Download Micronutrient Fortification of Foods Current practices, research, and

Micronutrient
Fortification of Foods
Current practices,
research, and opportunities
The
Micronutrient
Initiative
ARCHly
u
104386
••
International
Agricultural
Centre
Micronutrient Fortification of Foods
Current practices, research, and opportunities
1DRC
Mahshid LatH
M.G. Venkatesh Mannar
Richard J.H.M. Merx
Petra Naber-van den Heuvel
- L.ib.
© 1996 TheMicronutrient Initiative (MI), do International Development
Research Centre (IDRC)/InternationalAgriculture Centre (IAC)
Ml: P.O. Box 8500, 250 Albert Street, Ottawa, Ontario, CanadaKI G 3119
Tel: 613 236 6163; Fax: 613 236 9579; Telex: 053-3753
JAC: P.O. Box88, LawickseAllee 11,6700 AB Wageningen,The Netherlands
Tel: 31 317490355;
Fax: 31
317418552
ISBN: 0-660-16230-X
The viewsexpressed
in this publication are those ofthe authors and do not necessarilyrepresentthose of the
International Agricultural Centre or the Micronutrient Initiative or the sponsoring organizations.Mention of a
proprietary name does not necessarilyconstituteendorsementof the product and is given only for information.
CONTENTS
vii
PREFACE
1.
2.
3.
4.
INTRODUCTION
1
THE PROBLEMOF MICRONUTRIENTMALNUTRITION: MAGNITUDE, CONSEQUENCES,ANDCAUSES
1
ELIMINATION OF MICRONUTRIENTMALNUTRITION: AN OPPORTUNITYTO IMPROVE LIVES
2
GENERAL FEATURES OF INTERVENTIONSAND THEIR APPLICATION
3
REFERENCES
5
DEVELOPING A FOOD FORTIFICATION PROGRAM
7
RATIONALE AND OBJECTIVES
7
ROLE OF THE FOOD INDUSTRY IN FORTIFICATIONPROGRAMS
8
REFERENCES
10
FOOD VEHICLES AND FORTIFICANTS
11
SELECTIONOF FOOD VEHICLES
11
SELEcTION OF FORTIFICANTS
11
SOURCES OF FORTIFICANTS
11
STABILITY AND INTERACTIONSIN THE DIET
13
COST OF FOOD FORTIFICATION
14
BIOAVAILABILITYAND BIOCONVERSION OF MICRONUTRIENTS
15
LEVEL OF FORTIFICATION
16
TOXICITY CONSIDERATIONS
17
SINGLE FORTIFICATION
18
MULTIPEE FORTIFICATION
20
REFERENCES
22
FOOD FORTIFICATIONTECHNIQUES
25
FORTIFICATIONPROCEDURES
25
POINTOF FORTIFICATION
27
PACKAGING
27
REFERENCES
30
MicronutrientFortificationof Foods iii
5.
6.
7
QUALITY ASSURANCE AND CONTROL
31
REQUIREMENT FOR QUALITY ASSURANCE(QA)
31
ESTABLISHINGASUCCESSFULQA PROGRAM
31
DEVELOPMENT AND IMPLEMENTATIONOF QA/QC SYSTEMS
32
QUALITY MANAGEMENT SYSTEM
32
PRODUCT QUALITY MONITORING
33
MoNITORINGBY GOVERNMENT AND BY CONSUMERS
34
DETERMINATION OF LEVEL OF FOR11FICATION
34
REFERENCES
35
LEGISLATION AND REGULATIONS FOR FOOD FOR11FICATION
37
REFERENCES
38
REVIEW OF RESEARCHANDCURRENT PRACTICESIN MICRONUTRIENT FORTIFICATION
39
SINGLE FORTIFICATIONWITH IODINE
SALT
39
39
WATER
41
OTHER VEHICLES
42
SINGLE FORTIFICATIONWITH IRON
WHEATFLOURAND BREAD
MILK AND MILKPOWDER
INFANT FOODS/FORMULAS
BISCUITS
RICE FLOUR
43
43
46
47
50
52
FISH SAUCE(NAMPLA)
52
54
CURRY POWDER(MASALA)
56
OTHER VEHIClES
57
SALT
SINGLE FORTIFICATIONW1H VITAMIN A
FATS AND OIlS
SUGAR
MILKAND MILK POWDER
RICE (ULTRA RICE)
TEA
MONOSODIUM GWTAMATE (MSG)
OTHERVEHICLES
REFERENCES
iv Mkronutrient Fortification of Foods
58
58
60
63
65
66
69
72
74
8.
OPPORTUNITIES FORMULTIPLE FORTIFICATION
81
DOUBLE FORTIFICATIONWITH IODINE AND IRON
81
SALT
81
FISH SAUCE
82
82
82
86
86
DOUBLE FORTIFICATION WITH IRON AND VITAMIN A
RICE
SUGAR
BLENDED/FORMULATEDFOODS
88
89
MAIZE
WEANING RUSK
OTHERVEHICLES,e.g., MONOSODIUM
90
GLUTAMATE
MULTIPLE FORTIFICATION WITH IODINE, IRON, AND VITAMIN A
CEREAL-BASEDFLOUR
INFANT FOODS/FORMULAS
92
92
PROCESSEDBEVERAGES
FORTIFICATIONOF FOOD AID
9.
90
90
90
REFERENCES
94
IMPLEMENTATION ISSUES AND RESEARCHNEEDS
97
IMPLEMENTATIONISSUES
97
RESEARCHNEEDS
97
RECOMMENDATIONS
98
APPENDICES
100
1.
POTASSIUM IODATEPRODUCERSAND QUALITY SPECIFICATION
100
2.
A.
B.
COMMERCIALLYAVAILABLEIRON COMPOUNDS AND THEIR RELATIVECOSTS
101
RELATIVECOSTS OF COMMONLY USED IRON SOURCES
102
3.
COMMERCIALLYAVAILABLEVITAMIN
A.
B.
VITAMIN
A ANDCAROTENOIDSIN FOOD FORTIFICATION
A USED IN FOOD FORTIFICATION
SOME APPLICATIONSOF CAROTENOIDSAS VITAMIN
A PRECURSORS
103
103
104
4.
COMPOSITION OF SOME FORTIFICATIONPREMIXES PRODUCEDBYDIFFERENTMANUFACFURERS
105
5.
ACRONYMS AND ABBREVIATIONS
106
MicronutrientFortification of Foods v
PREFACE
Deficiencies in three micronutrients— iodine, iron, and vitamin A — are widespreadaffectingmore than a
third ofthe world'spopulation. Individuals and families suffer seriousconsequences including learning disabilities, impaired workcapacity, illness, and death.Theycould waste as much as 5°Io ofgross domestic product
(GDP). Addressingthem comprehensively, using an array of low-costsolutions, could cost less than 0.3°Io of
GDP. In the words of the World Bank in its recentpublication"Enriching lives"". . . No other technologyoffers
as largean opportunity to improvelives . . . atsuch low cost and in such a short time
Many national governments atthe World Summit for Childrenset the target to eliminate deficiencies in
micronutrientsin populationsthroughoutthe worldby the year 2000. The basicobjective of all national
micronutrientprogramsis to ensurethat needed micronutrientsare available and consumed in adequate
amountsby vulnerablepopulations.Strategies should be appropriateto the needand should use existing
deliverysystemsand availabletechnologieswhere they servethat need. Acombinationof interventions
involving the promotion ofbreastfeeding,dietary modification(e.g., improving food availability and increasing
food consumption), food fortification,and supplementationmayneedto be emphasized and implemented.
The fortification of commonlyeaten foods with micronutrientsis one ofthe main strategiesthat can be used to
improvemicronutrientstatus. Fortificationshould be viewed as partof a rangeofmeasures that influence the
quality offood including improvedagriculturalpractices, improvedfood processing and storage,and improved
consumereducationto adopt good food preparationpractices.
Today,in deveJoped countries where there is a highdependence on processed foodsand industriesare streamlined and automated,food fortification has played a major role in the health ofthese populationsover the last
40 years, andseveral nutritional deficiencies have been eliminated. In the developingcountriestoo,fortification
is increasinglyrecognized as a measure to improvethe micronutrientstatus of large populations.When
fortification is imposed on existing food patterns, itmaynot necessitate changes in the customary dietof the
population and will not call for individual compliance. Thus, fortification can oftenbe implementedand sustained over a longperiod. It can, therefore, be the most cost-effective means of overcomingmicronutrient
malnutrition.
The food industry is playing an increasinglycritical and complexrolethroughout the world. In the developed
countries,changes in livingand marketplacepatternshave stimulatedchanges in food industry practices,
resulting in a diversity offood-processingtechnologiesand ever-changingnumbers and types offoods on the
market shelves. As the food industry is increasinglydriven by market forces into the global marketplace it is
faced with a significantly differentscenario. In marked contrast to the developed world, most developing
countriesare grappling withfundamental issues of providing adequate food suppliesto feed their expanding
populations.
Simple nutritional and technologicalsolutions to the problemsofmicronutrientmalnutrition exist but are often
complicated by economic, social, and political factors.Interventionstrategiesmust take thesefactors into
account. This is the challenge, as well as the opportunity,for the food industry to play a key role in improving
the physical,social, and economic well-being of billions ofpeople.
This manual has beenprepared to facilitateand encourage large-scale implementationof fortification programs
in countries where micronutrientmalnutrition is prevalent. It respondsto a long-feltneedfor a comprehensive
documentationof technologiesand opportunities for fortification.
Giventhat technologiesare in different stages of developmentand application,an attemptis also madeto
review criticallythe status ofthesetechnologiesand identify the steps involved in refining themfor large-scale
application.In addition, the manual appraisestheir technologicalfeasibility, practicability, cost effectiveness, and
consumeracceptability. An annotatedbibliography on food fortification,containingmore than 500 references
with abstracts, including the references mentioned in this manual,will be publishedas a companionvolume.
It is hopedthatthis manual will be a useful reference for national micronutrientprogram managersand food
MicronutrientFortification of Foods vii
industry managersto planand expandfood fortification as a long-termand sustainablesolution to the global
problem ofmicronutrientmalnutrition.
This documentis a productofa unique collaboration between the InternationalAgriculturalCentre (IAC) in the
Netherlandsandthe MicronutrientInitiative (Ml) in Canada. It has also evolved out of experience gained in
organizingthe short-termtraining course in food fortification at the IAC. The authorsare gratefulto Ms i.
Cervinskas (Ml), and Ms F. de Boer(IAC) for overall technical review of the document.
Specific chapters have also benefited greatlyfromcritical reviews and inputs fromexpertsin nutrition and from
the food industry, especially Dr DavidYeung(Heinz Canada), Dr George Purvis, Dr Haile Mehansho(Proctor
a
Gamble), and DrFrits van der Haar and Dr Robin Houston (Programme AgainstMicronutrientMalnutrition
(PAMM), Emory University). Ms M. de Kort (IAC) provided technical assistance to review projectexperiences in
micronutrients.Special thanks are also dueto Ms KatherineKealeyfor editing and productioncoordinationand
Mr Bob Albery for layout and design, and to Ms Alison Ball (IDRC Library)who assisted withthe librarysearch
for relevantinformation andpublicationsand MsTanya Guay and Ms Alison Greig (Ml) for their administrative
assistance.
The support from the Governmentofthe Netherlandsfor the printingand distribution ofthis publicationis
gratefully acknowledged.
Mahshid Lotfi
M.G. Venkatesh Mannar
The MicronutrientInitiative
Richard J.H.M.Merx
Petra Naber-van den Heuvel
InternationalAgriculturalCentre
viii Micronutrient Fortification of Foods
INTRODUCTION
1.
THEPROBLEM OF MICRONUTRIENT MALNUTRITION:
MAGNITUDE, CONSEQUENCES, AND CAUSES
•
A significantproportion ofthe world'spopulationsuffers from,
or isatriskof, deficiencies ofvitaminsand minerals,commonly referredto as micronutrients. Adequate intake and
For all three micronutrients, prevalencerates are muchhigher
in developingrelative to developedcountries.Iron deficiency,
however, is so prevalentthat even in developednationsthe
availability of these dietaryessentialvitamins and minerals are
closelyrelatedto the survival,the physical and mentaldevelopment, the general good health, and the overall well-being ofall
individuals and populations.
rates among some pregnantwomen may reach the levelsof
public health significance.
Vitamin A, iron, and iodinearethree major micronutrients
attractingmuch attention,particularly in the last decade.The
reasons behind focusingefforts on reducingthe deficiencies of
these three micronutrients are:
•
•
Basedon availableinformation, vitaminA, iodine,and
iron deficiency anemiaare highly prevalentin the world
today;
Available information points totheserious adverse
consequencesofthese deficiencies for physical and
mental health,education,work capacity, and economic
efficiency;
•
•
Although someofthe obvious clinical consequencesof
micronutrient malnutrition have been known for a long
time, the globaldimensionsand broadspectrum of
detrimentaleffects of evenmild micronutrient deficiencies on physical and mentaldevelopment,mortality,
and morbidity have been recognized only recently;
The extent ofthese deficiencies at populationand
individual levelscan be measured relatively accurately;
and
Solutions for eliminatingthese deficiencies are known,
arefairly easy to implement,and are cost effective.
Therehave been severalstudies to identify the extentand
severityof micronutrient malnutrition in developingcountries.
Its distribution is illustratedin Table 1-1.
IODINEDEFICIENCY DISORDERS(IDD)
Iodine deficiency is probablythefirst nutritional disease
recognized by mankind, as both effects of iodine deficiency in
theform ofgoitre and cretinismand its dietarytreatmenthave
been known since ancienttimes. The thyroidgland,requiring
iodinefor producingits hormones,enlargesin iodine deficiency, makinggoitre (enlarged thyroid) the best known sign of
deficiency.Goitre, however, is onlyone indicator, and there are
many deficiencies that may begin before birth and persist
throughoutthe life cycle. Infants born to iodine-deficient
women,if they survive, maybe cretins with short life expectancy, physically ormentallyretarded,and deafor muteand
spastic,depending on the degree ofiodinedeficiency.The term
iodinedeficiency disorders (IDD) has thus been introduced
since 1983to representthis spectrum of physical and mental
deficiencies (Hetzel 1983). Iodine deficiency is the most
commoncause of preventablemental retardation.
Today, roughly 1.6 billion people live in areas where soils lack
sufficient iodine.About655 million people have goitre,
Table 1-1. Population at riska of and affected by micronutrient malnutrition(in millions).
Africa
181
86
53
49
206
Americas
168
63
16.1
20
94
SoutheastAsia
486
176
126.5
69
616
Eastern Mediterranean
173
93
16.1
22
149
Western pacificg
423
141
42.1
27
1,058
1,572
655
Total
254
2,150
aNumberof persons living inareasat risk of IDD and numberof preschool children living in vitamin Adeficientareas.
bWHOregions.
CSource:WHO 1994a.
dRefleestimatesonly fromdata availableto WHOin 1994(source: WHO 1995).
epopulationaffected bysubclinical,severe, andmoderatedeficiencies.
Preschoolchildrenonly (source: WHO 1992,1994b). lncludingChina.
Current Practices, Research,and Opportunities 1
whereas43 million are affected by somedegreeof mental
impairmentofwhich 6 million are cretins.More than half of the
affected individuals live in China and India.
By far, the major cause ofIDD is a low iodine contentin the
soil and local environment.There are large areas, particularly
mountainous and flooded riverines,that are deficient in iodine.
The situation is further aggravated by mankind's own misdeeds:deforestation accelerates soil leaching, which, in turn,
washes away the iodine from the topsoil. Foods grown and
consumed on iodine-deficient soil will notprovide enough
iodineto the population and livestockin the area. Entire
communitiescan thusbe affected by thesedisorders.
The aetiologyof iodine deficiency is differentfrom the other
two micronutrientdeficiencies in that itmainly results from
geological rather than socialand economic conditions.The
effects of iodine deficiency, however, may worsenwhen
combinedwith poverty, generalmalnutrition, poorsanitation,
and area remoteness with littlecontribution of food to the diet
from outside an iodine-deficient area.
IRON DEFICIENCY ANEMIA (IDA)
Iron deficiency anemia (IDA) is the world'smost prevalent
nutritional deficiencymaking up about half ofall the different
types of anemias. Accordingto the World HealthOrganization
(WHO), more than 2 billion peopleare at risk of IDA orare
affected by someformofanemia.Almost half ofall women and
children in developingcountrieshave anemia. Childrenwith
IDAsuffer impaired mentaland physicaldevelopment.
Pregnant women and young childrenwith IDA have a significantly diminishedability to combat infection. IDA in adults
causes fatigueand contributesto low workcapacity. Moreover,
iron deficiencyin terms of deficientiron stores in the body can
exist withoutclinicalanemia.
Iron is found in animal productssuchas red meat and in
vegetables, grains,and legumes. Red meatprovidesreadily
absorbable iron, but iron from plant sources is much less
absorbable. Absorptioncan be enhanced if meat is part ofthe
diet or iffoods rich in vitamin C are consumed at the same
time, In fact, a major cause of IDA is the low bioavailabilityof
iron in largely cereal- and legume-based diets leadingto poor
absorptionofthe iron fromdiets. In such instances, the iron
status ofthe population can be improvedby modificationof
dietary habitsand theapplicationof appropriatefood process-
ing techniques.
VITAMIN A DEFICIENCY (VAD)
Vitamin A deficiencyhas longbeenidentified as a serious and
preventable nutritional disease, but the extent to which
populationsare affected by it and the implicationsof the effects
for survival and health have onlybeen realized more recently.
Basic research has conclusivelydemonstrated the far reaching
biological effects of vitamin A deficiency.
2 MicronutrientFortification of Foods
VAD begins as a silent, unseenthreatthat, if untreated,can
eventually rob children oftheireyesight and their lives. The
progressiveeffects of vitamin A deficiencybeginwhen a child
can no longersee in dim light and thussuffersfrom whatis
known as "night blindness" orxerophthalmia.As the affliction
continues,the eye's conjunctivaand corneabecome dry,
lesionsthen appear on the corneaand, in the severest (clinical)
form, the corneasimply melts away causingpermanent
blindness. Although clinicalvitamin A deficiencyposesa major
threatto children'shealth, thosewith mild xerophthalmiaor
subclinical vitamin A deficiencyare also at increased risk of
sufferingfromcommonchildhood illnessesfound in most
developingcountries.These include in particularmeasles,
respiratorytract infections, and diarrheal diseases. Children
who have adequate vitaminAstatus or thosetreatedwith
vitamin A, however,have immune systems that are better
equippedto deal with problemsassociated with diseases like
measles.
Vitamin A deficiencyexists in more than 60 countries,at a
clinical and/or subclinical level. Based on the available data
projected to reflect conditionsin 1994,the global estimates of
the numbersofchildren 0—4 years of age clinically affected by
vitamin A deficiencyis 2.8 million, and thoseseverely!
moderately subclinicallyaffected is 251 million (WHO1995).
Thus, at least254 million children of preschoolage are "at
risk" interms of their health and survival. VAD is the second
largestcause ofglobal blindnessnext to cataracts.
The major causeof vitamin A deficiencyis inadequate dietary
intakeof the preformed retinol or precursors ofvitamin A.
Increased vitamin A requirementin certain physiologicalor
pathologicalconditions,inadequate absorption, or loss of
intestinal contents in diarrheaare often contributoryfactors in
establishingvitamin A deficiency.
ELIMINATION OF MICRONUTRIENTMALNUTRITION:
AN OPPORTUNITYTO IMPROVELIVES
of essentialmicronutrientscauses learning disabilities, mental retardation,poor health, low workcapacity,
blindness,and prematuredeath.The adverse effects of
micronutrientmalnutrition for survival, growth, development,
and quality of life through a widespectrumofspecificdisorders
Deficiency
are now known betterthan ever before. Together, these
disordersrepresent a loss to the socialand economic potential
ofnational societies thatno country can stand to afford.
The arguments for accelerating investment in eliminationand
controlof micronutrientmalnutrition are compelling.Such
investmentspromotechances for survival, physicaland mental
health and well-being, productivity,and economic improvement. In fact, accordingto a World Bank publication (World
Bank 1994) "Deficiencies ofjust vitamin A, iodine, and
iron. could waste as much as 5 percentof gross domestic
product(GDP), but addressingthem comprehensivelyand
sustainablywouldcost less than 0.3 percentof GDP:'
GENERAL FEATURES OF INTERVENTIONS AND THEIR
APPLICATION
Globalattention to understandbetter and to controland
eliminatemicronutrientdeficiencies reached a highlevel when
in 1990 specific goals for the eliminationand controlof
mtcronutrientmalnutrition by the year 2000 were adopted by
heads of states and governments at the World Summit for
Children held in New York. The goals included:
The main interventionstrategies againstmicronutrientmalnu-
•
Virtual eliminationof iodine and vitamin A deficiencies,
Reduction
•
Direct supplementationof vulnerablepopulationsor
groups with micronutrientsupplements,
•
Dietary improvement,and
•
Fortification
of commonfoods withmicronutrients,
These interventionsdemonstrate
and
•
trition are:
of iron deficiencyin women byone-third of
1990 levels.
This political commitmenthas beenreexamined at various
high-level global and regionalmeetingssince 1990. For
instance, at the PolicyConference on Hidden Hungerin
Montrealin 1991, about 250 representatives frommore than
60 governments and major internationaland bilateral agencies
concluded that the World Summit for Children goals were well
within reach of the technical and financialmeansavailable.The
World Declarationon Nutrition proclaimedby ministers of
more than 1 50 United Nations memberstatesat the InternationalConference on Nutrition in Romein 1992 also reiterated
the commitmentsto theseeminent global nutrition goals.
Subsequent tothe commitmentsmade by governmentsat the
World Summit for Children and the InternationalConference on
Nutrition, much groundwork has beendone in manycountries
to accelerate the reductionofmicronutrientmalnutrition.
National programsthat draw on the combinedresources of
government,industry,scientific,and grassrootsorganizations
are being designedand implemented.
As a meansto catalyze and facilitate global actionsfor elimination and controlof micronutrientmalnutrition, the Micronutrient
Initiative was created by its principal sponsors.1 Although a
combination ofthe main three strategiesto overcome micronutrientmalnutrition (supplementationwith highmicronutrient
doses, dietary improvement,and food fortification) is encouraged, micronutrientfortification of foods is seen as a sustainable strategythat can oftenbe implementedcosteffectivelyon
a largescaleto cover deficientpopulations. Realizingthatno
other agencies/groups have currently focused their activities in
this field,the Initiative has paid particularattention to micronutrientfortification offoods and food items commonly consumed
by the Third World population to ensurethe realizationof the
full potentialof fortificationas a meansto control and eliminate
micronutrientmalnutrition.
correction
two main approaches to the
ofmicronutrientdeficiency problem:supplementapreparations, which is a medically
tion with pharmacological
based intervention;and food fortification/dietaryimprovement,
which usesa food-based approach to solving thesedeficiencies. In any case, the major aim ofall these strategiesis to
improvethe micronutrientstatus of deficientindividuals,
communities,
and populations.
Supplementationthrough periodic administrationofpharmacological preparationsby injections or in the formofcapsules or
tablets is an effective strategywherebysubstantialand almost
immediatebenefitscan be brought to the most at-risk groups.
In situationswhen there is a clinical urgency, micronutrient
supplementationis of immensevalue to saving sightand life.
The supplementationstrategyis a relatively low-costmeasure
againstmicronutrientdeficiency. It only improves,however,the
micronutrientstatusof thosewho received the appropriately
administeredmedical preparations,leaving behind thosehard
to reach or practicallyunreachable at-risk groups (those who
are probably the most deficientand ill from the effects ofthe
deficiency), as well as other householdand community
members
nottargetedto receive any kind ofsupplementation.
If micronutrientdeficiency existseven in a mild form in the
community,
it can be assumedthatit will persistandcontinue
to harm the health and well-being ofindividuals.
Supplemen-
tationoften requiresa largeforeign currencyinput and an
elaborate and costlydistribution system. Moreover, ifthe
micronutrientsupplementhas to be administeredon a regular
basis (as is the case withlower dosesofvitamin A preparations), "patient compliance" is a prerequisitefor success.
Dieta,yimprovementaims to increase dietary availability,
regularaccess, and consumption of vitamin- and mineral-rich
foods in at-risk and micronutrient-deficientgroups of
populations in developingcountries.Such efforts involve
changes in dietary behaviourofthe targetedpopulation.The
strategyis reportedlyeffective but requires a relativelylong
timeto achieve concrete results.
TheMicronutrientInitiativeis currentlysponsored bytheCanadian International Development Agency (CIDA), the International Development Research
Centre (IDRC), the United Nations Development Programme (UNDP), the UnitedNationsChildren's Fund (UNICEF), andtheWorldBank.
Current Practices,Research, and Opportunities 3
Fortificationof foodswith thosemicronutrientsthat have been
shown to be insufficientin the daily diet has, to a large extent,
beenresponsiblefor the elimination ofvitamin and mineral
deficiencies in developedcountries such as Canada, Switzerland, the UK and the USA. Fortification ofmargarinewith
vitamin D is thought to have eliminatedricketsfrom Britain,
Canada, and Northern Europe in the early part ofthe century.
Fortificationof refined flourwith iron in Sweden andthe USA is
credited withthe dramatic reductionof iron deficiency anemia.
Salt iodization,which beganin 1922,showedimmediateand
spectacular results (BUrgi et al. 1990). Commercial food
fortification is particularly appealingbecause, ifthe right food
is selected, highcoverage is assured. Table 1-2 summarizes
some ofthe advantagesoffortification over high-dosesupplementation.
Because ofextensivedamagesto health and well-being caused
by micronutrientmalnutrition, its elimination bywhatever
means, should be regarded as a moral dutyofgovernments
and internationaland national agencies and donors. Nevertheless, to encourage policymakersto adopt effective and sustainable measures against micronutrientmalnutrition, some
attemptshave been made to computethe economic and social
returnsfollowing investmentsin these areas. An exampleis
given in Table 1-3 where economic returns on investmentin
food fortification or supplementationprogramsrelatedto the
threemicronutrientsare compared. Food fortification is
considerablymore costeffective than supplementationfor
iodine and iron; however, vitamin Asupplementationof
children under 5 yearsof age appears to be more cost effective
than a targetedfortification program for this age group.
Table 1-2. Advantagesof food fortification over high-dosesupplementation.
