The FSSAI has issued a notice on 31 January 2017 asking the general public as well as stakeholders for their suggestions, views and comments on the Consultant Paper on Food Fortification within a period of six weeks from the above mentioned date. The FSSAI has prepared this paper in association with the Ministry of Women and Child Development to address the rising issue of micronutrient deficiency that has become rampant in India. The Government of India has stated that it is essential to reduce the levels of malnutrition especially in children and women as well as reduce anaemia, deficiency of vitamin A and iodine.
The National Nutrition Monitoring Bureau (NNMB) data and the Household Consumer Expenditure Surveys reveal that the intake of foods rich in micronutrients is far lesser than the recommended intakes (RDA) in all age groups and socio-economic groups in the country. Because of lack of sufficient micronutrients almost 70% preschool children suffer from iron deficiency anaemia and 57% preschool children have sub-clinical Vitamin A deficiency, while Iodine deficiency is endemic in 85 percent of districts. Moreover, Neural Tube Defects (NTDs) are the most common congenital malformation in the Indian context with an incidence that varies between 0.5- 8/1000 births. It is estimated that 50-70% of these birth defects are preventable. Food fortification is one of the cost-effective and reliable methods of reducing micronutrient malnutrition. The goal is not to provide 100% daily requirements of micronutrients but rather “fill the gap” between intake from other sources and daily micronutrients needs.
Health benefits of food fortification
- Prevention or minimisation of micronutrient deficiencies in specific population groups
- Correction of demonstrated micronutrient deficiencies in a population or specific population groups
- Improvement in nutritional status and dietary intakes which result from lifestyle and dietary changes
Fortification is not new to India
- Fortification of vanaspati with vitamin A and D has been mandatory since 1953.
- Salt Iodization started with the National Goitre Control Program (NGCP) in1962 and gained momentum in early 80s and was mandated in 1997.
- Voluntary wheat flour fortification standards were notified in 1970s.
- Some State Governments have been implementing wheat flour fortification with iron and folic acid through public health programs.
Regulatory Provisions for Fortified Foods in India
The FSSAI has formulated comprehensive regulations for fortified foods namely Food Safety and Standards (Fortification of Food) Regulations, 2016. The regulations include standards for fortification of Wheat flour, Maida, Rice, Milk, Oil, Salt and Vanaspati. These have been operationalized since 16th October 2016. In India wheat flour, oil and salt have been identified as suitable vehicles for fortification. These food items are consumed regularly and in adequate amounts by the Indians and so they have the potential to improve the overall micronutrient status of the population.
Proposal and road map for fortification
In the Consultant Paper on Food Fortification, the FSSAI has made a proposal which will be able to address iron deficiency anaemia (IDA), neural tube defects (NTDs) due to folate deficiency, Iodine deficiency disorders (IDD), Vitamin-A, Vitamin-D and Vitamin B12 deficiencies with the help of fortified foods. Global experience has shown that a combination of several strategies is required to significantly reduce micronutrient deficiencies. Amongst these, staple food fortification offers a promising opportunity to deliver micronutrient rich foods to large populations.
The goal is to implement fortification through public funded food programme like Integrated Child Development Services (ICDS) Scheme, Mid-Day-Meal (MDM) as follows
- Double fortified salt use by 2018
- Fortified edible oil use by December 2019
- Fortified wheat flour use in all states by December 2019
Through open market channels
- Getting the supply side prepared to achieve the universalized availability of these commodities from January 2020.
- Increased availability of Fortified Wheat Flour across the Public Distribution Systems and positive trends in open market.
- Government efforts to focus on generic campaign on micronutrient deficiencies and the response strategy.
- Consumer awareness on micronutrient deficiencies and the role of fortification
Foods to be used to increase the fortification are as follows
- Wheat Flour fortified with iron, folic acid and vitamin B12 (Annexure I) Annexure I explains the suitability of wheat as a vehicle for fortification being a staple food. Wheat fortification also offers health benefits as it has shown to improve iron status in specific populations. Fortifying wheat flour with folic acid has helped to reduce of birth and neural tube defects.
Level of Fortification: The flour fortification standard of FSSAI recommends addition of iron, folic acid and B12 to atta or maida at the level of 20 mg/Kg Iron, 1300 micrograms/Kg Folic Acid and 10 micrograms/Kg Vitamin B12. Other nutrients such as Zinc, Vitamin A, Thiamine, Riboflavin, Niacin and Vitamin B 6 can also be added to wheat flour.
Constraints: Wheat is ground into atta in roller flour mills, automated stone chakkis or small chakkis. In large automated chakkis that produce branded atta it is easy to fortify wheat flour which is sold in urban or semi-urban areas. Small chakkis found mostly in villages and small towns are huge in number but here atta is difficult to fortify. Scaling up of automated small chakkis will require time. The cost of fortifying wheat flour would be 20-25 paisa/kg for wheat flour.
- Oil fortified with Vitamin-A and Vitamin-D (Annexure II)
Edible oils are best suited to carry fat soluble vitamin A and D and are easily absorbed by the body.
Constraints: The Indian oil industry is extremely fragmented and includes crushing units that are small-scale, medium scale and also large scale. All the edible oil that is produced by organized sector and sold in packaged form is fortifiable. It is estimated that about 30% of packaged oil is already fortified voluntarily by the industry. Oil produced by unorganized sector and that is sold in loose is not fortifiable. The cost of fortifying edible oil with Vitamins A and D will by 10 paisa/litre.
- Salt fortified with iron and iodine (Annexure III)
The successful and well established salt iodization infrastructure offers an excellent opportunity to integrate iron into it so as to tackle both iron and iodine deficiencies. Health Benefits are that anaemia (iron deficiency) and iodine deficiency can easily be reduced with salt fortification as it is part of the staple diet used by everyone. The standards for Double Fortified Salt (DFS), i.e. fortified both with iron and iodine, has been established by FSSAI which recommends addition of Iron at the level of 850 to 1100 parts per million. The standard of DFS is designed for use as a regular salt for cooking and for table.
Constraints: To make double fortified salt, the iodised salt manufacturers will require new equipment and access to technology, capacity building and training. Though the cost has been brought down significantly, salt fortified with both iodine and iron can be introduced only in a phased manner. The cost of fortifying iodized salt with iron is Rs.2-3 per kg.
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