Q: What is a standard?

A standard is a technical specification for a wide range of products including foods. A food standard is established by a country’s Metrology Department which is usually located within the Ministry of Industry. Other stakeholders including the food industry, Ministries of Agriculture, Health, or Finance, offer input into the development of the standard. A food standard does not always have legal status on its own.

A standard for fortified flour includes a list of vitamins and minerals to be included in flour. Effective standards specify a minimum and maximum level of each vitamin and mineral to add to flour. This provides a level that can be expected to have a health impact while allowing some margin so that implementation is practical.

Q: What is a regulation?

A regulation is a legal document that is usually supported by laws developed by the government with endorsement by parliament. In many countries regulations can be developed and implemented without having to change the food law which requires the permission of parliament.

Q: What is a guideline?

Guidelines provide recommended standards for food, but they do not always carry any legal weight. Guidelines are usually issued by normative agencies such as the World Health Organization. They can be issued for global or regional use.

Q: What is a premix?

A premix is a powdery blend of vitamins and minerals that flour millers use for fortification. Premixes may contain an anti-caking agent to prevent lumping. Premixes are usually prepared with diluents so they can be added to flour at a standard dosage rate such as 150, 200, 250, or 300 grams per metric ton.

A premix allows a miller to add several micronutrients at the same time to flour. A standard premix specification also allows millers to compare prices from different suppliers on a standardized basis which will prevent pricing and costing errors.

Q: Who supplies premix?

A number of reputable premix suppliers are located around the world. These companies are based in North and South America, Europe, Middle East, Africa, and Asia. Many companies have local agencies operating in the region or country level.

Q: What is a feeder and what does it do?

Stainless steel feeders accurately add premix directly to flour. The feeder is equipped with a variable speed drive motor which has a discharge mechanism and a hopper agitation device attached with a gearbox. The agitation device provides an even, consistent flow of premix into the flour.

Q: What types of feeders are there?

Feeders have one of three discharge systems: Screw discharge, disk discharge and drum discharge.

Most modern feeders use the screw discharge system. The size of the discharge screw and the speed range of the variable speed motor allow for a wide range of discharge rates. The feeders can be connected electronically or electrically to the main control panel or microprocessor that controls the flour mill. In addition, the feeder can be equipped with load cells which convert the feeder from a volumetric feeder into a gravimetric or loss-in-weight feeder.

Q: How do you know how to get the right size of feeder?

Feeder size is determined by the mill’s flour production rate range and the prescribed addition rate (in grams per metric ton) of the premix. Choose a feeder size that will operate at a discharge rate of between 30 to 70% of the full speed of the feeder. If the feeder is operating outside that range, the chances for more variation in discharge rates will be higher.

Q: How is flour fortified at the mill?

The fortification process is usually a continuous process that adds premix to flour as it is being produced. In some cases, fortification takes place in a high speed blending system following the flour milling process. In this case, this system is usually installed as part of a new flour mill.

Q: Where is the feeder installed?

The feeder is usually on top of the final flour collection conveyer where premix drops by gravity into flour as it move through the conveyer.

When an existing mill has to install a feeder to begin fortification, there may not be room on top of the conveyer for a feeder. In this case the feeder can be installed on the same floor as the conveyer. The feeder is connected to the conveyer using a blowline which blows the premix from the feeder into flour.

Q: How do you ensure that the feeder is operational?

The feeder must consistently deliver premix to the flour conveyer at a point that allows for sufficient mixing time so that the premix is evenly dispersed in the flour. Tips for doing that are:

1. Place the feeder more than three meters from the discharge end of the conveyer where the premix is added.
2. Interlock the feeder with the mill control panel or the first break sifter or the conveyer motor so that if the mill stops, the feeder stops.
3. Equip the feeder with a low level alarm indicator so that the feeder does not run out of premix.

Q: What quality control and quality assurance procedures are needed for flour fortification?

The steps provide quality control and quality assurance at the flour mill.

