Rationale and elements of a successful food-fortification programmer
However, there are now enough successful examples to suggest
this is no longer true. Mora and Dray* list 17 countries in Latin America that
now fortify foods with at least one microelectronic and sometimes more.
*Mora JO, Dray O. Strategies for prevention of micro-nutrient
deficiency through food fortification. Lessons learned from Latin America.
Presented at the 9th World Congress of Food Science and Technology, Budapest,
Hungary, 1995.
Requirements for effective fortification in food-aid
programmer will not be discussed, although the issue is very important and is
currently receiving a lot of attention. For the purposes of this review, it
suffices to mention that fortification of food aid for displaced persons and
refugees was endorsed at the International Conference on Nutrition (ICE), which
included the recommendation that “donor countries and involved organizations
must... ensure that the nutrient content of food used in emergency food aid
meets the nutritional requirements if necessary through fortification, or
ultimately supplementation” [1].
Fortification programmer
Some experiences with fortification, especially in
developing countries, will be examined below.
Vitamin A
Fortification has been important in reducing deficiencies of
vitamin A, especially in Latin America where sugar is fortified with it. Other
fortification vehicles have included whole wheat, mono sodium amalgamate and
instant noodles, rice and other cereals, tea, fats and oils, milk and milk
powder, rice, salt, so ya bean oil, and infant formulas [10].
Sugar
The fortification of sugar with vitamin A is actually a
success story but does offer a couple of lessons. Despite demonstrated success
in the Guatemalan programmed in the early 1970s, with increases in the status
of recipients’ vitamin A levels and, indirectly, hemoglobin levels, the
programmed faltered in the 1980s [11]. This was because of a lack of continuing
government commitment, indifference from the producing sector, economic
limitations, and, presumably, a lack of self-sustainability (in terms of
passing on costs, etc.), so that it could not continue without some
public-sector involvement. It has now been revitalized, although some technical
improvements are still needed. In a start-up programme in Bolivia, involving a
partnership among government, donors (US Agency for International Development
and UNICEF), and a commercial firm, sustainability has yet to be assured,
although there are currently plans for scaling up nationally by the private
sector. However, this is happening for reasons of economic scale and before all
the technological problems has been clearly resolved. For instance, a recent
evaluation of the levels of vitamin A in fortified sugar has shown them to be
quite low. Ecuador had moved along the path towards fortification, but after a
meeting on sugar fortification in Guatemala early in 1996, the government
decided that the technical problems were still too unresolved for the country
to commit to such a programmed. Nevertheless, sugar has been fortified with
vitamin A in Coats Rice, El Salvador, Guatemala, Honduras, and Panama. Other
countries, such as the Philippines in Asia and Uganda in Africa, are also
interested.
Wheat
An interesting programmer using whole wheat was developed in
Bangladesh with technical assistance and support from the US Agency for
International Development through Helen Keller International. Because wheat is
the less preferred staple, the fortification program me would have been
automatically targeted to the poor. It became, however, an example of a
technically feasible, properly developed programmed that failed politically
because it did not adequately involve the policy makers and those most affected
[9,12]. The Philippines is currently testing vitamin A fortification of wheat
flour.
Mono sodium amalgamate
The project to fortify mono sodium amalgamate (MSG) with
vitamin A was also technically feasible and had been properly developed by
consumption, taste, and impact trials in both Indonesia and the Philippines
[13, 14]. There are several reasons why it failed at the time. Some of the
technological developments were released too early and subsequently found not
to have been resolved, e.g., yellowing of the MSG in a product that sold itself
as “pure white” [9]. Key government policy makers were not convinced of the
safety of MSG, despite statements by the Food and Agriculture
Organization/World Health Organization (FAO/WHO) regarding its safety, and there
was a further lack of conviction on the part of the private sector in the
programmer’s cost-effectiveness. It is possible that it may still go ahead in
Indonesia as a purely private-sector initiative. However, in the Philippines
the program me seems permanently stalled, and other vehicles are now being
investigated.
Rice and other cereals
Again, although technically feasible as a pilot, the
fortification of rice with vitamin A has not proceeded to the national level in
any country. Both the Dominican Republic and the Philippines have attempted to
fortify rice with vitamin A [6]. In the Philippines the 15% to 20% losses from
water washing were considered unacceptable [9]. A feasibility trial of a
fortified rice premix is under way in Indonesia, but the government has made
known its lack of enthusiasm for fortifying the national staple. In Brazil the
program me is still at the stage of testing bio availability [10]. In Venezuela,
on the other hand, per-cooked corn flour, which is used to make areas, a staple
food in the national diet, has been successfully fortified with vitamin A,
thiamine, riboflavin, niacin, and iron [15].
Tea
In three countries, India, Pakistan, and Tanzania,
technically feasible programmer to fortify tea with vitamin A have not proceeded,
although they have been properly developed and tracked [10].
Fats and oils
In developed countries, fats and oils have been the main
vehicles of vitamin A fortification, often with other micro-nutrients such as
vitamin D. The production of a variety of vegetable oils is high throughout the
world, and consumption is increasing, especially among the low sociology-economic
sectors of the population. Thus, oil represents an ideal fortification vehicle
to reach these groups [10]. An important example of cooperation among the food
industry, government, and academics has been the relatively successful
fortification of Star Margarine with vitamin A in the Philippines, which has
led to the fortification of canned sardines. Programmers of fortifying
margarine with vitamin A are currently ongoing in Brazil, Chile, Colombia, El
Salvador, Mexico, and other countries around the world, especially developed
countries. In India, red palm oil is added to other edible oils, and vitamin
A-fortified so ya bean oil is being tested in Brazil [16].
Summary of vitamin A - fortification programmer
Success in vitamin A fortification has depended on sustained
political commitment (both in-country and by donors), persistence with
technical development of fortification technologies to overcome problems,
increased awareness of the health consequences of vitamin A deficiency by
governments, and involvement of the private sector. Fortification programmer
have been shown to be effective in a variety of settings [11,15,17].
Iron
Compared with other strategies used for correcting
iron-deficiency anemia, with which relatively little progress has been made
worldwide, iron fortification is the cheapest to initiate and maintain, reaches
the largest number of people, guarantees sustainability [18], and lacks the
side effects and logistical problems that have often affected
iron-supplementation programmer. Long implemented in developed countries, iron
fortification is now being adopted in several Latin American and Caribbean
countries in accordance with government regulations. In developed countries,
wheat flour and cereal-based foods have had significant success as vehicles for
iron. Other vehicles include infant weaning foods, salt, sugar, rice, curry
powder, fish sauce, soy sauce, bakery products, beverages, biscuits and
cookies, low-fat milk, chocolate milk, maize flour, margarine, and water
[4,10].
Rice
Other cereals
Programmers to fortify other cereals with iron
have generally been successful, although, given the inhibitory effect of
cereals on iron bio availability, cereal fortification may not be the most
efficient way
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