Micronutrient Fortification of Foods Current Practices, Research, and Opportunities

Home , Artificial rice, Enriched flour, Food fortification, Fortification

Micronutrient Fortification of Foods Current practices, research, and opportunities

The Micronutrient Initiative

International ARCHlyu •• Agricultural Centre 104386 Micronutrient Fortification of Foods Current practices, research, and opportunities

1DRC - L.ib. Mahshid LatH M.G. Venkatesh Mannar Richard J.H.M. Merx Petra Naber-van den Heuvel © 1996 The Micronutrient Initiative (MI), do International Development Research Centre (IDRC)/InternationalAgriculture Centre (IAC)

Ml: P.O. Box 8500, 250 Albert Street, Ottawa, Ontario, CanadaKI G 3119 Tel: 613 236 6163; Fax: 613 236 9579; Telex: 053-3753 JAC: P.O. Box 88, LawickseAllee 11,6700 AB Wageningen,The Netherlands Tel: 31 317490355; Fax: 31 317418552

ISBN: 0-660-16230-X

The viewsexpressed in this publication are those ofthe authors and do not necessarilyrepresent those of the International Agricultural Centre or the Micronutrient Initiative or the sponsoring organizations.Mention of a proprietary name does not necessarilyconstitute endorsementof the product and is given only for information. CONTENTS

PREFACE vii

1. INTRODUCTION 1

THE PROBLEMOF MICRONUTRIENTMALNUTRITION: MAGNITUDE, CONSEQUENCES,AND CAUSES 1

ELIMINATION OF MICRONUTRIENTMALNUTRITION: AN OPPORTUNITYTO IMPROVE LIVES 2

GENERAL FEATURES OF INTERVENTIONSAND THEIR APPLICATION 3

REFERENCES 5

2. DEVELOPING A FOOD FORTIFICATION PROGRAM 7

RATIONALE AND OBJECTIVES 7

ROLE OF THE FOOD INDUSTRY IN FORTIFICATIONPROGRAMS 8

REFERENCES 10

3. FOOD VEHICLES AND FORTIFICANTS 11

SELECTIONOF FOOD VEHICLES 11

SELEcTION OF FORTIFICANTS 11

SOURCES OF FORTIFICANTS 11

STABILITY AND INTERACTIONSIN THE DIET 13

COST OF FOOD FORTIFICATION 14

BIOAVAILABILITYAND BIOCONVERSION OF MICRONUTRIENTS 1 5

LEVEL OF FORTIFICATION 1 6

TOXICITY CONSIDERATIONS 1 7

SINGLE FORTIFICATION 18

MULTIPEE FORTIFICATION 20

REFERENCES 22

4. FOOD FORTIFICATIONTECHNIQUES 25

FORTIFICATIONPROCEDURES 25

POINTOF FORTIFICATION 27

PACKAGING 27

REFERENCES 30

MicronutrientFortification of Foods iii 5. QUALITY ASSURANCE AND CONTROL 31

REQUIREMENT FOR QUALITY ASSURANCE(QA) 31

ESTABLISHINGA SUCCESSFUL QA PROGRAM 31

DEVELOPMENT AND IMPLEMENTATIONOF QA/QC SYSTEMS 32

QUALITY MANAGEMENT SYSTEM 32

PRODUCT QUALITY MONITORING 33

MoNITORINGBY GOVERNMENT AND BY CONSUMERS 34

DETERMINATION OF LEVEL OF FOR11FICATION 34

REFERENCES 35

6. LEGISLATION AND REGULATIONS FOR FOOD FOR11FICATION 37

REFERENCES 38

7 REVIEW OF RESEARCHAND CURRENT PRACTICESIN MICRONUTRIENT FORTIFICATION 39

SINGLE FORTIFICATIONWITH IODINE 39 SALT 39 WATER 41 OTHER VEHICLES 42

SINGLE FORTIFICATIONWITH IRON 43 WHEATFLOUR AND BREAD 43 MILK AND MILKPOWDER 46 INFANT FOODS/FORMULAS 47 BISCUITS 50 RICE FLOUR 52 SALT 52

FISH SAUCE(NAMPLA) 54

CURRY POWDER(MASALA) 56 OTHER VEHIClES 57

SINGLE FORTIFICATIONW1H VITAMIN A 58

FATS AND OIlS 58 SUGAR 60 MILKAND MILK POWDER 63

RICE (ULTRA RICE) 65 TEA 66

MONOSODIUM GWTAMATE (MSG) 69

OTHERVEHICLES 72

REFERENCES 74

iv Mkronutrient Fortification of Foods 8. OPPORTUNITIES FOR MULTIPLE FORTIFICATION 81

DOUBLE FORTIFICATIONWITH IODINE AND IRON 81

SALT 81

FISH SAUCE 82

DOUBLE FORTIFICATION WITH IRON AND VITAMIN A 82

RICE 82

SUGAR 86

BLENDED/FORMULATEDFOODS 86 MAIZE 88

WEANING RUSK 89

OTHERVEHICLES, e.g., MONOSODIUM GLUTAMATE 90

MULTIPLE FORTIFICATION WITH IODINE, IRON, AND VITAMIN A 90 CEREAL-BASEDFLOUR 90 INFANT FOODS/FORMULAS 90

PROCESSEDBEVERAGES 92

FORTIFICATIONOF FOOD AID 92

REFERENCES 94

9. IMPLEMENTATION ISSUES AND RESEARCHNEEDS 97

IMPLEMENTATIONISSUES 97

RESEARCHNEEDS 97

RECOMMENDATIONS 98

APPENDICES 100

1. POTASSIUM IODATEPRODUCERS AND QUALITY SPECIFICATION 100

2. A. COMMERCIALLYAVAILABLE IRON COMPOUNDS AND THEIR RELATIVECOSTS 101

B. RELATIVECOSTS OF COMMONLY USED IRON SOURCES 102

3. COMMERCIALLYAVAILABLE VITAMIN A AND CAROTENOIDSIN FOOD FORTIFICATION 103

A. VITAMIN A USED IN FOOD FORTIFICATION 103 B. SOME APPLICATIONSOF CAROTENOIDSAS VITAMIN A PRECURSORS 104

4. COMPOSITION OF SOME FORTIFICATIONPREMIXES PRODUCEDBY DIFFERENT MANUFACFURERS 105

5. ACRONYMS AND ABBREVIATIONS 106

MicronutrientFortification of Foods v

PREFACE

— Deficiencies in three micronutrients— iodine, iron, and vitamin A are widespreadaffecting more than a third ofthe world'spopulation. Individuals and families suffer seriousconsequences including learning disabili- ties, impaired workcapacity, illness, and death.They could waste as much as 5°Io ofgross domestic product (GDP). Addressingthem comprehensively, using an array of low-costsolutions, could cost less than 0.3°Io of GDP. In the words of the World Bank in its recentpublication "Enriching lives"". . . No other technologyoffers as largean opportunity to improvelives . . . atsuch low cost and in such a short time

Many national governments atthe World Summit for Childrenset the target to eliminate deficiencies in micronutrientsin populationsthroughout the world by the year 2000. The basicobjective of all national micronutrientprograms is to ensurethat needed micronutrientsare available and consumed in adequate amountsby vulnerablepopulations. Strategies should be appropriateto the needand should use existing deliverysystems and availabletechnologies where they servethat need. Acombination of interventions involving the promotion ofbreastfeeding, dietary modification(e.g., improving food availability and increasing food consumption), food fortification,and supplementationmay needto be emphasized and implemented. The fortification of commonlyeaten foods with micronutrientsis one ofthe main strategiesthat can be used to improvemicronutrient status. Fortificationshould be viewed as partof a rangeof measures that influence the quality offood including improvedagricultural practices, improvedfood processing and storage,and improved consumereducation to adopt good food preparationpractices.

Today,in deveJoped countries where there is a high dependence on processed foodsand industriesare stream- lined and automated,food fortification has played a major role in the health ofthese populationsover the last 40 years, and several nutritional deficiencies have been eliminated. In the developingcountries too, fortification is increasinglyrecognized as a measure to improvethe micronutrientstatus of large populations.When fortification is imposed on existing food patterns, itmay not necessitate changes in the customary dietof the population and will not call for individual compliance. Thus, fortification can oftenbe implementedand sustained over a long period. It can, therefore, be the most cost-effective means of overcomingmicronutrient malnutrition.

The food industry is playing an increasinglycritical and complexrole throughout the world. In the developed countries,changes in living and marketplacepatterns have stimulatedchanges in food industry practices, resulting in a diversity offood-processing technologies and ever-changingnumbers and types offoods on the market shelves. As the food industry is increasinglydriven by market forces into the global marketplace it is faced with a significantly differentscenario. In marked contrast to the developed world, most developing countriesare grappling with fundamental issues of providing adequate food suppliesto feed their expanding populations. Simple nutritional and technologicalsolutions to the problemsof micronutrient malnutrition exist but are often complicated by economic, social, and political factors.Intervention strategies must take thesefactors into account. This is the challenge, as well as the opportunity,for the food industry to play a key role in improving the physical,social, and economic well-being of billions ofpeople.

This manual has beenprepared to facilitateand encourage large-scale implementationof fortification programs in countries where micronutrientmalnutrition is prevalent. It respondsto a long-feltneed for a comprehensive documentationof technologiesand opportunities for fortification. Giventhat technologiesare in different stages of developmentand application,an attemptis also madeto review critically the status ofthese technologies and identify the steps involved in refining themfor large-scale application.In addition, the manual appraisestheir technologicalfeasibility, practicability, cost effectiveness, and consumeracceptability. An annotatedbibliography on food fortification,containing more than 500 references with abstracts, including the references mentioned in this manual,will be publishedas a companionvolume. It is hopedthat this manual will be a useful reference for national micronutrientprogram managersand food

MicronutrientFortification of Foods vii industry managersto plan and expandfood fortification as a long-termand sustainablesolution to the global problem ofmicronutrient malnutrition.

This documentis a productof a unique collaboration between the InternationalAgricultural Centre (IAC) in the Netherlandsand the MicronutrientInitiative (Ml) in Canada. It has also evolved out of experience gained in organizingthe short-termtraining course in food fortification at the IAC. The authorsare gratefulto Ms i. Cervinskas (Ml), and Ms F. de Boer(IAC) for overall technical review of the document.

Specific chapters have also benefited greatlyfrom critical reviews and inputs fromexperts in nutrition and from the food industry, especially Dr DavidYeung (Heinz Canada), Dr George Purvis, Dr Haile Mehansho(Proctor a Gamble), and DrFrits van der Haar and Dr Robin Houston (Programme AgainstMicronutrient Malnutrition (PAMM), Emory University). Ms M. de Kort (IAC) provided technical assistance to review projectexperiences in micronutrients.Special thanks are also dueto Ms KatherineKealey for editing and productioncoordination and Mr Bob Albery for layout and design, and to Ms Alison Ball (IDRC Library)who assisted with the librarysearch for relevantinformation andpublications and MsTanya Guay and Ms Alison Greig (Ml) for their administrative assistance.

The support from the Governmentof the Netherlandsfor the printingand distribution ofthis publicationis gratefully acknowledged.

Mahshid Lotfi M.G. Venkatesh Mannar The MicronutrientInitiative

Richard J.H.M.Merx Petra Naber-van den Heuvel InternationalAgricultural Centre

viii Micronutrient Fortification of Foods 1. INTRODUCTION

THEPROBLEM OF MICRONUTRIENT MALNUTRITION: • Solutions for eliminatingthese deficiencies are known, MAGNITUDE, CONSEQUENCES, AND CAUSES arefairly easy to implement,and are cost effective. A significantproportion ofthe world'spopulation suffers from, For all three micronutrients, prevalencerates are muchhigher or is atrisk of, deficiencies ofvitamins and minerals,com- in developingrelative to developedcountries. Iron deficiency, monly referredto as micronutrients. Adequate intake and however, is so prevalentthat even in developednations the availability of these dietary essentialvitamins and minerals are rates among some pregnant women may reach the levelsof closelyrelated to the survival,the physical and mentaldevelop- public health significance. ment, the general good health, and the overall well-being ofall Therehave been severalstudies to identify the extentand individuals and populations. severityof micronutrient malnutrition in developingcountries. Vitamin A, iron, and iodineare three major micronutrients Its distribution is illustratedin Table 1-1. attractingmuch attention,particularly in the last decade.The IODINE DEFICIENCY DISORDERS(IDD) reasons behind focusingefforts on reducingthe deficiencies of these three micronutrients are: Iodine deficiency is probablythe first nutritional disease as both effects of iodine in • Basedon availableinformation, vitaminA, iodine,and recognized by mankind, deficiency theform ofgoitre and cretinismand its dietary treatmenthave iron deficiency anemia are highly prevalentin the world been known since ancienttimes. The today; thyroid gland, requiring iodine for producingits hormones, enlargesin iodine defi- • Available information serious adverse points tothe ciency, making goitre (enlarged thyroid) the best known sign of ofthese deficiencies for and consequences physical deficiency. Goitre, however, is only one indicator, and there are mental health, education,work capacity, and economic many deficiencies that may begin before birth and persist efficiency; throughoutthe life cycle. Infants born to iodine-deficient • Although someof the obvious clinical consequencesof women, if they survive, may be cretins with short life expect- micronutrient malnutrition have been known for a long ancy, physically or mentally retarded,and deafor mute and time, the global dimensionsand broad spectrum of spastic, depending on the degree ofiodine deficiency. The term detrimentaleffects of even mild micronutrient deficien- iodinedeficiency disorders (IDD) has thus been introduced cies on physical and mentaldevelopment, mortality, since 1983to representthis spectrum of physical and mental and morbidity have been recognized only recently; deficiencies (Hetzel 1983). Iodine deficiency is the most commoncause of preventablemental retardation. • The extent ofthese deficiencies at population and individual levelscan be measured relatively accurately; Today, roughly 1.6 billion people live in areas where soils lack and sufficient iodine.About 655 million people have goitre,

Table 1-1. Population at riska of and affected by micronutrient malnutrition(in millions).

Africa 181 86 53 49 206

Americas 168 63 16.1 20 94 SoutheastAsia 486 176 126.5 69 616

Eastern Mediterranean 173 93 16.1 22 149 Western pacificg 423 141 42.1 27 1,058 Total 1,572 655 254 2,150

aNumberof persons living inareas at risk of IDD and numberof preschool children living in vitamin Adeficient areas. bWHOregions. CSource:WHO 1994a. dRefleestimates only fromdata availableto WHOin 1994 (source: WHO 1995). epopulationaffected bysubclinical, severe, andmoderate deficiencies. Preschoolchildren only (source: WHO 1992,1 994b). lncludingChina.

Current Practices, Research,and Opportunities 1 whereas43 million are affected by somedegree of mental VAD begins as a silent, unseenthreat that, if untreated,can impairmentof which 6 million are cretins.More than half of the eventually rob children oftheir eyesight and their lives. The affected individuals live in China and India. progressiveeffects of vitamin A deficiencybegin when a child can no longersee in dim light and thus suffersfrom whatis By far, the major cause ofIDD is a low iodine contentin the known as "night blindness" or xerophthalmia.As the affliction soil and local environment.There are large areas, particularly continues,the eye's conjunctivaand corneabecome dry, mountainous and flooded riverines,that are deficient in iodine. lesionsthen appear on the corneaand, in the severest (clinical) The situation is further aggravated by mankind's own mis- form, the corneasimply melts away causingpermanent deeds:deforestation accelerates soil leaching, which, in turn, blindness. Although clinical vitamin A deficiencyposes a major washes away the iodine from the topsoil. Foods grown and threatto children'shealth, thosewith mild xerophthalmiaor consumed on iodine-deficient soil will not provide enough subclinical vitamin A deficiencyare also at increased risk of iodineto the population and livestockin the area. Entire sufferingfrom commonchildhood illnessesfound in most communitiescan thus be affected by thesedisorders. developingcountries. These include in particularmeasles, The aetiologyof iodine deficiency is differentfrom the other respiratorytract infections, and diarrheal diseases. Children two micronutrientdeficiencies in that itmainly results from who have adequate vitaminA status or thosetreated with geological rather than socialand economic conditions.The vitamin A, however,have immune systems that are better effects of iodine deficiency, however, may worsenwhen equippedto deal with problemsassociated with diseases like combinedwith poverty, generalmalnutrition, poorsanitation, measles. and area remoteness with little contribution of food to the diet Vitamin A exists in more than 60 at a from outside an iodine-deficient area. deficiency countries, clinical and/or subclinical level. Based on the available data IRON DEFICIENCY ANEMIA (IDA) projected to reflect conditionsin 1994,the global estimates of Iron deficiency anemia (IDA) is the world'smost prevalent the numbersof children 0—4 years of age clinically affected by nutritional deficiencymaking up about half ofall the different vitamin A deficiencyis 2.8 million, and thoseseverely! types of anemias. Accordingto the World HealthOrganization moderately subclinicallyaffected is 251 million (WHO 1995). (WHO), more than 2 billion peopleare at risk of IDA or are Thus, at least254 million children of preschoolage are "at affected by someform of anemia. Almost half ofall women and risk" in terms of their health and survival. VAD is the second children in developingcountries have anemia. Childrenwith largestcause ofglobal blindnessnext to cataracts. IDAsuffer impaired mentaland physicaldevelopment. The major causeof vitamin A deficiencyis inadequate dietary Pregnant women and young childrenwith IDA have a signifi- intakeof the preformed retinol or precursors ofvitamin A. cantly diminishedability to combat infection. IDA in adults Increased vitamin A requirementin certain physiologicalor causes fatigueand contributesto low workcapacity. Moreover, pathologicalconditions, inadequate absorption, or loss of iron deficiencyin terms of deficientiron stores in the body can intestinal contents in diarrheaare often contributoryfactors in exist withoutclinical anemia. establishingvitamin A deficiency. Iron is found in animal productssuch as red meat and in ELIMINATION OF MICRONUTRIENTMALNUTRITION: vegetables, grains,and legumes. Red meatprovides readily AN OPPORTUNITYTO IMPROVE LIVES absorbable iron, but iron from plant sources is much less absorbable. Absorptioncan be enhanced if meat is part ofthe Deficiency of essentialmicronutrients causes learning disabili- diet or if foods rich in vitamin C are consumed at the same ties, mental retardation,poor health, low workcapacity, time, In fact, a major cause of IDA is the low bioavailabilityof blindness,and prematuredeath. The adverse effects of iron in largely cereal- and legume-based diets leadingto poor micronutrientmalnutrition for survival, growth, development, absorptionof the iron from diets. In such instances, the iron and quality of life through a widespectrum of specific disorders status ofthe population can be improvedby modificationof are now known betterthan ever before. Together, these dietary habitsand the applicationof appropriatefood process- disordersrepresent a loss to the socialand economic potential ing techniques. ofnational societies that no country can stand to afford.

VITAMIN A DEFICIENCY (VAD) The arguments for accelerating investment in eliminationand Such Vitamin A deficiencyhas long beenidentified as a serious and controlof micronutrientmalnutrition are compelling. chances for and mental preventable nutritional disease, but the extent to which investmentspromote survival, physical health and and economic populationsare affected by it and the implicationsof the effects well-being, productivity, improve- for survival and health have onlybeen realized more recently. ment. In fact, accordingto a World Bank publication (World and Basic research has conclusivelydemonstrated the far reaching Bank 1994) "Deficiencies ofjust vitamin A, iodine, domestic biological effects of vitamin A deficiency. iron. could waste as much as 5 percentof gross

2 MicronutrientFortification of Foods product(GDP), but addressingthem comprehensivelyand GENERAL FEATURES OF INTERVENTIONS AND THEIR sustainablywould cost less than 0.3 percentof GDP:' APPLICATION

Globalattention to understandbetter and to controland The main interventionstrategies againstmicronutrient malnutrition are: eliminatemicronutrient deficiencies reached a high level when in 1990 specific goals for the eliminationand controlof • Direct supplementationof vulnerablepopulations or mtcronutrientmalnutrition by the year 2000 were adopted by groups with micronutrientsupplements, heads of states and governments at the World Summit for • Dietary improvement,and Children held in New York. The goals included: • Fortification of commonfoods with micronutrients, • Virtual eliminationof iodine and vitamin A deficiencies, and These interventionsdemonstrate two main approaches to the • correction ofmicronutrient deficiency problem:supplementa- Reduction of iron deficiencyin women byone-third of tion with pharmacological preparations, which is a medically 1990 levels. based intervention;and food fortification/dietaryimprovement, This political commitmenthas beenreexamined at various which usesa food-based approach to solving thesedeficien- high-level global and regionalmeetings since 1990. For cies. In any case, the major aim ofall these strategiesis to instance, at the PolicyConference on Hidden Hungerin improvethe micronutrientstatus of deficientindividuals, Montrealin 1991, about 250 representatives from more than communities, and populations. 60 and internationaland bilateral governments major agencies Supplementationthrough periodic administrationof pharmaco- concluded that the World Summit for Children were well goals logical preparationsby injections or in the formof capsules or within reach of the technical and financialmeans available. The tablets is an effective strategywhereby substantial and almost World Declarationon Nutrition proclaimedby ministers of immediatebenefits can be brought to the most at-risk groups. more than 1 50 United Nations memberstates at the Interna- In situationswhen there is a clinical urgency, micronutrient tional Conference on Nutrition in Romein 1992 also reiterated supplementationis of immensevalue to saving sightand life. the commitmentsto theseeminent nutrition global goals. The supplementationstrategy is a relatively low-costmeasure micronutrient It the Subsequent tothe commitmentsmade by governmentsat the against deficiency. only improves,however, World Summit for Children and the InternationalConference on micronutrientstatus of thosewho received the appropriately administeredmedical behind thosehard Nutrition, much groundwork has beendone in manycountries preparations,leaving to accelerate the reductionof micronutrient malnutrition. to reach or practicallyunreachable at-risk groups (those who are the most deficientand from the effects ofthe National programsthat draw on the combinedresources of probably ill as well as other householdand government,industry, scientific, and grassrootsorganizations deficiency), community members not to receive kind of are being designedand implemented. targeted any supplementation. If micronutrientdeficiency existseven in a mild form in the As a meansto catalyze and facilitate global actionsfor elimina- community, it can be assumedthat it will persistand continue tion and controlof micronutrientmalnutrition, the Micronutrient to harm the health and well-being ofindividuals. Supplemen- Initiative was created by its principal sponsors.1 Although a tationoften requiresa largeforeign currencyinput and an combination ofthe main three strategiesto overcome micronu- elaborate and costlydistribution system. Moreover, if the trientmalnutrition (supplementationwith high micronutrient micronutrient has to be administeredon a doses, dietary improvement,and food fortification) is encour- supplement regular basis (as is the case with lower dosesof vitamin A prepara- aged, micronutrientfortification of foods is seen as a sustain- tions), "patient compliance" is a prerequisitefor success. able strategythat can oftenbe implementedcost effectively on a largescale to cover deficientpopulations. Realizingthat no Dieta,yimprovementaims to increase dietary availability, other agencies/groups have currently focused their activities in regularaccess, and consumption of vitamin- and mineral-rich this field,the Initiative has paid particularattention to micronu- foods in at-risk and micronutrient-deficientgroups of trientfortification offoods and food items commonly consumed populations in developingcountries. Such efforts involve by the Third World population to ensurethe realizationof the changes in dietary behaviourof the targetedpopulation. The full potentialof fortificationas a meansto control and eliminate strategyis reportedlyeffective but requires a relativelylong micronutrientmalnutrition. time to achieve concrete results.

The MicronutrientInitiative is currentlysponsored bythe Canadian International Development Agency (CIDA), the International Development Research Centre (IDRC), the United Nations Development Programme (UNDP), the UnitedNations Children's Fund (UNICEF), andthe World Bank.

Current Practices,Research, and Opportunities 3 Fortification of foodswith thosemicronutrients that have been Because ofextensive damages to health and well-being caused shown to be insufficientin the daily diet has, to a large extent, by micronutrientmalnutrition, its elimination bywhatever beenresponsible for the elimination ofvitamin and mineral means, should be regarded as a moral duty ofgovernments deficiencies in developedcountries such as Canada, Switzer- and internationaland national agencies and donors. Neverthe- land, the UK and the USA. Fortification ofmargarine with less, to encourage policymakersto adopt effective and sustain- vitamin D is thought to have eliminatedrickets from Britain, able measures against micronutrientmalnutrition, some Canada, and Northern Europe in the early part ofthe century. attemptshave been made to computethe economic and social Fortificationof refined flourwith iron in Sweden andthe USA is returnsfollowing investmentsin these areas. An exampleis credited with the dramatic reductionof iron deficiency anemia. given in Table 1-3 where economic returns on investmentin Salt iodization,which beganin 1922,showed immediate and food fortification or supplementationprograms related to the spectacular results (BUrgi et al. 1990). Commercial food threemicronutrients are compared. Food fortification is fortification is particularly appealingbecause, if the right food considerablymore costeffective than supplementationfor is selected, high coverage is assured. Table 1-2 summarizes iodine and iron; however, vitamin Asupplementation of some ofthe advantagesof fortification over high-dosesupple- children under 5 yearsof age appears to be more cost effective mentation. than a targetedfortification program for this age group.

Table 1-2. Advantagesof food fortification over high-dosesupplementation.

• Effectiveness and timeframe • Effective strategy usually forshort term • Effective medium-to long-termmeasure • • Delivery requirements An effective health deliverysystem • Asuitable food vehicle and organizedprocessing facilities

Coverage • Reaches only populationsreceiving the service • Reaches all segments oftarget population

Compliance • Requires sustainablemotivation of participants • Does not require intensivecooperation and individual compliance ofindividual — • Cost ofmaintenance • Relatively high financialresources needed • Low cost compared to supplementation to maintainthe systemself-financing in the end • External resources • Foreign currency or externalsupport required • Adequate technology that is locally available for obtainingsupplements or can be easilytransferred

• Sustainability • Relates tocompliance and existingresources • Fortificantcompounds may needto be imported

Table 1-3. Comparison ofreturns on nutrition investment in supplementationand food fortifkation programs (in US$).

Iodine

Supplement women ofchild bearingage Supplement all under 60yrs Fortification Iron Supplement pregnant women only 800 25 13 Fortification 2000 84 4 VitaminA Supplementation targeted only 325 22 9 to under 5 yrs Fortification targetedonly to 1000 7 29 under 5 yrs

Source: World Bank (1994).

4 MicronutrientFortification of Foods Fortificationprograms, however, are usually not targetedto any WHO (World Health Organization). 1992. Nationalstrategies for micronutrientmalnutrition EB89/27. 45th specificage group and are plannedto coverall population overcoming World HealthAssembly Provisional AgendaItem 21; Doc. groups. A45/1 7. WHO, Geneva, Switzerland. The currently underexploitedfood-based approaches, namely 1 994a. Indicators for assessing iodinedeficiency disordersand food fortification and the more dietary improvement,represent their controlthrough salt iodization.WHO/UNICEF! sustainable,potentially long-lastingstrategic measures. The ICCIDD.Doc. WHO/NUT/94.6.WHO, Geneva, Switzerland. of elimination of micronutrientmalnutrition can, process 1 994b. Indicators and strategies foriron deficiency and anemia be accelerated fortification foods therefore, if ofappropriate programmes. Draft reportof the WHO/UNICEF/UNU with appropriatemicronutrients can be includedin national consultation. Geneva, 6—10 December 1993. WHO, programsof those countriesin which suchmicronutrient Geneva, Switzerland. are deficiencies prevalent. 1995. Global prevalence ofvitamin Adeficiency. WHO, Micronutrient Information REFERENCES Deficiency System (MDIS) WorkingPaper Number2. WHO/UNICEF. Doc. WHO/NUT! B. 1990. Iodine Burgi, H.; Supersaxo, Z.; SeIz, deficiency 95.3. WHO, Geneva, Switzerland. diseases in Switzerland one-hundred years afterTheatre World Bank. 1994. lives: vitamin and mineral Kocher's survey: Ahistorical review with somenew goitre Enriching Overcoming malnutritionin developing countries. TheWorld Bank, prevalence data. Ada Endocrinologica (Copenh), 123, 577— 590. Washington, DC, USA. 73 pp.

FAO/WHO Joint ExpertCommillee on Nutrition.1971. Eighth report. Food fortification. FAO Nutrition Meetings Report Series No 49. Food and Agriculture Organization (FAO)/World Health Organization (WHO), Geneva, Switzerland.

Current Practices, Research,and Opportunities5 6 Micronutrient Fortification of Foods 2. DEVELOPING A FOOD FORTIFICATION PROGRAM

RATIONALEAND OBJECTIVES • To increase the nutritional quality ofmanufactured food Food fortification is the addition ofone or more nutrients to products that are used as the sole source of nourish- foods. The main objective is to increase the level ofconsump- ment, e.g., infant formulas or formulated liquid diets and and tion ofthe addednutrients to improvenutritional status of a weaning foods; It the given population. should be noted that primary role of • To ensure nutritional equivalency of manufactured food food fortification is of prevention deficiency, therebyavoiding products substituting other foods, e.g., fortified marga- the occurrence ofdisorders that lead to human suffering and rine as a substitutefor butter. socioeconomic disadvantages. Nevertheless, food fortification The important steps in developinga genericfood fortification can also be practiced to eliminateand controldietary deficien- are mentionedin Table 2-1on the next The cies and theirdisorders. program page. generic model is valid for food fortification programsfocused To describe the process of nutrient addition to foods, other on single- as well as multiple-fortified products. Adjustments terms suchas enrichment, nutrification(Harris 1968),or must be made when designing a specific food fortification restorationhave beenused interchangeably, although each program. may implya specificcourse of action. Although fortification In this document, we are dealingwith fortificationof foods, refers to the addition of nutrients at levels higher than those food items,and food mixtureswith only three major found in the original or comparable food, enrichmentusually micronutrients:iodine, iron, and vitamin A. refers to addition ofone or more nutrients to processed foods at levelsspecified in the internationalstandards of food IODINEFORTIFICATION identity. Restoration refers to compensationfor nutrient losses Iodine deficiencyresults from irreversiblegeological conditions, during processing, and nutrificationmeans making a dietary therefore, dietary diversificationusing foodsgrown in the same mixture or a food more nutritious. Accordingto Bauernfeind deficientsoil cannotimprove the iodine intake ofan individual the term nutrification to nutritional (1994), is more specific or a community.Among the strategiesfor the elimination of whereasall other terms been bor- sciences, have originally !DD, presumablythe onlyfeasible, long-term approach is still rowed from other disciplines or applicationsthan food use. the fortification offoods with iodine.

The joint Food and AgricultureOrganization/World Health Overthe past 60 years, several ways of supplementingiodine Organization (FAQ/WHO) ExpertCommittee on Nutrition (FAQ! in the diet have beenproposed. A variety ofvehicles such as WHO 1971) considers the term fortificationto bethe most salt, bread, sweets,milk, sugar,and waterhave beentried. The appropriateto describe the process wherebymacro- or iodizationof salt has become the most commonlyaccepted micronutrientsare addedto foods commonlyeaten to maintain method of iodine prophylaxisin most countriesof the world or improvethe nutritional quality ofindividual foods in the because salt is widely and uniformly consumed byall sections total diet of a group, community,or population.It applies of any population.The process is simpleand inexpensive. The to the use of primarily relativelysmall quantities of added fortificantscommonly used are potassiumiodide (KI) and nutrients/micronutrients. potassiumiodate (Kb3). lodate is morestable in impure salt to and a humid environment. The The terms doublefortification and multiple fortification are used subjected poor packaging addition does not the or taste of when two or more nutrients,respectively, are addedto a food change colour, appearance, with or food mixture. The food that carries the nutrient is the vehicle, salt. Countries effective iodizedsalt programshave shown whereasthe nutrient added is calledthe fortificant. sustainedreductions in IDD prevalence. In hyperendemic areas where immediateaction is needed and/or where Generally speaking,food fortification can be employedfor the logistical problemscould delay the developmentof iodization followingpurposes: programs,the administrationof iodizedoil either by injection • or is the alternative To correcta demonstrateddietary deficiencyof those orally, strategy. nutrient(s) that are added; IRON FORTIFICATION • To restore nutrients initially present in significant Compared with other strategiesused for correcting iron amounts in a food but lost as a result of food processing deficiencyanemia, iron fortification ofthe diet is considered by and manufacturing; many investigatorsto bethe cheapest strategy to initiate,

Current Practices, Research,and Opportunities7 Table 2-1. Steps in the developmentof a food fortification tion program is the selection of an iron compoundthat is both program. acceptable and well absorbable (Cookand Reuser 1983). It should be noted that for pregnantwomen iron requirements 1. Determinethe of micronutrient prevalence are very high during the lasttwo trimesters ofpregnancy. Even deficiency. where iron fortification programsare in place, thesegroups needto continueto receive iron in combination 2. Segment the population if prevalence data indicate supplements the need. with other nutrients suchas folic acid.There are a number of fortificantscommonly used for iron fortification such as ferrous 3. Determinethe micronutrientintake from a dietary sulphate, elemental iron, ferric orthophosphate, etc. (see survey. Appendix 2). 4. Obtain data for vehicles. consumption potential VITAMINA FORTIFICATION

5. Determine micronutrientavailability from the Food fortificationwith vitamin A holds considerable potential typical diet. as a tool to alleviatevitamin Adeficiency by bridging the gap between intake of vitamin A and Fortifica- 6. Seek governmentsupport (policymakers and dietary requirement. tion with vitamin A is a ofmaintain- legislators). long-term strategy capable ing adequate vitamin A status over time. In Guatemala, z Seek food industry support. fortification ofsugar with vitamin A has provedto be more cost 8. Assess the status ofpotential vehicles and the effective and sustainablethan other strategiesthat are being processing industry chain (including raw material employed. and supply productmarketing). Most vitamins thatare producedcommercially are chemically 9. Choose the type and amountof micronutrient identicalto those naturally occurringin foods. Afat-soluble fortificant or mixes. vitamin (such as vitamin A) is usually prepared in the form of an oil solution, emulsion or dry, stabilized preparations that 10. Develop the fortification technology. can be incorporated into multivitamin—mineralpremixes or 11. Perform studies on interactions,potency, stability, added directlyto food. storage,and organolepticquality ofthe fortified The most important commercial forms ofvitamin Aare vitamin product. A acetate andvitamin A palmitate.Vitamin A in the form of 12. Determine food. bioavailabilityof the fortified retinol (the important active compoundin suchpreparations) or carotene beta-carotene and can be 13. Conductfield trials to determineefficacy and (as beta-apo-8'-carotenal) effectiveness. made commerciallyfor addition to foods. Thesepure chemicals have mainly beenadded to foodsas food improversand 14. standardsfor the fortified foods. Develop colorants,but foods can also carry them to increase vitaminA 15. Definefinal productand packagingand labelling intake of the populationsconsuming these foods. Vehicles such requirements. as sugar,fats and oils, salt, tea, cereals, and monosodium glutamate (MSG) have beenfortified with vitamin A. For 16. Developlegislation and regulationfor mandatory instance, sugar has beenfortified with vitamin A in Costa Rica, compliance. El Salvador, Guatemala, Honduras,and Panama. Variousoils 17. Promote campaignsto improveconsumer and fats have beenselected for fortification with vitamin A. acceptance. ROLE OF FOOD INDUSTRY IN FORTIFICATION PROGRAMS maintain, reach the largestnumber ofpeople, and guarantee The food industry plays a key role in anyfood fortification the best long-termapproach (Cook and Reuser 1983). Iron program in any country. Micronutrientdeficiencies are public fortification does not have the gastro-intestinalside effects that health problems.Many aspects of a food fortification program, iron supplementsoften induce.This is a major advantagein however, suchas determinationof prevalence of deficiencies, terms ofconsumer acceptability and marketing of iron fortified selection of an appropriateintervention, calculation of dietary products. intake levels of micronutrients,and daily consumptionof the Targeted iron fortification to thosebeneficiaries who are most food vehicle selected or levelsof fortificants to be added and likelyto be iron deficienthas provento be a safe and effective even technologydevelopment, should be evaluatedby the strategyto combatIDA (Ballot 1989).The choice of approach is scientificcommunity and health/agricultureauthorities and determinedby the prevalence and severityof the deficiency others.The actof fortification of a food vehiclewith fortificants, (INACG 1977). Acritical step inthe design of an iron fortifica- however,is carried out bythe private food industry. Unfortu-

8 MicronutrientFortification of Foods nately, in a majority ofcases, ministries ofhealth are often not Identify mechanismsfor collaborationbetween national able or willingto exercise control and motivate (private) industry. governments,food industry and its marketing system, and nongovernmentalorganizations (NGO5) and donor At best, linkages between the health and industry/agriculture agencies; ministries are usually weak or nonexistent.In such cases, it may be necessary to helpformalize an institutional linkage • Assistin the identificationof appropriatefortificants betweengovernment and (private) industry such as those and food vehicles; proposed in Pakistanand the Philippines.This institutional • Defineand developquality assurance systems;and model is the independentintermediary between governmental • in and educational efforts to institutions and private industry. Participate promotional reach the target population. In general,however, national governmentsdo not fortifyfoods Food workwithin one or more food chains. themselves. This is the task and responsibilityof the (private) technologists They well of informationwith food processingenterprises. Governmentstaff should act as are, therefore, positionedas sources to raw material or availabil- advocates, consultants, coordinators, and supervisorsto enable regard supply (national imported), of and and the market- the food industry to fortifyappropriate foods effectivelyand ity processing equipment technologies, network for the final profitably. ing/distribution products. The conditions for a successful food fortification The food industry can also play a significantrole in the program, the food and national are relatively long-term food diversificationsstrategy through supportedby industry government, summarizedin Table 2-2. from the food and the providing improvedpreservation techniques, improved Apart industry other include education- semiprocessed foods, and by promoting consumptionof locally government, partnersmay consumers, available micronutrient-richfoods in the diet or as a food ists/teachers unions,sport or youth clubs, teacher—parent fortificant. unions, disabled persons unions, women's organizations, pregnantwomen's groups,gynaecologists or midwive's Asuccessful approachto the micronutrientmalnutrition unions,pediatrician or ophthalmologistunions, the media, problem through micronutrientfortification offood in a country communicationservices, extensionworkers, political parties, is possibleonly if the participationof the food industry is religious leaders, cultural leaders, members of parliament, incorporated into a national program.The cooperationof the food industry should be sought at a very early stageof Table 2-2. Conditionsnecessary for the success offood program development. Both the promotion and regulative fortification programs. aspects of a fortification program needto be elucidated. The positive incentiveswill includethe profitability ofthe fortified • Political support; product. Product prices should be at a level that enablesthe • Industry support; producerto recover the cost offortification plus a modest profit and ensurethat the consumercan buy a wholesome product • Adequate applicationof legislation including for a fair price. externalquality control;

Food fortification also provides the opportunity for the industry • Appropriatefortification level; to diversifyits products range. A positive presscoverage or • Goodbioavailability ofthe compound; promotion ofthe fortified productby governmentcould create • No effect of the common consumer-demandfor the fortified product. Political and inhibitory diet; financial positive incentives can be offered in the formof tax • Human resource training at industry and marketing exemptions;import licenses and loans for equipmentand raw level; materials;initial subsidiesto procurefortificants; assistance in • Consumer acceptability; developingan in-process quality controlsystem; training of • production, administrative,and marketing personnel;training No cultural or other objection againstfortified foods; ofthe wholesaleand retail and of • sector; prohibition illegal Adequate laboratoryassessment of micronutrient can be ensured imports. Mandatory compliance through status; legislation and regulations(see Chapter 6). • Adequate study design or statisticalevaluation; Specifically, the industry (both national and multinational) • In caseof absence of or other needs to: IDA, parasitism nondietary causes of anemia;and • Participate from the very beginning in the planning of No constraint ofmicronutrients. the national programthat will define a feasiblefortifica- regardingprocurement tion strategy;

Current Practices, Research, and Opportunities 9 chambers of commerce, etc. Theycan all contributeto the — 1 989b:Fortification ofcurry powderwith NaFe(111 )EDTA inan iron- deficient ofa controllediron-fortification creationof demand and/or monitoring ofthe fortified product population:Report trial. Am J Clin Nutr, 49, 162—1 69. and thus to the success of the food fortification program. Bauemfeind, iC. 1994. Nutrificationof foods. In Shils, M.D.; Although simple nutritional and technologicalsolutions to the Olson, iA.; Shike,M., ed., Modem nutrition in health and problemsof micronutrientmalnutrition exist,these are often disease, Lea and Febiger, 8th edition, Chaper 91, pp. 1,579—1,592. complicated by economic,social, and political factors.Any Cook, iD.;Reuser, ME. 1983. Iron fortification:An update. intervention strategymust takethese factors into account. This AmJ Clin Nutr, 38, 648—659. is the challenge as well as the opportunity for the food indus- FAO/WHO Joint Expert Committee on Nutrition. 1971. Eighth try. In this endeavour, the food industry can draw uponactive Report. Food Fortification. FAO Nutrition MeetingsReport support from the other sectors. What is urgentlyneeded is to Series No. 49. Food and AgricultureOrganization(FAO)/ identify a set of priority actionsand initiate a process of World Health Organization (WHO), Geneva, Switzerland. R.S. 1968. Attitudesand to of continuousdialogue between the various sectors to move Harris, approaches supplementation foods with nutrients.i AgrFood Chem, 16(2), 149—152. quickly toward the implementationof schemes thatwill INACG (International NutritionalAnaemia Consultive Group). eliminatethe of micronutrientmalnutri- permanently problems 1977.Guidelines forthe eradication of iron deficiency tion. anaemia. INACG, Washington,DC, USA. WHO Health 1992. National for REFERENCES (World Organization). strategies overcomingmicronutrient malnutrition EB89/27. 45th World F.G. Ballot,D.E.; MacPhail, A.P.; Bothwell, T.H.; Gillooly,M.; Mayet, HealthAssembly Provisional AgendaItem 21; Doc. A45/1 7. 1989a. Fortification ofcurrypowderwith NaFe(l11)EDTA WHO, Geneva, Switzerland. in an iron-deficient population:initial survey ofiron status. AmJ Clin Nutr, 49,156—161.

10 MicronutrientFortification of Foods 3. FOOD VEHICLES AND FORTIFICANTS

Micronutrientfortification offoods commonlyconsumed by a Local circumstances are important determinantsin selectinga given population can be a powerfulstrategy to combat food, or a food accessory item, to act as the carrier for one or micronutrientdeficiencies in a sustainablemanner. By selecting more micronutrients(where customary diets ofa population the rightfood ingredientto actas a canler (food vehicle) of only provide suboptimal levelsof these essential specificmicronutrient(s) (fortificant),the needfor encouraging micronutrients).Vehicle selectionshould, therefore, be guided individual complianceor changes in the customarydiet will be by all thesefactors. minimized. SELECTION OF FORTIFICANTS General criteriafor selectionof fortificants are listed in Table SELECTIONOF FOOD VEHICLES 3-1 and opportunitiesfor food fortification in Table 3-2. There arerelevant criteria for selectinga food vehiclerelated to the following points: Table 3-1. General criteriafor selectionof fortificants.

CONSUMPTION . Goodbioavailability during normal shelf life of the • High proportion of the population covered, fortified product; • Regularconsumption in relatively constantamounts, . No interaction with flavour or colour systems; • Minimal variation in consumptionpattern between • Affordablecost; individuals, • and • Minimal in Acceptable colour,solubility, particlesize; regional variation consumptionpattern, • • Free commercial availability offood grade material; Appropriateserving size to meeta significantpart of daily dietary requirementof the micronutrientadded, • Available in encapsulated formif required;and • Consumptionnot relatedto socioeconomic status, • Feasibilityof addition and dispersionthrough dry or if • Low potentialfor excessive intake (to avoid any blending spray coatingusing premixes required. probabletoxicity), The following fortificationtechnologies are alreadywell • No in consumer after fortification, change acceptability developed and widely applied: and • Saltfortification for iodine • technology No change in quality (in a broadsense) as a result of • micronutrientaddition. Vitamin Afortification for oils, fats, sugar, milk, dairy products,RTE cereals PROCESSING/STORAGE • Iron fortificationfor flour, RTEcereals, weaning foods, • Centralized processing, biscuits,bread, milk modifiers • Simple,low-cost technology, • Multiple fortification of specific products,e.g., milk • Good masking qualities (dark colour and strong odour modifiers,powders, beverage powders,soup flavouring ofthe vehicleto mask slightchanges to original colour cubes, and pasteproducts or odour), SOURCES OF FORTIFICANTS • High stability and bioavailability of addedmicronutri- IODINE ent in final product, Iodine productionin the world is limited to a few countries. The • Minimal segregation ofthe fortificant and vehicle, principal producers/exporters are Chile and Japan. The Central • Asian Turkmenistanand are also iodine Goodstability during storage, and Republics, Azerbaijan, producers/exporters,although to a far lesserextent. • No micronutrientinteraction. For iodine deficiency disorder (IDD) control programs, iodine is MARKETING usually importedin the formof potassium iodate (Kb3).If the is it will be • Appropriatepackaging that will ensurestability, country requirement large (>30 tons/year), cheaper to elementaliodine and convert it to There are • import Kb3. Labellingaccording to prescribedstandards, and suppliers of potassiumiodate in France, Germany, India, the • Adequate turnover rate. Netherlands,and the UK (see Appendix 1).

Current Practices, Research, and Opportunities 11 Table3-2. Opportunitiesfor food fortification.

Milk: Liquid + + + + + + + + + o + + Powder + + + + + + + + + + + + With Cereal + + + + + + + + + + + +

Flours:

Wheat o + + + .4- + + x + + + + Corn o + + + + + + o + + + + Rice o + + + + + + + + + + +

Rice o + + + + + + + + + + o Snacks o + + + + + + + + + + o Corn Flakes o + + + + + + + + + + o

Oil + + + + x x x o o o o x Margarine + + + + o o o o o x o x Mayonnaise + + + + o o o o o x o x

Juices + o o + + + + + + + + Sugar x + o 0 x x x x o + o + PowderBeverages o + + + + + + + + + o + Salt x o x x x x x x x + + +

+= Possible, a= Trialsneeded, x = Not possible,Fe = iron, Ca = calcium,I = iodine.

IRON on commercially available iron compounds). Ferrous fumarate, When choosingan iron source to fortifya food product,one ferrousgluconate, and ferroussulphate are commonly used in Sodiumferric has to considerthe influenceof the addediron on the orga- mineral supplements(Lee 1979). ethylene- diamine-tetraacetic acid is the nonhaem nolepticproperties of the product,whether the iron source is (NaFe111EDTA) only likelyto besufficiently bioavailable, whether segregation iron compoundthat has a good bioavailability (mean occurs during mixing or storage, and the cost ofthe food bioavailability of approximately1 0°Io) that is relatively inde- fortification process. The two principal groups of compounds pendent of meal composition.It withstands the inhibitory are haem iron compoundsand nonhaem iron compounds, effects of phytates,a component ofthe staples foods like dependingupon theirsources. cereals and grainlegumes (Lamparelli 1987). Haemiron are a of bovine compounds by-product slaughter- The status ofNaFeEDTA as a recognized food additive is not yet houses.Haem iron is a very attractivefortificant of foodsof clear. The Joint FAOIWHO ExpertCommittee on Food Additives vegetableorigin, Inhibitors of nonhaem iron compoundsin (JECFA 1993) has reached the conclusionthat NaFeEDTAis foods do not interfere with haem iron. Haem iron, vegetable safe when used in supervised food fortification programs in however,does affectthe fortified and productorganoleptically iron-deficientpopulations and has given provisionalapproval is not suitablefor fortification of many A successful products. for its use. Pharmaceutical gradeNaFeEDTA is rather expen- fortification applicationhas been the Chileanbovine-haemo- the use and sive. Avery promising alternativeis of Na2EEYIA globin-fortified cookiesprogram (Walter 1993; see also EDTA iron between 1.0 and FeSO4 (in the molar ratio of to 7). Chapter 0.25) in mealswith low iron availability.The cost offood The nonhaem iron compoundscan be divided into elemental fortification with NaFeEDTAas a food additive may be reduced iron and nonelemental iron. Commercially availableiron with the alternative fortification mixture Na2EDTAplus FeSO4 compoundsare listed in Appendix 2 (INACG 1990).The four (INACG 1993). Also, a less pure grade (>97°/a) used in the principal iron sources that have had widespreaduse in food agriculturalindustry as a fortificant is commerciallyavailable at fortification are elementaliron, ferroussulphate, ferric ortho- lessthan half the cost of the pharmaceuticalNaFeEDTA (Ballot phosphate, and sodium ferric pyrophosphate(see Appendix 2 etal. 1989).

