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Fortifying flour, salt, and cooking oil offers an effective and inexpensive way to get essential vitamins and minerals into food for low-income populations at risk of malnutrition

MANILA, PHILIPPINES (22 August 2005) - A lack of basic vitamins and micronutrients in the diet is damaging the health of one third of the world's population and hampering economic development, according to a recent joint report from the United Nations Children's Fund and the Micronutrient Initiative (MI).

Simple iron deficiency in Indonesia reduces gross domestic product by some 0.5% each year ($485 million) through lost productivity, as estimated in 2003's Global Assessment Report on Vitamin and Mineral Deficiencies.

Yet food fortification offers a low-cost method for facing the problem, and ought to be the first public-policy choice for delivering nutrition improvement programs and lowering clinical malnutrition. With food fortification strategies supported and maintained through market-based systems, governments can focus the delivery of food supplements, nutrition services, and dietary education to disadvantaged populations with limited access to fortified food.

A Simple and Cheap Technology

Fortifying flour, salt, and oil, for example, offers an effective and inexpensive way to get essential vitamins and minerals into food for low-income and at-risk populations. The technology is simple, the product quality is unaffected, and the incremental price is low. Salt can be iodized, for example, for as little as five cents per person, per year.

Using food fortification to reduce micronutrient deficiencies helps strengthen economies by lowering health care costs and increasing worker productivity. It also improves children's cognitive development, further helping expand and sustain economic development. Access to fortified food, however, is often limited because of low purchasing power and underdeveloped distribution channels.

Control of micronutrient deficiencies through food fortification, nonetheless, is gaining international attention. For example, the Global Alliance for Improved Nutrition (GAIN) - funded primarily by the Bill & Melinda Gates Foundation, bilateral donors, and the MI - provides resources to alliances of governments, industry, and civil society to implement large-scale food fortification programs that reach low-income populations.

The Copenhagen Consensus, which addresses some of the biggest challenges facing the world, and assesses development opportunities and their costs, rated food fortification with micronutrients as the most successful intervention to reduce the prevalence of iron deficiency anemia, and iodine and vitamin A deficiencies. Lack of iron not only has an influence on fetal and childhood development, but also has a direct negative effect on the productivity of adults. Iodine deficiency in childhood reduces brain development, and vitamin A deficiency can permanently damage eyesight or even cause blindness.

Fortification: A National Challenge

To be successful, national fortification programs must be sustainable and market driven, and governments must back them up with adequate regulations, standards, and public education.

International experience shows that government policy, standards, and regulations are critical to establishing an environment that enables the private food sector to invest, produce, and distribute quality, fortified products. Government is key to creating producer awareness, building consumer demand, and shaping the marketplace with clear regulations and transparent regulatory enforcement procedures.

Food control and monitoring systems for fortified flour, salt, and other foods require technical and managerial capacity as well as coordination among government agencies charged with regulating domestic and imported food. There is also a need to strengthen food control and monitoring systems for fortified food at the market and household levels.

New Approaches in Indonesia

Vitamin A deficiency, iodine deficiency disorders, and iron deficiency anemia are common problems in Indonesia. These micronutrient deficiencies contribute to disease, mortality, growth retardation, brain damage, and reduced cognitive and working capacity among children and adults. That puts a severe strain on education and health systems, lowers productivity, and raises levels of sustained poverty.

In urban slum areas, the prevalence of underweight children is especially high, and anemia rates among young children remain alarmingly high. More than half the children under 5 years of age are vitamin A deficient. A recent study showed that consumption of palm oil by poor families was sufficient to deliver 30% of the recommended daily allowance for vitamin A, suggesting that vitamin A fortification of palm oil presents a promising opportunity to reduce the prevalence of vitamin A deficiency.

While iron supplementation is widely implemented to treat and prevent iron deficiency anemia in adults, realistic alternatives for young children remain very limited. Therefore, "in-home" fortification with multimicronutrient fortificants, which are also called "sprinkles," is a new option to address iron deficiency anemia in young children. It consists of microencapsulated iron and other essential micronutrients to treat and prevent iron and other deficiencies in infants and young children. The encapsulation is a thin lipid (vegetable fat) coating that prevents the iron from dissolving into the weaning food, thus, preventing any change in color, flavor, and taste of food. Multimicronutrient fortificants can be added to complementary food to reduce vitamin A deficiency and iron deficiency anemia in children 6-59 months of age.

"Sprinkles" have proved effective in Benin, People's Republic of China, Ghana, India, and Mongolia. Although the product is not yet commercially available, "sprinkles" may promise an alternative for Indonesian children who suffer micronutrient deficiencies.

To combat malnutrition in Asia and the Pacific region, ADB has provided technical assistance on nutrition and food fortification to 16 developing member countries since 1996. In addition, two grant projects - launched since 2001 and funded through the Japan Fund for Poverty Reduction (JFPR) - aim to promote sustainable food fortification programs in the Central Asian republics and Mongolia.

To address the alarming rates of micronutrient deficiencies in Southeast Asia, ADB has launched its first food fortification project for Indonesia, with $1.75 million financed through the JFPR.

The grant project pilots palm oil fortification with vitamin A and assesses the technical feasibility to locally produce multimicronutrient fortificants. It is estimated that about 70% of the population, particularly the poor, could be reached if palm oil is fortified with vitamin A. The oil fortification technology is uncomplicated and widespread. The project also aims to establish public-private partnerships for marketing and distributing "sprinkles."

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