FFI Newsletter March 2014
Grain Fortification at Micronutrient Forum
If you are attending the Micronutrient Forum, take advantage of several opportunities to learn about the latest topics in grain fortification. The international gathering is scheduled for 2-6 June in Addis Ababa, Ethiopia.
Below are summaries of activities where FFI staff are leading or participating. Many of our partners will be sharing valuable information related to fortification at the Forum as well. We will summarize the topics related to grain fortification in the June newsletter for people who are unable to attend.
Evaluate Samples of Fortified Rice at FFI Booth
Samples of fortified rice made via three fortification methods will be available to touch and observe at the FFI booth in the Micronutrient Forum’s exhibit area. Fortified rice will not be sold there; the uncooked rice will simply be available to evaluate for differences between it and unfortified rice.
In addition, Judith Smit, Rice Fortification Manager for the World Food Programme (WFP) Regional Bureau for Asia, will be at the FFI booth Tuesday, 3 June, to discuss WFP's experiences with rice fortification. She will be there from 13:00 to 14:00 and during the afternoon break at 15:30. Staff from PATH will also be available at the FFI booth to discuss rice fortification options.
In many cultures, rice preparation includes picking out kernels that do not conform in color, shape, or texture. Consequently, for fortified rice to be effective, it needs to meet the consumers’ expectations for how rice should look, taste, and smell.
Three primary technologies are used to fortify rice with vitamins and minerals: extrusion, coating, and dusting. Extrusion involves making a dough from rice flour and nutrients then putting the dough through an extruder to make rice-shaped kernels. This can be done at various temperatures. Coating requires spraying rice with a mix of vitamins and minerals plus ingredients such as waxes and gums that help the nutrients adhere to the rice. Both coating and extrusion methods require blending fortified kernels with unfortified rice, usually at ratios between 1:50 and 1:200. Rice is sometimes fortified by dusting it with a powdery mix of vitamins and minerals. Dusting is not appropriate in cultures where rice is rinsed or cooked in water that is discarded as these steps will wash off the added nutrients.
Rice is the second most commonly consumed cereal grain in the world, according to the Food and Agriculture Organization of the United Nations (FAO). Yet rice is not commonly fortified.
Rice fortification is considered economically feasible if the population consumes at least 100 grams per capita per day. The 25 countries with the highest amounts of rice available for human consumption, according to FAO, are listed below. These countries have a combined population of 3.4 billion, yet of these, only the Philippines has mandatory rice fortification.
More information about each type of rice fortification will be available at the FFI booth. Also, see answers to frequently asked questions about rice fortification on the FFI website.
|Country|| Grain Available
(grams per person per day)
|Lao People's Democratic Republic||454||6,112|
|Korea, Republic of||223||47,964|
|Korea, Democratic People's Republic||209||24,238|
|Total population (in thousands)||3,455,298|
Population figures from United Nations Population Division
Begin a Social Marketing Plan in the Learning Center
Begin developing a social marketing plan for fortification by attending a learning center session at the Micronutrient Forum. Scheduled for Tuesday, 3 June, at 16:00, the session will guide participants through a new Fortification Advocacy Toolkit. The resource is designed for grain fortification programs, and it can also be used for fortification of other foods. Consult the Micronutrient Forum schedule for the learning center location.
Social marketing applies the techniques of commercial marketing to influence voluntary behaviors. For example, effective grain fortification programs require cooperation from multiple stakeholders, including millers, policy makers, industry and government authorities, and consumers. Social marketing can garner support for fortification and foster action among these target audiences.
During the learning center session, we will discuss the steps for creating a successful social marketing campaign, supply templates for strategic planning and implementation of multimedia activities, and provide examples of previous social marketing campaigns from a variety of countries. Participants will use an accompanying workbook to begin outlining a social marketing campaign for their country.