12 MicronutrientFortification of Foods VITAMIN A addition of stabilizerslike sodium thiosulphateand calcium Preformed vitamin A or retinol is found in foods of animal hydroxideand/or dryingagents such as magnesiumor calcium origin, whereasgreen leafy and yellow vegetables and fruits carbonate. are rich sources of carotenoids, such as beta-carotene, which In most cases, however,potassium iodate (Kb3)is the is a A the human is of convert- provitamin (i.e., body capable preferred compound.It is resistant to oxidationand does not it into vitamin Some commonsources of retinol are ing A). requirethe addition of stabilizers. Kb3 is less soluble than Kl mother's milk, liver, butter, and whole cow's milk. eggs, and it is less likelyto migrateout of the bag. Calcium iodate Examples ofcarotenoid sources are greenleafy vegetables, has also beenshown to be stablein impure salts,but its use in and and carrots, yams squashes, mango, papaya, plantain. ediblesalt has not beenwidespread so far (Bauemfeind 1991). Red palm oil is naturally rich in beta-carotene. In processing IRON crude oil to remove undesirablecolour and odour, most of In the of the iron is carotene is lost. Recent new technologies, however,tend to general, solubility compounds inversely retain carotene during the refining process (UNU 1994). relatedto the duration of storage. The more solublethe compound, the greater its chemical reactivity, and the higher Both retinol and carotenes are commerciallyproduced the risk of rancidity. Although ferroussulphate is the most (Bauernfeind et al. 1986; Klaeui eta!. 1981). The major suitableiron compoundfrom the point ofview of bioavailability commerciallyavailable vitamin A productsand carotenoid and cost,it is unstable, The addition of stabilizersproved to precursors are listed in Appendix 3. Equivalency between give acceptable results withoutdeterioration ofthe iron retinyl palmitate and beta-carotene for controlling vitamin A availability (Suwaniket al. 1980). deficiencywas studied in Senegal (Carlier et al. 1993).It was concluded that beta-carotene supplementationwas a promis- Ferric phosphateand other insoluble iron compoundsare ing candidatefor the alleviation of vitamin A deficiency. A stable, but the iron absorptionis unacceptably low, particularly workshop on bioavailability and bioconversionof carotenoids, when ingested with food.The use ofabsorption promoters can sponsoredby the MI and USAIDin 1995,concluded that improvebioavailability without deterioration of the keeping carotenoid-rich fruits and vegetables provide a substantial quality (Rao et al. 1975). and contribution to the ofvitamin A necessary requirements Ascorbicacid is a powerlul enhancerof nonhaemiron absorp- and some other nutrients of the at risk of deficien- population tion and can reverse the inhibiting effectof tannins. High costs cies ofsuch nutrients. the ofthese Although consumption and instability during food storage are the major obstacles to valuablesources of micronutrientsshould be promoted, using ascorbicacid in programsto combatiron deficiency factorsthat influence their and bioconversion bioavailability anemia(IDA) (Lynch and Cook 1980). There is evidence that needto be more elucidated and studied. clearly vitaminC also has a postabsorptiverole on iron metabolism STABILITY AND INTERACTIONSIN THE DIET (Anon. 1987). A number ofstudies (I-lodges etal. 1978;Reddy and that vitamin A in The stability of the fortificant in the fortified food or the meal 1985; others)reported deficiency might some be in anemia in man, reversible is highlydependent on the chosen compound,the processing way responsible causing iron when vitamin A is administered 1987). conditions,the characteristics ofthe food, transport and by only (ACC/SCN More recently, Mejia et al. (1992) suggested thatthere is an storageconditions, and food preparationand storagehabits between vitaminA and iron nutrition. of the consumer. A field trial, therefore, to establish the impact interrelationship of the fortified food on micronutrientmalnutrition and Improving vitamin A nutrition of underprivilegedchildren in countrieshas a effect on their iron consumeracceptability is a prerequisitefor a food fortification living developing positive status. program.Although knowledge regardingvitamin/mineral interactionsis limited, it is evidentthat such interactions VITAMIN A reduceimpact on nutritional status (Lonnerdal 1986). Some Purevitamin A and carotenoid structures are fairlystable when information on and interactions of the mia'onutrient stability heatedto a modesttemperature, in an inert atmosphereand in sources is in the given following. the dark,but are unstablein the presence of oxygenor airor IODINE when exposed to ultraviolet light.Vitamin A is quite stablein an alkaline environment.The food fortification has Iodine is normally introducedas the iodide or iodate of industry vitamin A and carotenoid structures with addition of potassium,calcium, or sodium. Potassium iodide (KI) is the developed antioxidantsas et al. leastexpensive but most unstablecompound. It can easily be stabilizing agents(Bauernfeind 1986; Klaeui etal. lost if the iodized salt is subjected to moist conditions, 1981). excessive aeration, sunlight, heat,relatively high acidity,or Tests in Brazil have shown that vitamin A palmitateadded to the presence of impurities in the salt. The adverse effects on soybean oil was stable (99°/o retention) for up to 9 months of potassiumiodide caused by oxidation can be reduced bythe storagein sealed metal cans. Cookingtrials involving cooking

Current Practices,Research, and Opportunities 13 rice and beans with fortified soybean oil indicated that reten- These are onlyapproximate costs and indicate the order of tion ofvitamin A in cookedrice was 99% and in beans it was magnitudefigures for actualprocessing and chemical costs at 88% when cookedby boiling for 90 minutes and 900/a when source. They exclude costs related to program management cooked under pressure. Trials with oil for fryingpotatoes under and productpromotion/marketing and monitoring. Oftenthe conditions of at 1 and repeated deepfrying 700C storage extra cost at source when passedon to the consumertends to indicated there was a loss with that, although progressive get magnified at the various stages ofdistribution because the 58% ofthe vitamin A was still retained after repeated frying, marginsat everylevel will also increase proportionately.The four repeated fryings of potatoesin the sameoil. ultimate cost to the consumer, therefore, will be progressively COST OF FOOD FORTIFICATION inflatedas the food passes from producerto retailer.This is an economic that need on a The cost offortification varies over a wide range dependingon again question may investigation the vehicle and the fortificantto be added. Vitamin—mineral case-by-case basis. Anothermajor source of cost is incurred in the addedto with premixesare now utilized by manufacturers for uniform controlling levels ensureconsistency the label addition to foodsand to reducecontrol costs. Certain typical declaration (Clydesdale 1991,p. 95), although this cost is valuesto indicatethe order ofmagnitude are given in Table 3-3 lowered if analyticalequipment, personnel, and expertiseare (Mannar 1993). available.At least a part of the cost increase related to fortifica-

Table 3-3. Dosageand approximatecost of fortification.

Fe(ll)sulphate + 1,000 ppm Fe + 12—18(1991) Na-acid pyrophosphate 2,500 ppm + + Na-acidsulphate 5,000 ppm

÷ + K-iodide 50 ppm 12 India ++ Fe(II)fumarate 1,000 ppm Fe 12—20(1990)

+ 12—20 lndiaa K-iodate+ 20 ppm 12 (1992) Fe(II)sulphate + 1,000 ppm Fe + Na-polyphosphate 10/0 Na-polyphosphate

Sugar Vitamin A 250CWS 15,000 lU/Kg 29 (1994) Guatemalaa

NaFeEDTA 1.3°/o Fe 10(1981) Guatemala ++

Wheatflour Elemental iron 25—35 ppm 1.5 (1980) Severala

Cookingfat Vitamin A 50,000lU/Kg 30—40 (1988) Severala

Biscuits 1-laem iron concentrate 1.8 gHb/30 g 108 (1981) Chile +

Edible oil VitaminA 20 IU/g n/a Pakistana

Margarine VitaminA 375 RE/15g 20 (1994) Philippinesa

Fish sauce NaFeEDTA 1 mg Fe/mi 5—15(1970) Thailand++

Monosodium VitA Palmitate 250 CWS 175,000 lU/kg 6 (1988) Indonesia + glutamate (MSG)

Comfiour! Iron 20—50 mg/kg 7—8 (1994) Venezuelaa Wheatflour Vitamin A 39,000lU/kg (plus Niacin,Thaimine, and Riboflavin)

acammercial scale;+ = pilot; ++= laboratoryscale; n/a = not available.

14 MicronutrientFortification of Foods tion should initially be subsidized(as fundingfor a nutrition setting providesan important sectionof data that are neces- intervention). Gradually, the entire cost could be passed on to saryfor establishingdietary requirements for nutrients. the consumer. The three factors involvedin determiningthe bioavailability of BIOAVAILABILITY AND BIOCONVERSION OF a food, meal,or diet are: MICRONUTRIENTS • Availability in the intestinal lumen for absorption; The termbioavailability generally refers to the extentto which a • Absorptionor retention in the body,or both; and nutrient is capableof being absorbed(i.e., entersthe blood system)to be utilized within the body. The proportion ofa • Utilization in the body. nutrientthat can beabsorbed is largely relatedto the functions Ofthese factors, utilization of the nutrient in the body is the of the digestivesystem, the form in which the nutrient is central feature. The degreeof utilization in the body depends ingestedand its concentration (i.e., whether it is present in on physiologicalfactors and on the nutritional statusof the physiological or pharmacologicaldoses), the compositionof organism. the food vehicleand its intestinal motility and other dietary components,or even certaindrugs taken concurrently. Other Bioavailabilitycriteria of a nutrient are: factors includethe health and status ofthe may physiological • The nutrient must be presentin a form that can either be individual who consumedthe nutrient in For exam- question. transporteddirectly through the intestinal mucosa, or factorssuch as motility, the immaturity of ple, gastrointestinal the ingested nutrient must be convertible into a form intestinal functions in or in the of infants, changes efficiency that can be transportedthrough the intestinal mucosa; absorptionthat occurwith age may influence the bioavailability and of nutrients ingested. • The absorbed form must be capable of being metabo- Other constituentsof the foods or the or can meal, both, modify lized, or the absorbed form must be capable ofpartici- the Interactionsbetween ofa absorptionprocess. components pating in metabolism. dietary mixture withinthe intestinal contents can either inhibit The ofa nutrientin the diet is thus a functionof: or enhancetransport of the nutrientthrough the mucosa. For bioavailability can • instance, excessive intakes of certainforms of calcium The form in which the nutrient is ingested; decrease iron absorption. This, however,is thought to be due • The extent ofconversion to absorbable forms; to competitionat the intestinal absorptionsite rather than to • food interactions. In additionto the interactions between dietary The compositionof the diet, including concurrent inges- components,therefore, interactions between the dietary tion of certaindrugs; and componentsand the intestinal mucosatransport system may • The physiologicalstatus ofthe organismand function of occur. Accordingto Clydesdale (1989), itis not only essential the digestivesystem. to knowthe major physicaland chemical propertiesthat affect bioavailability but also to understandhow these may be in- In any food fortification program,the bioavailabilityof a fluenced byfood composition, processing, andstorage conditions. nutrient in its dietary context, the food consumptiondata of the target population,and the prevalence rate of thosenutrient Some transport systems are controlledby the nutritional status deficiencies to be controlled/eliminatedby the plannedfood ofthe person consumingthe diet. Iron status, for example,is fortification program are among someof the major determi- decisivefor the absorptionof iron. When iron status is low, iron nants ofthe level of vehicle fortification. It should, therefore, be absorption is enhanced and when iron status is within normal noted that it is the total diet (or meal),and not the nutrient per ranges,iron absorptionis restricted. This formof individual se, that significantly influences the bioavailabilityof the physical control is limitingthe developmentof predictive separate nutrients. equationsand "rules of the thumb" that are practical in the food fortification field. BIOAVAILABILITY OF IODINE Inorganiciodide is readily and completelyabsorbed from the The conceptof bioavailability is central to one of the key goals gastrointestinaltract and mostly storedin the thyroid gland. of the nutritional sciences, i.e., the relationshipbetween the Excess iodine is readily excreted bythe kidney. Other forms of compositionof the diet andthe nutritional responses to the diet iodine are reduced to iodide before absorption(Pennington by the organism(see Southgate etal. 1989).Micronutrient 1988). Goitrogens such as thiacyanates can block the uptake malnutrition, especiallyIDA, may occuras a result ofa low of iodine by the thyroid gland. bioavailability/bioconversionof the micronutrientin its dietary and physiologicalsetting. IDA may even occurin cases where BIOAVAILABILITY OF IRON ingestionis well in excess ofphysiological requirements. The iron in the dietmay be presentas haem iron (from animal Knowledgeof the bioavailability ofa nutrient in its dietary foods)or nonhaemiron (from foods of plant origin). In the

Current Practices, Research,and Opportunities15 intestine,these two forms are absorbed by differentmecha- fibre reduces the bioavailability of vitamin A if consumed nisms. Because haem iron is more easily absorbed from the within the samemeal. The bioavailability of carotenoidsis also diet than nonhaemiron, its bloavailabilityis higher than thatof dependent on the level and type of fat in the meal.The actual nonhaemiron. As a generalrule, scientistsassume that 25% bioavailabilityof carotenoids can be as low as 10/0. Mild of the haem iron from the diet is availablefor utilization by the cookingcan enhance the bioavailability by releasingthe free human body.This factor of 25% is fairlyconstant and irrespec- carotenoids from the carotenoid—protein complexes in green tive of other substances in the diet. leafy vegetables, but overcookingcan destroyany positive effect Generally, the bioavailabilityof nonhaem iron is much lower (Fairweather-Tait 1993). and also much more variable. Table 3-4 shows majoriron LEVEL OF FORTIFICATION used in food fortification andtheir relative compounds There is no universalspecification for the level offortification of bioavailabilityand cost. the chosen food vehicle. Numerous factorsinfluence the recommended level offortification and the practical amounts If provided within the samemeal, the following substances will used should be decidedby the appropriatenutrition authori- improvethe absorptionof nonhaemiron: meat, amino acids, ties, based on sound nutritional surveys.The main determi- vitamin C, and EDTA. The absorptionlevel, however, never nants ofthe fortification level are: reaches that of haem iron. Tannins (tea), phytates (legumes and • cereal bran), oxalates, and calciumare dietary substances that Recommended dietary intake (RDI) ofthe micronutrient; inhibitthe ofnonhaem iron from the same meal. absorption • Prevalence ofthe micronutrientdeficiency; Bioavailabilityof elemental iron powder increases as particle • of the food size decreases. The assessment of bioavailabilityof iron from a Percaput consumption vehicle; diet a issuethat needs attention • is, thus, complex particular Extent of processing, transit, storage, and food prepara- when decisionsare made on the appropriatevehicle, fortificant, tion losses; and level offood fortification with iron. • Current dietary habits ofthe population in questionwith BIOAVAILABILITY OF VITAMIN A AND CAROTENOIDS regardto food selection and preparation;and If provided within the samemeal, fat and proteinswill improve • Other its and the bioavailability of vitamin A. Vitamin A deficiency is often dietary ingredientsaffecting absorption bioavailablity. associated with protein or protein—calorie malnutrition.Dietary IODINE Table 3-4. Majoriron compoundsused in food fortification. The RDI of iodinevaries from 150 to 200 pg/day. The basic RDI for adults of both sexes is setat 150 pg/day. An increment over the basiclevel of 25 pg/day in the RDI is recommended during pregnancy, and an increase of 50 pg/day is recom- Water-soluble mendedfor lactatingwomen (NAS 1989). Ferrous 100 1 sulphate Currentlevels of iodization in different countries vary between Ferrous gluconate 89 5 Ferricammonium citrate n/a 5 20 and 100 ppm iodine (35—165ppm intake). In a given Ferrous ammonium country,the level offortification may be changedover time, in sulphate n/a 2 responseto changes in averagedaily consumptionof salt and iodine losses duringdistribution and storage.A sample Poorly water-soluble Ferrous succinate 92 4 calculation for fixingthe level of iodizationin salt is given in Ferrous fumarate 100 1 Chapter 7 (Table 7-1). Ferric saccharate 75 4 IRON Water-soluble The RDI ofiron variesby ageand physiologicalgroup and Ferric orthophosphate 31 4 depends on the iron bioavailability in the diet (Table 3-5). Ferricpyrophosphate 39 4 women and the iron Elemental iron 13-90 Menstruating teenagegirls require highest intake (40—48 mg/day), whereas the requirementsfor iron in Experimental young children in the age of 1—6 years are the lowest (12—14 Sodium iron EDTA Depends on food vehicle 10 mg/day), assuming a low iron availability of 5%. Forfoods Bovinehaemoglobin n/ab n/a with a high iron availability (15°/a) thesefigures should be a Both bioavailabilityand costare expressedas a percentage relativeto thatof loweredby a factorof 3 (FAO/WHO 1988). FeSO4'7H20. bn/a= notavailable. Pregnant women needa total of 1,000mg iron during a Source: Adaptedfrom Hurrell and Cook (1990, p. 57). normal pregnancy. This needfor iron is not equally distributed

16 MicronutrientFortification of Foods Table 3-5. Recommended dietary intake (RDI) for iron Table 3-6. Estimated requirements for vitamin A (pgretinol (mg/day). equivalentper day).

Adults Children Men (>16 years) 23 11 8 0—1 180 (600) 350 (1,165) Women (menstruating) 48 24 16 1—6 200 400 Women (postmenopausal) 19 9 6 (665) (1,330) Women (lactating) 26 13 9 6—10 250 (835) 400 (1,330)

10—12 300 (1,000) 500 (1,665) Children (age in years) 0.25—1 21 11 7 12—15 350 (1,165) 600 (2,000) 1—2 12 6 4 15—18 400 (1,330) 600 (2,000) 2—6 14 7 5 6—12 23 12 8 boys 12—16(boys) 36 18 12 15—18 330 (1,100) 500 (1,665) 12—16 (girls) 40 20 13 girls Adults Source: Adaptedfrom FAOIWHO (1988). Men 300 (1,000) 600 (2,000) Women 270 (900) 500 (1,665) Pregnant over the duration ofthe pregnancybut variesfrom 0.8 mg/day women 370 (1,230) 600 (2,000) in the first trimesterto 6.3 in the third trimester.Even if mg/day Lactating the food consumedby a pregnantwoman has iron with a high women 450 (1,500) 850 (2,830) bioavailability,the dietalone cannotsatisfy this extra require- = ment. Administrationof supplements may be indicated. Note: RE (retinalequivalent( 3.33 IU(international unit vitaminA activity from retinolL No samplecalculation for the amount ofiron to be addedto a Source: FAO/WHO (1988). vehiclecan be given because the amountto be addeddepends on the estimatedbioavailability (see this chapterunder an item non-toxic:')This statementis still valid today. If a food "Sources of Fortificants" and Appendix 4 for premixes). fortification program is properly designedand implemented and the level ofthe micronutrientadded is VITAMIN A carefullyevaluated, there should be no reasonfor concerns over the possibility of As shown in Table 3-6, women the lactating require highest toxic effects ofthe addedminerals and/or vitamins. The vitamin A intake. Accordingto FAO/WHO (1988), the safe benefitsof a food fortification program clearlyfar outweigh any intake level is a factor 2 higher than the critical intake level. adverse effects (FAO/WHO 1988). Documented toxic effects Critical intake level for lactating women is 1,415lU, whereas have been few andtransient. Every food fortification program for children aged 0—10 yearsit is 585—670IU. should balanceits beneficial aspects againstthe toxicological There are variations in the consumptionpatterns ofdifferent risks, which are very limited for iodine, iron, and vitamin A. socialand economic groups consideringage and physiological It is the responsibilityof the nutritionists/toxicologistson the status. The appropriatelevel offortification should be based on program staff to determinethe safefortification levelsof a consumptiondata for the food vehiclechosen for fortification micronutrientin the dietary setting. Anyone involvedin a food by different socioeconomic and physiologicalgroups in the fortification however, should be aware of the toxico- An is vitamin A and vitaminA program, population. example precursor the fortificant. from the — logical aspects of Apart dose,the levelsin margarine,33,000 IU B carotene (as colorant), — exposureperiod is another important factor when evaluating 10,000—12,000lU the remainderto be supplied by added the toxicity aspects of fortification programs. vitamin A ester. The safetyof any ingestedsubstance can de distinguished TOXICITY CONSIDERATIONS accordingto the followingfactors (Marks 1989): SAFETY INDEX • The number of dosesand the time intervalbetween The Swiss medical scientistTheophrastus Bombastus von them, Hohenheim,better known as Paracelsus (1493—1 541)stated: • "Alle Dinge sind Gifft.... allein die Dosemaclit das em Ding The health status ofthe person (main indicators are age, kein Giffiist" ("Everything is toxic... it is the dose which makes pregnancy, and vitamin/mineral status),

Current Practices, Research,and Opportunities17 • Interference by food or food components (like alcohol) had been present for years)(Lowenstein 1983). Atransient, and pharmaceutical (orother) drugs, and slightlyhigher prevalence of hyperthyroidismmay occurafter • the introduction of an iodization This effect The mode of administration(oral or parenteral), (i.e., salt) program. is temporal and will disappearwithin a shortperiod. In some In general,for vitamins and mineralsthat have a large RDI, studies,the incidence ofthyrotoxicosis has doubledover there is little concern about toxicity from individual foods, several yearsfollowing introduction of iodine into iodine- except if a large spectrumof foods pertaining to an individual's deficentpopulations, but the incidencethen characteristically diet were to be fortified with the samemicronutrient. But a decreases to a level below that existing before correction of well-designedfood fortification program should be based on iodinedeficiency (ICCIDD 1995). sound nutritional survey data,taking into consideration in its IRON design the total diet of the target population. An individual's iron statusregulates iron absorption to some Fortificationwith iodine, iron, and vitamin A is considered to be extent (Gavin et al. 1994). Asthe iron store increases, the safe, provided the fortification level does not exceed the RDI bioavailability and, thus, the absorptionof the dietary iron, level ofthe micronutrientin the total diet. Table 3-7 gives the decreases. Furthermore, the losses ofiron from the body will safetyindexes for the three micronutrients. increase because with increased iron stores,desquamated cells The important question to be considered when attemptingto will have a higher iron content(Hallberg 1993). For this define toxic thresholds is the characteristics ofthe target reason, there are no reportsof iron toxicity in healthysubjects population of a food fortification program.The fortification level fromiron-containing foods. One exceptionhas beenreported ofa food has to be fixed to a concentration ofthe micronutrient resultingfrom long-termingestion of homemadebrews in iron well below the toxic threshold level for normal individuals. itis vessels (Gordeuk 1986). Changingbeer-producing and essentiallya policy matter to make a dedsion regarding what drinking habits ofthe urban population has significantly proportion ofthe population shouldbe considerednormal reduced the prevalence and severityof the dietary iron over- when settingacceptable, safe intake levels. If the target load in the urban population. Perhaps only in the rural population includes individuals or groups of individuals who population of sub-Saharan Africadoes the issue remain a mightbe more susceptibleto the toxicity of the nutrient than public health concern. the measures to these general population safeguards, protect VITAMINA individualsat risk should be incorporated into the food Vitamin Afortification offoods in dosages not exceedingthe fortificationprogram. RDI does not causetoxic effects. Usually, small excesses of IODINE vitamin Afor short periods do not exert any harmful effects. In general, iodine fortification at levelsof up to 200 pg/day Sustained daily intakes,from both foods and supplements, that does not give rise to any concerns for toxicity. Iodine intakes of exceed 50,000 IU in adults and 20,000 IU in infants and up to 2 mg/dayhave caused no adverse physiological reac- young children may causetoxic effects. tionsin adults and one no indica- healthy mg/day produced Carotenoids are not known to be toxic. A high intake may, tionsof physiological abnormalitiesin children. however, cause a discolorationof the skin, which will gradually Allergic reactions to iodine compoundsare always due tothe disappearwhen the high intake is discontinued (NAS 1989). organiccomponent of the molecule. Incidentaltoxic reactions Nevertheless, fortification levelsfor food fortification programs as a result ofan increased iodine intakeafter the introduction aimed at the general population have to be establishedwith of a salt iodization program have been reported. These cases extremecaution. are rare and confined to individuals with an mostly underlying SINGLE FORTIFICATION thyroid disease ("hotnodules" of goitrousthyroid tissue,which In the contextof this report,single food fortification refersto fortification offood vehicles with either iodine, iron, or vitamin Table3-7. Safety of the micronutrients. A (whetheror not other types of (micro)nutrients are also RDI addedto the samefood vehicleis not considered here). (reconYd Safety MiD IODINE Micro- dietafy Index (mm toxicdose) nutilent Intake! (M7D/RDI) A variety ofvehicles for iodine supplementationin the diet Iodine 0.15mg 13 2mg such as salt, bread, tea, sugar,sweets, milk, andwater have beentried over the past 60 years. The iodizationof salt has Iron 18mg 5.5 100mg become the most commonlyused method of iodine prophy- Vitamin A 5,000 IU 2—2.4 10,000—1 2,000 IU laxis in most countriesin the world. This is because of its Source: Adaptedfrom Bailey (1991); Clydesdale (1991); Hathcock (1990); advantagesfrom the points ofview of uniformity of consump- NAS (1989). tion, universalcoverage, acceptability, andsimple, low-cost

18 MicronutrientFortification of Foods technology. In Table 3-8, vehicles suitable for single fortification Rice:Because rice is a staplefood for more than halfthe with iodineare listedand, in Chapter 7 inthe section "Project world'spopulation, and is the main componentof the diet in Experiences in SingleFortification with Iodine;' more informa- many countrieswhere the prevalence of IDA is high, iron tion is provided. fortification of rice is a logical choice. Since 1949, efforts in iron fortification have beenmade. There still no IRON is, however, large- scaleprogram in operation.Research is now focusingon Wheat-flour and cereal-basedfoods: In developed fortification of rice with iron and vitamin A (see countrieswheat-flour and cereal-based foods have had multiple Chapter 8). significantsuccess as vehicles for iron. Fortificationof milled cereals (such as wheat and maize) has also been adoptedin Currypowder and fish sauce:Dark-coloured foods with a several countries in Latin America and the Caribbean as a result strong taste like curry powder and fishsauce are particularly ofgovernment regulations. suitablefor iron fortification because the iron sources generally have a slightlydark colour and oftenhave a metallic taste. Infant weaning foods: As breastmilkgradually becomes that have been fortified with iron include insufficientto meetthe iron requirementsof a growingchild Other foods: Foods after 6 months,infant foods and formulas can be used for bakery products,beverages, biscuits,low-fat milk, chocolate and water. In Table vehicles supplementation.They generally consistof a cereal (wheat, milk, maize-flour, margarine, 3-9, suitablefor fortification with iron are and more rice, maize, sorghum),a high-quality protein compound single listed, in 7 in the sectionon (soybean, nonfat dry milk, whey), and a fat component.The information is given Chapter "Single food should be fortified with vitamins and minerals.Small Fortificationwith lron quantities ofsugar can be added as flavouring. The ingredients VITAMINA may be milled and processed, i.e., heat treated, rolled, par- Sugar: Fortificationof sugar with vitamin A has beensuccess- or extruded.In of infant foodsto be used boiled, preparations fully implementedin several countries in Central Americain the in any given area, local ingredientsshould be used as muchas 1970s. possible. Ifplanned and prepared appropriately,the resultwill Oils, fats, and In several countries, margarine, be a nutritionally improvedproduct compared to any of the margarine: hydrogenatedoil, and shorteningare being fortified with single ingredientsused in the formulation.The final product vitamin A can be sold to consumers as a drink or in a dry form for later palmitate. cooking like rice. Monosodium glutamate(MSG): Efforts to fortify MSG (a widely consumed condiment in Indonesia) with vitamin A are Salt:Encouraging results of iron fortification ofsalt have been in progress. reported from India and Thailand,but more effortsare focused now on developinga formulation thatwill permit the addition Tea:Fortification of tea with vitamin Ahas beenestablished in of both iodine and iron (see also Chapter 8). India and Pakistan and is beingconsidered in Tanzania. Sugar:Sugar is an attractivevehicle for iron fortification in Otherfoods: Food vehicles that can be fortified with vitamin sugar-producing areas like the Caribbean and Central America. A include milklmilkpowder, whole wheat, rice, salt, soybean

Table 3-8. Food vehicleswith potentialfor single fortification with iodine.

Vehicle Fortlflcant Stability BloavailabIlity Status j j 1 Bread Potassium iodate (Kb3) n/a good +

(Brick) Tea Iodine n/a good n/a

Milk Iodophor good n/a +

Salt (Purified) Potassium iodide (KI) poor good +

Salt (Impure) Potassium lodate (Kb3) fair good ÷

Sugar Iodine n/a good lab

Sweets Iodine n/a good lab

Water or Kb or n/a + 12 Kb3 good = Note: += ongoing; lab = laboratorystage; n/a = notstated, ++ this is unintendedaddition of iodine through sterilizationof cow udders.

Current Practices,Research, and Opportunities 19 oil, peanut butter, and infant formulas.In Table 3-10, vehicles Multiple food fortification may be a way to address two or all suitablefor single fortificationwith vitamin A are mentioned. three major micronutrientdeficiencies in a more cost-effective When available,more information is given in Chapter 7 (Single manner. Multiple fortification of cereal and weaning foods! Fortificationwith Vitamin A). formulas has already beendone successfully. Micronutrient multimixes for cereals (primarily wheat) in addition to iron MULTIPLE FORTIFICATION and/or vitamin A often includethiamine, riboflavin, and niacin. In the contextof this report,multiple fortification refers to Examples ofcommercially available cereal fortification fortification of food vehicleswith two or more ofthe three multimixes produced by differentmanufacturers are shown in major micronutrients(iodine, iron, and vitamin A). Fortification Appendix 4. Opportunitiesfor multiple fortification offoods are with other micronutrients,such as B vitamins, vitamin C, zinc, still limited. Some possiblevehicles for such purposesare folic acid, etc., is not considered here. shown in Table 3-11.

Table 3-9. Food vehicleswith potential for single fortification with iron.

Wheatflour Elemental iron good Ferrous sulphate good

Infantcereals Elemental iron good fair + Infantformulas Ferrous fumarate good good ÷ CSMICSB/WS Ferrous sulphate fair good + -other

Maize meal Elemental iron good good +

Potato starch Ferric chloride fair fair lab Ferric citrate fair poor discontinued

Processedcereals Ferrous fumarate n/a good n/a Ferric orthophosphate good poor discontinued

Rice flour Bovinehaemoglobin fair good exp concentrate

Bread Ferrous sulphate fair good exp

Salt Premix: ferrous n/a good + sulphate/sodium- acid- pyrophosphate/sodlum- acid-sulphate Ferric orthophosphate n/a good lab

Sugar Ferrous sulphate good good exp Ferric orthophosphate n/a n/a n/a Ferrous-sodium-EDTA good fair exp

Milk powder Ferrous sulphate fair fair exp

Cheese Ferrous sulphate + ascorbic good good lab acid

Coffee Ferrous fumarate good fair exp

Curry powder Ferric-sodium-EDTA good good exp

Eggs Ferric citrate fair poor lab

Fish sauce Ferric-sodium-EDTA good good exp

'IKool-aid' Ferrous sulphate fair good exp

Note: += ongoing; exp.=experimental/field trials; lab = laboratorystage; n/a = not available.

20 MicronutrientFortification of Foods Table 3-10. Food vehicles with potentialfor single fortification with vitamin A.

Sugar Premix: vit Apalmitate 250-SD or -Iacetate 325-L = peanutoil + stabilizer

Fats and oils B-carotene-vit Aester

Cereal grain VitA palmitateor dry retinyl flour palmitate

Infantfoods VitA palmitate

Milk powder Encapsulated retinyl palmitate

Rice Premix: vitA palmitate 250-SD + I antioxidants + preservatives + Tea dust VitA palmitate250 SD Tea leaves VitA palmitate250-SD + vit A acetate + sucrose + antioxidants + preservatives

Whole wheat Premix: vitA attached to wheat grains

MSG VitA palmitate250-CWS + (Monosodium carbohydrate + antitoxidanls+ white glutamate) pigmentcoating

Peanut butter Vitamin A palmitate

Salt VitA palmitate

Yoghurt VitA palmitate

Note: += ongoing; exp = experimental/fieldtrials; lab = laboratorystage; n/a = not stated.

Some possiblevehicles for multiple fortification with ofbreastfeeding. In most cases, home prepared weaning foods micronutrients: are the best solution, but there are several constraints that have Fortificants Vehicle hampered preparationand marketing of local weaningfoods. Some ofthese are poverty,lack ofcurrent knowledge and lodine+vitamin A Rice, MSG, wheat sugar, existence oftaboos, non or irregularsupply of raw materials, flour, and infant foods time constraints for preparation,shortage of fuel/cleanwater lodine+iron Salt, fish sauce for cooking, poorhygiene practices, shortstorage time, and lodine+iron+vitamin A Processedfoods and infantfoods low socialprestige value for homemade products. Availability ofready-made weaning foods can overcome some of these These technologiesare yet to be fully developedas stable constraints. formulations in a way thatthe relativeabsorption of the Many effortshave been made to developcommercial, low-cost, micronutrientsadded are not adverselyaffected. There have multiple fortified weaning foods. Since the 1950s, large-scale beensome scattered effortsto fortifysalt with both iron and industrially produced weaning foods have been subsidized by iodine. The MicronutrientInitiative is currentlyfunding a internationalorganizations like FAO, UNICEF, and the World research projectwith the Universityof Toronto, Canada, to Food Programme (WFP), in an attemptto popularizethe investigatethis issuethoroughly by meansof a collaborative productsin developingcountries. Nevertheless, experience has effort among variousinvestigators. The aim of this research shown that large-scale local productionof weaning foods activity is to provide fortified salt with both iodine and iron so hardly met with any commercial success. The use ofthese that thesetwo micronutrientsare supplied in the diet in a productsremained restricted to the urban populationwith stableand bioavailablemanner. Fieldtrials are now plannedto higher purchasingpower. Only Incaparina (Guatamala) and test the developed formulation for doublefortified salt in Pronutro(South Africa) had somesuccess. Other weaning foods developingand developed countries. produced on a large scale have never gainedan important In recent years, there has been an increased interestfor ready- market position. Suparamine (Algeria), Faffa (Ethiopia), Balahar, made weaning foodsto supplementbreastmilk after 6 months Bal Amul, MultiPurpose Food (India),Soy-Ogi (Nigeria), and

Current Practices,Research, and Opportunities21 Table3-11. Food vehicles with potentialfor multiple fortification.

Cereal based food vitA + Fe, 12 and good n/a

Fish sauce Feas NaFeEDTA n/a n/a exp iodate 12 as potassium (Kb3) ÷ Infantformula Fe, vitA (and 12) n/a n/a

Maize meal Feas elemental iron good fair + Vit A as retinyl palmitate fair n/a +

Milk powder Feas ferrous sulphate (FeSO4) and vit A n/a n/a i-

MSG (Monosodium Feas ferricorthophosphate good good lab glutamate) VitA as vitApalmitate fair good exp or Fe as zincstearate coated ferrous good good lab sulphate VitA as vit Apalm itate fair good exp

Rice Fe as ferric orthophosphate good poor lab VitA as retinyl palmitate fair n/a exp

Salt Fe as ferric fumarate fair good exp 12 as potassium iodide(1(l) n/a n/a exp

Weaningrusk Fe as ferric ammonium citrate poor good lab Vit Aas retinyl acetate n/a n/a exp

Wheatflour Feas elemental iron good fair + Vit Aas retinyl palmitate fair n/a +

Note: + = ongoing; exp. = experimental/fieldtrial; lab = laboratorystage; n/a = not available.

Lishi (Tanzania) are examplesof multiple fortified weaning In this approach, emphasis is given to the self-sustaining foods mostly distributed free (Caritas Neerlandica 1983) for character andthe gradual expansionpossibilities of planned use in supplementaryfeeding programsby international activities.Projects in variouscountries in Africa, Asia, and Latin organizationsor governments. In Table 3-11, vehicles America carried out under the auspicesof the Netherlands suitable for multiple food fortification are mentioned.Chapter government(Benin, Burundi, Mozambique), EC (Sierra Leone), 8 (Opportunitiesfor Multiple Fortification) providesmore CaritasNeerlandica (DominicanRepublic, Ghana,Jamaica), information. NOVIB (Ghana), and WFP (Bangladesh, Ethiopia, Kenya, Malawi, Nepal),have shown thata tow-investment,labour- Small-scale productionof weaning foods is often linked to intensive projectfor manufacturingweaning foods on a semi- another developmentprogram, and such products are industrial scalefrom indigenousraw materials can besuccess- predominantlyused in rehabilitationcentres. There are, ful (Dijkhuizen 1992). Although addition of micronutrientsin however,uses and marketsfor theseproducts outside most cases was not considered, there are no technological recoveryclinics for malnourishedchildren and charity constraints for multiple fortification ofthese weaning foods. programs.Many poor householdswith weaning-age children can benefitfrom suchproducts if they are appropri- REFERENCES atelymade, have high nutritional quality, and can be ACC/SCN 1987. oforal doses ofvitamin A to vitamin afforded bythese families. Production costsare relatively low Delivery prevent Adeficiency and nutritional blindness,A state-of-the-art when local raw materials,simple technology, and local review.In West, K. P.; Sommer, A. ACCISCNState-of-the-Art and labour are used.In the Royal management 1986, Series, Nutrition Policy Discussion Paper No. 2 . ACCISCN, the "new Tropical Institute (KIT) presented blueprint for a Geneva, Swierland. approach to low-costweaning food production;'based on the Altes, F.W.K.; Menc R. 1985. Production de farine pour bêbs a petite the "Farine Bébé" at the CHNO in Benin experience of project echelle (Small-scale productionof weaning food). Final (Altes and Merx1985; KIT 1987), which proved to work in report.Royal Tropical Institute(KIT), Amsterdam, The practice. Netherlands.

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Press, NewYork, NY, USA. 139 pp. Bauemfeind, iC.; Arroyave, G. 1986. Control ofvitamin Adeficiency by Hodges, R.E.,et aI. 1978.Hematopoietic studiesin vitamin Adeficiency. the nutrificationapproach. In Bauemfeind, IC.; Lachance, AmJ Clin NJutr, 31, 876—885. P.A., ed., Nutrientadditions to food: Nutritional,technological and regulatoryaspects. Academic Press, London, UK. Hurrell, R. F.; Cook, J.D. 1990. Strategies for ironfortification of foods. Trends in Food Science and Technology, September, pp. 56— Bauemfeind, iC.; Lachance,P.A., ed. 1991. Nutrientaddition to food: 61. Nutritional,technological and regulatoryaspects. Food and Nutrition Press Inc. CT, USA. p. 103. ICCIDD (International Council forControl ofIodine Deficiency Disorders). — 1995. Statement on iodine induced thyrotoxicosis (lIT). Caritas Neerlandica, 1983. Ready-made weaningfood mixturesin ICCIDD Executive GroupMeeting, held at theMicronutrient developingcountries. Caritas Neerlandica's-Hertogenbosch/ Initiative,Ottawa, Canada, 7—9 September 1995. ICCIDD, Royal Tropical Institute (KIT), Amsterdam,The Netherlands. Brussels, Belgium. (Mimeo) Carlier, C.; Coste,J.; Etchepare, M.; Periquet, B.; Amedee-Manesme, 0. INACG (International NutritionalAnaemia Consultative Group). 1993. 1993. A randomised controlledtrial to test equivalence Iron EDTA forfood fortification:A reportof the INACG. between retinyl palmitateand beta-carotene for vitamin a INACG, Washington, DC, USA. deficiency. BMJ, 307, 1,106—1,110. 1990. Combatting iron deficiency anemiathrough food fortifica- Clydesdale, F.M. 1989. The relevance of mineralchemistry to tion technology. INACG, Washington, DC, USA. bioavailability. Nutr Today, 4(2), 23—30. JECFA(Joint FAO/WHO Expert Committee on Food Additives). 1993. — 1991. Mineraladditives. In Bauemfeind, iC.; Lachance, P.A., ed., Summary and conclusions. 41st Meeting,Geneva, 9—18 Nutrientadditions tofood: Nutritional,technological and February 1993. JECFA, Geneva, Switzerland. regulatoryaspects. Food and Nutrition Press Inc.,CT, USA, pp. 87—107. KIT (Royal Tropical Institute). 1987 WeaningFood. A new approach to small-scale weaningfood production from indigenous raw Dijkhuizen,P. 1992. Low costweaning food production. Successof an materialsin tropical countries. KIT, Amsterdam, The feasible Royal Institute(KIT), economically project. Tropical Netherlands. Newsletter, 3, 3. Klaeui,H.M.; Bauernfeind, iC. 1981. Carotenoids asfood colours. In Disler, P.B.; Lynch, SR.; Charlton, R.W.; Torrance, iD.; Bothwell,T.H.; Carotenoids as colorants and vitamin A precursors: Techno- Walker, R.B.; Mayet, F. 1975. The effect oftea on iron logical and nutritionalapplications. pp. 47—318. absorption. Gut 16, 193—200. R.D.; MacPhail, A.P.; Bothwell,T.H.; Ballot,D.; Danilewitz, Fairweather-Tait, S. 1993. Bioavailability ofnutrients. In Maccrac, R.; Lamparelli, M.D.; Macfarlane, B.i.; Mayet,F.; Baynes, R.D. 1987 Curry Robinson, RK;Sadler, Mi., ed.,Encyclopaedia ofFood powderas avehicle for iron fortification:effects on iron Science, Food Technology and Nutrition.Vol. one,A- Am Clin 335—340. Cassava.Academic Press, London, UK. absorption. i Nutr, 46, Lee, K.; Clydesdale, F.M. 1979. Iron sources usedin food fortification FAO/WHO (Food and AgricultureOrganization/World HealthOrganiza- and their changes dueto food processing. CRCCritical tion). 1988. Requirements of vitaminA, iron, folate and Reviews in Food Science and 117—153. vitamin Bi 2. FAO Food and Nutrition Series No. 32, FAO, Nutrition,pp.

Rome, Italy. Lonnerdal, B. 1986. Vitamin—mineral Interactions. In Bodwell, C.E.; Erdman, J.W., ed., Nutrition interactions. Marcel Dekker Gavin, M.W.; McCarthy, D.M.; Gaily, P,J, 1994. Evidence that iron lnc, — New York, NY, USA. stores regulate iron absorption a setpoint.Am i Clin Nutr, 59, 1,376—1,380.

Current Practices, Research,and Opportunities 23 Lynch, SR.; Cook, iD. 1980. Interaction ofvitamin C and iron. United Pennington, J.A.T. 1988. Iodine, chapter 8. In Smith, K.T., ed., Trace States Agency for International Development (USAID), mineralsin foods. Marcel DekkerInc, NewYork, NY, USA. Washinton, DC, USA. Reddy, V. 1985. Physiological effects of vitamin A deficiency. In Taylor, Mannar,M.G.V. 1993. Complementarities—Fortification. Paper presented T.G.; Jenkins, N,K., ed., Proc. XIII Inter. Congr. of Nutr. 18—23 atthe SCN MicronutrieritForum, Feb 15-16, Geneva. August,Brighton, UK.John Libbey, London, UK.Chap. 9, pp. 468—471. Marks, J. 1989. The safety ofthe vitamins: An overview. In Staehelin, W.P.; Brubacher, H. G., ecL, Elevated dosages ofvitamins. Soutligate, DAT.;Johnson, I. T.; Fenwick, G. R., ed.1 989. Conceptual Hans Huber Publishers. issues concerningthe assessment ofnutrient bioavailiabilty. Special Publications, NO. 72. Nutrientavailabilty: Chemical Molina, MR. 1991. Foods considered fornutrient addition:sugars. In and biological aspects. Royal Society of Chemistry, pp. 10— Bauernfeind, iC.; Lachance,PA., ed., Nutrientadditions to 12. food: Nutritional,technological and regulatoryaspects. Food and Nutrition Press Inc., CT, USA., pp. 251—264. UNU (United Nations University). 1994. Food and nutrition bulletin. Special issueon palm oil. UNU Press, 15(2), 176. NationalAcademy of Sciences(NAS). 1989. Recommended dietary allowances/subcommittee onthe tenth edition ofthe RDAs, Walter, T., etal. 1993. Effect ofbovine-hemoglobin-fortified cookies on Food and Nutrition Board, Commission on Life Sciences. iron statusof schoolchildren: A nationwideprogram in Chile. NationalResearch Council, 10th rev. ed. Am J Clin Nutr, 57, 190—194.

Nestel, P. 1993. Food fortificationin developingcountries. United States Agency for International Development (USAID), Washington, DC, USA.

24 MicronutrientFortification of Foods 4. FOOD FORTIFICATION TECHNIQUES

Once the micronutrient(s) to be added and the suitablefood density,hygroscopic and electrostatic propertiesof the parti- vehicleare selected, fortification is donebasically in a mixing cles, as well as proportionsof the components being mixed. process. The goal is to deliver adequate micronutrientswithout For uniform mixingand maintenance ofmix, homogeneity adverselyaffecting the characteristics of the vehicle.This seems during processing, packaging,and storage and distribution, to be quite straightforward,yet finding the right processing the ingredient propertiesof all additivesshould be as close as point for such additions in the manufacturingchain ofproc- possible.The largerthe differences, the easier segregation will essed foods needs carefulconsideration. occur.

FORTIFICATIONPROCEDURES The choice of mixing equipmentdepends largely on the ofthe Mixer which Dependingon the food processing technologies, different requirements mixing operation. attributes, addition methodshave beendeveloped: can greatly affectthe mixingeffectiveness, include mechanical batchsize or size of continuous • energy input, particleattrition, Dry mixingfor cereal floursand products,powder milk, flow, and mixing time. Mixers are widely used in the food powder beverages; industry and are available in a variety ofdesigns and configu- • Dissolutionin waterfor liquidmilk, drinks, fruit juices, rations to match the differentrequirements. The main types of and in the waterto be used for making bread, pastas, mixers for dry mixing follow. and cookies; Batch mixers:In batchsystems the micronutrientpremix is • Sprayingasin iodizationof salt and corn flakeswhere the prepared separatelyand a specific quantity is addedto each vitamins do not support the cookingor extrusion step; batch. The most commonbatch mixers are: • • Dissolutionin oil for the liposolublevitamins for Drum mixers:The simplest type ofmixers, whichconsist with or without enrichmentof oily productslike margarine; of a horizontalrotating drum ribbons. • Screwmixers A mixer is the "Nauta" a • Adhesionfor sugar fortification where the vitamin A in popular mixer, vertical cone which consistsof an inverted cone powder form is adheredto the crystalssurface by a mixer, fitted with screw 4-1 vegetableoil; circulating agitators (Fig. a). • Ribbonblender: The horizontal ribbon blenderconsists • Coatingas in rice where the vitamins sprayedover the of a shaft fitted with two helical which grain must be coatedto avoid the losses when washing rotating ribbons, rotatein directions inside a semicircular the grains before cooking; and opposite trough (Fig. 4-lb) • Extrusionas in rice where vitamins are mixed with • Continuous mixers For continuous the powderedcereal using binding agents and extruded into systems, fortificant is added a volumetricor whole cereal grains. through gravimetric solids feeder at a rate compatiblewith the flow rate ofthe The to add one or more micronutrienfsto a food simplestway food vehicleto ensurethe correctdosage in the product. vehicleis to use a Even when more mixing procedure. sophisti- Commonlyused continuousmixers are screw conveyors cated or reconstitutionof rice techniques (e.g., encapsulation (oftenwith cut and folded flights and/or paddles). grains fortified with vitamin A) are employedin specific situations and for specific purposes,mixing will still be Fig. 4-la. The "Nauta" mixer. requiredfor uniform dispersionin the food vehicle.

Dependingon the nature of the mixed components, various types of mixes can be distinguished:solid-solid, solid-liquid, and liquid-liquid. Most dry foodsare fortified using a dry premix. (Information on procedures/distributorsof premixes and fortificantscan be obtained from the Micronutrient Initiative.)

SOLID-SOUDMIXING (DRY MIXING) The most commonmethod offortifying dry foods with small quantitiesof micronutrients is dry blending, either in batches or continuouslyor with a combinationof both. Mixingeffective- nessdepends on the ingredient propertiessuch as size, shape,

Current Practices, Research,and Opportunities25 Fig. 4-lb. The Ribbonblender. Fig. 4-2. Two types ofrotary drum salt iodizationunits.