• Effectiveness and timeframe
• Delivery requirements
• Effective strategy usuallyforshortterm
• An effective healthdeliverysystem
• Effectivemedium-to long-termmeasure
• Asuitablefood vehicle and organizedprocessing
• Reaches only populationsreceiving the service
• Requires sustainablemotivationof participants
• Reaches all segments oftarget population
• Does not require intensivecooperation
• Relatively high financialresources needed
• Lowcostcompared to supplementation
facilities
Coverage
Compliance
and individual compliance ofindividual
•Cost ofmaintenance
—
to maintainthe systemself-financing in the end
• External resources
• Foreign currency or externalsupportrequired
• Adequate technology that is locally available
• Relatestocompliance and existingresources
• Fortificantcompounds may needto be imported
for obtainingsupplements
• Sustainability
Table 1-3.
Comparison
or can be easilytransferred
ofreturns on nutrition investment in supplementationand food fortifkation programs (in US$).
Iodine
Supplement women ofchild
bearingage
Supplement all under 60yrs
Fortification
Iron
Supplement pregnant women only
Fortification
25
84
13
2000
800
325
22
9
1000
7
4
VitaminA
Supplementation targeted only
to under 5 yrs
Fortification targetedonlyto
under 5 yrs
Source: World Bank(1994).
4 MicronutrientFortification of Foods
29
Fortificationprograms,however, are usually not targetedto any
specificage group and are plannedto coverall population
groups.
The currently underexploitedfood-based approaches, namely
food fortification and dietary improvement,representthe more
sustainable,potentially long-lastingstrategicmeasures. The
process of elimination of micronutrientmalnutrition can,
therefore, be accelerated iffortification ofappropriatefoods
with appropriatemicronutrientscan be includedin national
programsofthose countriesin which suchmicronutrient
deficiencies are prevalent.
REFERENCES
Burgi, H.; Supersaxo, Z.; SeIz,B. 1990. Iodinedeficiency
diseases in Switzerland one-hundred years afterTheatre
Kocher's survey: Ahistoricalreviewwith somenew goitre
prevalence data.Ada Endocrinologica (Copenh), 123, 577—
590.
WHO (World Health Organization). 1992. Nationalstrategies for
overcomingmicronutrientmalnutritionEB89/27.45th
WorldHealthAssemblyProvisional AgendaItem 21; Doc.
A45/17. WHO, Geneva, Switzerland.
1994a. Indicators for assessing iodinedeficiency disordersand
their controlthroughsalt iodization.WHO/UNICEF!
ICCIDD.Doc. WHO/NUT/94.6.WHO, Geneva, Switzerland.
1994b. Indicators and strategies
foriron deficiency and anemia
programmes. Draft reportofthe WHO/UNICEF/UNU
consultation. Geneva, 6—10 December 1993. WHO,
Geneva, Switzerland.
1995. Global prevalence ofvitamin Adeficiency. WHO,
MicronutrientDeficiency InformationSystem (MDIS)
WorkingPaper Number2. WHO/UNICEF. Doc. WHO/NUT!
95.3. WHO,Geneva, Switzerland.
WorldBank. 1994. Enriching lives: Overcoming vitamin and mineral
malnutritionin developing countries. TheWorld Bank,
Washington, DC, USA. 73 pp.
FAO/WHO JointExpertCommillee on Nutrition.1971. Eighth report.
Food fortification. FAO Nutrition Meetings
Report Series No
49. Food and Agriculture Organization
(FAO)/World Health
Organization (WHO), Geneva, Switzerland.
Current Practices, Research,and Opportunities5
6 Micronutrient Fortification of Foods
2.
DEVELOPING A FOOD
FORTIFICATION PROGRAM
RATIONALEAND OBJECTIVES
•
To increase the nutritional quality ofmanufacturedfood
products that are used as the sole source of nourishment, e.g., infant formulas orformulated liquid diets
and weaning foods; and
•
To ensure nutritional equivalency of manufactured food
products substituting other foods, e.g., fortified margarine as a substitutefor butter.
Food fortification is the addition ofone or more nutrients to
foods. The main objective is to increase the level ofconsumption ofthe addednutrients to improvenutritional status of a
given population. Itshould be noted that the primary role of
food fortification is preventionof deficiency, therebyavoiding
the occurrence ofdisordersthat lead to human suffering and
socioeconomic disadvantages. Nevertheless, food fortification
can also be practiced to eliminateand controldietary deficiencies and theirdisorders.
To describe the process of nutrient addition to foods, other
terms suchas enrichment, nutrification(Harris 1968),or
restorationhave beenused interchangeably, although each
may implya specificcourseof action. Although fortification
refers to the addition of nutrients at levels higher than those
found in the original or comparable food, enrichmentusually
refers to addition ofone or more nutrients to processed foods
at levelsspecifiedin the internationalstandardsoffood
identity. Restoration refers to compensationfor nutrient losses
during processing, and nutrificationmeans making a dietary
mixture or a food more nutritious. Accordingto Bauernfeind
(1994), the term nutrificationis more specificto nutritional
sciences, whereasall other terms have originally been borrowed fromother disciplines orapplicationsthan food use.
The joint Food and AgricultureOrganization/WorldHealth
Organization (FAQ/WHO) ExpertCommittee on Nutrition (FAQ!
WHO 1971) considers the term fortificationto bethe most
appropriateto describe the process wherebymacro-or
micronutrientsare addedtofoods commonlyeaten to maintain
or improvethe nutritional quality ofindividual foods in the
totaldiet of a group, community,or population.It applies
primarily to the use of relativelysmall quantities of added
nutrients/micronutrients.
The terms doublefortificationand multiple fortification are used
when two or more nutrients,respectively, are addedto a food
or food mixture. The food that carriesthe nutrient is the vehicle,
whereasthe nutrient added is calledthe fortificant.
Generally speaking,food fortification can be employedfor the
followingpurposes:
•
•
To correcta demonstrateddietary deficiencyof those
nutrient(s) that are added;
The important steps in developinga genericfood fortification
programare mentionedin Table 2-1on the nextpage. The
generic model is valid for food fortification programsfocused
on single- as well as multiple-fortified products. Adjustments
must be made when designing a specific food fortification
program.
In this document, we are dealingwith fortificationoffoods,
food items,and food mixtureswith only three major
micronutrients:iodine, iron, and vitamin A.
IODINEFORTIFICATION
Iodine deficiencyresults from irreversiblegeologicalconditions,
in the same
deficientsoil cannotimprovethe iodine intake ofan individual
or a community.Among the strategiesfor the elimination of
!DD,presumablythe onlyfeasible,long-term approach is still
the fortification offoods with iodine.
therefore, dietary diversificationusing foodsgrown
Overthe past 60 years, several ways of supplementingiodine
in the diet have beenproposed. A variety ofvehicles such as
salt, bread, sweets,milk, sugar,and waterhave beentried. The
iodizationofsalt has become the most commonlyaccepted
method of iodine prophylaxisin most countriesof the world
because salt is widely and uniformly consumed byall sections
of any population.The process is simpleandinexpensive. The
fortificantscommonlyused are potassiumiodide (KI) and
potassiumiodate (Kb3). lodate is morestable in impure salt
subjected to poor packagingand a humid environment. The
addition does not changethe colour, appearance, ortaste of
salt. Countries with effective iodizedsalt programshave shown
sustainedreductionsin IDD prevalence. In hyperendemic
areas where immediateaction is needed and/or where
logistical problemscould delay the developmentof iodization
programs,the administrationof iodizedoil either by injection
or orally, is the alternativestrategy.
IRON FORTIFICATION
To restore nutrients initially present in significant
amounts in a food but lost as a result of food processing
Compared
and manufacturing;
many investigatorsto bethe cheapest strategy to initiate,
with other strategiesused for correcting iron
iron fortification ofthe diet is considered by
anemia,
deficiency
Current Practices, Research,and Opportunities7
Table 2-1. Steps in the developmentofa food fortification
program.
1.
Determinethe prevalence of micronutrient
deficiency.
2.
Segment the population if prevalence data indicate
the need.
3.
Determinethe micronutrientintakefroma dietary
survey.
tion program is the selection of an iron compoundthat is both
acceptable and well absorbable (Cookand Reuser 1983). It
should be noted that for pregnantwomen iron requirements
are veryhigh during the lasttwo trimesters ofpregnancy. Even
where iron fortification programsare in place, thesegroups
needto continueto receive iron supplementsin combination
with other nutrients suchas folic acid.There are a number of
fortificantscommonlyused for iron fortification such as ferrous
sulphate, elemental iron, ferric orthophosphate, etc. (see
Appendix 2).
4.
Obtain consumptiondata for potentialvehicles.
5.
Determine micronutrientavailability from the
Food fortificationwith vitamin A holds considerable potential
typical diet.
as a tool to alleviatevitamin Adeficiencyby bridging the gap
between dietary intake of vitamin A and requirement. Fortification with vitamin A is a long-term strategy capable ofmaintaining adequate vitamin A status over time. In Guatemala,
fortification ofsugar with vitamin A has provedto be more cost
effective and sustainablethan other strategiesthat are being
6.
Seek governmentsupport (policymakers and
legislators).
z
Seek food industry support.
8.
Assess the status ofpotential vehicles and the
processing industry chain (including raw material
supply and productmarketing).
9.
Choose the type and amountofmicronutrient
fortificant or mixes.
10.
Develop the fortification technology.
11.
Perform studies on interactions,potency, stability,
storage,and organolepticquality ofthe fortified
product.
12.
Determinebioavailabilityof the fortified food.
13.
Conductfield trials to determineefficacy and
effectiveness.
14.
Developstandardsfor the fortified foods.
15.
Definefinal productand packagingand labelling
requirements.
16.
Developlegislation and regulationfor mandatory
compliance.
17.
Promote campaignsto improveconsumer
acceptance.
maintain, reach the largestnumber ofpeople, and guarantee
the best long-termapproach(Cookand Reuser 1983). Iron
fortification does not have the gastro-intestinalside effects that
iron supplementsoften induce.This is a major advantagein
terms ofconsumeracceptabilityand marketing of iron fortified
products.
Targeted iron fortification to thosebeneficiaries who are most
likelyto be iron deficienthas provento be a safe and effective
strategyto combatIDA (Ballot 1989).The choice of approach is
determinedby the prevalence and severityofthe deficiency
(INACG 1977). Acritical step inthe design of an iron fortifica-
8 MicronutrientFortification of Foods
VITAMINA FORTIFICATION
employed.
Most vitamins thatare producedcommerciallyare chemically
identicalto those naturally occurringin foods. Afat-soluble
vitamin (such as vitamin A) is usually prepared in the formof
an oil solution, emulsion or dry, stabilized preparations that
can be incorporated into multivitamin—mineralpremixesor
added directlytofood.
The most important commercial forms ofvitamin Aare vitamin
A acetate andvitaminA palmitate.Vitamin A in the form of
retinol (the important active compoundin suchpreparations) or
carotene (as beta-carotene and beta-apo-8'-carotenal) can be
made commerciallyfor addition to foods. Thesepure chemicals
have mainly beenaddedto foodsas food improversand
colorants,butfoods can also carrythem to increase vitaminA
intake of the populationsconsumingthesefoods. Vehicles such
as sugar,fats and oils, salt, tea, cereals, and monosodium
glutamate (MSG) have beenfortified with vitamin A. For
instance, sugar has beenfortified with vitamin A in Costa Rica,
El Salvador, Guatemala, Honduras,and Panama. Variousoils
and fats have beenselected for fortification with vitamin A.
ROLE OF FOOD INDUSTRY IN FORTIFICATION
PROGRAMS
The food industry plays a key role in anyfood fortification
program in any country. Micronutrientdeficiencies are public
health problems.Manyaspects of a food fortification program,
however, suchas determinationofprevalence of deficiencies,
selection of an appropriateintervention,calculationofdietary
intake levels of micronutrients,and daily consumptionofthe
food vehicle selected or levelsoffortificantsto be added and
even technologydevelopment, should be evaluatedby the
scientificcommunity and health/agricultureauthoritiesand
others.The actof fortification of a food vehiclewith fortificants,
however,is carried outbytheprivate food industry. Unfortu-
in a majority ofcases, ministries ofhealth are often not
able orwillingto exercisecontrol and motivate (private) industry.
Identify mechanismsfor collaborationbetween national
governments,food industry and its marketing system,
and nongovernmentalorganizations(NGO5) and donor
nately,
At best, linkages between the health andindustry/agriculture
ministries are usually weak or nonexistent.In such cases, it
maybe necessary to helpformalize an institutional linkage
betweengovernmentand (private) industry such as those
proposed in Pakistanand the Philippines.Thisinstitutional
model is the independentintermediarybetween governmental
institutions and private industry.
In general,however,national governmentsdo not fortifyfoods
themselves. This is the task and responsibilityofthe (private)
food processingenterprises. Governmentstaffshould act as
advocates, consultants, coordinators, and supervisorsto enable
the food industry to fortifyappropriatefoods effectivelyand
profitably.
The food industry can also play a significantrole in the
relatively long-term food diversificationsstrategythrough
providing improvedpreservationtechniques, improved
semiprocessed foods, and by promoting consumptionof locally
available micronutrient-richfoods in the diet oras a food
fortificant.
Asuccessful approachto the micronutrientmalnutrition
problem through micronutrientfortification offood in a country
is possibleonly if the participationofthe food industry is
incorporated into a national program.The cooperationofthe
food industry should be sought at a very early stageof
program development. Both the promotion and regulative
aspects of a fortification program needto be elucidated. The
positive incentiveswill includethe profitability ofthe fortified
product. Product prices should be at a level that enablesthe
producerto recover the cost offortification plus a modest profit
and ensurethat the consumercan buy a wholesome product
agencies;
•
Assistin the identificationof appropriatefortificants
and food vehicles;
•
•
Defineand developquality assurance systems;and
Participate in promotional and educational efforts to
reach the target population.
Food technologistsworkwithin one or more food chains. They
are, therefore, well positionedas sources of informationwith
regardto raw materialsupply (national or imported),availabil-
ityof processing equipmentand technologies, and the marketing/distribution network for the final products.
The conditions for a successful food fortification program,
supportedbythe food industry and national government,are
summarizedin Table 2-2. Apart from the food industry and the
government,other partnersmay include consumers, educationists/teachers unions,sportor youth clubs, teacher—parent
unions, disabled persons unions, women's organizations,
pregnantwomen's groups,gynaecologists ormidwive's
unions,pediatricianor ophthalmologistunions,the media,
communicationservices, extensionworkers, political parties,
religious leaders, cultural leaders, members of parliament,
Table 2-2. Conditionsnecessary for the success offood
fortification programs.
• Political support;
• Industry support;
• Adequate applicationoflegislation including
for a fairprice.
Food fortification also provides the opportunity for the industry
to diversifyits products range. A positive presscoverage or
promotion ofthe fortified productby governmentcould create
consumer-demandfor the fortified product. Political and
financial positive incentives can be offered in the formoftax
exemptions;import licenses and loans for equipmentand raw
materials;initialsubsidiesto procurefortificants; assistance in
developingan in-process quality controlsystem;trainingof
production, administrative,and marketing personnel;training
ofthe wholesaleand retail sector;and prohibition ofillegal
imports. Mandatory compliance can be ensuredthrough
legislation and regulations(see Chapter 6).
Specifically, the industry (both national and multinational)
needs to:
•
Participate from the very beginning in theplanning of
the national programthat will define a feasiblefortifica-
externalquality control;
• Appropriatefortification level;
•
•
•
Goodbioavailability ofthe compound;
No inhibitory effect of the commondiet;
Human resource training at industry and marketing
level;
•
•
•
•
Consumer acceptability;
No cultural or other objection againstfortified foods;
Adequate laboratoryassessment
status;
of micronutrient
Adequate study design or statisticalevaluation;
• In caseof IDA, absence of parasitismor other
nondietary causes of anemia;and
No constraintregardingprocurement
ofmicronutrients.
tion strategy;
Current Practices, Research, and Opportunities
9
of commerce, etc. Theycan all contributeto the
creationofdemand and/or monitoring ofthe fortified product
and thus to the success of the food fortification program.
chambers
Although simple nutritional and technologicalsolutions to the
problemsof micronutrientmalnutrition exist,theseare often
complicated by economic,social, and political factors.Any
intervention strategymust takethesefactorsinto account. This
is the challenge as well as the opportunity for the food industry. In this endeavour, the food industry can draw uponactive
support from the other sectors. What is urgentlyneededis to
identify a set of priority actionsand initiate a process of
continuousdialogue between the various sectors to move
quickly toward the implementationof schemes thatwill
permanentlyeliminatethe problemsof micronutrientmalnutrition.
REFERENCES
Ballot,D.E.; MacPhail, A.P.; Bothwell, T.H.; Gillooly,M.; Mayet,F.G.
1989a. Fortification ofcurrypowderwith NaFe(l11)EDTA
in an iron-deficient population:initial survey ofiron status.
AmJ Clin Nutr, 49,156—161.
10 MicronutrientFortificationof Foods
— 1989b:Fortification ofcurry powderwith NaFe(111)EDTA inan irondeficientpopulation:Reportofa controllediron-fortification
trial. AmJ ClinNutr, 49, 162—1 69.
Bauemfeind, iC. 1994. Nutrificationoffoods.In Shils, M.D.;
Olson, iA.; Shike,M., ed., Modem nutrition in healthand
disease, Lea and Febiger, 8th edition,Chaper 91, pp.
1,579—1,592.
Cook, iD.;Reuser, ME. 1983. Iron fortification:An update.
AmJ ClinNutr, 38, 648—659.
FAO/WHO Joint Expert Committee on Nutrition. 1971. Eighth
Report. Food Fortification. FAO Nutrition MeetingsReport
Series No. 49. Food and AgricultureOrganization(FAO)/
WorldHealth Organization (WHO), Geneva, Switzerland.
Harris, R.S. 1968. Attitudesand approaches to supplementation of
foods with nutrients. AgrFood Chem, 16(2), 149—152.
INACG (International NutritionalAnaemia Consultive Group).
i
1977.Guidelines forthe eradication of iron deficiency
anaemia. INACG, Washington,DC, USA.
WHO (World Health Organization). 1992. Nationalstrategies for
overcomingmicronutrientmalnutritionEB89/27.45thWorld
HealthAssemblyProvisional AgendaItem 21; Doc. A45/17.
WHO,Geneva, Switzerland.
3.
FOOD VEHICLES AND FORTIFICANTS
Micronutrientfortification offoods commonlyconsumed by a
given population can be a powerfulstrategyto combat
micronutrientdeficiencies in a sustainablemanner. By selecting
the rightfood ingredientto actas a canler (food vehicle) of
specificmicronutrient(s) (fortificant),the needfor encouraging
individual complianceor changes in the customarydiet will be
minimized.
SELECTIONOF FOOD VEHICLES
There arerelevantcriteriafor selectinga food vehiclerelatedto
the following points:
High proportion of the population covered,
Regularconsumptionin relatively constantamounts,
Minimal variation in consumptionpatternbetween
individuals,
•
Minimal regional variation in consumptionpattern,
•
Appropriateserving size to meeta significantpart of
daily dietary requirementof the micronutrientadded,
•
Consumptionnot relatedto socioeconomic status,
•
Low potentialfor excessive intake (to avoid any
probabletoxicity),
•
•
food, or a food accessory item, to act as the carrier for one or
more micronutrients(wherecustomarydiets ofa population
only provide suboptimal levelsoftheseessential
micronutrients).Vehicle selectionshould,therefore, be guided
by all thesefactors.
SELECTION OF FORTIFICANTS
General criteriafor selectionoffortificantsare listed in Table
3-1 and opportunitiesfor food fortification in Table 3-2.
Table 3-1. General criteriafor selectionoffortificants.
.
CONSUMPTION
•
•
•
Local circumstances are important determinantsin selectinga
No change in consumer acceptabilityafter fortification,
and
No change in quality (in a broadsense) as a result of
micronutrientaddition.
Goodbioavailabilityduringnormal shelf life of the
fortified product;
. No interaction withflavour orcolour systems;
• Affordablecost;
• Acceptable colour,solubility, and particlesize;
• Free commercial availability offood grade material;
• Available in encapsulated formif required;and
• Feasibilityof addition and dispersionthrough dry
blending or spray coatingusing premixesif required.
The following fortificationtechnologiesare alreadywell
developed
and widely applied:
• Saltfortification technologyfor iodine
• Vitamin Afortification for oils, fats, sugar, milk, dairy
products,RTEcereals
PROCESSING/STORAGE
•
Centralized processing,
•
Simple,low-costtechnology,
•
Good masking qualities (dark colour and strong odour
ofthevehicleto mask slightchanges to original colour
or odour),
• Iron fortificationfor flour, RTEcereals, weaning foods,
biscuits,bread, milk modifiers
• Multiple fortification of specific products,e.g., milk
modifiers,powders,beverage powders,soup flavouring
cubes, and pasteproducts
SOURCES OF FORTIFICANTS
•
High stability and bioavailability of addedmicronutrient in final product,
•
Minimal segregation
•
Goodstability during storage, and
•
No micronutrientinteraction.
ofthe fortificant and vehicle,
MARKETING
•
Appropriatepackagingthat will ensurestability,
•
Labellingaccordingto prescribedstandards,and
•
Adequate turnover rate.
IODINE
Iodine productionin the world is limited to a few countries. The
principal producers/exporters are Chile and Japan. The Central
Asian Republics, TurkmenistanandAzerbaijan,are also iodine
producers/exporters,although to a far lesserextent.
For iodine deficiency disorder (IDD) control programs, iodine is
usually importedin the formofpotassiumiodate (Kb3).Ifthe
country requirementis large (>30 tons/year), itwill be cheaper
to import elementaliodine and convert it to Kb3. There are
suppliers of potassiumiodate in France, Germany, India, the
Netherlands,and the UK (see Appendix 1).
Current Practices, Research, and Opportunities 11
Table3-2. Opportunitiesfor food fortification.
Milk:
Liquid
Powder
With Cereal
Flours:
Wheat
Corn
Rice
Rice
Snacks
Corn Flakes
Oil
Margarine
Mayonnaise
Juices
+
+
+
+
+
+
+
+
+
+
+
+
o
o
o
+
+
+
+
+
+
+
+
+
o
o
o
+
+
+
+
+
+
+
+
+
x
+
+
+
+
+
+
+
+
+
+
+
+
+
x
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
x
x
x
o
o
o
o
o
o
o
+
+
+
x
x
x
+
x
+
x
PowderBeverages
o
o
+
+
Salt
x
o
Sugar
0
+
+
+
+
.4-
+
x
o
+
+
+
o
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
+
o
+
+
o
o
o
o
o
o
o
o
o
o
o
x
x
x
+
+
x
x
+
x
+
o
+
+
+
+
+
+
+
x
+
+
o
+
+
x
x
x
+
o
+
o
o
+
+
+
+
+= Possible, a=Trialsneeded, x=Not possible,Fe=iron, Ca =calcium,I= iodine.
IRON
When choosingan iron source to fortifya food product,one
has to considerthe influenceof the addediron on the organolepticpropertiesofthe product,whether the iron source is
likelyto besufficientlybioavailable,whether segregation
occurs during mixing or storage, and the cost ofthefood
fortification process. The two principal groups of compounds
are haem iron compoundsand nonhaem iron compounds,
dependingupon theirsources.
Haemiron compoundsare a by-productof bovine slaughterhouses.Haemiron is a very attractivefortificant of foodsof
vegetableorigin, Inhibitors of nonhaem iron compoundsin
vegetablefoods do not interfere withhaem iron. Haem iron,
however,does affectthe fortified productorganolepticallyand
is not suitablefor fortification of many products.A successful
fortification applicationhas been the Chileanbovine-haemoglobin-fortified cookiesprogram (Walter1993; see also
Chapter 7).
The nonhaem iron compoundscan be divided into elemental
iron and nonelemental iron. Commercially availableiron
compoundsare listed in Appendix 2 (INACG 1990).The four
principal iron sources that have had widespreaduse in food
fortification are elementaliron, ferroussulphate,ferric orthophosphate, and sodium ferric pyrophosphate(see Appendix 2
12 MicronutrientFortification of Foods
on commercially available iron compounds). Ferrous fumarate,
ferrousgluconate, and ferroussulphate are commonly used in
mineral supplements(Lee 1979). Sodiumferric ethylenediamine-tetraacetic acid (NaFe111EDTA) is the only nonhaem
iron compoundthat has a good bioavailability (mean
bioavailability of approximately1 0°Io) that is relatively independent of meal composition.It withstands the inhibitory
effects of phytates,a component ofthe staples foods like
cereals and grainlegumes (Lamparelli 1987).
The status ofNaFeEDTAas a recognized food additive is notyet
clear. The Joint FAOIWHO ExpertCommittee on Food Additives
(JECFA 1993) has reached the conclusionthat NaFeEDTAis
safe when used in supervised food fortification programs in
iron-deficientpopulationsand has given provisionalapproval
for its use. Pharmaceutical gradeNaFeEDTAis rather expensive. Averypromising alternativeis the use of Na2EEYIA and
EDTA to iron between 1.0 and
FeSO4 (in the molar ratio of
0.25) in mealswith low iron availability.The cost offood
fortification with NaFeEDTAas a food additive may be reduced
withthe alternative fortification mixture Na2EDTAplus FeSO4
(INACG 1993). Also, a less pure grade (>97°/a) used in the
agriculturalindustry as a fortificant is commerciallyavailableat
lessthan half thecost of the pharmaceuticalNaFeEDTA(Ballot
etal. 1989).
VITAMIN A
Preformed vitamin A or retinol is found in foods of animal
origin, whereasgreenleafy and yellow vegetables and fruits
are rich sources of carotenoids, such as beta-carotene, which
is a provitamin A (i.e., the human body is capable of converting it into vitamin A). Some commonsourcesof retinol are
mother's milk, liver, eggs,butter, and whole cow's milk.
Examples ofcarotenoidsources are greenleafyvegetables,
carrots, yams and squashes, mango, papaya, and plantain.
Red palm oil is naturally rich in beta-carotene. In processing
crude oil to remove undesirablecolour and odour, most of
carotene is lost. Recent new technologies, however,tend to
retain carotene during the refining process (UNU 1994).
Both retinol and carotenes are commerciallyproduced
(Bauernfeind et al. 1986; Klaeui eta!. 1981). The major
commerciallyavailablevitamin A productsand carotenoid
precursors are listed in Appendix 3. Equivalency between
retinyl palmitate and beta-carotene for controlling vitamin A
deficiencywasstudied in Senegal (Carlier et al. 1993).It was
concluded that beta-carotene supplementationwas a promising candidatefor the alleviation of vitamin A deficiency. A
workshop on bioavailability and bioconversionof carotenoids,
sponsoredby the MI and USAIDin 1995,concludedthat
carotenoid-rich fruits and vegetables provide a substantial
and necessary contribution to the requirementsofvitaminA
and some other nutrients of the population at risk of deficiencies ofsuch nutrients.Although the consumptionofthese
valuablesources of micronutrientsshould be promoted,
factorsthat influence theirbioavailability and bioconversion
needto be more clearly elucidated and studied.