1. Store premix in a dry, secure location and away from direct light to prevent degradation of the vitamins.
2. Calibrate the feeder on a regular basis and whenever the premix composition is changed or the supplier is changed.
3. Calculate the feed rate for the feeder to establish an acceptable dosage range of +/- 5% of the target addition rate for premix.
4. Conduct the check weighing process of the feeder regularly. This involves weighing the amount of premix discharged by the feeder over one to two minutes then comparing it to the weight of premix expected to be discharged over that period.
5. Perform the iron spot test at least three times per eight-hour shift.
6. Send monthly samples for full analytical testing of all the nutrients added to flour.
7. Use an inventory control system to verify that the amount of premix being used is close to the specified or target rate.

Q: What does fortification cost the milling industry?

To fortify flour, the miller has the one-time expense of buying feeders plus the on-going costs of buying premix and supplies for quality control and quality assurance testing. Some costs may be associated with staff training.

Q: How much does premix cost?

The cost of the premix is most affected by the number of vitamins and minerals included and the quantity of each nutrient. Vitamin A is the most expensive nutrient to include in flour.

The following gives an indication of the premix cost:

Cost Range per Metric Ton of Flour (US dollars) for Nutrients in Premix Iron and folic acid: $0.85-$3.00 Iron, folic acid, B group vitamins: $1.60-$3.90 Iron, folic acid, B group vitamins and vitamin A: $2.85-$9.90

These estimates should NOT be used as official market prices. These prices do not reflect import duties and value added tax (VAT). Millers should request premix price quotations from more than two suppliers to ensure competitive prices.

Q: What other factors affect the cost of premix?

Prices are affected by supply and demand worldwide. Vitamins and minerals are also used for animal feed preparations, and premix cost is affected by the demand for animal feed use. The cost of transportation from the supplier’s location via air freight or surface is also a factor. Import duties can range from 15-45% of the price of the premix.

Q: How much do feeders cost?

Feeder costs have a wide range. Assuming the rated capacity of the flour mill is greater than 50 metric tons of wheat ground per 24 hour period, a volumetric manual operation feeder can cost from US $3,000 to $10,000. For the same mill, the cost for a loss in weight automatic feeder with linked microprocessor control can range from US $15,000 to $35,000.

These prices should NOT be used as official market prices. These prices do not reflect the costs of import duties and value added tax (VAT). Millers should request feeder price quotations from more than two suppliers to ensure competitive prices.

When a new mill is being constructed, the additional cost of automatic loss-in-weight feeders is very low compared to the capital cost outlay for a new mill. New mill owners should always consider the use of loss-in-weight automatic feeders in this instance.

Q: What is the cost of installing feeders?

Typically, installing a feeder costs 10-15% of the feeder price.

Q: Is this feasible for small mills?

While fortification is technically feasible in very small mills, ensuring consistency is challenging. Very small mills (less than 10MT per day) are usually located in rural and peri-urban areas. If they are fortifying flour with assistance from non-governmental organizations and development agencies, the agencies provide training and supervision required to fortify flour. Trying to bring this program to national scale is challenging.

Some countries, such as the Kyrgyz Republic, have successfully started flour fortification in mills where capacity ranges from 10 to 30 metric tons per day. The mills use a small feeder which consistently fortifies flour adequately. This feeder is available from a supplier in China at a reasonable cost. Feeders designed for larger mills are too expensive relative to the cost of the small mill equipment.

See additional resources for fortifying in small mills.

Q: Does fortified flour change its baking qualities? Does fortification affect the color, smell, and taste of foods made with fortified flour?

When appropriately implemented, fortification does not impact the organoleptic and food technology attributes of flour when used in foods such as baked goods, breads and noodles.

Q: What is the role of government in monitoring and evaluation?

The milling industry and the government share responsibility for ensuring that the flour is fortified correctly and consistently. The government is responsible for:

1.Developing and publishing fortified flour standards and regulations

2. Enforcing the regulations through effective inspection procedures and audits1. Controlling and enforcing the applicable standards on both national production of flour and imported flour.
3. Conducting routine analytical testing of flour samples from both the milling industry and the marketplace to verify compliance to the standard and regulations
4. Evaluating the impact of the fortification program and making changes as needed

Q: Does fortification present a trade barrier?

Flour fortification specifications are technical specifications that also include moisture content, protein content, amylase activity, and baking performance and quality tests. Many different flour specifications are already in place, and they do not prevent trade between countries.

