Micronutrient Fortification of Foods Current Practices, Research, and Opportunities
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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 SUCCESSFULQA 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 improve lives . 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 delivery systems and availabletechnologies where they servethat need. A combinationof 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 commonly eaten foods with micronutrientsis one ofthe main strategiesthat can be used to improve micronutrientstatus. 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 improve the 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 sus- tained 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