STABILITY AND INTERACTIONSIN THE DIET
The stability of the fortificant in the fortified food or the meal
is highlydependenton the chosen compound,the processing
conditions,the characteristics ofthefood, transport and
storageconditions,and food preparationand storagehabits
of the consumer. A field trial,therefore, to establish the impact
of the fortified food on micronutrientmalnutrition and
consumeracceptabilityis a prerequisitefor a food fortification
program.Although knowledge regardingvitamin/mineral
interactionsis limited, it is evidentthatsuch interactions
reduceimpact on nutritional status (Lonnerdal 1986). Some
information on stability and interactions of the mia'onutrient
sources is given in the following.
IODINE
Iodine is normally introducedas the iodide or iodate of
potassium,calcium, orsodium. Potassium iodide (KI) is the
leastexpensive but most unstablecompound.It can easily be
lost ifthe iodized salt is subjected to moist conditions,
excessive aeration, sunlight, heat,relatively highacidity,or
the presence of impurities in the salt. The adverse effects on
potassiumiodide caused by oxidation can be reduced bythe
addition of stabilizerslike sodium thiosulphateand calcium
hydroxideand/or dryingagents such as magnesiumor calcium
carbonate.
In most cases, however,potassiumiodate (Kb3)is the
preferred compound.It is resistant to oxidationand does not
requirethe addition of stabilizers. Kb3 is less soluble than Kl
and it is less likelyto migrateoutof the bag. Calcium iodate
has also beenshown to be stablein impure salts,but its use in
ediblesalt has notbeenwidespreadso far (Bauemfeind 1991).
IRON
In general,the solubility of the iron compoundsis inversely
relatedto the duration of storage. The more solublethe
compound, the greater its chemical reactivity, and the higher
the risk of rancidity. Although ferroussulphateis the most
suitableiron compoundfromthe point ofviewofbioavailability
and cost,it is unstable, The addition of stabilizersproved to
give acceptable results withoutdeterioration ofthe iron
availability (Suwaniket al. 1980).
Ferric phosphateand other insoluble iron compoundsare
stable, butthe iron absorptionis unacceptably low, particularly
when ingested with food.The use ofabsorptionpromoterscan
improvebioavailabilitywithoutdeteriorationofthe keeping
quality (Rao et al. 1975).
Ascorbicacid is a powerlul enhancerof nonhaemiron absorption and can reverse the inhibiting effectof tannins. High costs
and instability during food storage are the major obstacles to
using ascorbicacid in programsto combatiron deficiency
anemia(IDA) (Lynch and Cook 1980). There is evidence that
vitaminC also has a postabsorptiverole on iron metabolism
(Anon. 1987). A number ofstudies (I-lodges etal. 1978;Reddy
1985; and others)reportedthat vitamin A deficiency mightin
some waybe responsiblein causinganemia in man, reversible
by iron only when vitamin A is administered (ACC/SCN 1987).
More recently, Mejia et al. (1992) suggested thatthere is an
interrelationshipbetween vitaminAand iron nutrition.
Improving vitamin A nutrition of underprivilegedchildren
livingin developingcountrieshas a positive effect on their iron
status.
VITAMIN A
Purevitamin A and carotenoid structures are fairlystablewhen
heatedto a modesttemperature, in an inert atmosphereand in
the dark,but are unstablein the presence of oxygenorairor
when exposed to ultraviolet light.Vitamin A is quite stablein
an alkaline environment.The food fortification industry has
developed vitamin A and carotenoid structures withaddition of
antioxidantsas stabilizing agents(Bauernfeind et al. 1986;
Klaeui etal. 1981).
Tests in Brazil have shown that vitamin A palmitateaddedto
soybean oil was stable (99°/o retention) for up to 9 months of
storagein sealed metal cans. Cookingtrialsinvolving cooking
Current Practices,Research, and Opportunities 13
rice and beans withfortified soybean oil indicated that retention ofvitamin A in cookedrice was 99% and in beans it was
88% when cookedby boiling for 90 minutes and 900/a when
cooked under pressure. Trialswith oil for fryingpotatoesunder
repeated conditions of deepfryingat 1700C and storage
indicated that, although there was a progressiveloss with
repeated frying, 58% ofthe vitamin A was still retained after
four repeated fryings of potatoesin the sameoil.
COST OF FOOD FORTIFICATION
The cost offortification varies over a wide range dependingon
the vehicle and the fortificantto be added. Vitamin—mineral
premixesare now utilized by manufacturers for uniform
addition to foodsandto reducecontrolcosts. Certain typical
valuesto indicatethe order ofmagnitudeare given in Table 3-3
(Mannar 1993).
These are onlyapproximatecostsand indicate the order of
magnitudefigures for actualprocessingand chemical costs at
source. They exclude costs related to program management
and productpromotion/marketingand monitoring. Oftenthe
extra cost at source when passedon to the consumertendsto
getmagnified at the various stages ofdistribution because the
marginsat everylevel will also increase proportionately.The
ultimate cost to the consumer, therefore, will be progressively
inflatedas the food passes from producerto retailer.This is
again an economic questionthat may need investigationon a
case-by-case basis. Anothermajorsourceofcost is incurred in
controllingthe levelsaddedto ensureconsistency withthe
label declaration (Clydesdale 1991,p. 95), although this cost is
lowered if analyticalequipment,personnel,and expertiseare
available.At least a part of the cost increase related to fortifica-
Table 3-3. Dosageand approximatecost of fortification.
Fe(ll)sulphate +
Na-acid pyrophosphate
1,000 ppm Fe +
2,500 ppm +
12—18(1991)
+
Na-acidsulphate
5,000 ppm
K-iodide÷
50 ppm 12 +
Fe(II)fumarate
1,000 ppm Fe
K-iodate+
Fe(II)sulphate +
20 ppm 12 +
1,000 ppm Fe +
India ++
12—20(1990)
12—20 (1992)
lndiaa
Na-polyphosphate
10/0 Na-polyphosphate
Vitamin A 250CWS
15,000 lU/Kg
29 (1994)
Guatemalaa
NaFeEDTA
1.3°/o Fe
10(1981)
Guatemala ++
Wheatflour
Elemental iron
25—35 ppm
1.5 (1980)
Severala
Cookingfat
Vitamin A
50,000lU/Kg
30—40 (1988)
Severala
Biscuits
1-laem iron concentrate
1.8 gHb/30 g
108 (1981)
Chile +
Edible oil
VitaminA
20 IU/g
n/a
Pakistana
Margarine
VitaminA
375 RE/15g
20 (1994)
Philippinesa
Fish sauce
NaFeEDTA
1
5—15(1970)
Thailand++
Monosodium
VitAPalmitate 250 CWS
175,000 lU/kg
6 (1988)
Indonesia
Iron
Vitamin A
(plus Niacin,Thaimine,
and Riboflavin)
20—50 mg/kg
7—8 (1994)
Venezuelaa
Sugar
mg Fe/mi
+
glutamate
(MSG)
Comfiour!
Wheatflour
= pilot; ++= laboratoryscale;n/a= notavailable.
acammercial scale;+
14 MicronutrientFortification of Foods
39,000lU/kg
tion should initially be subsidized(as fundingfor a nutrition
intervention). Gradually, the entire cost could be passed on to
setting providesan important sectionof data that are necessaryfor establishingdietary requirements for nutrients.
the consumer.
The three factors involvedin determiningthe bioavailability of
BIOAVAILABILITY AND BIOCONVERSION OF
MICRONUTRIENTS
a food, meal,ordiet are:
The termbioavailabilitygenerally refers to the extentto which a
nutrient is capableofbeing absorbed(i.e., entersthe blood
system)to be utilized within the body. The proportion ofa
nutrientthat can beabsorbedis largely relatedto the functions
of the digestivesystem,the form in which the nutrient is
ingestedand its concentration (i.e., whether it is present in
physiological or pharmacologicaldoses), the compositionof
the food vehicleand its intestinal motility and other dietary
components,or even certaindrugs taken concurrently. Other
factorsmay includethe health and physiologicalstatus ofthe
individual who consumedthe nutrient in question. For example, factorssuch as gastrointestinalmotility, the immaturity of
intestinal functions in infants, or changes in the efficiency of
absorptionthat occurwithage mayinfluence the bioavailability
of nutrients ingested.
Other constituentsofthe foods or the meal,or both, can modify
the absorptionprocess. Interactionsbetween components ofa
dietary mixture withinthe intestinal contents can either inhibit
orenhancetransport of the nutrientthrough the mucosa. For
instance, excessive intakes of certainforms of calcium can
decrease iron absorption. This, however,is thought to be due
to competitionat the intestinal absorptionsite rather than to
food interactions. In additionto the interactions between dietary
components,therefore, interactions between the dietary
componentsand the intestinal mucosatransport system may
occur. Accordingto Clydesdale (1989), itis not only essential
to knowthe major physicalandchemical propertiesthataffect
bioavailability but also to understandhowthesemaybe influenced byfood composition, processing, andstorage conditions.
Some transport systems are controlledbythe nutritional status
ofthe person consumingthe diet. Iron status, for example,is
decisivefor the absorptionof iron. When iron status is low, iron
absorption is enhanced and when iron status is within normal
ranges,iron absorptionis restricted. This formof individual
physical control is limitingthe developmentof predictive
equationsand "rules of the thumb" that are practical in the
food fortification field.
The conceptof bioavailability is central to one of the key goals
of the nutritional sciences, i.e., the relationshipbetween the
compositionofthe diet andthe nutritional responses to the diet
by the organism(see Southgate etal. 1989).Micronutrient
malnutrition, especiallyIDA, may occuras a result ofa low
bioavailability/bioconversionofthe micronutrientin its dietary
and physiologicalsetting. IDA may even occurin cases where
ingestionis well in excess ofphysiological requirements.
Knowledgeof the bioavailability ofa nutrient in its dietary
•
•
Availability in the intestinal lumen for absorption;
•
Utilization in the body.
Absorptionor retention inthe body,or both; and
Ofthesefactors,utilization of the nutrient in the body is the
central feature. The degreeofutilization in the body depends
on physiologicalfactors and on the nutritional statusofthe
organism.
Bioavailabilitycriteria of a nutrient are:
•
The nutrient must be presentin a form that can either be
transporteddirectlythrough the intestinal mucosa, or
the ingested nutrient must be convertible into a form
that can be transportedthrough the intestinal mucosa;
and
•
The absorbed form must be capable of being metabolized, or the absorbed form must be capable ofparticipating in metabolism.
Thebioavailabilityofa nutrientin the diet is thus a functionof:
•
The form in which the nutrient is ingested;
•
•
The extent ofconversion
•
The physiologicalstatus ofthe organismand function of
the digestivesystem.
to absorbable forms;
The compositionofthe diet, including concurrent ingestion of certaindrugs; and
In any food fortification program,the bioavailabilityofa
nutrient in its dietary context, the food consumptiondata of the
target population,and the prevalence rate of thosenutrient
deficiencies to be controlled/eliminatedbythe plannedfood
fortification program are among someofthe major determi-
nants ofthe level of vehicle fortification. It should, therefore, be
noted that it is the total diet (or meal),and not the nutrient per
se, that significantly influences the bioavailabilityofthe
separate nutrients.
BIOAVAILABILITY OF IODINE
Inorganiciodide is readily and completelyabsorbedfromthe
gastrointestinaltract and mostly storedin the thyroid gland.
Excess iodine is readily excreted bythe kidney. Other forms of
iodine are reduced to iodide before absorption(Pennington
1988). Goitrogens such as thiacyanates can block the uptake
of iodine by the thyroid gland.
BIOAVAILABILITY OF IRON
The iron in the dietmaybe presentas haem iron (fromanimal
foods)or nonhaemiron (from foods of plant origin). In the
Current Practices, Research,and Opportunities15
intestine,thesetwo forms are absorbed by differentmechanisms. Because haem iron is more easily absorbed fromthe
diet than nonhaemiron, its bloavailabilityis higher than thatof
nonhaemiron. As a generalrule, scientistsassumethat 25%
of the haem iron from the diet is availablefor utilization by the
human body.Thisfactor of 25% is fairlyconstantand irrespective of other substances in the diet.
fibre reduces the bioavailability of vitamin A if consumed
within the samemeal. The bioavailability of carotenoidsis also
dependent on the level and typeof fat in the meal.The actual
bioavailabilityof carotenoids can be as low as 10/0. Mild
cookingcan enhance the bioavailability by releasingthe free
carotenoids fromthe carotenoid—protein complexes in green
leafy vegetables, but overcookingcan destroyany positive
Generally, the bioavailabilityof nonhaem iron is much lower
and also much more variable. Table 3-4 shows majoriron
effect (Fairweather-Tait 1993).
compoundsused in food fortification andtheir relative
bioavailabilityand cost.
There is no universalspecificationfor the level offortification of
If provided within the samemeal, the following substances will
improvethe absorptionof nonhaemiron: meat, amino acids,
vitamin C, and EDTA. The absorptionlevel,however,never
reaches that of haem iron. Tannins (tea), phytates (legumes and
cereal bran), oxalates, and calciumare dietary substances that
inhibitthe absorptionofnonhaem iron from the same meal.
Bioavailabilityof elemental iron powder increases as particle
size decreases. The assessment of bioavailabilityof iron from a
diet is, thus, a complexissuethat needs particularattention
when decisionsaremade on the appropriatevehicle, fortificant,
and level offood fortification with iron.
LEVEL OF FORTIFICATION
the chosen food vehicle. Numerous factorsinfluencethe
recommended level offortification and the practical amounts
used should be decidedby the appropriatenutrition authorities, based on sound nutritional surveys.The main determinants ofthe fortification level are:
•
Recommended dietary intake (RDI)
•
Prevalence ofthe micronutrientdeficiency;
•
Percaput consumptionof the food vehicle;
•
Table 3-4. Majoriron compoundsused in food fortification.
Water-soluble
100
89
n/a
1
n/a
2
92
100
4
75
4
Ferric orthophosphate
31
Ferricpyrophosphate
39
4
4
Ferrous sulphate
Ferrous gluconate
Ferricammonium citrate
Ferrous ammonium
sulphate
5
5
Poorly water-soluble
Ferrous succinate
Ferrous fumarate
Ferric saccharate
1
Water-soluble
Elemental iron
Experimental
Sodium iron EDTA
Bovinehaemoglobin
13-90
Depends on food vehicle
n/ab
a Both
10
n/a
bioavailabilityand costare expressedasa percentage relativeto thatof
FeSO4'7H20.
bn/a= notavailable.
Source: Adaptedfrom Hurrell and Cook (1990, p. 57).
16 MicronutrientFortificationof Foods
Extent of processing, transit, storage, and food prepara-
tion losses;
•
BIOAVAILABILITY OF VITAMIN A AND CAROTENOIDS
Ifprovided within the samemeal, fat and proteinswill improve
the bioavailability of vitamin A. Vitamin A deficiency is often
associated with protein or protein—calorie malnutrition.Dietary
ofthe micronutrient;
Current dietary habits ofthe population in questionwith
regardto food selection and preparation;and
•
Other dietary ingredientsaffectingits absorptionand
bioavailablity.
IODINE
The RDI of iodinevaries from 150 to 200 pg/day. The basic
RDI for adults of both sexes is setat 150 pg/day. An increment
over the basiclevel of 25 pg/day inthe RDI is recommended
during pregnancy, and an increase of 50 pg/day is recommendedfor lactatingwomen (NAS 1989).
Currentlevels of iodization in different countries varybetween
20 and 100 ppm iodine (35—165ppm intake). In a given
country,the level offortification maybe changedover time, in
responseto changes in averagedaily consumptionofsalt and
iodine losses duringdistribution and storage.A sample
calculation for fixingthe level of iodizationin salt is given in
Chapter
7 (Table 7-1).
IRON
The RDI ofiron variesby ageand physiologicalgroup and
depends on the iron bioavailability in the diet (Table 3-5).
Menstruatingwomen and teenagegirls requirethe highest iron
intake (40—48 mg/day), whereas the requirementsfor iron in
young children in the age of 1—6years are the lowest (12—14
mg/day), assuming a low iron availability of 5%. Forfoods
with a highiron availability (15°/a) thesefigures should be
loweredby a factorof 3 (FAO/WHO 1988).
Pregnant women needa total of 1,000mg iron during a
normal pregnancy. This needfor iron is not equally distributed
Table 3-6. Estimated requirements for vitamin A (pgretinol
equivalentper day).
Table 3-5. Recommended dietary intake (RDI) for iron
(mg/day).
Adults
Children
Men (>16 years)
Women (menstruating)
Women (postmenopausal)
Women (lactating)
23
11
8
48
24
16
19
9
26
13
0—1
6
9
Children (age in years)
0.25—1
21
11
1—2
2—6
6—12
12
6
12—16(boys)
12—16 (girls)
7
4
5
8
(1,665)
(2,000)
(1,165)
600
15—18
400
(1,330)
600
(2,000)
330
(1,100)
500
(1,665)
300
270
(1,000)
(900)
600
500
(2,000)
Women
Pregnant
women
370
(1,230)
600
(2,000)
Lactating
women
450
(1,500)
850
(2,830)
15—18
girls
boys
Adults
Men
over the duration ofthe pregnancybut variesfrom0.8 mg/day
in the first trimesterto 6.3 mg/day in the third trimester.Even if
the food consumedby a pregnantwoman has iron with a high
bioavailability,the dietalone cannotsatisfy this extra requirement. Administrationofsupplementsmaybe indicated.
The Swiss medical scientistTheophrastusBombastusvon
Hohenheim,betterknown as Paracelsus (1493—1 541)stated:
"Alle Dinge sind Gifft.... allein die Dosemaclit das em Ding
kein Giffiist" ("Everything is toxic... it is the dose which makes
(1,000)
350
12
SAFETY INDEX
(1,330)
500
12—15
13
TOXICITY CONSIDERATIONS
(835)
300
20
There are variations in the consumptionpatterns ofdifferent
socialand economic groups consideringage and physiological
status. The appropriatelevel offortification should be based on
consumptiondata for the food vehiclechosen for fortification
by different socioeconomic and physiologicalgroups in the
population.An exampleis vitamin A and vitaminA precursor
levelsin margarine,33,000IU — B carotene (as colorant),
10,000—12,000lU — the remainderto be supplied by added
vitamin A ester.
(1,330)
400
10—12
40
As shown in Table 3-6, lactatingwomen requirethe highest
vitamin A intake. Accordingto FAO/WHO (1988), the safe
intake level is a factor 2 higher than the critical intake level.
Critical intake level for lactating women is 1,415lU, whereas
for children aged 0—10 yearsit is 585—670IU.
(665)
250
7
VITAMIN A
(1,165)
400
200
12
18
of Fortificants" and Appendix 4 for premixes).
350
1—6
14
Source: Adaptedfrom FAOIWHO (1988).
"Sources
(600)
6—10
23
36
No samplecalculationfor the amount ofiron to be addedtoa
vehiclecan be given because the amountto be addeddepends
on the estimatedbioavailability (see this chapterunder
180
(1,665)
Note: RE (retinalequivalent(= 3.33 IU(internationalunit vitaminAactivity
from retinolL
Source: FAO/WHO (1988).
an item non-toxic:')This statementis still valid today. If a food
fortification program is properly designedand implemented
and the level ofthe micronutrientaddedis carefullyevaluated,
there should be no reasonfor concerns over the possibility of
toxic effects ofthe addedmineralsand/or vitamins. The
benefitsofa food fortification program clearlyfar outweigh any
adverse effects (FAO/WHO 1988). Documented toxic effects
have been few andtransient.Everyfood fortification program
should balanceits beneficial aspects againstthe toxicological
risks, which are verylimited for iodine, iron, and vitamin A.
It is the responsibilityofthe nutritionists/toxicologistson the
program staff to determinethe safefortification levelsof a
micronutrientin the dietary setting. Anyone involvedin a food
fortification program, however, should be aware of the toxicological aspects ofthe fortificant.Apart from the dose,the
exposureperiod is another important factor when evaluating
the toxicity aspects of fortification programs.
The safetyof any ingestedsubstance can de distinguished
accordingto the followingfactors(Marks 1989):
•
The number of dosesand the timeintervalbetween
them,
•
The health status ofthe person (main indicators are age,
pregnancy, and vitamin/mineral status),
Current Practices, Research,and Opportunities17
•
•
Interference by food or food components (like alcohol)
and pharmaceutical (orother) drugs, and
The mode of administration(oralor parenteral),
In general,for vitamins and mineralsthat have a large RDI,
there is littleconcern about toxicity fromindividual foods,
except ifa large spectrumof foods pertaining to an individual's
diet were to be fortified with the samemicronutrient.But a
well-designedfood fortification program should be based on
sound nutritional survey data,taking into consideration in its
design the totaldiet of the target population.
Fortificationwith iodine, iron, and vitamin A is considered to be
safe, provided the fortification level does not exceed the RDI
level ofthe micronutrientin the totaldiet. Table 3-7 gives the
safetyindexesfor the three micronutrients.
The important question to be considered when attemptingto
define toxic thresholds is the characteristics ofthe target
population of a food fortification program.The fortification level
ofa food has to be fixed to a concentration ofthe micronutrient
well below the toxic threshold level for normal individuals. itis
essentiallyapolicymatter to make a dedsion regarding what
proportion ofthe population shouldbe considerednormal
when settingacceptable, safe intake levels. If the target
population includes individuals orgroups of individuals who
mightbe more susceptibleto the toxicity of the nutrient than
the general population safeguards, measures to protectthese
individualsat risk should be incorporated into the food
fortificationprogram.
IODINE
In general, iodine fortification at levelsof up to 200 pg/day
does not give rise to any concerns for toxicity. Iodine intakes of
up to 2 mg/dayhave caused no adverse physiological reactionsin healthy adults and one mg/day producedno indicationsof physiological abnormalitiesin children.
Allergic reactions
to iodine compoundsare always due tothe
organiccomponentof the molecule. Incidentaltoxic reactions
as a result ofan increased iodine intakeafter the introduction
of a salt iodization program have been reported. These cases
are rare and mostly confined to individuals withan underlying
thyroid disease ("hotnodules" of goitrousthyroid tissue,which
Table3-7.Safety of the micronutrients.
RDI
(reconYd
Micro-
Safety
Index
MiD
toxicdose)
nutilent
dietafy
Intake!
Iodine
0.15mg
13
2mg
Iron
18mg
5.5
100mg
Vitamin A
5,000 IU
2—2.4
10,000—1 2,000 IU
(mm
had been present for years)(Lowenstein 1983). Atransient,
slightlyhigher prevalence of hyperthyroidismmayoccurafter
the introduction of an iodization(i.e., salt) program.This effect
istemporal and will disappearwithin a shortperiod. In some
studies,the incidence ofthyrotoxicosishas doubledover
several yearsfollowingintroduction of iodine into iodinedeficentpopulations,butthe incidencethen characteristically
decreases to a level below that existing before correction of
iodinedeficiency(ICCIDD 1995).
IRON
An individual's iron statusregulatesiron absorption to some
extent (Gavin et al. 1994). Asthe iron store increases, the
bioavailability and, thus, the absorptionofthe dietary iron,
decreases. Furthermore, the losses ofiron from the body will
increase because with increased iron stores,desquamated cells
will have a higher ironcontent(Hallberg 1993). For this
reason, there are no reportsof iron toxicity in healthysubjects
fromiron-containingfoods. One exceptionhas beenreported
resultingfrom long-termingestion of homemadebrews in iron
vessels (Gordeuk 1986). Changingbeer-producingand
drinking habits ofthe urban population has significantly
reduced the prevalence and severityofthe dietary iron overload in the urban population. Perhaps only in the rural
population of sub-Saharan Africadoes the issue remain a
public health concern.
VITAMINA
Vitamin Afortification offoods in dosages not exceedingthe
RDI does notcausetoxic effects. Usually, small excesses of
vitamin Afor short periods do not exert any harmful effects.
Sustained daily intakes,from both foods and supplements, that
exceed 50,000 IU in adults and 20,000 IU in infants and
young children may causetoxic effects.
Carotenoids are not known to be toxic. A high intake may,
however, cause a discolorationof the skin, which will gradually
disappearwhen the high intake is discontinued (NAS 1989).
Nevertheless, fortification levelsfor food fortification programs
aimed at the general population have to be establishedwith
extremecaution.
SINGLE FORTIFICATION
In the contextofthis report,single food fortification refersto
fortification offood vehicles with either iodine, iron, or vitamin
A (whetheror notother types of (micro)nutrients are also
addedto the samefood vehicleis not considered here).
IODINE
A variety ofvehiclesfor iodine supplementationin the diet
(M7D/RDI)
Source: AdaptedfromBailey(1991); Clydesdale (1991); Hathcock (1990);
NAS (1989).
18 MicronutrientFortification of Foods
such as salt, bread, tea, sugar,sweets,milk, andwaterhave
beentried over the past 60 years. The iodizationof salt has
become the most commonlyused method of iodine prophylaxisin most countriesin the world. This is because of its
advantagesfrom the points ofviewof uniformity of consumption,universalcoverage, acceptability, andsimple, low-cost
Rice:Because rice is a staplefood for more than halfthe
world'spopulation, and is themain componentofthe diet in
many countrieswhere the prevalence of IDA is high, iron
In Table 3-8, vehicles suitable for single fortification
with iodineare listedand, in Chapter 7 inthesection "Project
Experiences in SingleFortificationwith Iodine;' more information is provided.
technology.
fortification of rice is a logical choice. Since 1949, efforts in iron
fortification have beenmade.There is, however, still no largescaleprogram in operation.Research is now focusingon
multiple fortification of rice with iron and vitamin A (see
IRON
Wheat-flourand cereal-basedfoods:In developed
countrieswheat-flour and cereal-based foods have had
significantsuccess as vehicles for iron. Fortificationof milled
cereals (such as wheat and maize) has also been adoptedin
several countries in Latin America and the Caribbean as a result
Chapter 8).
Currypowderand fish sauce:Dark-coloured foods witha
strong taste like curry powder and fishsauceare particularly
suitablefor iron fortification because the iron sources generally
have a slightlydark colour and oftenhave a metallic taste.
ofgovernmentregulations.