The World Trade Organization allows member states to implement measures to protect human health. See more information in our FAQ for Economists.

Q: When is rice fortification feasible?

Research indicates that rice fortification is economically feasible if rice consumption is at least 100 grams per person per day.

Rice fortification is most easily implemented in modern mills with a production capacity of at least 5 metric tons an hour. Rice can also be fortified in large distribution channels such as government programs.

Rice fortification is not yet practical if the milling industry primarily consists of small, decentralized operations. The business trend towards consolidation of mills favors the feasibility of rice fortification.

See reports from Africa and Asia for factors determining the feasibility of fortifying rice.

Q: How much does rice fortification cost?

The cost of rice fortification varies greatly based on the type of fortification technology used, whether fortified kernels are produced locally or procured from another source, and the ratio of fortified kernels blended with unfortified rice.

A facility which produces fortified kernels may need an initial capital investment of US$ 0.3 million, US$ 0.75, or US$4 million for coating, cold extrusion or hot extrusion technology respectively. Alternatively, fortified kernels can be ordered from another source then blended with unfortified rice. That option requires the on-going costs of shipping. If fortified kernels are imported, duties and fees will be applied unless the government exempts fortified kernels from these fees.

Fortified kernels are blended with unfortified rice to make fortified rice. If blended at a ratio of 1:100, the consumers' estimated price increase is estimated to be between 2% to 5% of the current retail price.

The cost to fortify one metric ton of rice varies based on the technology used. Estimates range from US$ 10 to US$ 30. In comparison, the average price of one metric ton of rice from Thailand and Viet Nam in 2018 was about US$ 400, according to World Bank commodity markets.

Rice fortification costs are expected to decrease as rice fortification becomes more common and competitive markets emerge.

See a review of the cost components of industrial rice fortification.

Q: What are fortified kernels?

Fortified rice kernels are either coated rice kernels or extruded rice-shaped kernels prepared with a mix of vitamins and minerals.

Sometimes a powdery blend of nutrients is dusted onto unfortified rice, but this is only useful in countries where consumers do not wash rice before cooking it.

Q: How are fortified kernels produced?

Fortified kernels can be made a number of ways, including:

Extrusion: A dough made from rice flour, broken rice kernels, and a mixture of vitamins and minerals is passed through an extruder to make fortified rice-shaped kernels. See video in English or Portuguese for an extrusion demonstration.

Extrusion can be done at various temperatures. Hot extrusion (70-110o C) produces the highest quality kernels and is most expensive. Cold extrusion (70o C) is less expensive but might be rejected by consumers demanding uniformity in each grain's shape, size and texture. A hybrid method called warm extrusion is being researched.

Coating: Rice is sprayed 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 the fortified kernels to be blended with unfortified rice. This is usually done at ratios between 1:50 and 1:200.

Dusting: Rice is dusted with a powdery mix of vitamins and minerals. This is not appropriate in cultures where rice is rinsed or cooked in excess water. These preparations will wash off the added nutrients.

Q: How are fortified kernels procured?

Extrusion technology uses rice flour and broken rice kernels. Consequently, rice millers may install extrusion equipment at their mills to use their broken rice kernels and produce fortified kernels.

With coating technology, fortified kernels are shipped to a location where they are blended with unfortified rice. Fortified kernels made with extrusion technology can also be ordered if rice millers do not produce it internally.

Q: Who produces fortified rice kernels?

PATH maintains a list of fortified rice kernel suppliers. This list is for information only. It is not an endorsement of any company or a statement of quality.

Q: At what point are fortified kernels blended with unfortified rice?

Blending fortified kernels with unfortified rice can be done:

• During the milling process in large centralized mills that are well equipped for blending operations
• Where rice is bagged
• In large warehouses where rice is stored prior to distribution
• In point-of-use situations, such as school feeding programs.
• The optimal blending method varies based on the type of fortification program or strategy – whether it is a national mass fortification program, select public feeding program, or commercial retail distribution.

Q: How can uniform blending be ensured?

Equipment with variable flow mechanisms and modern mixing systems guarantee uniform blending of premix with unfortified rice. Continuous quality assurance by producers, periodic government inspections, and regular analyses of the concentration of nutrients will also ensure uniform blending.