SOLID-LIQUID MIXING If the fortificant or premix is in liquidform then the fortificant components,as well as proportionsof the components being should be fed to the food vehicleby spraying, where the mixed. For micronutrientssuch as vitaminA, vitaminC, and fortificant is addedin a solution form as an atomizedspray. B vitamins, which are subjectto oxidative degradation, Spray nozzles are positionedover a belt conveyoror a screw antioxidantsare addedto the premix. Furthermore, exposure conveyoror inside a rotating drum. Both the "Nauta" mixer to oxygenand divalent ions is minimized. and ribbon blenderare used for mixing liquids into solids by mounting spray nozzles. ENCAPSULATION Encapsulation is a process ofcoating dry, free-flowing For iodization of salt crystals,drip-feeding, where the fortificant powder particles. Dependingon the size of theseparticles, is addedin solution form tothe dry salt, is still commonly the technologyis referred to as microencapsulation (coating used, but spray mixing is increasinglypreferred (Mannarand liquids and super-finepowder particles of 500 microns and Dunn 1995). Figure 4-ic is a schematic elevation ofa continu- under),or macroencapsulation (coatingof larger particlesof ous spray mixing plant for salt iodization. 5,000microns and above). Coatingpowder particles Forsmall-scale productionof fortified foods, simple low-cost between this range (500and 5,000 microns) is simply can mixing equipment be used. One can think of handmixing referred to as encapsulation (with no micro or macroprefix and the use ofa drum rotary unitthat works likea cement added). The primary objectiveof encapsulation is to extend mixer (Fig. 4-2). shelflife and quality of the productby separatingthe LIQUID-LIQUIDMIXING fortificantsfrom the vehicle'scomponents and environment until release is desired. a slow ofthe For liquidor semimoist foods, the micronutrientis dissolvedor Despite development encapsulation over the few its dispersedin a liquidvehicle (water or oil) and subsequently technique past years, application in the food is now blendedor homogenizedinto the product.The mixing is done processing industry growingrapidly. in verticaltanks filled with turbine or propelleragitators. The Encapsulation is used to mask undesirableflavours and to effectiveness ofthe mixing depends upon a number of factors isolatereactive componentsto preventthe degradationof such asviscosity, flowing characteristics, and mixability of the micronutrients.In multinutrient fortification,the use of

Fig. 4-ic. Spray mixingplant for salt iodization (with precrushing). Verti-Lift Conveyor

Belt Conveyor Spray Nozzles Iron Remover Spray Chamber

Screw Conveyor

Roll Crusher

Bagging lodated Chamber Salt

Feed Hopper with Stainless Steel Drums Agitator and Rotary Valve for lodate Solution

26 MicronutrientFortification of Foods encapsulationwill help to providebarrier protection to separate the food. Consequently, it is advisablethat certain the micronutrients from one another to avoidadverse nutrient— micronutrients be added to the foodsafter unit operations nutrientreactions. For encapsulatingvitamins, modifiedfood involving heating, aeration,and washing (Lund 1991), starch or vegetablefats may be used as a coating agent. As a general guideline, addition is preferred atthat point in the vitaminsoffer reduced after-tasteand off- Encapsulated process thatwill: flavours;are protectedfrom hygroscopic, thermal,or oxidative • Provide sufficient ensure that the nutrients degradation; and have enhanced shelf life, better flowability, agitation to are and less dusting (Duxbury and Swientek1992). In developing uniformly distributed, a stable formulation to fortify salt with both iron and iodine,the • Presentthe food at some fixed, knownvolume or University ofToronto has, under a Micronutrient Initiative- weight, funded study, used a new techniqueof dextrin • Provide for ease of addition, and microencapsulation to createa barrier between ferrousfuma- • rate and potassium iodate. Acceptability and bioavailability of Eliminate as many adverse processingconditions as the micronutrients using this formulation are proposed to be possible (Parmanand Salinard 1963). studied in a series oftrials. For productsimported at a single entry point by a single large CEREAL GRAIN RECONSTITUTION importer, the point-of-addition couldbe atthe point-of-entry Cereal grain reconstitution involves the reconstitution of broken where the productis invariably repacked. This, however, rice grains into whole grains. In the manufacturingprocess, rice depends on cost and availableresources. For products im- flour made from broken rice grains is mixed with this premix ported from one productionsource by multiple importers, itis the containingall-trans retinyl palmitate,a small amount of maize best to specifythat the productbe fortified at production oil, and lard offood grade. A new formulationreplaces lard sourceat the prescribedlevel. Sometimes, a combination ofthe with other types of oils like coconutor peanut oils. Alpha- foregoing strategies will have to be adopted. tocopherol and ascorbic acid are added at 1 mg/g premix.The There are pros and cons for locatingthe fortification plants fortified are then as rice and mixed with grains reshaped grains either at the point-of-manufacture or closeto the consuming regular rice ata ratio of 1:100to 1:200, depending on the areas. If the plant is located at the productionpoint, there is of the vitaminA-deficient patterns of rice consumption popula- minimum additionalhandling involved, butlosses in transit tion to served. The the be proprietarybinding agent protects and storage are possible. If thefortification plants are located at fortificant during rinsing and cooking. the consumptionpoints, losses would be minimized, but POINT OF FORTIFICATION multiple handling and storage mightmake it uneconomical. The method ofmicronutrient addition is frequentlydependent The question also arises as to whichagency would own and on the manufacturer'sprocessing system, packagingand food operatethese plants at the consumptioncentres and bear the preservationtechniques, the commodityto be fortified, the additionalhandling charges. The consensus is in favourof fortificant to be added, and the processor'spreferences. For locatingthe plantas close to the point of production as better stabilityprofiles, the fortificant should be addedafter possible and/or just before packingto maximize retentionof processingas in the case of flaked cereals,although this can the fortificant (Mannarand Dunn 1995). Table 4-1 summarizes cause separation. In somecases, therefore, the fortificant must the preferable point-of-addition for a numberof foods. addedbefore heat in cannedfoods. To be processingsteps as PACKAGING identify suitable and convenient point(s) where fortification can be integratedwith the prevailingsystem at minimumaddi- To minimize micronutrient losses duringstorage, the fortified tional cost, the whole manufacturingprocess from production! food should be properlypackaged. The retention rate ofthe importationpoints to the consumer should be carefully studied. micronutrient in foodsdepends on the fortificant used, thetype of packaging,the exposureof the package to prevailing One ofthe most importantfactors affecting the point-of- climatic conditions,and the time elapsed betweenthe moment addition of a micronutrient or premixis thestability of the offortification and actual consumption.Because of a lack of micronutrients. Operationssuch as cleaning/rinsing,cooking, availability of packagingmaterial in many developingcoun- aeration, heating, extrusion, or drying,etc., maysignificantly tries, packagingassumes great importance. In somecases, an affect the biological functionsand stabilityof the added availablesource of appropriatepackaging material is found nutrients.Iodine, for example,is subjectto vaporisationwhen before the productis designed (Fellows and Axtell 1993). exposed to excess heat during processing.Iron compoundsare subjectto oxidationand colour changes. Vitamin A is subjectto Fortified food-production centresare often far from the con- oxidation,hydrolysis, and biochemical reactionsthat could sumption areas, therefore, adequate precautions should be reduce its potency. The importanceof any of these factors is taken to ensurethat these foods ultimately reach the consumer dependent on time, temperature,oxygen, and composition of with the recommended level of fortificant. For this reason, shelf-

Current Practices, Research, and Opportunities 27 Table 4-1. Point-of-additionof a dry premixof micronutrienfs to food vehicles.

Baked items Coating,spraying, or drypremix In water-flourmix

Beverages Solution ordry premix Before pasteurization

Bread Tabletor dry premix Water-flour mix Breakfast cereals (dry) Coating orspraying Aftertoasting

Cereals (cooked) Dry premix Last mixing stage

Cheese(processed) Solution or drypremix During blending

Cheese(primary) Solution or drypremix Before curdling

Maize grits Dry premix End ofmiling Maize meal Dry premix During milling Wheatflour Dry premix During milling

Fruitjuice Solution Before pasteurization

Infantfood (dry) Dry premix During mixing

Infantfood (liquid) Dry premix Prior to homogenization

Margarine Emulsion Before churning

Milk Emulsion Priorto homogenization Milk powder Dry premix Before instantizing

Pasta products Dry premix In water-doughmix Peanut butter Dry premix With salt addition Potato chips Dry premix Coatafter toasting

Rice Coating,spraying or dry premix After milling

Salt Spraymixing or dry premix After milling Snackfood Coating,spraying or drypremix After heat processing

Soups (dry) Dry premix During mixing Soups (processed) Dry premix Before pasteurization

Soya flour Dry premix During mixing

Sugar Dry premix During blending(dry)

Tea leaves Dry premix During blending

Vegetable oil Direct fortification Followed by blending

Source: Adaptedfrom Bauemfeind and Brooke(1973).

28 Micronutrient Fortification of Foods life testing is highlyrecommended. Hygroscopic productslike Rigid containersinclude glass and plastic bottles,jars, cans, flourand salt easily attract moisture and become wet when pottery,wood, boxes, drums, tins, plastic pots, and tubes. They improperly packaged andtransported over long distances all, to avarying degree, give physical protectionto the food under humid conditions.This causes biochemical and micro- inside that is not provided by flexible packaging.On the one biological deterioration.Efforts should be made to improvethe hand, some types of rigid packaginghave the advantage of distribution network to reducethe time between fortification providing a perfecthermetic seal. On the other hand, although and consumptionof foods. most rigid containersare strong, they are more expensive than flexible packaging.Glass jars are not suitableas packaging Packaged foods should be markedto identify the contents for materialsfor foodsthat are adversely affected by light unless monitoring purposes. Ideally,the package should also be the jars are storedin a dark place or if the fortified food stored markedwith the productiondate ofthe contentso that the time in a glass jar stays stableon exposureto light. elapsed between fortification and consumptioncan be catcii- lated.All packages should carry expirationdates to ensurethat Flexiblepackagingthat can be used to make wrappings,sacks, the product still has the adequateamount of the fortificant.The and bags includes plasticfilms, papers, foil, sometypes of stipulations for handling, transportation,storage, and salesof vegetablefibres, and cloths. iodized, salt as described in Table 4-2 are also packaged Packagingoptions for groups offoods are described by Fellows for other fortified foods and Dunn applicable (Mannar 1995). and Axtell (1993): PACKAGING MATERIALS AND CONTAINERS Hygroscopicfoods: When packedfor the humid tropics, There aretwo types ofpackaging materials: rigid containers hygroscopicfoods suchas wheat flour, maizeflour, and salt and flexible packaging. requirea moisture barrier.These foods should be packed in

Table 4-2. Stipulationsfor handling, transportation,storage, and salesfor packaged fortified foods. • Do not expose food to water, excessive humidity, and/ordirect sunlight atany stage of storage, transportation,or sale. • Transport,store, and keep the food for sale in the original packing only. • Store baggedfood only in covered roomswith adequate ventilation. • Stack baggedfood on wooden pallets (raisedat least 10 cm above floor level). • Avoid the baggedfood making directcontact with the walls ofstorage rooms or warehouses. • Do not use hooks or pointed or sharp instrumentswhen handling the bags. • Keep a stock registerwith batch numbers and the date of receipt and despatch.

• Despatch, distribute,and sell the food strictly accordingto the principle offirst in first out.

• Agents, distributors,and retailersshould cooperate with government-designated inspectors in the inspectionof fortified food stocks and the drawing ofsamples. • Fortifiedfoods may be sold by retailers only if the period between the date stampedon the bag and the date ofsale is less than 6 months, Samples of all date-expired foods shall be sent to a designatedauthority for confirmationregarding adequate micronutrientcontent. If not adequate, the food shall be returned to the appropriateagent or distributor for free replacement. • Agents and distributors of fortified foods shall return all foodsthat are date-expired or do not conformto the minimum standard offortification to a designatedauthority for free replacement. • Retailers shall adviseconsumers to storefortified foodsin sucha manner as to protectthem from direct exposureto moisture,heat, and sunlight

• Retailers shall replace, free-of-charge, any fortified food purchased by a consumerand subsequently certified to be not - conformingto the minimum standardof fortification.Such food shall be kept separately and returnedto the distributor or agent for free replacement. • Bags of fortified food maybe storedtemporarily after opening only for purposesof retail sale. Such bags shall be kept covered or closed atall times. • Retailers shall prominently display the government approval,sign boards,and postersrelating tofortified foods.

Source: Adaptedfrom Mannar and Dunn (1995).

Current Practices,Research, and Opportunities 29 airtight bags or containers. In manycountries, this implies a Beverages Fruitjuices, which are intended for immediate major switch from conventional packagingmaterials, like straw consumptionafter opening, rely on pasteurizationfor their or jute, tothe more expensive plastic lined bags and other preservation. The packaging is used to prevent containers. The packagingunits in the case of bulk packaging recontaminationby microorganisms. Glass jars, cardboard should not exceed 50 kg (in accordance with International cartons coated with polypropyleneor cellulose film, or coated LabourOrganization (ILO) regulations)to avoid the use of metal tins are applicable. hooks for lifting the bags.Bags once used for packagingother Cereals/flour: Like hygroscopicfoods, these also requirea articles suchas fertilizers,cement, chemicals, etc., should not moisture barrier and should be packedin airtight bags or be used for fortified foods. packaging containers. Edibleoils and fats: Cookingoils are susceptibleto rancid- Peanut butter: Although peanut butter is yetto become ity, therefore, lightproof and airtight packagingis required. popular in developingcountries, it can be a good source of Metal cans, glass, andpossibly plasticbottles are the most protein and micronutrients.Peanut butter is susceptibleto suitable containers. rancidity because ofthe high oil content.The packagingused Dairyproducts: Mkrobial contaminationis the major must be Iightproof and airtight. Metal cansand glassbottles problem in usingdairy productsas a vehiclefor fortification. are the most suitable containers. Packagingshould be sterilizedto preventcontamination after processing. During distribution and storagethe products REFERENCES should be kept cool and away from direct sunlight. Bauernfeind, ic.; Brooke, C.L. 1973. Guidelines for nutriIing 41 Polyethylene bags are adequate if the product is carriedhome processed foods. Food Eng, 45(6), 91 —97, 100, and consumed right away. For long-termstorage of cheese, Ri. 1992. face polyethyleneshould not be used because of migration of Duxbury, D.D.; Swientek, Encapsulated ingredients 'healthyfuture Food Processing, February, 38—46. chemicals from the plastic into the fatty food. For distribution purposes,reusable glass bottles with foil lids are used as a Fellows, P.; Axtell,B. 1993. Appropriatefood packaging. International Labour Switzerland. relatively low-costpackage,for milk. Organization (ILOITOOL), Geneva, Lund, D.B. 1991. Engineering aspects ofnutrifying foods. In Bread:Because of its short shelf life, packagingbread is Bauemfeind, iC.; Lachance,P.A., ed.,Nutrient additions to used these clean and not mainly to keep products is usually food: Nutritional,technological and regulatory aspects. used as a barrier to moistureor air. Clean paperis an adequate Food and Nutrition Press, pp. 473—494. material. If film is on packaging polyethylene used, condensing Mannar, M.G.V.; Dunn, iT. 1995. Salt iodizationfor the elimination of the inside the should be the of bag preventedby allowing iodine deficiency. MicronutrientInitiative (Ml/ICCIDD), baked goods to cool down after baking and before packaging. Ottawa,ON, Canada. 126 pp.

Biscuits:When packed for the humidtropics, dry biscuits Parman, G.K.; Salinard, G.i. 1963. Vitaminsas ingredientsin food In Food requirea moisture barrier and packagingto resist mechanical processing. Joslyn, M.A.; Heid, iL., ed., processing operations, Vol. II. AVINan Nostrand Reinhold, NewYork, damage. NY, USA. For biscuits with a high fat contenta lightproof/airtight packagingto avoid rancidity is also required. Cardboard cartonscoated with polypropyieneor cellulose film is applicable. The use ofpolyethylene should be discouraged because of the migration ofchemicals from the plastic into the fats containedin the biscuits,

In dry areas,the foregoing constraints are not of importance. In theseareas, the packagingis simply used as a way to storethe food and to keep it clean.

30 MicronutrientFortification of Foods 5. QUALITY ASSURANCE AND CONTROL

Ensuringthe adequacyand quality of fortified food products Quality assurance incorporates GMP, which is that part ofQA fromproduction to consumptionis a most critical componentof that ensures that food productsare consistentlyproduced and anyfood fortification program. It should be a primary concern controlledto the quality standardsappropriate for their ofthe food industry to validatethe consistency ofthe manufac- intended use. The QA approach involves the control,evalua- turingprocess to release a uniformly fortified productfor tion, and audit of a food processing system: distributionthat has all the intendedcharacteristics and qualities. • Quality controlinvolves operational techniques and The availability of trained staff to carry out the procedures activitiesthat are used to fulfil requirements for quality adequatelyis of great importancefor a successful outcome. (line inspectionof supplies, materials,raw materials; REQUIREMENT FORQUALITY ASSURANCE (QA) operating procedures; and finished products). • evaluation the worthof all raw and The word "quality" has beendefined in various ways. Accord- Quality appraises chemical,sensory, and ingto the standarddefinition, quality is "the totality offeatures processed products (physical, microbiologicalanalysis). and characteristics ofa productor servicethat bear on its ability tosatisfy stated or implied needs" (ISO 1987). Another • Quality audit verifies or examines finished products or popular definition is "fitnessfor use which is very similar to even processes over time (shelflife, market review,and the standard definition but less neutral. Teboul (1991) intro- consumercomplaints). duced a more when he defined as "the dynamic aspect quality ESTABLISHING A SUCCESSFUL QA PROGRAM ability tosatisfy needs atthe time ofpurchase and during use There are six basicfundamentals that must be carefully atthe best cost,while minimizing losses and surpassingthe considered and worked out for the success of any QA competition:' The twoterms, quality assurance and quality clearly (Gouldand Gould 1988): control, are often used interchangeably, although based on the program WHO (1990) definition, there are differences between the two. • Organization ofthe QA department:Quality assurance must start with top managementsupporting the Quality control(QC) is the part ofgood manufacturingpractice conceptof quality. The needfor productquality control (GMP) that is concerned with sampling, specifications, and should be explainedto, and demandedfrom, all personnel. testing, and with the organization,documentation, and release • procedures that ensurethat the necessary and relevant tests are Personnelselection: Personnel in the QA department actually carried out and that productsare not released until must be selected on certain qualificationsand trained to their quality has been judged to be satisfactory. Quality control be able to fulfill the responsibilitiesnecessary for a is not confinedto laboratoryoperations but must be involvedin successful QAprogram. Itmay not befeasible to establish a all decisions that may concern the quality of the product. full QA departmentin smaller businesses because of cost and staffing issues. These issues must be examined Quality assurance (QA) is a wide-ranging conceptthat covers and worked out to have a successful program. all mattersthat individually or collectively influence the quality • for evaluation and line control: ofa product. It is the total ofthe organized arrangementsmade Sampling product that a is and applies to equipment, product design,supplies and Adequate sampling, assuming QA program is The taken of a logistics, management and human resource development, and already established, important. sample batchfrom the line must be all elements with the objective of ensuring that productsare of production representative and must be selected at random. a quality requiredfor their intended use at the consumerlevel. Poor, inadequate sampling is one ofthe greatestobstacles to achieving assurance as to the should be Quality it applies laboratory successful control of productquality. differentiated fromQA as itapplies to the program,which • Standardsand spedflcations: Quality assurance and would include incorporation of quality in management,the so controlfollows the establishmentof ingredients called total quality management(TQM) methods. product and productand process specifications. No other facetof Totalquality managementis only one of many methodsthat quality assurance is more important than the establish- have beenused to instilla certainfoais on customersthrough ment ofspecifications and the developmentof stand- recognizingthat those involvedwith the processes needto be ards ofquality for productevaluation. Government involved in the decisions about those processes. All this relates agencies involved in food regulationshould be commit- to a managerialattempt to build betterQA throughoutthe ted to quality assurance and control,otherwise the ranks byworkers. objectives of food fortification may not be met.

Current Practices, Research,and Opportunities31 • Measurement (laboratory, equipment, proce- productionuntil the problem is resolved.In salt iodization,for dures, and reports): The facilitieswill varywith the example,this would prevent large batches ofsalt from being size ofthe operation,the number ofproducts being released if they did not consistentlyhave the intendediodine in packed, and the different qualities being packed. Report- the acceptedrange. ing ofthe results is just as important as the analysis of Throughquality assurance and control it is ensured that the thesamples. Reportforms thatprovide findings and manufacturedfood is properlyfortified without affecting the recommendationsshould be and completed daily kept organolepticproperty of the vehicle, that it is safe to be used, for future reference. Results should be used to guide and that it meets all quality standards and government decisionsand corrective when management actions, Fortified foods should be made availableat needed. regulations. competitive prices comparedto nonfortified foods. Itshould, • Data collection and interpretation:Careful data however,be pointed out that performinga QA program with collection using correct sampling proceduresand analysis this degree of sophistication may be difficult in many countries. is critical. The the control data is interpretationof quality DEVELOPMENT AND IMPLEMENTATION OF QA/QC one ofthe more functionsin thesuccessful important SYSTEMS operation ofa QA program.The use ofstatistical methods The developmentand implementation of a sound quality can be of great value for the proper interpretationof assurance and productcontrol system is instrumentalto processesand data. developingan effective, practical, and economical micronutrient The basic is the routine limits ofthe concept establishing fortification of food program. The industryshould organize system,i.e., through a control chart with calculated upper and itself in such a way thatthe technical, administrative, and lower control limits and then using this chart to demonstrate human factorsaffecting the quality of its productswill be under that the process is "in control When it is not, there would be control. All such control should be oriented toward the reduc- specific proceduresto follow to determinethe cause and to stop tion, elimination, and preventionof quality deficiencies. The process is in control if: Steps for Implementation of a QualityAssurance • The specific product/processparameter complieswith (QA) Program the formulated standard at the CCP5 at regular intervals, and • Providing specifications for both fortificant and food vehicle (particle size, colour, potency, acceptable ranges • Corrective action is immediately taken if an observation offortificant, fortification level); deviates from the specification. • Routinely undertakinghazard analysis offortificants and Everyone in the company, from the director to the junior fortified foods for chemical, microbiological, and physical labourer,has a responsibility for assuming a good-quality contaminants; product. The benefitsfrom meeting these responsibilitiesare often notfully realized, This results in failure to organize • Samplingand testing of fortificants, food vehicle, and effective quality-control cycles. To be effective, the cycle must be fortified food for potency, particle size, colour, netweight, complete. An example of such a quality control cycle is given in adulteration,packaging, and storage conditions; Fig. 5-1. • Identifying and regulatingthe critical control points QUALITY MANAGEMENT SYSTEM (CCP5) that might adverselyaffect fortified foods; Aquality managementsystem should be developedand • Establisha recall to trace or identify the system product implemented, appropriateto thetype ofactivity and product in case of consumer complaints; being offered to achievemaximum effectiveness and to satisfy • Auditingand evaluatingthe QA system on a regular customerexpectations. The quality system typically applies to, basisto determine whether variouselements within a and interacts with, all activitiespertinent to the quality of a quality managementsystem are effective in achieving product. It involves all phases from initial identification to final stated quality objectives; satisfactionof requirements and customer expectations. A schematicrepresentation of the quality loop is shown in Fig. • Implementation of corrective actions (detection of quality 5-2. or safety problemsand measuresto eliminatethe recurrence ofthese problems); and The impactof quality upon the profit-and-loss statement can be • highly significant. A companymight surviveif individual Documenting all aspects of the QA system and making fail to meet but if the most senior the documentationavailable to those responsiblefor products requirements, fail to that cost must be identified and the fortified food. management appreciate measured in relationto quality as part of a company-wide

32 MicronutrientFortification of Foods Fig. 5-1. Quality control cycle.

PRODUCT

—p PRODUCT

iicaIcontrolPoinE______.______Measurement/inspection

,r Registration correction Registration result

Requirements/tolerance

Deviation acceptable?

NO YES Correction I Continue

Fig. 5-2. Quality loop.

Source: ISO (1978) policy, then the companywill cease to trade competitivelyand on a regular basis at four levels: the production plant and inter- will eventuallycease to trade at all. It is well known that the mediate pointssuch as wholesale, itail outlets, and households, reportedcosts of are markedly lowerthan the quality frequently At the production plant, the mixing process must be validated. actualcosts of It is not uncommon for the cost of quality. This must include monitoring of micronutrientcontent during quality to be as as 25°/oof sales (Lock 1990). high production,and samples must be taken periodicallyat the end of the processing line to monitor micronutrientlevels in the final Both the process and the product ofany fortification program product. needto be monitored. Indicatorsfor monitoring a micronutrient The responsibilityfor routine monitoring atthe production food fortificationprogram should include both the fortification plant rests with the factoryitself (internalmonitoring). For process atthe industry end, to ensureconstant and appropriate example, in the case of iodine, the recommended procedure is levelsof micronutrientin the food, and also the actualcon- to carry out hourly monitoringduring productionwith the sumption of the fortified food by the population. Once the rapidtest kit and confirmedperiodically by titration. External necessary infrastructureand legislation for micronutrientfood monitoring, however, by independentagencies at periodic, fortification are in place, fortification levels could be monitored regularchecks should be promoted.

Current Practices,Research, and Opportunities 33 The overall for controlinside the The that responsibility quality country steps specifically requirequality often with the Public Health but consumers' assuranceare: rests Department, organizationscan and should also be involvedin monitoring 1. Purchase quality equipmentand supplies; micronutrientlevels at the off-factorylevel. The objectiveof this is to ensurethat the containsthe 2. Routinely inspectprocessing equipment; monitoring activity product predeterminedlevel ofmicronutrients added atthe consumer 3. Validatethe mixing process to ensureconsistant mixing; level.For example, in India, three nongovernmentalorganiza- 4. Monitor food readyfor distribution; and tions (NCO5) in the severelyiodine-deficient state of Uftar Pradesh were involved in monitoring salt atthe retail and 5. Keepadequate monitoring records. householdlevel. Each month, saltsamples were obtained from Source: Adaptedfrom PAMM/MI/ICCIDD/UNICEF (1995). local retail shops and the results communicated to the community and civic officials. Local politicianswere made aware of inadequacies in the iodine contentof salt. The issuethen went Legal provisions on monitoring should cover: on to be raised in the Provincialand National Parliament Internal,or self-monitoring,by the industry referred to as (PAMM/Ml!ICCIDD/UNICEF1995, p. 43),2 assurance With internal the quality (QA). monitoring, DETERMINATION OF LEVELOF FORTIFICATION examinesits own and industry routinely processes proce- IODINE dures to identify and correctany problem areas found. The iodine content in salt can be checked using simpletitration External monitoring bythe governmentpursuant to its techniques or field-testingkits (PAMM/Ml!IJNICEF1995). and investigationpowers. External inspection monitoring Titration may be used where an accurate determination of the provides the governmentwith the information necessary to iodine level is required(e.g., atthe point ofproduction or enforce the law whenevernoncompliance with legal import). For routine checkingat the field level,a simple test kit is found. requirements made up of a stabilized starch solution can be used.Table 5-1

Source: PAMM/MI/ICCIDD/UNICEF(1995, p. 19). shows the criteriafor assessingthe adequacy of a salt iodization program,which has beenestablished by a joint WHO! UNICEF/ICCIDD (1992) consultation. MONITORING BY GOVERNMENT AND BY CONSUMERS IRON For externalQA, the authorizedgovernment agency should Iron contentcan be determinedby a variety of techniques such develop a plan for periodicchecking of all producersof fortified as a simple colorimetricniethod or by using an atomic products.The frequency ofthese checks should be adaptedto absorptionspectrophotometer (AAS). Simplefield kits can give ensurethat the food reachingthe market meets government a qualitative (not quantitative)indication ofthe presence or standards.External monitoring should increase in frequency absence of iron. Regular monitoringof iron levels in the productis when householdsor retail-levelmonitoring indicatethat some needed to avoidexcess iron additionin case ofpoor iron distribu- products fail to meetthe standard.The steps involvedare: tion during production. Criteria forassessing the adequacy of an iron fortification program can be established similar to those 1. Develop standardsfor fortified foodsand the legislations prepared for a salt iodization program(Table 5-1). required to ensurethat these standards are maintained. VITAMIN A 2. Develop a monitoring plan. Assay methodsfor vitamin A requiresophisticated laboratory 3. Establish a list of offortified to producers products equipmentsuch as high-pressureliquid chromatography monitor. (HPLC). For developingcountries semi-quantitive colorimetric because of lower costs 4. Monitor producers. test methodsare more appropriate (Arroyave etal. 1979). Criteria for assessingthe adequacyof a 5. Record data. vitaminA fortification program can be establishedsimilar to 6. Implementenforcing procedures. those shown for a salt iodizationprogram (Table 5-1).

2A manualentitled "MonitoringUniversal Salt lodizationProgrammes" has recently been publishedby PAMM/Ml/ICCIDD/UNICEF in response toa similar manualis strong need for guidance on systematic procedures to establish a permanent, iodizedsalt-monitoring system within a country. A underpreparation for a monitoringsystem suitable for programs dealing with vitamin A-fortified foods. Copies can be obtainedfrom the Micronutri- entInitiative or PAMM.

34 MicronutrientFortification of Foods Table 5.1 Criteria for assessing adequacyof a salt iodization program.

A. Factory or importerlevel 1. Percentage offood gradesalt claimedto be iodized 100°/a

2. Percentage offood-grade salt effectively iodized 90°/aor more

3. Adequacy of internalmonitoring process 90°/aor more

4. Adequacy of external monitoringprocess0 10—12 monthlychecks per producer/importer per year

B. Consumer and districtlevel 1. Percentof monitoringsites with adequately Adequacy in 90°/o ofsamples iodizedsalt — households (or schools) — districtheadquarters (includingmajor markets)

2. Adequacy of monitoringprocessb 90°/oor more

0Corrective action systematically takenwithin 3 hours in 90°/o ofcases, followingthe lot quality assurance methodology. bMonitoringundertaken in 900/0 ofdistricts in each state, atwholesale, retail, and householdlevel. Source: WHO/UNICEF/ICCIDD (1992).

REFERENCES Teboul, J. 1991. Managingquality dynamics. Prentice Hall, London, UK. Arroyave, G.; Aguilar,JR.; Flores, M.; Guzman, M.A. 1979. Evaluation ofsugar fortification with vitamin Aat the international WHO (World HealthOrganization). 1990. Good manufacturing practice level. Pan American HealthOrganization (PAHO),Washing- for pharmaceutical products.PHARM/90. 129/Rev. 3a. ton, DC, USA. WHO/UNICEF/ICCIDD. 1992. Indicators for assessing iodine Gould, W.A.; Gould, R.W. 1988. Total quality assurance forthe food deficiency disorders and their control programmes. Report industry.Cr1 Publications, Baltimore,MD, USA. of ajoint WHO/UNICEF/ICCIDD Consultation, World Health Organization (WHO), Geneva Switzerland. ISO (International Organization for Standardization). 1987.Quality — management and qualitysystem elements guidelines. Wilson, L.A. 1988. Proposed quality assurance guidelinesfor the ISO, 9004, 1987-03-15. fortificationof MSG with white vitaminA in Indonesia project. Dept.Food Techn., Iowa State University, IA, USA. Lock, D., ed. 1991. Gower handbookof quality management. Gower PublishingCompany, London, UK. PAMM/MI/ICCIDD/UNICEF. 1995. Monitoringuniversal salt iodization programmes. In Sullivan, KM.; Houston, R.; Gorstein, J.; Cervinskas, J., ed. PAMM/MI/ICCIDD.

Current Practices, Research,and Opportunities 35 36 MicronutrientFortification of Foods 6. LEGISLATION AND REGULATIONS FOR FOOD FORTIFICATION

Effective fortification programsin any country needto be programs, regulationsare rules issuedby governmental supportedby suitable legislationand regulations.To advocate ministries and departmentsto carry out the intent ofthe law and plan a food fortification program it is essential to ensure and to regulateactivities ofdepartments and sections under the existenceof mechanisms through which the entire process the guidanceof the ministry to ensureuniform applicationof can be legally controlled. Two points needto be noted. the law, It is simpler to have a generallegislation covering fortification than to have individual of First, the mere existenceof legislation and regulations is not pieces legislationdealing with each relatedto food fortification. sufficient to ensurethat fortification is taking place.When activity combinedwith awareness-raising, among policymakersand In somecases, in place of legislation, it is quickerand simpler control can the other principal players,however, suchlegal to enforce a regulation(based, e.g., on an existing public health play an important role by helping to accelerate the fortification or food law), which does not have to be officiallypassed by process and by protectingthe consumers from harmful parliamentor the head ofthe state ofthe country. This is practices that may impinge on their health (e.g., fraud or because it is generallyeasier, both politically and logistically,to technological inadequacies in the production of a fortified changeregulations than to introduceand passlegislation to commodity). amend an existing law (Nathan 1995). Table 6-1 outlines matters included in the law versus in the Second, even in the absence oflegislation or regulations,the appropriately as to the offortification ofsalt privatesector is often capable oftaking appropriate action to regulations applied example fortifyselected vehicles with micronutrients,and has doneso with iodine. in a number of countries Here some level (Nestel 1993). again, Once the review ofthe existing law and regulationsis com- of and activitiesto create the needfor such advocacy pleted, any shortcomingsshould be communicated tothose micronutrientshave a role in the action. played encouraging with the political power to influence legislation and regula- Nevertheless, to ensuresustainability ofthese efforts,to tions. Expertsto assistwith drafting amendments totile law preventunfortified food from entering the country and being and/orregulations should also be involved.If possible,the consumed in ofthe fortified one, and to the whole place protect programmanager should seek input from the program fromthe conflictsraised process byany antagonisticgroup, perspective to be incorporatedinto legal provisions governing somesort of control is bound to be necessary. legal fortification. If it is necessary to amend the existing law, Although the laws enacted by the country's legislative organ sponsors must be found to introducenew legislation. Once provide the governmentwith the legal authority to carry out its introduced, the legislation might need lobbying for its passage.

Table6-1. Mattersappropriately included in the law versus in the regulationsas applied to the exampleof salt fortification.

Requirements forcompulsory iodizationof all salt intendedfor human Potassium iodate levels at manufacture, import,wholesale, and retail or animal consumptionwith Kb3 in compliance with all regulatory levels requirements

Requirement that manufacturers, importers,wholesalers, retailers, QAactivities to be undertaken, such as routineequipment and instrument and transporters must undertakeperiodic QA activities calibration, and sample testing ofiodine content

Authorityof the government toinspect or investigateany premises When the governmentmay inspect or investigate, whatthe government where salt is manufactured, imported,received, held, stored,or found, maylook at, orhow the governmentmay test salt samples orwhere it is reasonably believed tobe the case

Penalties fornoncompliance, includingfines, licence suspension or The circumstances underwhich penalty orincentive may be applied,the revocation, adverse publicity,or confiscation amounts offines and periodsof suspension, and the procedural stepsfor imposingpenalties

Incentives forcompliance, including transportand display priority for As above iodized salt, exclusive use of logo, andfavourable taxtreatment

Source: PAMM/Ml/ICCIDD/IJNICEF(1995, p. 21).

Current Practices, Research,and Opportunities 37 Additionally,monitoring is necessary to watch for any amend- • Applicability ofthe measure to all food that is produced, ments proposedby othersthat mightweaken the law and thus imported, or marketedin the country. make the program difficult to administer. • Designate the governmentunit, e.g., Ministry ofHealth, Ifthe law is adequate, but the implementing regulationsneed to issuespecific enablingregulations for each amending,program managersshould alert the appropriate fortification measure so that it is possibleto respond personwithin the ministry charged with enforcingand promptly to changing requirements for food fortification administeringthe existing law. Programmanagers then should withoutpassing new legislation. become involved in the standardsand require- • establishing Enforcement and penalties for noncompliance. mentsthat will be containedin the regulations. To be effective, there should be an efficientsystem ofmonitor- Once the law and are in regulations place, programmanagers ingto ensurecompliance, i.e., the system should besupported should assist in the ofclear thatwill development guidelines byan inspectionforce that has clearlydefined procedures for the understandand with the help industry comply quality sampling foodsand well-establishedstandards and analytical assurance ofthe law and The requirements regulations. methods for determiningthe micronutrientcontent of fortified should be in collaboration with guidelines developed industry, food. Legislationand regulationsthat mandatefortification other and other affected NGO5, ministries, any groups.Finally, should create a devicefor enforcement through a systemthat the of fortificant in the fortified food is not if proportion fines the defaulters and preventsa continuation of operationsif the can into the appropriate, program manager provide input manufacturers do not meetlegal requirements embodied in the legal process, suchas modifying the level offortificant in law. production(PAMM/Ml/UNICEF 1995). Regulationof a food fortification program can only be a As the first in sucha step developing regulatorymechanism, support measure. It is more important to motivatethe food the following points needto be examinedcarefully: industry to comply through education. Consumergroups • whose main is to ensurethat the receives Is a new legislation actually required/desirable or can objective public high- and services can an role in the existing law adequatelyregulate food fortification? quality goods play important ensuring thatthe food sector complieswith the regulation.For • If a changeto a law is necessary, should the existing more informationon the subjectof legislationand regulation food controllaw be amended,or will a separate law see Nathan (1995). needto be enacted? • REFERENCES Is the existing regulatoryinfrastructure adequate or Nathan, R. 1995. food fortificationlegislation and regulations manual. does it need improvement? ProgramAgainst Micronutrient Malnutrition (PAMM), USA. Second 52 • Shouldthe legislation be limited to fortificationwith a Atlanta,GA, edition, pp. micronutrientor will a more general food fortification Nestel, P. 1993. Food fortificationin developingcountries. United law required?In either case, should the legislation be States Agency forInternational Development (USAID), DC, USA. VITAL, 47 introducedat the national or provinciallevel? Washington, pp. PAMM/MI/ICCIDD/UNICEFIWHO. 1995. Monitoringuniversal salt The major components that should becovered in the legisla- iodization programmes. MI/PAMM/UNICEF/ICCIDD/WHO. tion include: Program Against Micronutrient Malnutrition (PAMM), Atlanta, • Mandatory fortification at a level to be determinedby GA, USA. the public health authorities of each country.

38 MicronutrientFortification of Foods 7. REVIEW OF RESEARCH AND CURRENT PRACTICES IN MICRONUTRIENT FORTI FlCATION

SINGLE FORTIFICATIONWITH IODINE iodine source or premix, drip feed addition of an iodine com- SALT pound to salt, and spray mixing ofan iodine solution to salt. Countries: A wide rangeof both developed and developing (a) oiy mixing countriesall over the world. A premix of potassiumiodate and an anticakingagent like calcium tricalcium or Organizations andgroups involved: Ministries ofhealth! carbonate, phosphate, magnesium carbonate is in a ratio of 1:9. One of the stock industry, salt industry, UNICEF,WHO, ICCIDD, Ml, PATH, prepared part mixture is then mixed with 10 ofsalt and the is OMNI, USAID, bilateral agencies, NGOsetc. parts premix introducedinto a "cement" mixer or screw conveyor at a Vehicle: Saltfulfils all the characteristics ofa suitable nearly prefixedrate. Salt is also introducedinto the dwm or conveyor. food vehicle. Salt is one ofthe few commoditiesconsumed by Mixing takes placeas the dwm rotatesor the material moves all membersof the of sociallevel. It is community regardless through the conveyor. This process is suitablefor dry powdered consumed at the samelevel the all roughly throughout year by salt only. Dry mixingis widely adoptedin several countriesof membersof a Thus a nutrient like iodine when community. South and Central America likeArgentina, Bolivia, Guatemala, introducedthrough saltwill be administeredto each individual and Pew as well as Pakistan. at a steady dosagethroughout the year. (b) Drip feedaddition Fortificants: Thetwo principal tortificantsare potassium Drip feed addition is commonlyused for iodizationof salt iodide (KI) and potassiumiodate (see Chapter 3) For (Kb3) crystals. The salt crystalsare fed onto a hopper that discharges quality standards ofpotassium iodate in salt iodization see at a uniform rate into a belt conveyor, about 35—40 cm wide Appendix1. and 5.5 m long inclined at a slope ofabout 20 degrees. The Fortificationlevel: Currentlevels ofiodization in different conveyoris equippedwith a tensioningdevice. The feed countriesvary between 20 and 165 ppm potassiumiodate hopper has a capacity ofabout 300 kg and the rate ofsalt flow (12—100ppm iodine). In a given country, the level offortifica- onto the conveyor is controlledby means of a slide valve. tion may be changed over time, in responseto changes in The Kb3solution is stored in two 200-litre polyethylenestock averagedaily consumptionof saltand iodine losses during tanks with dischargevalves at the bottomto permit the filling distribution and storage.A samplecalculation for fixingthe oftwo 25-litrefeed bottles mounted in such a wayas to ensure level of iodization in salt is in Table 7-1. given a continuouscirculation of solution from the main tank to the Technology:Process and equipment: The process ofsalt feed bottle. Thus, the solution continuouslydrips at the desired iodizationinvolves mixing salt with a premixedquantity of rate onto the salt crystals.The iodatedsalt falls into a discharge iodine to ensurethe desireddosage of iodine in the salt. Three hopper from which it is collected in bags. Experience has processes commonlyused for iodating salt are describedby shown that a capacity of 5 tons!hour is idealfor a drip feed Mannar and Dunn (1995), these include:dry mixing ofan system, which requiresonly a low-pressure headto maintain

Table 7-1. Samplecalculation for fixingthe level of iodizationin salt.

Assumingthat the requirementof iodine is 200 ig'day and the saltconsumption is 10 g!day.

Level of iodine required is 200 ! 10 = 20 ig!g ofsalt or 20 ppm (partsper million) Compensationfor transit and storagelosses 20 ppm

= Fixed level ofiodization required 40 ppm iodine 40 x 1 685a = 67 ppm Kb3

aThe ratio of molecularweight of K103/12 i.e. 214/127 = 1.685. Source: Mannarand Dunn (1995).

Current Practices, Research,and Opportunities39 the requiredflow rate. This method is adoptedin someAsian with an overhead drip or spray arrangement.A preweighed countries like Indonesia. quantity ofsalt is fed into the blender.The blender is operated and a of iodate is overhead (c)Spray mixing prefixed quantity sprayedthrough nozzlesusing a hand pump or compressoras mixing proceeds. Salt received in crystal form is crushed into a coarse powder in After iodizationthe batchis discharged and packed.It is simple a rollermill and fed into a feed hopperfitted with a wire mesh to operate in the capacity rangeof 0.5—3 ton/hour. It is already screen or a grating at the top to preventlarge lumps ofsalt beingused in Bangladesh, India, and Vietnam. It may also be from into it. A second shaft with four is fitted in falling plates relevantin several other countrieswhere there is needfor the outlet ofthe hopper and regulates the flow onto an inclined installation and operation of small lodizationplants closeto conveyorbelt. Both theseshafts are driven by a variable speed salt productionsites or at in the distribution drive and the rate of rotation is to the strategicpoints system adjusted give network. requiredthroughput. Table 7-2 shows a comparisonof the different iodization The sheet of salt from the belt into the discharging spray methodswith their relativeadvantages and restraints. chamber receives a fine atomized sprayof Kb3 solution from two Status: Full-scale production. speciallydesigned nozzles at a pressure of 1.4 kg/cm2.The spray nozzlesare designedto deliver a flattenedspray that Product: Theaddition of iodine to salt (as potassiumor spreadsover the entire width ofthe salt stream. The spraying sodium iodide/iodate) does not impart any colour or odour to chamberis provided with a viewing window. The concentration the salt. Iodizedsalt is not distinguishablefrom noniodizedsalt of solution and the spray ratesare adjustedto yield the and is fully acceptable by consumers. ofiodate in the salt. The iodate solution is required dosage Qualityaspects: The physical characteristics and chemical kept under pressure in two stainlesssteel drums each of about compositionof the salt vary widely dependingon the process 80 litres capacity. The pressure in the drums is maintainedby ofmanufacturing, composition of the raw material brine/salt, an air with a compressorequipped regulator. and refining methodsadopted. Salt for iodization should at leastconform to the as recorded in Table 7-3. The salt along with Kl03 falls into a screw conveyor20—25 cm specifications wide and 2.5—3.0 m long. As it travels through the screw, Samples of freshly made iodized saltshould be collected at of is ensured. The screw dis- uniformity mixing conveyor regular intervalsand analyzed to determinethe iodine content. into twin outlets where are for charges bags kept ready filling. Corrective measures should be taken, ifneeded, by adjusting The plant can also be made mobile for operationalconven- the flow ofsalt and/or spray. Iodized salt should be collected ience. A spray mixing type ofplant built to UNICEF specifica- into bags directlyas it flows out ofthe chutes insteadof tions operates at 6 ton/hour or about 12,000 ton/year.This allowingit to fall onthe ground. As the crystalswill still be method is increasinglypreferred. moist from the spray, they may pick up dust and dirt. Person- nel should be advised not to or walk on iodized salt. A batch-type versionhas beendeveloped in India for small- step scale manufacturers who cannotafford or do not needcontinu- bodization equipmentshould be builtof stainless steeland ous spray mixing plants. It consists of a ribbon blenderfitted regularly maintainedand cleaned from salt particles. Mainte-

Table 7-2. Comparison ofprincipal salt iodizationmethods.

Salttype Refined dry powder ++

unrefined dry powder +++ ++ +++

Unrefined moist powder ÷+ ++ ++

Unrefined dry crystals + ++ ++

unrefinedmoist crystals ÷ + +

cost Capital outlay High High Medium

Operating High High Medium

Cost to consumer High High Medium

Note: + = notrecommended, ++= reasonable, +++ = good. (For a flowchart of salt iodizationsee Fig. 4.1 cin Chapter 4.) Source: Mannar and Dunn (1995).

40 MicronutrientFortification of Foods Table7-3. Minimum specificationof salt for lodization. Based on 1992 costs of materialsand services in someAsian and Africancountries, a 20,000 ton/year continuousspray- mixing iodizationplant is calculated at about US$ 8/ton.The and cost for a ton/year batch SodiumChloride (as NaCI) 98.0 capital operating 4,000 spraymixing iodizationplant works out at about US$12/ton. Calcium (asCa) 0.2 Project/program evaluation: In many countriessalt Magnesium(as Mg) 0.1 iodation programshave beensuccessfully implemented. Sulphate (as SO4) 0.5 Observations: In the less-developed countries,where the Insolubtes 0.5 availablesalt is of uneven purity and humidity, and packaging Moisture 3.0 materialis often inadequate, the preferred productionmethod is crushingthe salt and iodizing it by spray-mixingusing K103. Drymixing of salt with potassiumiodate is only possibleif the nance painting is vital to protecting equipmentbuilt ofmild salt is dry and finelyground. Otherwise, the K103 will segre- steel (carbon steel) from saline corrosion.This will involve gate and settle atthe bottom of the container. The drip-feed surface preparationand subsequently coveringwith a proper systemis the simplest and cheapest. When the particlesize of coating. the salt is veryfine (less than 2 mm), however, the drip-feed Marketing/distributionchannels: In most countries,the systemis unsuitablebecause it does not disperse the iodate salt-producingunits are concentrated in a few areas. Often, the solution wWi sufficientuniformity. For national IDD control iodine-deficientareas arewidespread and lieat considerable programs,it maybe necessary to import potassiumiodate. distancesfrom the salt-productioncentres. Saltmoves from Alternatively,if the country's requirementis large (at least 30 productioncentres to consumptionsites by differentmodes of ton/year),it will becheaper to import elemental iodine and transport. Distribution patternsare complexand erratic. Under convertit to potassium iodate (see Appendix 1). thesecircumstances it will be difficult to a dual market regulate Future requirements/developments: In the caseof comprising iodized and noniodized salt or a target program small-scale producers, either theyshould set up individual aimed at iodizationof salt for the endemic areas. The only small-batch iodizationplants or form cooperatives for a long-term solution in most cases is universaliodization of all centralized iodizationand packing(UNICEF 1994). The salt produced for human and animal consumption. feasibility of developingportable iodizationunits that could be Cost effectiveness: Suitable equipmentand techniques are movedfrom one field to another should also be considered. It availableat relativelylow cost and can easilybe integrated is recommended to demonstrate iodizing units byusing with any existing salt-crushingor refining system. The photographs,slides, or videos. incremental cost of salt iodization, materials,labour, including WATER and amortization,is rather low and estimatedat US$0.6—i .9/ Countries: Burkina Faso, Central AfricanRepublic, some ton, which is less than 8°/o of the retail price of salt in most Central Asian Republics, Italy, Mali,Senegal, and Thailand. developing countries (see Table 7-4). Assuming a yearly consumptionof 5 kg ofsalt per person,the additional cost of Organizations andgroups involved: Ministry of Health salt iodizationthen would be 3—10 US cents/personper year. and Water and StandardDepartments of local governments.

Table 7-4. Estimationof total costsof salt iodization in developingcountries.

Chemical (Kl03)a 0.50—1.30 0.90 Processing 2.35—5.50 4.00 Extra packingmaterial (if required) 0.00—4.00 Administrative overheads 0.60—1.50 1.00 Amortization 0.50—2.50 1.50

Total costof iodization 3.95—14.80 7.40

Retail pricecrystalline salt 250—1,000 625

Cost of lodization asa percentage ofretail price 1.6—1.5°/o 1 .2°Io

'Iodine: rangeof 40-100 ppm @ US$30/kg. Source: Mannarand Dunn (1995, p. 70).