Infant weaning foods: As breastmilkgradually becomes
insufficientto meetthe iron requirementsofa growingchild
Other foods: Foods that have been fortified with iron include
bakery products,beverages, biscuits,low-fat milk, chocolate
milk, maize-flour, margarine,and water. In Table 3-9, vehicles
suitablefor single fortification with iron are listed, and more
information is given in Chapter 7 in the sectionon "Single
Fortificationwith lron
after 6 months,infantfoods and formulas can be used for
supplementation.Theygenerally consistofa cereal (wheat,
rice, maize, sorghum),a high-quality protein compound
(soybean, nonfat drymilk, whey), and a fat component.The
food should be fortified with vitamins and minerals.Small
quantities ofsugar can be added as flavouring. The ingredients
maybe milled and processed, i.e., heat treated, rolled, parboiled, or extruded.In preparationsof infant foodsto be used
in any given area, local ingredientsshould be used as muchas
possible. Ifplanned and prepared appropriately,the resultwill
be a nutritionally improvedproductcomparedto any of the
single ingredientsused in the formulation.The final product
can be sold to consumers as a drink orin a dry form for later
VITAMINA
Sugar: Fortificationofsugar with vitamin A has beensuccessfullyimplementedin several countries in Central Americain the
1970s.
Oils, fats, and margarine:In several countries, margarine,
hydrogenatedoil, and shorteningare being fortified with
vitamin A palmitate.
Monosodium glutamate(MSG):Efforts to fortify MSG (a
widely consumed condiment in Indonesia) with vitamin A are
in progress.
cooking like rice.
Salt:Encouragingresults of iron fortification ofsalt have been
reported from India and Thailand,but more effortsare focused
now on developinga formulation thatwill permit the addition
of both iodine and iron (see also Chapter 8).
Tea:Fortificationoftea withvitamin Ahas beenestablishedin
India and Pakistan and is beingconsidered in Tanzania.
Otherfoods: Food vehicles thatcan be fortified with vitamin
A include milklmilkpowder, whole wheat, rice, salt, soybean
Sugar:Sugaris an attractivevehiclefor iron fortification in
sugar-producing areas like the Caribbean and Central America.
Table 3-8. Food vehicleswith potentialfor single fortification with iodine.
Vehicle
j
Fortlflcant
j
Stability
Status
BloavailabIlity
1
Bread
Potassium iodate (Kb3)
n/a
good
+
(Brick) Tea
Iodine
n/a
good
n/a
Milk
Iodophor
good
n/a
+
Salt(Purified)
Potassium iodide (KI)
poor
good
+
Salt(Impure)
Potassium lodate(Kb3)
fair
good
÷
Sugar
Iodine
n/a
good
lab
Sweets
Iodine
n/a
good
lab
n/a
good
+
Water
12
or Kb orKb3
Note: += ongoing;lab =laboratorystage;n/a=notstated,++ =this is unintendedaddition of iodine through sterilizationof cow udders.
Current Practices,Research, and Opportunities 19
oil, peanut butter, and infant formulas.In Table 3-10,vehicles
suitablefor single fortificationwith vitamin A are mentioned.
When available,more information is given in Chapter 7 (Single
Fortificationwith Vitamin A).
MULTIPLE FORTIFICATION
In the contextofthis report,multiple fortification refers to
fortification of food vehicleswith two or more ofthe three
major micronutrients(iodine,iron, and vitamin A). Fortification
with other micronutrients,such as B vitamins, vitamin C, zinc,
folic acid, etc., is not considered here.
Multiple food fortification may be a wayto address two orall
three major micronutrientdeficiencies in a more cost-effective
manner. Multiple fortification of cereal and weaning foods!
formulas has already beendone successfully. Micronutrient
multimixes for cereals (primarily wheat) in addition to iron
and/or vitamin A often includethiamine, riboflavin, and niacin.
Examples ofcommerciallyavailablecereal fortification
multimixes produced by differentmanufacturers are shown in
Appendix 4. Opportunitiesfor multiple fortification offoods are
still limited. Some possiblevehiclesfor such purposesare
shown in Table 3-11.
Table 3-9. Food vehicleswith potential for single fortification with iron.
Wheatflour
Elemental iron
good
Ferrous sulphate
good
Infantcereals
Infantformulas
Elemental iron
good
fair
Ferrous fumarate
good
good
CSMICSB/WS
Ferrous sulphate
fair
good
+
÷
+
Maize meal
Elemental iron
good
good
+
Potato starch
Ferric chloride
fair
fair
fair
lab
Ferric citrate
poor
discontinued
Ferrous fumarate
n/a
good
n/a
Ferric orthophosphate
good
poor
discontinued
Bovinehaemoglobin
fair
good
exp
-other
Processedcereals
Rice flour
concentrate
Bread
Ferrous sulphate
fair
good
exp
Salt
Premix: ferrous
n/a
good
+
acid-sulphate
Ferric orthophosphate
n/a
good
lab
Ferrous sulphate
Ferricorthophosphate
good
n/a
good
n/a
exp
Ferrous-sodium-EDTA
good
fair
exp
Milkpowder
Ferrous sulphate
fair
fair
exp
Cheese
Ferrous sulphate
good
good
lab
sulphate/sodium- acidpyrophosphate/sodlum-
Sugar
+ ascorbic
n/a
acid
Coffee
Ferrous fumarate
good
fair
exp
Curry powder
Ferric-sodium-EDTA
good
good
exp
Eggs
Ferric citrate
fair
poor
lab
Fish sauce
Ferric-sodium-EDTA
good
good
exp
'IKool-aid'
Ferrous sulphate
fair
good
exp
Note: += ongoing;exp.=experimental/fieldtrials; lab =laboratorystage;n/a = not available.
20 MicronutrientFortification of Foods
Table 3-10. Food vehicles with potentialfor single fortification with vitamin A.
Sugar
Premix:
vit Apalmitate250-SD or
-Iacetate 325-L = peanutoil +
stabilizer
Fats and oils
B-carotene-vit Aester
Cereal grain
VitA palmitateordry retinyl
flour
palmitate
Infantfoods
VitA palmitate
Milk powder
Encapsulated retinyl palmitate
Rice
Premix:
vitApalmitate250-SD+
+ preservatives + I
antioxidants
Tea dust
Tea leaves
VitA palmitate250 SD
VitA palmitate250-SD +vitA
acetate +sucrose + antioxidants +
preservatives
vitAattached to wheat grains
Whole wheat
Premix:
MSG
VitA palmitate250-CWS+
(Monosodium
carbohydrate
glutamate)
+ antitoxidanls+ white
pigmentcoating
Peanut butter
Vitamin A palmitate
Salt
VitA palmitate
Yoghurt
VitA palmitate
Note: +=ongoing;exp =experimental/fieldtrials; lab =laboratorystage; n/a = not stated.
Some possiblevehiclesfor multiple fortification with
micronutrients:
Fortificants
Vehicle
lodine+vitamin A
lodine+iron
Rice, MSG, sugar,wheat
flour, and infant foods
Salt, fish sauce
lodine+iron+vitamin A
Processedfoods and infantfoods
These technologiesare yet to be fullydevelopedas stable
formulations in a way thatthe relativeabsorptionofthe
micronutrientsaddedare not adverselyaffected. There have
beensome scattered effortsto fortifysaltwith both iron and
iodine. The MicronutrientInitiative is currentlyfundinga
research projectwith the UniversityofToronto,Canada, to
investigatethis issuethoroughly by meansofa collaborative
effort among variousinvestigators.The aim of this research
activity is to provide fortified salt with both iodine and iron so
that thesetwo micronutrientsare supplied in the diet in a
stableand bioavailablemanner. Fieldtrialsare now plannedto
test the developed formulation for doublefortified salt in
developingand developed countries.
In recent years, there has been an increased interestfor readymade weaning foodsto supplementbreastmilkafter 6 months
ofbreastfeeding. In most cases, home prepared weaning foods
are the best solution, butthere are several constraints that have
hampered preparationand marketing of local weaningfoods.
Some oftheseare poverty,lack ofcurrentknowledgeand
existence oftaboos, non or irregularsupply of raw materials,
timeconstraints for preparation,shortageof fuel/cleanwater
for cooking, poorhygiene practices, shortstorage time, and
low socialprestigevalue for homemade products. Availability
ofready-made weaning foods can overcome some of these
constraints.
Many effortshave been made to developcommercial, low-cost,
multiple fortified weaning foods. Since the 1950s, large-scale
industrially produced weaning foods have been subsidized by
internationalorganizationslike FAO, UNICEF, and the World
Food Programme (WFP), in an attemptto popularizethe
productsin developingcountries.Nevertheless, experience has
shown that large-scale local productionofweaning foods
hardly met with any commercial success. The use ofthese
productsremainedrestrictedto the urban populationwith
higher purchasingpower. Only Incaparina (Guatamala) and
Pronutro(South Africa) had somesuccess. Other weaning foods
produced on a large scale have never gainedan important
market position. Suparamine (Algeria), Faffa (Ethiopia), Balahar,
Bal Amul, MultiPurposeFood (India),Soy-Ogi (Nigeria), and
Current Practices,Research, and Opportunities21
Table3-11. Food vehicles with potentialfor multiple fortification.
Cereal based food
Fe, 12 and vitA
good
n/a
+
Fish sauce
Feas NaFeEDTA
n/a
n/a
exp
12
as potassium iodate(Kb3)
Infantformula
Fe, vitA (and 12)
n/a
n/a
÷
Maize meal
Feas elemental iron
Vit A as retinyl palmitate
good
fair
fair
n/a
+
+
Milkpowder
Feasferroussulphate (FeSO4) and vitA
n/a
n/a
i-
MSG (Monosodium
Feas ferricorthophosphate
good
good
lab
glutamate)
VitA as vitApalmitate
fair
good
exp
good
good
lab
VitA as vit Apalmitate
fair
good
exp
Fe as ferric orthophosphate
good
fair
poor
lab
n/a
exp
fair
n/a
good
exp
12 as potassium iodide(1(l)
n/a
exp
Fe as ferric ammonium citrate
poor
n/a
good
n/a
lab
Vit Aasretinyl acetate
exp
Feaselemental iron
good
fair
fair
+
n/a
+
or
Fe as zincstearate coated ferrous
sulphate
Rice
VitAasretinyl palmitate
Salt
Weaningrusk
Wheatflour
Fe as ferric fumarate
Vit Aas retinyl palmitate
Note: +=ongoing;exp. =experimental/fieldtrial;lab =laboratorystage;n/a = not available.
Lishi (Tanzania) are examplesofmultiple fortified weaning
foods mostly distributed free (Caritas Neerlandica 1983) for
use in supplementaryfeeding programsby international
In this approach, emphasis is given to the self-sustaining
character andthe gradual expansionpossibilitiesof planned
activities.Projects in variouscountries in Africa, Asia, and Latin
organizationsor governments. In Table 3-11, vehicles
suitable for multiple food fortification are mentioned.Chapter
8 (Opportunitiesfor Multiple Fortification) providesmore
information.
America carried out under the auspicesofthe Netherlands
government(Benin, Burundi, Mozambique), EC (Sierra Leone),
Small-scale productionofweaning foods is often linked to
another developmentprogram,and such products are
predominantlyused in rehabilitationcentres. There are,
however,usesand marketsfor theseproductsoutside
recoveryclinics for malnourishedchildren and charity
programs.Manypoor householdswith weaning-age
children can benefitfromsuchproductsiftheyare appropriatelymade,have high nutritional quality, and can be
afforded bythesefamilies. Production costsare relatively low
when local raw materials,simpletechnology,and local
managementand labour are used.In 1986,the Royal
Tropical Institute (KIT) presented the blueprint for a "new
approach to low-costweaning food production;'based on the
experience of the "Farine Bébé"projectat the CHNO in Benin
(Altes and Merx1985; KIT 1987), which proved to work in
practice.
22 MicronutrientFortification of Foods
CaritasNeerlandica (DominicanRepublic, Ghana,Jamaica),
NOVIB (Ghana), and WFP(Bangladesh, Ethiopia, Kenya,
Malawi, Nepal),haveshown thata tow-investment,labourintensive projectfor manufacturingweaning foods on a semiindustrial scalefrom indigenousraw materials can besuccessful (Dijkhuizen 1992). Although addition of micronutrientsin
most cases was not considered, there are no technological
constraints for multiple fortification ofthese weaning foods.
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M.D.; Macfarlane, B.i.; Mayet,F.; Baynes, R.D. 1987 Curry
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Lee, K.; Clydesdale, F.M. 1979. Iron sources usedin food fortification
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Erdman, J.W., ed., Nutrition interactions. Marcel Dekkerlnc,
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Current Practices, Research,and Opportunities
23
Lynch, SR.; Cook, iD. 1980. Interaction ofvitamin C and iron. United
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Mannar,M.G.V. 1993. Complementarities—Fortification. Paper presented
atthe SCN MicronutrieritForum, Feb 15-16, Geneva.
Marks,J. 1989. Thesafety ofthevitamins: An overview. In Staehelin,
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Bauernfeind, iC.; Lachance,PA., ed., Nutrientadditions to
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NationalResearchCouncil, 10th rev. ed.
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24 MicronutrientFortification of Foods
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Am JClin Nutr, 57, 190—194.
FOOD FORTIFICATION TECHNIQUES
4.
to be added and the suitablefood
vehicleare selected, fortification is donebasically in a mixing
process. The goal is to deliver adequate micronutrientswithout
adverselyaffecting the characteristics of the vehicle.Thisseems
to be quite straightforward,yetfindingthe right processing
point for such additions in the manufacturingchain ofprocessed foods needs carefulconsideration.
density,hygroscopic and electrostatic propertiesof the particles, as well as proportionsofthe components being mixed.
For uniform mixingand maintenance ofmix, homogeneity
during processing, packaging,and storage and distribution,
the ingredient propertiesof all additivesshould be as close as
possible.The largerthe differences, the easier segregation will
FORTIFICATIONPROCEDURES
The choice of mixing equipmentdepends largely on the
requirementsofthe mixing operation.Mixer attributes,which
can greatly affectthe mixingeffectiveness, include mechanical
Once the micronutrient(s)
Dependingon the food processing technologies, different
addition methodshave beendeveloped:
•
Dry mixingfor cereal floursand products,powder milk,
powder beverages;
•
Dissolutionin waterfor liquidmilk, drinks, fruit juices,
and in the waterto be used for making bread, pastas,
and cookies;
•
Sprayingasin iodizationofsalt and corn flakeswherethe
vitamins do not support the cookingorextrusion step;
•
Dissolutionin oilfor the liposolublevitamins for
enrichmentof oily productslike margarine;
•
Adhesionfor sugar fortification where the vitamin A in
powder formis adheredto the crystalssurfaceby a
occur.
energy input, particleattrition, batchsize or size of continuous
flow, and mixing time. Mixers are widely used in the food
industry and are available in a variety ofdesignsand configurations to match the differentrequirements.The main types of
mixers for dry mixing follow.
Batch mixers:In batchsystemsthe micronutrientpremix is
prepared separatelyand a specific quantity is addedto each
batch. The most commonbatch mixers are:
•
Drummixers:The simplest type ofmixers, whichconsist
of a horizontalrotating drum with or withoutribbons.
•
Screwmixers A popular mixer is the "Nauta" mixer, a
vertical conemixer, which consistsofan inverted cone
fitted with circulatingscrew agitators (Fig. 4-1a).
vegetableoil;
•
•
Coatingas in rice where the vitamins sprayedover the
grain must be coatedto avoid the losses when washing
the grains before cooking; and
Extrusionas in rice where vitamins are mixed with
powderedcereal using binding agents and extruded into
whole cereal grains.
The simplestwayto add one or more micronutrienfsto a food
vehicleis to use a mixing procedure. Even when more sophisticatedtechniques (e.g., encapsulation or reconstitutionof rice
grains fortified with vitamin A) are employedin specific
situations and for specific purposes,mixing will still be
requiredfor uniform dispersionin the food vehicle.
•
Ribbonblender:The horizontal ribbon blenderconsists
of a rotating shaft fitted withtwo helical ribbons, which
rotatein opposite directions inside a semicircular trough
(Fig. 4-lb)
•
Continuous mixers For continuoussystems, the
fortificant is addedthrough a volumetricorgravimetric
solids feeder at a rate compatiblewiththe flowrate ofthe
food vehicleto ensurethe correctdosage in the product.
Commonlyused continuousmixers are screw conveyors
(oftenwithcut and folded flights and/or paddles).
Fig. 4-la. The "Nauta" mixer.
Dependingon the nature of the mixed components, various
types of mixes can be distinguished:solid-solid, solid-liquid,
and liquid-liquid. Most dry foodsare fortified using a dry
premix. (Information on procedures/distributorsof premixes
and fortificantscan be obtained fromthe Micronutrient
Initiative.)
SOLID-SOUDMIXING (DRY MIXING)
The most commonmethod offortifying dryfoods with small
quantitiesofmicronutrientsis dry blending, either in batches or
continuouslyor with a combinationof both. Mixingeffectivenessdepends on the ingredient propertiessuch as size, shape,
Current Practices, Research,and Opportunities25
Fig. 4-lb. The Ribbonblender.
Fig. 4-2. Two types ofrotary drumsalt iodizationunits.
SOLID-LIQUID MIXING
If the fortificant or premix is in liquidform then thefortificant
should be fed to the food vehicleby spraying, where the
fortificant is addedin a solution formas an atomizedspray.
Spray nozzles are positionedover a belt conveyoror a screw
conveyoror inside a rotating drum. Both the "Nauta" mixer
and ribbon blenderare used for mixing liquids into solids by
components,as well as proportionsof the components being
mixed. For micronutrientssuchas vitaminA, vitaminC, and
B vitamins, which are subjectto oxidative degradation,
antioxidantsare addedto the premix. Furthermore, exposure
to oxygenanddivalent ions is minimized.
ENCAPSULATION
mounting spray nozzles.
For iodization of salt crystals,drip-feeding,where the fortificant
is addedin solution form tothe dry salt, is still commonly
used, but spray mixing is increasinglypreferred (Mannarand
Dunn 1995). Figure 4-ic is a schematic elevation ofa continuous spray mixing plant for salt iodization.
Forsmall-scale productionof fortified foods, simple low-cost
mixingequipmentcan be used. One can think of handmixing
and the use ofa rotary drum unitthat works likea cement
mixer(Fig. 4-2).
LIQUID-LIQUIDMIXING
For liquidorsemimoist foods, the micronutrientis dissolvedor
dispersedin a liquidvehicle(wateror oil) and subsequently
blendedorhomogenizedinto the product.The mixing is done
in verticaltanks filled with turbine or propelleragitators.The
effectiveness ofthe mixingdepends upon a number of factors
such asviscosity,flowingcharacteristics, and mixability of the
Encapsulation
is a process ofcoating dry, free-flowing
powder particles. Dependingon the size of theseparticles,
the technologyis referred to as microencapsulation (coating
liquids and super-finepowder particles of 500 microns and
under),or macroencapsulation (coatingof larger particlesof
5,000microns and above). Coatingpowder particles
this range (500and 5,000 microns) is simply
referred to as encapsulation (with no micro or macroprefix
added). The primary objectiveof encapsulation is to extend
shelflife and quality of the productby separatingthe
fortificantsfromthe vehicle'scomponentsand environment
until release is desired.Despitea slowdevelopmentofthe
encapsulation techniqueover the pastfew years, its application inthe food processing industry is now growingrapidly.
Encapsulation is used to mask undesirableflavours and to
isolatereactive componentsto preventthe degradationof
micronutrients.In multinutrient fortification,the use of
between
Fig. 4-ic. Spray mixingplantfor salt iodization (with precrushing).
Verti-Lift
Conveyor
Belt Conveyor
Iron Remover
Spray Nozzles
Spray Chamber
Screw Conveyor
Roll Crusher
Bagging
Chamber
Feed Hopper with
Agitator and Rotary Valve
26 MicronutrientFortification of Foods
Stainless Steel Drums
for lodate Solution
lodated
Salt
encapsulationwill help to providebarrier protection to separate
the micronutrients from one anotherto avoidadverse nutrient—
nutrientreactions. For encapsulatingvitamins,modifiedfood
starch or vegetablefats may be used as a coating agent.
Encapsulated vitaminsoffer reduced after-tasteand offflavours;are protectedfrom hygroscopic, thermal,or oxidative
degradation;and have enhancedshelf life, betterflowability,
and less dusting (Duxbury and Swientek1992). In developing
a stable formulation to fortify salt with both iron and iodine,the
University ofToronto has, under a Micronutrient Initiativefundedstudy, used a new techniqueofdextrin
microencapsulation to createa barrier between ferrousfumarate and potassium iodate.Acceptability and bioavailability of
the micronutrients usingthis formulation are proposed to be
studied in a series oftrials.
CEREAL GRAIN RECONSTITUTION
Cereal grain reconstitution involves the reconstitution of broken
rice grains into whole grains. In the manufacturingprocess, rice
flour made from brokenrice grains is mixedwith this premix
containingall-transretinyl palmitate,a small amount of maize
oil, and lard offood grade. A new formulationreplaceslard
with other types of oils like coconutorpeanut oils. Alphatocopherol and ascorbic acid are added at 1 mg/g premix.The
fortified grains are then reshaped as rice grains and mixedwith
regular rice ata ratio of 1:100to 1:200, depending on the
patterns of rice consumptionof the vitaminA-deficientpopulation to beserved. The proprietarybinding agent protectsthe
fortificant during rinsingand cooking.
POINT OF FORTIFICATION
The method ofmicronutrient additionis frequentlydependent
on the manufacturer'sprocessingsystem, packagingand food
preservationtechniques,the commodityto be fortified, the
fortificant to be added, andthe processor'spreferences. For
betterstabilityprofiles, the fortificantshould be addedafter
processingas in the caseof flakedcereals,althoughthis can
cause separation. In somecases, therefore, the fortificant must
beaddedbeforeheat processingstepsas in cannedfoods.To
identify suitable and convenient point(s) where fortification can
be integratedwiththe prevailingsystem at minimumadditionalcost, the whole manufacturingprocessfrom production!
importationpoints to the consumershould be carefully studied.
One ofthe most importantfactorsaffecting the point-ofadditionof a micronutrient or premixis thestabilityofthe
micronutrients. Operationssuch as cleaning/rinsing,cooking,
aeration,heating, extrusion, or drying,etc., maysignificantly
affect the biological functionsand stabilityof the added
nutrients.Iodine, for example,is subjectto vaporisationwhen
exposedto excess heat during processing.Iron compoundsare
subjectto oxidationand colour changes.Vitamin A is subjectto
oxidation,hydrolysis, and biochemical reactionsthat could
reduce its potency. The importanceofanyof these factors is
dependent on time, temperature,oxygen,and composition of
the food.Consequently, it is advisablethat certain
micronutrients be added to the foodsafter unit operations
involving heating, aeration,andwashing (Lund 1991),
As a general guideline, additionis preferred atthat point in the
processthatwill:
•
Provide sufficient agitationto ensure that the nutrients
are uniformly distributed,
•
Presentthe food at some fixed, knownvolumeor
weight,
•
•
Provide for easeof addition, and
Eliminate as many adverse processingconditions as
possible(Parmanand Salinard 1963).
For productsimportedata single entry point bya single large
importer, the point-of-addition couldbe atthe point-of-entry
where the productis invariably repacked. This, however,
depends on cost and availableresources.For products imported from one productionsource by multiple importers, itis
best to specifythat the productbe fortified atthe production
sourceat the prescribedlevel. Sometimes, a combination ofthe
foregoing strategieswill have to be adopted.
There are pros and cons for locatingthe fortification plants
eitherat the point-of-manufacture or closeto the consuming
areas. If the plant is located at the productionpoint,there is
minimum additionalhandling involved, butlosses intransit
and storage are possible. If thefortification plants are located at
the consumptionpoints,losses would be minimized, but
multiple handlingand storage mightmake it uneconomical.
The questionalso arises as to whichagency wouldown and
operatethese plantsat the consumptioncentresand bearthe
additionalhandling charges. The consensus is in favourof
locatingthe plantas close to the point of production as
possibleand/or just before packingto maximize retentionof
the fortificant (Mannarand Dunn 1995). Table 4-1 summarizes
the preferable point-of-addition for a numberoffoods.
PACKAGING
To minimize micronutrient losses duringstorage, the fortified
food should be properlypackaged.The retention rate ofthe
micronutrient in foodsdepends on the fortificant used, thetype
of packaging,the exposureof the packageto prevailing
climatic conditions,and the time elapsed betweenthe moment
offortification and actual consumption.Because of a lack of
availability of packagingmaterialin many developingcountries, packagingassumes greatimportance. In somecases, an
availablesource of appropriatepackagingmaterial is found
before the productis designed (Fellows and Axtell 1993).
Fortified food-production centresare often far from the con-
sumption areas, therefore, adequate precautions should be
taken to ensurethat these foods ultimately reach the consumer
withthe recommended level of fortificant. For this reason, shelf-
Current Practices, Research, and Opportunities 27
Table 4-1. Point-of-additionofa dry premixofmicronutrienfs to food vehicles.
Baked items
Coating,spraying,or drypremix
Beverages
Solution
Bread
Tabletor dry premix
Water-flour mix
Breakfast cereals (dry)
Coating orspraying
Aftertoasting
Cereals (cooked)
Dry premix
Last mixing stage
Cheese(processed)
Solution
or drypremix
During blending
Cheese(primary)
Solution
or drypremix
Before curdling
Maize grits
Dry premix
End ofmiling
Maize meal
Dry premix
During milling
Wheatflour
Dry premix
During milling
Fruitjuice
Solution
Before pasteurization
Infantfood (dry)
Dry premix
During mixing
Infantfood (liquid)
Dry premix
Priorto homogenization
Margarine
Emulsion
Before churning
Milk
Emulsion
Priorto homogenization
Milkpowder
Dry premix
Before instantizing
Pasta products
Dry premix
In water-doughmix
Peanut butter
Dry premix
With salt addition
Potato chips
Dry premix
Coataftertoasting
Rice
Coating,sprayingor dry premix
After milling
Salt
Spraymixing or dry premix
Aftermilling
Snackfood
Coating,sprayingor drypremix
Afterheat processing
Soups (dry)
Dry premix
During mixing
Soups (processed)
Dry premix
Before pasteurization
Soya flour
Dry premix
During mixing
Sugar
Dry premix
During blending(dry)
Tea leaves
Dry premix
During blending
Vegetable oil
Direct fortification
Followed by blending
Source: AdaptedfromBauemfeindand Brooke(1973).
28 Micronutrient Fortification of Foods
ordry premix
In water-flourmix
Before pasteurization
life testing is highlyrecommended. Hygroscopic productslike
flourand salt easily attract moisture and become wet when
improperly packaged andtransportedover longdistances
under humid conditions.This causes biochemical and microbiological deterioration.Efforts should be made to improvethe
distribution network to reducethe timebetween fortification
and consumptionof foods.