Q: Does fortified rice segregate from unfortified rice after blending?

Because the fortified kernels are so similar to unfortified rice in size, shape and density, little segregation occurs. A 2008 pilot project in India evaluated segregation during transport and storage of blended, fortified rice. The homogeneity of the blend remained constant, even after transporting long distances.

Q: What vitamins and minerals are lost as rice is milled?

Iron, zinc, calcium, thiamine, riboflavin, and niacin are among nutrients naturally in rice. The nutrient content ranges greatly, depending on the rice variety.

Regardless of variety, however, the nutrient-rich layers of rice are generally removed in the milling process. Unpolished, brown rice retains more of its original vitamins, but polishing removes 75% to 90% of these nutrients.

Parboiled rice contains more of the natural water-soluble vitamins than brown rice because the vitamins are preserved in the endosperm.

Fortification restores these nutrients or adds nutrients as needed by the population.

See more in The Rice Grain and Its Gross Composition and the United States Department of Agriculture food composition tables.

Q: Does fortified rice maintain its nutrition after cooking?

A study published in 2014 quantified the losses of vitamin A, iron, zinc, folic acid, and vitamin B12 in fortified rice that was produced using hot extrusion, cold extrusion, and coating. The study involved five cooking methods: absorption method with or without soaking, washing before cooking, cooking in excess water, and frying rice before cooking.

The authors concluded that different regional cooking methods do not lead to a major loss of most micronutrients, with the exception of vitamin A. All production techniques of fortified rice kernels yielded similar results.

Q: What is the shelf life of fortified rice kernels?

The shelf life of fortified rice kernels is between 3 months and 2 years. Among the influencing factors are type of rice (milled or parboiled), the type of iron used, and whether the rice is fortified with one or multiple nutrients.

Q: What is the shelf life of blended fortified rice?

The shelf life of rice that is a blend of fortified and unfortified kernels is at least 6 months. Additional storage studies are required to establish exactly how long fortified rice can stay free of rancidity and microbial growth.

Q: Does rice fortification improve people's health?

Several controlled studies have confirmed that rice fortification improves nutrient intakes, although no data from large-scale programs is yet available. This is partly because only a few large-scale rice fortification programs have been implemented.

Several randomized, controlled trials comparing the efficacy of rice fortified with iron successfully improved the iron status of the intervention group.

See our Global Progress page or contact us at info@ffinetwork.org for information about country practices regarding rice fortification.

Q: Is anything available in Spanish? La fortificación del grano de arroz

Yes. This presentation gives an overview of how rice fortification can benefit rice consumers and the rice industry as well as the different technologies available.

Q: What is the source of this information?

Answers to these frequently asked questions are primarily from the following three articles. Click on the title for more informaiton.

1. Piccoli, N.B., et al., Rice fortification: Its potential for improving micronutrient intake and steps required for implementation at scale. Food and Nutrition Bulletin, 2012, vol. 33, no. 4. S360-S372.
2. Muthayya, S., et al., Rice fortification: An emerging opportunity to contribute to the elimination of vitamin and mineral deficiency worldwide. Food and Nutrition Bulletin, 2012, vol. 33, no. 4, 296-307.
3. Alavi, S., et al., Rice fortification in developing countries: a critical review of the technical and economic feasibility. A2Z Project, Academy for Education Development, 2008.

Q: Where can I get more information?

• Guideline: Fortification of rice with vitamins and minerals as a public health strategy. World Health Organization, 2018.
• Technical considerations for rice fortification in public health. Annals of the New York Academy of Sciences, 2014, vol. 1324, nine papers.
• Summary of rice fortification's impact on nutrition. FFI, 2015.
• Rice Fortification Toolkit technical manual. Global Alliance for Improved Nutrition (GAIN) and PATH, 2015.
• Resources for implementing rice fortification, FFI

Q: How will fortification benefit me?

Wheat and maize flours and rice are most commonly fortified with iron, folic acid, and other B vitamins. Iron improves your capacity for physical activity and productivity. Iron also facilitates children’s physical and mental development and improves the health of pregnant women. When iron deficiency causes severe anemia, it contributes to maternal deaths.