Current Practices,Research, and Opportunities 41 Target group: The potential of using communitydrinking appropriatedose for each well requirespreliminary water as a carrier of iodine has been of interestfor several study. Itwill, therefore, be difficult to estimatevariation decades. Experimental systems for iodizing townand school in water iodine values (for different draw rates from the water supply systemshave beentried in Sicily (Italy), Malaysia, wells)and the correspondingvariation in iodine intake. and the Central African Mali, Thailand, Republic. • Because the dose of iodine deliveredby the diffusers Vehicle: Drinkingwater. varies at each waterpoint,a monitoringsystem to assess the efficacy ofthe interventionwill be complex. Fortificant: Iodine crystals. Routine monitoringof iodine levelsin water from all Fortification The is to iodine level: objective providean tubewells in all villageswould be costly, whereas moni- concentration of 50—200 litre ofwater. ig per toring on a sampling basis risks giving misleading results. Technology:Process and equipment: lodizationof public water supplies is achievedby divertinga small amount of • The silicone—iodinepolymer in the canisterinserted in water through a canistercontaining crystals of iodine and the tubewellshas to be replacedannually. The CAR the into reintroducing iodizedwater the main water flow. In figures indicatea cost muchhigher than oil capsules. Thailand,an iodinesolution is prepared in small dropper • Even with communitycost-recovery schemes, it is bottles and distributedto schools and households in the questionablewhether beneficiaries will be willingto pay endemicareas for direct addition to drinkingwater in a jar. on a permanentbasis for iodizedwater, especiallyas School water supply systems arefitted with iodine-dosing the problembecomes less visible with goitreregression. pumps. Itcould be an option in certainisolated areas. Duringthe last 5 years, a major initiative has been made by Futurerequirements/developments: Large-scale water the French companyRhone-Poulenc in the developmentof a iodization programs are planned or underimplementation in technologyfor adding iodine to drinking water in tubewells. Mali and CAR. In Burkina Faso, Rhone-Poulenc is workingwith The method involvesplacing an iodine—silicone polymerin a local firmsto make the iodine—polymersystem directly basket atthe bottom of the tubewell, which releases iodine availableto communities.In Senegal, the governmentis slowly or diffusesinto thewater uniformly over 12 months, workingwith UNICEF to integrate iodization with a water afterwhich the basket is replaced. supply and guinea worm eradicationproject. Statusand results ofthe field trial: The iodization of Wateriodization couldbe an effective complementarymeasure water has been shown to be effective in drinking improving where problemswith salt iodizationpersist or as an additional iodinestatus but has notyet been adequatelyfield tested for intervention in water supply programs with strong community operational effectiveness. participation and health educationcomponents. Experience in Cost and cost effectiveness: Water iodization has metwith Thailand shows that its feasibility maybe in institutional limited applicationbecause of high capital and operatingcosts. settings such as schools where tubewells orstorage tankswith As in the case of iodized oil distribution, large investmentsin water distributionsystems exist. The feasibility of using the human and materialresources for water iodization programs canisters in schoolwater supplies couldalso be tested. risk attentionand resourcesfrom the initiation or may diverting The operationalrequirements of ensuring an uninterrupted ofsalt iodization strengthening strategies. supply of polymersystems to deficient populationsand Project/program evaluation: After tests with theRhone- effective coverageof affected communitieswith iodine have yet Poulenc method in tubewellsin rural Mali, urinary iodine levels to be addressed. Examples of such issues arecommunity and goitre prevalence showed significant improvement. sensitization,determination of program responsibilitiesat the communitylevel, trainingfor installation, cost recoveryand Observations: There is no documentationof pilotprojects in supply, monitoring, and compliance. water iodizationwith diffusers. Some of the practical constraints in programs ofcommunity water iodization will likely includethe following (Mannar and Stone 1993): OTHER VEHICLES Some with iodization of other foods is discussed • In additionto tubewells, rural populationsmay have experiments in the following. These have limited applicationand are of other, preferred options for noniodized drinking water, minor programmaticimportance. For some, only limited e.g., streams, rainwatercollection, and open wells. information is available. • The amount of polymerrequired for a tubewell diffuser Breadiodization system has to be calculated in terms of the average water consumptionper person and the average number Abstract: In 1966, the wheat flour used for bread in the of persons using each well. Determination ofthe island of Tasmania, SouthAustralia, wasfortified with potas-

42 MicronutrientFortification of Foods — siumiodate at a level of 2 ppm. Based on estimatesof bread previouschapters suchas iron compoundand food vehicle consumption,average daily iodine intakes in various age selected, and the acceptabilityof the fortified productby the groups were: 81 pg (age 1—3 years), 187 pg (age 7—11 consumers. The following will briefly reviewsome ofthe years),and 270 pg (age 15—18 years).The enormousvariabil- vehicles usedto carry iron. in bread an unevenness in iodine ity consumptionimplies WHEAT FLOUR ANDBREAD intakes (Clements etal. 1970). Countries: A wide rangeof developed and developing Otheriodized foods countriesall over the world. Brick tea:Brick tea is fortified with iodine in Tibetand West Organizations andgroups involved: WHO; FDA, FNB- China. NAS-NRC, CFN-AMA (USA); the Panel of Iron in Flour (MOH), Sweets:Trials to fortifiy sweets have been carriedout in the MRC (UK); MRC, SCFAR, SARCDC(Sweden); School of Public Middle East. Health,Institute of PublicHealth Research, TebranUniversity, Iran. Sugar Sugariodization has beentested in Sudan but has apparentlybeen abondoned because, even though Sudan Target group: Whole population,especially anemicmen and rations and controls its sugar distribution, a huge black market women, menstruatingwomen, pregnantwomen and children, for sugar flourishes,leading to both a sugar shortage in even in populationswith high standardsof living. western Sudanwhere IDD is endemic and a sugar oversupply Vehicles: Flour is considered the ideal vehiclefor iron in Khartoum and where (DO is not a neighbouringprovinces fortification in countries with cereal-based diets. Cereals (wheat, problem. maize, or rice) most often provide the largestsingle source of Iodine in milk calories and are relatively inexpensive. Theyare often milled in a few places in a country and arewidely consumed, irrespec- Abstract: The iodine contentof milk is influencedprimarily tive ofage, sex, and socioeconomic status. Moreover, there is by the exposureof dairy cattle to iodine through water, forage, no risk of overconsumption. For wheat, the amount of iron feed,feed supplements,salt blocks and veterinary medications, added is designedto restore the iron lost in milling(milling and bythe exposureof the milk to iodine contaminationfrom removes about two-thirds ofthe natural iron contentof a cereal) iodophor sanitizing solutions directly used as desinfectanton or to enrich the flour.Nevertheless, consideringthe inhibitory cattle as well as on milkingequipment, vats, and other milk effects ofcereals on iron bioavailability,fortification ofcereals containers in the dairy industry.Variability of thesepractices may not be the most efficientway for reducing iron deficiency may resultin a variation of iodine concentrations in milk. Some anemia. seasonal and perhaps regionalvariation in iodine concentration in milk may reflect the amount of indoor feeding (i.e., Fortificants: Hallberget al. (1989) gave two requirements iodine-supplementedfeed) duringthe colder months versus for an iron fortificant in flour: insolubility in water(due tohigh outdoor feeding during the warmer months.Milk availablein water contentof flour) and good bioavailabilityin humans. the US supermarketsis usually pooledfrom several local dairy Schricker and Miller (1982) state that solubility under gastric farms. High iodine concentrations in milkfrom one farm will be conditionsis required to obtain an availability similar tothat of diluted by lower iodineconcentrations in milk from other the nativeiron in the meal. farms.The iodine contentof milk availableto the US public Ironsalts: Easily soluble iron compounds, such as ferrous appearsto be relativelystable with an overall mean of 23 (±9) sulphate, ferrousfumarate, and ferrousgluconate in flour,are pg/i 00 g. One cup of milk (56 pg/i 00 g) in this case covers readily availablefor absorptionbut can dissolveduring for 37%of the RDAfor adults. Continuedmonitoring is needed storage. Theseferrous iron salts may be oxidizedto form to ascertainthat the iodine levelsare adequate and appropriate coloured ferric oxides, Iron salts induce rancidity in flour on (Pennington1990; Nestel 1993). storage (by catalyzinglipid oxidation reactions). Encapsulated SINGLE FORTIFICATIONWITH IRON ferroussulphate seems to have even more inferior storage propertiesthan reagentgrade ferrous sulphate. Iron salts also Iron fortification is generally considered to be a long-term have a harmful effect on baking qualities. In the latter case, the approachto combatingiron deficiencyanemia, as it reaches all particlesize of iron salts is important. segmentsof the population,it does not requirethe cooperation of individuals, or an effective system of health delivery,and it In Britain, the addition offerrous sulphate and ferric ammo- costsless. While iron-fortifiedfoods increase iron intake of all nium citrateto flouris allowed and, in the USA, ferrous individuals consumingsuch foods, because ofvery high sulphateis routinelyused. In somestudies, ferric orthophos- requirement during pregnancy, there will still be a needfor iron phate,ferric sodium EDTA,sodium iron phosphate, and iron supplementation.The success of iron fortification to combat pyrophosphateare used.The less-soluble iron salts have the — iron deficiencydepends on manyfactors mentionedin the leastfunctionality problems, but their bioavailability is also less.

Current Practices, Research,and Opportunities43 Searching for an iron source that can be absorbed better, chart illustrating flour millingsteps and point at which Hallberget al. (1989) found a microcrystallinecomplex ferric fortificationtakes place. The addition of iron can be performed orthophosphate(CFOP, Fe3H8(NH4)—(P04)6•6H20) to fortifyflour in a continuousprocess using a feeder or in a batchprocess by for bread rolls. CFOP is added in the rangeof 2—14 mg/meal hand. Forthe latter, compressed tablets are availablefor (Flallberg et al. 1989). specific sizes of dough. Because iron fortification offlour is with other Elemental ironpowders (reduced iron): Elemental iron usually performed fortificants,(commercially available) premixesare often used. The addition ofpremixes to powdersare extensivelyused for fortification offlour. They are flour is describedin 8. inhibit chemicallymore inertthan iron salts and induce fewertechnical Chapter Stability problems ferrous mixed with wheat flour to form a problems.Storage properties of reduced iron are muchbetter sulphatebeing concentrated premix. than iron salts.The greyish powder maycause off-colour problems,but theseare not veryserious. Elemental iron can be Reduced iron maybe entrapped by the magnetused to remove obtained by the following processes: tramp metalsfrom incoming flour. Unlike iron salts, reduced iron is magnetic.Tests did not show differences in 1. High temperaturereduction of ground iron oxideswith significant iron content or ofthe flour and the reduced iron either hydrogen or carbonmonoxide; segregation before and after magnetictreatment. The addition ofreduced 2. Reduction an This by electrolyticdeposition process. iron to less-finemilling products like farina, semolina, or grits is than the former and has a somewhat product purer may cause segregationproblems, especially when the fortified smaller particlesize; and productis run through a purifier to remove dust. 3. iron Decomposing pentacarbonyl (produced byreacting Status and resultsof field trials: Fortificationof bread iron with carbonmonoxide) to iron (and carbonyl with iron seems to be an effective and safe methodto prevent carbonmonoxide This gas). process providesprobably IDA, or even to cure its mildforms. A lot of laboratoryand field the finest iron particles. studies are performedon the bioavailability of iron in bread. Foriron availability,the small particlesize and acid solubility of Several field projects do report positive effects of fortification of reduced iron seem to be important factors to be considered. breadwith iron. The iron deficiency rate in Sweden has been reduced from about 25—30%to 7% when the fortification Otheriron sources On page 51, a haem iron concentrate started. About 40% of the iron consumed in Sweden of bovine blood used for iron fortification of biscuits is men- program and 20% of that in North America comes from fortified wheat tioned.Johnson et al. (1985) suggest using soybean hulls for flourand bakeryproducts. iron fortification in bread. The hulls are low in oil so rancidity should not be a concern and they containnegligible quantities The presentlevel ofiron restorationor enrichmentof flour for ofphytic acid,which is frequentlythe plant component the use of breadin Britain and the US, however, is not suffi- associated with poormineral availability.Soybean hulls are cientfor several population groups, particularly females in the considered a by-productof soyprocessing. age group of 9—54 yearsand children under 6 years of age. Also, the decreased cereal consumption(in the US) has partly Fortificationlevel: The maximum ferroussulphate addition beenresponsible for this insufficient iron intake. Fortification in flour for bakery productsis 40 ppm. The standardset by with CFOP and soybean hulls is reported only on a laboratory various countries are: Canada, 29—43 ppm; Chile, 30 ppm; scale. Denmark,30 ppm;Guyana, 29—36ppm; Kenya, 29—36ppm; Nigeria, 35 ppm; Sweden, 25—75 ppm; UK, 16.5 ppm (mg/kg Product: Addition ofiron in the used amounts does not seem flour, this meansrestoration of 80% extraction); the US to affect the breadquality. increased iron fortification in 1982 from 28—36 ppm to 44 Qualityaspects: The maximum ferroussulphate addition in and Zambia, 29—36 Not all countriesthat have set ppm; ppm. flour for bakery productsis 40 ppm, and the fortified flour fortification standardshave made fortification mandatory. should not be storedfor more than 3 months at moderate Soybean hulls can be addedto breadat 5°/o flour replacement temperature. Not much is said about iron quality apart from the withoutdeleterious effects on baking performance and overall level of iron fortification.The US requiresthe form of iron that acceptability. Five percent replacement would cause an iron is harmlessand assimilable. Canada requiresthe particlesize level of 1.9 mg/i 00 g bread, which is 68°/oof the iron of95°/o of the reduced iron <44 tm, and at least 90°/o requiredby the US Food and Drug Association (FDA) (Johnson solubility in 0.1 N HCI. etal. 1985). An iron-fortificationprogram requiresperiodic analysesto Technology:Process and equipment: The technologyof ensurethat iron is in the food in the desiredamounts. Method iron fortification in whole-grainwheat is comparable to 40—40of the AmericanAssociation of Cereal Chemists (AACC) fortification of rice. Fortificationof wheat is normally done is a qualitative method that roughly determinesthe type of iron either at the mill or atthe bakery. Figure 7-1 shows a flow used in fortification. By adding a dropof a reagent, large red

44 MicronutrientFortification of Foods Fig. 7-1. Flow chart of flour millingand point of fabrication(source: Nelson 1985).

spots rapidlyappear if ferroussulphate is present,little red Cost and cost effectiveness: The easiestavailable and by spots appearafter about 10 minutes if reduced iron is used as far the leastexpensive iron sourceis ferroussulphate the iron source. heptahydrate.In Appendix 2, someestimated costs of commonly used iron sources are given.Although ferroussulphate To measure iron quantitatively,extraction is necessary before heptahydrateis not included in this table, it is much cheaper detection.For extraction, one can performdry-ashing, which than dried ferroussulphate. Ferric ammoniumcitrate and ferric has problemswith sampleloss, volatilization, iron contamina- pyrophosphateare extremelyexpensive. tion, or wet-ashing, which is more dangerousbecause ofthe use ofhot, concentrated, oxidizing acids. For detection, Barrettand Ranum (1985) indicated the cost for ferrous colorimetric procedures can be performedor atomicabsorption sulphatein amountssufficient to add 38 mg iron/kg at can be used (e.g., AACC method 40—41A), which can detect US$0.01 5 for 100 kg flour. They estimatedthe cost of a several minerals in the samesample but this is more expensive. fortification program in Egyptwhere providing 9 mg iron/day to would cost US$0.01 Ifthe Marketing/distributionchannels: When millingis everyperson 5/person peryear. sameeffect would be obtained with iron centralized and distribution offlour and breadcan be controlled supplementstablets, the cost ofthe tablets alone would be US$0.11/personper adequatelyand accurately, enriching bread (in developing year.The price of the iron itself is always a countries) would be simple. Ifthe use of dried yeast becomes compound very small part of the overall price ofthe product. the rule, and all bakersare obligedto use it, this leavening agent could serveas the vehiclefor enrichment(Vaghefi et al. Project/program evaluation: Effective fortification 1974). Moreover, yeast has a positive effect on iron programshave been implementedunder strict government bioavailability. supervisionand after proper legislationhas been passed.

Current Practices,Research, and Opportunities45 Observations: IrOn fortification often goes hand in hand with The chemical changeof iron compoundsto insoluble forms fortification with niacin, thiamin, riboflavin, calcium, vitamin A, during baking as mentionedearlier is not seen with NaFeEDTA. pyridoxine, folic acid,magnesium, and zinc. Because the add- The enhancingeffect ofEDTA is not endorsedby all scientists ition ofvitamin A toflour and breadstarted in the US only in (Ranum and Loewe 1978) and seems to be the oppositewhen 1982,a lot of research has beendone on single iron fortifica- the ratio EDTA:Fe> 2:1 (Hurell 1984): tion. Processingmethod: The processingeffects are not very different sources Elwood et al. Bioavailabiity of iron clear; El Guindi et al. (1988) and Hallberget al. (1986) found (1971) that the bioavailabilityof iron salts eaten with did not find an effectof the baking process on the breadis much lower than has beensuggested from highly relativeavailabilities of nonhaem iron in breadsand controlledradioactive studies. Lee and isotope Clydesdale meals. As mentioned, Lee and Clydesdale (1980) found that iron sources when addedto flour and baked (1980) report an effect ofthe baking process in which almost all initial as biscuitsor breaddo not remain in the chemical original iron forms changed into insoluble forms of iron with form. The net effect ofthe seems to be the baking process equal availabilities.Potassium bromate,a maturing of formation insolubleforms ofiron, An exception is made for agent addedto flour atthe mill, can reactwith ferrous ferric sodium EDTA.The of availability the iron in soybean hulls sulphateand produceFe3* (Lorenz 1982). Schricker and seems to be to the used equal commonly ferroussulphate Miller (1982) suggest an enhancingeffect of heat and (Johnson et al. 1985). The relative bioavailabilityof CFOP pressure on iron availability.The waterconcentration in from varied 30 to 60°Iowhen wheat rolls were servedwith the baked product during this processmight hydrolyze the 'different meals (Hallberg 1989). phytate causingthe enhancingeffect. Circumstancesthat affect of iron in • bloavailability High levelsof salt in breadmay decrease, whereashigh breadIflour The relative availability of nonhaemiron in levelsof yeast may increase, iron availability in bread bread seems to be affected by several factors. There are many (Kadan andZiegler (1986). substances in a normal diet that interfere with iron absorption: Future requirements/developments: There is an urgent • Compositionof the meals:Studies in which bread is needto discoveror develop an iron preparationthat is more eaten aloneare not representative ofreal life situations. readily availableor that can be addedto flour in relatively high • status the individual: Iron Iron of deficientsubjects concentrations withoutseriously affectingits storing or baking absorba than and larger percentage healthy subjects do, if qualities.There mightbe a future for CFOP,bovine haem less iron is available,absorption seems to be more concentrate, and/orEDTA-containing compounds. efficient. MILKAND MILKPOWDER • Presenceof inhibitors in food:Bran content of the Countries: flour and bread. Bran components inhibitiron absorption Australia,Canada, Chile, India,Jamaica, Mexico, (Bruneet al. 1992). So a lower extractionrate offlour USA, Yugoslavia. a content of causes less iron (with higher bran) Organizations andgroups involved:International Atomic This was also confirmedin on absorption. experiments EnergyAgency; National Institute ofArthritis, Metabolic,and the of ferrous absorption sulphatein fortified Egyptian DigestiveDiseases; DairyCouncil of California; National Dairy flatbreads compared to European breads (El Guindi et Council;Nutrition Foundation;Chilean Ministry ofHealth; The al. In animal Ranhotra al. 1988). experiments, et (1979) Consejo Nacional para Ia Alimentaciony Nutricion; United found no effectof to bread inhibitory adding cellulose (to Nations University;Departamento de Investigaciony make high-fibre bread) on the availability ofiron inbread. Bibliotecas de Ia Universidadde Chile;the NestleNutrition • Ascorbicacid is known as an enhancerfor iron availabil- Research Grant Programme; Hoffmann-La Roche and Co. Ltd. ity, but its addition toflour or bread is not useful. The Target group: Infants and young children. high temperatures requiredfor baking cause oxidative destructionof the ascorbic acid.The pH conditions Vehicles:Cow's milk, liquidmilk, dry skim milk (DSM),full milk. duringfortification can also affectthe proposedenhancing cream milk powder,buffalo effectof ascorbicacid et al. 1973; Dermanet al. (Sayers Fortificants: The main iron sourceused is ferroussulphate, and Nadeau 1977; Clydesdale 1985;Hallberg 1986). but all iron sources mentionedin Appendix 2 are eligible. El Guindi etal. (1988) found positive effects on iron absorption Enrichmentof iron-fortified milk with ascorbicacid improves if EDTA was added. Also Whittaker and Vanderveen (1989) iron bioavailability. Roughly 5—10°/oof iron in fortified milk is report a higher availability ofiron when Egyptianflat bread is absorbed. Ferric orthophosphateseems to have poorer or fortified with Fe504+Na2EDTAor NaFeEDTA insteadof FeSO4. bioavailabilitythan ferroussulphate, electrolytic iron, This is due to the chelatingeffects of EDTA. carbonyl iron. The bioavailabilityof ferrouschloride was found

46 MicronutrientFortification of Foods tobe betterthan ferric lactobionate. Addition ofzinc does not There is little informationon the storage stability ofiron affectbioavailability of iron in milk. Results about the effect of fortified milk. Fortifiedpasteurized milk can only be kept for a milk productsthemselves on iron availability are contradictory. fewdays, during which someoff-flavours often developdue to An inhibiting effect ofmilk is sometimessuggested, which oxidative rancidity. Rancidityin milk powder is not described mightcome from milk fat and not from low fat milk products extensively. In some studies, the iron source is addedto the (Ashworthand March 1973;Momeilovi and Kello 1979; milk or reconstituted milk just before consumption,so stability Ranhotraet al. 1982; Rivera etal. 1982; Hurell 1984; Galan is no problem.The full-fat milk powder in the Stekel et al. etal. 1991). (1 988a,b) and Olivares et al. (1989) studies was fortified with ferroussulphate. Because packagingin oxygen-free containers Addition of iron to dairy productscan cause lipolytic oxidation, was not possiblelocally, rancidity occurred. resulting in "oxidized"flavours and odours.Iron chelates are lesssusceptible to oxidative rancidity than ferrous salts, Cost and cost effectiveness: Switching from unfortified to a although ferroussulphate causes much more ranciditythan, for fortified milk, like in the program in Chile (about 13 million kg instance, ferric ammoniumsulphate and ferric ammonium ofdry milk are distributed each year to infants), meansan citrate. increase in price of about 13—i4°/o. Ofthis, only about 1O/ is contributedby ferroussulphate and ascorbic acid and the rest Heatingdecreases the oxidativeeffect of ferroussulphate and by the increased cost of packaging(see the discussionin Hurell increases the oxidative effect of iron chelates as ferric (1982)). nitrilotriacetateand ferric lactobionate. But afterheating, iron chelates are less susceptible to oxidative ranciditythan ferrous INFANTFOODS/FORMULAS salts. Countries: A wide rangeof countries all over the world, both Fortificationlevel: Unfortified milk containsless than one in developed and in developingcountries. Iron fortified infant food is availablearound the world. ppm of iron. In most studies, fortification levels of 10—25 mg iron/I milk are sometimes (reconstituted) employed,although Parties involved/cooperation: PAG, UNU/WH P. TPI, fortificant at the level of 100—125 iron/I is studied. mg INACG, ILSI, HNI, AAP/CN, CPS, ESPGAN; USDA/ARS, USAID, Ascorbic add is addedat the level of 50—100 ppm. FDA, PHS, NIH, NDC (US); CMAFP (UK); FPR, FCR (Finland); AEB, cr (South Africa); IAEA; MRC; FFWF (Austria);CPHIIF, Technology:Process and equipment: The main problem INTA SECYT, UBACYT in fortifying milk powder with iron is the requiredsophisticated MOH, (Chile); CONICET, (Argentina); NNRGP Mead Johnson Nutritional packaging.In principle,the technologyis simple and it is not (Switserland); Group(US); International very expensiveto fortifyregular milk powder availablein Bristol-Myers Group. countrieswith ferrous The developing sulphate. oxygen-free Target groups: Infants and pregnantand lactatingwomen. to makes packaging,however, necessary preventrancidity, Because ofthe expansionof blood volume and extremelyrapid fortification and To oxidationas compUcated expensive. prevent growth during infancyand early childhood,infants arethe much as iron fortification of milk is recommended possib'e, most critical population group regardingiron deficiency. After after of milk which is of homogenisation(emulsification fat, about 4—6 months,the neonatal iron stores are depletedand and before et al. great influence) just pasteurization(Hegenauer additional iron is essential,particularly up to 24 months. 1979a,b; Kiran et al. 1977). Vehicles: Breastfeeding is recommended as the best infant Status and results offield trials: Iron deficiencycan be food, and exclusivebreastfeeding should be encouraged for all prevented by programsdistributing iron fortified milk (Rivera et infants upto the age of6 months.Thereafter, because of al. 1982;Stekel et al. 1 988a,b;Olivares et al. 1989).In Chile, increased demandfor higher energy and iron for growth in the National Program of SupplementaryFeeding is involved, children over 6 months, breastmilkshould preferablybe but most often studiesare at laboratoryor field trial levels. supplemented. Infant cereals have been used to supplement breastfeeding well after 6 months when the older infants' diet Product: It is possibleto formulate iron fortified milk with should be supplementedwith some solid foods. good organolepticacceptability. Stekelet al. (1988b) found good acceptabilityof powderedfull-fat milk with ferrous The distinction between infant formulas and infant cereals is sulphate(15 mg/i00 g) in the presence ofascorbic acid (100 not evident,and they are oftenmade with the sameingredi- mg/i00 g). Sainiet al. (1987) did organolepticresearch and ents. Infantformulas are more liquid and not designedfor found that an addition of upto 20 ppm ferroussulphate or addition to milk, whereasinfant cereals meetthe solid food ferric ammonium citrate added to buffalo milk is acceptable. If requirement,are usually dry, and most are designedto be the iron level is further increased, off-flavoursdevelop. Boiling addedto milk. No cow's milk is recommended before the age can improvethe flavour offortified milk, probably because the of oneyear. It containslittle vitamin D and iron and can cause cookedflavour masksthe oxidative rancidity. occult bloodloss. Instead, infant cereals are preferred. The use

Current Practices,Research, and Opportunities47 ofsoya as an ingredientis often recommended to avoid formula and other foodsthat do not contain reactive forms. Fat allergies to cow's milk. Soya flour productshave a high native oxidation and discolorationare common problemsusing iron content, so when soyaflour is used,the processed food ferroussulphate, so research to use encapsulated ferrous will have a higher iron contentthan the other flour-based sulphateis ongoing. infantcereals. Infant cereals are not compatiblewith ferroussulphate and, Infant cereals were mainly designedfor weaning infants but therefore, small-particleelemental iron is usually added. also for risk groups suchas pregnantwomen, lactating Sodium iron pyrophosphatewas commonly used in cereals but women, and children in developingcountries. They generally has beenreplaced due to its low bioavailability (Hurell 1984; consistof a cereal (wheat,rice, maize, and sorghum),a high- Purvis 1 98; Rees et al. 1985). nonfat and quality protein compound(soybean, dry milk, Ferrous fumarate is often.used because of its reddish brown and a fat Vitamins and mineralsare added whey) component. colour,which is compatiblewith the yellow and brown colour for and be addedfor Local fortification, sugar may flavouring. characteristics of the CSM, WSB,and other blendedfoods. should be used as muchas The result is ingredients possible. Ferrous succinate seems to bejust as suitableas ferrous a nutritionally improvedformula with ofthe compared any fumarate,without causing fat oxidation or discoloration(Hurell single ingredients. 1989), The be milled and like heat treated, ingredientsmay processed In Europe, iron EDTA is widely accepted for iron fortification.A rolled, parboiled,or extruded. The final productfor consumers wide range of other iron sourcesare also used: ferrouscitrate, is sold as a drink or as a dry powder to be cooked like rice ferrouslactate, and ferric ammonium citrate mightbe used in and Ranum A ofthe (Barrett 1985). typical composition widely liquidformula. Ferriccitrate and ferric gluconatemight be used used infant cereal, is shown in Table 7- corn—soy-milk (CSM), in liquid soya formula. Ferric pyrophosphate,ferric orthophos- 5. Table 7-6 the sources of several used gives protein widely phate,and saccharated ferric oxide are used in infant cereals. infant cereals. Stabilizedferrous carbonate, ferrous gluconate, and ferrous Fortificants: Ferrous sulphate (heptahydrate, reagentgrade) saccharate are other possibilities. is far the most added iron source to both by commonly liquid The main technologicalproblem with iron fortification of infant and milk and infant formulas, powdered soy-based especially foods concerns colour and off-flavour production.In general, in the US and Canada. It can sastifactorilybe used in infant the more soluble the salt, the greaterthe problem.Addition of ferroussulphate to liquidmilk or soyaproducts darkenstheir colour. It is possibleto fortifymilk formulas with acceptable Table 7-5. Atypical composition ofcorn—soy milk (CSM) (°/o). results, but this requires a balanced compositionand (most importantly) appropriatepackaging. This is possible in Maize meal 59 industrializedcountries, but is not likelyto befeasible in small, Soybean flour 17.5 local industries.Adequate packagingis often a limitingfactor offortified formulas.Fortification with Nonfatdrymilk 15 regardingproduction ferroussulphate requires the use ofoxygen-free sealed cans. Soybean oil 5.5 Flavour problems in iron fortification are usually due to fat Iron (as ferrous fumarate)a 1 80 ppm oxidation. This is especially seen with the cereal products, Ascorbic acida 1,000 ppm which contain a high level of readily oxidizableunsaturated acids. Ferrous and ferrous are the most aAddedamong others ina mineral premix (ppm indry food). fatty sulphate gluconate Source: Cookand Bothwell(1984). important enhancers of lipid oxidation. Elemental iron hardly

Table 7-6. Percentages oftotal protein contributed bythe differentmajor ingredients.

Corn—soy-milk (CSM) 45 27 28

Corn—soyblend (CSB) 63 37

Wheat—soyblend (WSB) 55 45

Wheat—protein-concentrateblend (WPC) 61 39

Whey—soy drink (WSD) 74 26

Source: Cook and Bothwell (1984).

48 MicronutrientFortification of Foods • inducesoff-flavours, if particlesize is not too small. Ninety-five Preblending of dry major ingredients, percent should be below 44 which seems to be the most • i. Separate weighing and addition of vitamins and suitable in infantfoods dry concerningorganoleptic properties minerals, and bioavailability.Also, encapsulated ferroussulphate causes • of the entire batchfor uniform little rancidity during storage.On adding ferroussulphate (even Blending distribution, when it is encapsulated) or other iron sources (ferrous/ferric Addition ofthe fat or oil component, salts with chloride,citrate, or acetate) to infant cereals, a dark Final blending, and grey or greencolour develops when (hot) milk is added.The colour developmentof encapsulated ferroussulphate is related Packaging. to the ofthe material and on the melting point coating depends Forfortified blendedfoods, a premix offortified cereals is also milk temperature(Hurell 1984). used insteadof the separate addition ofvitamins and minerals Addition of haemeiron is also a possibility. Although it is (Barrett and Ranum 1985). suitablefor use in meat etal. especially products,Hertrampf Status and resultsof fieldtrials: Iron-supplemented (1990) used a bovine haemoglobinconcentrate (BHC) to fortify infant foodsare universally available. In 1985,already 80°/o of an infant cereal made by extrusion of rice flour. The main all US formula sold was iron fortified, and this has been with BHC concerns the colour. Because technological problem creditedas the major factor in the declining prevalence of of the low iron level in the coloured the relative strongly BHC, anemia in US infants among both low-incomeand middle-class level of 5°Io has to be added.Also high microbiological populations. Some groups rejectiron-fortified formula believing problemscan develop. Extruded rice cereal fortified with BHC that infants fed iron-fortifiedformulas are more likelyto suffer was to iron anemia if adequate prevent deficiency only fromgastrointestinal problems. Theories about gastrointestinal consumed in a dose over 30 For several the glday. infants, problemsare the presumedbacterio-static propertiesof the iron volumewas a Another of problem. aspect fortifying (infant) binding proteinsof milk (lactoferrin and transferrin). They may foodswith BHC is or resistance to the ethical,cultural, religious lose thoseproperties when full saturation with iron occurs addition of blood productsto foods. instead of the normal one-thirdsaturation. This is a reasonto Fortificationlevel: The Codex Alimentariussets the avoid unnecessarilygenerous iron supplementation(Saarinen minimal iron fortification level for infant foodsat 1 mg Fe/iO0 and Siimes 1977). No effects ofthis kind, however,have been kcal, which is about 7 mg Fe/I formula. Maximum fortification reported,except for stool colour,Even therapeutic doses ofiron are well-tolerated infants etal. Committee on levelsare 3 mg/laO kcal (20 mg/I) in the us; i mg/i00 kcal by (Nelson 1988; Nutrition Dallman in the UK, and 1.5—2 mg/i00 kcal in France. In the US, if 1989; 1989). fortification level is raised to over 75 mg/serving, the formula A more important point of disagreement and reasonto or cereal is considered a supplementand no longer is regarded minimize iron fortification is the effect of iron on the absorption a as food. of copperand zinc. The Committee on Nutrition (1989) claims iron fortification formulas does not the In most studiesfortification levels are describedof about 12 that of impair absorption ofzinc and to a that is mg Fe/I formula (10—17 mg/I) and 0.15—0.5mg Fe/g cereal. copper degree nutritionally important. But Haschke et al. found of The US upper limit of 20 mg/I is often relatedto the use ofsoy, (1986) repressed absorption with 10.2 Fe/I infant formulaand et al. because soybeanisolate has a high and variable native iron copper mg Seely that in can content. Lower levelsare commonin Europe with more efficient (1972) report prematureinfants, copperdeficiency be caused iron fortificationof infant formula. use ofiron from foods with lower fortification levels, these presumably by Effects on zinc are also and is a of levelsare also sufficient.Decreasing tile US level to the absorption reported point A maximum Fe:Zn ratio of2:1 be European levels, is a main point ofdiscussion. The minimal controversy. might good advice. In human breast the ratio of Fe:Zn is <1. level to preventiron deficiencywas found to be 7 mg/I by milk, (FlureIl Haschke et al. Dallman Power et al. Saarinen and Siimes (1977), which was supportedby Bradley 1984; 1986; 1989; et aI. (1993). Haschke et al. (1993) found that 3 mg ferrous 1991). sulphate/Iin a whey-predominantformula is sufficientto Marketing/distributionchannels: Infant foodsare either protectinfants (3—6 months of age) from becomingiron distributed by feeding programsor by sale on the open market deficient. all over the world.

BHC is added to extruded rice flour ata level of 5°/o, the iron in Costand cost effectiveness: See also the section on "Milk BHC is only 0.28%. (Calvo etal. 1989; Hertrampf etal. 1990). and Milk Powder"and "WheatFlour and Bread" Seealso Appendix2 about iron sources andpage 50 "Biscuits:' Project/program evaluation: The feeding ofiron-fortified Technology:Process and equipment: Most infant formula to infants has beenshown to eliminateovert iron cereals/formulas are produced under batch conditions: deficiency, the most commoncause of anemia in childhood,

Current Practices,Research, and Opportunities 49 almost completely.Iron-fortified infant formulas or cereals are bioavailabilityof breast-milkiron is unknown. This higher also suitableto maintain adequate iron levels. Supplementsto bioavailabilityis not due to lactoferrinbut could possibly be breastfeeding over 6 months of age should also contain due to chelatingagents. additional iron. Factors enhandngabsorption: Vitamin C or ascorbicacid Iron fortification should not be considered a separate goal of found in freshfruits and vegetables is a strong enhancer of health and nutritional programstargeted to infantpopulations. nonhaem iron absorption.This is also true in infantformula, It should be part ofa broaderstrategy to ensure, for example, due to the ability of ascorbic acid to form a soluble complex adequate levelsof protein,energy, and other micronutrients. with iron, which protects iron from the inhibitory ligands. can increase to six times in the of Observations Absorption up presence vitamin C. Addition ofascorbic acid to infantfoods is common. Bloavailability: Breastmilkcontains small amounts of iron, Stabilized cellulose coated ascorbic acid is often used because it but this is well absorbedand utilized. About 49—70°Io ofthe is more resistantto deteriorationby moisture and temperature. breast-milkiron (0.66mg/I) is absorbedby infants.Maximum Ascorbicacid is commonly addedat a level offive times the absorptionof cow's milk iron (which is presentin levelsof iron content. No other organic acidshave such strong enhanc- 0.1—0.2 mg/I) is 30%.Only about 3—10% ofsupplemented ing properties(Derman et al. 1980; Rizk and Clydesdale iron in infant formulas (about 12.5 mg/I) is absorbed.Iron 1985; Stekel etal. 1986; Haschke et al. 1988).Fructose absorptionfrom infantcereals is even less. seems to be an enhancer, but other sugars like glucose and galactose, which also form complexeswith iron are not, The oxidationstate of iron affects the absorption. The iron in therefore, the use of ferric fructoseas source of iron can be foods can exist in ferric (Fej, ferrous (Fej, and elemental considered. (Fe) states. Ferrous iron is more soluble than ferric, especially at higher pH. Iron absorptiontakes place in the intestine, which Among sugars,sorbitol, mannitol, andxylose have enhancing has a slightly alkaline environment. properties. Meat and fish enhance absorptionof nonhaemiron and haem iron as well. An important role is probably played by Ferrous salts like ferroussulphate, -fumarate, -gjuconate, cysteine or a typical protein type. The phosphoproteinin egg -lactate, and -citrateare all seen as highly available,which has beenshown to be a strong inhibitor. EDTA and NTA meansthey are roughly absorbed by 3—1 0°/a on average. (nitrilotriaceticacid) have chelatingproperties, with enhancing Ferric ammonium citrate also have in might good bioavailability effects. NaFe EDTA can be used as an iron source and is seen humans.The availability of elementaliron is not clear and by someas a promisingchelator. But if the ratio EDTA:iron is variesgreatly between very poor and good acid solubility, greaterthan 2:1, EDTA acts like an inhibitor. Because EDTA is dependingon particlesize. Phosphate-iron salts showusually often used as afood preservative,inhibition is likely in many poorerabsorption. Absorption of BHC in extrudedrice cereal is foods (Cookand Bothwell 1984; Hurell 1984). about 1 4°/a. Factorsdecreasing absorption: Soya productscan inhibit These bioavailabilityfigures for iron sources are definitely not iron absorption, but results of research on soya inhibition are absolute:A lot of research studies contradictone another. Many oftencontradictory. Soya may havean iron-binding factor, factorsaffect and animal studies are not absorption, directly which does not seemto be dietary fibre or phytates,probably comparable to human studies.Because iron is often absorption due to partially digested soy proteins.Availability of iron in less than whatis the intake not meetthe assumed, may daily soy-based or milk-basedformulas is not obviously different. This is in requirements. especially important developing Cow'smilk has also an inhibitory effect, mainly due tothe countries where iron is not different usually provided by nature ofcow's milk proteins (casein with its strong iron- sourcesas it is in western countries. the iron Simply increasing binding propertiesvia its serine phosphategroups) and the content not result in increased Thereare many may uptake. high level of calciumand phosphorus(Stekel et al. 1986; the toleranceand questions concerning gastrointestinal Hurell 1989; PabOn and Lönnerdale 1992). Cereals can inhibit interactionwith other minerals.Moreover, simplyincreasing iron absorption.The exact reason is not clear but the inhibitory iron uptake may also be inefficient, because the lower the level effectmight be due to phytate,phosphate, and/or dietary ofadded iron, the more effective absorptionoccurs. fibre.

Factorsaffecting absorption: Ligands, which chelate iron, BISCUITS can inhibitabsorption by forming insolublecomplexes or very Countiy: Chile. high affinity complexes(as phosphates, oxalates, dietary fibre, tannins, and phytate) or can enhance absorptionby forming Organizations and groupsinvolved: Instituto de soluble chelates with iron, thus preventingprecipitation (as NutriciOn y TecnologIa de los Alimentos (INTA), Universidadde amino acids, citrate, and ascorbate) (Hurell 1984). In practice, Chile, Santiago;Departemento de investigaciOn y Bibiliotecas many chelatorsdo affect iron absorption.The reasonfor high de Ia Universidadde Chile.

50 MicronutrientFortification of Foods Target group: School children. Supplementaryfeeding Table7-8. Composition of the haem iron concentrate. program in Chile;biscuits and milk (substitute) for school children. This program is national in scope, reaches a significant proportion of the nutritionally vulnerablepopulation, and Proteins has enjoyed long-standingsupport. Lipids Vehicles: Wheat-flour biscuits. The composition of iron Carbohydrates fortified biscuItsis given in Table 7-7. Ash Iron content of ash Fortificants: Haemiron concentrate (HIC), also called bovine haemoglobinconcentrate (BHC). Bovine blood from slaughter- ing operationshas an enormouspotential as a sourceof large The process for producingiron-fortified biscuits is as follows: quantitiesof haem iron and proteins (see Table 7-8). Iron yield • and antioxidanfsare was 0.27°/a of HIC. The bioavailabilityof HIC is betterthan Flour,HIC, additives, dry-mixed; which used in the • nonhaem-ironcompounds, are generally Hydrogenated lard and liquid sugar are added; fortification of wheat flourand its processing products. • The dough is kneadedto a homogeneous consistency; Fortificationlevel: Consideringtechnical and organoleptical • It is moulded in an automaticmachine; and possibilities,6% HIC was chosen as the appropriatefortifica- • tion level. Not only was iron contenteight times higherthan in Biscuits are cookedin a continuoushorizontal electric the unfortifled controlsamples, protein content was also 1 .6 oven for 10 minutes at 270°C (Asenjo et al. 1985). times higher. Bioavailabilityof hemoglobiniron measuredwith Status and results of the field trial: Serumferritin values a double showeda haem-iron of isotopetechnique absorption significantly increased by the fortified biscuits, even though the 19.7 0/a. The schoolchildren received 30 offortified grams groups of school children had very good initial iron statusto biscuitsa two school This made a day, during periods. daily start with. The effect ofhemoglobin-fortified biscuits in a of 0.96 iron x 6°/a x 0.27°/a x 19.7°/a uptake mg (30,000mg population with a pooriron statuswill, therefore, be even more =0.96 mg iron). evident.The high-iron bioavailability,the good organoleptic andthe effecton iron nutriture make Technology:Process and equipment: HIC is obtained by characteristics, biological the biscuitsan alternativeto separatingbovine blood into plasmaand red blood cell hemoglobin-fortified appealing fractionsby centrifuging.The bloodcells are washedthree combat iron deficiency. Moreover, HIC is not onlyan excellent times with 0.9 % NaCI and are freeze-dried, The use of HIC iron source, and its high lysine contentimproves the protein et may producesome microbiological problems, yet the main quality of the biscuitsas well (Asenjoet al. 1985;Olivares al. biscuitswith 6°/a FIIC were in problem in using HIC for fortification is that because the 1990). Although acceptable amount of iron in HIC is low, it is necessary to use high this trial, sensoryevaluation showed a preference for the amounts of HIC. This results in a dark colour that, although it is controlbiscuits that had no FIIC. Nevertheless, Olivares et al. acceptable in biscuits, it is not acceptable in many other foods. (1990) reportedan excellent acceptabilityof both types of It is, therefore, not yet feasible to use this technologyfor biscuits. of other foods. fortification Qualityaspects: A catalytic effect ofthe HIC on the lipid auto-oxidationwas observed. Under controlledconditions (1 7— 20°C, oxygenand light-proofpackaging), the biscuitscan be Table 7-7. Composition of controland 6°/a fortified biscuits. stored up to 7 months (Asenjoet al. 1985). Marketing/distributionchannels: School feeding program.

Costand cost effectiveness: Bovine haemoglobin is largely wasted during the commercial slaughteroperation, particularly in poor countries.Industrial methods to collect and process the blood are both availableand are rather inexpensive(Hertrampf etal. 1990).

Futurerequirements/developments: The biscuit project in Chile seems to provide great opportunities.Technical possibilities of upscalingthe FIIC productionhave to be researched and cost analysisshould be performed.

