Food fortification temporary measure to tackle malnutrition: ICMR-NIN director

Food fortification with one or more micronutrients of public health importance is considered to be one of the practical approaches by policymakers, and implementation agencies as it does not require behavioural modification, which is difficult to achieve across population groups, Hemalatha told PTI.She said efficacy studies such as randomised control trials RCTs using iron fortified rice conducted under the MDM programme supervised feeding improved iron stores of the children and reduced anaemia.

The ICMR's National Institute of Nutrition Director Dr. Hemalatha R has said that the fortification of food should be seen as a temporary measure to address the problem of malnutrition until more upstream long-term approaches are achieved.

She noted that the fortification program is designed to fill the gap between the actual intakes and the requirement of a particular nutrient.

Her remarks come over some concerns raised by experts that fortified food cannot be considered as a replacement for a well-balanced diverse diet.

The government is planning to fortify the rice distributed to the poor via different schemes such as midday meals in a bid to tackle malnutrition.

Prime Minister Narendra Modi had recently announced that whether through ration shops or the Midday Meal (MDM) scheme, the rice made available under every government program would be fortified by 2024.

The Indian Council of Medical Research-National Institute of Nutrition director said micronutrient deficiency is primarily due to inadequate dietary intakes, poor food quality, and lack of minimal dietary diversity. ''Food fortification with one or more micronutrients of public health importance is considered to be one of the practical approaches by policymakers, and implementation agencies as it does not require behavioral modification, which is difficult to achieve across population groups,'' Hemalatha told PTI.

She said efficacy studies such as randomized control trials (RCTs) using iron-fortified rice conducted under the MDM program (supervised feeding) improved iron stores of the children and reduced anemia. ''However, supervised feeding and deworming even without fortified rice also improved hemoglobin levels and reduced anemia. The above results are from studies that supervised the feeding program and hence, cannot be generalized. Effectiveness trials on fortified rice in real-life conditions have not been conducted so far in India, therefore the benefits of rice fortification are not yet fully understood,'' Hemalatha said.

Responding to concerns that fortified foods cannot be treated as a substitute for a good quality diet, she said fortification of food should be seen as a temporary measure until more upstream long-term approaches such as diet diversification are achieved.

''Fortification programs are designed to fill the gap between the actual intakes and the requirement of a particular nutrient. But a diversified diet provides all the nutrients required for good health. A balanced diet that sources nutrients from a minimum of eight food groups have the potential to deliver all the required nutrients. Fruits, vegetables, nuts, and oilseeds can be great sources of vitamins, minerals, and bioactive substances essential for health and immunity,'' she said. ''Legumes, pulses, beans, peas as well as poultry, meat, and most preferably fish are important sources of essential fatty acids and amino acids crucial for immunity, and to combat micronutrient deficiencies. In addition, milk or curd is not only rich in quality protein but also calcium and essential fats. Similarly, whole grains, cereals, millets are important sources of energy, protein, fiber, and other nutrients,'' the national institute of nutrition director added.

Elaborating on how rice fortification is done, she said the fortified rice kernels (FRK) are produced either by a hot or cold extrusion process and the target nutrients, along with other stabilizing ingredients, are added to rice flour, made into dough through a preconditioning process, extruded in twin screw extruder machines using a die with rice-shaped inserts and dried on dryer belts. The level of fortificants in the FRKs should conform to the standards of the national regulatory body. This FRK is mixed with natural rice to prepare fortified rice based on the scientific evidence on the dietary needs of the population. Usually, the appropriate ratio is 1:100; that is one fortified rice kernel for 100 unfortified normal rice, Hemalatha said.

The experts said fortified rice cannot be considered as a replacement for a well-balanced diverse diet but needs to be viewed as a complementary food to the daily diet to meet the gaps in nutrients noted in the Indian diet consumed by masses.

Dr. Sheila Vir, the director of Public Health Nutrition and Development Centre, said since a diverse diet comprising food items from at least eight food groups in not accessible easily to one and all, interventions like fortification of staple food item contributes to improving the nutrition quality of food and contribute to improving nutrition security of men, women, adolescents, and children in the country.

''Rice, a cereal staple of 65 percent of Indians, is devoid of nutrients such as vitamin B12 and further processes like milling and polishing lead to loss of iron and folic acid content. The addition of these micronutrients to rice during fortification at levels that provide 30-50 percent of daily recommended dietary allowances will improve the nutrient quality of diet which otherwise is not available,'' she told PTI.

Vir further said that with the development happening in the area of rice fortification, special attention would be needed to develop strong quality assurance and quality control systems and monitoring mechanisms to ensure that the quality of the product is maintained throughout the supply chain and beneficiaries get the maximum benefit from it.

Sakshi Jain, the national program manager of Food Fortification for India, said one of the most effective, scalable, affordable, and sustainable ways to address micronutrient deficiencies among vulnerable populations is through the distribution of fortified staples via the social safety net programs.

The prime minister's recent announcement on the fortification of all rice supplied through the Public Distribution System by 2024 will require synthesized efforts from all stakeholders ranging from the rice producers, millers, quality controllers, and policymakers to convert the significant, Jain said.