Folic acid (vitamin B9) is needed for the health production of cells. It reduces the prevalence of neural tube defects such as spina bifida and anencephaly. These birth defects are permanently disabling or fatal. Severe vitamin B9 deficiency also leads to anemia.

Other vitamins and minerals frequently used in fortification and their role in health include:

Niacin (vitamin B3) prevents the skin disease known as pellagra. Riboflavin (vitamin B2) helps with metabolism of fats, carbohydrates and proteins. Note: Riboflavin cannot be added to rice as the orange color is too bright and will change the color of fortified rice. Thiamin (vitamin B1) prevents the nervous system disease called beriberi. Vitamin B12 maintains functions of the brain and nervous system. Vitamin D helps bodies absorb calcium which improves bone health. Vitamin A deficiency is the leading cause of childhood blindness. It also diminishes an individual’s ability to fight infections. Zinc helps children develop, strengthens immune systems and lessens complications from diarrhea.

Q: Will fortification harm me?

It is highly unlikely that anyone will get an excess amount of vitamins and minerals from fortified foods. Studies and research in countries with long histories of fortification have established overwhelming evidence of the protective effect of fortification.

A study published in 2004 found that the “prevalence of excessive micronutrient intakes in current European diets is non-existent or extremely low, even for consumers choosing higher amounts of fortified foods. Diet-based models indicate that future increases in the proportion of foods fortified at levels between 10 and 50% RDA (recommended daily allowance) would not be expected to lead to excessive intakes for the majority of vitamins and minerals.”

In the United States, most wheat flour and many breakfast cereals are fortified with folic acid. Also, vitamin supplements containing folic acid are widely available. Yet a population-based study found that less than 3% of U.S. adults exceeded the recommended upper level of folic acid. None reached that level by eating fortified foods; they only exceeded the level if they consumed high-dose supplements.

Q: Will fortification add to the cost of my flour, noodles, bread, rice, etc.?

The ongoing cost to fortify wheat and maize flour with quality iron, zinc, folic acid and other B vitamins ranges from US $1.50 to US $3 per metric ton of flour. If the miller passes that cost to the consumer, it amounts to only pennies per pound of flour. Reports from different countries all say the cost is less than 50 cents per person per year.

When Uzbekistan launched a flour fortification program in 2005, the cost was 120 Sums (around 10 US cents) per person, per year. The total cost of adding mandatory nutrients to flour in the United States is $0.07 per person per year. The retail cost of rice may increase 1-4% depending on the fortification method used.

Q: What kind and what levels of vitamins and minerals are in my rice and flour products?

Each country sets its own fortification standard, so this answer varies by country. The country standard is determined by the prevalence of vitamin and mineral deficiency in that country and the people’s typical eating habits. Global and some regional recommendations are available to help countries set standards. When FFI knows the country standard, the kind and levels of each nutrient are included in the country profile.

Q: What if I prefer unfortified flour or rice?

Countries which require fortification usually allow exceptions for certain types of whole wheat flour or perhaps brown or parboiled rice. If you prefer unfortified food, read the labels and choose these products.

Q: Why not just take supplements?

Supplements can provide protective health benefits when taken consistently as directed. People tend to forget to take supplements, however. They are costly for some consumers, and they carry slight risks of toxicity if taken in excess. Fortification, on the other hand, does not depend on personal behavior changes, and people are unlikely to consume too many vitamins and minerals from fortified foods alone.

With folic acid, for example, women need adequate levels of folic acid prior to conception and early in the pregnancy. If the pregnancy is unplanned, the woman may not be taking folic acid supplements to prevent neural tube birth defects. By the time she learns she is pregnant, it is typically too late for folic acid supplements protect against neural tube defects.

Also, supplement use is more prevalent among groups with higher education and income, and hence less likely to reach poorer population than a fortification program.

1. In a survey of 1,240 pregnant women in Quebec hospitals, 70% of respondents were aware of the preventive role of folic acid, but only 25 % had taken the recommended dose of supplements during the periconception period.

2. In a study conducted in Colorado, 53 % of mothers with a neural tube defect affected pregnancies did not know about the recommendation to consume 400 micrograms of folic acid.