Current Practices,Research, and Opportunities51 RICE FLOUR SALT Countries: Argentina and Chile. Countries: India and Thailand. Organizations andgroups involved: CESNI, Buenos Organizations and groups involved: In India: National Aires, Argentina;and the University of Santiago,Chile. Institute ofNutrition, Hyderabad; Food and Nutrition Board, of of Food and Civil Target group: When an infant reaches 4—6 months of age, Ministry Agriculture; Ministry Supplies, All India Instituteof and Public breastmilkalone becomes insufficientto meetthe iron requ ire- Madras; Hygiene health, ments ofa normal, healthychild. Cereals, traditionallyused to Calcutta; Institute of Child Health, Madras; All India Instituteof Medical supplementbreast-fed infantshave several limitations, such as Sciences, New Delhi; HaryanaAgricultural University, Machine Build Industries Pvt. low iron availability, low quality ofprotein, low nutrient Hisar; Ltd., Madras,India. In Thailand: of and Mahidol density, and high bulk. The full-term Hispanicinfant population Ministry Health, Bangkok; University, oflow socioeconomic class in urban areas of Santiagowas Bangkok. to selected participatein a field trial to assess the effect ofthe Target group: Iron deficiencyanemia (IDA) is an important iron-fortified rice flour on iron nutritionstatus. public health problem in India.It has been estimated that up to Vehicles: Extruded rice flourobtained from a local supplier. 60°/a ofpreschool children, 300/a of women ofchild-bearing age, and 50°/aof pregnant women sufferfrom anemia. Iron Fortificant: Bovine haemoglobinconcentrate (BHC). BHC is a deficiency anemia is particularly prevalentin the Northeast fine,dark red powder obtained by centrifugation and further Region ofThailand where an estimated40°/a ofthe population dehydrationof the corpuscularfraction ofblood of slaughtered suffersfrom IDA, due, among other factors,to the relative animals. L-ascorbicacid (20 mg/i00 of powder) was added g isolation of extreme and condi- as antioxidantin relationto the fat content. To balancethe Ca/P villages, poverty, poor living tions. ratio, CaCO3 (500 mg/i 00 g of rice) was added as well. Vehicle: Common salt is consideredto be a suitablevehicle Fortification level: The level offortification used was 5°/a for salt fortification, satisfyingall the criteria ofan ideal vehicle BHC (iron content280 mg/i00 of powder), which means 14 g in India and Thailand: mg ofelemental iron per 100 g dry product. Assumingan • average daily intake of dry cereal of40 g/infantand an Salt is consumedby all segments ofthe population, rate of 1 it 0.8 ofabsorbed iron/ absorption 4.2°/a, provided mg • There is no relationbetween salt consumptionand infant Geometric mean of the rice-BHC iron per day. absorption socioeconomic statusof the population,and was 14.2°/a, which is slightly over one-third ofthe optimal • salt has a narrow of 12—20 absorptionof elementaliron. Daily consumption range g, with an average intake of 15 g/day. Technology:Process and equipment:The rice flourwas Fortificants: In the iron source for extrudedin a 6" AndersonExpansion Extruder-Cooker identifying fortifying salt, the criteriawere considered: (Anderson Ibec, Strongsville, Ohio, USA). After processing,the following extruded flour was dried to 10% moisturecontent and ground • Iron sources must be stable when mixed with salt, over a 60-mesh sieve.A premixof BHC, L-ascorbicacid, and • It must not develop colour when mixed with salt, CaCO3 was then dry mixed with the extruded rice flour. • It must not impartcolour ortaste to the food to which Flow chart: See this chapterunder "WheatProcessing:' the salt is added, Status: Field trial. Agroup of92 breast-fed infants from 4 to 12 • It must be stable under the prevailing conditionsof monthsof age mceivedthe fortified cereal. Acontrol group of 96 storage and transportationof salt, and infants received regularsolid foods(cooked vegetables and meat). • Bioavailability ofthe iron sourcemust be satisfactory, Atthe end ofthe trial, a subsampleof infants in both groupswas particularly when the iron-fortified salt is added to food supplemented with 45 mg Fefor 90days. At 12 months, iron during cooking. deficiencyanemia was present in 17% ofcontrols, in 10% of fortifiedinfants as awhole, but only in 6% ofthe infants who Although ferroussulphate isthe most suitable iron salt from consumed more than 30 g of rice/day,demonstrating that the the point of view of bioavailability and cost, it is unstable and consumption ofhaemoglobin-fortified rice is effective in tdudng developscolour readily when added to NaCl. Ferric phosphate the incidence of IDA in breast-fed infants. and other insolubleiron compoundsare stable and do not develop colour, butthe iron absorption rate is unacceptably Project/program evaluation: The use of a haem-iron low, particularly when ingestedwith food. fortified cereal as a weaning food seems feasibleand advanta- geous, supplyingan appropriateamount of absorbableiron, an Two approacheswere investigated: the use ofstabilizers to adequate energy density, and a proteinthat could complement prevent discolouring and absorptionpromoters to improve milk protein. bioavailability. The use ofsodium hexametaphosphateand

52 MicronutrientFortification of Foods sodium acid sulphateas stabilizerswas proposed(Diamond et Grinding and washing: Raw salt isfed into ahopper and at. 1974). Absorptionpromoters have beenfound to have delivered ata uniformrate througha rollerfeeder andbucket betterkeeping quality withoutdeterioration of iron availability. elevator to a hydromill into whichbrine is also introduced. Here, into a With sodium acid sulphate(NaHSO4), the iron absorptionfrom the salt is groundand discharged as slurry slurry receiving wherefresh brine once intmduced. The and ferric phosphate(FePO4) significantly increased to nearly tank is again gypsum doublethe rate and reached 800/0 of the value obtainedwith fine insolubles are separated byfloatation with frothformed in the The formula was al. The then ferroussulphate (FeSO4). improved (Rao et hydtDm ill. saltslurry is pumpedthrough a slurry pump 1978) to avoid occasional yellow discolorationand to reduce to athickener where the salt concentration is increased before it is The brine returned a the cost. Instead ofthe more expensive FePO4, a mixtureof FSO4 fed into a continuous centrifuge. wash is to add used. brine from where the thickener. The wash and sodiumorthophosphoric (NaH2PO4) can be tank it is repumped to is sent to a where the Studies in Thailand concentrated on the use ofstabilizers. A liquor carryingimpurities sludge pit insolubles settle. Theclear brine is recirculated throughthe pump formula based on Na-hexamethaphosphate and NaHSO4was to the slurry receiving tank. tested (Suwaniket al. 1980). Iron absorptionand stability from a meal containingthis fortified salt is reportedsatisfactory. This Centrifuging and drying:The brine is given a freshwater is contradictoryto the findings of Rao et al. (1975) who wash and its moisturecontent should be reduced, in the reporteddeterioration of iron availability on storagedue to centrifuge,to about 3°/o. The centrifuged salt is passed through formation of insolubleferric phosphate. a fluid bed drier where it is driedto a moisturecontent of less than 0.15°/o and then cooled. Fortificationlevel: The fortificant as producedin India from After and the NaHSO4 (5,000ppm), FeSO4 (3,200ppm), and NaH2PO4 Fortificationand packaging: refining drying, (2,200ppm) provides one gram of elementaliron per kg of driedsalt is transferred through a bucket elevator to a vibrating fortified salt (1,000ppm). Absorption ofiron in the cereal- screen andsieved. The undersized particlesare fed to a based diet in India is impaired due to the high phytate content continuous mixer where the salt is dry blendedwith a premix of thesediets. Assuming an absorptionrate of 5% and an of salt and NaH504, FeSO4, and NaH2PO4. The fortified salt is average intake of 15 g of saltlday per person,it provides0.75 packed in 50 kg bags or retail packs of 0.5 or 1 kg. The mg of additional absorbable iron/day.This is just over one- blendingtechnique is critical as improper mixing could result in third of the average daily iron requirement in India. ununiformfortification and discolorationof the salt either or within a few of For salt delivered Thailand Na- immediately days mixing. The fortificant made in from FeSO4 (5,000ppm), to the iodizationplant as a semirefinedgrade, the grinding and hexametaphosphate (4,000 ppm), and NaHSO4 (3,000ppm) washing step is not necessary. When refinedsalt is used, only give a fortified product containingone gram of elementaliron the fortification and packagingstep is required. In Thailand, perkg of fortified salt (1,000ppm). Assuming an absorption insteadof was to fortify rate of 10°/o ofthe total intake of iron in the Thai diet and an dry blending, spray-mixing applied salt with iron because this techniquegives a consistent and average intake of 10 g ofsalflday per person,it providesabout uniform iron concentration. one mg of additional absorbable iron/day. Flowchart: See Chapter4 (Fig. 4-Ic). The processing requiredfor different gradesof salt is summarized in the next column: Status: Based on a communitytrial among childrenaged 5— 15 years etal. 1980) and field trials the rural Category Type Processingrequired (Nadiger among population (Nadiger et al. 1980;Working Group Report a. Unrefined Grinding and washing 1982), fortified salt made a significantimprovement in haemoglobinlevels and in reducingthe prevalence of anemia. Centrifugingand drying The impact was the highest in a regionwhere the incidence Fortificationand was highest. Afurther study among female collegestudents confirmedthese al. have been packaging findings (Jam et 1987). Steps takento implement this program on a national scale. b. Semirefined Centrifugingand drying The Tamil Nadu projectis expected to covertwo districts in the Fortificationand state and the Midday-MealPrograms for schoolchildren packaging (coveringroughly 2.5 millionpeople). UNICEF has carried out and c. Refined Fortificationand Knowledge,Attitudes, Practices (KAP) studies in these areas and has prepared a detailed publicity campaignfor iron- packaging fortified salt (Mannar 1991). Technology:Process and equipment: Forsalt that needs Consumer acceptabilitytrials have beencarried out with salt be refined are involved: to the following steps fortified with FePO4-NaI-1S04 in India. This fortified salt was

Current Practices, Research,and Opportunities53 found to be generally acceptable in both the communitytrials Cost effectiveness: On the basis ofprevailing pricesin India in schoolsand the field trialsin four regions in lncfla. Field (as of 1991), the cost of machineryhas beenestimated at trials are reportedto be under way in Thailand,but results of US$1 10,000for a unit producing one ton/hour. The cost of this study are not available(Suwanik 1980). processingfortified salt including the cost of chemicalsand packaging (at 1985 levels) are estimatedat US$25/ton and Product: Salt fortified with FePO4and NaHSO4 in 1:2 molar US$1 6/tonwhen using FePO4 and FeSO4-NaH2PO4 respec- proportionswas found to be stableover 8 months,and iron tively. Iron fortification adds about 50—80°/o to the thst ofsalt absorptiondid not deteriorate on storage. Crude salt with a and costs US$0.20/personper year. high contentof magnesiumchloride (MgCI2) occasionally gave a yellow discoloration, which gradually disappeared within 10 Project/program evaluation: The National Institute of days on exposureto the atmosphere. Salt fortified with a Nutrition, India, is evaluatingthe impact ofthe fortified salt in two districtsin Tamil Nadu state. Baseline surveyshave been mixture of FeSO4 (NaH2PO4) and NaHSO4 was found equally The results ofthe evalua- good with resped tobioavailability and stability, while completed.(Mannar 1991). impact tion are discussed under "Double FortifiedSalty occasional discolorationdid not occur. When used in cooking, taste or colour of the was not altered. product Observations: Although this approach wouldhelp to reduce the incidence ofmild and moderate of anemia in the Salt fortified grades with a mixture of FeSO4 Na-hexametaphosphate, community,it is unlikely to meet the iron needs of pregnant and NaHSO4 gave good bioavailability in testsin Thailand. women who mayhave the most severe forms of anemiawith Taste or colour were not altered and no significantreduction in associated highest risks. iron levels afterstorage of up to 15 months was observed. No change in taste and palatability was noted when used in more Even though technologyfor iron fortification ofsalt has been than 50 commonThai recipes, which involvedboiling, developed and field trialsconfirming the effectiveness ofthe roasting,frying, steaming, grilling, salting, sundrying, or formulation were completedin the 1 970s,the program did not fermentation. find large-scale application,partly because it was overtaken by a major thrustin several developingcountries, including India, Qualityaspects: The purityof salt used for iron fortification to iodate saltto control IDD. In somecountries like Sri Lanka, is a critical factor to ensurethe stability and bioavailabilityof cookingsalt is steeped in waterand onlythe saturatedbrine is the ironcompound. Presence ofmoisture in the salthastens used for cooking.In suchcases, fortification of saltwith iron of the ferroussalts and a brown colour to hydrolysis imparts may not be feasible. the salt. The presence of a high level of magnesium(Mg) in the There was no evidence ofthe of factors salt increases its tendencyto absorb moistureand aggravates presence inhibiting the problem.Salt used for iron fortification will requirea such as phytatesand phosphatesin the Thai diet. The absorption of iron was enhanced the of in the minimum purityof 99°!o (dry base), a maximum moisture by presence protein form ofsmall fish and the of which contentof 0.5°Io, and a maximum Mg level of 0.05°Io. The salt by ingestion papaya, should be fine and be of uniform size (0.5—1 mm). contains ascorbic acid. Future requirements/developments: Given that the Effective implementationof a program for producing and infrastructure for salt iodation is now in place in several distributing iron-fortifiedsalt requires regular monitoring, developingcountries, this presents an opportunity to Introduce particularly atthe retail and householdlevels. A simple, iron alongwith iodine in the salt. inexpensivefield kit has beendeveloped for this purpose (Ranganathan and Rao 1992). FISH SAUCE (NAMPLA) Thailand. Marketing/distributionchannels: A well-established Country distribution system exists in India. The productionof iron- Organizations andgroups involved: The Faculty of fortified salton a commercial scalehas recently beenapproved Tropical Medicine, Mahidol University, Bangkok;The Swedish by the Governmentof India. Specifications for iron-fortifiedsalt Medical Research Council;and WHO. have been incorporated as part ofthe regulationsgoverning Target group: The prevalence of anemia in Thailand is the Prevention ofFood AdulterationAct. Private companies in estimatedto be 30—50°/o, dueto a high incidenceof hook- Madrasand Hyderabadhave begunmarketing iron-fortified worminfection and a low intake ofiron from animal foods. salt in limited quantities.In the statesof Tamil Nadu and Anemia,due to iron deficiency, is probably most severe in the Rajasthan, large commercial-scale fortification plantsare being north-easternpart ofThailand (Tuntawiroonet al. 1980). establishedby government-ownedcompanies. Of the esti- matedannual productionof 7 milliontons of salt, about 4.5 Vehicle: In Thailand,the use of fish sauce as a condiment, million tons are availablefor human consumption,most of flavour, or saltsubstitute is widespread.Fish sauceis an which is producedin about 120 manucturingcentres. important salt substitute.Whereas solid salt is usually not in

54 MicronutrientFortification of Foods the market in the local village shops, fish sauce always is. It is meals prepared with the fortified fish sauce (Garbyand Areekul used in most kinds of foodsand is added during cooking. 1974). Absorptiontests showed that the iron present in the food with the fortified fish sauceis well absorbed. Fish sauce has beenproduced in some 130 factories (Garby and Areekul 1974). Ofthese factories, some 10—15 of the Status: After laboratorytests were doneto identify a suitable largestcompanies produceroughly 80°Ioof the total amount of iron compound,a one-year field trial in two villages situatedin fish sauceproduced. The consumptionof fish sauce has the Central Plainof Thailand was conducted. This area is increased from 20—30million litres in 1962to 40—80million considered to be representative of the economic andsocial litres in 1967. The main reasonfor the increasingproduction is structureof the majority of Thai provinceswhere 80—90°/o of the increasingconsumption in the ruralareas. The improved the population are rice-growingfarmers. The area, however, is transportfacilities have openedthe rural areas for centrally not as severelyaffected by iron deficiencyanaemia as the processed products.The averageconsumption of fish sauceis north-eastern provinces. The fish sauce, used in the field trial 10—1 5 mi/head per day (estimates for the average consump- was fortified with 6.56 mg NaFeEDTA.The results showedthat tion bythe military forces is 25 mI/head per day). because of the fish sauce fortification program it is possibleto increase iron intake by 10—20 mg of per day. The In 1969,Garby suggested fish sauce as a suitablevehicle for Fe/person trial duration is too short to iron fortification to the WHO Nutritional Division for these (one year) provide optimal beneficialresults but the results that a continuous reasons: imply consumptionof the fortified fish sauce should be expected to Its low price; give goodanemia-reducing results.

Wide-spread consumption; Fortificationlevel: One mg elementalFe/mI sauce, which • Fairly constantconsumption level of 10-15 ml/person/ correspondents with 6.56 mg NaFeEDTA/ml sauceextraction of day; and marine fish. The salt contentof the productis 30g/l and the iron content is 10 mg/I. The variance in fish saucequalities is • Overallavailability in the market. dependent ofthe degree of extraction, the cheaper qualities Overconsumption of the productis highlyunlikely as its salt beingdilutions ofthe high-extraction-rate qualities. Problems contentlimits the amount that can be consumed without with colour,taste, and odour, caused bythe iron fortificant,are negative organolepticeffects. minimized by choosingthis highlyflavoured product as the Fortificants: Thefollowing iron fortificantswere tested in the vehicle. laboratory: Technology,process, and equipment: A small factoryin 1. Iron(III) SodiumEthylenediaminetetia-Acetate (NaFeEDIA). Bangkokwas askedto fortify the sauce for the pilot project. The NaFeEDTAwas addedto the fish sauce just before bottling. 2. lron(IU) CholineHydroxide Citrate. The bottles were transportedto the villages once in every2 3. Iron(II) GlycineSulphate. months. The village headman was responsiblefor storage and distribution ofthe fish sauce tothe when needed. 4. Iron(II) Digluconate. villagers Full-scale No industrial fortification 5. Iron(II) Succinate. production: large-scale program has beenreported in the internationalliterature 6. Iron(II) Sulphate. (INACG 1993). The fortification concentration was 0.5 and 1.0 mg elemental Product: Theproduct is a clearbrown liquidwith a pH of iron/mi fish sauce. about 5.5, produced by salt extractionof marine fish. The salt Only the first iron compound(NaFeEDTA) provedsuitable as a contentof the productis 30 g/I and the iron contentis 10 mg/I. fortificant.Fish sauce is a clear brown liquidthat masks well The variancein fishsauce qualities is dependent ofthe degree any discolorationcaused bythe addition of the iron fortificant. of extraction, the cheaperqualities being dilutions ofthe high- Only the NaFeEDTA,however, did not changethe visual extraction-rate qualities. Problemswith colour,taste, and appearance, whereasthe other fortificants (2 through 6) were odour, caused by the iron fortificant,are minimized by choos- rapidly precipitated(from afew minutes to somehours). ingthis highlyflavoured product as the vehicle.

The status of NaFe11 1EDTA as a recognized food additive is not Cost effectiveness: The costsof the fish sauce fortification yetclear. JECFA(1993) has reached the conclusion that as suggested bythe field trial will increase the costsof the NaFe11 1EDTA is safewhen used in supervisedfood fortification product by 1 0—20%or by about 0.3—1 .0°/o of the average programsin iron-deficientpopulations and has given provi- monthly cashincome of a Thai farmer. A less pure grade sional approval for its use. NaFeEDTAdid not alter the pH of (>97%), however,as is used in the agriculturalindustry as a the fish sauce. Further organoleptictests showedno significant fortificant,is commerciallyavailable at less than halfthe costs effect ofthe NaFeEDTAfortified fish sauce on the taste ofthe ofthe pharmaceutical NaFe1111EDTA (Ballot et al. 1989). The

Current Practices,Research, and Opportunities 55 • costs of food fortification with Nafe111EDTA as a food additive Regularconsumption, may also be reduced with the alternative fortification mixture • Relativelyconstant amounts (average of 5.5 g/d) Na2EDTAplus FeSO4in a molar ration of 0.5:1.0in diets consumed bya high percentage ofthe targetpopulation, (INACG 1993). • Not consumed the Project/program evaluation: The active role ofthe fish by nontargetpopulation, sauce processing industry is limited to one producerin • Goodmasking qualities(dark colour and strong aroma), Bangkokwho providesthe fortified product. It is important to and includethe fish sauce processing industry as a wholein a very • A iron effectof the vehicle early stage of the program to maximize their cooperation in slight absorption-enhancing et al. pilottests and full-scaleproduction. Viteri et al. (1981) and (Lamparelli 1987). Cookand Reusser (1983) report a large-scale fishsauce Fortificants: FeEDTA is the only known nonhaemiron fortification conducted in Thailand. programbeing fortification source that resists the inhibitory effectof phytic Future requirements/developments: The JECFA(1993) acid, a componentof cereals and grain legumes,which is the stated that NaFeEDTA is safe when used in supervisedfood main compoundof the target group's diet. Studies have shown fortification programsin iron-deficientpopulations and has thatthe iron absorptionfrom NaFe1111EDTA fortified foods is given provisionalapproval for its use. A cheaperyet very significantly betterthan from other fortified foods. Mean alternative the use of the fortificantwas about 10°/a. promising is of Na2EDTAand FeSO4 in the bioavailability Lamparelli molar ratio ofEDTA to iron between 1.0 and 0.25 in meals of (1987) showedthat the mean iron absorptionfrom low iron availability.In a large-scale/full-scale fortification NaFe111EDTA-fortifiedmasala was almost twice that offerrous program both theseiron sources may be tested for efficacy. sulphate,when eachwas taken togetherwith a traditional vegetablemeal. An increase in the iron absorptionof approxi- CURRY POWDER (MASALA) mately 7 mg/daywas established. In the study, an absorption Fortification of with NaFe111EDTA. Project title: curry powder increase of 12 pmol/d in iron-depletedwomen was demonstrated.No adverse effects in individuals with normal iron Country: SouthAfrica. status at the beginning of the experimentswas observed. Parties involved/cooperation: The MedicalResearch Fortificationlevel: 10 Council (MRC), the University of Witwatersrand,the University mg NaFe111EDTA/g curry powder, which 1.4 of Natal, and the Indian population of South Africa. equals mg Fe/gcurry powder. Target group: The Indian population of Durban shows a Product: Commercial masala was purchased from a local high prevalence of nutritional iron deficiency. Mayet (1972, supplier. Experimental batches offortified masalawere 1976) found evidence of iron deficiencyin 20°/aof the male prepared bythe investigatorsin a separate location.The local and in 33% of the female population.In a later study,McPhail supplier packagedthe experimentalbatches in the regular et al. (1994) reportedIDA in 14°/a of the femalesin the packagingmaterial. The level of fortification was 10 mg reproductiveage in the sameIndian population.A further 26°/a NaFe11 1EDTA/ g curry powder,which equals 1.4 mg iron/g was shown to have depletediron stores and another 8% had curry powder.Consumer acceptabilitywas assessed usinga iron-deficienterythropoiesis (IDE). In a recentstudy, Ballot et al. questionnaire. Acceptabilityin terms of taste and appearance (1 989a) found evidence of iron deficiencyin 30°/a of the male was high. The NaFe111EDTAshowed no tendencyto segregate, and 60% ofthe femaleIndian population in Natal. Of the the curry powder beingslightly sticky. Stability afterseveral females, 24% had IDA, 13°/aIDE, and 1 6% had depleted months of storage was good. stores. This is ascribed to a rate and a diet in high pregnancy Technology:Process and equipment:No commercial which the bioavailability ofthe iron is low (Mayet1972; productionof fortified masalahas yet beenreported. Pro- McPhail 1981). The Indian population ofNatal was, therefore, duction is still at the laboratoryphase. selected for a pilotprogram to establishthe feasibility ofa fortification program using curry powder. Status: Lamparelli (1987) describes an experimentthat was designedto study the acceptabilityof curry powder as an iron Vehicle: Thechoice of an appropriatevehicle was compli- fortification vehicleand the suitability of NaFe111EDTAas the cated the fact that the black South African shows by population fortificant. a high prevalence ofiron overload,due to the traditional method ofbeer brewing in cast-iron pots. This excludes the Ballot et al. (1989b) describes a field study, which assesses the choice of a staple food like flour as the vehiclefor the iron effect offortification ofcurry powder with NaFe11 1EDTA on the fortification (MRC 1978). Masalawas especially suited to iron status ofthe target population. No further investigations servethe goal of the projectbecause it has the following and/or trials with NaFe111EDTAfortified currypowder have characteristics: beenreported. Investigationsare now concentrated on the

56 MicronutrientFortification of Foods issueof the optimal molar ratio ofNa2EDTA to iron in mealsof and Mohoney(1991) fortifiedcheddar cheese with Fe-casein, Fe- lmn concentrations the fortifiedcheese low bioavailability (McPhail etal, 1994). wheyprotein, or FeCI3. in were 40mg/kg, whereas the imn content ofthe unfortifiedcontrol Cost effectiveness: The pharmaceutical gradeNaFe11 1EDTA cheese was 1—2 mg/kg.The qualitywas determined by used in the study raised the price of the fortified masalaby thiobarbituricadd assay and taste panel evaluation. After3 1 5°Io, A less pure grade(>97°/o), however,as is used in the monthsof storage no difference in oxidized off-flavouror cheese agricultural industry as a fortificant, is commerciallyavailable flavour,texture, and qualitybetween the fortifiedand unfortified at less than half the cost of the pharmaceutical NaFe111EDTA cheesewas detected. (Ballot et al. 1989). Results indicate that it is possible to produce good-quality, iron- The costs offood fortification with NaFe111EDTAas a food fortified processcheddar cheese. Similar results were obtained by additive may be reducedwith the alternativefortification Wong and LaCroix (1979)who fortifiedcottage cheese withferric mixture plus FeSO4 in a molar ration of 0.5:1.0 in Na2EDTA ammonium citrate. This study demonstrated that milkprotein does diets (INACG 1993). not affect iron absorption and that the fortifiedcheese iseffective in Projectiprogram evaluation: The status ofNaFe111EDTA restoring low haemoglobin. Jackson and Lee (1992) fortified as a recognized food additive is not yet solved.JECFA (1993) Havarti-style cheese with microencapsulated iron. The cheesewas has reached the conclusionthat NaFe111EDTAis safe when fortifiedwith stearine coated microcapsules containingiron as used in food fortification in iron-deficient 141 supervised programs FeSO4 FeSO4 + ascorbic acid,or FeCL3with upto mg iron/kg populationsand has given provisionalapproval for its use. ofchese. Sensory evaluation indicated thatcheese with encapsulated + ascorbic acid was from cheese Although the results of the field trials are very promising, FeSO4 indistinguishable without imn. introductionof a full-scale operational food fortification program is not possible. Avery promising alternativeis the use Other iron-fortifiedcheese types had high initial concentrations ofNa2EDTA and FeSO4in the molar ratio of EDTA to iron of malonaldehydeand undesirableoxidized flavours. Unencap- between 1.0 and 0.25 in mealsof low iron availability. sulated iron salts are not suitable as fortificantsdue totheir and stearine Future requirements/developments: Thusfar, an active reactivity. The rapid simple niicroencapsulation methodallows fortification of and other fat role of the masala producers, with regardto adviseon the dairy products high and moisturefoods with iron and Lee feasibility of the process in the existing processing facilities, high (Jackson 1992). packaging,price setting, and the marketability of the productis Coffee not reported. When active cooperationof the industry is Abstract: Coffee grounds were fortified with ferrousfumarate guaranteed, steps to develop a monitoring unit and a program and the resulting perkedcoffee was fed to rats (Johnson and evaluationprocedure can be taken. Evans 1977). Fe-fumarate mixes well with coffee grounds and is undetectable after mixing. It did not sift out after 3 months of OTHER FOOD VEHICLES Taste could not tell the difference in flour storage. panels organoleptic Barley-sprout propertiesof fortified and unfortified coffee. Bioavailabilityof Abstract: In an attemptto increase the iron contentof barley the iron was assessed with the extrinsiclabel technique. For flour, seeds were soaked in distilled water for 6 hours and black coffee, coffee with sugar,coffee with nondairy creamer, grown hydroponicallyunder controlledconditions in the dark coffee with milk, and coffee with sugar and nondairy creamer, for 132 hours. Theywere sprayed automaticallyevery 4 hours bioavailability ofthe iron averaged 39 ± 12.1%. There was no for 15 minutes with either distilled wateror distilled water to significant difference in iron absorptionfrom the coffees. which iron as ferroussulfate had beenadded at 5, 7, and 10 Assuming that iron absorptionin rats and humansis similar, iron concentration. The were frozen, ppm sprouts freezedried, coffee could supply a substantialamount of the daily iron into flour, and analyzed for iron, Iron ground bioavailability requirement. Ata level of 5 ppm in brewed coffee, four cups was evaluated the of iron to by efficiency convertingdietary (200ml each) wouldsupply 4 mg iron in the diet. Layrisse the concentration in the iron in the haemoglobin.Increasing (1976) has reportedaddition of iron-fortifiedsugar to coffee spray water resultedin marked increases in iron levels, sprout without adverse effects on its organolepticproperties. but solutions of 7 ppm and above inhibited seed germination. Itis thatiron fortification of coffee bea feasible Iron from the sproutedbarley flourwas significantly more suggested might method of iron intakesfor Morcket al. availablethan thatfrom the ungemlinated barley seed flour increasing manypeople. concluded thatwhen the coffee was (Alexander and Cudjoe 1989). (1983), however, ingested directly with or within an hour after a meal,iwn absorption was Cheese reduced dramatically. No decrease in iron absorption occurred Abstract:Dairy products contribute high-qualityprotein, calcium, when coffee was consumed within an hourbefore ameal (Layrisse and other nutrients tothe humandiet but are low in iron. Zhang etal. 1976; Johnson and Evans 1977; Morck et al. 1983).

Current Practices, Research, and Opportunities 57 Eggs pastes decreased when rinsed with water, whereas it increased when rinsed with acid.Starch 60—80 Abstract: Eggs are an important source of dietary protein and hydrochloric containing Fe/i00 of matter was characterized a lowered potentially could add appreciablyto tile dietary iron absorp- mg g dry by to an tion. The poorabsorption from egg yolk (100/0 of thatfrom susceptibility degradationby alpha-amylase ferrous iron salt), however,detracts from theirvalue in this glucoamylase (Leszaynski 1985). respect. Another disadvantageof eggs in relation to iron Othersingle iron-fortified foods metabolismis their interference with iron from other absorption The use of wheat flournoodles for iron and other micronutrient sources. do not, however, to interfere with the Eggs appear fortification is currentlyunder considerationin Indonesia. The absorptionof iron fromhaemoglobin, which emphasizes the main constraintis the lackof expertisein this technical area. importance of haem iron in iron nutrition. The addition of Kool-aidis an ofa fortified with iron and is orangejuice to the meal shows a highly significantpositive example beverage under in Because of its dark this effect on iron absorption (Callender et al. 1970). development Egypt. colour, could be a suitablevehicle for iron fortification Grain amaranthcereal beverage (Nestel 1993). Abstract: Iron bioavailability in Nigean grainamaranth cetal fortifiedby two iron compounds, sodiumethylenediamine- SINGLE FORTIFICATIONWITH VITAMIN A tetraacetate and ferrousfumarate was (NaFeEDTA) (FeC4H2O4), FATS AND OILS compared with that in cereal fortified with ferroussulphate. Fats and oils are used directly or as food ingredients.Whereas Grainamaranth is important because of its potential as a cereal oils referto liquidproducts like oils from canola, corn, for children in and young Nigeria other Third World countries. cottenseed, coconut, olive, palm, peanut,safflower, soybean, in all three fed fortified Although haemoglobingain groups and sunflower,fats are solid productssuch as butter, lard, cereal was than that in the no significantly higher group given shortenings,margarine, ghee, tallow, and vanaspati.Fats and addediron, haemoglobingain was highest in animalsfed oils are suitable as vehiclesfor vitamin A because: amaranthcereal with ferrousfumarate. High relativebiological • Vitamin A and provitamin Acompounds are highlyfat valuesand expected body weight gain indicated optimum iron soluble and, when addedto fats or oils, distribute easily absorptionfrom the amaranthcereal. The study indicates that and uniformly; ferrousfumarate is the iron fortifierof choice for grain amaranth cereal (Whittackerand Ologunde 1990). • Vitamin A is more stablein fats and oils than in other Maize meal foods as they are protected from aircontact, this delays theiroxidation and prolongs their stability; Maizecan be readily fortified with iron withoutany technical • problems.Dry-milled maize meal fortified with reducediron Dietary fat facilitates absorptionand utilization ofvitamin A the its fortification vitamin is (88 mg/kg) was stable after 6 days of accelerated storage. To in body, therefore, with A date, maizemeal has not beenconsidered as a food vehiclein one of the most appropriatemeans of supplying this developingcountries because a considerable amountof the vitamin to a deficientpopulation; and maizeconsumed is atthe home. Given the increas- • processed Fats and oils are used directly or are basicingredients of of urban ing numbers migrants dependenton processed food, most diets and are, thus, consumedby almost everyone. it be to considermaize meal as a however, may appropriate High coverage of the population with fortified fats and oils primary vehiclefor iron in countrieswhere maizeis a staple can, thus, be achieved. food (Nestel 1993). Countries: A large number of developed and developing Potato starch countries. Commercial production of vitamin A fortified Abstract: In spite ofthe fact that starch present in the diet margarinestarted as early as 1927 lowersthe assimilation ability of iron addedto food, for Organizations andgroups involved: Fats and oils pro- technical reasons bread and flourproducts are most frequently cessingindustry, MOH, Universityof Liverpool,Pennsylvania enriched with iron. This provides the possibility to enrich these StateUniversity, University of Sao Paulo, Hoffmann-La Roche, productswith a supplementof potato starch after its saturation Unilever, Universityof British Columbia, Procter & Gamble. with ferric salts.Starch saturatedwith ferric chloride or ferric citrate solutions and containing7—80 mg fe/i00 gof dry Vehides: matter was examined. Edible oils: Vegetable oils from maize, olive, peanut,soybean The increase in iron contentwas higher in the caseof chloride etc. Fortificationof refined soybean oil is currently under trial in than of citrate and did not dependon the previousrinsing of Brazil (Favaro et al. 1991, 1992). In India, red palm oil is starch with water or 1/10 M hydrochloricacid. Simultaneously, addedto peanut oil and distributed as a concentrate providing with the increase ofiron content, the viscosityof 0.25°/o starch vitamin Acorresponding to 1 00°Io of RDA of an adult male.

58 MicronutrientFortification of Foods Lard, shorteningghee, vanaspati: Mixture of fats/oils. Table7-9. VitaminsA and D commonlyadded to margarine.

Margarine:Ripened skim milk and mixture of fats/oils. Country VitaminA Vitamin0 Product: (lU/kg) (lu/kg)

Margarine is an economical, nutritious, and palatablesubsti- Australiaa 30,000 4,000 tute for butter. It resembles butter in appearance, form, and Austriac 20,000 3,000 a fat and oil mix. Shelf- compositionusing vegetable-based BeIgium 16,000 3,000 stable that does not is now margarine requirerefrigeration Brazilb 15,000—50,000 500—2,000 availablein many countries. canadac 35,000 7,000

Vanaspatiis a hydrogenatedvegetable fat used as a butter substitute in India. chileb 30,000 3,000 Colombiab 30,000 0,120—300 Fortificants: Vitamin A acetate or palmitate ester(vitamin D Denmark 24,000 500 and E optional);The fortificant used for soybeanoil in Brazil is FinIand 16,000 2,400 France retinol palmitate + antioxidants.

Fortificationlevel: Gerniany' 20,000 1,000 Greecea 25,000 1,500 Edibleoil: VitaminA was addedat a rate of 200 IU/g of oil, India (Vanaspati) 25,000 based on a of 15—30 ofoil in daily consumption g per person Israelc 30,000 3,000—4,000 Southern Brazil. Fortification edible oils level of ata of 20 IU/g Italyc prohibited prohibited was made compulsoryin Pakistanfor over 20years now. But Japana 30,000—40,000 it is not enforced or monitored.Actual levels, therefore, vary Mexicob 20,000 2,000 NetherIands from0 to 20 lU/g oil. 20,000 3,000 Norwayc 20,000 2,500 Vanaspati (hydrogenated fat): Fortificationwith vitamin A Philippinesa 22,000 1,100 (25,000lU/kg) was made compulsoryin 1953 in India.The addition of vitamin D is optional, but most manufacturers Polandc 30,000 3,000 voluntarily add vitamin D. Portugala 20,000—35,000 875—1,000 SouthAfrica 20,000 1,000 Margarine: On average, about 30,000 IU of vitamin A and Spain 20,000 3,000 3,000IU ofvitamin D are addedper kgof margarine.In Table Swedenc 30,000 3,000 7-9, the fortification level in a number ofcountries is shown. Recently, fortification of shelf-stable margarine in the Philip- Swilzerlan& 30,000 2,700 pines has beenshown to be highly effective in improving the Turkeya 20,000 1,000 uK vitamin A status ofpreschool Filipino children (Solon et.al. 27,000—33,000 2,800—3,500 usA 30,000 2,100 1994). Processand Technology: equipment a Bauemfeindand Arroyave (1986). Edible vegetable oils: Usedas salad oils or for lightcooking bNeI (1993). Kubler in household,vegetable oils can befortified with vitamin A. (1973). After clarification,a vitaminA ester in the form of an oily liquid concentration is addedand carefully agitatedfor uniformity. Qualityassurance: Edibleantioxidants may also be added to protectboth the Margarine:Storage ofvitamin A-fortified margarine for 6 oil and the vitamin Aester from oxidation. vegetable months at 20—25°C results in minimal losses (O'Brien and Lard,shortening ghee, vanaspatiand otherhydrogenated fats Robertonn.d.; Morton 1970). Heatingat 160°C, 180°C, and can likewise befortified technologicallyin a similar way. 200°C resulted in losses of max. 20%, 35°/o, and 50°/a (Morton 1970). An average of 10°/a vitamin Aand 0 is more to Margarinc The productionof margarine is done in a batchor compensate for distribution variations rather than heat continuous process. The oily vitamins are mixed thoroughly in degradation.Losses occurringwould be due to oxidationof the warmoil (ratio 1:5) to producea uniform solution that is added oily vitamins, a process thatwould cause rancidity ofthe fats at to the fat blend before the emulsifying process (see Fig. 7-2). the sametime. B-carotene (provitaminA) is addedas a colorant Status and resultsof fieldtrials: Full-scale productionin but it is also a significantsource of vitamin A. Biological assays many countries.Fortification of soybean oil is currentlyunder demonstrate full availability ofadded vitamin A (Bauernfeind trial in Brazil with promising results. and Arroyave 1986).

Current Practices, Research, and Opportunities 59 Fig. 7-2. Flow chart of vitaminenriched margarine manufacturing.

Ripened skim milk Mixture of oils/fats Oily vitamins

MARGARINE

Source; O'Brienand Roberton,n.d.

Ediblevegetable oils: Fortifiedoil was tested for acceptabil- Marketing/distributionchannels: Through open market ity in basicrecipes for mayonnaise, fried beans, fried potatoes, channels. soup, cookedrice, wheat tortillas, and fried meat. Consumers Cost and cost effectiveness: Margarine is cheaper than were not able to detect the difference between productspre- butter with similar nutritional value. Soybean oil in Brazil costs with or withoutfortified oil. testswith pared Frying cottonseed less than other oils and fats. oil showed that the qualityof the oil was best preserved at 160— evaluation: in several 180°C, and 60—80°Io ofthe vitaminA content was retained after Project/program Fully accepted countries.In oil is often 30minutes of frying (Paden et al. 1979). many countries,vegetable processing centralized and controlledby large companies and coopera- Research has beendone on ofthe of specificaspects stability tives,thus facilitating large-scale fortification with vitamin A. vitamin A in oils. Vitamin A in oil storedin palmitate soybean Commercial vegetableoils are oftenpackaged and sealed in sealed cansin the dark retainedits after for activity storage up metal cans and thus protected fromlight in storage. to 9 months.After 18 months, its vitamin activity was more The importance ofmargarine in the Western world can be than halved,down to about 40°Io of the original concentration. comparedwith that ofvanaspati in India. The vanaspati The vitamin A activity of oil storedin opencans began to industry is one of the largestprocessed-food industries in India deteriorateafter 6 months of storage. Oil stored in the dark today. retained 33°Ioof its vitaminA activity,whereas oil stored in the light had a negligible amount ofvitamin A after 18 months. Vegetable oil consumption,in particular soybean oil, is Brazil, the With normal household or increasingrapidly throughout especiallyamong cooking (boiling pressure cooking) lower economic sectors. the vitamin A activity remained nearly unchanged, but repeated Observations: In somecountries water soluble vitamins use of oil in fryinggradually destroyed the vitamin A (Favaro may et al. 1991, 1992; Desai et al. 1994;Dutra Olivieraet al. be added. In this case, the vitamins wouldbe dissolved in milk and added to the 1994; Universityof Dhaka 1994). Because of the stability of pasteurized (ratio 1:20) aqueousphase chur. vitamin A in oil, vegetableoil is used as a carrier by vitamin A before pumping into the emulsification manufacturers. Accordingto Hoffmann-La Roche "the stability SUGAR of the vitamins presentin afat is usuallythe same as the Countries: Fortificationof sugar with vitamin A has been general stability ofthe fat itself As the shelf life ofsuch successfully implementedin various countriesin Central and as oils and is about 6—12 months, products cooking margarine South America: Chile, Costa Rica, El Salvador, Guatemala, vitaminA losses in fortified oils can beexpected to be minimal Honduras, and Panama. for this length of time. This compares favourablywith vitamin • Brazil A stability in solid food ingredients. (Araujo 1978): Bioavailabilitystudy; • Chile (Toro 1975): Bioavailability,field study, organolep- In of low fat content Shortening: products (bread, biscuits, tic analysis; cake), which are baked under moderateconditions, vitamin A • Guatemala (Arroyave 1987): Bioavailability,field study, appearsto survive the baking process to the extent of 80— analysis; 1 00°Io (Rice et al. 1942;Paden et al. 1979). The stability of organoleptic • vitamin A addedto fatty foods is shown in Table 7-10. Panama (Navia 1983);

60 Mkronutrient Fortification of Foods Table 7-10. Stabilityof vitamin Aadded to fattyfoods. market. Regulations followed in 1975. Epidemiological surveys followinga 2-year sugar fortification showed a Period of Lossof 1)peofMWl storage significantpositive impact on the vitamin A status of preschool at20-25°C vltaminA children. (months) (%) - Such results were reconfirmedwhen vitamin A deficiency rose Margarine 3 10—12 6 15—20 to its former level after fortification effortslagged. Since the mid 1 980s, Nutrition Institute ofCentral America and Panama 2 2—7 1.ard and other have in a 4 10—15 (INCAP), UNICEF, agencies participated 6 15—20 broad-based effort to ensureadequate vitamin A consumption through sugar fortification,supplementation, and nutrition Cookingfat 2 0— 5 education. Sugarfortification was revitalized during the 1987— 4 5—10 88 harvest a concerted effort UNICEF, INCAP, the 6 20—25 following by NationalAssociation of Sugar Producers of Guatemala, and the Source: Morton (1970); Klaui et al. (1970). Ministry of Health. Impact studies during the past 5 years indicatethat vitamin A deficiencylevels among preschool in The International Sugar Federation at its May 1995 meeting in children Guatemala have significantly decreased. Sao recommended fortification with Paulo, Brazil, sugar Fortificants: Retinol palmitate 250-SD Hoffmann-La Roche vitamin A to all membercountries where vitamin A deficiency (waterdispersible). is prevalent: Retinolacetate 325-1 Hoffmann-La Roche (waterdispersible). Organizations and groupsinvolved: Fortificationlevel: Based on the RDA suggested by WHO Ministries of Health, INCAP (regional operating,program and the estimateddaily sugar intake of Guatemalan development),National agencies/research institutes/universi- preschoolers (20 grams, or about 2 teaspoons), INCAP ties, InternationalSugar Institute, and UNICEF. recommended that sugar be fortified at a concentration of 15 Target group: Originally, the program in Guatemalawas micrograms(50 IU) of retinol pergram ofsugar or 300 targetedat the whole population (fortificationlevels set micrograms per day. accordingto the RDA for adults). As the primary goal of the Product: Stability ofthe retinol acetate 325-L under various program was an adequate intake of vitamin A by preschool conditions(low temperature, room temperaturewith varying children,the target group changedto the preschoolchildren, as and room with was is reflected in the level offortification (Molina 1991). humidity, temperature high humidity) good. The maximum decrease of the retinol acetate325-L was Vehicles: was chosen for the reasons: Sugar following 20% after 8 months ofstorage. Paden (1979) reportsa 89— • Universaland fairlyconstant consumptionby the whole 90°/arecovery of the vitamin A in coffee and Incaparina after population, cooking. Recovery during the preparationof cakes was retained at 76°/o. • No organolepticinterference of the fortificant with the vehicle, Organoleptic tests showedno effect on the taste ofproducts as cakes and powderedjuices, but a slight"medicinal" off-taste • Longshelf life, when mixed with coffee. No organolepticdifferences between • Economical substantial raise in the feasibility (no price the fortified and the nonfortifiedsugars was detected by the ofthe fortified in to the nonfortified product comparison population involved in the field study. product),and Technology:Process and equipment: The proportion of • Central processing facilities. retinol palmitate addedis 1100/a ofthat needed to fulfill the In Chile,80% of the sugar is producedin two plants. Refined law and to compensate for any potentialsubsequent losses of sugar is consumed in fairlyconstant amounts by the whole potency. The proportionsand ingredientsused have been population (Navia 1968; Arroyave 1987). In Guatemala, sugar modifiedslightly over time but, in 1994, a batchof concen- was chosen as a vehiclebecause it is producedthrough a trated premix consistedof: sugar (75°/o), vitamin A palmitate relatively centralized process and is consumedregularly by (22%), sunflower or other peroxide-free oil to promote adults and children. It is also added to liquidand cereal adhesionof the vitamin A compoundto the sugar crystals mixturesprepared for younger children (UNICEF 1994). In (2,1%), and an antioxidant like Ronoxan (0.9°/a). These are 1974, the Guatemalan Congress enacted a law requiring mixed in a drum mixeror other proven equipment. A number fortification with vitamin A of all sugar producedfor domestic of vitamin A sources have beeninvestigated:

Current Practices, Research,and Opportunities61 • Premix of sugar (ofthe sameparticle size as the final The sole source ofvitamin A for the newborn is mother's milk; product) and vitamin Aacetate 325-L (Toro 1975), therefore, an adequate supply of vitamin A in the milkof a lactating motheris imperativefor the health and appropriate • Premixof sugar (ofthe same size as the final particle growth of her baby.Bioavailability of addedvitamin Ato sugar product)and vitamin Apalmitate 250-SD (Paden in pregnantand lactating motherswas investigatedby 1979), and Arroyave (1974). Results indicatedthat lactation depletes vitamin Astores of mothers.This was • Premix of sugar (ofthe sameparticle size as the final lactating depletion arrested the of the fortified product)and retinyl palmitate beadlets 250 GA/S by consumption sugar. (Molina 1991). Field studies have beendone in an isolated population ofa very low socioeconomic level with a high prevalence of VAD. The premix is baggedfirst in opaqueplastic bags and then The field study included: placed in fibre sacks, sewn togetherat the top to prohibit the • entrance of light,and deliveredto the mills as required.The A nutritional survey in the experimentalvillages, fibre sacks are marked for contentand with caution against • A clinicalexamination, and human consumptionof the premix. • An assessment ofserum levelsof retinol and B- The fortification process involvesblending the premix with the carotene. regularwhite table sugar. It is the responsibilityof the produc- All the inhabitantsof the were tion managerto ensurethat premix is addedto domestic experimentalvillages provided with fortified over a 3-month (a blindstudy with sugar.The premix can be introducedin the centrifugeat the sugar period sugar consumptionad libitum). After 3 months,serum levels of end ofthe washing cycle. The amount ofpremix to be added retinol and B-carotene were analyzedon the sameindividuals must correspond with the chargeper centrifuge. The premix is as were analyzed in the baselineperiod. During the following 3 addedto sugar by designated sugar mill employees (afterthe months, regularsugar was provided,and after 3 months, the sugar emerges from the centrifuge and before it is dried), via a same were determinedin the "dosage" machine producedin Guatemala. The machineis parameters population. designedto vibrate as it works to spread the premix uniformly A significantincrease in blood retinol levels was observedafter throughoutthe sugar and thus ensurethe predetermined three months of receivingfortified sugar.Blood retinol levels concentration ofvitamin A in sugar. decreased after interrupting of the fortified sugarprovision.

During each 8-hour shift, an operatoroversees the addition of BloodB-carotene levelsdid not changeduring the study the premix by pouring it into the hopper of the dosage (carotene was exclusivelyingested from vegetable sources in machine,which in turn integratesthe premix into the sugar as the ordinary meal). The incidence of clinicalsigns attributed to it moves along a conveyorbelt. A bell has beenadded to the VAD did not changeduring the (short)experimental period. machine;when the machineis low on original dosage running Qualityaspects: Homogenousdistribution ofthe vitamin A the bell sounds, the of the needto premix alerting employee in the final product is assured bythe goodmanufacturing add more The fortified is then premix (UNICEF 1994). sugar practice when preparingthe premix. Rapid quantitative inside fibrous sacksin placed 100-pound poly-propylene methodsfor determining vitamin A distribution in the sugar which it is distributed.The sacksare closed and each is tightly havebeen developed for the sugar manufacturers.These marked date,the name ofthe mill, and with a by weight, instructionsare distributed to the manufacturers through easy- notificationthat it containsfortified sugar. to-readpublications (Molina 1991). The premix can also be introducedduring the transportationof Cost effectiveness: At the concentration of 0.021 mg the sugar (eitherbefore or afterdrying). This process requires retinol or 69.5 IU vitamin AIg table sugar the costs of vitamin an fee the adjustableprecision mechanism,synchronized with Afortification ofsugar was US$ 0.03/person peryear (WHO rate ofthe belt. propulsion system 1976). This relatively low cost was a major factor in the decision by the Central Americansugar manufacturers to Stabilityand resultsof fieldtrials: Toro (1975) reportson absorbthe costs ofthe food fortification program. the laboratorystudies toverify the absorptionof retinol acetate 325-L in normal human individuals and on the fortified sugar Project/program evaluation: Full-scale national programs stability tests. Absorbabilityof retinol acetate 325-L was have beenoperational in Costa Rica, Guatemala,Honduras, significantlyhigher when the dose was administeredtogether and Panama. The achievements are outstanding in the history with a meal compared to the administrationof retinol acetate of public health.Economical and political constraints are now 325-1 without a meal. Both experiments showed an increase of hindering the continuity ofthe programs. Recently, these serumretinol levels, at 50°/oand 11 5°Io of the basal value, programshave received renewed attention in several of these respectively. countries.