Packaged foods should be markedto identify the contents for
monitoring purposes. Ideally,the package should also be
markedwith the productiondate ofthe contentsothat the time
elapsed between fortification and consumptioncan be catciilated.All packages should carry expirationdatesto ensurethat
the product still has the adequateamountof the fortificant.The
stipulations for handling, transportation,storage, and salesof
iodized,packaged salt as described in Table 4-2 are also
applicablefor other fortified foods (Mannarand Dunn 1995).
PACKAGING MATERIALS AND CONTAINERS
There aretwo types ofpackagingmaterials:rigid containers
and flexible packaging.
Rigid containersincludeglass and plastic bottles,jars, cans,
pottery,wood, boxes, drums, tins, plastic pots, and tubes. They
all, to avarying degree, give physical protectionto the food
inside that is not provided by flexible packaging.On the one
hand, some types of rigidpackaginghave the advantage of
providing a perfecthermeticseal.On the other hand, although
most rigidcontainersare strong, they are more expensive than
flexible packaging.Glassjars are not suitableas packaging
materialsfor foodsthat are adversely affected by light unless
the jars are storedin a dark place or if the fortified food stored
in a glass jar stays stableon exposureto light.
Flexiblepackagingthat can be used to make wrappings,sacks,
and bags includes plasticfilms,papers, foil, sometypes of
vegetablefibres, and cloths.
Packagingoptions for groups offoods are described by Fellows
and Axtell (1993):
Hygroscopicfoods: When packedfor the humid tropics,
hygroscopicfoods suchas wheat flour, maizeflour, and salt
requirea moisture barrier.These foods should be packed in
Table 4-2. Stipulationsfor handling, transportation,storage,and salesfor packaged fortified foods.
•
•
•
•
•
•
•
Do not expose food to water, excessive humidity, and/ordirectsunlight atany stage of storage, transportation,or sale.
Transport,store, and keep the food for sale in the original packing only.
Store baggedfood only in covered roomswith adequate ventilation.
Stack baggedfood on wooden pallets (raisedat least 10 cm above floor level).
Avoid the baggedfood making directcontactwith the walls ofstorageroomsorwarehouses.
Do not use hooks or pointed orsharp instrumentswhen handling the bags.
Keep a stock registerwithbatch numbers and the date of receipt and despatch.
• Despatch, distribute,andsell the food strictly accordingto the principle offirst in first out.
• Agents, distributors,andretailersshould cooperate with government-designated inspectors in the inspectionoffortified
food stocks and the drawing ofsamples.
•
Fortifiedfoods may be sold by retailers only ifthe period between the date stampedon the bag and the date ofsale is
less than 6 months, Samples of all date-expired foods shall be sent to a designatedauthority for confirmationregarding
adequate micronutrientcontent. If not adequate, the food shall be returned to the appropriateagent or distributor for free
replacement.
•
Agents and distributors of fortified foods shall return all foodsthat are date-expired
standard offortification to a designatedauthority for free replacement.
•
Retailers shall adviseconsumersto storefortified foodsin sucha manner as to protectthem from direct exposureto
ordo notconformto the minimum
moisture,heat,and sunlight
• Retailers shall replace, free-of-charge, any fortified food purchased by a consumerand subsequently certified to be not
-
conformingto the minimum standardof fortification.Such food shall be kept separately and returnedto the distributor or
agent for free replacement.
• Bags of fortified food maybe storedtemporarily after opening only forpurposesofretail sale. Such bags shall
covered
be kept
or closed atall times.
• Retailers shall prominently display the government approval,sign boards,and postersrelating tofortified foods.
Source: AdaptedfromMannar and Dunn (1995).
Current Practices,Research, and Opportunities 29
airtight bags or containers. In manycountries,this implies a
major switch from conventional packagingmaterials,like straw
orjute,tothe more expensive plastic lined bags and other
containers. The packagingunits in the case of bulk packaging
should not exceed 50 kg (in accordance with International
LabourOrganization (ILO) regulations)to avoid the use of
hooks for lifting the bags.Bags once used for packagingother
articles suchas fertilizers,cement, chemicals, etc., should not
be used for packagingfortified foods.
Edibleoils and fats:Cookingoils are susceptibleto rancidity, therefore, lightproof and airtight packagingis required.
Metal cans, glass, andpossibly plasticbottles are the most
suitable containers.
Dairyproducts:Mkrobial contaminationis the major
problem in usingdairy productsas a vehiclefor fortification.
Packagingshould be sterilizedto preventcontaminationafter
processing. During distribution and storagethe products
should be kept cool and away from direct sunlight.
Polyethylene bags are adequate ifthe product is carriedhome
and consumed right away. For long-termstorageofcheese,
polyethyleneshould notbe used because of migration of
chemicals fromthe plastic into the fatty food. For distribution
purposes,reusableglass bottles withfoil lids are used as a
relatively low-costpackage,formilk.
Bread:Because of its short shelf life, packagingbreadis
mainly used to keep theseproductsclean and is usually not
used as a barrier to moistureorair. Clean paperis an adequate
packagingmaterial. If polyethylenefilm is used, condensingon
the inside ofthe bagshould be preventedby allowingthe
baked goods to cool downafter baking and before packaging.
Biscuits:When packed for the humidtropics, dry biscuits
requirea moisture barrier and packagingto resist mechanical
damage.
For biscuits witha highfat contenta lightproof/airtight
packagingto avoid rancidity is also required. Cardboard
cartonscoated with polypropyieneor cellulose film is applicable. The use ofpolyethyleneshould be discouraged because of
the migration ofchemicalsfrom the plastic into the fats
containedin the biscuits,
In dry areas,the foregoing constraints are not of importance. In
theseareas, the packagingis simply used as a wayto storethe
food and to keep it clean.
30 MicronutrientFortification of Foods
Beverages Fruitjuices,which are intended for immediate
consumptionafter opening, rely on pasteurizationfor their
preservation. The packaging is used to prevent
recontaminationby microorganisms. Glass jars,cardboard
cartons coated with polypropyleneor cellulose film, or coated
metal tins are applicable.
Cereals/flour: Like hygroscopicfoods, these also requirea
moisture barrier and should be packedin airtight bags or
containers.
Peanut butter: Although peanut butter is yetto become
popular in developingcountries,it can be a good source of
protein and micronutrients.Peanutbutter is susceptibleto
rancidity because ofthe highoil content.The packagingused
must be Iightproof and airtight. Metal cansand glassbottles
are the most suitable containers.
REFERENCES
ic.; Brooke, C.L. 1973. Guidelines for nutriIing 41
processed foods. Food Eng, 45(6),91—97, 100,
Bauernfeind,
Ri. 1992. Encapsulated ingredientsface
future
Food Processing, February, 38—46.
'healthy
Duxbury, D.D.; Swientek,
Fellows, P.; Axtell,B. 1993. Appropriatefood packaging. International
Labour Organization (ILOITOOL), Geneva, Switzerland.
Lund, D.B. 1991. Engineering aspects ofnutrifying foods. In
Bauemfeind, iC.; Lachance,P.A., ed.,Nutrientadditionsto
food:Nutritional,technological and regulatory aspects.
Food and Nutrition Press,pp. 473—494.
iT. 1995. Saltiodizationfortheeliminationof
iodine deficiency. MicronutrientInitiative(Ml/ICCIDD),
Ottawa,ON, Canada. 126 pp.
Mannar, M.G.V.; Dunn,
Parman, G.K.; Salinard, G.i. 1963. Vitaminsas ingredientsinfood
processing. In Joslyn, M.A.; Heid, iL., ed., Food processing
operations, Vol. II. AVINan Nostrand Reinhold, NewYork,
NY, USA.
5.
QUALITY ASSURANCEAND CONTROL
Ensuringthe adequacyand quality of fortified food products
fromproductionto consumptionis a most critical componentof
anyfood fortification program. It should be a primary concern
ofthefood industry to validatethe consistency ofthe manufacturingprocess to release a uniformly fortified productfor
distributionthat has all the intendedcharacteristics andqualities.
The availability of trained staff to carry out the procedures
adequatelyis of great importancefor a successful outcome.
Quality assurance incorporates GMP, which is that part ofQA
that ensures that food productsare consistentlyproduced and
controlledto the quality standardsappropriatefor their
intended use. The QA approach involves the control,evaluation, and audit of a food processing system:
•
(line inspectionofsupplies, materials,raw materials;
operating procedures; and finished products).
REQUIREMENT FORQUALITY ASSURANCE (QA)
The word "quality" has beendefined in various ways. Accordingto the standarddefinition, quality is "the totality offeatures
and characteristics ofa productor servicethatbearon its
ability tosatisfy stated or implied needs" (ISO 1987). Another
popular definition is "fitnessfor use which is verysimilar to
the standard definition but less neutral. Teboul (1991) introduced a more dynamic aspect when he defined quality as "the
ability tosatisfy needs atthe timeofpurchaseand during use
atthe best cost,whileminimizing losses and surpassingthe
competition:' The twoterms, quality assurance and quality
control, are often used interchangeably, although based on the
WHO (1990) definition, there are differences between the two.
Quality control(QC) is the part ofgood manufacturingpractice
(GMP) that is concerned withsampling, specifications, and
testing, and with the organization,documentation, and release
procedures that ensurethatthe necessary and relevant tests are
actually carried out and that productsare not released until
their quality has been judged to be satisfactory. Quality control
is notconfinedto laboratoryoperationsbut must be involvedin
all decisions that may concern the quality of the product.
Quality assurance (QA) is a wide-ranging conceptthat covers
all mattersthatindividually or collectively influence the quality
ofa product. It is the total ofthe organized arrangementsmade
and applies to equipment, product design,suppliesand
logistics, management and human resource development, and
all elements with the objective of ensuring that productsare of
a quality requiredfor their intended use at the consumerlevel.
Quality assurance as it appliesto the laboratoryshould be
differentiated fromQA as itapplies to the program,which
would include incorporation of quality in management,the so
called totalquality management(TQM) methods.
Totalquality managementis only one of many methodsthat
have beenused to instilla certainfoaison customersthrough
recognizingthat those involvedwiththe processes needto be
involved in the decisions about those processes. All this relates
to a managerialattemptto build betterQA throughoutthe
ranks byworkers.
Quality controlinvolves operational techniques and
activitiesthat are used to fulfil requirements for quality
•
Quality evaluationappraisesthe worthofall raw and
processed products (physical, chemical,sensory, and
microbiologicalanalysis).
•
Quality audit verifies or examines finished products or
even processes over time (shelflife, market review,and
consumercomplaints).
ESTABLISHING A SUCCESSFUL QA PROGRAM
that must be carefully
and clearlyworked outfor the success of any QA
There are six basicfundamentals
considered
program (Gouldand Gould 1988):
•
Organization ofthe QA department:Quality
assurance must start withtop managementsupporting the
conceptof quality. The needfor productquality control
should be explainedto, and demandedfrom, all personnel.
•
Personnel
selection:
•
Sampling forproduct evaluation andline control:
Adequate sampling, assuming that a QA program is
already established, is important.The sampletaken of a
Personnel in the QA department
must be selected on certain qualificationsand trained to
be able to fulfill the responsibilitiesnecessary for a
successful QAprogram. Itmaynot befeasible to establish a
full QA departmentin smaller businesses because of
cost and staffing issues. These issues must be examined
and worked out to have a successful program.
batchfromthe productionline must be representative
and must be selected at random.Poor, inadequate
sampling is one ofthe greatestobstaclesto achieving
successful control of productquality.
•
Standardsandspedflcations:
Quality assurance and
productcontrolfollows the establishmentof ingredients
and productand process specifications. No other facetof
quality assurance is more important than the establishment ofspecifications and the developmentofstandards ofquality for productevaluation.Government
agencies involved in food regulationshould be committed to quality assurance and control,otherwisethe
objectives of food fortification maynot be met.
Current Practices, Research,and Opportunities31
•
Measurement (laboratory, equipment, procedures,and reports):The facilitieswill varywith the
size ofthe operation,the number ofproductsbeing
packed,and the different qualitiesbeing packed.Reporting ofthe results is just as importantas the analysis of
thesamples. Reportforms thatprovidefindingsand
recommendationsshould be completed daily and kept
for futurereference. Results should be used to guide
managementdecisionsand corrective actions,when
needed.
•
Data collection and interpretation:Careful data
collection using correct sampling proceduresand analysis
is critical. The interpretationof thequalitycontrol data is
one ofthe more importantfunctionsin thesuccessful
ofa QA program.The use ofstatisticalmethods
can be of great value for the proper interpretationof
operation
processesand data.
The basic conceptis establishingthe routine limits ofthe
system,i.e.,through a control chart withcalculated upper and
lowercontrol limits and then using this chart to demonstrate
that the processis "in control When it is not, there wouldbe
specific proceduresto follow to determinethe cause and to stop
Steps for Implementation of a QualityAssurance
(QA) Program
•
•
Providing specifications for bothfortificant and food
vehicle (particle size, colour, potency, acceptable ranges
offortificant, fortification level);
Routinely undertakinghazard analysis offortificants and
fortified foods for chemical, microbiological, and physical
contaminants;
• Samplingand testingof fortificants,food vehicle, and
fortified food for potency, particle size, colour, netweight,
•
adulteration,packaging,andstorage conditions;
Identifying and regulatingthe critical control points
(CCP5) that might adverselyaffect fortified foods;
• Establisha recall system to trace or identify the product
in case of consumercomplaints;
•
Auditingand evaluatingthe QAsystem on a regular
basistodeterminewhether variouselements within a
quality managementsystemare effective in achieving
stated qualityobjectives;
•
Implementation
of corrective actions (detection of quality
or safetyproblemsand measuresto eliminatethe
recurrence oftheseproblems);and
•
Documenting all aspects of the QAsystem and making
the documentationavailableto those responsiblefor
the fortified food.
32 MicronutrientFortification of Foods
productionuntil the problem is resolved.In salt iodization,for
example,this would preventlargebatches ofsalt from being
releasedif they did notconsistentlyhavethe intendediodine in
the acceptedrange.
Throughquality assuranceand control it is ensured that the
manufacturedfood is properlyfortified without affecting the
organolepticpropertyof the vehicle, that it is safe to be used,
and that it meets all quality standards and government
regulations. Fortified foods should be made availableat
competitive pricescomparedto nonfortified foods. Itshould,
however,be pointed outthat performinga QA programwith
this degree of sophistication may be difficult in many countries.
DEVELOPMENT AND IMPLEMENTATION OF QA/QC
SYSTEMS
The developmentand implementation of a sound quality
assuranceand productcontrol system is instrumentalto
developingan effective, practical, and economical micronutrient
fortificationof food program. The industryshould organize
itselfin such a way thatthe technical, administrative, and
human factorsaffecting the quality of its productswill be under
control. All such control should be orientedtowardthe reduction, elimination, and preventionofqualitydeficiencies. The
processis in control if:
• The specific product/processparameter complieswith
the formulated standard at the CCP5 at regular intervals,
and
•
Corrective action is immediately taken if an observation
deviatesfrom the specification.
Everyone in the company, from the director to the junior
labourer,has a responsibility for assuminga good-quality
product. The benefitsfrom meeting these responsibilitiesare
often notfullyrealized, Thisresults in failure to organize
effective quality-control cycles. To be effective,the cycle must be
complete. An exampleof such a qualitycontrol cycle is given in
Fig. 5-1.
QUALITYMANAGEMENT SYSTEM
Aqualitymanagementsystem should be developedand
implemented, appropriateto thetypeofactivity and product
being offered to achievemaximum effectiveness and to satisfy
customerexpectations. The quality system typically applies to,
and interacts with, all activitiespertinentto the quality of a
product. It involves all phases from initial identification to final
satisfactionofrequirementsand customer expectations. A
schematicrepresentationofthe quality loop is shown in Fig.
5-2.
The impactof quality upon the profit-and-loss statement can be
highly significant. A companymight surviveif individual
productsfail to meet requirements, but if the most senior
managementfail to appreciatethat cost must be identified and
measured in relationto qualityas part of a company-wide
Fig. 5-1. Quality control cycle.
PRODUCT
—p
PRODUCT
Measurement/inspection
iicaIcontrolPoinE________._________
,r
Registration correction
Registration result
Requirements/tolerance
Deviation acceptable?
NO
Correction
Fig. 5-2. Quality
I
YES
Continue
loop.
Source: ISO (1978)
policy, then the companywill cease to trade competitivelyand
will eventuallycease to trade at all. It is well known that the
reportedcostsof quality arefrequently markedly lowerthan the
actualcostsofquality. It is not uncommon for the cost of
quality to be as high as 25°/oofsales (Lock 1990).
Both the process and the product ofany fortification program
needto be monitored. Indicatorsfor monitoring a micronutrient
food fortificationprogram should include both the fortification
process atthe industry end, to ensureconstantand appropriate
levelsof micronutrientin the food, and also the actualconsumption of the fortified food by the population. Once the
necessary infrastructureand legislation for micronutrientfood
fortification are in place, fortification levels could be monitored
on a regular basis at four levels: the production plant and intermediate pointssuchas wholesale, itail outlets, and households,
At the production plant, the mixingprocess must be validated.
This must include monitoring of micronutrientcontentduring
production,and samples must be taken periodicallyat the end
of the processing line to monitor micronutrientlevels in the
final product.
The responsibilityfor routine monitoring atthe production
plant rests with the factoryitself (internalmonitoring). For
example, in the case of iodine, the recommended procedure is
to carry out hourly monitoringduring productionwiththe
rapidtestkitand confirmedperiodicallyby titration. External
monitoring, however, by independentagencies at periodic,
regularchecks should be promoted.
Current Practices,Research, and Opportunities 33
The stepsthat specifically requirequality
assuranceare:
1. Purchase quality equipmentand supplies;
2. Routinely inspectprocessing equipment;
3. Validatethe mixing process to ensureconsistant mixing;
4. Monitor food readyfor distribution; and
5. Keepadequate monitoring records.
Source: AdaptedfromPAMM/MI/ICCIDD/UNICEF
(1995).
Legal provisions on monitoring should cover:
Internal,or self-monitoring,by the industry referred to as
quality assurance (QA). With internal monitoring, the
industry routinely examinesits own processes and procedures to identify and correctany problem areas found.
External monitoring bythe governmentpursuantto its
inspection and investigationpowers. External monitoring
provides the governmentwith the information necessary to
enforce the law whenevernoncompliance with legal
requirements
is found.
Source: PAMM/MI/ICCIDD/UNICEF
(1995, p. 19).
MONITORING BY GOVERNMENT AND BY
CONSUMERS
For externalQA, the authorizedgovernmentagency should
develop a plan for periodiccheckingofall producersof fortified
products.The frequency ofthesechecks should be adaptedto
ensurethat the food reachingthe market meets government
standards.External monitoring should increase in frequency
when householdsor retail-levelmonitoring indicatethatsome
products fail to meetthe standard.The steps involvedare:
1.
Develop standardsfor fortified foodsand the legislations
required to ensurethatthesestandards are maintained.
2.
Develop
3.
Establish
monitor.
a monitoring plan.
a list of producers offortified productsto
4. Monitor producers.
5.
Record data.
6.
Implementenforcingprocedures.
The overall responsibilityfor quality controlinside the country
often rests withthe Public Health Department,but consumers'
organizationscan and should also be involvedin monitoring
micronutrientlevelsat the off-factorylevel.The objectiveof this
monitoring activity is to ensurethatthe product containsthe
predeterminedlevel ofmicronutrientsadded atthe consumer
level.For example, in India, three nongovernmentalorganizations (NCO5) in the severelyiodine-deficient state of Uftar
Pradesh were involved in monitoring salt atthe retail and
householdlevel.Each month, saltsamples were obtained from
local retail shops and the results communicated to the community and civic officials. Local politicianswere made aware of
inadequacies in the iodine contentofsalt. The issuethen went
on to be raised in the Provincialand National Parliament
(PAMM/Ml!ICCIDD/UNICEF1995,p. 43),2
DETERMINATION OF LEVELOF FORTIFICATION
IODINE
The iodine content in salt can be checked using simpletitration
techniques or field-testingkits (PAMM/Ml!IJNICEF1995).
Titration maybe used where an accurate determination of the
iodine level is required(e.g., atthe point ofproduction or
import). For routine checkingat the field level,a simple test kit
made up of a stabilized starch solution can be used.Table 5-1
shows the criteriafor assessingthe adequacy of a salt iodization program,which has beenestablishedbya joint WHO!
UNICEF/ICCIDD (1992) consultation.
IRON
Iron contentcan be determinedby a variety of techniques such
as a simple colorimetricniethod orby using an atomic
absorptionspectrophotometer (AAS). Simplefield kits can give
a qualitative (not quantitative)indication ofthe presence or
absence of iron. Regular monitoringof iron levels inthe productis
needed to avoidexcess iron additionin case ofpoor iron distribution during production. Criteria forassessing the adequacy of an
iron fortification program can be established similar to those
prepared for a salt iodization program(Table 5-1).
VITAMIN A
Assay methodsfor vitamin A requiresophisticatedlaboratory
equipmentsuchas high-pressureliquidchromatography
(HPLC). For developingcountriessemi-quantitivecolorimetric
test methodsare more appropriatebecause of lower costs
(Arroyave etal. 1979). Criteria for assessingthe adequacyof a
vitaminAfortification program can be establishedsimilar to
those shown for a salt iodizationprogram (Table 5-1).
2A manualentitled"MonitoringUniversal Salt lodizationProgrammes" has recently been publishedby PAMM/Ml/ICCIDD/UNICEF
in response toa
strong need for guidance on systematic procedures to establish a permanent, iodizedsalt-monitoringsystemwithin a country. Asimilar manualis
underpreparationfora monitoringsystemsuitablefor programs dealingwith vitamin A-fortified foods. Copies can be obtainedfrom the Micronutri-
entInitiativeor PAMM.
34 MicronutrientFortification of Foods
Table 5.1 Criteria for assessing adequacyof a salt iodization program.
A. Factory orimporterlevel
1. Percentageoffood gradesalt claimedto be iodized
100°/a
2. Percentageoffood-grade salt effectively iodized
90°/aormore
3. Adequacy of internalmonitoringprocess
90°/aor more
4. Adequacy of external monitoringprocess0
10—12 monthlychecks per
producer/importer per year
B. Consumer and districtlevel
1. Percentof monitoringsites with adequately
iodizedsalt
— households
(or schools)
— district
headquarters (includingmajor markets)
Adequacy in 90°/o ofsamples
2. Adequacy of monitoringprocessb
90°/oor more
0Corrective action systematically takenwithin3 hours in 90°/o ofcases, followingthelotquality assurance methodology.
bMonitoringundertaken in 900/0 ofdistrictsin each state, atwholesale, retail, and householdlevel.
Source: WHO/UNICEF/ICCIDD (1992).
REFERENCES
Arroyave, G.; Aguilar,JR.; Flores, M.; Guzman, M.A. 1979. Evaluation
ofsugarfortificationwith vitamin Aattheinternational
level. Pan American HealthOrganization (PAHO),Washington, DC,USA.
Gould, W.A.; Gould, R.W. 1988. Total quality assurance forthe food
industry.Cr1 Publications, Baltimore,MD, USA.
ISO(International Organization for Standardization). 1987.Quality
—
management and qualitysystemelements guidelines.
ISO, 9004, 1987-03-15.
Lock, D., ed. 1991. Gower handbookofquality management. Gower
PublishingCompany, London, UK.
Teboul, J. 1991. Managingqualitydynamics. Prentice Hall,London,
UK.
WHO (World HealthOrganization). 1990. Good manufacturing practice
for pharmaceutical products.PHARM/90.129/Rev. 3a.
WHO/UNICEF/ICCIDD. 1992. Indicators for assessing iodine
deficiency disorders and their control programmes. Report
of ajointWHO/UNICEF/ICCIDD Consultation, World Health
Organization (WHO), Geneva Switzerland.
Wilson, L.A. 1988. Proposed quality assurance guidelinesforthe
fortificationof MSG with white vitaminAin Indonesia
project. Dept.Food Techn., IowaState University, IA, USA.
PAMM/MI/ICCIDD/UNICEF. 1995. Monitoringuniversal salt iodization
programmes. In Sullivan, KM.; Houston, R.; Gorstein, J.;
Cervinskas, J., ed. PAMM/MI/ICCIDD.
Current Practices, Research,and Opportunities 35
36 MicronutrientFortification of Foods
6. LEGISLATIONAND REGULATIONS
FOR FOOD FORTIFICATION
Effective fortification programsin any country needto be
supportedby suitable legislationand regulations.To advocate
and plan a food fortification program it is essential to ensure
the existenceofmechanisms through which the entire process
can be legally controlled. Two points needto be noted.
First,the mere existenceof legislation and regulations is not
sufficient to ensurethat fortification is taking place.When
combinedwith awareness-raising, among policymakersand
the other principal players,however, suchlegal control can
play an important role by helping to accelerate thefortification
process and by protectingthe consumers fromharmful
practices that may impinge on their health (e.g., fraud or
technological inadequacies in the production of a fortified
commodity).
in the absence oflegislation or regulations,the
privatesector is often capable oftakingappropriateaction to
fortifyselected vehicles with micronutrients,and has doneso
in a number of countries (Nestel 1993). Here again, some level
ofadvocacyand activitiesto create the needforsuch
micronutrientshave played a role in encouragingthe action.
Nevertheless, to ensuresustainability ofthese efforts,to
preventunfortified food from entering the country and being
consumed in place ofthe fortified one, and to protectthe whole
process fromthe conflictsraised byany antagonisticgroup,
somesort oflegal control is bound to be necessary.
Second, even
Although the laws enacted by the country's legislative organ
provide the governmentwith the legal authority to carry out its
programs, regulationsare rules issuedby governmental
ministries and departmentsto carry outthe intent ofthe law
and to regulateactivities ofdepartmentsand sections under
the guidanceofthe ministry to ensureuniform applicationof
the law, It is simpler to have a generallegislationcovering
fortification than to have individual pieces of legislationdealing
with each activity relatedto food fortification.
In somecases, in place of legislation, it is quickerand simpler
to enforce a regulation(based, e.g., on an existing public health
orfood law), which does not have to be officiallypassed by
parliamentorthe head ofthe state ofthe country. This is
because it is generallyeasier, both politically and logistically,to
changeregulationsthan to introduceand passlegislation to
amend an existing law (Nathan 1995). Table 6-1 outlines
mattersappropriatelyincluded in the law versus in the
regulationsas appliedto the example offortification ofsalt
with iodine.
Once the review ofthe existing lawand regulationsis completed, any shortcomingsshould be communicated tothose
with the political power to influence legislation and regulations. Expertsto assistwith drafting amendments totile law
and/orregulationsshould also be involved.If possible,the
programmanager should seek input fromthe program
to be incorporatedinto legal provisions governing
fortification. If it is necessary to amend the existing law,
sponsors must be found to introducenew legislation. Once
perspective
introduced, the legislation might need lobbying for its passage.
