano materials as fortificants.
•There is need to understand the link between consumption and outcomes of the changes occuring as a result of food processing.
Sustainable approaches in bringing diversity in the dietary habits of the citizensfood fortification can be seen as one of the important ways forward in improving the health of the citizens of the country. Further, there is need to develop wide consumer outreach to build awareness and sensitise people to the need and importance of fortification. The need of the hour is to strengthen measures of food fortification and harness fully the benefits of food fortification to place India on the path of sustained growth, prosperity and well-being.
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