62 MicroriutrientFortification of Foods Fortificationof refinedtable sugar with retinol is legislatedin High Commissioner for Refugees (UNHCR)and WFPissued Costa Rica, Guatemala, Bolivia, Panama and Honduras. The guidelines on the use ofmilk powderas afood aid or in feeding blood retinol levels (in 1965—1967)were in Costa Rica programs. Based on these, driedskimmed milk has to befurtified 32.5°/o, in Guatemala 26.2°/o and in Honduras32.5%. In El with vitamin Abefore it can be acceptedfor distribution. Salvadorthe percentage ofserum retinol levelsof <20 pgJdl The Food and Nutrition Boardselected milk as the ideal vehicle were 50% in 1965—1967. In 1977—1980,the of prevalence for vitaminA because it provided 10 % ofthe American serum retinol levels< 20 were: Costa Rica, 1 .60/0; pg/dl customers'food energy and would not create an imbalanceof and 9.2°Io. Panama not Guatemala, 9.2%; Honduras, has the essentialnutrients. Pasteurized and UHT low fat milks are continuedthe fortification of compulsory sugar (Arroyave fortified with vitamin A. 1987). By 1994,63% of sugar for human consumptionwas fortified in Honduras. Fortificants: Vitamin A naturally occurs as retinyl esters (retinyl palmitate) in milk. B-carotenes are also present in milk Future is a and requirements: Sugar pure carbohydrate but theirvitamin A activity is lower.The levelsdecrease by does not containtile co-factors needed for its metabolism. defatting the raw milk. Retinyl palmitate is commonlyused to metabolismis on of the Sugar dependent, therefore, provision increase vitaminA in (partially) skimmed milks. Retinylacetate co-factors involved in carbohydrate metabolism,such as can also be used. thiamineand niacin,provided by other foods in the diet. The Because ofrecommendations of PAG, vitamin Afortification of total dietary compositionis ofessential importance when the milk (mainly DSM for countries) usually goes decision for the fortification of sugar is taken. Monitoring of developing with fortification with vitamin which is also a fat- sugar consumptionpatterns is essential. An increase in sugar together D, soluble vitamin. consumptioncan lead to dilution of the nutritional quality of the diet and dental carries. The national sugar fortification Fortificationlevel: The fortification level of 5,000IU programshave, therefore, opted for the policy that does not vitamin All00 gdry skim milk (about 1,500pg retinol) is promotesugar consumption(compare the promotion policy in used globally, based on a daily intake of 40—80g DSM/ the MSG programs).Any type of advertisement or incentive to subject. Adding an averageof 20 % is common. increase sugar consumption,and any emphasisto increase the In the US, addition of vitamin A to whole milk is optional, but consumptionof sugar between meals, has to be avoided.Even when added it must be presentat a level of 2,000 lU/quart if modificationsresult in a decreased dietary sugar consump- (about 2,100 lU/I). Formilks with less fat, addition of vitamin tion, this can easilybe compensated by increasingthe fortifica- A is mandatory,using the samelevel. Using the information in tion concentration. the Canadian Food and Drug Act, a recommended fortification MILKAND MILKPOWDER level of 1,400—3,000lU/i 00 g, can be calculated, which to a intake of IU vitamin A Countries: In the ProteinAdvisory Group (PAG)bulletin corresponds daily 1,200—2,500 (WHO 1976), manycountries are listed where vitamin A from milk (deManet al. 1986). deficiency is a public health problemand where fortified milk Springand summermilk has the highest and winter milk the powder is needed. Food aid in the formof fortified dry skim lowestvitamin A activity. To obtain uniform levels of vitamin A, milk comes from the (DSM) Australia, Canada, Netherlands, periodiconline monitoring and periodicalterations in the level and the US. In the fortification has become for US, mandatory of fortification atthe processing plant will be necessary to low fat milks. India has introducedfortification of milk with makeup for seasonal fluctuations in the vitamin A level of vitaminA in all major urban dairies. milk, Differentamounts of vitamin A addition for skim milk and low fat milk is also for uniform levels. Organizations andgroups involved:WHO, FAO, UN ICE F, necessary obtaining FAD, USDA, FNB—NRC,CFN—AM, HPB—CDNHW; Hoffmann-La Technology:Process and equipment:Two main methods Roche Inc., Phillips-Duphar(main suppliers). are usually used for fortifyingmilk with vitaminA: a dry methodand a wet method Target group: The target groups are particularly children (Fig. 7-3). and women of child-bearingages in developingcountries, but Dry method: For the dry method,skim milk powder is WHO's recommendation is to have a universalfortification mixed with beadlefs of encapsulated vitamin A; therefore, a rather than only covering groups at risk ofvitamin A defi- premix is usually added onlineto the milk powder afterleaving ciency. the dryingtower just before enteringthe end cyclone(continuous or it can be blendedafter in a Vehicles: Because vitamin A deficiencymostly affects young process), processing separate mixer children,the UnitedNations PAG recommended that DSM (batch process). The latter is not commonbecause it distributed by UNICEF andWHO in their programsbe fortified requiresspecial machinery. with vitamin A (and vitamin D). This started in the 19605. For the premix, dry-stablevitamin A beadlets (100,000 lUlg) Usually, vitamin D is also added. In 1989, the UnitedNations are blendedwith DSM at a rate of 1:50 to 1:85, resultingin a

Current Practices, Research, and Opportunities63 premix of 200,000—1 20,000 lU/l 00 g. The premix is added Mol et al. (1976) made an exampleof manufacturing 4,600 kg totheDSMatarateofl:2Oto 1:50. DSM: The required amount ofvitamin A is diluted in 2 Litresof oil or fat (both at in 40 Litres of milk The beadlets are little drops of a vitamin solution in oil, coated 40—50°C), homogenized about 15 MPa), and mixed with a batchof 50,000 with, for example,gum arabicand/or lactose. This coating (pressure kg milk, or addedcontinuously. Finally, the concentrated milk protects the vitamin against oxidation.These beadlets should is spray-dried.The amount ofadded fat is controlledto about never be used in fluid milk; although it has good solubility in 0.1—0.2%, so that the fat contentof the does not cold water(or milk), the vitamin A is veryunstable in solution. product exceed levelsfor skim milk It is For this kind of dry fortification,special attention should be permissable powder. important to ensurethat no ofthe can cause given to homogeneity. parts machinery copper contamination.A disadvantage of the wet method can be that Wet method For the wet method, vitamin A can be addedto the fat-soluble vitamins could be removed during fat-separa- the thin milk before all processing, or addedto the concen- tion. Karinen (1989) patented such a wet methodclaiming that trated milk when it has leftthe vacuum installation (before used emulsionwill not phase separate. Both methodsare entering the dryingtower). The wet method using concentrated suitable for fortifying DSM. The dry methodseems to result in milk is the most common,but both methods show the same somewhatmore stable vitamin levels, but is also more retentionafter processing. Today, it is possibleto keepvitamin expensive. A stable, notwithstanding the detrimental process conditions Product: Customers do not have a preference for vitaminA For this wet an oil-based vitamin during spray drying. method, fortified or unfortified milk. Old milk flavours were noticed in A premix is used,stabilized with antioxidantslike BHA and storedmilk before significant decrease ofvitamin A occurred. BHT. It should be addedas an emulsion,therefore, the vitamin is diluted with an oil (for examplebutter oil or coconutfat) and Qualityaspects: General requirements for a fortified premix homogenized in some milk, requiringemulsifiers and a for DSM are: homogenizer. The quality ofthe fat used is important for • Homogeneous distribution of vitamin A in the premix; vitaminA should have minimum stability (it peroxidevalue). • Any contaminationswith copper or oxidation productsshould Appropriatesize and densityto preventsegregation; be prevented. • Guaranteed and controlledvitamin content;

Fig. 7-3. Flow chart ofvitamin incorporationin liquidmilk and spray-driedmilk.

Oily Bulk milk Partmilk vitamins

I I

Homogenization

P su Aeration

Homogenization H Pasteurization t Bulk skimmedmilk Dry vitamins UHTtreatment Cooling conce trating

Buffer tank H Packaging Spray drying

1 FINISHED FINISHED PRODUCT Mixing ] PRODUCT

Source: OBrien and Robertson,nd.

64 MicronutrientFortification of Foods • Adequate stability for use in DSM, also in tropical expected. In the early storageperiod (first 6 months),usually circumstances. After storage for 6 months at 30°Cthe the greatestlosses can be expected. Manycircumstances, level of vitamin Ashould still be above the required however,can causedeviation of this general storage stability. level of 5000 Ri/i 00 g; and At highertemperatures (>35°C) losses ofmore than 50% within a year are reported. When humidity increases, especially • General requirements for human products (directlyfrom accompanied with heat,stability dramaticallydecreases. Slump (1976). Exposureto light also has negative effects on vitamin A Rapid test to detect vitamin A: Because not all DSM for retention in DSM. Oxygen-free packagingdoes not really seem food aid is fortified with vitamin A, and this is not always noted to affect vitamin A stability (Bauernfeind and Praman 1964; on the label, a simple field test to check is describedby Dustin Mol et al. 1976;DeMan et al. 1986;Woollard and Edmiston (1977). A reagentshould, therefore, be prepared by dissolving 1983). 50 g crystallinereagent grade trichloroacetic acid in 5 ml Storage stabilityof vitamin A in reconstitutedmilk: distilled water. Heatingup to 60°C will assist, the reagentis The vitamin A in milk reconstituted from fortified nonfat highly light sensitive.If a few drops of reagentturn blue in a milkpowder (DSM) is stablefor several days, at room and teaspoonof DSM, vitamin A is present. To checkfor false- cooling temperature. Only a few percentage loss and little off- negative results 2 x 15 g DSM should be put in 2 cups, 15 ml flavour were reported. Heatingthe reconstituted milk up to 30 ofwater should be addedto one and 15 ml reagentto the minutes (common processing in manycountries) caused losses other.Stir, and if after about a minute, a pale blue or green of about 20%. Addition offat can preventmain cooking losses colour shows up (compared to the blank) vitamin A is present. (Anantakrishnanand Conochie 1958;Wilkinson and Conochie The final fortification level is often not controlledenough. This 1958; Bauernfeind and Praman 1964). mightcause someproblems especially with DSM or fluid milk stabilityof vitamin A in fortified milk: fortified bythe wet method. If vitamin A is added to the raw Storage Defatting has a negative effecton vitamin A stability in fluid milk, most ofthe added fat soluble vitamins could be stripped milk. Vitamin A stability in low fat milk is betterthan in skim from the milk during fat separation. This also results in milk. Exposure to light causes obviousoxidation ofvitamin A, excessive vitaminA levelsin productswith high fat contentlike resulting in off-flavours. Afew days lightexposure can reduce cream. Tanneret al. (1988) report that in the US this often vitamin A 30°/ain whole and to 95°/ain skim results in label claims of vitamin A in low fat and skim milk yield by milk, up milk. Addition of B-carotene can preventoxidation. Darkness, that do not agreewith practice. however,does not guarantee preventionof vitamin A losses, Cost and cost effectiveness: The cost ofvitamin A fortifica- and significant loss (roughly, 20—40°/a) can always be of tion DSM in the 1 970swas about $2 per metric tonne. expected over a period of time. With UHT milk, which can be on Depending the price per tonne,this was 0.2—i°/o of the storedfor much longer at higher temperatures than pasteurized costs of DSM. For a manufacturingcountry, itmay be much milk, losses of 0—70°/awithin half a year are reported, with the cheaper to enrich all of its food-aid donationsthan to do it only greatestloss happeningin the first 2 months (DeMan 1981; for thoseconsignments destined to countriesor areas where Woollard and Fairweather1985; McCarthy et al. 1986; high prevalence ofxerophthalmia demands enrichment. The Fellman etal. 1991;Zaharetal.1992). dry method is usuallysomewhat more expensive than the wet RICE method. (ULTRA RICE) Riceis the main dietary staple in manypopulations with Project/program evaluation: It is known that adequately vitamin A deficiency. Fortification ofrice with vitamin A can, enriched DSM can effectively preventxerophthalmia. Current thus, make a significantcontribution to preventionand understandingof the disease entails the moral obligation to correction of vitamin A deficiency. prevent it wherevera food-aid program providesthe opportunityto do so. Such policy will certainly savethe sightof many Project title: Ultra rice fortified with vitamin A. childrenwho mightotherwise have beenamong the 100,000 Countries: Brazil, Philippines. xerophthalmia-caused cases of blindnessevery year. (WHO 1976;Dustin 1977). Organizations andgroups involved: Federal University of MOH Food and Nutrition Observations: Pernambuco, (Brazil); Philippines Institute (FNRI), MOH (Philippines); MI (Canada); Bon Dente Storage stability ofvitamin A in fortifiedmilk powder: Nutrition (BDN) (supplier),Iowa State University,PAMM, PATH/ Several studies showthat it is now possibleto manufacture USA, USDA, USAID(USA). highly stablevitamin A fortified DSM. The wet method seems Vehicles: Broken rice grains. to result in somewhatless stable DSM, but this difference will not be decisive. Within a year,losses of less than 20°/acan be Fortificant: Stabilizedall-trans retinyl palmitate.

Current Practices, Research,and Opportunities65 Fortificationlevel: Vitamin A palmitateat a level of 800 Because rice is a staple that is produced,milled, and consumed pglg premix. underconditions that vary from communityto community, the deliveryof vitamin A-fortified rice will notbe simple,and only Technology:Process Rice flourmade from broken rice a carefully developedpublic health initiative is likely to meet grains is mixed with a premixcontaining all-trans retinyl with success.This initiative must include IEC (information, palmitate,a small amount ofmaize oil, and a fatsource for education,communications), public policy dialogue, interac- vitaminA stabilization.Previously, lard was used with good tions with local NGO5, socialmarketing, and all the other tools results.Recently, coconut and peanut oils have been used to to assist introduction, implementation, and sustainabilityof avoid the use oflard and animal fats. Alpha-tocopherol and such activities. ascorbicadd are added at 1 mg/g premix(see Fig. 7-4). Observations: It is the of Bon Dente to Status and resultsof fieldtrials: laboratory tests (Brazil, goal (BDN) support the transfer of to countriesto a Philippines). technology developing provide local sourceof supply as well as minimize productioncosts. Product: The reconstitutedbroken rice is not distinguishable fromwhole rice grains. The recentresults of an informal taste Futurerequirements/developments: Ambitious plansfor test ofvitamin A-fortified ultra rice in Indonesiashowed that a major test-marketintroduction in Indonesia and Brazil have the 10 tasters were able to detect differences betweentwo been well received by the governmentofficials, but not yet ultra rice will be fortified with vitaminA. types of rice used (Rojolete and Bulog), but only two outof 10 approved, Initially, were able to detect differences between fortified and Preliminary laboratorytests have been successfullycompleted nonfortified samples. with iron and iodine.Multiple fortification is being explored. The technology is alsoapplicable to mixers ofmaize and ultra Qualityaspects: The vitamin A proved stableto storage and rice to make a higher protein product. cooking. The enriched rice proved to benontoxic and had the same sensorycharacteristics of ordinary tice. Some advantagesof TEA ultra rice arethat it is cooking quicker,can be augmentedwith The first of tea as a vehicle for vitamin A flavours, spiced, and will last for hourson a steamtable. suggestion using fortification is describedin a US patent of 1943 (Buxton and Cost and cost effectiveness: When local is production Harrison 1943). establishedand depending on productionquantities, the local retail price offortified rice is estimatedat US$0.20/personper Countries: Pakistan,India, Tanzania. If the has to be from the US, the retail year. premix imported and involved: India: USAID, New is estimated at Organizations groups price US$0.30/personper year. Delhi (experiments carried out in 1971/1 972);Pakistan: Project/program evaluation: Bioavailabilitystudies have Governmentof Pakistan, USAID (experiments carried out in been conducted in Brazil.Similar confirmingtests are under way 1973/1974); Tanzania: TFNC,Ministry of Minerals, Waterand in the Philippines. Results indicate that the bioavailabilityis good. Energy, MOH, Muhimbili Medical Centre, Tea Authority, Storagetests indicatethat vitaminA half life will be a year or Tanzania Tea Blenders, UNICEF (Tanzania); Uppsala University more.Under an MI-funded pilot project, thefeasibility ofintroduc- (Sweden), IAC (Wageningen); and PAMM (Atlanta) (Temalilwa ing ultra rice in one area in Indonesia is under investigation. and Momburi 1992).

Fig. 7-4. Flow chart of production of ultra rice fortified with vitaminA.

Broken VitaminA gins

FINISHED PRODU

66 Micronutrient Fortification of Foods • Target group: To provide a fortification solution with a contentof 10,000 IU vitamin A/g tea the emulsion was diluted (2 g India: The entire Indian population. Ofthe total estimated of emulsion plus 98 g ofsolution) in water, in a 20°/o population of 15.9 millionin the age group of 0—4 years (UN dextrin solution and in a 50°/osucrose solution, The population projectionin 1995) 86.9'millionare at risk of results are summarizedin Table 7-12. vitamin A deficiency(WHO 1995). For reasons, the 50°/o sucrosesolution was chosen as Pakistan: The children and pregnant tmen of the lower stability the best medium for dilution of the palmitateor acetate incomegroups. The nutrition survey ofWest Pakistanindicated emulsion. of the vitaminA solutions in the final an apparentdeficiency in \4tamin A in the Pakistan diet, Stability was tested 250-SD for tea especiallyamong the childrenand pregnant and lactating product using palmitate powder dust and a water-solubleoil ofvitamin A a women ofthe lower incomegroups. palmitate, palmitate emulsion, and an acetate emulsion. The retention ofthe Tanzania:Theentire ofTanzania. The sentinel population vitamin A in tea after5 minutes ofboiling time and one hour of surveillance in discloses xerophthalmia system (started 1982) boilingtime was 1 00%for both the palmitate(both the a severeVAD in children under five. Ofthe children under five, powdered form and the diluted emulsionform). 30% are affected and ofthe total population 6%. The investigatorsin Pakistan includedsegregation tests, Vehicles: Nutritionsurveys in severalof the Indian states shipping tests, brewing tests, (accelerated) stoge tests, and revealed that tea is the obviousvehicle for a laige-scale food- taste tests pertrmedby a professional panel of experienced fortification It meets all the criteriafor a program. general tasters in the laboratoryphase and the pilot phase of the suitablevehicle. program.No organolepticdifferences between fortified tea (at Researches in several ofthe Indian states have pointed out the levelsof 125, 250, 375, and 1,125 lU/cup) could be deter- following chaiacteristics. Tea is the national drink, consumed mined bythe taste panel. by all agegroups, irrespective ofsocioeconomic status, and in Fortificationlevel: The targetlevel of fortificationwas set at both rural and urban areas.Even very young children aie given 125 IU/g for vitamin A percup ofbrewed tea. This targetwas 1—2 cups oftea per day. The price ofthe consumerpioduct is based on the assumptionthat for the productionof one cup sufficientlyhigh to absorbthe costsof the added nutrient. The (150 ml) ofbrew, 3 g ofdry tea materialsare used.Daily stability of the vitaminA during processingand in the finished consumptionof tea was establishedat 3 cups/person.Thus, is and Cort In an product high (Bn)oke 1972). Pakistan, the fortified tea would lUs of vitamin about — supply 1,125 A, additional criterion was formulated supplies (except vitamin 40% ofthe averageRDA (according tothe 1970Nutrition A) and machines are to be availablein the national market Survey of VVest Pakistan). The 1972 RDA for India, are 1,000 (Fulleret al. 1974). In India, Pakistan, and Tanzania tea is lu/day for childrenand 2,500 lU/day for age 16 and up. A centraHy plDducedor processed. child given 1—2 cups oftea per day tould thus receive 375— The tea to be fortified was oftwo grades.First, is tea dust (the 750 lU/day, an adult would ingestabout 45% ofthe average term dust refers to the size ofthe tea particles, which consistof RDA (Brookeand Cort 1 2). About 27% ofthe vitamin A the smallest particlessecured in the grading process excluded from the fortified tea was available within 5 minutes of the waste products,i.e., fluff and chalk). 'a dust is used to brewing. provide a strong, darkbrew or it is blendedwith bioken Storagetests in Pakistan showed an average loss of vitamin A grades. Second, is tea leaves used to provide a light or pale of about 47°/oafter 12 teks ofstorage. The initial fortification colour and flavoury brew. level should compensate for theselosses. The tea was, Fortificants: The characteristics offour types ofvitamin A therefore, fortified at 250 IU/g. The level of antioxidantis fortificant were tested: decisivefor the relativelyhigh stability ofthe Pakistan product et al. • Powder: Retinolpalmitate 250-SD from Hoffmann{a (Paden 1979). Roche (waterdispersible), a palmitate estherof vitamin Technology: Processand equipment: Aat 250,000IU/g. It is a fine, stabilizedwhite dr The in India forthe fortification oftea 250,000 IU ofvitamin A technologydeveloped powder,containing pergram. was: • Ofthe retinol palmitate250-SD powder and of vitamin • Dry mixingof tea dustand vitamin A Palmitate 250-SD, Aacetate an emulsion ofretinol palmitate in an acacia and and water-based solutionat 400,000IU/g was made to be • used for fortifying tea leaves. (The Pakistan investigators Spray mixing ofthe diluted emulsion by splayingthe report this emulsion containingBHT and dl-alpha- solution onto the tea as itemeiges fromthe drying tocopheml as antioxidantsand sodium benzoateas chamberand subsequentlydrying at 60°Cduring one preservative.) hour.

Current Practices, Research,and Opportunities 67 Table 7-12. Stabilitytests ofvitamin A fortificantsin tea dust and tea leaves.

Dust Palmitate 250 SD powder Dry mixing 1 yr, room temperature 85

Leaves Palmitate or acetate emulsion in water Sprayed 1 mth, room temperature 50

Leaves Palmitate or acetate emulsion diluted Sprayed 1 mth, room temperature 85 in 200/o dextrinsolution

Leaves Same Sprayed 6 mth, room temperature 43

Leaves Same Sprayed 6 mth, 37°C 20 Leaves Palmitate or acetate emulsion diluted Sprayed 1 mth, 37°C 98 in 500/0 sucrose solution

Leaves Same Sprayed 6 mth, 37°C 90

Source: Brookeand Cort (1972).

The technologytested in Pakistan for the fortification oftea The vitamin A-collonseed applicationwas rejected for orga- was: nolepticreasons; the final brew yielded an oily appearance. The oil-sprayprocess was discardedalso for occupational • oftea and vitamin A, Dry mixing powdered safety reasons (dispersed oil being potentially explosive). • Sprayingtea materialwith glycerine (adhesive) and Status: subsequentdry oftea and powderedvitamin A, mixing India: Laboratory tests have resulted in the developmentof • the fortificant and the Pilot trialson a Sprayinga vitamin A emulsion diluted in a coftonseed processingtechnology. commercial scale and a and consumer oil solution onto tea material, and producer acceptance survey havebeen finished.Taste panels from the tea producing • Sprayinga vitaminA emulsion diluted in a 500/0 industry and consumertaste panels were not able to detectany sucrosesolution onto tea material. difference in taste,odour, colour,clarity, or other characteristics ofthe brewedtea. No regional or national field trials have been As a result of the test in Pakistan the tea fortification following reported. process was developed. Pakistan: Laboratory tests and pilot plant tests have been Batch productionof a fortified tea concentrate in a pan coater: completed. The results have beenpresented on a model scale to tea-processing manufacturers throughoutthe country. • Dilution of 25 vitamin A emulsionin 75 of 500/0 g g Detailedprocess descriptions, productioncharacteristics, and sucrose to the vitamin A solution, and produce spray plant definitions for severalproduction capacities have been • prepared as well as the housing, equipment,and operating Air sprayingof 25 g ofthe spray solution onto 975 g of costs tea material in a pan coater(45 seconds, airspray gun) budgets. to producethe fortified tea concentrate. A projectimplementation strategy was developed in which four private tea-processing enterpriseswould participate.Before The fortified tea concentrate (100 at 2,500 lU/g)was used as g implementation,investigations into tea purchaseand con- the vitamin A carrierto be one ofthe for a tea blend. The inputs sumption behaviourand vitamin Astatus of children and fortification ofthe final was carriedout in a PKtwin- product pregnant womenwill assistin establishingthe fortification shell blender a time of one hour. during blending level.The industrial projectwill be complemented by research into storageunder industrial productionconditions, effect on The technologyof dry blending tea material or tea material the vitamin Astatus in the samplepopulation, and industrial- plus glycerine was abandoneddue to excessive segregation. scale productionfeasibility. Although the technology developed The fortified tea plus glycerine showeda lower level of is very promising in terms ofcosts of fortification and incorpo- segregationthan the fortified dry tea. This process, however, ration in local productionfacilities, no further mention ofthe requiresthe applicationof two unit operationsto arrive atthe projecthas appearedin the internationalliterature. desired product,whereas the vitamin A emulsion in 50°/o sucroserequires one unitoperation only. Figure 7-5 shows a Tanzania: Theproject in Tanzania is still beingformulated. flow chart of vitamin A enrichedtea manufacturing. The cooperation of the tea industry has beengained in the very

68 MicronutrientFortification of Foods Fig. 7-5. Diagrammaticflow sheetfor fortification oftea with vitamin A.

FLOOR SCALE

WAREHOUSE

first stageof the program.Test runs in the tea plant and In Indonesia, the national xerophthalmiasurvey of 1978 developmentof the properpackaging and labelling is now in showedxerophthalmia and vitamin A deficiencyas a signifi- progress. cant public health problem,way below the WHO limit for defining the presence ofa significantpublic health problem. Future requirements/developments: When considering Almost 0.64 per 1,000 preschool children suffered from severe vitamin A fortification oftea, a note of cautionshould be made. blinding eye disease as a result ofvitamin A deficiency, one per Drinking tannin-containingbeverages (tea) with meals may 100 sufferedfrom mild xerophthalmia,and a majority ofthe contributeto the developmentof iron deficiencyif the diet children had a low vitamin A status. consistslargely of vegetablefoodstuffs (Disler et al. 1975). Vehicles: MSG is a crystalline,"snow- MONOSODIUMGLUTAMATE (MSG) (C5H8N04.Na.H20) white" product, difficult to fortifybecause ofmoisture retention Countries: The Indonesia. Philippines, and discoloration, The MSG particlesare large, elongated Organizations and groupsinvolved: MOH, Union ("needle") crystals. When shaken,the productproduces a Chemicals (The Philippines); MOH, PT Sasa Inti (Indonesia); the crystallinesound indicatinga dry, free-flowingcontent, which CoatingPlace, Iowa State University, Helen Keller Int, (USA). is consideredto be an important marketing characteristic. Target group: Inthe Philippines,the baselinesurvey In the Philippines,three products (salt, flour,and MSG) were indicated a high prevalence of low or deficientserum vitamin A candidates for food fortification because oftheir consumption levels(47% of the children between one and 16 yearsof age). frequency, and MSG was found suitablefor food fortification Some 4.5°/o ofthe children between one and 16 yearsof age (Bauernfeind 1991) because it is centrallyproduced. Only two showed clinicalsigns ofxerophthalmia. The first MSG- manufacturers produceMSG, of which one produces 95%of fortification field trial was conducted in the island ofCebu. This the total marketed production.Food-frequency surveysshowed small-scale fieldtrial was followed by a tn-provincesfield trial that, on average, 94°/aof the children consumed MSG at least (Solon et al. 1984). once a week. The MSG was sold in packages of 2—4 g.

Current Practices, Research,and Opportunities69 Families consumean average of two packages a day, with a 250,000IU/g Hoffmann-LaRoche). The average potency loss maximum ofthree packages a day. MSG consumptiondoes was 3% per month during the first 6 months.After this period, not influencesalt consumptionpatterns (Solon et al. 1979). potencylosses were markedly declined.

In Indonesia,four products(white sugar,flour, MSG, and salt) As some objectionsagainst the powdered,fortified MSG arose were candidates for the vitamin Afortification projectand, during the Cebu fieldtrial, the fortificant chosen for the second among them, MSG had most of the generalcriteria required tn-provincesfield trial was a dry vitamin A beadlet (vitamin A (Muhilal 1984, 1988a, 1989). acetate 3251, 325,000lU/g Hoffmann-LaRoche). The vitamin A 325Lis less soluble than the vitamin A 250-SD. The selection criteriain both the Philippinesand Indonesiacan be summarizedas follows: Indonesia:The fortificant chosen for the field trial was 250- • Produced centrally (therefore, fortification can be CWS (250,000 IU/g,cold-water storage, Hoffman-La Roche), centrallycontrolled and monitored); yellowish beadlets.

• Reaches the largestproportion ofthe target children; MSG is marketedin Indonesiaas a perfectlywhite, crystalline powder.As a result, the slightlyyellowish colour ofthe vitamin • Consumed in substantialamounts by the target A fortificant should not be visible, and a technologyto produce children; "white" vitamin A particles, not detectable in the final product • Consumed with relatively small variation; was developed. To mask the yellow colour ofthe tortificant,the • powder was coated with finelyground MSG dust (Muhilal Permitsan adequate fortification level without affecting 1988a). A more recentdevelopment was the productionof the consumeracceptance; "white" vitamin A bycoating the beadlets with whitetitanium • Marketed in small packages to the families at risk, which dioxide (Muhilal 1989). enabledtargeted fortificationto the poorestand highest To producethe premix, 800 g of vitamin A 250-CWSwas risk (low socialand economic) segmentsof society; mixed with 60 g of hydroxypropylcellulose dissolvedin 450 • Sanitary handling and someenvironmental protection ml ethyl alcohol (toserve as binding agent). To this mixture (marketed in small plastic sachets); and was added 3,200g of 100-meshMSG powder,so thatthe MSG would stickto the vitamin and the final • powder A, premix A shortturnover period. was dried by fanning.The resulting premix was "dust free" and Flour and sugar consumptionwas highlyvariable, andthere free flowing. was no sized at the specially package targeted high-risk The premix was combinedwith commercial grade MSG in a families in the market. Both flour and were as sugar rejected ratio of 5:95 and mixed until homogeneous. The final fortified vehiclesbecause ofthe difficulties in the fortification defining productcontained about 3,000lU ofvitamin A/g (Muhilal level. Salt was because this vehicle was rejected already 1 988b). "claimed"in the iodizationprogram and because of its highly Vitamin A 250-CWSis sensitive to hygroscopiccharacter, which would affectthe vitamin A oxygen,high temperatures, and It retains more than 50°/aof its stability (Muhilal 1988b, 1989). moisture, light. potency when storedfor more 18 months at 25°Cand for more than 7 MSG is generallyconsidered a safeadditive. The maximum months under dark, humid conditions. permissibledaily intake is 150 mg/kgbody weight (WHO Fortificationlevel: 1974). When addedto food as an enhancer, there is an optimal concentration (up to 0.8°/o ofa food, by weight). As the ThePhilippines: The fortification level chosen for the Cebu palatability ofthe food decreases beyondthis concentration, the and the tn-provincesfield trialswas 15,000 lU vitamin A/ use is self-limiting (Bauemfeind 1991). The average consump- package of 2.4 g MSG. Because of manufacturingconstraints, tion of MSG for preschoolchildren was 18 mg/kgbody weight, the variation in the mean vitamin A contentof the sachets at andthe maximum recorded intakes rarely exceed 85 mg/kg various points ofthe distribution chain is significant. Underthe body weight. normal marketing and environmentalconditions, however, the level offortification can be reasonablymaintained. Turnoverof the productis generally in the rangeof between 2 and 4 months. The productreaches the consumerabout 2 Indonesia: The vitamin A consumptionsurvey revealed a months afterthe manufacturingdate (Solon et al. 1985). dietary intake ofvitamin A equivalentto 700 lU/day. Main sourceswere and oil. The fortified MSG Fortificants: greenleafy vegetables should contain sufficientvitamin Ato provide between25% The Philippines: The fortificant chosen for the Cebu field trial and 50°/a of the RDA. Given a consumptionof 0.23 ± 0.20 g was a dry vitamin A 250-SD (vitamin Apalmitate 250-SD, MSG/day,the fortification level was set at 700 lU/0.23g MSG.

70 MicronutrientFortification of Foods Technology/processconditions: a retentionof 80°Ioafter 2 months and a retentionof 50% after 11 months.When the product is protected from light,the The Philippines: To overcome segregationproblems dueto fortified MSG showed a retention of50°!o after 2 yearsof physiochemical differences ofthe MSG crystals and the vitamin storage at 35°C. Turnoverrates of the productare 2—4 months. A, the MSG was reduced in size (100mesh) and a free-flowing The level offortification atthe point of consumption,therefore, agentwas added.All ingredientswere blendedin a Nauta is satisfactory. mixer and the final productwas heat sealed in plastic sachets. The standarddeviation ofmean vitamin A contentat the point In the second (tn-provinces) field trial,the manufacturer did not ofprocessing indicated someproblems with the homogeneity considerthe total amountof fortified product as justification for ofthe product. The package size, however,and the large the installation of new mixing equipment. Mixing was, number of packages purchased over a long term should therefore, a manual process. The vitaminA 325Lbeadlets were approach the averagedesirable fortification level. weighed in a polyethylenebag together with the MSG.The bag was tumbleduntil even distribution ofthe components was One ofthe problemsthat hadto be solvedwas the masking of achieved. The contentwas then gravity fed through the chute of the yellow colour ofthe vitamin A in the white MSG. The the packagingmachine for sachet filling andsealing. This marketing and distribution figuresfrom the producershowed choice oftechnology suggests a rather large variability in no changein sales of the fortified productafter the startof the vitaminA concentration per package. field trial. Neither did consumptionof the fortified product change. The constantsales volumesproved that the fortified Indonesia: Before the beginning ofthe field trials, cooperation product did not differ in organoleptic qualitiesfrom the was sought from the MSG manufacturingindustry. The nonfortifiedproduct. companythat controlled80°!o of the market in the test area, PT In further field trialsin Indonesiaunder the Sasa lnti, Surabaya, was willingto cooperate on the condition Qualityaspects: that fallingsales volumes would entitle the companyto auspices of HKI in 1989, problemswith regardto the stability ofthe withdraw from the program. ofthe whitecoating (and thus the whitecolour MSG-A) evolved.A newly developed white coating did result in a The premix was mixed with commercial grade MSG crystals, dramatic impairmentof vitamin A potency. It was discovered using a Patterson Kelly blender (East Stroudsburg,PA) until the that the whitevitamin A beadlets should approximatethe size fortified productwas homogeneous. ofthe MSG crystals. An agglomerationstep in the production Product: process of the premix had to be developed. In the following years, new vitamin A prototypesand new coatingshave been The Philippines: During the Cebu field trial some objections tested for bioavailability;stability; resistance to moisture,heat, to the quality of the fortified productarose, from the point of and light;dissolvability; and organolepticcharacteristics. viewof the MSG producer: Blendingof the whitevitamin A and the MSG need special • The fine particlesof the MSG could cause fouling ofthe aftentionas the vitamin A is only 2% of the final product seals, thus causinga higher percentage of rejects and! (Wilbur 1991). or caking of the product; and Marketing/distributionchannels: The fortified MSG was • The producerpreferred the needle-likelarge crystals marketedin the samepackage size as the nonfortified product, over the powder formof the milled fortified product. alongthe normal marketing/distribution channels ofthe manufacturer in the test area. The label mentionedthe addition The MSG fortified with the vitaminA 3251beadlets in a batch of vitamin A to the productas MSG-A. mixing process showeda larger degreeof inhomogeneitythan the powderedfortified productand a tendencyto segregation. Costand cost effectiveness: The target of the programwill The package size, however,and the largenumber of packages be fortification of 35—50%of the MSG that reaches the rural purchased over a long-term,should approach the average areas. There will be a difference in price between the fortified desirablefortification level, and the experimentalproduct was and the nonfortified MSG. The initial subsidy will gradually be considered adequate for the field trial. The labelling on the withdrawn and the cost offortification ofthe MSG will passon packages was similar to the labelling on the regularMSG with to the consumer of all MSG produced,regardless ofpackage the exception of adding +A to the brand name (Aji-no-moto+A) size. The actualcosts of fortification, 13% of the cost ofthe and statingthe fortification level of 15,000 IU vitamin A. nonfortifiedproduct, will bespread over all consumers, thus increasingthe costsof the MSG and MSG-A by a marginal 7% The process conditions in the tn-provincesfield trial (mixing over a period ofseveral years. the dust-free vitamin A premix with MSG crystals) guaranteed the watertight heat seal ofthe plastic packages. This improves Project/program evaluation: The results ofthe field trials the stability ofthe vitamin A under normal marketing condi- in both the Philippinesand Indonesiashowed multiple benefits tions. Stability of the vitamin A in the fortified productshowed for preschool children:

Current Practices, Research,and Opportunities71 • Improvementin serum retinol levels, was 5,000 lU/pound of flour, which is a 150/0average of the NAS fortification level of4,333 lU/pound (= 1.3 retinol • Reductionin the low and deficientserum retinol levels, equivalents). No vitamin A is originally found in flour,with the • Reduction in the of prevalence xerophthalmia, exceptionof maize flour thatcontains someprovitamin A Improvementin growth, activity from carotenoids(Parrish et al. 1980). A • Increase in haemoglobinlevel, and The carrierfor vitamin was maizestarch, about 40°Io of the premix weight. Vitamin and mineral enrichmentmaterials were • Reduction in the mortality rate. premixedwith 5 pounds offlour by "fluidizing" (shaking)in a Not all the children in the field trial area consumed MSG,and closed plastic bagfilled with air. Flourswere mixed in 100 or of thosewho did, 200/0 did not receive the fortified brand. 200 pounds lots in a Wengerdouble-ribbon horizontal batch Mandatoryfortification ofall MSG marketed to poor, rural mixer. Equallydivided portions ofthe premix were distributed communitiesshould have an even greaterpositive impact on on the top of each 50 pounds of flour after it was spreadout in health,growth, and survival ofthe children. the mixer. Flour and premix were blepdedfor 1 5 minutes (Parrishet al. 1980). In the phase followingthe field trialsin Indonesia(1987— 1991),the marketing of fortified MSG will be expanded. The It is also possibleto add fortification materialsduring flour differentindustries that will have to cooperate in a nation-wide making in a productionmill. Parrish et al. (1980) used a fortification programwill thus become familiar with the Sterwinenrichment feeder and found no differences in vitamin productionand marketing ofMSG-A and adapt theirproduc- A contentcompared to the mixing method. tion procedures in time, before a national fortificationproject is Losses ofvitamin A during storage of flours (made ofwheat started. and durum) were up to 10°/o in 6 months at cooling and room The logical continuation ofthe program would be a full-scale temperature(i.e., 3°C and 21—32°C). Losses in maizeflour and — MSG fortification program aimed at the poor rural areas. meal were a little more over 20°/o. An averageof 1 5% of the Unfortunately,the safetyof MSG as a vehicle has beensubject proposedlevels might be more than needed under normal to debate. Furthermore, manufacturers were reluctantto conditions.Storage at 40°Cshowed losses of about 50°Ioin all introducethe technologybecause oftheir doubtsthat the flours. would a white process guarantee sufficiently product. This is confirmedby other workers,but the loss stabilizes Observations: The pioneeringwork done in the Philippines probably after3 months.Yellow maizecontains natural and in Indonesiahas demonstratedthat fortification ofMSG carotenoidswith provitamin A activity.Their loss during and marketing the fortified productthrough the normal storagetests was about twice that ofstabilized vitamin A channels can be an effective strategyfor controllingVAD. The (Parrish etal. 1978, 1980). MSG fortification projectin Indonesiais an example of a The bioactivity ofthe remainingvitamin A did not change successful food-fortificationprogram in progress, although it during storage(Lan-Ing Liu and Parrish 1989). No losses were has not yet been implementedon a nation-widescale. Issues reportedduring pneumaticconveying or simulatedshipping related to MSG as a carrierand associated health results, and handling (Parrish et al. 1980). however,remain to be solved. Most importantly from the the least in is industrialists'point ofview is that the projectis not dependent Wheat, preferred staple Bangladesh, generally on the good will of industry to cooperate, but it is designedto eaten bythe verypoor. Wheataid goes to the particularly at thosemostin become financially self-supportingafter the initial years of disadvantaged through programstargeted subsidy. for those countries in Asia where VAD is a public need. The mixingof syntheticvitamin A powder with wheat but as health problem,fortification ofMSG can be an adequate flourhas beenconsidered rejected inappropriate householdstend to milled strategythat could be implementedin a relativelyshort period because Bangladeshi buy locally whole wheat in the market. fortification ofwhole using the experiences of the Philippineand Indonesiatrials. grain Thus, wheat with vitamin Awas considered. A premix of concen- tratedvitamin A attachedto wheat grain was added to the OTHER VEHICLES regular grain in the proportions1:400. But the projectto demonstrate the technical feasibility offortification and its Cerealgrain products: nutritional impact was not approvedby the government(Nestel In the Food and Nutrition Board of the Abstract: 1974, 1993). National Research Council of the US a newfortifica- proposed Peanut butter: tion formula for cereal grain products (wheatflour, semolina (from durum), maizeflour, maizemeal). Vitamin A was added Abstract: As early as 1954,experiments were carried out in as retinol palmitate or dry retinyl palmitate.The added level the US to fortifypeanut butter with vitaminA palmitate.The

72 MicronutrientFortification of Foods peanut butterprepared containedhydrogenated peanut oil, nonuniform crystalsdestabilize vitamin A. Because salt is salt, and peroxide-free peanut oil. Syntheticvitamin A palmitate hygroscopic,it must contain a desiccant and/or must be was dissolvedin peanutoil in an amountcalculated to ensure packagedin a moisture-resistantcontainer to preventit from at least 71 USP unitsof vitamin A/g of peanutbutter. First- absorbing moisture (Nestel 1993). shelled were and grade, peanuts roasted, split-blanched, Yoghuit sorted. Through special feeders, the materials were deliveredto Plain and low-fat the grinder. Differences in temperatureof processing 140— Abstract: raspberry-flavoured yoghurt were fortified with various commercial forms of 180°F (60—82°C) were not found to have an appreciable effect samples vitamins A and C under actual conditions and on the contentof vitamin. The content of the vitaminA incorpo- production (Ilic Ashoor after rated in the peanut butterwas found to remain satisfactorily 1988) (see Fig. 7-6). Immediately processing, were at 3°C for 6 weeks and were high, although reduced, afterstorage of the product for 6 yoghurt samples kept A months at 80—100°F(27—38°C) (Willich et al. 1954). analyzed biweekly for pH, titratable acidity, and vitamins and C. Datarevealed that both vitamins decreased gradually in Salt: fortified yoghurt with vitamin C decreasing at a higher rate Abstract: Fortificationof salt with vitamin A has beentried than vitamin A. At a level of fortificationof 10,000 IU of under laboratoryconditions. The fortificant used was dry vitamin A, however,and 300 mg ofvitamin C per227 g vitaminA palmitateType 250-SD protected by a lipid. For a containerof plain or flavouredyoghurt providedat least 100% moisture contentlower than 2°Io, the protection ofvitamin A ofthe US RDA up to 6 weeks of storageat 3°C.This level of activity was satisfactory. Administrationof salt fortified with fortification did not significantly changepH, titratableacidity, or vitaminA in a concentration of 440 IU/g of salt over a 6-month sensory characteristics of yoghurt samples. After 6 weeks of period was found to be effective in improving vitamin A status storage,however, a light yellow taint was noted in plain among preschool-age children. Impurities in the salt and yoghurt samplesfortified with vitamin C or with vitamin A+C.

Fig. 7-6. Flow chart of yoghurt productionand points ofvitamin addition.

(1) Vitamins Milk Dry ingredients

Starterculture

Vitamins (3)

Flavours

(2) Vitamins

fruit concentrate

flavours

Source: O'Brienand Roberton, nd.

Current Practices, Research,and Opportunities73 The taint was absent in yoghurt fortified with vitaminA alone Bauemfeind, iC.; Arroyave, G. 1986. Control ofvitamin A deficiency by or in raspberry-flavoured yoghurt fortified with vitamin c, the nutrificationapproach. In Bauernfeind, J.D., ed., Nutnent vitamin A, or both. additionsto food. Academic Press, London, UK. Bauernfeind, iC.; Parman, G.K. 1964. Restoration ofnonfat dry milk Dependent on the method of manufacturingto fortifythe with vitaminsA & D. Food Technol (Nutrition), February, and addition there a product preferredstage of of vitamins, are 52—57. number of possibleroutes. Temperatures and times ofprocess- Bon Dente (BDN). 1993. Ultra Rice Newsletter 1(1). Bon Dente. ing varyfrom process to process. The two basicmethods of C.K.; Hillman, L.; Rothman, S.A.; D.; A. 1993. adding vitamin A toyoghurt are: Bradley, Leedy, Cordano, Evaluation oftwo milk-based formulas • iron-fortified, during Addition as a dry premix to the base ingredientat initial infancy. Pediatrics 9(5), 908—9 14. and mixing stage, Brooke, C.L.; Coil, W.M. 1972. VitaminA fortification of tea. Food • Technol, 58. Addition to the fruit conserve via the fruit supplier. 50, 52, Brune, M.; Rossander-Hultén, L.; Hallberg, L; Gleerup, A.; Sandberg, AS. 1992. Iron absorptionfrom bread in humans: effects of cereal fibre, and inositol REFERENCES Inhibiting phytate phosphates with different numbers ofphosphate groups. J Alexander, iC.; Cudjoe, A. 1989. Iron fortified hydroponically-grown Nutr, 122(3),442—449. barley-sproutflour. Can Inst Food Sci Technol J 22(2):124— 128. Callender, ST.; Marney, SR.; Wamer, G.T. 1970. Eggs and iron absorption. Bri Haern, 19, 657—665. Anantakrishnan, C.P.; Conochie, J. 1958. 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Stekel, A.; Olivares, M.; Pizarro, F.; Chadud, P.; Lopez, I.; Amar, M. Universityof Dhaka 1994. Fortification ofedible oilswith vitamin A: Loss 1986. Absorptionof fortification iron from milk formulas in during storage and heatingunder different conditions. (MSc. infants. Am J Clin Nutr,43, 917—922. dissertation).Institute ofNutrition and Food Science.

78 MicronutrientFortification of Foods Vaghefi, SB.; Ghassemi, H.; Kaighobadi, K. 1974.Availability of iron in Wilbur, S.E.;Kodyat, B.A. 1991. VitaminA fortification of MSG in an enrichment mixtureadded to bread. J Am Diet Assoc, Indonesia: An update. XIV IVACG meeting,Guayaquil, 64(3), 275—280. Ecuador.

Viteri, F.E.; Alvarez, E.; Bulux,J.; Gonzalez, H.; Pineda, 0.; Mejia, L.A.; Wilkinson,R.A.; Conochie, J. 1958. The stabilityof vitamin Ain Batres, R.; Town, B. 1981. Iron fortificationin developing reconstituted fortified non-fat milk solids. Part I. The effect of countries. In Nutrition in Healthand Disease and Interna- heat. Australian J Dairy Technol, Jan—March,29—31. tional Development: Symposia From the XII International Willich, R.K.; Morris, N.J.; O'Connor, R.T.; Freeman, A.F. 1954, Effects Congress of Nutrition,pp. 345—354. ofprocessing and storage onvitamin A incorporated into Walter, T.; Dallman,P.R.; Pizarro, F.;Velozo, L.; Pefla, G.; Bartholmey, peanutbutter. Food Techn, August 1954. SJ.; Hertrampf, E.; Olivares, M.; Leteliere, A.; Arredondo, M. Wang,NP.; LaCroix, D.E. 1979. Bioavailability of iron in cottage cheese 1993. Effectivenessof iron fortifiedinfant cereal in fortifiedwith ferric ammonium citrate. Abstr PapersAm prevention ofiron deficiency anemia. Pediatrics, 91(5), Chem Sac, 177(1),AGFD 85. 976—982. Woollard, D.C.; Edmiston, A.D. 1983. Stabilityof vitamins in fortified Wharton, B. 1992. Whichmilk fornormal infants? Europ J Clin Nutr, milk powders during a two-yearstorage period.New 46(suppl 1), S27—S32. Zealand J Dairy ScTechnol, 18, 21—26. Whittaker,P.; Ologunde,MO. 1990. Studyof iron bioavailabilityin a Woollard, D.C.; Fairweather, J.P. 1985. The storage stabilityof vitamin nativenigerian grain amaranth cereal foryoung children, A infortified ultra-hightemperature processed milk. using a rat model.Cereal Chem, 67(5), 505—508. MicronutrAnal, 1,13—21. Whittaker,P.; Vanderveen, i.E. 1989. Effect of EDTAon the Yong, S.H. 1979. Fortification technology. In Austin,i.E., ed., Global bioavailabilityof fortification iron used in Egyptian balady malnutritionand cereal fortification. Chapter 4, Ballinger bread. FASEB J, 3(3), A345. PublishingCompany, Cambridge, MA, USA. WHO (World Health Organization). 1974. Toxicological Zahar, M.; Smith, D.E.; Warthesen, J.J. 1992. Effect ofB-Carotene on evaluation ofcertain food additiveswith a reviewof general vitamin Alight stability in fortifiedmilk. Int Dairy J, 2, principleand specification. WHOtechnical report series 538. 363—371. WHO, Geneva, Switzerland. Zardo,H. 1994. Food fortification:An ever improvingquality 1976. Vitamin Aenrichment of donated foods (with special perspective. Presented atFood Based Approaches tothe reference todry skim milk powder). PAG-Bulletin, IV,4. Eliminationof HiddenHunger: An International Training WHO,Geneva, Switzerland. and InformationExchange Workshop, Papendal, The 1986. Regional strategyand plan ofaction forthe control of Netherlands, 12—24 June 1994. iodinedeficiency disorders (IDD) in the African region. Zhang, D.; Mahoney, A.W. 1991. Iron fortificationof process cheddar World Health Organization Regional Officefor Africa. cheese. J Dairy Sci, 74, 353—358. Brazaville, Congo. WHO, Geneva, Switzerland.

.__1995. Global prevalence ofvitamin A deficiency. WHO, MicronutrientDeficiency InformationSystem (MDIS) WorkingPaper Number2. WHO/UNICEF. Doc. WHO/NUT! 95.3. WHO,Geneva, Switzerland.

Current Practices, Research,and Opportunities79 80 MicronutrientFortification of Foods 8. OPPORTUNITIES FOR MULTIPLE FORTI FlCATION

DOUBLE FORTIFICATIONWITH IODINEAND IRON iodate with SNMP improves iodine retentionto 73°Ioafter 6 months. SALT If, however, magnesiumchloride is present, the samples discolour. Countries: India,Thailand, Canada. The Universityof Toronto has recentlydeveloped a stable Organizations and groupsinvolved: National Institute of formulation ofsalt (double fortified with iodineand iron) under Nutrition (India); Departmentof Radiology, Mahidol University, a study sponsoredby MI and the InternationalDevelopment MON (Thailand); Ml, and University ofToronto (Canada). Research Centre (IDRC) (L.L. Diosady, personalcommunication). Target group: The productcould be made availableuniver- A new techniqueof dextrin microencapsulation has helped sallyto large populationsor targetedat particular consumers create a barrier between the iron and iodine compounds or customers, and through special deliverychannels, e.g., for (ferrous fumarateand potassiumiodate) and retain them in pregnantwomen and young children. stableform under varying environmental conditions.In vitro Vehicles: From the of the of standpoint fortification, quality and in vivo studies on this formulation to test their absorption salt in developingcountries would broadly fall under the are under way and will be followed by a multicentricfield trial three following categories: to assess their impact on iodine and iron statusand consumer • Refined: The salt is already refinedand well packed to acceptability. matchthe for fortification. requirements Fortificationlevel: Rao (1990) proposed a mixture of • and Semirefined: The salt is partially refined but does not FeSO4 (3,200ppm), KI (40 ppm), polyphosphate(1 O/), which Fe and 20 Mannar al. meetspecifications for fortification. provides 1,000ppm ppm 12. et a mixture of ferrousfumarate • Unrefined: The salt is not refined. (1979) proposed (3,200 ppm) Fe and and KI (65 ppm),which pmvides1,000 ppm 50 ppm 12 Fortificants: Mannaret al. (1989) reportedthat ferrous Processand The hydromilling fumarateand potassiumiodide represent a workable combina- Technology: equipment tion without stabilizers. Salt fortified with ferrousfumarate and process (Fig 7-1) is commonlyused for refining the salt. This is a in which the salt is potassiumiodide is of a very light brownish colour and does essentially physical upgradingprocess and washedseveral times saturated brine. This not deteriorateovertime, provided it is kept sealed in water- ground using a that is in most proof packing.The formula proposedis ferrousfumarate 3,200 process produces product comparable respects to recrystallized salt and, to a customer, the difference between ppm (Iron content 1,000ppm); Potassium iodide 65 ppm the two varieties be (Iodinecontent 50 ppm). may indistinguishable. for ofsalt is: For NarasingaRao (1990) has proposeda formula using ferrous The processing required differentgrades unrefined— and and sulphate(1000 ppm Fe), potassiumiodide (20 ppm Iodine) and grinding washing, centrifuging a stabilizer (a chelatingpolyphosphate). He has reportedthat drying, fortification and packaging;for semirelined—centrifug- the bioavailabilityand stability ofthe double-fortifiedsalt under ing and drying, fortification and packaging;and for refined— differentconditions of storageand acceptabilitywere found to fortification and packaging. For a detaileddescription of each see 7 under Fortificationwith Iodine:' be good. The formula proposedby Rao is Ferrous Sulphate process Chapter "Single 3,200ppm; Potassium Iodide 40 ppm; Stabilizer(Sodium Status: A pilot fortification program in the northeastregion in 1 O/o) hexameta-phosphate Thailand was proposed in 1979, but its implementationhas The National Instituteof Nutrition (NIN) has recentlyreported not been reported. The fortified productwas availableon a (V. Reddy, Personal communication)that a dry mixing tech- large scale, but an effective distribution and educational system nique was found superiorto the spray mixing techniqueused was lacking. Moreover, universalfortification was not consid- earlierto mix the additiveswith the salt. ered a suitable approach dueto financialconstraints and possible iron overloadfor the healthypart of the population. Work done by Diosady and others at the Universityof Toronto has shown that the NIN formula + SHMP (unpublished) (FeSO4 National Institute of Nutrition (NIN) proposesto conduct + Kb3)works well in pure salt but shows heavy iodine losses multicentrictrials in six centres in India to test impact of its in the presence of magnesiumchloride impurity in the salt. It double fortified salt and its acceptabilityand bioavailability.The has beendetermined that encapsulationof the potassium study is expected to take 2—3 years.

