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.

By: Shubham Tiwari