Table6-1. Mattersappropriatelyincludedin the law versus in the regulationsas applied to the exampleofsaltfortification.
Requirements forcompulsory iodizationofall salt intendedforhuman
or animal consumptionwith Kb3 in compliance with all regulatory
Potassium iodate levels at manufacture, import,wholesale, and retail
levels
requirements
Requirement that manufacturers, importers,wholesalers,retailers,
and transporters must undertakeperiodicQA activities
QAactivitiesto be undertaken, suchas routineequipment and instrument
calibration, and sample testing ofiodine content
Authorityofthe government toinspectorinvestigateanypremises
wheresalt is manufactured, imported,received, held, stored,orfound,
orwhere it is reasonably believed tobe the case
When the governmentmay inspect or investigate, whatthe government
Penalties fornoncompliance, includingfines,licence suspension
revocation, adverse publicity,or confiscation
Thecircumstances underwhich penaltyorincentive may be applied,the
amounts offinesand periodsofsuspension, and the procedural
stepsfor imposingpenalties
or
Incentives forcompliance, including transportand display priorityfor
iodized salt, exclusive use of logo, andfavourable
maylookat, orhowthe governmentmay testsalt samples
As above
taxtreatment
Source: PAMM/Ml/ICCIDD/IJNICEF
(1995, p. 21).
Current Practices, Research,and Opportunities 37
Additionally,monitoring is necessary to watch for any amendments proposedby othersthat mightweakenthe law and thus
make the program difficult to administer.
•
Applicability ofthe measure to all food that is produced,
imported, or marketedin the country.
•
Designate the governmentunit, e.g., Ministry ofHealth,
to issuespecific enablingregulationsfor each
Ifthe law is adequate, butthe implementing regulationsneed
amending,program managersshould alert the appropriate
personwithin the ministry charged with enforcingand
administeringthe existing law. Programmanagersthen should
become involved in establishingthe standardsand requirementsthat will be containedin the regulations.
Once the law and regulationsare in place, programmanagers
should assist in the developmentofclear guidelinesthatwill
help the industry understandand comply withthequality
assurance requirementsofthe law and regulations.The
guidelines should be developedin collaboration withindustry,
NGO5, other ministries, and any other affected groups.Finally,
ifthe proportion of fortificant in the fortified food is not
appropriate,the program manager can provide input into the
legal process, suchas modifying the level offortificant in
production(PAMM/Ml/UNICEF1995).
As the firststep in developingsucha regulatorymechanism,
the following points needto be examinedcarefully:
•
Is a new legislation actually required/desirable or can
the existing law adequatelyregulatefood fortification?
•
If a changeto a law is necessary, should the existing
food controllaw be amended,or will a separate law
needto be enacted?
•
•
•
Enforcement and penalties
for noncompliance.
To be effective, there should be an efficientsystem ofmonitoringto ensurecompliance, i.e., the system should besupported
byan inspectionforcethat has clearlydefined procedures for
sampling foodsand well-establishedstandardsand analytical
methods for determiningthe micronutrientcontentoffortified
food. Legislationand regulationsthat mandatefortification
should create a devicefor enforcement through a systemthat
fines the defaulters and preventsa continuation of operationsif
manufacturers do not meetlegal requirements embodied in the
law.
Regulationofa food fortification program can only be a
support measure. It is more important to motivatethe food
industry to comply through education. Consumergroups
whose main objective is to ensurethat the public receives highquality goods and services can play an important role in
ensuring thatthe food sector complieswiththe regulation.For
more informationon the subjectof legislationand regulation
see Nathan (1995).
REFERENCES
Is the existing regulatoryinfrastructureadequate or
does it needimprovement?
Nathan, R. 1995. food fortificationlegislationand regulations manual.
Shouldthe legislation be limited to fortificationwith a
micronutrientorwill a more general food fortification
law required?In either case, should the legislation be
introducedat the national or provinciallevel?
Nestel, P. 1993. Foodfortificationin developingcountries. United
States Agency forInternational Development (USAID),
The major components that should becovered in the legisla-
tion include:
•
fortification measure so that it is possibleto respond
promptly to changing requirements for food fortification
withoutpassing new legislation.
Mandatory fortification at a level to be determinedby
the public health authorities of each country.
38 MicronutrientFortification of Foods
ProgramAgainstMicronutrientMalnutrition(PAMM),
Atlanta,GA, USA. Second edition,52 pp.
Washington,DC,USA. VITAL, 47pp.
PAMM/MI/ICCIDD/UNICEFIWHO. 1995. Monitoringuniversal salt
iodization programmes. MI/PAMM/UNICEF/ICCIDD/WHO.
Program Against Micronutrient Malnutrition (PAMM), Atlanta,
GA, USA.
7.
REVIEW OF RESEARCH AND CURRENT
PRACTICES IN MICRONUTRIENT
FORTIFlCATION
iodine source orpremix, drip feed addition of an iodine compound to salt, and spray mixing ofan iodine solution to salt.
SINGLE FORTIFICATIONWITH IODINE
SALT
Countries: A wide rangeof both developed and developing
countriesall over the world.
(a)oiy mixing
A premixof potassiumiodate and an anticakingagent like
Organizations andgroups involved: Ministries ofhealth!
calciumcarbonate, tricalciumphosphate, ormagnesium
carbonate is prepared in a ratio of 1:9. One part of the stock
mixture is then mixed with 10 parts ofsalt and the premix is
introducedinto a "cement" mixer or screw conveyor at a
prefixedrate. Salt is also introducedinto the dwm or conveyor.
Mixing takes placeas the dwm rotatesorthe material moves
through the conveyor. This process is suitablefor dry powdered
salt only. Dry mixingis widely adoptedin several countriesof
industry, salt industry, UNICEF,WHO, ICCIDD, Ml, PATH,
OMNI, USAID, bilateral agencies, NGOsetc.
Vehicle: Saltfulfils nearly all the characteristics ofa suitable
food vehicle. Salt is one ofthe few commoditiesconsumedby
all membersofthe community regardless of sociallevel. It is
consumed at roughly the samelevel throughout the year by all
membersof a community.Thus a nutrient like iodine when
introducedthrough saltwill be administeredto each individual
at a steady dosagethroughoutthe year.
Fortificants: Thetwo principal tortificantsare potassium
iodide (KI) and potassiumiodate (Kb3) (see Chapter 3) For
quality standards ofpotassium iodate in salt iodization see
Appendix1.
Fortificationlevel: Currentlevels ofiodization in different
countriesvarybetween20 and 165 ppm potassiumiodate
(12—100ppm iodine). In a given country, the level offortification may be changed over time, in responseto changes in
averagedaily consumptionof saltand iodine losses during
distribution and storage.A samplecalculationfor fixingthe
level of iodization in salt is given in Table 7-1.
Technology:Processandequipment:The process ofsalt
iodizationinvolves mixing salt with a premixedquantity of
iodine to ensurethe desireddosage of iodine in the salt. Three
processes commonlyused for iodating salt are describedby
Mannar and Dunn (1995), these include:dry mixing ofan
South and Central America
likeArgentina,Bolivia,Guatemala,
and Pew as well as Pakistan.
(b) Drip feedaddition
Drip feed addition is commonlyused for iodizationofsalt
crystals. The salt crystalsare fed onto a hopper that discharges
at a uniform rate into a belt conveyor, about 35—40 cm wide
and 5.5 m longinclined at a slope ofabout 20 degrees. The
conveyoris equippedwitha tensioningdevice.The feed
hopper has a capacity ofabout 300 kg and the rate ofsaltflow
onto the conveyor is controlledbymeansof a slide valve.
The Kb3solution is stored in two 200-litre polyethylenestock
tanks withdischargevalves at the bottomto permit the filling
oftwo 25-litrefeed bottles mounted in such a wayas to ensure
a continuouscirculationofsolution from the main tankto the
feed bottle. Thus, the solution continuouslydrips at the desired
rate onto the salt crystals.The iodatedsaltfallsinto a discharge
hopper from which it is collected in bags. Experience has
shown that a capacity of 5 tons!hour is idealfor a drip feed
system, which requiresonly a low-pressure headto maintain
Table 7-1. Samplecalculation for fixingthe level of iodizationin salt.
Assumingthat the requirementofiodine is 200 ig'day and the saltconsumptionis 10 g!day.
Level of iodine required
is 200
! 10 = 20 ig!g ofsalt or
Compensationfor transit and storagelosses
Fixed level
ofiodization required
aThe ratio of molecularweight of K103/12 i.e. 214/127
20 ppm (partspermillion)
20 ppm
40 ppm iodine= 40 x 1 685a = 67 ppm Kb3
=1.685. Source: Mannarand Dunn (1995).
Current Practices, Research,and Opportunities39
the requiredflowrate. This method is adoptedin someAsian
countries
like Indonesia.
(c)Spraymixing
Salt received in crystal form is crushed into a coarse powder in
a rollermill and fed into a feed hopperfitted witha wire mesh
screen or a grating at the top to preventlarge lumps ofsalt
from fallinginto it. A second shaft withfourplates is fitted in
the outlet ofthe hopper and regulates the flow onto an inclined
conveyorbelt. Both theseshaftsare driven by a variable speed
drive systemand the rate of rotation is adjustedto give the
requiredthroughput.
The sheet of salt from thebelt discharginginto the spray
chamber receivesa fine atomized sprayofKb3solutionfrom two
speciallydesigned nozzles at a pressure of 1.4 kg/cm2.The
spray nozzlesare designedto deliver a flattenedspraythat
spreadsover the entire width ofthe salt stream. The spraying
chamberis provided with a viewing window. The concentration
of solution and the spray ratesare adjustedto yield the
required dosageofiodate in the salt. The iodate solution is
kept under pressure in two stainlesssteeldrums each of about
80 litres capacity. The pressure in the drums is maintainedby
an aircompressorequippedwith a regulator.
The salt along with Kl03 falls into a screw conveyor20—25 cm
wide and 2.5—3.0 m long. As ittravels through the screw,
uniformity of mixing is ensured. The screwconveyordischarges into twin outlets where bags are kept ready for filling.
The plant can also be made mobile for operationalconvenience. A spray mixing typeofplantbuilt to UNICEFspecifica-
tionsoperates at 6 ton/hour or about 12,000 ton/year.This
method is increasinglypreferred.
A batch-type versionhas beendeveloped in India forsmallscale manufacturers
who cannotafford or do not needcontinuIt consists of a ribbon blenderfitted
ous spray mixing plants.
Table 7-2.
Salttype
Comparison
network.
Table 7-2 shows a comparisonofthe different iodization
methodswiththeir relativeadvantagesand restraints.
Status: Full-scale production.
Product: Theaddition of iodine to salt (as potassiumor
sodium iodide/iodate) does not impart any colour or odour to
the salt. Iodizedsalt is not distinguishablefrom noniodizedsalt
and is fullyacceptable by consumers.
Qualityaspects: The physical characteristics andchemical
compositionof the salt vary widely dependingon the process
ofmanufacturing,compositionofthe raw material brine/salt,
and refining methodsadopted. Salt for iodization should at
leastconformto the specifications as recorded in Table 7-3.
Samples of freshly made iodized saltshould be collected at
regular intervalsand analyzed to determinethe iodine content.
Corrective measures should be taken, ifneeded,byadjusting
the flowofsalt and/or spray. Iodized salt should be collected
into bags directlyas it flows out ofthe chutes insteadof
allowingitto fall onthe ground. As the crystalswill still be
moist from the spray, theymay pickup dust and dirt. Personnel should be advised not to step or walkon iodized salt.
bodization equipmentshould be builtof stainless steeland
regularly maintainedand cleaned from salt particles. Mainte-
ofprincipal salt iodizationmethods.
++
Refined dry powder
+++
++
+++
Unrefined moist powder
÷+
++
++
Unrefined dry crystals
+
++
++
unrefinedmoist crystals
÷
+
+
Capital outlay
High
High
Medium
Operating
High
High
Medium
Cost to consumer
High
High
Medium
unrefined
cost
with an overhead drip orspray arrangement.A preweighed
quantity ofsalt is fed into the blender.The blender is operated
and a prefixed quantity of iodate is sprayedthrough overhead
nozzlesusing a hand pump or compressoras mixingproceeds.
After iodizationthe batchis discharged and packed.It is simple
to operate in the capacity rangeof0.5—3 ton/hour. It is already
beingused in Bangladesh, India, and Vietnam. It may also be
relevantin several other countrieswhere there is needfor
installation and operation of small lodizationplants closeto
salt productionsites or at strategicpoints in the distribution
dry powder
Note: +=notrecommended, ++=reasonable, +++ = good. (For a flowchart of salt iodizationseeFig. 4.1 cinChapter 4.)
Source: Mannar and Dunn (1995).
40 MicronutrientFortification of Foods
Table7-3. Minimum specificationofsalt for lodization.
SodiumChloride(as NaCI)
98.0
Calcium (asCa)
0.2
Magnesium(as Mg)
0.1
Sulphate (as SO4)
0.5
Insolubtes
0.5
Moisture
3.0
Based on 1992 costs of materialsand services
in someAsian
and Africancountries,a 20,000 ton/year continuousspraymixing iodizationplant is calculated at about US$ 8/ton.The
capitaland operatingcost for a 4,000ton/year batch spraymixing iodizationplant works outat about US$12/ton.
Project/program evaluation: In many countriessalt
iodation programshave beensuccessfully implemented.
is vitalto protecting equipmentbuilt ofmild
steel (carbon steel) fromsaline corrosion.This will involve
surface preparationand subsequently coveringwith a proper
nance painting
coating.
Marketing/distributionchannels: In most countries,the
salt-producingunits are concentrated in a few areas. Often, the
iodine-deficientareas arewidespreadand lieat considerable
distancesfrom the salt-productioncentres. Saltmoves from
productioncentres to consumptionsites by differentmodes of
transport. Distribution patternsare complexand erratic. Under
thesecircumstances it will be difficult to regulatea dual market
comprising iodized and noniodizedsalt or a target program
aimed at iodizationofsalt for the endemic areas. The only
long-term solution in most cases is universaliodization of all
salt produced for human and animal consumption.
Cost effectiveness: Suitable equipmentandtechniquesare
availableat relativelylow cost and can easilybe integrated
with any existing salt-crushingor refining system. The
incremental cost of salt iodization,including materials,labour,
and amortization,is rather low and estimatedat US$0.6—i .9/
ton, which is less than 8°/o of the retail price of salt in most
developing countries (see Table 7-4). Assuming a yearly
consumptionof 5 kg ofsalt per person,the additional cost of
salt iodizationthen would be 3—10 US cents/personperyear.
Observations: In the less-developed countries,where the
availablesalt is of uneven purity and humidity, and packaging
materialis often inadequate, the preferred productionmethod
is crushingthe salt and iodizing it by spray-mixingusing K103.
Drymixingof salt with potassiumiodate is only possibleifthe
salt is dry and finelyground. Otherwise, the K103 will segre-
gate and settle atthe bottom of the container. The drip-feed
systemis the simplest and cheapest. When the particlesize of
the salt is veryfine (less than 2 mm), however, the drip-feed
systemis unsuitablebecause it does not disperse the iodate
solution wWi sufficientuniformity. For national IDD control
programs,it maybe necessary to import potassiumiodate.
Alternatively,if the country'srequirementis large (at least 30
ton/year),itwill becheaperto import elemental iodine and
convertit to potassium iodate (see Appendix 1).
Future requirements/developments: In the caseof
small-scale producers, either theyshould set up individual
small-batch iodizationplants or form cooperatives for a
centralized iodizationand packing(UNICEF 1994). The
feasibility of developingportable iodizationunits that could be
movedfromone field to another should also be considered. It
is recommended to demonstrate iodizing units byusing
photographs,slides, orvideos.
WATER
Countries: Burkina Faso, Central AfricanRepublic, some
Central Asian Republics, Italy, Mali,Senegal, and Thailand.
Organizations andgroups involved: Ministry of Health
and Water and StandardDepartments of local governments.
Table 7-4. Estimationof total costsof salt iodization in developingcountries.
0.90
4.00
Chemical (Kl03)a
0.50—1.30
Processing
Extra packingmaterial(ifrequired)
2.35—5.50
Administrative overheads
0.60—1.50
Amortization
0.50—2.50
1.00
1.50
Total costofiodization
3.95—14.80
7.40
Retail pricecrystalline salt
250—1,000
625
Cost of lodization
1.6—1.5°/o
1.2°Io
asa percentage ofretail price
0.00—4.00
'Iodine: rangeof40-100ppm @ US$30/kg.
Source: Mannarand Dunn (1995, p. 70).
Current Practices,Research, and Opportunities 41
Targetgroup: The potential of using communitydrinking
water as a carrier of iodine has been of interestfor several
for iodizing townand school
water supply systemshave beentried in Sicily (Italy), Malaysia,
Mali, Thailand,and the Central African Republic.
appropriatedose for each well requirespreliminary
study. Itwill,therefore, be difficultto estimatevariation
in water iodinevalues (for different drawrates from the
wells)and the correspondingvariation in iodine intake.
decades. Experimental systems
•
Vehicle: Drinkingwater.
Fortificant: Iodine crystals.
Fortificationlevel: The objective is to providean iodine
concentration of 50—200ig per litre ofwater.
Technology:Process andequipment: lodizationofpublic
water supplies is achievedby divertinga small amount of
water through a canistercontainingcrystals of iodine and
reintroducingthe iodizedwater into the main water flow. In
Thailand,an iodinesolution is preparedin small dropper
bottles and distributedto schoolsand households in the
endemicareas for direct additionto drinkingwater in a jar.
School water supply systems arefittedwith iodine-dosing
pumps.
Duringthe last 5 years, a major initiative has beenmade by
the French companyRhone-Poulenc in the developmentof a
technologyfor adding iodineto drinkingwater in tubewells.
The method involvesplacingan iodine—silicone polymerin a
basket atthe bottom of the tubewell, which releases iodine
slowly or diffusesinto thewater uniformly over 12 months,
afterwhichthe basket is replaced.
Statusandresults ofthe fieldtrial: The iodization of
drinkingwater has been shown to be effective in improving
iodinestatus but has notyet been adequatelyfieldtested for
operational effectiveness.
Cost andcost effectiveness: Water iodization has metwith
limited applicationbecause of high capital and operatingcosts.
As in the case of iodized oil distribution, large investmentsin
human and materialresourcesfor water iodization programs
may riskdivertingattentionand resourcesfrom the initiation or
strengtheningofsalt iodization strategies.
Project/program evaluation: After tests withtheRhonePoulenc method in tubewellsin rural Mali, urinaryiodinelevels
and goitre prevalence showed significant improvement.
Observations: There is no documentationof pilotprojectsin
water iodizationwith diffusers. Someof the practical constraints in programsofcommunitywater iodization will likely
includethefollowing(Mannarand Stone 1993):
•
In additionto tubewells, ruralpopulationsmayhave
other, preferred options for noniodized drinkingwater,
e.g., streams, rainwatercollection, and open wells.
•
The amount of polymerrequired for a tubewell diffuser
system has to be calculated in terms of the average
water consumptionperperson and the average number
of persons using each well. Determination ofthe
42 MicronutrientFortification of Foods
Because the dose of iodinedeliveredby the diffusers
varies at each waterpoint,a monitoringsystemto
assessthe efficacyofthe interventionwill be complex.
Routine monitoringof iodinelevelsin water from all
tubewells in all villageswouldbe costly, whereasmonitoring on a sampling basis risksgiving misleading
results.
•
The silicone—iodinepolymer inthe canisterinserted in
the tubewellshas to be replacedannually.The CAR
figuresindicatea cost muchhigher than oil capsules.
•
Even with communitycost-recovery schemes, it is
questionablewhether beneficiaries will be willingto pay
on a permanentbasisfor iodizedwater,especiallyas
the problembecomesless visible with goitreregression.
Itcould be an option in certainisolatedareas.
Futurerequirements/developments: Large-scalewater
iodization programsare planned orunderimplementation in
Mali and CAR. In Burkina Faso, Rhone-Poulenc is workingwith
local firmsto make the iodine—polymersystem directly
availableto communities.In Senegal, the governmentis
workingwith UNICEF to integrateiodization with a water
supply and guinea worm eradicationproject.
Wateriodization couldbe an effective complementarymeasure
where problemswith salt iodizationpersist or as an additional
intervention in water supply programswith strong community
participation and health educationcomponents.Experience in
Thailand shows that its feasibility maybe in institutional
settings such as schoolswhere tubewells orstorage tankswith
water distributionsystems exist. The feasibility of using the
canistersin schoolwater supplies couldalso be tested.
The operationalrequirementsofensuring an uninterrupted
supply of polymersystems to deficient populationsand
effective coverageof affected communitieswith iodinehave yet
to be addressed. Examples of such issues arecommunity
sensitization,determinationof programresponsibilitiesat the
communitylevel, trainingfor installation, cost recoveryand
supply, monitoring, and compliance.
OTHERVEHICLES
experimentswith iodization of other foods is discussed
in the following. These have limited applicationand are of
minor programmaticimportance. For some, only limited
Some
information is available.
Breadiodization
Abstract: In 1966,the wheat flour used for bread in the
island of Tasmania, SouthAustralia, wasfortified with potas-
siumiodate at a level of 2 ppm. Based on estimatesofbread
consumption,averagedaily iodine intakes in various age
groups were: 81 pg (age 1—3 years), 187 pg (age 7—11
years),and 270 pg (age 15—18 years).The enormousvariability in bread consumptionimplies an unevenness in iodine
intakes (Clements etal. 1970).
Otheriodizedfoods
Brick tea:Bricktea is fortified with iodine in TibetandWest
China.
Sweets:Trialsto fortifiy sweets
have been carriedout in the
Middle East.
Sugar Sugariodizationhas beentested in Sudan but has
apparentlybeen abondoned because, even though Sudan
rations and controls its sugar distribution, a huge black market
for sugar flourishes,leading to both a sugar shortage in
western Sudanwhere IDD is endemic and a sugar oversupply
in Khartoum and neighbouringprovinceswhere (DO is not a
problem.
Iodinein milk
Abstract: The iodine contentof milkis influencedprimarily
by the exposureof dairy cattle to iodine through water, forage,
feed,feed supplements,salt blocks and veterinary medications,
and bytheexposureof the milkto iodine contaminationfrom
iodophor sanitizing solutions directly used as desinfectanton
cattle as well as on milkingequipment, vats, and other milk
containers in the dairy industry.Variability of thesepractices
may resultin a variation of iodine concentrations in milk. Some
seasonal and perhaps regionalvariation in iodine concentra-
tion in milk may reflect the amount of indoor feeding (i.e.,
iodine-supplementedfeed) duringthe colder months versus
outdoor feeding during the warmer months.Milk availablein
the US supermarketsis usually pooledfrom several local dairy
farms. High iodine concentrations in milkfromone farm will be
diluted by loweriodineconcentrations in milkfromother
farms.The iodine contentofmilk availableto the US public
appearsto be relativelystablewith an overall mean of 23 (±9)
pg/i00 g. One cup of milk (56 pg/i00 g) in this case covers
for 37%of the RDAfor adults. Continuedmonitoring is needed
to ascertainthatthe iodine levelsareadequateand appropriate
(Pennington1990; Nestel 1993).
SINGLE FORTIFICATIONWITH IRON
Iron fortification is generally considered to be a long-term
approachto combatingiron deficiencyanemia, as it reaches all
segmentsofthe population,it does not requirethe cooperation
of individuals, or an effective system of health delivery,and it
costsless. While iron-fortifiedfoods increase iron intake of all
individuals consumingsuch foods, because ofveryhigh
requirement during pregnancy, there will still be a needfor iron
supplementation.The success of iron fortification to combat
iron deficiencydependson manyfactors — mentionedin the
—
previouschapters suchas iron compoundand food vehicle
selected, and the acceptabilityofthe fortified productby the
consumers. The following will briefly reviewsome ofthe
vehicles usedto carry iron.
WHEAT FLOUR ANDBREAD
Countries: A wide rangeof developed and developing
countriesall over the world.
Organizations andgroups involved: WHO; FDA, FNBNAS-NRC, CFN-AMA (USA); the Panel of Iron in Flour (MOH),
MRC (UK); MRC, SCFAR, SARCDC(Sweden); School of Public
Health,Institute of PublicHealthResearch, TebranUniversity,
Iran.
Targetgroup: Whole population,especially anemicmen and
women, menstruatingwomen, pregnantwomen and children,
even in populationswith highstandardsofliving.
Vehicles: Flour is considered the ideal vehiclefor iron
fortification in countries with cereal-based diets. Cereals (wheat,
maize, or rice) most often provide the largestsingle source of
calories and are relatively inexpensive. Theyare often milled in
a few places in a country andarewidely consumed, irrespective ofage, sex, and socioeconomic status. Moreover, there is
no risk of overconsumption. For wheat, the amount of iron
added is designedto restore the iron lost in milling(milling
removes about two-thirds ofthe natural iron contentofa cereal)
orto enrich the flour.Nevertheless, consideringthe inhibitory
effects ofcereals on iron bioavailability,fortification ofcereals
maynot be the most efficientwayfor reducing iron deficiency
anemia.
Fortificants: Hallberget al. (1989) gave two requirements
for an iron fortificant in flour: insolubility inwater(due tohigh
water contentofflour) and good bioavailabilityin humans.
Schricker and Miller(1982) state that solubility under gastric
conditionsis required to obtain an availability similar tothat of
the nativeiron in the meal.
Ironsalts: Easily soluble ironcompounds, such as ferrous
sulphate, ferrousfumarate,and ferrousgluconatein flour,are
readily availablefor absorptionbut can dissolveduring
storage. Theseferrous iron salts may be oxidizedtoform
coloured ferric oxides, Iron salts induce rancidity in flour on
storage (by catalyzinglipid oxidation reactions). Encapsulated
ferroussulphateseems to have even more inferior storage
propertiesthan reagentgradeferrous sulphate. Iron salts also
have a harmful effect on baking qualities. In the latter case, the
particlesize of iron salts is important.
In Britain, the addition offerroussulphateand ferric ammonium citrateto flouris allowed and, in the USA, ferrous
sulphateis routinelyused. In somestudies,ferricorthophosphate,ferricsodium EDTA,sodium iron phosphate, and iron
pyrophosphateare used.The less-soluble iron salts have the
leastfunctionalityproblems, but their bioavailability is also less.