Current Practices, Research,and Opportunities81 The stability testsat Universityof Toronto (supported by Ml! large-scale applicationof availabletechnology for the double IDRC) are complete. Efficacy trials will be completed by June fortification of saltwould representa majorbreakthrough for 1996.The main focus of thesetrials will be on biochemical the global alleviation of the problemsof iron and iodine impact and consumeracceptance. deficiency. Product: Rao (1990) reportedthat the bioavailabilityand FISH SAUCE stability ofthe double fortified salt under differentconditions of Country: Thailand. storage and acceptabilitywere found to be good. Mannar et al. Organizations andgroups involved: Mahidol University (1989) reportedthat ferrousfumarate does not impart any and Ministry of Health,Bangkok, Thailand. noticeable colour to the salt and does not deteriorate with time The Northeast ofThailand in salt. Owing.to the fine particlesize (200mesh), it can be Target group: Region probably one of the most affected areas with to iron addedin a dry form as a rich mix and still get evenly dispersed presents respect anemiabecause other the relative in the salt. Its toxicity is less than thatof ferrous sulphateand deficiency of, among factors, isolation of extreme and condi- the effect on stomach lining is also less than ferroussulphate villages, poverty, poorliving tions. Iodine is common in Thailand.Prevalence or ferrousgluconate. A test report on iron and iodine levelsin deficiency undertaken the Nutrition MO in 1992 the doublefortified saltestimated that 8 weeks afterprepara- surveys by Division, Fl, found ratesof 1a to from tion therewas no depletion. prevalence goitre (grade 3) ranging 1.42%to almost 40% ofthe population tested.Thirty-four of Qualityaspects: The purityof salt used for doublefortifica- the 39 provinces tested had fallen intothe WHO categoryof tion with iron and iodine is a critical factorto ensurethe severelyaffected by iodine deficiency. stability and bioavailabilityof the iron and iodine compounds. Vehicles: salt was the main the Presence ofmoisture in the salt hastens hydrolysis of the Although crystalline source, also ate salt in the form of ferroussalts and imparts a brown colour to the salt. This also people commonly "Nampla" (sauce extractfrom fish fermented in and to a lesserextent "Pla- accelerates iodine losses. The presence of a high level of brine) ra" (a condimentextracted from fish fermentedwith salt, magnesiumchloride in the salt increases its hygroscopicity roasted rice, or rice bran). (tendency to absorbmoisture) and aggravates the problem. Future The formulations Salt used for iron fortification will requirea minimum purityof requirements/developments: needfurther for under a of environmen- 99% (dry basis), a maximum moisture contentof 0.5°/a, and a testing stability variety tal conditions.This will needto befollowed tests maximum magnesiumlevel of 0.05°/a. The salt should be fine by absorption in animals and humansto establishthe ofthe grained and of uniform size (0.5—1 mm). efficacy product to control iodine and iron deficiency. Costeffedivenes On the basis ofprevailing pricesin India DOUBLE FORTIFICATIONWITH IRON AND (1990),the cost ofmachinery for a saltfortification unit VITAMINA producing 2 ton/hour has beenestimated at US$40,000— US$300,000 dependingon the extent ofprerefining facilities RICE required.The cost of processing fortified salt including the cost Countries: Brazil,Japan, Philippines,Puerto Rico, Thailand, of chemicals and packagingare estimatedat US$90/ton.Iron and the USA. Fortificationof rice is an accepted practicein fortification adds 50°/o—200% to the cost of salt and costs many countriesbut is legally enforced in only a few. US$0.30—US$0.65/head peryear. The currentprice of ferrous Organizations andgroups involved: FDA, FNB-NRC, fumarateand potassiumiodide is US$8/kg and US$20/kg, USDA, USAID, PHS (USA); FNRCC, FNRI; MOHW (Japan); respectively. Hoffman-La Roche; Merck Co.; Wright EnrichmentCo.; RCL; Observations For the mutual coexistence of iron and iodine Takeda Chemical IndustriesLtd, Ajinimoto Company ofJapan. in doublefortified salt, it was to lookfor suitable necessary Vehicles: Rice is the staple diet of roughly one-thirdto one- stabilizers.Iron is stable in an acidicmedium, whereas the half of the world's population.Out ofthe two edible whole iodine salt is alkaline.When mixed, oxidation ofthe iodide/ grain forms,brown and white, there has been a worldwide iodateto free iodine takes The free iodine and place. vaporizes trend to eat whiterice in preference to the more nutritious is lost. stable and neutral salts of iron had to be Alternatively, brown. White rice is primarily a carbohydratesource, the bran identifiedthat are with KI or in a slightly compatible Kl03 layer has been removed during milling. White rice is mostly alkaline medium. associated with the widespreadoccurrence of beriberi, caused Future requirements/developments: The formulations bythiamin-deficiency. The loss ofother vitamins and minerals, needfurther testing for stability under a variety of environmen- however,also has detrimental effects on human health. tal conditions.This will needto be followedby absorptiontests Undermilling,parboiling, acid-parboiling,conversion, and in rats and humans to establish the efficacyof the productto malekizing can prevent (some) nutrient loss, but such rice is controliodine and iron deficiency. The successful testing and less accepted. Enrichmentis a logical step.

82 MicronutrientFortification of Foods Fortificants: Rice is usuallyfortified with more than one Powderenrichment To the rice a preblended powder nutrient. In the early days, only B-vitaminsand iron were mixture is addedat a rate of 1:3,000—6,000.This type of rice added. Later on, other nutrients like vitamin A were built in. should not bewashed before cookingas most of the fortificants will be lost. Also,cooking in excess waterwill removemost of Virtually all iron salts are strongly colouredor darken rapidly the fortificants. Powderenrichment is most effective when by oxidation and hydration (particularunder tropicalcondi- appliedsoon after millingand sifting. Because ofthe heat and tions). Ferric sulphategives the rice an off-white to yellow moistureat the surface, the adheres to the colour,which is undesirableto somecustomers. Reduced iron grain powder grain well atthis point. has the potentialto turn rice grey to black. Because of its white colour,ferric orthophosphateor ferric pyrophosphateis most The method of mixing nutrients at the timeof cookinghas the suitable for addition to rice but their bioavailability is arguable. sameprinciple. A mixture of nutrients (powdered or in tablets) When theseferric salts are oxidizedor contain excessive should be dissolvedin the cookingwater. The water must be moisture,they can turn tan, yellow, purple, and/orblack. Their absorbed totallyby the rice. This method is onlysuitable for stability, however, is much betterthan ferroussulphate. mass cooking. Fortification with vitamin A is usuallydone with retinyl palmitate Grain enrichment This type of enrichmentis known as 250-SD, a stabilizedvitamin A. Murphy et al. (1992) used ini- premix and is the most common way to fortifyrice. It consists tially pure retinol palmitate as vitamin Asource, but its stability ofgrains ofrice that have beentreated with vitamins and was not satisfactory. Retinyl palmitate was a better alternative. mineralsthat will not rinse off the rice when washed.Usually, the are concentrated and must be blendedwith Fortification level: Inthe US, manystates followedthe federal grains highly white rice, mostly at a rate of 1:200. Several methods regulations of 1990whereby each kg of enriched rice should ordinary have been over the last 50 The most contain4.4—8.8 mg thiamin,2.6—5.3 mg riboflavin,35—70 mg developed years. simple method of enrichment isto a concentrated niacinor niacinamide, 29—57 mg iron, 1,100—2,200 mg calcium, grain apply powder blend to milled rice and then coat the rice with a water- and 550—2,200USP units ofvitamin D. Calcium andvitamin D insoluble, materialthat cannotbe rinsed off. are optional, ifadded, the levels must agree with the federal food-grade ofcolour riboflavinis oftennot regulations. Because problems, The first patented method in the US (19405), was the Hoffman- added.There is no standard forbrown rice. LaRoche method For this, a premix (a sulphuricacid solution ofthiamin and is onto the In Thailand,23,700 IU vitamin A/kgand 80 mg iron/kg are hydrochloride nicotinamide) sprayed surfaceof whiterice containedin a horizontal recommended in rice. Some rice fortification programsalso use tumbling rotating drum or trumbol. Riceis assisted hot air. A amino acidsor proteinsfor fortification. dried, by protective coating (an ethanol or isopropanolsolution ofzein, fatty acid Table 8-1 shows fortification levelsof vitamin A and iron in rice (palmiticor stearicacid), and abieticacid) is applied, immedi- in several studies to illustratethe used levels. ately followed by an applicationof talc and ferric orthophos- Technology:process and equipment: Two types of phate powder.After drying, the latter process is repeated until — enrichmentare currently available powder enrichmentand the requirediron level is reached. The finished productis grainenrichment. sieved,packaged, and distributed for blending. Addition to

Table 8-1. Levels of iron and vitamin A in unfortified and blendedfortified rice.

White rice 6.6—8.8 Furteretal. (1946) White rice 5 Hunnel! eta!. (1985) Brown rice 15—18 Furter eta!. (1946) Brown rice 11 Hunne!! et a!. (1985)

— Coated (Hoffman-l.a Roche) 28 Furter et a!. (1946) Coated basedon Hoffman-La Roche 55 13,200 Coil eta!. (1976) Coated based on Wright 88 16,000 Coil eta!. (1976) Coated (RCL-method) 20 — Bramall (1986) — Coated 9,250 Rubin eta!. (1977) Coated 6 2,400 Peil eta!. (1981) — Infused (Japanese Shingen) 11 Hunne!! eta!. (1985) — Artificial rice grains 12,500 Murphy eta!. (1992) Artificialrice grains 20 4,075 Gershoff etal. (1977)

Current Practices, Research, and Opportunities 83 plainwhite rice occurs at the rate of 1:200 (Furter et at. 1946). An even more stablepremix was claimedby Peil et at. (1981). This method has improvedduring the yearsbut it is still a Theyfound a coatingthat is moreresistant against cooking/n basicmethod used today for rice fortification. excess waterthan othersand soluble at 37°C. The best they found was made by 1.2°/a (w/w) methylceltuloseA 15, 3.6% The Merck Co. method, patented in 1955, is the other main hydroxypropylmethylcellulose F50, 28.5°/a ethanol (95°/a), basicmethod used. The samesort of rice premix concentrate is and 66.7°/owater. This polymer solution is sprayedon rice and manufactured with an acetone/watersuspension of thiamin dried in six layers: hydrochloride,nicotinamide, an iron salt, and ethyl cellulose. When this coatingdries, several coats of an alcoholic shellac 1. 0.8 mg thiamin and 6.66 mg niacin/g polymersolution, solution containinga whitening agent are appliedto yield a 2. 7.3 mg riboflavin/g polymer solution, glossy whitegrain. Again blending has to be doneat a rate of 1:200with untreatedwhite rice. 3. Reduced iron powder was sprayedalternately with polymersolution in a rate of 37 mg/g polymersolution, The Wright EnrichmentCo. methodproduces a fortified rice premix usinga process based on a combinationof the 4. A layer of unfortified polymer solution to separate, Hoffman-La Roche and the Merck Co. process. 5. VitaminA (250-SD)was sprayedalternately with polymer In 1981,a new, simpler method was developed by solution in a rate of 455 IU/g polymer solution, and Limitedas an answerto the less- Ricegrowers'Co-operative 6. Alayer ofunfortified polymersolution to seal the coating. accepted Hoffman-La Roche rice premix (RCL-method). A A differentbasic method of the of enrichment surfaceadhesive techniquehas to be used and discoloration totally grain type is the of artifidalrice. are made here to has to be preventedby using ferric orthophosphate.An acid manufacturing Attempts manufacture enriched artificial rice rice that was usedto dissolve iron, thiamin, and niacin.This solution (simulated kernels) is mixed with milled rice. The cookedrice does not react with the iron salt and, therefore, preventsthe regularly containing the artificial rice often had a poor By now, it is colourchange. It generates a thin, sticky sugar layer by appearance. possibleto make acceptable grains of a dough offortificants reaction with the surfacestarch of the rice particles. The ferric and a binder of starch rice or an orthophosphate is bound to the rice in the sugar coating.After (e.g., flour) proteins, using extrusion of 100—200°C are used. Also, applying the solution to the rice (in trumbot), it is dried and the process. Temperatures a is often addedto losses premix is ready for blending (Bramall 1986). coating prevent through washing. Usually,heat-labile vitamins as vitamin A and thiamin are In for thiamin/riboflavin enriched Japan, many yearsmostly sprayedon the artificial rice because ofthe high temperature rice was eaten.Since multinutrient enriched rice has 1981, during the extrusion process. beenmarketed in Japan.It is called Shingen,which means Status and resultsof fieldtrials: Most of the rice sold in "brown rice in the new age:' The rice is manufactured using the US is enriched, fortified rice is normally availablein Japan infusion bya combinationof acid-parboilingbefore coating. and Puerto Rico. Polished rice, therefore, is soaked in a 10/0acetic acid solution containingwater soluble vitamins (thiamin, riboflavin, niacin, Field trials in the Bataan province of the Philippines,which pantothenic,acid and pyridoxine).The soakedrice is then provided fortified rice accordingto Furteret at. (1946), reported steamed, dried, and coated with vitaminE, calcium, and iron 76—94%decrease in the incidence of beriberiwithin a few separately in different layers. Finally, a protective coating years (Salcedo et at. 1950). Also, someJapanese studies material is applied to preventlosses through washing. The reported positive effects ofrice fortification programs.Increased coatingmelts at 70°C, but is insoluble in cold water (In Japan, thiamine blood levelsand numbersof red blood cellswith the usual cooking method is with total waterabsorption.) It is subjects fed with multinutrientfortified rice were observed. differentfrom the coatingof Furteret at. (1946). The premix is Misaki and Yasumatsu (n.d.) and Gershoffet at. (1977) could E packedunder CO2 (to preventvitamin destruction) and ready not find an improvementof general health during a 4-year for blending in a rate of 1:200 (Hunellet at. 1985; Misaki and feeding program in Thailand with rice fortified with vitamin A, Yasumatsu n.d.). iron, thiamin, and amino acids. The investigatorswere unable to explain the results obtained. Liuzzo et at. (1992) claim to have a more stablepremix with their cross-linked grains. The rice is incubatedwith an aqueous Qualityaspects: A fortified rice premix should look like rice, vitamin (thiamin, riboflavin, niacin,and pyridoxine)-sotutionat cook like rice, taste tike rice, and maintain its nutrient qualities pH 2.3—2.5 for 30 minutes,then acetaldehyde (the cross- through rinsing and cooking. If the premix grains look differ- linkingagent) is addedand incubationat 60°C for 45 minutes ent, they will be picked out by the consumers. That is why follows. After washing with tap water and neutralizingwith riboflavin is often not added, it forms brightyellow spots in the ascorbicacid, the grains were air-driedto a moisturecontent of cookedrice. It is possibleto hide the colour in grains fortified 10—14%. with riboflavin, but it stilt forms the yellow colour during

84 MicronutrientFortification of Foods cooking, which is not acceptable to many consumers. In Japan, In a humidatmosphere, however, artificial rice usually clumps the yellow colour ofthe rice premix has beenaccepted sincethe togetherwhen stored. Combinationsof more saturatedoils, 19505. Talc is also usedto obtain the right,white colour. tocopherol, and ascorbate are recommended for adequate of vitamin A in the artificial rice Consumerhabits have a significantinfluence on the availability preservation grains,particu- in environments. there was no of the nutrients in the meal. For example,whether the rice is larly tropical Unfortunately, correlationbetween and retention. rinsed before cookingand whether it is cookedwith a meas- storage stability cooking uredamount of water, which is completelyabsorbed, or with Retentionafter washing: Ordinarywhite rice lose about excess water, which is drainedoff and thrown away. 60% of its iron (and vitamins) through washing because what the In the US, the standard requires that the label on enriched rice is left after millingis usually close to surface (Furter et al. includesthe statement:"To retain vitamins, do not rinse before 1946). Ifpowder enrichmentis used,20—100°/o ofthe enrichmentwill wash offthe rice. or drain after cooking The statement is not required if >85°Io of minimum levelsremain a the after cookingby prescribed Because most consumers insist on washing rice before method. In South is common to cook rice in Asia, it practice cooking, it is important that any method of enrichmentof white excess water. The Food and Nutrition Institute Philippine (FNRI) rice protectthe added nutrients againstwashing. Today, a loss ofvitamin A of 1 0—20°/o as judged washing unaccept- coatingmethods seemto be adequate, although Murphy et al. able. is the minimum. Fifty-percent cooking stability (1992) found washing losses of 10—20% with vitamin A Costand cost effectiveness: Powderenrichment is less fortified rice enrichedby Wright Enrichment, Inc. Rubin et al. expensive than other forms. Coatingis slightlymore expensive. (1977), however,found washing losses ofonly 1.10/o of Accordingto Yong(1979) pricesfor total enrichedrice (includ- vitamin A and none of iron with fortified rice based on the ing amino acids) would be US$0078, 0.080, and 0.073per Hoffman-La Roche method.Artificial rice used by Murphy et al. kg fortified rice for a surface coatingmethod, an infusion (1992) showed no loss of vitamin A through washing. The method, and artificial rice, respectively. One reasonto develop cross-linked method (Liuzzo et al. 1992) claims to have less the RCL-method wasthat the Hoffman-La Roche production loss during rinsing, cooking, or processing, but they did not tooktoo muchtime. Because ofthe simplicity ofthis method it fortifywith iron or vitamin A. is much cheaper. Retention aftercooking: Cooking losses canbe verylittle if Observations: rice is cooked in a suitable amountof water that can be absorbed Coil etal. madefortified rice based on the Hoffman- Storage stability: The mineralsand vitamins in powder- totally. (1976) La Roche method and on the enrichedrice are less stableand they can easily reactwith Wrightmethod, adding thiamin, niacin, vitamin vitamin A,folic acid, iron, other food compounds.The most-usedrice fortification pyridoxine, E, calcium, zinc, and talc. losses in both methods were 1% methods seems to be adequate for storage. The RCL premix Cooking only ofvitamin Arice that was cooked was de- (containingthiamin, niacin,ferric orthophosphate) showedno Stability strongly even on That with the significantcolour changeand no loss ofnutritional quality after creased, coolingtemperatures. agrees results of etal. who a detrimental effect 12 months under tropicalstorage conditions. It was developed Murphy (1992) reported on vitamin A undermore humid conditions. The because the Hoffman-La Roche rice was found to be easily stability storage artificial rice of etal. showed vitaminA distinguishedfrom plain white rice, and it rapidly darkenedin grains Murphy (1992) retention of affected the ofseveral colour under tropicalstorage conditions. cooking 55—96°/o, by presence antioxidants andoils. Cooking in excess waterresulted in 81% An has to be made for vitaminA. Stabilizationis the exception loss ofvitamin Aof the fortifiedrice based on the Hoffman-La main problem with the fortification process (Hoffpauer 1992). Rochemethod (Rubin etal, 1977). Peil et al. (1981) improved the Coil etal. (1976) made fortified rice based on the Hoffman-La coating, andthey managed to lose only 30°/o vitamin A. Roche methodand on the Wright method. The Hoffman-La Roche methodshowed storage losses of 1 2°/o vitamin A, Bioavailability: As described in Chapter 7 (Single Fortification whereas the Wright methodonly showed 1% loss. Rubin et al. of Iron in Wheatflour and Bread),the presence ofascorbic acid (1977) found a 13%loss ofvitamin A and no loss of iron has an enhancing effect on iron absorption, not only in bread but of rice based on Hoffman-La Roche. during storage premix also if iron is eaten with rice. The presence ofrice itself in the diet Vitamin A in artificial rice grains accordingto Gershoffet al. inhibitsiron absorption, as most vehicles do. Additionof ascorbic (1975) had lost 50°/oof its activity during and processing acid to fortifiedrice may be an improvement to beconsidered. If storage. the ascorbic acid is oxidized during longor excessiveheating of Murphy et al. (1992) found a vitamin A half-life of238—408 the food,this effect is reduced.This might occur during rice days in artificial grains (at T=25°C, a=0.1 1). Storagestability cooking (Sayers etal. 1974; Guiroet al. 1991). Incorporation of was affected by the presence of several antioxidants and oils. If glucose in the ricediet seems tohave an inhibiting effect on iron no ascorbate is present, an increased humidityis detrimental. absorption. Incorporation of starch or lactose seems tohave the

Current Practices,Research, and Opportunities85 leastinhibiting effect,whereas sucrose or fructose were in 18—48 yearsof age in one lowland community.Iron stores in between (Snehalata andReddy 1985). the controlcommunity remainedunchanged exceptfor a rise in SUGAR adult males. It is highlyimprobable that this is caused by a possibleeffect of vitamin A fortification of sugar,which has An approachto controliron deficiency and vitamin Adeficiency beenconsumed in this and all other communitiesfor several where dietary availability of the two micronutrientsis low is to years. fortifya vehicle consumedby all the deficientpopulations. This has been tested in a double-blindfield study in four highlands Qualityaspects: The doubly fortified sugar was very stable and lowlands, semirural, low-incomecommunities in Guate- except for a slowprogression of brownish discolorationin mala (Viteri et al. 1995). extreme conditions that was noticeable after 6 months of under the most severe environmentalconditions. No Countries: Guatemala. storage settling of NaFeEDTAor vitamin Ato the bottom of the sacks Organizations andgroups !nvolvet INCAP, University storedunder natural storageconditions in tropical, humid of California, Berkeley;PAHO/WHO; Kellogg's Latin America; environments was noted.Acceptability and organoleptic USAID. propertiesof commonlyused food recipes were completely satisfactory. A qualitative test to detect iron in sugar was also Vehicles: Sugarhas alreadybeen shown to be an adequate introducedto reinforce the of unfortified for the vehiclefor vitamin A fortification in Guatemala, and it does not exchange sugar fortified one when the formerwas filtered intothe impair iron absorption (Layrisse etal. 1976). occasionally fortified communities. Fortificants: In this field research, sugar was doubly fortified Cost: Cost—benefit of fortified with iron and with retinyl palmitate and FeNaEDTA. analysis sugar vitamin A provedto be extremelyfavourable. Fortificationlevel: One gram FeNaEDTA/kg sugar,provid- Observations: A of and of ing 130 mg Fe/kgsugar and 15 mg vitamin A/kgsugar. systematic monitoring compliance in nutritional status should be established. This Twelve sugar sampleswere obtained sequentiallyat the changes should includeserum ferritin determinationsin well-defined packagingsite, coveringthe productionperiod of each offive of adult malesto term risk of iron sugar batches produced for the study. samples preventany long- overload, although,currently, this is a veryremote possibility. Technology:Process: FeNaEDTAwas addedby a sugar BLENDED/FORMULATED FOODS factoryin the lowlands of Guatemala to the vitamin A-fortified sugar alreadybeing producedby the factory. This addition, as Blended/formulatedfoods are made byblending several describedby Viteri etal. (1995), was achieved by manually componentingredients to producea food that is nutritionally delivering, in a sweepingmotion, the yellow powder to the last improved compared to any of the individual components.The centrifugationof refinedsugar while it still had about 2% formula usually contains a staple cereal (like wheat, rice, corn, humidity. The amount was addedto the sugar load that each groundnut,sorghum) and a high-qualityprotein source such a centrifugedelivered. The sugar discharged byeach centrifuge soybean,milk powder,whey, and the like. fell into a conveyingscrew thatcarried and mixed the sugar to Many differentvarieties have been developed around the its final drying and further mixing stagebefore packaging.This world. Examples of infantfoods fromEthiopia, Nigeria, India, process did not alter the normal flow of sugar production. and Tanzania are described in Table 8-2. There are many more Status and resultsof fieldtrials: Iron stores in the examples,however, ofdouble-fortified infant foods in many fortified communitiesincreased significantlyexcept for women other countries.The ingredientsmay be milled or undergo

Table 8-2. Nutritional value per 100 gproduct.

Energy 1,400 KJ 1,700KJ 1,600 Ki 1,700KJ 1,500KJ Protein 21,Og 15.Og 42.Og 20.Og 18.Og Protein-energy-°/a 25.0°/a 1 4.8°/a 44.00/0 20.0°/a 20.0°/a Fat-energy-°/a 6.00/a 27.0°/a 20.0°/a 1 4.0°/o 19.0°/o

Iron 15.0mg VitaminA 3,000 IU 3,000 IU 1,430 IU

a = Dependingon added vitamin/mineralmix. Source: CaritasNeerlandica (1983).

86 MicronutrientFortification of Foods somesort of further processing (heating,parboiling, rolling, Qualityaspects: Soy-Ogi is kept for 3—6 months in extruding, etc.). Nutritional value is enhanced byfortification of polyethylenebags, packed in cartonboxes, or kept 9—i2 blendedfoods with mineralsand vitamins and, to increase months in tins. The keeping quality of groundnutsused for their acceptability, sugar is usually added to the formula. These Balaharis a major problem because ofaflatoxin contamination. foodsmay be cookedand servedas a meal or made into a For the other products,the keeping quality is not mentioned drink and theycan be usedto supplementanother less and generally is not a primary concern. nutritious cassava and Ranum food, e.g., (Barreft 1985). Marketing/distributionchannels: Countries: (Faffa), India (Balahar, multi Ethiopia purpose Faffa was originally distributedthrough retail trade in the Tanzania food),Nigeria (Soy-Ogi), (Lisha). 1960s—70s.Then, for a fewyears, it was mainly used for Organizations andgroups involved: ENI (Ethiopia), emergency relief. In the 1980s, commercial salesincreased CFTRI (India),FIIRO (Nigeria),TFNC (Tanzania), WFP. again. Production now is taken over by a governmentcom- pany. Target group: Infants and pregnantand lactatingwomen. Balahar:Almost all production is distributed throughsupple- Vehicles: Infant foods consistof a cereal (wheat,maize), a mentaryeding programs. In 1976, a production of 40,000tons high-quality protein compound(soybean, chickpea,DSM), and was mentioned. Commerdal marketingnever succeeded. afat component(groundnut, soybean). MPFwas used almost solely in supplementaryfeeding Fortificants: VitaminA and iron (see Table 8-3). programs. Product promotionwas neglected and the product Process: The in Faffa are Technology: chickpeas precooked has never reached retail shops. before millingto increase digestibility. Soy-Ogi:Distribution is donethrough the governmentand Maizeand soybeansare selected and washed.Maize Soy-Ogi: retail shops. The productionin 1980 was 17 tons. is soaked overnightand wet-milled into a slurry. Soybeans are Lisha: marketed. heated, dehulled,cooked (10 minutes),and wet-milled into a Commercially slurry. The maize, soybeans, and mineralsare mixed and Costand cost effectiveness: pasteurized. Itis spray dried and the powder is mixed with a Faffa: The cost was US$0.90/kg (1982). Sold at a subsidized vitamin/mineral premix. price ofUS$0.50/kg. Lisha: A mixture of maizeand soybeans is made into a thick Balahar: Little is known about the actualprice. A cost price of pasteby a low-cost extrusioncooker, the pulp is dried and US$0.40/kg was mentionedin 1965. milled. The powder is mixed with milkpowder and the vitamin! mineral premix. MPF:Actual prices are not known. A cost price ofUS$0.33— 0.72,depending on packagingmaterial, was mentionedin Status: Full production. 1972. Product: The compositionof the various infantfoods are Productioncost was US$1 and wholesale shown in Table 8-3. Vitamins and mineralsare addedfor Soy-Ogi: .70/kg price was US$2.18 (1982). fortification and sugar for flavouring. Local ingredientsare used (see also Chapter 7). Lisha: Retail price was US$1.96/kg (1980).

Table8-3. Composition of some infantfoods.

Faffa Balahar MPF SoyOgl Lisha

Wheatflour 570/s 65°/o — — — Soyaflour 18% — — 30°/a — Groundnutflour — 25°/a — — — — — Chickpeas 100/a 100/a 25°/o Maizeflour — — — 70°/o — — — — — Maize grits 65°/a Hulled Soybean — — — — 28°/o DSM 5°/o — — — 5°/a Sugar 8°/o — — — — Salt 1°/a — — — — Vitamin A + iron 1 °/o <1°/a <1°/a <10/ 1 a/ Detailedpeanut — — 75°/o — —

Source: CantasNeerlandica (1983).

Current Practices, Research,and Opportunities87 Projectiprogram evaluation: meal and flour, 46—57mg/kg for grits, and none for whole corn which does not have an enrichmentstandard Faffa was marketed in 1967for the first time. In 1969,the meal, (Ranum and Loewe 1978). compositionwas changedas a result ofmarket plus acceptability studies.It is betteraccepted by womenwith higher educa- Maize does containvitamin A activity that is presentnaturally, tion and families with a steady income.Market studies (1982) whereasother cereals do not. The recommended level of showedthat 75% ofthe userswere from low-incomegroups. fortification with vitaminA in maizemeal and related products in the US is 22,000—26,000 lU/kg, but this is not a federal Balaharwas developed to replaceCSM. No market or accep- standard. In most studies,the added amount of vitamin A is tability studies preceded the introduction.A large proportion of lower (11,000—16,000lU/kg, dueto olderrecommendations the target group (preschool children) was not reached. (Cortet al. 1976;Rubin et al. 1977; Yong 1979;Parrish et al. MPFhad been tested in 300 institutionson acceptability and use 1980a). before production startedin 1960. MPFhas never reached retail Technology:Process and equipment: When the maize is shops, andthe use in supplementary feedingprograms has milled and consumed withoutrinsing or discardingthe cooking decreased because of imported free donations ofother foods. water, it can be fortified in the same ways as wheat. Soy-Ogimarket surveysshowed good acceptance and a high Forwet-milled maize, there is no needto sift the product into demand for Soy-Ogi. particlesizes. It can be fortified simplyby adding a fortification Lisha productdevelopment was preceded by a seriesof mixture by hand or with a feeder. Powdered premix, therefore, surveys on traditional weaning food practices and recipes. is sufficient and there is no needfor palletization of the premix. Initial mixturesof maize with beans, fish, or meatwere tested The more humid conditions,however, might affect the stability but the productswere too expensive. Soybean proved to bethe ofvitamin A, which is particularlyunstable in such circum- bestaccepted legumethat has beentried. stances. Maize more fortification than wet milled MAIZE grits present problems maize-dough because they are often rinsed before cooking. Countries: Some Africancountries, Canada, Chile,Guate- Technologies like those for fortifying milled rice may be mala, South Africa,the US. suitable (Yong 1979). and involved: Organizations groups FDA, NAS/NRC, For tortillas, maize is cooked in water with limestoneand and USDA/CSRS, USDA/ARS, IAEA, SAAEB, SASA, WT, UNU, washedto remove the outer hull before grinding. The iron Hoffman-La Roche Inc. — contentof the dough is affected by the grinding process the in Vehicles: Maizegrits, fine and coursemaize, degerminated grindingstones used the villages of Guatemala increase the and soyahave beenused for fortification. iron content in dough comparedto dough made by hand or by motorized mills. Other circumstances did not affectthe iron Fortificants: Maize meal and commercial grits are fairly level (Krause et al. 1993). similar to wheat flour in moisture contentand are normally Status and results trials: In the most ofthe sufficientlyshelf stable. Multiple fortification is oftenperformed offield US, in a similar fashionto fortification ofwheat flourand bread. For maizemeals and commercial grits are enriched, usually with reduced iron. Because vitaminA is not included in federal the enrichmentof maize meals and grits, however, elemental fortificationof corn with vitamin A is not iron powder is the preferred iron sourcebecause soluble regulations, products commonin commercial In is often added reactiveiron salts such as ferroussulphate are prone to products. studies, it fortification studies. rancidity. as an extensionof bread Observations: Even stabilized ferroussulphate, the so called bio-iron, causes rancidity soonerthan elementaliron. The latterdoes not cause Bioavailability:The bioavailability of iron in maizeproducts functional problemsof separation, colour,or rancidity. Ferric is not totallysimilar to thatin breadbecause processinghas a phosphateor ferric sodium pyrophosphate could also be used great influence on availability.Absorption of nonhaeme iron is withoutfunctional problems,but their bioavailabilityis less still low; Derhamet al. (1977) report 3.8% absorptionof than that of reduced iron (Anderson 1985). Just like wheat ferroussulphate from maize-meal porridge. MorOnet al. flour, fortification with vitamin A is usually performedwith (1989) studied extruded maize—soybean fortified with iron, retinyl palmitate,a stabilizedform of vitamin A. vitamin A and others.Iron absorption (ferrous fumarate) varied between2.4°/a and 6.8°/a. Fortificationlevel: The original iron levels in maizeare 24 mg/kgwhole meal unbolted,18 mg/kgbolted meal, 11 mg/kg Inhibiting/enhancement: Derhamet al. (1977) reported degerminatedmeal, and 10 mg/kgmaize grits. The FDA the inhibitory effect oftannin in tea, mentionedearlier in standardsfor enrichment are 28—57 mg iron/kgfor maize Chapter 7 (Single Fortificationwith Iron in WheatFlour and

88 MicronutrientFortification of Foods Bread). A strong enhancing effectof ascorbic acid is seen in Organizations andgroups involved: Institute of Nutrition maizemeal porridgeby Derham et al. (1977) and Sayers et al. and Food Hygiene, Academyof Preventive Medicine, (China); (1 973). The processing temperatures were low enoughto MRC Dunn Nutrition Centre, Dept ofTrade and Industry,United preventoxidation of the ascorbic acid (as is seen in bread), to Biscuits, and APV Baker (UK). avoid depressingits enhancingeffect. Target group: Weanlingchildren. Stability of vitamin A in milled maize (meal and Storage: Vehicle: Rusk made from wheat flour,sugar, and vegetable at room is not as as in wheat flour. grits) temperature good oil. tosses were up to 200/o in 6 months, but the moisture content Vitamin A and iron as ferric ammonium citrate. was an important factor, A 6.5°/o moisturecontent showed Fortificants: The lafter to be muchmore and hardly any loss, whereas 11.40/0 in maize grits lost one-fifth of proved palatable acceptable than iron salts. vitamin A. Also at higherstorage temperatures, vitamin A cheaper — losses increase up to 40°/o loss in 3 months at 45°C. These Technology: The micronutrientcomponents were prepared valuesdo not really differfrom results found in wheat flour. A as a premix, before being used for rusk manufacturing. 150/0average vitamin A in milled corn will provide for storage Status and resultsof fieldtrials: During the field trial, losses atwarehouse conditions (Cort et al. 1976;Rubin et al. palatability and compliance appeared to be good. Despitethe 1977; Parrish et al. 1 980a). plant acids in the flour, the ruskwas shown to be an effective Iron addedas reduced iron was found to be stableat both and, thus, an availablesource of iron. The iron addedto the temperatures in all milled maize. When stabilizedferrous rusk is likelyto be bioavailable. sulphateis used, deteriorationoccurred. If iron levelsincreased Fortificationlevel: See Table 8-4. (from 88 to 440 mg/kg) off-flavoursshowed upwith all iron sources. In soya-fortifiedmaize, stabilized ferroussulphate was Product: Therusk is a biscuit productthat has low residual and is in warm found to be an acceptable iron sourcefor fortification.Segrega- moisture rapidly soluble liquids. tion of iron sources in milled maizewas not noted et (Anderson Qualityaspects: Theadvantage of the ruskweaning food is al. 1976; Rubin et al. 1977; Anderson 1985). the long shelf life. or Processingretention: Processingthe maize meal grits Costand cost effectiveness: The costof productionwas losses ofvitamin A— the the causes longer cooking tempera- 1.4 renminbi (yuan)/1 00 g, which seems to be reasonable. On ture the greaterthe loss. tosses upto 30°/owith 30 minutes the assumptionthat one ruskwould be eaten everyday, a cooking were reported. Making maizebread causes the usual typical rural familywould spend 4°/o of its incomeon the rusk. processing loss, but storagestability is lithe lessthan in wheat Observations: The rusk (one per child per day) was eaten flour bread(Rubin et al. 1977; Parrishet al. 1 980b). either dry or taken in liquidform, after dispersionin water. WEANING RUSK Some evidence of interaction between iron and vitamin E was Countries: China. shown. It was stated that other antioxidantmicronutrients, like

Table8-4. Nutrient contentof fortified rusk.

Protein 60.0 mg lOg 2—4 g Fat 80.0 mg 1.4g Sugar 310.0mg 5.3g Energy 9.2 KJ 156.OKJ Vitamin A 13.2 pg 224.0 pg 200.0 pg Iron 0.29 mg 5.0mg 10.0mg Calcium 17.6mg 300.0 mg 600.0 mg Zinc 180.0 pg 3.0mg 5.0mg Cholecalciferol 0.22 pg 4.Opg 10.0 pg Thiamine 0.009pg 0.15 pg 10.0 pg Riboflavin 12.0 pg 200.0 pg 400.0 pg Niacin 147.0pg 2.5 mg 4.0mg Cyanocobalamin 0.018pg 0.3pg Folic acid 1.47 pg 25.0 pg

aperkg body weight.

Current Practices, Research,and Opportunities89 vitamin C and carotenoids, could not be includedbecause of Fortificants: Vitamin A was added as retinol palmitate or dry their instability during baking.The compositionof the premix retinyl palmitate.For total fortification of the flour, iron (as could be varied to make it suitablefor differentregions. ferroussulphate and electrolyticallyreduced iron) and other vitamins and mineralswere also added. Future requirements/developments: The optimum compositionof the supplementmay requirefurther study. Fortificationlevel: In 1974, the Food and Nutrition Boardof Inclusion of vitamin E as a protectivesubstance and heat-stable the NationalResearch Council/USA proposeda new fortifica- antioxidant needs to be considered. tion for cereal grain products. The addedvitamin A level was OTHER VEHICLES, e.g., MONOSODIUM GLUTAMATE 5,000 lU/pound flour, which is 150/0coverage of the NAS (MSG) fortification level of4333 lU/pound (= 1.3 retinol equivalents). Countries: Philippines. Technology:Process and equipment: The carrier for the vitamin-iron was maize about 400/0 of the Organizations andgroups involved: Ministry of Health, premix starch, Vitamin and mineral enrichmentmaterials were Philippines;Hoffman-La Roche, USA. premix weight. premixedwith 5 pounds of flour by "fluidizing" (shaking)in a Target group:See Chapter7 "Milk and MilkpowdeC closed plasticbag filled with air. Flours were mixed in 100-or Fortificants: The preferred sourceof iron to be added to MSG 200-pound lots in a Wengerdouble-ribbon horizontal batch should have good bioavailability,have a blandtaste, and be mixer. Equallydivided portions of the premix were distributed nearly whitein colour. It should be low in cost and available on the top ofeach 50 pounds offlour after it was spread out in commercially. the mixer. Flour and premix were blendedfor 1 5 minutes (Parrish et al. 1980). Micronized ferric orthophosphate(produced by Joseph Turner Co.) and zinc stearate-coated ferroussulphate (produced by It is also possibleto add fortification materialsduring flour Durkee'sIndustrial Foods Group) have beenadded to MSG making in a productionmill. Parrish et al. (1980) used a alongwith stabilizedvitamin A palmitatetype 250-SD. Sterwin enrichment feederand found no differences in vitamin Durkees-coated ferrous sulphateis a light-coloured,tasteless, A contentcompared to the mixing method. relatively nonreactive, free-flowing powder varying in particle Status and resultsof field trials:Laboratory scale. size (100—200mesh). The coating protects the ferrous sulphateup to a temperatureof 122°C, the melting point of the Stabilityof vitamin A: Losses ofvitamin A during storage encapsulatingmaterial. For characteristics offerric orthophos- offlours (made of wheat and durum) were up to 10%in 6 phate,see Chapter 7. months at cooling and room temperature(i.e., 3°C and 21— 32°C). Losses in maizeflour and meal were a little more: over Fortificationlevel: Sachets comprising2.4 g fortified MSG 20°/a. An average of 15% of the proposedlevels might be contained15,000 IU vitamin A and 50 mg iron. morethan needed under normal conditions.Storage at 40°C Technology:Process and equipment:See Chapter 7, showed losses ofabout 50°/oin all flours. This is confirmedby "Milk and Milkpowder' other workers; the loss stabilizesprobably after 3 months, Status and resultsof field trials:Laboratory. Yellow maizecontains natural carotenoidswith provitamin A activity. Their loss during storagetests was about twice that of Qualityaspects: Products were found to have favourable stabilized vitamin A (Parrish et al. 1978, 1980). The bioactivity colour,taste, bioavailability, and particlesize characteristics, of the remainingvitamin A did not changeduring storage(Liu Storage trialsindicated that the iron did not influence vitamin A and Parrish 1979). No losses were reportedduring pneumatic activity. conveyingor simulatedshipping and handling (Parrish et al. Future requirements/developments: Large-scale 1980). productiontrials and field testing needto be carried out. INFANTFOODS/FORMULAS MULTIPLE FORTIFICATIONWITH IODINE,IRON, AND title: New to low-cost food VITAMINA Project approach weaning production. CEREAL BASED FLOUR In 1986,the Royal Tropical Institute(KIT) presentedthe Countries:USA. blueprint for a "new approachto low-costweaning food Organizations andgroups involved: CSRS (Parrishet al. production" (KIT 1987). This approach was developed in a on food carried 1978); FNB-NRC. research project low-costweaning production out in cooperation with the CHNO in Benin (Altesand Merx Ta All Americansociety. rgetgroup: 1985). In this approach,emphasis is given to the self-sustain- Vehicles:Wheat flour, semolina(from durum), maizeflour, ingcharacter and the gradualexpansion possibilities of maizemeal. planned activities.Since its introduction,22 productionunits

90 MicronutrientFortification of Foods have beenimplemented in 13 projects in 12 different countries ingredients.See also chapters 7 and this chapterunder "Infant in Africa,Asia, and Latin America. Theseprojects have shown Foods/Formulas:' that a low-investment,labour-intensive project for manufactur- Fortificants: Although addition ofmicronutrients in most ing weaning foods on a semi-industrialscale fromindigenous cases was not considered, there are no technological con- raw materials can be successful (Dijkhuizen 1992). straintsfor multiple fortification ofthese weaning foods. Countries, organizations, andparties involved: Processand equipment: Cereals and pulses Projects were carried out underthe auspicesof the Netherlands Technology: are cleaned by meansof a mechanical winnower and/or by government(Benin, Burundi, Mozambique, Niger), EC (Sierra hand. If needed, the cereals are washedwith clean water and Leone), CaritasNeerlandica (Dominican Republic, Ghana, dried, Pulses like a Jamaica), NOVIB (Ghana), and WFP (Bangladesh, Kenya, soybeanmay undergo special soaking/ treatmentto inactivate the and Malawi, Nepal). Also see Table 8-5. steaming antitrypsineenzyme preventflatulence. Groundnuts are selected manuallyand may Infantsand pregnantand lactatingwomen. Target group: undergo a specialtreatment (dipping in boiling, saltedwater Vehicles: The infantfood is generallycomposed of 80% and drying) to removethe mould infested groundnutsthat cereals (wheat,rice, maize, sorghum), 1 0% pulses (soybean, discolourafter this treatment. The roasting is done in either a cowpea,mungbean), and 100/0oilseeds (groundnut,sesame scorcher, electricoven, or rotating drum. After cooling,the seed). Vitamins and minerals can be addedfor fortification and ingredientsare mixed, milled in a hammermill,and packed. sugar for flavouring. Local ingredientsare used.The result is a See Figure 8.1 for a flow chart ofthe KT approach in infant nutritionally improvedformula comparedto any of the single food manufacturing.

Table8-5. Countries and partiesinvolved in infantfood production.

Africa Benin Farine Bbé 1/100 KIT/DGIS 1979— Burundi Musalac 6/800 KIT!DGIS 1985 — Ghana Vitalmix 1/100 KIT/NOVIB 1987— Nutrimix 1/25—75 KIT/Caritas 1987—

— Kenya U-mix 2/1,000 KIT/WFP 1992 Malawi Likundi Phala 4/600—800 KIT/WIP 1991 — Mozambique Farina Lactea 1/500—1,000 KIT/DGIS 1993— Niger Bitamin 1/30—100 KIT/DGIS 1990— Sierra eone Bennimix 1/250—250 KIT/EC 1989— Asia

Bangladesh Unknown 1/250 KIT/WfP 1994— Nepal Unknown 1/250 KIT/WFP 1993— Latin America Dom.Republic Prosur 1/30—1 00 KIT/Caritas 1990— Jamaica Unknown 1/500—1000 KIT/Caritas 1993—

Note: KIT = Royal Tropical Institute,DGIS = DutchDirectorate General International,NOVIB = Netherlands Organizationfor International Development Cooperation, WPF= World Food Programme,EC = European Community.

Fig. 8-1. Flow chart "KIT approach"infant food manufacturing.

Current Practices,Research, and Opportunities91 Status and resultsof fieldtrials: Full production.Good children in Mexico.A similar chocolate powder mix fortified acceptabilityof the products. with iron, vitamin A, and iodine has also beenproduced for addition to milk and is currentlyunder evaluation in the Product: The productis used as a porridge. Boiling with Philippines. water for about 15 minutes is necessary to get a smooth porridge. On adding cold water, lumps will beformed sinceit is Fortificants: Iron, iodine, and vitamin A as well as other not an instant product. micronutrienfs.

Qualityaspects: The producthas a nutritional composition Fortificationlevel: When 25 g oforange-flavoured powder of400 Kcal/1 00 fat. g, 13°/a protein, and 7°/a The product is addedto 200 ml ofwater, it providesmicronutrients at the is excellent. quality following levels, vitamin A at 35°/a of RDA, iodine at 35°/aof iron at 35°/a of and vitamin C at 100°/aof RDA. The Tests have shown that the product is microbiologicallysafe. RDA, RDA, exactamounts ofthese micronutrients can be Dependingon the type of packagingmaterial and storage readily adapted conditionsthe shelflife of the flouris 2 weeks to morethan 4 tomeet the recommendations of local experts. months (in and aluminium laminatefoil, polyethylene respec- Technology:Process and equipment: Ready-made tively). premixesare producedby private companies for use by Marketing/distributionchannels: The infantfoods are beverage manufacturers. Technologies for productionof such either distributed byfeeding program or by sale on the open premixesare usually not disclosed. market. In is done women vendors Burundi, e.g., marketing by Status and resultsof field trials: Currentlyin process of who earn commissions and are to nutrition obliged provide beingfield-tested in Tanzania. education. Product: The powder is near whiteand rapidly dissolvesin Cost and cost effectiveness: An average 100-ton project water. The drink is orangecoloured and is palatable.It is made has an annual turnover of US$60,000with a invest- required for addition to water because milk is not widely used by rural mentof US$ The rate ofreturn is 10—20°Io. The 60,000. price children in Tanzania. is half or less the price of importedweaning foods. Qualityaspects: The productcan be storedfor up to a year Project/program evaluation: Overthe pastfew years, the withoutsignificant deterioration. low-costweaning food projects have proven their economic value. The Musalacproject was awardedthe WHO annual prize Observations: It is suggested thatthis productbe offered as in 1989 for the most innovativeprimary health care project. a new approach to reducingmicronutrient deficiencies in conjunction,but not in place, of other currentstrategies. Observations: The advantageof this productcompared to the importedinstant productsis not only price but also the nec- Future requirements/developments: Research into essityto cookthe flour to make it consumable. Oftenthe pro- factors that determinesuccess and reporting on successes in jects are attached to a hospital or health centre. The Musalac fortification programsimplemented. projectis supportedby the Netherlandsgovernment to operate FORTIFICATION OF FOODAID as a training centre for low-costfood production in Africa. The inadequacy of both quantity and quality ofthe food PROCESSEDBEVERAGES distributed to refugee populations has beenwidely docu- Countries: Mexico and are new (Tanzania Philippines testing mented.A typical refugeeration is composed of only a few and the US. products) commoditiessuch as cereals, sugar, and oil, If refugees are Producer: Various companies in the USA. Procter and unableto supplementtheir rations,they are proneto a variety GambleCo., Cincinnati,Ohio, USA has beeninvolved in proof nutrient deficiencies. fortified for Mexico,the and ducing beverages Philippines, Prolonged refugeefeeding situations are speciallyprone to Tanzania. micronutrientdeficiency problems.The developmentof Target group: Different parts ofTanzania where several xerophthalmia,iron deficiency anemia,scurvy, and pellagra micronutrientdeficiencies coexist,for the use of children, among refugees in camps have beenreported (Toole 1994). women, and the wholefamily. In somespecific cases, deficiencydiseases have been control- Vehicles:A fine orange-flavoured powder near whitein colour led, at leastintermittently, by supplying appropriatefoodstuffs. that can be made into a fortified drink under field-testingin Yet, to help preventand alleviatesuch deficiencies from Tanzania. occurring, fortification offood aid has been suggested.

