Powering up food: fortification is good but needs regulation
Scince a diversified diet that meets all nutritional requirements is difficult to provide, fortification of food is relied upon by many countries to prevent malnutrition. The World Health Organisation estimates that deficiency of key micronutrients such as iron, vitamin A and iodine together affects a third of the world’s population; in general, insufficient consumption of vitamins and minerals remains problematic. Viewed against the nutrition challenge India faces, processed foods with standards-based fortification can help advance overall health goals, starting with maternal health. It is imperative, for a start, to make iron-fortified food widely available, since iron deficiency contributes to 20% of maternal deaths and is associated with nearly half of all maternal deaths. The shadow of malnutrition extends to the children that women with anaemia give birth to. They often have low birth weight, are pre-term, and suffer from poor development and lower cognitive abilities. Low intake of vitamins, zinc and folate also causes a variety of health issues, particularly when growing children are deprived. Fortification is a low-cost solution. The benefit is maximised when there is a focus also on adequate intake of oils and fats, which are necessary for the absorption of micronutrients and something poorer households often miss in their diet.
The efficacy of the fortification standards introduced by the Food Safety and Standards Authority of India (FSSAI) will depend on enforcement. It is important to ensure that all sections of producers meet the norms, since the FSSAI plans to get local flour mills to add premixed nutrients. Making affordable, good quality fortified foods widely available is the key. Only such standardised processes can provide micronutrients to women, and in turn to breastfed children in the first six months after birth. A well-functioning public distribution system is the best channel to reach precisely those sections that need fortified food the most. In the case of children, recent studies show that adding zinc to food during the six months to 12 years growth period reduced the risk of death from infectious diseases and all causes put together. Fortified food, therefore, provides near to medium-term gains, and addresses micronutrient malnutrition concerns at the population level. Yet, as the WHO points out, in the long term, public health goals on prevention and elimination of nutritional deficiencies should aim at encouraging people to adopt a diversified and wholesome diet. Children, including those in school, should get a wholesome cooked meal that is naturally rich, and augmented with vegetables, fruits, dairy and other foods of choice. Fortified foods can help fill the gaps, particularly in areas that are in need of speedy remedial nutrition. It is also vital that food regulation views the issue of affordability as a central concern, because unaffordable fortified food would defeat the very purpose of fortification.