3. In a study to evaluate the uptake of folic acid among 301 Northampton women in 2001, only 43 % women reported taking folic acid before pregnancy and 67 % consumed supplements with folic acid in the first trimester of pregnancy. Also, women under age of 21 and women from lower social classes were found to less likely to take folic acid supplements than women over the age of 21.

Q: Why not just eat a balanced diet?

Meeting nutrient requirements through the food alone is not a practical solution in many parts of the world for several reasons—economic, geographic, social and cultural.

Iron deficiency, for example, is one of the most widely prevalent nutrient deficiencies. The best source of iron is meat, fish, and poultry, but people’s ability to absorb iron from these sources is inhibited by other components in food. Also, many people do not eat meat for cultural reasons, personal beliefs or because meat is too expensive.

Vitamin B9 is present in small quantities in many foods. But women would have to consume an unrealistic amount of these foods to get the dietary equivalent of 400 micrograms of folic acid a day, which is the amount recommended to reduce the risk of a pregnancy affected by a neural tube defect. To get the dietary equivalent of 400 micrograms of folic acid a day, a person would need to consume one of the following:

• 4 slices of fried beef liver
• 44½ medium ripe tomatoes
• 14½ cups of raw broccoli
• 17½ cups of orange juice
• 19½ cups of raw green beans
• 5½ cups of black beans
• 200 medium red apples

Q: Does fortification change the appearance or taste of food?

Appropriately fortified rice resembles natural rice grains and has been shown to be indistinguishable from natural rice in appearance, taste and texture. When cooked, fortified rice has the same appearance, texture, and taste as cooked, unfortified rice.

Global recommendations for flour fortification are based on levels that will not affect the flour’s taste, smell, or appearance. Some people fear that iron could cause sensory problems at the levels recommended if flour consumption is less than 150 grams per capita per day. However a study of 15 kinds of noodles and breads commonly eaten in Asia showed that the foods would be acceptable to consumers if the food were made with fortified flour. The study included foods fortified with recommended iron levels for groups that eat less than 150 grams per capita per day.

Q: Will there be nutrient losses when fortified rice is rinsed before cooking?

Rice fortified with coating and extrusion technologies can be rinsed with minimal nutrient losses, depending on the types of nutrients added. Vitamins and minerals used in extrusion are evenly distributed and adequately sealed, resulting in high retention of most of the nutrients. Greater losses occur with coating and powder techniques, but limited data are available.

Q: Can fortified rice be cooked in the same way as unfortified rice?

Yes, fortified rice can be cooked in exactly the same way as unfortified rice.

Q: What vitamins and minerals are in cereal grains naturally?

Wheat, maize, and rice are natural sources of the following minerals: calcium, phosphorus, zinc, iron, and copper.

They are also natural sources of the following B vitamins: folate (B9), thiamin (B1), riboflavin (B2), niacin (B3), pyridoxine (B6), and biotin (B7).

Source: Bauernfeind and DeRitter, Nutrient Additions to Food

Q: Why are vitamins and minerals added to cereal grains during fortification?

Nutrients in cereal grains are mainly in the outer layers, and these are discarded as the grain is milled. Fortifying returns the lost nutrients, but simply restoring the nutrients may not be enough to make a health impact in populations where deficiencies have been identified. Appropriately fortifying grains with additional amounts of vitamins and minerals can improve public health.

Q: What nutrients are added to flour and rice in fortification?

This is different in every country. Global guidelines are available for wheat fortification, but each country is encouraged to consider its unique nutritional needs to establish fortification standards. Another consideration in setting standards is whether other staple foods are fortified. For example, if a country fortifies cooking oil with vitamin A, it might not include vitamin A in fortified wheat flour.

The most common nutrients added to flour are iron and folic acid, a form of vitamin B9. Other vitamins commonly added to flour are thiamin, riboflavin, and niacin. Likewise, rice is commonly fortified with iron and most of the B vitamins. Riboflavin (vitamin B2) is usually not added to rice because its orange color changes the appearance of rice.