Current Practices, Research,and Opportunities43
Searching for an iron source that can be absorbed better,
Hallberget al. (1989) found a microcrystallinecomplexferric
orthophosphate(CFOP, Fe3H8(NH4)—(P04)6•6H20) to fortifyflour
for bread rolls. CFOP is added in the rangeof 2—14 mg/meal
(Flallberg
et al. 1989).
Elemental ironpowders(reduced iron): Elemental iron
powdersare extensivelyused for fortification offlour. They are
chemicallymore inertthan iron salts and induce fewertechnical
problems.Storagepropertiesof reduced iron are muchbetter
than iron salts.The greyish powder maycauseoff-colour
problems,buttheseare notveryserious. Elemental iron can be
obtained by the following processes:
1.
High temperaturereductionof ground iron oxideswith
either hydrogen or carbonmonoxide;
2.
Reduction
by an electrolyticdepositionprocess. This
product is purerthan the former and has a somewhat
smaller particlesize; and
3.
Decomposingiron pentacarbonyl (produced byreacting
iron with carbonmonoxide)to carbonyliron (and
carbonmonoxidegas).This process providesprobably
the finest iron particles.
Foriron availability,the small particlesize and acid solubility of
reduced iron seem to be important factors to be considered.
Otheriron sources On page 51, a haem iron concentrate
of bovine blood used for iron fortification of biscuits is mentioned.Johnson et al. (1985) suggest using soybean hulls for
iron fortification in bread. The hulls are low in oil so rancidity
should not be a concern and they containnegligible quantities
ofphytic acid,which is frequentlythe plant component
associated with poormineral availability.Soybean hulls are
a by-productof soyprocessing.
Fortificationlevel: The maximum ferroussulphateaddition
considered
in flour for bakery productsis 40 ppm. The standardset by
various countries are: Canada, 29—43 ppm; Chile, 30 ppm;
Denmark,30 ppm;Guyana, 29—36ppm; Kenya, 29—36ppm;
Nigeria, 35 ppm; Sweden, 25—75 ppm; UK, 16.5 ppm (mg/kg
flour, this meansrestorationof80%extraction); the US
increased iron fortification in 1982 from 28—36 ppm to 44
ppm;and Zambia, 29—36 ppm. Not all countriesthat have set
fortification standardshave made fortification mandatory.
Soybean hulls can be addedto breadat 5°/o flour replacement
withoutdeleteriouseffects on baking performance and overall
acceptability. Five percent replacement would cause an iron
level of 1.9 mg/i00 g bread, which is 68°/oof the iron
requiredbythe US Food and Drug Association (FDA) (Johnson
etal. 1985).
Technology:Processand equipment: The technologyof
iron fortification in whole-grainwheat is comparable to
fortification of rice. Fortificationofwheat is normally done
either at the mill oratthe bakery. Figure 7-1 shows a flow
44 MicronutrientFortificationof Foods
chart illustrating flour millingsteps and point at which
fortificationtakes place. The addition of iron can be performed
in a continuousprocess using a feeder or in a batchprocess by
hand. Forthe latter, compressed tablets are availablefor
specific sizes of dough. Because iron fortification offlour is
usually performedwithother fortificants,(commercially
available) premixesare often used. The addition ofpremixesto
flour is describedin Chapter 8. Stability problems inhibit
ferroussulphatebeing mixed with wheat flour to form a
concentrated premix.
by the magnetused to remove
metals
from
flour.
Unlike iron salts, reduced
tramp
incoming
iron is magnetic.Tests did not showsignificant differences in
iron content orsegregationofthe flour and the reduced iron
before and after magnetictreatment. The addition ofreduced
iron to less-finemillingproductslike farina, semolina, orgrits
may cause segregationproblems,especiallywhen the fortified
Reduced iron maybe entrapped
productis run through a purifier to remove dust.
Status and resultsoffield trials: Fortificationof bread
withiron seems to be an effective and safe methodto prevent
IDA, or even to cure its mildforms. A lot of laboratoryand field
studies are performedon the bioavailability of iron in bread.
Several field projects do report positive effects of fortification of
breadwith iron. The iron deficiency rate in Sweden has been
reduced fromabout 25—30%to 7% when the fortification
program started. About 40% of the iron consumed in Sweden
and 20% of that in North America comes fromfortified wheat
flourand bakeryproducts.
The presentlevel ofiron restorationor enrichmentofflour for
the use of breadin Britain and the US, however, is not sufficientfor several population groups, particularly females in the
age group of 9—54 yearsand children under 6 years of age.
Also, the decreased cereal consumption(in the US) has partly
beenresponsiblefor this insufficient iron intake. Fortification
with CFOP and soybean hulls is reported only on a laboratory
scale.
Product: Addition ofiron in the used amounts does not seem
to affect the breadquality.
Qualityaspects: The maximum ferroussulphate addition in
flour for bakery productsis 40 ppm, and the fortified flour
should notbe storedfor more than 3 months at moderate
temperature. Not much is said about iron quality apart fromthe
level of iron fortification.The US requiresthe form of iron that
is harmlessand assimilable. Canada requiresthe particlesize
of95°/o of the reduced iron<44 tm, and at least 90°/o
solubility in 0.1 N HCI.
An iron-fortificationprogram requiresperiodic analysesto
ensurethat iron is in the food in the desiredamounts. Method
40—40ofthe AmericanAssociationofCereal Chemists (AACC)
is a qualitative method that roughly determinesthe typeof iron
used in fortification. By adding a dropofa reagent, large red
Fig. 7-1. Flowchart of flour millingand point of fabrication(source: Nelson 1985).
spots rapidlyappearifferroussulphate is present,littlered
spots appearafterabout 10 minutes if reduced iron is used as
the iron source.
To measure iron quantitatively,extractionis necessary before
detection.Forextraction, one can performdry-ashing, which
has problemswith sampleloss, volatilization, iron contamination,orwet-ashing, which is more dangerousbecause ofthe
use ofhot, concentrated, oxidizing acids. For detection,
colorimetricprocedures can be performedor atomicabsorption
can be used (e.g., AACC method 40—41A), which can detect
several minerals in the samesamplebut this is more expensive.
Marketing/distributionchannels: When millingis
centralized and distribution offlour and breadcan be controlled
adequatelyand accurately, enriching bread (in developing
countries) would be simple. Ifthe use of dried yeast becomes
the rule, and all bakersare obligedto use it, this leavening
agent could serveas the vehiclefor enrichment(Vaghefi et al.
1974). Moreover, yeast has a positive effect on iron
bioavailability.
Cost and cost effectiveness: The easiestavailableand by
far the leastexpensive iron sourceis ferroussulphate
heptahydrate.In Appendix 2, someestimatedcostsofcommonly used iron sources are given.Although ferroussulphate
heptahydrateis not included in this table, it is much cheaper
than dried ferroussulphate. Ferric ammoniumcitrateand ferric
pyrophosphateare extremelyexpensive.
Barrettand Ranum (1985) indicated the cost for ferrous
sulphatein amountssufficientto add 38 mg iron/kg at
US$0.01 5 for 100 kg flour. They estimatedthe cost of a
fortification program in Egyptwhere providing 9 mg iron/day
to everyperson would cost US$0.01 5/person peryear. Ifthe
sameeffectwouldbe obtained with iron supplementstablets,
the cost ofthe tablets alone would be US$0.11/personper
year.The price of the iron compounditself is always a very
small part of the overall price ofthe product.
Project/program evaluation:
Effective fortification
programshave been implementedunderstrictgovernment
supervisionand after proper legislationhas been passed.
Current Practices,Research,and Opportunities45
Observations: IrOn fortification often goes hand in hand with
fortification withniacin, thiamin, riboflavin, calcium, vitamin A,
pyridoxine, folic acid,magnesium,and zinc. Because the addition ofvitamin A toflour and breadstarted inthe US only in
1982,a lot of research has beendone on single iron fortifica-
The chemical changeof iron compoundsto insoluble forms
during baking as mentionedearlier is not seen with NaFeEDTA.
The enhancingeffect ofEDTA is not endorsedby all scientists
(Ranum and Loewe 1978) and seems to be the oppositewhen
the ratio EDTA:Fe> 2:1 (Hurell 1984):
tion.
Processingmethod:The processingeffects are not very
clear; El Guindi et al. (1988) and Hallberget al. (1986)
did not find an effectof the baking process on the
relativeavailabilities of nonhaem iron in breadsand
meals. As mentioned, Lee and Clydesdale (1980) found
an effect ofthe baking process in which almost all initial
iron forms changed into insoluble forms of iron with
equal availabilities.Potassium bromate,a maturing
agent addedto flour atthe mill,can reactwith ferrous
Bioavailabiity ofdifferentironsources Elwood et al.
(1971) found that the bioavailabilityof iron salts eaten with
breadis much lower than has beensuggested from highly
controlledradioactive isotopestudies. Lee and Clydesdale
(1980) report that iron sources when addedto flour and baked
as biscuitsor breaddo not remain in the original chemical
form. The net effect ofthe baking process seems to be the
formation of insolubleforms ofiron, An exception is made for
ferric sodium EDTA.The availability ofthe iron in soybean hulls
seems to be equalto the commonly usedferroussulphate
(Johnson et al. 1985). The relative bioavailabilityofCFOP
varied from30 to 60°Iowhen wheat rolls were servedwith
'different meals(Hallberg 1989).
Circumstancesthat affectbloavailabilityofiron in
breadIflour The relative availability of nonhaemironin
bread seems to be affected by several factors. There are many
substances in a normal diet that interfere withiron absorption:
•
Compositionofthe meals:Studies inwhich bread is
eaten aloneare not representative ofreal life situations.
•
Ironstatusofthe individual:Iron deficientsubjects
absorba larger percentage than healthy subjects do, and if
less iron is available,absorptionseems to be more
efficient.
•
Presenceofinhibitors in food:Brancontentof the
flour and bread. Bran components inhibitiron absorption
(Bruneet al. 1992). So a lower extractionrate offlour
(witha higher content of bran)causes less iron
absorption.This was also confirmedin experimentson
the absorption of ferroussulphatein fortified Egyptian
flatbreads compared to European breads (El Guindi et
al. 1988). In animal experiments, Ranhotra etal. (1979)
found no inhibitory effectof adding cellulose to bread (to
make high-fibre bread) on the availability ofiron inbread.
•
Ascorbicacid is known as an enhancerfor iron availability, but its addition toflour orbread is not useful. The
hightemperatures requiredfor baking cause oxidative
destructionof the ascorbic acid.The pH conditions
duringfortification can also affectthe proposedenhancing
effectof ascorbicacid (Sayers et al. 1973; Dermanet al.
1977; Clydesdale and Nadeau 1985;Hallberg 1986).
El Guindi etal. (1988) found positive effects on iron absorption
if EDTA was added. Also Whittaker and Vanderveen (1989)
report a higher availability ofiron when Egyptianflatbread is
fortified with Fe504+Na2EDTAorNaFeEDTA insteadof FeSO4.
This is due to the chelatingeffects of EDTA.
46 MicronutrientFortification of Foods
sulphateand produceFe3* (Lorenz 1982). Schricker and
Miller (1982) suggest an enhancingeffectofheat and
pressure on iron availability.The waterconcentration in
the baked product during this processmighthydrolyzethe
phytate causingthe enhancingeffect.
•
High levelsof salt in breadmaydecrease, whereashigh
levelsofyeast may increase, iron availability in bread
(Kadan andZiegler (1986).
Future requirements/developments: There is an urgent
needto discoverordevelop an iron preparationthat is more
readily availableor that can be addedto flour in relatively high
concentrations withoutseriously affectingits storing or baking
qualities.There mightbe a future for CFOP,bovine haem
concentrate, and/orEDTA-containing compounds.
MILKAND MILKPOWDER
Countries:Australia,Canada, Chile, India,Jamaica, Mexico,
USA, Yugoslavia.
Organizations andgroups involved:InternationalAtomic
EnergyAgency; National Institute ofArthritis, Metabolic,and
DigestiveDiseases; DairyCouncil of California; National Dairy
Council;Nutrition Foundation;Chilean Ministry ofHealth; The
Consejo Nacional para Ia AlimentacionyNutricion; United
Nations University;Departamentode Investigaciony
Bibliotecas de Ia Universidadde Chile;the NestleNutrition
Research Grant Programme; Hoffmann-La Roche and Co. Ltd.
Targetgroup:Infantsandyoung children.
Vehicles:Cow's milk, liquidmilk, dryskim milk (DSM),full
cream milk powder,buffalomilk.
Fortificants: The main iron sourceused is ferroussulphate,
but all iron sources mentionedin Appendix 2 are eligible.
Enrichmentof iron-fortified milkwith ascorbicacid improves
iron bioavailability. Roughly 5—10°/oof iron in fortified milk is
absorbed. Ferric orthophosphateseems
to have poorer
bioavailabilitythan ferroussulphate,electrolyticiron, or
carbonyl iron. The bioavailabilityof ferrouschloride was found
tobe betterthan ferric lactobionate. Addition ofzincdoes not
affectbioavailabilityof iron in milk. Results about the effect of
There is little informationon the storage stability ofiron
fortified milk. Fortifiedpasteurizedmilk can only be keptfor a
milkproductsthemselves on iron availability are contradictory.
An inhibiting effect ofmilk is sometimessuggested,which
mightcomefrommilkfat and not from low fat milk products
(Ashworthand March 1973;Momeiloviand Kello 1979;
Ranhotraetal. 1982; Rivera etal. 1982; Hurell 1984; Galan
etal. 1991).
fewdays, during which someoff-flavoursoften developdue to
oxidative rancidity. Rancidityin milk powder is not described
extensively. In some studies, the iron source is addedtothe
milk or reconstituted milkjust before consumption,so stability
is no problem.The full-fat milk powder in the Stekel et al.
(1 988a,b) and Olivares et al. (1989) studies was fortified with
ferroussulphate.Because packagingin oxygen-free containers
Addition of iron to dairy productscan cause lipolytic oxidation,
resulting in "oxidized"flavours and odours.Iron chelates are
lesssusceptibleto oxidative rancidity than ferrous salts,
although ferroussulphatecauses much more ranciditythan,for
instance, ferric ammoniumsulphate and ferric ammonium
citrate.
Heatingdecreases the oxidativeeffectof ferroussulphateand
increases the oxidative effect of iron chelates as ferric
nitrilotriacetateand ferric lactobionate. But afterheating, iron
chelates are less susceptible to oxidative ranciditythan ferrous
salts.
Fortificationlevel: Unfortified milk containsless than one
ppm of iron. In most studies, fortification levels of 10—25 mg
iron/I(reconstituted) milkare employed,although sometimes
fortificant at the level of 100—125mgiron/I is studied.
Ascorbic add is addedatthe level of 50—100ppm.
Technology:Process andequipment:The main problem
in fortifying milk powder with iron is the requiredsophisticated
packaging.In principle,the technologyis simple and it is not
very expensiveto fortifyregular milkpowder availablein
developingcountrieswith ferroussulphate.The oxygen-free
packaging,however,necessary to preventrancidity,makes
fortification compUcated and expensive. To preventoxidationas
much as possib'e, iron fortification of milk is recommended
after homogenisation(emulsificationof milkfat, which is of
great influence) and just before pasteurization(Hegenauer et al.
1979a,b; Kiran et al. 1977).
Status andresults offieldtrials: Iron deficiencycan be
prevented by programsdistributing iron fortified milk (Rivera et
al. 1982;Stekel et al. 1988a,b;Olivares et al. 1989).In Chile,
the National Program of SupplementaryFeeding is involved,
but most often studiesare at laboratoryor field trial levels.
Product: It is possibleto formulate iron fortified milkwith
good organolepticacceptability. Stekelet al. (1988b) found
good acceptabilityof powderedfull-fat milkwith ferrous
sulphate(15 mg/i00 g) in the presence ofascorbicacid (100
mg/i00 g).Sainiet al. (1987) did organolepticresearch and
found that an addition of upto 20 ppm ferroussulphate or
ferricammonium citrate added to buffalo milk is acceptable. If
the iron level is further increased, off-flavoursdevelop. Boiling
can improvethe flavour offortified milk, probably because the
cookedflavour masksthe oxidative rancidity.
was not possiblelocally, rancidity occurred.
Cost and cost effectiveness: Switching from unfortified to a
fortified milk, like in the program in Chile (about 13 million kg
ofdry milkare distributed each year to infants), meansan
increase in price of about 13—i4°/o. Ofthis, only about 1O/ is
contributedby ferroussulphateand ascorbic acid and the rest
by the increased cost of packaging(see the discussionin Hurell
(1982)).
INFANTFOODS/FORMULAS
Countries: A wide rangeofcountriesall over the world, both
in developed and in developingcountries.Iron fortified infant
food is availablearoundthe world.
Parties involved/cooperation:
PAG, UNU/WH P. TPI,
INACG, ILSI, HNI, AAP/CN, CPS, ESPGAN; USDA/ARS, USAID,
FDA, PHS, NIH, NDC (US); CMAFP (UK); FPR, FCR (Finland);
AEB,
(South Africa); IAEA; MRC;FFWF (Austria);CPHIIF,
cr
MOH, INTA(Chile); CONICET, SECYT, UBACYT (Argentina);
NNRGP(Switserland);Mead Johnson Nutritional Group(US);
Bristol-MyersInternationalGroup.
Targetgroups: Infants and pregnantand lactatingwomen.
Because ofthe expansionofblood volume and extremelyrapid
growth duringinfancyand early childhood,infants arethe
most critical population group regardingiron deficiency. After
about 4—6 months,the neonatal iron stores are depletedand
additional iron is essential,particularlyup to 24 months.
Vehicles: Breastfeeding is recommended as the best infant
food, and exclusivebreastfeeding should be encouraged for all
infants upto the age of6 months.Thereafter, because of
increased demandfor higher energy and iron for growth in
children over 6 months, breastmilkshould preferablybe
supplemented. Infant cereals have been used to supplement
breastfeeding well after 6 months when the older infants' diet
should be supplementedwithsome solid foods.
The distinction between infant formulas and infant cereals is
not evident,and they are oftenmade with the sameingredients. Infantformulas are more liquid and not designedfor
addition to milk, whereasinfant cereals meetthe solid food
requirement,are usually dry, and most are designedto be
addedto milk. No cow's milkis recommended before the age
of oneyear. It containslittlevitamin D and iron and can cause
occult bloodloss. Instead, infant cereals are preferred. The use
Current Practices,Research, and Opportunities47
ofsoya as an ingredientis often recommended to avoid
allergies to cow's milk. Soya flour productshave a high native
iron content, so when soyaflour is used,the processed food
will have a higher iron contentthan the other flour-based
infantcereals.
Ferrous fumarate is often.usedbecause of its reddish brown
colour,which is compatiblewith the yellow and brown colour
characteristics of the CSM, WSB,and other blendedfoods.
Ferrous succinate seems to bejust as suitableas ferrous
fumarate,withoutcausingfat oxidation or discoloration(Hurell
single ingredients.
1989),
The ingredientsmaybe milled and processed like heat treated,
rolled, parboiled,orextruded. The final productfor consumers
is sold as a drink or as a dry powder to be cooked like rice
(Barrett and Ranum 1985). Atypical compositionofthe widely
used infant cereal, corn—soy-milk (CSM), is shown in Table 75. Table 7-6 gives the protein sources of several widely used
infant cereals.
Fortificants: Ferrous sulphate (heptahydrate, reagentgrade)
is by farthe most commonlyadded iron source to both liquid
and powderedmilkand soy-based infant formulas,especially
in the US and Canada. It can sastifactorilybe used in infant
Atypical composition ofcorn—soymilk(CSM) (°/o).
Maize meal
59
Soybean flour
17.5
Nonfatdrymilk
15
Soybean oil
5.5
Iron (as ferrous fumarate)a
Ascorbic acida
ferrouslactate, and ferricammonium citrate mightbe used in
liquidformula. Ferriccitrate and ferric gluconatemightbe used
in liquid soya formula. Ferric pyrophosphate,ferric orthophosphate,and saccharated ferric oxide are used in infant cereals.
Stabilizedferrouscarbonate, ferrous gluconate, and ferrous
saccharate are other possibilities.
The main technologicalproblem with iron fortification of infant
foods concerns colour and off-flavour production.In general,
the more soluble the salt, the greaterthe problem.Addition of
ferroussulphateto liquidmilk or soyaproducts darkenstheir
colour. It is possibleto fortifymilk formulas with acceptable
results, but this requires a balanced compositionand (most
importantly) appropriatepackaging.This is possible in
industrializedcountries,but is not likelyto befeasiblein small,
local industries.Adequate packagingis often a limitingfactor
regardingproductionoffortified formulas.Fortificationwith
ferroussulphaterequiresthe use ofoxygen-freesealed cans.
oxidation. This is especially seen with the cereal products,
which contain a high level of readily oxidizableunsaturated
fatty acids. Ferrous sulphateand ferrous gluconateare the most
important enhancers of lipid oxidation. Elemental iron hardly
1,000 ppm
Percentages oftotalprotein contributed
In Europe, iron EDTA is widely accepted for iron fortification.A
wide range of other iron sourcesare also used: ferrouscitrate,
Flavour problems in iron fortification are usually due to fat
1 80 ppm
aAddedamong others inamineralpremix (ppmindryfood).
Source: Cookand Bothwell(1984).
Table 7-6.
sulphateis ongoing.
Infant cereals are not compatiblewith ferroussulphateand,
therefore, small-particleelementaliron is usually added.
Sodium iron pyrophosphatewas commonly used in cereals but
has beenreplaced due to its low bioavailability (Hurell 1984;
Purvis 1 98; Rees et al. 1985).
Infant cereals were mainly designedfor weaning infants but
also for risk groups suchas pregnantwomen, lactating
women, and children in developingcountries.Theygenerally
consistof a cereal (wheat,rice, maize, and sorghum),a highquality protein compound(soybean, nonfatdry milk, and
whey) and a fat component. Vitamins and mineralsare added
for fortification,and sugar may be addedfor flavouring. Local
ingredientsshould be used as muchas possible.The result is
a nutritionally improvedformula compared with any ofthe
Table 7-5.
formula and other foodsthat do not contain reactive forms. Fat
oxidation and discolorationare common problemsusing
ferroussulphate,so research to use encapsulated ferrous
bythe differentmajor ingredients.
Corn—soy-milk (CSM)
45
27
Corn—soyblend (CSB)
63
37
Wheat—soyblend (WSB)
55
45
Wheat—protein-concentrateblend (WPC)
61
39
Whey—soy drink (WSD)
74
Source: Cook and Bothwell (1984).
48 MicronutrientFortification of Foods
28
26
inducesoff-flavours, if particlesize is not too small. Ninety-five
percent should be below 44 which seems to be the most
suitable in dry infantfoods concerningorganolepticproperties
and bioavailability.Also, encapsulated ferroussulphatecauses
littlerancidity during storage.On adding ferroussulphate (even
when it is encapsulated) or other iron sources (ferrous/ferric
salts with chloride,citrate, or acetate) to infant cereals, a dark
grey or greencolour develops when (hot) milk is added.The
colour developmentofencapsulated ferroussulphate is related
to the melting point ofthe coatingmaterial and dependson the
i.
milktemperature(Hurell 1984).
Addition of haemeiron is also a possibility. Although it is
especially suitablefor use in meatproducts,Hertrampfetal.
(1990) used a bovine haemoglobinconcentrate (BHC) to fortify
an infant cereal made by extrusion of rice flour. The main
technological problem withBHCconcerns the colour. Because
of the low iron level in the strongly colouredBHC, the relative
highlevel of 5°Io has to be added.Also microbiological
problemscan develop. Extruded rice cereal fortified with BHC
was adequate to preventiron deficiencyanemia only if
consumed in a dose over 30 glday. For several infants,the
volumewas a problem. Anotheraspect offortifying (infant)
foodswith BHC is ethical,cultural, or religious resistance to the
addition of blood productsto foods.
Fortificationlevel: The Codex Alimentariussets the
minimal iron fortification level for infant foodsat 1 mg Fe/iO0
kcal, which is about 7 mg Fe/I formula. Maximum fortification
levelsare 3 mg/laO kcal (20 mg/I) in the us; mg/i00 kcal
in the UK, and 1.5—2 mg/i00 kcal in France. In the US, if
i
fortification level is raised to over 75 mg/serving, the formula
or cereal is considered a supplementand no longer is regarded
as a food.
In most studiesfortification levels are describedof about 12
mg Fe/I formula (10—17 mg/I) and 0.15—0.5mg Fe/g cereal.
The US upper limit of 20 mg/I is often relatedto the use ofsoy,
because soybeanisolatehas a high and variable native iron
content. Lower levelsare commonin Europe with more efficient
use ofiron from foods with lower fortification levels, these
levelsare also sufficient.Decreasing tile US level to the
European levels, is a main point ofdiscussion. The minimal
level to preventiron deficiencywas found to be 7 mg/I by
Saarinen and Siimes (1977), which was supportedby Bradley
et aI. (1993). Haschke et al. (1993) found that 3 mgferrous
sulphate/Iin a whey-predominantformula is sufficientto
protectinfants (3—6 months of age) from becomingiron
•
•
Preblending
of dry major ingredients,
Separate weighing and addition of vitamins and
minerals,
•
Blendingof the entire batchfor uniform distribution,
Addition ofthe fat or oil component,
Final blending, and
Packaging.
Forfortified blendedfoods, a premix offortified cereals is also
used insteadofthe separate addition ofvitamins and minerals
(Barrett and Ranum 1985).
Status and resultsoffieldtrials: Iron-supplemented
infant foodsare universally available. In 1985,already80°/o of
all US formula sold was iron fortified, and this has been
creditedas the major factor in the declining prevalence of
anemia in US infants among both low-incomeand middle-class
populations. Some groups rejectiron-fortifiedformula believing
that infants fed iron-fortifiedformulas are more likelyto suffer
fromgastrointestinalproblems.Theories about gastrointestinal
problemsare the presumedbacterio-static propertiesofthe iron
binding proteinsof milk (lactoferrin and transferrin). They may
lose thosepropertieswhen full saturation withiron occurs
instead of the normal one-thirdsaturation.This is a reasonto
avoid unnecessarilygenerous iron supplementation(Saarinen
and Siimes 1977). No effects ofthis kind, however,have been
reported,except for stool colour,Even therapeutic doses ofiron
are well-toleratedby infants (Nelson etal. 1988; Committee on
Nutrition 1989; Dallman 1989).
A more important point of disagreement and reasonto
minimize iron fortification is the effect of iron on the absorption
of copperand zinc. The Committee on Nutrition (1989) claims
that iron fortification of formulas does not impair the absorption ofzinc and copperto a degree that is nutritionally important. But Haschke et al. (1986) found repressed absorptionof
copper with 10.2 mg Fe/I infant formulaand Seely et al.
