Context: Iron fortification of foods in India is a complementary strategy to dietary diversity but it has the risks associated with it, particularly in children.
Issue

• Many things have been said about the necessity for mandatory iron fortification of foods in India but Food fortification is not a magic bullet.

Why mandatory fortification is not a feasible option?

• Occurrence of deficiencies: We do not even know if anaemia is as rampant to warrant such mandatory measures.
• Manipulating food choices: When mandatory fortification is enforced in parts of the population that do not need this, it removes their choice of foods, or autonomy.
• Morbidities due to excess: It could even be unethical if the risk of other morbidities is increased.
• No successful example: Rice fortification has not been shown to work in a combined analysis.

National Nutrition Survey

• National Nutrition Survey evaluated the risk of high blood sugar, high blood lipids and high blood pressure in Indian adolescents.

Key highlights of the Survey

• Fortification of any one staple (rice, wheat, or salt) will increase serum ferritin, without changing the hemoglobin level. There is a significant risk to health as serum ferritin increases.
• An additional 10 mg of iron/day increased high blood sugar prevalence by 2-14% across States of India, with similar findings for high blood pressure and high lipids.

Fortification of Food

• Fortification is the addition of key vitamins and minerals like iron, iodine, zinc, Vitamin A & D to staple foods such as rice, milk and salt to improve their nutritional content.

Need for Fortification of Food

• 70% of people in India do not consume enough micronutrients such as vitamins and minerals.
• 70 % of pre-school children suffer from anaemia caused by iron deficiency and 57 percent of preschool children have Vitamin A deficiency.
• Neural Tube Defects (NTDs) are the most common congenital malformation that varies between 0.5-8/1000 births.

Benefits of Fortification

• Since the nutrients are added to staple foods that are widely consumed to improve the health of a large section of the population, it is an excellent way to improve the health of a large section of the population, all at once.
• It does not require any changes in food habits and patterns of people.
• It does not alter the characteristics of the food—the taste, the feel, the look.
• It can be implemented quickly as well as show results in improvement of health in a short period of time.
• The method is cost-effective especially if advantage is taken of the existing technology and delivery platforms.

Disadvantages of Food Fortification
Not a Substitute of Good Nutrition

• Fortified foods contain increased amounts of selected micronutrients, they are not a substitute for a good quality diet that supplies adequate amounts of energy, protein, essential fats etc.

Might not benefit Infants and Children

• A child will get nutrition only if the lactating mother will be healthy and consumes adequate nutrition.
• After the six months complementary feeding is initiated, wherein infants and children consume small amounts of food.

No access to Poorest Segment of the Population

• Poorest segments of the general population have restricted access to fortified foods in the open markets due to low purchasing power.

Not a Long-Term Solution

• FSSAI (Food Safety and Standards Authority of India) has titled food fortification as a complementary strategy rather than a replacement of balanced, diversified diets to address malnutrition.
• Fortification only bridges the gap between the need and actual consumption of required micronutrients through food.

Detrimental Effects

• Fortified foods as a public health measure should be promoted after analyzing the efficacies and micronutrient status of the population.
• Excess dosages of vitamins and minerals can have harmful effects.

Road Ahead

• Food fortification is not a magic bullet. It should be viewed as a complementary strategy for the prevention and control of micronutrient deficiencies. As dietary patterns and deficiency states change, monitoring and periodic evaluation will be essential in helping to make necessary changes.