The following table shows the types of common nutrients and their compound form that are used in fortification of cereal grains:

• Vitamin A: Vitamin A Palmitate water dispersible, spray dried stabilized; Vitamin A Acetate water dispersible spray dried, stabilized
• Vitamin B group: B1 Thiamine Mononitrate, B2 Riboflavin Hydrochloride, B3 Niacin or Nicotinamide, B5 Calcium Panthothenate, B6 Pyridoxine hydrochloride, B9 Folic acid, B12 Cyanocobalamin 0.1% or 1% spray dried
• Vitamin D: D3 Cholecalciferol
• Calcium: Calcium Carbonate, Calcium Sulphate
• Iron: For flours: Sodium Iron EDTA, Ferrous Sulfate, Ferrous Fumarate, Electrolytic Iron powder For rice: Ferric pyrophosphate
• Zinc: Zinc Oxide, Zinc Sulphate

Q: How much of each nutrient is used in fortification?

This is different in every country. Some factors to consider in determining the amount of each nutrient to include in fortification are:

• Vitamin and mineral deficiency among the population
• Average flour/rice consumption
• The body's ability to absorb the vitamin or mineral compound
• Effect on the food’s sensory properties
• Ongoing cost to buy premix of vitamins and minerals for fortification

Q: Does flour and rice fortification help reduce vitamin and mineral deficiencies in the general population?

Fortifying flour with iron has been shown to improve iron status among specific populations in at least four countries: China, Iran, Venezuela, and Fiji. Many countries with fortification programs, however, do not measure iron status before and after fortification. Eight sub-national studies have found that fortifying flour with folic acid reduced the incidence of neural tube birth defects such as spina bifida by 31% to 78%.

Several controlled research studies conducted in children and young women have demonstrated that regular consumption of rice fortified with adequate levels of easily absorbed nutrients results in a significant reduction in the prevalence of micronutrient deficiencies.

Q: Is it safe for children and pregnant/lactating women to eat fortified foods every day?

Children and pregnant and lactating women especially benefit from consuming fortified foods as they require high levels of vitamins and minerals to support physical growth and the development of new tissues. When many fortified foods reach the same population, a country may want to conduct a comprehensive analysis of food consumption to ensure that the population is not consuming excessive levels of nutrients.

For example, United States residents have access to folic acid in foods made with enriched flour, breakfast cereals that are voluntarily fortified, and through easily-accessible vitamin supplements. Yet a study found that only 2.7% of the adult population consumed excessive levels of folic acid, and only people who took high-dose supplements reach the high levels.

Q: Are there any known side effects to consuming fortified rice, wheat, or maize flour?

No side effects on health have been reported in the studies published on fortified rice or wheat and maize flour.

Q: How fast can health effects of consuming fortified food be expected?

When appropriate levels of easily absorbed iron are used, fortification can impact iron status within 12 months after the program is fully implemented if the vulnerable population consumes fortified products daily. As it takes time for programs to be fully operational, fortification leaders estimate it may be three years between fortification’s initiation and a nutritional impact on iron status.

With folic acid, changes in folate status may be observed within 3 to 4 months after fortification is fully implemented. It will take at least 12 months to see an impact on neural tube defects because women need to be consuming folic acid at the time they conceive to prevent these birth defects.

Q: Is fortification cost-effective?

The benefits of fortification far outweigh its associated costs.

The economic consequences of iron deficiency include reduced work capacity, undeveloped physical and mental skills, and increased risk of maternal death. The mental capacity that is undeveloped when children are iron deficient is never regained. That affects their academic performance and future earnings potential. Consequently childhood anemia is associated with a 2.5% drop in wages in adulthood. The median value of annual physical productivity losses due to iron deficiency is $2.32 per capita, based on illustrative calculations for 10 developing countries. Median total losses which include both physical and cognitive losses are $16.78 per capita.

The Copenhagen Consensus, a panel of the world's leading economists who meet every four years, consistently rank improving nutrition as one of the most cost-effective ways for governments and philanthropists to spend aid and development money. See the results from 2012 and 2008 and 2004.

The most obvious economic impact is healthcare expenditures averted when neural tube defects (NTDs) are prevented by fortifying with folic acid. The most common of these birth defects is spina bifida. These children have varying levels of paralysis and loss of bowel and bladder control. They undergo a lifetime of surgeries and often have many complications as a result of spina bifida. These surgeries and treatment take a toll both emotionally and financially.