The Company has alreadyproduced an iron-fortified,chocolate- Accordingto the recommendations ofthe International Confer- flavouredmixture for addition to milk for use by iron-deficient ence on Nutrition (World Declaration and Plan ofAction for

92 MicronutrientFortification of Foods Nutrition 1992), donor countriesand involved organizations available. The choice between fortifying vegetableoil or must ensure that the nutrientcontent of emergencyfood aid for blended foods with vitaminA would, therefore, depend on the refugeesand displacedpersons should "meet the nutritional particularneeds of recipientcountries. requirements, if necessarythrough fortification or ultimately When foodstuffs are provided in nonemergencyfood aid (Para. 40m, Also, through supplementation" p. 30.). "govern- programs,e.g., food- for-work or supplementaryfeeding in collaboration with the international ments, community, programs,they should be fortified with micronutrients that are should sustainable assistance to to provide giving high priority known to be deficient in the populationin question. In Guate- the ofmalnutrition, and the outbreak of micronutri- prevention mala, a biscuit made from the commodities providedby the ent diseases" (Para. 37a, 26). Such fortification deficiency p. WFP is distributedto 1.3 million primaryschool students every should include vitamins and and other iodine; iron; A, B, C; day. Usingtechnology developed by the Institute of Nutrition in micronutrientsdepending on the local situations and risk of Central America and Panama (INCAP), thebiscuit isfortified various deficiencies. with vitamin A, some B vitamins, iron, and iodine.In Malawi, a Potential vehicles for micronutrient addition are cereals,oil, food fortification plant, has been establishedto produce pulses, salt, and, occasionally, sugar. Henry (1995) has fortified maize meal for both refugee and domesticpopulations. identified the following opportunitiesfor micronutrient addi- The WFP reports distribution of iodizedsalt, vitaminA-fortified tions to refugee foods: skim milk, and vitamin-and mineral-fortified cereal-legume Vehicle Fortificant blends in somecountries with populationsat risk of these deficiencies. Cereals B vitamins, iron, calcium, and zinc Food aid will be requiredon an increasingscale duringthe Oil Vitamin A 1990s both as emergency nutritionintervention and when Sugar Iron and vitaminA indigenousfood supplies are limited.There is a definiteneed for a new blended food, producedspecifically for relief The of fortification of bulk food aid commodi- possibility using programs and nutrition rehabilitation centres. In many refugee ties to the of rations is improve quality refugee being explored feeding situations,blended foods are included in the rationfor by some donors. For instance, Canada and the US provide their micronutrient content. Both WFP and UNHCRhave taken of edible oil as food aid for significantquantities many actionto includeblended foods in thegeneral refugee ration countries. These can be fortified with vitaminA supplies readily (WFP/UNHCR1994). at sourcein the countriesof origin. Fortification ofprocessed Thereare several of blendedfoods available, most of cereals with vitaminA should be given priority, particularly if types whichhave been as a to the available sufficient quantities ofblended foods are not available. Iron and designed supplement local diet to target the childrenand pregnant womenas B-complex vitaminscan be added to cereal flour. Whole grains young well as refugeesand displacedpeople. The composition of should be provided to displacedpeople or refugeesunder someexisting/proposed blended foodshas been summarized emergency situations, only ifcentralized milling is available Beaton (1995). The Milk Board, UK, has and in-country fortification is feasible. In such cases, uniform by Marketing recently an instant blended food that has been tested for mixingof premixes with milled commodities should be produced (IBF) in ensured. acceptability by six NGO5 operating nutrition programs Rohingya,Bangladesh, with reported successful results.This Where distribution and can be more consumption closely productrequires no cookingand has good storage and cereals are the most feasible vehicles monitored, for food handling properties.IBF is fortified with vitaminA, iron, and fortification. In other edible oils are alterna- situations, good iodinealong with someother micronutrients. The question is tives. For in the instance, Integrated Child Development whether a universalblend can be designed for use in different Services in India, fortification of (ICDS) feeding program feeding programs or whether different blendswill be necessary oils with vitaminA has been found be more cost vegetable to for specific applications. effective thanfortification of a corn-soyblend (CSB) (Atwood et Recently, the CanadianInternational al. 1994). Shipmentlosses were reportedto be 35% for CSB, Development Agency commissioneda to for a but only 15°/afor oil. Also, addition ofvitamin A to oil costs (CIDA) study developspecifications micronutrient premixto be addedin circumstances where less than fortifying flourwith vitaminA (OMNI 1994).This is blended foods are intendedfor general distribution.The final because vitaminA is fat-soluble and is readily dispersed in oil of the has identified three and the cost ofconverting it to powder for addition to flour is report study (Beaton, August 1995) saved. distinct optionsto fortificationof the general diet of refugees çrable 8-6): In other situationsas in Ecuador, however, oil is not consumed • Centralized fortification ofthe with blended foods at maternal and childhealth centresand, staple cereals, therefore, vitaminA-fortified blended foods should bemade • Community level fortification of cereals, and

Current Practices, Research,and Opportunities93 Tab'e 8-6. Some possiblefortification points: Advantagesand disadvantages.

Nationalor regionalmilling Likely to be most efficientand effective Presents increased handling and shipping costs. and fortification The shortened shelf life of milled cereal more likely to be a problem. Milling and/or fortification of milled Very likely tobe effective. Used soon Increased difficulty of qualitycontrol cereal at communitylevel enoughthat shelf life notproblematic manyfacilities. Need equipment and training. (BEFOREDISTRIBUTION)

Grindingand fortification at Less likelyto be effective (but likely tobe Requires substantialeducation component. household level better than present blendedfoods). Recognizes Effectiveness depends upon conscious action (AFTERDISTRIBUTION OF the reality ofthe existingsystem. by individuals. WHOLE GRAINCEREAL)

Table 8-7. Interim specificationfor a cereal fortification premix for refugees in Africa (applicable to maize-,wheat-, and sorghum-basedrations).

Nutrient In 1900kcal ration Suggested source Proportionactive (°/o) Amount per kgpremix

VEt A 960 ug° Encapsulated 75°/a 0.750g retinyl Palmitate VEt D 10 ug Commercial food 0.25°/a 2.343 g grade source VitC 110 mg° Coated ascorbic acid 97.5°/a 66.08 g Vit B12 1.5 vga Commercial food 1°/a 0.088g grade source — Folate 0.3mg 100°/a O.176g Riboflavin 0.84 mg — 100°/a 0.492 g Niacin 6.5 mg Nicotinamide form 100°/a 3.807 g — Pantothenate 1.7mg 100°/a 0.996g

Calcium 570 mg Calcium carbonate 40°/a 843.6 g lodineb Iron 8mg NaFeEDTA 13°/a 36g Selenium 15 ug — 100°/a 0.0087 g Zinc 18 mg Zincsulphate 23°/a 45.94 g

Note:This premix is basedon estimated normativenutrient requirements. Itwould be usedat arate of 4.22kg! MTof maize. aindudesprovision for a 25°/aloss during storage(added level is 33°!o over target). blodinenot included on basisof assurance that WFP distributes iodized salt; if uncertain,add potassiumiodate.

Household-level fortification using a multiple-fortified Anderson, R.H.; Vojnovich, C.; Bookwalter, G,N. 1976. Iron enrichment of corn Cereal 937—946. premix. dry-milled products. Chem, 53(6), Atwood,Si., et al. 1994. Draftreport. Stability of fortified vegetable oil All three approaches mentionedin the foregoing would make and corn-soya blend used in child feedingprograms in use ofthe samefortification but the ofdilution premix, degree India.WA, USA. II.SINITAL and dispensationwould differ in each case.The report contains Barrett, F.;Ranum, P. 1985. Wheatand blendedcereal foods. In interim specificationfor a cereal fortification premix for refugees Clydesdale, F.M.; Wiemer,K.L., ed.,Iron fortificationof foods. in Africa (Table 8-7). Academic Press, NewYork, NY, USA. Chapter6, pp. 75—109.

REFERENCES Bauemfeind, iC. 1991. Foods considered for nutrientadditions: Altes,F.W.K.; Menç R. 1985. Productionde farinepour bébes a petite Condiments. In Bauernfeind, iC.; Lachance, PA., ed., Nutrient and echelie (Small-scale production ofweaning food). Final report. additions tofood, Nutritional,technological regulatory Food &Nutrition Press, mc, Trumbull,Cr, USA, Royal Tropical Institute (KIT), Amsterdam. aspects. pp. 347—366. Anderson, R.H. 1985. Breakfast cereals and drymilled corn products. In Clydesdale, F.M.; Wiemer, K.L., ed., Ironfortification of Bauemfeind, iC.; Timreck,A. 1980. Monosodiumglutamate: Afood food. Academic Press, Inc., NewYork, NY, USA. carrierfor vitamin A and iron. PhilippJ Sd, 107,203—213.

94 MicronutrientFortification of Foods Beaton, G.H. 1995. Fortification offoods for refugee feeding.Report to Mannar,M.G.V. 1991. Doublefortification of salt with iron and iodine. theCanadian International Development Agency (CIDA), Status reviewand blueprintfor action. UNICEF, NewYork, CIDA, Hull, QC, Canada. Final report,August 1995. NY,USA.

Bramall,L.D. 1986. A novelprocess forthe fortification of rice. Food Mannar,M.G.V.; Jayapal, S.; Pandav, C.S. 1989. Doublefortification of Technol Austr, 38(7), 281—284. salt with iron and iodine. In Kim WhaYoung; Lee 'ng Cha; Lee Ki Yull; Jin Soou; Kimj Sook, ed., Proceedings ofthe Caritas, Neerlandica. 1983. Ready-made weaning food mixtures in 14th International Congress of Nutrition,20—2 5 August developingcountries. Caritas Neerlandica, Royal Tropical 1989, Seoul, Korea. pp. 1,035—1,037 Institute (KIT), Amsterdam. Misaki, M.; 'sumatsu,K., n.d. Rice enrichment and fortification. In Cort, W.M.; Borenstein, B.; Harley, J.H.; Osadca, M.; Schemer, J. 1976. Juliano, B.O., ed., Chemistry and technology. The American Nutrientstability offortified cereal products. Food Technol, Association ofCereal Chemists, Inc., St. Paul, MN, USA. 30(4), 52—62. MorOn, C.; Kremenchuzky, S.; Passamai, MI.; Cintioni, A.; Derman,D.; Sayers, M.;Lynch, SR.; Charlton, R.W.; Bothwell,T.H.; Gerschcovich, C.; Mendiondo, I. 1986. Bioavailability of Mayet,F. 1977 Iron absorption from a cereal based meal iron ina dietbased on fortifiedextruded maize-soybean in containingcane sugarfortified with ascorbic acid. Br J Nutr, women. Nutr Rep Int, 39(6), 1,195—1,204. 38, 261—269. Murphy, PA.; Smith, B.; Hauck, C.;O'Connor, K. 1992. Stabilization of Dijkhuizen,P. 1992. Low costweaning food production. Successof an vitamin A in asynthetic rice premix.J Food Sc, 57(2), 437— economically feasibleproject. KIT Newsletter, 3, 3. 439. Furter, M.F.; Lauter, W.M.; De Ritter, E.; Rubin, S.H. 1946. Enrichment Narasinga Rao, B.S. 1990. Doublefortification ofsalt with iron and of rice. Ind 486—492. Eng Chem, 38(5), iodineto control anaemia and goitre.National Institute of Gershoff, SN.; McGandy, R.B.; Suttapreyasri, D.; Nondasuta, A.; Nutrition,Hyderabad, India. P. 1975.Amino acid Pisolyabutra, U.; Tantiwongse, 1994. Fortification of salt with iron and iodineto control anemia fortificationof rice studiesin Thailand. I. Background and and goitre:Development ofa new formula with good stability baselinedata. Am J Clin Nutr,28, 170—182. and bioavailabilityof iron and iodine. Food Nutr.Bull. 15(1), Gershoff, SN.; Mccandy,R.B.; Suttapreyasri, D.; Promkutkao, C.; 32—39. Nondasuta, A.; U.; P.; Pisolyabutra, Tantiwongse, OMNI (Opportunities for MicronutrientInterventions). 1994. V. 1977Nutrition studiesin Thailand. II. Viravaidhaya, Micronutreintfortification and enrichment ofP.L.480 Title II Effectsof fortification of rice with threoninethiamin, lysine, commodities: Recommendations for improvement. OMNI, riboflavin,vitamin A, and iron onpreschool children. Am J Technical reviewpaper, November 1994. OMNI/USAID. Clin Nutr, 30, 1,185—1,195. Parrish, D.B.; Eustace,W.D.; Ponte, J.G. 1978.Stability of vitamin A in S. 1991. Guiro, AT.; Galan, P.; Cherouvrier, F.;Sail, MG.; Hercberg, flours containingthe NAS proposed fortificationmixture. Iron from African millet and absorption pearl rice meals. Fed Proc FedAm SocExp Biol, 37(3), 708. Nutr Res, 11,885—893. Parrish,D.B.; Eustace,W.D.; Ponte, J.G.; Herod, L. 1 980a. Distribution C.J.K. 1995. food rationsfor casefor food Henry, Improving refugees: a ofvitamin A infortified flours and effect ofprocessing, fortification. 34—37. Postgraduate Doctor, (17)2, simulated shipping,and storage. Cereal Chem, 57(4), 284— 287 Hoffpauer, D.W. 1992. Rice enrichment fortoday. Cereal Foods World, 757—759. 37(10), Parrish, D.B.; Herod, L.; Ponte Jr. J.G.; Seib, P.A.; Tsen, C.C.; Adams, K.A. 1 980b. vitamin Ain foods Hunnell,J.W.; Yasumalsu, K.; Moritaka, S. 1985. Iron enrichment of Recovery of processed madefrom fortified flours. Food rice. In Clydesdale, F.M.; Werner, K.L., ed., Iron fortification i Sc, 45, 1,438—1,439. foods. Academic New of Press, Inc., York, NY, USA. Peil,A.; Barrett, F.; Rha,C.; Langer, R. 1981. Retention ofmicronutrients used to rice. J Food 260— Krause, V.M.; Kuhnlein, H.V.; LOpez-Palados,C.Y.; Tucker, K.L.; Ruz, M.; by polymercoatings fortify Sc, 47, 262. Solomons, N.W. 1993. Preparation effects on tortilla mineral content inGuatemala. Arch Latinoamericanos Nutr, Ranum, P. 1991. Cereal enrichment. In Lorenz, K.J.; Kulp, K., ed., 43(1), 73—77 Handbookof cereal science and technology. Dekker, New NY, USA. Layrisse, M.,et al. 1976. Sugar as a vehicle foriron fortification. York, AmJ Clin 8—18. Nutr, 29, Ranum, P.; KuIp, K.; Barrett, F. 1983, Cereal fortificationprograms. Dev in Food Sc, SB, 1,055—1,063. Liu, D.S.; Bates, C.J.;Yin, T.A.;Wang, X.B.; Lu, C.Q., 1993. Nutritional efficacy ofa fortifiedweaning rusk ina rural area near Ranum, P.M.; Loewe, R.J. 1978. Iron enrichment of cereals. The Bakers Am J Beijing. Clin Nutr, 57, 506—511. Digest, June, 14—20.

Liu, LI.; Parrish,D.B. 1979. Biopotency ofvitamin Ain fortified flour Royal Tropical Institute(KIT). 1987A new approach tosmall-scale after acceleratedstorage. JAgr Food Chem, 27(5), 1,134— weaningfood production from indigenous rawmaterials in 1,136. tropical countries. KIT, Amsterdam.

Liuzzo, iA.; Joseph, E.W.; Rao, R.M. 1992. A new way tovitamin- Rubin,S.H.; Emodi, A.; Scialpi, L. 1977 Micronutrientadditions to enriched rice. Louisiana Agric 35(5), 5—6. cereal grain products. Cereal Chem, 54, 895—904.

Current Practices, Research,and Opportunities95 Salcedo, Jr J.; Bamba, M.D.; Carrasco,EU.; Chan, G.S.; Concepcion, I.; Suwanik,R.; The Study Group. 1979. Iron and iodinefortification in Jose, F.R.; DeLeon, J.F.; Oliveros, S.B., Pascual, CR., Thailand.J Med Assoc Thailand,62(Suppl 1), 1—48. Santiago, L.C.; Valenzuela, R.C. 1950. Artificial enrichment of Toole, MJ. 1994. Preventing micronutrient deficiency diseases. Paper white rice as a solutionto endemic beriberi. J Nutr, 42, presented atthe workshopon the "Improvementof the 501—523. nutrition ofregugees and displaced people in Africa:' Sayers, M.H.;Lynch, S.R.; Charlton, R.W.; Bothwell, T.H. 1974.Iron Machakos, Kenya, December, 1994. absorption from rice meals cooked with fortifiedsalt Viteri, F.E., et al. 1995. Fortification of sugar with iron sodium containingferrous sulphate andascorbic acid. Br J Nutr, 31, ethylenediaminotetraacetate (FeNaEDTA) improves iron status 367—375. in semiruralGuatemalan populations.Ami Clin Nutr, 61(1), Sayers, M.H.;Lynch, SR.; Jacobs, P.; Charlton, R.W.; Bothwell, T.H.; 153—163. Walker, R.B.; Mayet,F. 1973. Theeffects ofascorbic acid WFP/UNi-ICR cworldFood Programme). 1994. Memorandum of supplementation on the absorption ofiron in maize, wheat understandingon the jointworking arrangements for and soya.BrJ Haematol, 24, 209—218. refugee, returneeand internallydisplaced persons feeding Snehalatha Reddy, N.; Reddy, P.R. 1985. Effect of different carbohy- operations. WFP/UNHCR, January, 1994, drateson the bioavailabilityof iron from rice. Nutr lnt, Rep World Declaration and Plan of Actionfor Nutrition. 1992. International 31(5), 1,117—1,120. conference on nutrition. Rome, Italy, December 1992. Suwanik,R., etal. 1 980a. Simultaneous fortification ofcommon salt Yong,S.H. 1979.Fortification technology. In Austin, J.E., ed., Global with iron and iodine inThailand. J Med Assoc Thailand,63, malnutritionand cereal fortification. 53. BallingerPublishing Company, Cambridge, MA, USA. Suwanik,R., etal. 1 980b. Iron deficiency anaemiaand endemicgoitre: Selective fortificationfor their eliminationfrom the Thai population.J Med Assoc Thailand,63(11), 611—616.

96 MicronutrientFortification of Foods 9. IMPLEMENTATION ISSUES AND RESEARCH NEEDS

IMPLEMENTATION ISSUES and applicationof fortification technologiesstill exists. With a few notable exceptions,national programsfor micronu- In certaincases, the technology still needs to be refined trientfortification of food have not as yet beenimplemented in and/or tested for productstability, absorption, and can be on a developingcountries or have not beenvery successful. There consumeracceptability before it applied scale. Micronutrientutilization from the fortified are a number ofconstraints that jeopardize the success of a large fortification program.Identification of such constraints is an foodsalso needs to be carefullyevaluated. Oftenthe urgent priority: technologythat is alreadydeveloped is not available to countriesthat need it most. • Inadequate awareness among both governmentand In the choice of vehicles industry ofthe extent and severityof micronutrient many countries, appropriate deficiencies and, hence, lackof commitmentfor their that are widely and consistentlyconsumed by the elimination; populationsat risk is limited, Local dietary habits should be taken into account. The identificationof such • Need for, and role of, food fortification is not clearly foods, including condimentsand snackfoods and their defined; consumptionpatterns, is an urgent priority. Fortified • Barriersto technologytransfer; foodsthat have provento be viable in a controlled environmentshould be considered in countrieswhere • Limitedchoice of suitablevehicles; consumptionlevels of the food vehicleare known. • Nonexistentor ineffective monitoring and evaluation • From a nutritional and economic pointof view, the systems; search for suitable micronutrientmultimixes, incorpo- • Price differences between fortified and unfortified foods. rated in suitablefood vehicles, should be supported.To This often leadsto lack of demandfor fortified products; reduce the cost offortification, fortificant productionat a national or be • Legislationmandating food fortification to add a regional level should explored. of where in measure compulsion not enacted or, place, RESEARCHNEEDS inadequatelyenforced; Research needsspecific to each of the three micronutrientsare • Lackof logo or seal ofapproval; and discussed below. • Weakcoordination and linkage between the health and Iodine: In the case of iodine, problemsyet to be resolved industry sectors. relate mainly to the stability of the addedcompound under issues to be considered Key are: differentstorage and cooking conditions.The stability of iodine • Although considerable progress has beenmade in compoundsin salt can be significantly improvedby better and for fortifica- initiating and streamlining control programsin several refining procedures packaging. Applications countries,logistic problemsand bottlenecksdo remain. tion offish sauce, soyasauces, pickledpreserves, salted The challengeis to identify and tackle theseconstraints preserves, fish curing,meat curing etc., with iodizedsalt systematicallyat the regional and country level through should be investigated. effective advocacy, coordination,and monitoring. Field research is needed to solvethe problem of low retention Research is needed into factors that determinesuccess. of iodine, e.g., losses of iodine during handling, transport,and The successes of fortificationprograms in execution storage, including in-house iodine losses. Anotherfield that needto be reported, e.g., reporting on successful salt could be investigatedis the use ofiodine (or iodizedsalt) in iodization, vitamin-fortifiedsugar, or iron-fortified cereal oral rehydrationsalts. could providevaluable lessonsto be used in planning Iron: Cereals are the major staple foods consumed by many strategiesfor the other micronutrientfortification of the poorerpopulations of the world. Iron in cereal-based programs.Similary, reasons for program failuresshould vegetariandiets is poorly absorbed and, in consequence, be identifiedand carefully evaluated. nutritional iron deficiencyis prevalent. Many constraints need • Research and developmentefforts have enhanced to be overcome for fortification ofsuch diets with iron because effectiveness offortification technology. In spite ofthese the potential vehicles are not centrally processed and the iron developmentefforts, a large gap betweenknowledge compoundsreact with several food ingredients.

Current Practices, Research,and Opportunities97 • The buff-coloured,insoluble iron phosphatecompounds are Standards for quality assurance and monitoring for: stableunder a variety ofstorage conditions but are poorly simple semiquantitiveassay systemand sampling and absorbed. Addition of ascorbic acid has proven to be a suitable date analysis procedures. way to improve iron bioavailability.The soluble iron salts like • Selection and specificationof simple mixing/feeding ferroussulphate arewell absorbed but could easily produce equipment(large and small scale). discolourationthrough reactingwith other food ingredients. Stabilizers have beenadded alongwith the iron compoundto • Developtechnology to improvevit A/iodine stability and retain it in an absorbable form, and the structureof certainiron interaction with iron (e.g., antioxidant). compoundshas beenmodified to improveabsorption. • Development of a computermodel to project Research should be focusedon the identificationof a form of bioavailability ofdifferent iron sources. iron thatis adequatelyabsorbed and yet does not alter the appearance or taste ofthe food vehicleselected. The and rapid RECOMMENDATIONS simple stearine microencapsulation methodas used to fortify The controlof micronutrientdeficiencies is a realizable cheese with iron may be a suitabletechnology to allow iron global the ofthe task and the fortification ofother dairy productsand foods with high fat and goal, notwithstanding magnitude many moisture content. challenges and constraints that remain to be resolved. The developmentof successful programsfor micronutrientfortifica- VitaminA: Currently, some experimentalwork has been tion offoods calls for active collaboration between several sectors: the undertakento retard loss of potencyof vitamin A-fortified the sdentificcommunity, nationaland local governments, NGO5, foods on Field research is storage. needed into the problem of private industry, media, consumer gmups,and donoragencies. stability of the addedcompound under differentstorage and The scientific will needto and cooking conditions. community develop provide workable technologiesthat can be implementedin the develop- More attentionshould be to given locallyavailable sources of ing countries. Nationaland local governmentsmust have the vitamin A for meals. B-Carotene is a fortificarit fortifying good politicalwill, providethe administrativesupport, and prescribe with little limitations. When vitamin A-rich fruits very toxicity the framework within which the solutions can be implemented and vegetables are seasonally availableand are in excess, and regulated. Private industry needs to be motivated to become improvedtechnologies are required for their preservation for an active partner in this effort recognizingthe economic and later use in foods as condiments,flavourants, and colourants. social benefits thatit could derive. The media should be used to educate the on the of micronutrient The refiningof red palm oil without significantloss of B-carotene population problems malnutritionand onthe importance andsafety of fortified foods. hasbeen a recent breakthrough. Thistechnology needs tobe The consumershould be educatedregarding the benefitsand adopted by all palm oil refineries. low cost offortified foodsto create a "demandpull" to which Overallsome knowledgegaps in food fortification are: industry will haveto respond. Internationaland bilateral aid • agencies could provide the link and the coordinationbetween Simplesemiquantitative assay to measure iron and the differentsectors to the and make vitamin A in foods. implement programs them self-supportingand sustainable. • Simplefeeding and mixing equipmentfor powder The recommendations are made with a view to fortification. following identifying and promoting opportunities for food fortification as • Typeof iron sources as relatedto compatibility and an important componentof the strategiesto eliminatemicronu- bioavailability in differentdiets. trientmalnutrition: • Organolepticproperties of the productsmade from Food fortification is a unique example where industry and fortifying foods. trade, working in a largely commercialenviroment, are required to participateand play a leading role in a health • Stability of vitamin A and iron, under a variety of storage interventionendeavour. To have an effective and sustain- and processing conditions. ablefortification program, it is vital that the health and • Stabilityand interaction between ironand vitamin C in bread. industry sectors work in closecollaboration and explicitly understandand recognize each other's viewpoints, • Safety data for some iron sources, e.g., FeEDTA. concerns, and interests. Furtherresearch/knowledge in the following areas would • The food fortification strategyshould be linked with other aid program implementation: interventionstrategies like supplementationand nutrition • Standardfor fortification (minimum requirement). education.

98 MicronutrientFortification of Foods • The establishmentand sustenance ofan effective • The importanceof socialcommunication cannot be over- micronutrientdelivery system callsfor a multisectoral stressed, All availablemedia should be used to educate effort that will involverelevant sectors likegovernment, the population on the problemsof micronutrientmalnutri- industry, and consumergroups in planning and imple- tion and on the importance and safety of fortified foods. mentation.The food industry should be motivatedto Consumers should be educated to demand a better comply and penaltiesshould be enforced for noncom- productand be readyto pay a slightly higher price for that pliance. product. • • A detailed,technical, problem-solvingexercise should Regardless ofexternal input, nothing can succeed without be carried out to confirm thatthe fortification process is an adequatenucleus of well-trainedpeople. Specialized feasibleand does not alter the vehicle in any way and training is especiallycalled for in the assessment, fortifica- that nutrient losses on storage and cookingare within tion, quality control, and monitoring/evaluationproce- tolerablelimits. Industry should be involvedin technol- dures. ogy development, production,and quality control. • As programsget underway, effective monitoring of Companies with R&D facilities could provide a rich source process and outcomevariables is critical. Measurement oftechnical expertise. International expert groups on offood quality and fortificant levels in the foods at iodine, iron, and vitamin A issues need to take the lead. differentlevels from productionto consumptionis an • There is a needto coordinatedevelopment of multiple essential step to ensurethat adequate quantities of the fortification programs.Technology is now availableto a nutrient are reachingthe population.This must be limited extent, and more extensiveand coordinated combinedwith periodicestimation of clinical and bio- research and developmentis needed. Technology chemical indicatorsto evaluate the impactof the interven- developmentwill haveto be followed up with field trials tion. Programs should be envisionedas longterm with and pilot commercial trialsto evaluate the evaluationas an essential component to identify progress, technoeconomic feasibility and consumeracceptability problems,and needs. ofthe product.There should be a mechanismfor transfer • Intersectoral and internationalmechanisms of coopera- of from availablesources to countries! technology tion and coordinationshould be establishedto control companies that needthem. distribution and marketing of fortified foods. In Sub- • Fortificationprograms should be planned to dovetail Saharan Africa, regional initiativeshave beendeveloped into existing food-productionand distribution systems to iodize salt at the productionsource so that all within a country or region with minimum disruption recipient countrieswill benefit.A similar initiative may be and cost. Mechanisms like subsidiesneed to be called for to ensurethat all wheatflour, dry skimmed identifiedto reducecosts to consumers.Such costsare milk powder,salt, and processed foods exportedto the marginal for iodine and vitamin Abut become more developingcountries is fortified with micronutrientsat a significantfor iron. level thatthe importing country may specify. • Food quality should be regulatedthrough legislation and effectivelyenforced. In countrieswhere there is no political will, food adulterationis commonand consumers accept tampering as the norm, it may be difficult to enforce legislation.Consumer unions can play an important role in ensuring thatthe food sector complies with food legislation by informing the consumers about the importance of fortification and lobbying the government and food industry to fortifyfood.

Current Practices, Research,and Opportunities99 APPENDIX 1

POTASSIUM IODATE PRODUCERSAND QUALITY heavy-dutypolyethylene bag of 50 kg net and is availableat SPECIFICATION US$770/kg FOB Valparaiso (in 1995 prices). PRODUCTION OF POTASSIUM IODATE Potassium iodate is producedby the electrochemical reaction of The major iodineproducers are Japan and Chile. Many iodine with potassiumhydroxide. The chemical reaction manufacturers produceand supply potassiumiodate, both in is: + KOH —> + + The equation 3 12 6 Kb3 5 KI 3 H20. and in developed developingcountries. Some ofthem are: process involves dissolving iodine in caustic potash solution and the solution to suitable INQUIM (Chile) subjecting electrolysis, using electrodes. About 80% of Kb3 crystallizesfrom the reaction Helm (Hamburg, Germany) mixture, which is separated. One kg ofiodine will yield 1.55 • ACF Chemie (Maarssen, The Netherlands) kg of potassiumiodate. The process know-how can be obtained from the National Research Development Corporation • William BlytheLtd (Lancashire, UK) of India, New Delhi. • MBI Chemicals (Madras, India) QUALITY SPECIFICATIONSFOR POTASSIUM IODATE UNICEF's Supply Division based in Copenhagen, Denmark, The specifications ofthe "standard" potassiumiodate are listed has entered into a long-termarrangement with INQUIM. The in the followingand conformto the Food Chemical Codex product is packagedin new fibre drums with a sealed, (FCC):

QUALITY SPECIFICATIONSFOR POTASSIUM IODATE

- 1. Physical appearance (Almost) whitecrystalline powder 2. Particles retained on 100 mesh B.S. sieve - Max 5°/a (w/w) - 3. Solubility Soluble in 30 partswater 4. Reaction - A 5% solution in watershall be neutral to litmus - 5. Iodine Max 0.005°/o (w/w) - 6. Sulphate Max0.02°/a (w/w) - 7. Heavy metals (as Pb) Max2O ppm 8. Iron - Maxloppm - 9. Bromate, bromide,chloride and chlorate Max0.5°/o (w!w) 10. Insolublemafter - Max0.5%(w/w) 11. Loss on dryingat 105°C - Max0.5%(w/w) - 12. Assay Mm 99°/opotassium iodate (dry base) - 13. Packaging Plastic bag or paper drums with closed seal (50 kg)

Source: Mannarand Dunn (1995). See p. 76 forfull reference.

100 MicronutrientFortification of Foods APPENDIX 2

A. COMMERCIALLYAVAILABLE IRON COMPOUNDS AND THEIR RELATIVE COSTS IodvehWe# r O/ iron Bioavailabilitya Relative Cereal Salt Sugar Infant Bever- content cost food age factorb (milk)

Human Animal

Freelywater soluble Ferrous sulphate 20 1 1 5.0 ± + + + + Ferrous gluconate 12 1 1 8.3 ± + + + + Ferrous lactate 19 1 1 5.3 n/a — — ± ÷ Ferric ammonium citrate 18 1 1 5.5 ± — — + ± Ferrous ammoniumsulphate 14 n/a 1 — n/a n/a n/a n/a n/a — — Ferric cholinecitrate 14 n/a 1 — n/a n/a n/a

Slowly soluble Driedferrous sulphate 33 1 1 3.0 ± ± + ± + Ferric glycerophosphate 15 1 1 6.6 ± — — ± ± Ferric citrate 17 3 2 17.6 ± ± + ± + Ferric sulphate 22 3 1 13.6 — — — — — Ferricsaccharate 35 2 1 6.6 + n/a n/a n/a +

Ferric chloride 34 2 1

Poorly soluble Ferrous fumarate 33 1 1 3.0 + + — — — Ferrous succinate 35 1 1 2.8 + n/a — — — Ferrous tartiate 22 2 2 9.0 n/a n/a n/a n/a n/a Ferrous citrate 24 2 2 8.4 ± ± n/a ± +

(Almost) insoluble Ferricpyrophosphate 25 3 3 12.0 + + + — — Ferricorthophosphate 28 3 3 10.7 + + + — ± Sodium iron pyrophosphate 15 3 3 20.0 — — — — — Reduced elemental iron: - — — — — by hydrogen (10—45 pm) 96 2 2 2.1 ± - by carbonmonoxide 96 2 2 2.1 ± — — — — - — — — — carbonyl iron 98 2 2 2.1 ± - by electrolysis (—20 pm) 97 2 2 2.1 ± — — — — Ferric oxide 70 3 3 4.2 — — — — Ferric hydroxide 62 3 3 4.8 — — — — — Ferrous carbonate 35 3 3 8.5 — — — — — Ironcomplex compounds Sodium ferric EDTA 13 1 1 7.7 + n/a + ± ±

aRating: 1 = good; 2 fair; 3 = poor; n/a = info notavailable. bRelative costfactor forhumans =[ (Bioavailabilityx 100)+ /o iron content I. Equivalentcost on bioavailabilitybasis = [relative cost factorfor compoundx price/kg ofiron compound1. — Wehicles: += recommended; ±= variable; = notrecommended; n/a = info notavailable. Source: Adapted from INACG (1990). Seep. 23 forfull reference.

Current Practices, Research,and Opportunities 101 B. RELATWE COSTS OF COMMONLY USED IRON SOURCES

Ferrous sulphate, dried Hydrogen-reduced Electrolytically reduced Carbonyl-reduced Ferric orthophosphate Sodium iron pyrophosphate Ferrous fumarate

Source: Bauemfeind and Lachance (1991). Seep. 23 forfull reference.

102 MicronutrientFortification of Foods APPENDIX 3

COMMERCIALLYAVAILABLE VITAMINA AND CAROTENOIDSIN FOOD FORTIFICATION A. VITAMIN A USED IN FOOD FORTIFICATION.

LIQUID PRODUCTS

Vit. A palmitate 1.65—1.8 Edibleantioxidant; Where maximumconcentration is required;with no oil diluent stabilizers

Vit. A palmitate 1.65—1.8 Noantioxidant; Where maximumconcentration isrequired; with no oil diluent stabilizers

Vit. A palmitate 1.0 Edibleoil; Recommended for general use;with stabilizers Type PIMO/BH) edible antioxidant

Vit. Aacetate or 1.0 Edibleoil diluent; Forspecific uses -palmitate no antioxidant

Vit. Apalmitate 0.5 Emulsifiers; antioxidants; Fortification ofcereals, milk products, potatoflakes and emulsion preservative productsthat require specific processing techniques

DRY PRODUCTS

Vit Apalmitate beadlets, 0.5 Gelatin;carbohydrate; tricalcium Forproducts not dispersed in cold water wherehigh Type 500 phosphate; antioxidant; resistance to moistureand heat required, e.g. preservative extrudedfoods

Vit. A palmitatebeadlets, 0.25 Gum acacia; carbohydrates; Water dispersable; fordry products to be reconstituted Type 250-CWS modifiedfood starch; antioxidants before use, e.g. sugar

Vit A palmitatebeadlets, 0.25 Gelatin;dextrose; modifiedfood Water dispersable; free flowing beadlels to help meet Type 250-S starch;coconut oil;sorbitol; thestringent flavour needs ofmilk based products and sodium citrate; antioxidants otherbeverages

Vit. Apalmitate beadlets, 0.25 Acacia; carbohydrate; modified Water dispersable fine beadlet product forpremixes Type 250-T starch; aipha-tocopherol; preservative

Vit. Apalmitate 0.25 Acacia; lactose; coconut oil; Forproduct use wherevery fine particle size is desired, Type 250-SD preservatives i.e. maize flour, vitamin premixes, drymilk, sugar, beverage powders

Source: Bauemfeindand Arroyave(1986). See p. 23 forfull reference.

Current Practices, Research,and Opportunities103 B. SOME APPLICATIONSOF CAROTENOIDSAS VITAMINA PRECURSORS — 30°/o B-carotene liquid Micronized B-carotene suspension in Colouringfat and oil products, 1.5 gof suspension to 450 ml suspension food-grade vegetable oil; pourable at margarine,process cheese, frozen >24°C; semisolid at 4-16°C; no anti- and dried eggyolk, winter butter oxidants;dissolves readily in warm oil and other fat-base products

24°/o B-carotene Micronized B-carotene in Colouringfat and oil products, 2 gof suspension to480 ml semisolid hydrogenated vegetable oil; margarineand otherfat-base warm vegetable oil; stirring to suspension pourableat> 38°C;semisolid at products dissolve. 21-32°C;no antioxidants;dissolves 1 ml = 1 mg B-carotene readilyin warm oil

22°/c B-carotene HS Micronized B-carotene in food- Colouring popping oil, heat- 2 gof suspension to 440 ml liquid suspension grade vegetable oil; pourable at stressed cookingoils, fat-base warm vegetable oil;stirring >24°C; semisolid at 4-16°C; products where greater carotene todissolve. = stabilizedwith anti-oxidants; stability is required 1 ml 1 mg B-carotene dissolves readily in wami oil

3.6°/o B-carotene 6-carotene in orange oil and Especially designed forcolouring 3 gof emulsion to 108 mIs liquid emulsion brominated vegetable oil orange-flavoured drinks and water; stirring to disperse. emulsifiedin a hydrolysed protein fruit juices blends; adjusted for 1 ml = 1 mg B-carotene base; pourable at 24°C; specific specific gravity in clear glass gravity, oil phase 1.053 ± 0.003 or opaque container (12.5—1 3.6°Brix); stabilized with antioxidants

Dry B-carotene ColloidB-carotene in agelatin- Colouringwater-based foods 1 gof beadlelsof 96 ml of beadlets 100/0 carbohydrate matrix; stabilized with and beverages for dry products warm water; stirring to disperse. antioxidants;readily dispersible, with tobe reconstituted inwarm 1 ml= 1 mgB-carotene stirring in warm water (54°C) water

Dry B-carotene B-carotene in vegetable oil emulsified Colouring juice drinks, dry 4 gof beadlets of 100 ml of beadlets 2.4°/o ina gelatin-carbohydrate matrix; beverage bases, beverages and warm water; stirring to disperse. stabilized with antioxidants; readily other water-base liquidor dry 1 ml = 1 mgB-carotene dispersible in water (24°C) foodsto be reconstituted in water Dry B-carotenepowder B-carotenein diy powderform; Colouring dairy products, baked logofpowderto 100 ml of 1°/o CWS indextrin, acacia carbohydrate; goods, sauces, icing, puddingsetc warm water; stirring to disperse. ascorbate + tocopherol asanti- 1 ml = 1 mg B-carotene oxidants; readilydispersible in water

B-carotene blendwith Micronized B-carotene suspension Simultaneous colouringand vitA (and D) in vegetable oil; with dissolved vitamin Afortification of vit A+D margarine,mellorine, etc.

20°Jo Apo-carotenal Micronized suspension infood Colouringfat and oilproducts, 1 gof suspension to 200ml liquidsuspension graded vegetable oil; pourable at saladdressing, processed cheese warm vegetable oil; stirring 24°C;no addedantioxidants; and otherfat-base foods to disperse. semisolidat 4-16°C; dissolves 1 ml= 1 mgapo-carotenal readily in warm oil;

Apo-carotenal solution Apo-carotenal (1.4°/c) + B-carotene Colouringprocess cheese, salad 5 g ofsolution to 100ml of 2°/o (0.6°/c) dissolvedin a food-grade dressings and otherfat-base vegetable oil; stirring to dilute modifiedvegetable oil composition; foods 1 ml = 1 mg apo-carotenal 5 solution to 100 ml of Apo-carotenal solution Apo-carotenal + B-carotene Colouringprocess cheese,salad g of #73 dissolvedina food-grade modified dressings and other fat-base vegetable oil, stirring to dilute vegetable oil composition; stabilized foods 1 ml = 0.7 mgapo-carotenal with antioxidant + 0.3 mg B-carotene

Apo-carotenal solution Apo-carotenal dissolved in a food- Colouring process cheese, salad 5 gof solutionto 200 ml of modified oil and otherfat-base oil, todilute. 40/s grade vegetable dressings vegetable= stirring composition witha-tocopherol foods; dryspice 8bread mixes 1 ml 1 mgapo-carotenal

Source: Adaptedfrom Klaeui and Bauemfeind(1981).

104 MicronutrientFortification of Foods APPENDIX 4

COMPOSITION OF SOME FORTIFICATIONPREMIXES PRODUCED BY DIFFERENT MANUFACTURERS Atochem N-richment-Acereal fortification premixes (fortificationlevel per kg flour).

Thiamine (vit B1) 4.9mg 5.7mg 3.3mg

Riboflavin(vit B2) 2.6mg 4.0 mg 2.2 mg Niacin 31 mg 46mg Iron 26mg 37mg 11 mg Vitamin A 2,340 IU 2,340 IU 2,340 IU

Parched, crushedwheat asprepared and usedas a dietarystaple inTurkey and someother countries.

Roche rovifarin 955 fortification premix. Roche precision premix.

Thiamine (vitamin B1) 4.45 mg Riboflavin(vitamin B2) 2.65 mg Vitamin A250 SD 24.00 Niacin 35.62 mg Iron electrolyte 19.10 Iron 29.28 mg Potassium iodide 243.00 Ascorbic acid FR 78.00 Niacinamide 22.00 Pyridoxine hydrochloride 2.78 Riboflavin, typeS 1.96 Thiaminemononitmte 1.73

Vitamin B12 1°/a SD 0.70 Vitamin E 50°/o CWS/F 69.00

Vitamin D3 100 SD 4.80 Folicacid 0.48 D-calcium pantothenate SD 12.54 Biotin 0.36 Di-cal phosphate anhydrous 0.00 Copper gluconate 15.70 Zinc oxide 20.00

Current Practices, Research,and Opportunities 105 APPENDIX 5

ACRONYMS AND ABBREVIATIONS HIC HaemIron Concentrate AACC AmericanAssociation of Cereal Chemists HNI Human Nutrition Institute AAP AmericanAcademy of Paediatrics HPLC High pressure liquid chromatography AAS Atomic absorptionspectrophotometer HPB Health Protection Board (CDNHW) AMA AmericanMedical Association IAC InternationalAgricultural Centre ARS AgriculturalResearch Service (USDA) IAEA InternationalAtomic EnergyAgency BDN Bon DenteNutrition, Inc. ICCIDD InternationalCouncil for the Control of IDD BHC Bovine Haemoglobin Concentrate IDA Iron Deficiency Anemia BM(G Bristol-MyersInternational Group IDD Iodine Deficiency Disorders CAR Central African Republic IDRC InternationalDevelopment Research Centre CCP Critical Control Point ILO InternationalLabour Organization CDNHW Canadian Departmentof NationalHealth and 1151 InternationalLife Science Institute Welfare INACG InternationalNutritional AnaemiaConsultative CESNI Centre of Studies on Infant Nutrition Group CFN Council of Food and Nutrition (AMA) INCAP Nutrition Institute of Central America and CFOP ComplexFerric Ortho-Phosphate (microcrystal- Panama line) INTA Chilean Public HealthInstitute for Infant Foods CFTRI Central Food Technological Research Institute IVACG InternationalVitamin A Consultative Group CHNO Centre Horticoleet Nutritionnel de Ouando IU InternationalUnit CIDA Canadian InternationalDevelopment Agency JECFA Joint FAO!WHO ExpertCommittee on Food CMAFP Committee on MedicalAspects of Food Policy Additives CN Committee on Nutrition (AAP) KIT Royal Tropical Institute CONICET Consejo Nacional de Investigaciones MFP Multi Purpose Food Cientificas y Tecnicas Ml MicronutrientInitiative CPS Canadian Paediatric Society MJNG Mead Johnson Nutritional Group CPHIIF Chilean Public HealthInstitute for Infant Foods MM MicronutrientMalnutrition CSRS Cooperative Research Service (USDA) MON Ministry ofHealth CSM Corn-Soyabean-Milk mixture MOHW Ministry ofHealth and Welfare Cr ChampionTrust MRC MedicalResearch Council CWS ColdWater Soluble MSG Monosodium Glutamate (C5H8N04.Na.H2O) DGIS Dutch Directorate General International MSI Mineral Safety Index Development Cooperation NAS National Academy ofSciences EC European Community NDC US National Dairy Council EDTA Ethylene-Diamine-Tetraacetic Acid NGO Nongovernmentalorganization ENI EthiopianNutrition Institute NIH US National Institutesof Health ESPGAN Societyfor Pediatric Gastroenterology and NIN National Institute of Nutrition Nutrition NNRGP Nestlé Nutrition Research Grant Programme FAO Food and AgricultureOrganization NOVIB NetherlandsOrganization for International FCC Food Chemical Codex Development Cooperation FCR Foundationfor Chemical Research NRC US NationalResearch Council FD Food Diversification ORS Oral RehydrationSalt FDA US Food and Drug Administration PAG ProteinAdvisory Group FF Food Fortification PAMM Programme Against MicronutrientMalnutri- FFWF Fonds zur Forderung derWissenschaftlichen tion Forshung PATH Program for AppropriateTechnology in Health FIIRO Federal Institute of Industrial Research, Oshodi PHC Primary Health Care FNRCC PhilippineNational Riceand Corn Corporation PHS US Public Health Service FNRI Philippine Food and Nutrition Institute PPM Partsper million FPR Foundation for Pediatric Research QA Quality assurance GMP GoodManufacturing Practices QC Quality control

106 MicronutrientFortification of Foods RCL Ricegrowers'Co-operative Limited UBACYT Universidadde Buenos Aires RDI Recommended Dietary Intake UNDP UnitedNations Development Programme RE Retinol Equivalent UNICEF UnitedNations Children'sFund SAAEB South African Atomic Energy Board UNU UnitedNations University SARCDC Swedish Agencyfor Research Cooperation USAID USAgency for InternationalDevelopment with DevelopingCountries USDA US Departmentof Agriculture SASA South AfricanSugar Association USP US Pharmacopea SD Spray Dried VAD Vitamin Adeficiency SCFAR Swedish Council for Forestry and Agricultural WFP World Food Programme Research WHO World HealthOrganization SECYT Argentina Secretaria de Ciencia y Tecnica WIC Women, Infantsand Childrenprogramme TFNC Tanzania Food and Nutrition Centre WPC Wheat-Protein Concentrate TOOL Transfer ofTechnology for Development WSD Whey-SoyaDrink TOM Totalquality management WT Welcome Trust

Current Practices,Research, and Opportunities 107 DRC / CR01 IM H PillP II 285736

108 MicronutrientFortification of Foods Photo Credits

Top Bar: (left to right) VITAL, UNICEF\C-59.24\Murray-Lee, UNICEF\92-015\Press. Photo collage: (left to right) UNIICER9O-063\Goodsmith, UNICEF\C-6,14\Enkelis, UNICEF/93-0479/O'Connor.