The fight against nutritional deficiencies

FOOD fortification, which is basically the safe practice of adding small amounts of micronutrients to staple foods and condiments, has proven to be among the world’s best and most cost-effective interventions to nutritional deficiencies. The approach gained momentum during World Wars 1 and 2 in a bid to help prevent nutritional deficiencies and to add on nutrients lost during food processing. Countries from the West introduced compulsory guidelines on fortification to increase the intake of essential nutrients, and this trend continues today.

More than 140 countries have national salt iodization programs. About 85 have at least one kind of cereal grain fortification processes with iron and folic acid.

The Global Alliance for Improved Nutrition (GAIN), and Project Health Children (PHC), both non-profit organizations, are partners to improve the quality and delivery of the food fortification process. Both have committed to work with food control and the food industries across low- and middle-income countries. GAIN is helping find solutions to end malnutrition which is affecting 3.5 billion people or nearly half the world’s population. Annually, malnutrition claims the lives of 3.1 million children under five and leaves 159 million stunted.

Annually, some 150 million people consume fortified food with GAIN’s premix facility, a food quality and safety solution. Since 2009, it has offered US$59 million worth of premix – a powder containing a blend of vitamins and minerals – and micronutrients in more than 40 countries.

“Every year, it is estimated that the food fortified by the premix sourced through the GPF will be eaten by over 150 million people, who will benefit from certified quality premix at an affordable cost,” according to Penjani Mkambula, Senior Manager of Food Safety Quality and Procurement at GAIN.

Fortifying flour with nutrients for everyday food products has boosted significantly reduced nutritional deficiencies in the Arab Gulf region (Photo © Raphotography I Dreamstime)

Maternal and infant health

The US Centers for Disease Control and Prevention (CDC) have touted maternal and infant health improvements as one of the greatest 10 public health feats. Mandatory cereal grain products’ fortification with folic acid began in 1998 in the United States, contributing to a 36% decline in neural tube defects, during 1996 to 2006. It helped prevent an estimated 10,000 pregnancies that were affected by neural tube disorders in a decade and helped save US$4.7 billion in direct costs.  

Combating iron and vitamin D deficiencies

Iron deficiency is one of the most common nutritional challenges globally. The World Health Organization (WHO) suggests that the Arab Gulf countries hold the highest rates of this deficiency.

Iron deficiency and related anaemia are major public health challenges in the Middle East. Figures show that between 24% and 56% women in the Arab Gulf region suffer from iron deficiency anaemia.

In the UAE, nearly 90% of the population is deficient in vitamin D, according to data from the International Osteoporosis Federation (IOF).  The lack of the sunshine vitamin contributes to cardiovascular disease, diabetes, hypertension, menstrual issues, and depression.

Sun exposure and supplements are solutions to this problem.

The Arab Gulf kick-started the food fortification initiative in the late 1970s. The KSA was one of the first to introduce wheat flour fortification, and as international organizations supported further, other countries followed suit in the 1990s.

Today wheat flour fortification is mandatory in the KSA, Oman, Kuwait, and Bahrain and voluntary in UAE and Qatar. Recently, the KSA begun to add vitamin D to wheat flour to help improve vitamin D levels. 

In Bahrain, the National Flour Fortification program launched in 2001 mandated the addition of iron and folic acid to wheat flour, resulting in a significant decline in anaemia among pregnant women and in neural tube birth defects.

Since its mandatory folic acid fortification of wheat flour in 1996, Oman has seen cases of Spina Bifida, a birth defect, drop by 70%.  This defect is the incomplete closing of the backbone and membranes around the spinal cord.

To spread awareness globally and create cross-border alliances, the UK’s Department for International Development launched a new food fortification plan in Pakistan to reduce iron deficiency anaemia by one-third and to decrease vitamin A deficiency by a quarter in women and children. The plan is to increase the micronutrient content of flour and edible oil or ghee.

Pakistan has the third-highest number of children below five that also suffer from malnutrition. A recent national survey suggested that 44% of children there under five were stunted, 62% have anaemia and 54% are deficient in vitamin A.

In countries where food fortification is mandatory, food products are made from locally sourced wheat flour containing higher levels of folic acid and iron. In the KSA, flour will also contain vitamin D. According to the European National Food Surveys, fortified food products generally consumed include: ready-to-eat breakfast cereals, cereal bars, fat spreads, breads, milk and juices.

A continuing global issue

Positive developments in reducing malnutrition and ‘hidden hunger’ are helping millions, however millions still continue to suffer from micronutrient deficiencies.

Deficiencies in iodine, iron and vitamin A and zinc are among the most serious global health risk factors, according to the WHO. Malnutrition results in losses of up to 11% of GNP across Africa and Asia, draining economic growth. Health and opportunity costs related to malnutrition go up to estimated losses of US$3.5 trillion dollars in the global economy.

Women at reproductive ages and children less than two years need iron, folic acid, vitamin A and zinc.  People that suffer from hidden hunger may physically not appear malnourished, but do suffer from poor brain development, weak immune functions, decreased work productivity and concentration issues. - ZAINAB MANSOOR

References

https://www.devex.com/news/futurefortified-how-food-fortification-can-help-end-micronutrient-malnutrition-88414 

http://www.gainhealth.org/knowledge-centre/improving-food-quality-hundreds-millions-people/

http://www.gainhealth.org/knowledge-centre/helping-food-producers-increase-the-nutritional-value-of-their-products/

https://www.kelloggsnutrition.com/en_AE/knowledge/nutrition/foodfortification.html

http://www.khaleejtimes.com/nation/general/warning-90-of-uae-residents-lack-vitamin-d

http://www.ffinetwork.org/about/stay_informed/publications/documents/FolicAcidBackground.pdf

https://www.gov.uk/government/world-location-news/new-food-fortification-programme-to-help-tackle-malnutrition-in-pakistan