Q: Who pays for fortification?

Costs associated with fortification are often shared by the public and private sectors. In most cases, millers are responsible for capital investment in machinery, testing supplies for mill quality control, and staff training while the state pays for national quality assurance, monitoring, and evaluation. Determining who is responsible for these various costs requires dialogue between government and industry.

To reduce costs for flour fortification, milling associations sometimes order premix in large quantities, have it delivered to a central location, and then distribute it among members. Governments may eliminate import taxes on premix or fortified flour and flour products, provide tax incentives for investment in new equipment, or subsidize fortification start-up costs. Non-governmental organizations in some cases offer grants for start-up costs.

When costs are passed on the consumer, the incremental increase in retail cost of fortified flour and rice is negligible. For 1 kilogram of flour, the increase may be around US$ 0.00063, or 0.16% of current retail price. For 1 kilogram of fortified rice, it may be around 1.5 - 3% of current retail price (between 8 and 16 US cents per 10 kg of rice).

Q: Will the free market system be impeded?

In the model free market, buyers and sellers engage in transactions without any government intervention or regulation, and the price of goods results solely from supply and demand. In reality, many government controls affect transactions, and mandatory fortification laws are no greater impediment to the free market system than these laws.

Q: Does fortification impact trade (imports and exports)?

The technical specifications for fortification do not prevent trade between countries, but any country considering fortification should address its unique international and regional trade obligations. For instance, Pacific Island countries have to respect World Trade Organization (WTO) Agreements, Pacific Island Countries Trade Agreement (PICTA), the Pacific Agreement on Closer Economic Relations (PACER), the Cotonou Agreement, and various Compacts of Free Association with the United States of America.

Since fortification specifications are considered technical specifications, they are most impacted by the Agreement on Technical Barriers to Trade (TBT Agreement) of the WTO. The agreement notes that it allows members to implement measures to protect human health.

In general, the WTO requires non-discrimination between trading partners as well as non-discrimination between imported and locally-produced goods. It would seem that mandatory fortification discriminates against trade partners that do not produce flour or rice according to the country’s standards. However, exceptions to the WTO principles of non-discrimination allow member countries to adopt trade measures ‘necessary to protect human, animal or plant life or health.’

To prove that a measure meets this criterion, the country must show that (1) the measure is necessary to meet a public health need and (2) the measure is not a disguised attempt to restrict trade or promote discrimination. Countries which evaluate the vitamin and mineral deficiencies in their population then set fortification standards to address those deficiencies meet those criteria.

Most countries mandating fortification are members of the World Trade Organization (WTO), and a few are observer governments. It is therefore unlikely that other countries interested in mandatory fortification would be in danger of compromising WTO obligations.

For more information: A Study on Regulatory Requirements for Food Fortification in the Pacific

Q: How much does it cost to fortify?

The costs of fortification depend on a number of factors including the vitamins and minerals included in the pre-mix and the type of iron fortificant used.

Costs to the flour milling industry are outlined in the Frequently Asked Questions (FAQ) for Millers. Several studies estimate that the cost to fortify flour with iron alone is between US$ 0.05 and US$ 0.07 per person per year. The cost of including other nutrients such as folic acid is minimal once the equipment and procedures for fortification are in place.

Costs to fortify 1 metric ton of rice is only about US$ 15, and the cost of providing a child a school lunch meal of fortified rice daily for an entire year is about 40 US cents.

Q: If my country is already fortifying, what costs are involved in changing country standards for fortification?

Revising a country’s existing standards may involve organizing a multi-sector group to review the current policy and develop new recommendations. If new standards are necessary, some costs may be involved in publishing the new standards for premix, the milling process, and/or point of sale of fortified foods.

Changes in premix formulation may require changes in internal and external quality assurance processes like the purchase of new laboratory testing equipment. As an example, most iron compounds used in flour fortification can be monitored with a traditional spot test, but the sodium iron EDTA compound requires different testing methods. If a country changes its required iron compound to sodium iron EDTA, new testing materials will be needed.