The toolkit is based on country experiences as well as a literature review of social marketing related to fortification. The literature review showed no other resource that provides instruction on fortification advocacy and communications. Professional guidance for creation of the toolkit was provided by staff of Porter Novelli, a public relations firm in Atlanta, USA, as well as a global health communications professor at Emory University in Atlanta.
The free toolkit will be distributed during the learning center session as well as the FFI booth at the Micronutrient Forum. After the Micronutrient Forum, the toolkit and the accompanying workbook will be posted on the FFI website in June for downloading.
Fortification in Oral Presentations
Insights into various aspects of grain fortification will be highlighted during oral presentations at the Micronutrient Forum, including the following:
Monday, 2 June, 12:30
A symposium will be presented on “A decade of large-scale food fortification in the developing world: emerging evidence and lessons learned.” The Global Alliance for Improved Nutrition (GAIN) is organizing this event to provide new evidence of the efficacy and effectiveness of large-scale fortification programs. The program will showcase country examples, and it will conclude with a 25-minute expert panel discussion on evidence and lessons learned. See more.
The symposium will include two presentations from FFI. They are:
- Review of effectiveness of wheat and maize flour fortification programs on iron status and anemia outcomes in developing countries presented by Helena Pachón, FFI Senior Nutrition Scientist. While the efficacy of flour fortification for improving iron status and anemia has been established and reviewed, the public-health effectiveness of flour fortification programs has not been reviewed. This presentation will discuss the process and results from a global review of countries' flour fortification programs and their impact on iron status and anemia. Information from this topic will also be presented as a poster.
- The enabling environment: partnerships and mandatory legislation for flour fortification in Africa and their relevance for program outcomes presented by Scott Montgomery, FFI Director. In 2011, we estimated that only seven countries in Africa were fortifying at least 75 percent of their domestically produced wheat flour with at least iron and folic acid. Now, we estimate that 21 countries have reached that level of fortification. This presentation will discuss the environment that fostered that progress.
Wednesday, 4 June, 10:30
At this time, five concurrent sessions will be offered. One session is about innovation and challenges in fortification. Two topics specifically related to FFI will be:
- Analyzing the association between flour fortification and world-wide anemia prevalence. This study used existing national-level data to assess whether anemia in non-pregnant women was reduced after countries began fortifying wheat flour, alone or in combination with maize flour, with at least iron, vitamin A, vitamin B9 (folic acid) or vitamin B12. After adjusting for several factors, the evidence suggests anemia prevalence has decreased significantly in countries that fortify flour with micronutrients, while remaining unchanged in countries that do not.
- Regulatory monitoring systems of fortified salt and wheat flour in selected ASEAN countries, led by Annoek van den Wijngaart, FFI Associate Executive Officer for Asia. Regulatory monitoring consists of monitoring activities conducted at the production level, at customs warehouses, and at retail stores by concerned regulatory authorities, and at the production level by producers themselves, as part of quality control and assurance efforts. This analysis shows that without appropriate enforcement and quality assurance mechanisms in place to stimulate compliance by food producers, having national legislation will not necessarily lead to increased coverage of fortified products and associated outcomes.
Thursday, 5 June, 10:30
At this time, six concurrent sessions will be offered. One session is about translating global guidelines into national policies. Karen Codling, FFI Executive Officer for Asia, will present information on implementation of the WHO recommendations on wheat and maize flour fortification in Asia. The presentation will discuss FFI’s experiences and lessons learnt in supporting countries to update their legislation and develop new legislation. The presentation will show that countries in the region have been slow to implement the WHO recommendations for a variety of reasons including concerns about changes to organoleptic properties of foods made with wheat flour, slow national processes to change national standards, other considerations for establishing national standards and misunderstandings about the recommendations.
Fortification in Poster Presentations
- Monitoring of flour fortification programs: Case studies in three countries. Although monitoring should be an integral part of any fortification program, few flour fortification monitoring systems have been detailed in their entirety. This study involved describing the monitoring systems in South Africa, Indonesia, and Chile; including the strengths and challenges of each system and the lessons learned.
- Food Fortification in India: A literature review. The objective of this project was to review and analyze food fortification studies for their efficacy and effectiveness in India. The review process identified 47 papers. On average, four positive outcomes were noted in each paper, and only a handful of negative effects were noted across all papers in the review.
- Fortification of wheat flour and maize meal with different iron compounds: Results of a series of baking trials. Common wheat-based foods in Kenya, South Africa, and Tanzania were made with flour that had been fortified with iron compounds included in World Health Organization recommendations. Fortification did not lead to changes in the baking and cooking properties of the wheat flour and maize meal.
- Contribution of wheat flour fortification to reducing anemia in Indonesia. Mandatory wheat flour fortification with iron, zinc, thiamine, riboflavin, and folic acid began in Indonesia in 2002, but the effectiveness had not been evaluated. This study used data from the Indonesian Family Life Survey, a longitudinal study that followed over 30,000 Indonesians, to estimate the contribution of fortified wheat flour to changes in hemoglobin concentration and anemia prevalence from before fortification to after its introduction. Wheat flour fortification does not appear to have significantly contributed to the reduction in anemia prevalence among women in Indonesia. Changing the standard to require use of a more bioavailable form of iron is recommended.
- Common Asian wheat flour-based foods: impact of flour fortification on processing factors and organoleptic properties. A series of tests was conducted on 15 different kinds of noodles and bread products commonly eaten in Asia. The foods were fortified with at least iron, folic acid, and vitamin B12 at levels recommended by the World Health Organization. Depending on country regulations, some foods were also fortified with vitamin A, thiamine, riboflavin, and zinc. The results show that foods made with fortified flour were acceptable in all cases, several iron compounds could be used successfully in these foods, and the nutrients appear to be retained throughout the food preparation process.
Folic Acid in the News
The United Kingdom has fortified wheat flour for decades, but the standard has not been updated to include folic acid. This form of vitamin B9 prevents most neural tube defects (NTDs), such as spina bifida, if the woman has enough folic acid before conception and in the early weeks of pregnancy.
A study published in February showed that of 466,860 women who attended antenatal clinics in England, only about 35 percent took folic acid supplements before their pregnancies. The authors concluded that “the policy of folic acid supplementation is failing and has led to health inequalities.” They also noted that the study “demonstrates the need to fortify flour and other cereal grain with folic acid in all countries of the world.” See more.
Fortifying food with folic acid is voluntary in Ireland, and women who may become pregnant are encouraged to take folic acid supplements. A study published in March of Ireland’s ante-natal clinics found that in 2002, women were more aware of folic acid’s role in preventing birth defects than they had been in 1996. Despite that increased knowledge, the peri-conceptual intake of folic acid did not rise above 24% of the women in any year.
“The main barrier to peri-conceptual uptake is the lack of pregnancy planning,” the authors concluded. “Consequently, fortification of staple foodstuffs is the only practical and reliable means of primary prevention of NTD.” See more.
Calls for mandatory fortification with folic acid seem to generate opinion pieces that folic acid has negative consequences. When reading those pieces, remember that fortification does not introduce mega-high levels of folic acid. The highest level of folic acid recommended for any country to add to one metric ton of wheat flour is five parts per million. Fortifying with folic acid has been practiced since 1996, and this has shown to reduce NTD incidence by an average of 46 percent. See more.
- A model of legislation for fortifying corn flour and maize meal is proposed in an article published by the Annals of the New York Academy of Sciences. See more.
- “Birth Defects surveillance: A manual for program managers” is a new manual published by the World Health Organization along with the National Center on Birth Defects and Developmental Disabilities from the US Centers for Disease Control and Prevention (CDC), and the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Using the manual will help a country expand an existing hospital-based surveillance program into a population-based program. It can also be used in a country that is beginning a population-based registry. See more.
FFI Newsletter March 2014 Table of Contents
Federation des Minotiers at the Institut de Formation