(1972) report that in prematureinfants, copperdeficiency can
presumablybe caused by iron fortificationof infant formula.
Effects on zincabsorptionare also reportedand is a point of
controversy. A maximum Fe:Zn ratio of2:1 mightbe good
advice. In human breastmilk, the ratio of Fe:Zn is <1. (FlureIl
1984; Haschke et al. 1986; Dallman 1989; Power et al.
1991).
Marketing/distributionchannels: Infant foodsare either
distributed by feeding programsorby sale on the open market
deficient.
all over the world.
BHC is added to extruded rice flour ata level of 5°/o, the iron in
BHC is only 0.28%. (Calvo etal. 1989; Hertrampf etal. 1990).
Costand cost effectiveness: See also the section on "Milk
and Milk Powder"and "WheatFlour and Bread"
Seealso Appendix2 about iron sources andpage 50 "Biscuits:'
Technology:Processand equipment: Most infant
Project/program evaluation: The feeding ofiron-fortified
formula to infants has beenshown to eliminateovert iron
cereals/formulas are produced under batch conditions:
deficiency, the most commoncause of anemia in childhood,
Current Practices,Research, and Opportunities
49
almost completely.Iron-fortifiedinfant formulas orcereals are
also suitableto maintain adequate iron levels. Supplementsto
breastfeeding over 6 months of age should also contain
additional iron.
Iron fortification should notbe considered a separate goal of
health and nutritional programstargetedto infantpopulations.
It should be part ofa broaderstrategyto ensure, for example,
adequate levelsof protein,energy, and other micronutrients.
Observations
Bloavailability:Breastmilkcontainssmall amounts of iron,
but this is well absorbedand utilized. About 49—70°Io ofthe
breast-milkiron (0.66mg/I) is absorbedby infants.Maximum
absorptionof cow's milk iron (which is presentin levelsof
0.1—0.2 mg/I) is 30%.Only about 3—10% ofsupplemented
iron in infant formulas (about 12.5 mg/I) is absorbed.Iron
absorptionfrominfantcereals is even less.
The oxidationstate of iron affects the absorption. The iron in
foods can exist in ferric (Fej,ferrous (Fej, and elemental
(Fe) states. Ferrous iron is more soluble than ferric, especially at
higher pH. Iron absorptiontakes place in the intestine, which
has a slightly alkaline environment.
Ferrous salts like ferroussulphate,-fumarate,-gjuconate,
-lactate, and -citrateare all seen as highly available,which
meansthey are roughly absorbed by 3—1 0°/a on average.
Ferric ammonium citrate mightalso have good bioavailabilityin
humans.The availability of elementaliron is not clear and
variesgreatly between verypoor and good acid solubility,
dependingon particlesize. Phosphate-iron salts showusually
poorerabsorption.Absorption of BHCin extrudedrice cereal is
about 1 4°/a.
These bioavailabilityfigures for iron sources are definitely not
absolute:A lot of research studies contradictoneanother. Many
factorsaffectabsorption,and animal studies are not directly
comparable to human studies.Because iron absorption is often
less than whatis assumed,the intake maynot meetthe daily
requirements.This is especially important in developing
countries where iron is notusually provided by different
sourcesas it is in western countries.Simply increasingthe iron
contentmay not result in increased uptake.Thereare many
questions concerningthe gastrointestinaltoleranceand
interactionwithother minerals.Moreover, simplyincreasing
iron uptake may also be inefficient, because the lower the level
ofadded iron, the more effective absorptionoccurs.
Factorsaffectingabsorption: Ligands, which chelate iron,
can inhibitabsorptionbyforming insolublecomplexesor very
high affinity complexes(as phosphates, oxalates, dietary fibre,
tannins, and phytate) or can enhance absorptionbyforming
soluble chelates with iron, thus preventingprecipitation(as
amino acids, citrate, and ascorbate) (Hurell 1984). In practice,
many chelatorsdo affect iron absorption.The reasonfor high
50 MicronutrientFortification of Foods
bioavailabilityof breast-milkiron is unknown. This higher
bioavailabilityis not due to lactoferrinbutcould possibly be
due to chelatingagents.
Factors enhandngabsorption:Vitamin C or ascorbicacid
found in freshfruits and vegetables is a strong enhancer of
nonhaem iron absorption.This is also true in infantformula,
due to the ability of ascorbic acid to form a soluble complex
with iron, which protects iron fromthe inhibitory ligands.
Absorptioncan increase upto six times in the presence of
vitamin C. Addition ofascorbicacid to infantfoods is common.
Stabilized cellulose coated ascorbic acid is often used because it
is more resistantto deteriorationby moisture and temperature.
Ascorbicacid is commonly addedat a level offive times the
iron content. No other organic acidshave such strong enhancing properties(Derman et al. 1980; Rizk and Clydesdale
1985; Stekel etal. 1986; Haschke et al. 1988).Fructose
seems to be an enhancer, but other sugars like glucose and
galactose, which also form complexeswith iron are not,
therefore, the use of ferricfructoseas source of iron can be
considered.
Among sugars,sorbitol, mannitol, andxylose have enhancing
properties. Meat and fish enhance absorptionof nonhaemiron
and haem iron as well. An important role is probably played by
cysteine ora typical protein type. The phosphoproteinin egg
has beenshown to be a strong inhibitor. EDTA and NTA
(nitrilotriaceticacid) have chelatingproperties,with enhancing
effects. NaFe EDTA can be used as an iron source and is seen
by someas a promisingchelator. But ifthe ratio EDTA:iron is
greaterthan 2:1, EDTA acts like an inhibitor. Because EDTA is
often used as afood preservative,inhibition is likely in many
foods (Cookand Bothwell 1984; Hurell 1984).
Factorsdecreasingabsorption: Soya productscan inhibit
iron absorption, but results of research on soya inhibition are
oftencontradictory. Soya mayhavean iron-binding factor,
which does notseemtobe dietary fibre or phytates,probably
due to partially digested soy proteins.Availability of iron in
soy-based or milk-basedformulas is not obviously different.
Cow'smilk has also an inhibitory effect, mainly due tothe
nature ofcow's milkproteins (casein with its strong ironbinding propertiesvia its serine phosphategroups) and the
highlevel of calciumand phosphorus(Stekel et al. 1986;
Hurell 1989; PabOnand Lönnerdale 1992). Cereals can inhibit
iron absorption.The exact reason is notclear but the inhibitory
effectmightbe due to phytate,phosphate, and/or dietary
fibre.
BISCUITS
Countiy: Chile.
Organizations and groupsinvolved: Instituto de
y TecnologIa de los Alimentos (INTA), Universidadde
NutriciOn
Chile, Santiago;Departemento de investigaciOn
de Ia Universidadde Chile.
y Bibiliotecas
Targetgroup: School children. Supplementaryfeeding
Table7-8.
program in Chile;biscuitsand milk (substitute) for school
children. This program is national in scope, reaches a significant proportion of the nutritionally vulnerablepopulation,and
Proteins
has enjoyed long-standingsupport.
Lipids
Vehicles: Wheat-flour biscuits. The composition of iron
fortified biscuItsis given in Table 7-7.
Fortificationlevel: Consideringtechnical andorganoleptical
possibilities,6% HIC was chosen as the appropriatefortification level. Not only was iron contenteight times higherthan in
the unfortifled controlsamples, protein content was also 1.6
times higher. Bioavailabilityof hemoglobiniron measuredwith
a double isotopetechniqueshoweda haem-ironabsorption of
19.7 0/a. The schoolchildren received 30 grams offortified
biscuitsa day, during two schoolperiods.This made a daily
uptake of 0.96 mg iron (30,000mgx 6°/a x 0.27°/a x 19.7°/a
=0.96 mg iron).
Technology:Processandequipment: HIC is obtained by
separatingbovine blood into plasmaand red blood cell
fractionsby centrifuging.The bloodcellsare washedthree
times with 0.9 % NaCI and are freeze-dried, The use of HIC
may producesomemicrobiologicalproblems,yetthe main
problem in using HIC for fortification is that because the
amount of iron in HIC is low,it is necessary to use high
amounts of HIC. This results in a dark colour that, although it is
acceptable in biscuits, it is not acceptable in many other foods.
It is, therefore, notyet feasible to use this technologyfor
fortification of other foods.
Table 7-7.
Composition
of controland6°/a fortified biscuits.
of the haem iron concentrate.
Carbohydrates
Ash
Iron content of ash
Fortificants: Haemiron concentrate (HIC), also called bovine
haemoglobinconcentrate (BHC). Bovine blood from slaughtering operationshas an enormouspotentialas a sourceof large
quantitiesof haem iron and proteins (see Table 7-8). Iron yield
was 0.27°/a of HIC. The bioavailabilityof HIC is betterthan
nonhaem-ironcompounds, which are generally used in the
fortification of wheat flourand its processing products.
Composition
The process for producingiron-fortified biscuits is as follows:
•
•
•
•
•
Flour,HIC, additives,and antioxidanfsaredry-mixed;
Hydrogenated
lard and liquid sugar are added;
The dough is kneadedto a homogeneous consistency;
It is moulded in an automaticmachine;and
Biscuits are cookedin a continuoushorizontalelectric
oven for 10 minutes at 270°C (Asenjo et al. 1985).
Status andresults ofthe fieldtrial: Serumferritin values
significantly increased by the fortified biscuits, even though the
groups of school children had very good initialiron statusto
start with. The effect ofhemoglobin-fortifiedbiscuits in a
population with a pooriron statuswill, therefore, be even more
evident.The high-iron bioavailability,the good organoleptic
characteristics, andthebiological effecton iron nutriture make
the hemoglobin-fortifiedbiscuitsan appealingalternativeto
combat iron deficiency. Moreover, HIC is not onlyan excellent
iron source, and its highlysine contentimprovesthe protein
quality of the biscuitsas well (Asenjoet al. 1985;Olivares et
al. 1990). Although biscuitswith 6°/a FIIC were acceptable in
this trial, sensoryevaluationshoweda preference for the
controlbiscuitsthat had no FIIC. Nevertheless, Olivares et al.
(1990) reportedan excellent acceptabilityof both types of
biscuits.
Qualityaspects:Acatalytic effect ofthe HIC on the lipid
auto-oxidationwas observed. Under controlledconditions (1 7—
20°C, oxygenand light-proofpackaging),the biscuitscan be
stored up to 7 months (Asenjoet al. 1985).
Marketing/distributionchannels:School feeding
program.
Costandcost effectiveness: Bovine haemoglobin is largely
wasted during the commercial slaughteroperation,particularly
in poor countries.Industrial methods to collect and process the
blood are both availableand are rather inexpensive(Hertrampf
etal. 1990).
Futurerequirements/developments:
The biscuit project
in Chile seems to provide great opportunities.Technical
possibilities of upscalingthe FIIC productionhave to be
researched and cost analysisshould be performed.
Current Practices,Research,and Opportunities51
RICE FLOUR
SALT
Countries: Argentina and Chile.
Countries: India and Thailand.
Organizations andgroups involved: CESNI, Buenos
Aires, Argentina;and the University of Santiago,Chile.
Organizationsand groups involved: In India: National
Institute ofNutrition,Hyderabad; Food and Nutrition Board,
Ministry ofAgriculture; Ministry of Food and Civil Supplies,
Madras;All India Instituteof Hygieneand Public health,
Calcutta; Institute of Child Health, Madras;All India Instituteof
Medical Sciences, NewDelhi; HaryanaAgricultural University,
Hisar; Machine Build Industries Pvt. Ltd., Madras,India.In
Thailand: Ministry of Health, Bangkok;and Mahidol University,
Targetgroup: When an infant reaches 4—6 months of age,
breastmilkalone becomes insufficientto meetthe iron requ irements ofa normal,healthychild. Cereals, traditionallyused to
supplementbreast-fed infantshave several limitations, such as
low iron availability, low quality ofprotein,low nutrient
density, and high bulk. The full-term Hispanicinfantpopulation
oflow socioeconomic class in urban areas of Santiagowas
selected to participatein a field trial to assessthe effect ofthe
iron-fortified rice flour on iron nutritionstatus.
Vehicles:
Extruded rice flourobtained from
a local supplier.
Fortificant: Bovine haemoglobinconcentrate(BHC). BHC is a
fine,dark red powderobtained by centrifugation and further
dehydrationof the corpuscularfraction ofblood of slaughtered
animals. L-ascorbicacid (20 mg/i00 gof powder) was added
as antioxidantin relationto the fat content. To balancethe Ca/P
ratio,CaCO3 (500 mg/i 00 g of rice) was added as well.
Fortification level: The level offortification used was 5°/a
BHC(iron content280 mg/i00 g of powder), which means 14
mg ofelementaliron per 100 g dry product. Assumingan
average dailyintake of dry cerealof40 g/infantand an
absorptionrate of 14.2°/a, it provided 0.8 mg ofabsorbed iron/
infantper day. Geometric mean absorptionof the rice-BHC iron
was 14.2°/a, which is slightly over one-third ofthe optimal
absorptionof elementaliron.
Technology:Processand equipment:The rice flourwas
extrudedin a 6" AndersonExpansionExtruder-Cooker
(Anderson Ibec, Strongsville, Ohio, USA). After processing,the
Bangkok.
Targetgroup: Iron deficiencyanemia (IDA) is an important
publichealth problem in India.It has been estimated that up to
60°/a ofpreschool children, 300/a of women ofchild-bearing
age, and 50°/aof pregnantwomen sufferfrom anemia. Iron
deficiency anemia is particularly prevalentin the Northeast
Region ofThailandwhere an estimated40°/a ofthe population
suffersfrom IDA, due, among other factors,to the relative
isolation of villages, extreme poverty, and poor livingconditions.
Vehicle: Common salt is consideredto be a suitablevehicle
for salt fortification, satisfyingall the criteria ofan ideal vehicle
in India and Thailand:
•
Salt is consumedby all segments ofthe population,
•
There is no relationbetweensalt consumptionand
socioeconomic statusofthe population,and
•
Daily salt consumptionhas a narrow range of 12—20 g,
withan average intake of 15 g/day.
Fortificants: In identifying the iron source for fortifying salt,
the following criteriawere considered:
extrudedflour was dried to 10% moisturecontentand ground
over a 60-mesh sieve.A premixof BHC, L-ascorbicacid, and
CaCO3 was then dry mixedwith the extrudedrice flour.
•
•
•
Iron sources must be stable when mixedwithsalt,
Flow chart: See this chapterunder "WheatProcessing:'
Status: Field trial. Agroup of92 breast-fedinfants from 4 to 12
monthsof age mceivedthefortifiedcereal. Acontrol group of 96
•
It must be stable under the prevailing conditionsof
storageand transportationof salt, and
Bioavailability ofthe iron sourcemust be satisfactory,
particularly when the iron-fortified salt is added to food
during cooking.
infants received regularsolid foods(cookedvegetables and meat).
Attheend ofthetrial, a subsampleofinfants inbothgroupswas
supplemented with45 mg Fefor 90days.At 12 months,iron
deficiencyanemia was present in 17% ofcontrols, in 10% of
fortifiedinfants as awhole, but onlyin 6% ofthe infants who
consumed more than 30 g of rice/day,demonstratingthat the
consumption ofhaemoglobin-fortifiedrice is effective in tdudng
the incidence of IDA in breast-fed infants.
Project/program evaluation: The use of a haem-iron
fortified cerealas a weaning food seems feasibleand advantageous, supplyingan appropriateamountof absorbableiron, an
adequate energy density, and a proteinthatcould complement
milk protein.
52 MicronutrientFortification of Foods
•
It must not develop colour when mixedwith salt,
It must not impartcolour ortaste to the food to which
the salt is added,
Although ferroussulphate isthe most suitable iron salt from
the point of view of bioavailability and cost, it is unstable and
developscolour readily when added to NaCl. Ferric phosphate
and other insolubleiron compoundsare stable and do not
develop colour, butthe iron absorption rate is unacceptably
low, particularly when ingestedwith food.
Two approacheswere investigated: the use ofstabilizersto
preventdiscolouring and absorptionpromoters to improve
bioavailability. The use ofsodium hexametaphosphateand
sodium acid sulphateas stabilizerswasproposed(Diamondet
at. 1974). Absorptionpromotershave beenfound to have
betterkeeping quality withoutdeteriorationof iron availability.
With sodium acid sulphate(NaHSO4),the iron absorptionfrom
ferricphosphate(FePO4) significantly increased to nearly
doublethe rate and reached 800/0 of the value obtainedwith
ferroussulphate(FeSO4). The formula was improved (Rao et al.
1978) to avoid occasional yellow discolorationand to reduce
the cost. Instead ofthe more expensive FePO4, a mixtureofFSO4
and sodiumorthophosphoric add (NaH2PO4) can be used.
Studies in Thailand concentrated on the use ofstabilizers.A
formula based on Na-hexamethaphosphate and NaHSO4was
tested (Suwaniket al. 1980). Iron absorptionand stability from
a meal containingthis fortified salt is reportedsatisfactory. This
is contradictorytothe findings of Rao et al. (1975) who
reporteddeteriorationofiron availability on storagedue to
formation of insolubleferric phosphate.
Grinding and washing: Rawsalt isfed into ahopperand
ata uniformrate througha rollerfeeder andbucket
elevator to a hydromillinto whichbrine is also introduced. Here,
the salt is groundand discharged as slurry into aslurry receiving
tankwherefreshbrine isonce againintmduced. The gypsumand
fine insolubles are separated byfloatation withfrothformedinthe
hydtDm ill. Thesaltslurry isthen pumpedthrougha slurrypump
to athickenerwherethe salt concentration is increased before it is
fed into a continuous centrifuge. The washbrineis returned to a
brinetankfrom where it is repumped to the thickener. The wash
liquor carryingimpuritiesis sent to a sludge pit where the
insolubles settle. Theclearbrineis recirculated throughthe pump
to the slurry receiving tank.
delivered
Centrifuging and drying:The brine is given a freshwater
wash and its moisturecontent should be reduced, in the
centrifuge,to about 3°/o. The centrifuged salt is passed through
a fluid bed drierwhere it is driedto a moisturecontentof less
Fortificationlevel: The fortificant as producedin India from
than 0.15°/o and then cooled.
NaHSO4 (5,000ppm), FeSO4 (3,200ppm), and NaH2PO4
(2,200ppm) provides one gram of elementaliron per kg of
fortified salt (1,000ppm).Absorption ofiron in the cereal-
Fortificationandpackaging: After refining and drying, the
driedsalt is transferred through a bucket elevator to a vibrating
screen andsieved. The undersized particlesare fed to a
continuous mixer where the salt is dry blendedwith a premix
based diet in India is impaired due to the high phytate content
of thesediets. Assuming an absorptionrate of 5% and an
average intake of 15 g of saltlday per person,it provides0.75
mgof additional absorbable iron/day.This is just over one-
third of the average daily iron requirement in India.
The fortificant made in Thailand from FeSO4 (5,000ppm), Nahexametaphosphate (4,000 ppm), and NaHSO4 (3,000ppm)
give a fortified product containingone gram of elementaliron
perkg of fortified salt (1,000ppm).Assuming an absorption
rate of 10°/o ofthe total intake of iron in the Thai diet and an
average intake of 10 g ofsalfldayper person,it providesabout
one mgof additional absorbable iron/day.
The processing requiredfor different gradesof salt is summarized in the next column:
Category Type
Processingrequired
a.
Grinding and washing
Unrefined
Centrifugingand drying
Fortificationand
packaging
b.
Semirefined
Centrifugingand drying
Fortificationand
packaging
c.
Refined
Fortificationand
packaging
Technology:Processand equipment: Forsalt that needs
to be refinedthefollowing steps are involved:
of salt and NaH504, FeSO4, and NaH2PO4. The fortified salt is
packed in 50 kg bags or retail packs of 0.5 or 1 kg. The
blendingtechniqueis critical as improper mixing could result in
ununiformfortification and discolorationofthe salt either
immediatelyorwithin a few daysof mixing. For salt delivered
to the iodizationplantas a semirefinedgrade, the grinding and
washing step is not necessary. When refinedsalt is used, only
the fortification and packagingstep is required. In Thailand,
insteadof dry blending, spray-mixingwas applied to fortify
salt with iron because this techniquegives a consistent and
uniform iron concentration.
Flowchart: See Chapter4 (Fig.4-Ic).
Status:
Based on a communitytrial among childrenaged 5—
15 years(Nadigeretal. 1980) and field trials among the rural
population (Nadiger et al. 1980;Working Group Report
1982), fortified salt made a significantimprovementin
haemoglobinlevelsand in reducingthe prevalence of anemia.
The impact was the highest in a regionwhere the incidence
was highest. Afurther study among female collegestudents
confirmedthesefindings (Jam et al. 1987). Steps have been
takentoimplement this program on a national scale.
The TamilNadu projectis expected to covertwo districts in the
state and the Midday-MealProgramsfor schoolchildren
(coveringroughly 2.5 millionpeople). UNICEF has carried out
Knowledge,Attitudes,and Practices (KAP) studies in these
areas and has prepared a detailed publicity campaignfor ironfortified salt (Mannar 1991).
Consumer acceptabilitytrialshave beencarriedoutwith salt
fortified with FePO4-NaI-1S04 in India. This fortified salt was
Current Practices, Research,and Opportunities53
found to be generally acceptable in both the communitytrials
in schoolsand the field trialsin four regions in lncfla. Field
trials are reportedto be under wayin Thailand,but results of
this study are not available(Suwanik1980).
Product: Salt fortified with FePO4and NaHSO4 in 1:2 molar
proportionswas found to be stableover 8 months,and iron
absorptiondid not deteriorate on storage. Crude salt with a
highcontentof magnesiumchloride (MgCI2) occasionally gave
a yellow discoloration, which gradually disappeared within 10
days on exposureto the atmosphere. Salt fortified witha
mixture of FeSO4 (NaH2PO4)and NaHSO4 was found equally
good with resped tobioavailability and stability, while
occasional discolorationdid not occur. When used in cooking,
taste orcolour of the productwas notaltered.
Salt fortified witha mixture of FeSO4 Na-hexametaphosphate,
and NaHSO4 gave good bioavailability in testsin Thailand.
Taste or colour were notaltered and no significantreductionin
iron levels afterstorageof up to 15 months was observed. No
change in taste and palatability was noted when used in more
than 50 commonThai recipes, which involvedboiling,
roasting,frying,steaming,grilling,salting, sundrying, or
fermentation.
Qualityaspects: The purityof salt used for iron fortification
is a critical factor to ensurethe stability and bioavailabilityof
the ironcompound.Presence ofmoisture in the salthastens
hydrolysisof the ferroussalts and imparts a brown colour to
the salt. The presence of a high level of magnesium(Mg) in the
salt increases its tendencyto absorb moistureand aggravates
the problem.Salt used for iron fortification will requirea
minimum purityof 99°!o (dry base), a maximum moisture
contentof 0.5°Io, and a maximum Mg level of 0.05°Io. The salt
should be fine and be of uniform size (0.5—1 mm).
Effective implementationofa program for producing and
distributing iron-fortifiedsaltrequiresregular monitoring,
particularly atthe retail and householdlevels. A simple,
inexpensivefield kithas beendeveloped for this purpose
(Ranganathan and Rao 1992).
Cost effectiveness: On the basis ofprevailing pricesin India
(as of 1991), the cost of machineryhas beenestimatedat
US$1 10,000for a unit producing one ton/hour. The cost of
processingfortified salt including the cost of chemicalsand
packaging (at 1985 levels) are estimatedat US$25/ton and
US$1 6/tonwhen using FePO4 and FeSO4-NaH2PO4 respectively. Iron fortification adds about 50—80°/o to the thst ofsalt
and costs US$0.20/personper year.
Project/program evaluation: The National Institute of
Nutrition, India, is evaluatingthe impact ofthe fortified salt in
two districtsin Tamil Nadu state. Baseline surveyshave been
completed.(Mannar 1991). The results ofthe impact evaluation are discussed under "DoubleFortifiedSalty
Observations: Although this approach wouldhelpto reduce
the incidence ofmild and moderategradesof anemia in the
community,it is unlikely to meet the iron needs of pregnant
women who mayhave the most severe forms of anemiawith
associated highest risks.
Even though technologyfor iron fortification ofsalt has been
developed and field trialsconfirming the effectiveness ofthe
formulation were completedin the 1970s,the program did not
find large-scale application,partlybecause it was overtaken by
a major thrustin several developingcountries,including India,
to iodate saltto control IDD. In somecountries like Sri Lanka,
cookingsalt is steeped in waterand onlythe saturatedbrine is
used for cooking.In suchcases, fortification of saltwith iron
maynot be feasible.
There was no evidence
ofthe presence of inhibiting factors
such as phytatesand phosphatesin the Thai diet.The absorption of iron was enhanced bythe presence of protein in the
form ofsmall fish and by the ingestion of papaya, which
contains ascorbic acid.
Future requirements/developments: Given that the
infrastructure for salt iodation is now in place in several
developingcountries,this presents an opportunity to Introduce
iron alongwith iodine in the salt.
FISH SAUCE (NAMPLA)
Thailand.
Marketing/distributionchannels:A well-established
Country
distribution system exists in India. The productionof ironfortified salton a commercial scalehas recently beenapproved
by the Governmentof India. Specifications for iron-fortifiedsalt
have been incorporated as part ofthe regulationsgoverning
the Prevention ofFood AdulterationAct. Private companies in
Madrasand Hyderabadhave begunmarketing iron-fortified
salt in limited quantities.In the statesofTamil Nadu and
Rajasthan, large commercial-scale fortification plantsare being
establishedby government-ownedcompanies. Of the estimatedannual productionof 7 milliontons of salt, about 4.5
million tonsare availablefor human consumption,most of
which is producedin about 120 manucturingcentres.
Organizations andgroups involved: The Faculty of
54 MicronutrientFortification of Foods
Tropical Medicine, Mahidol University, Bangkok;The Swedish
Medical Research Council;and WHO.
Targetgroup: The prevalence of anemia in Thailand is
estimatedto be 30—50°/o, dueto a highincidenceofhookworminfectionand a low intake ofiron fromanimal foods.
Anemia,due to iron deficiency, is probably most severe in the
north-easternpart ofThailand (Tuntawiroonetal. 1980).
Vehicle: In Thailand,the use of fish sauce as a condiment,
flavour, or saltsubstitute is widespread.Fish sauceis an
important salt substitute.Whereas solid salt is usually not in
the market in the local village shops, fish sauce always is. It is
used in most kinds of foodsand is added during cooking.
Fish sauce has beenproducedin some 130 factories (Garby
and Areekul 1974). Ofthesefactories, some 10—15 of the
largestcompanies produceroughly 80°Ioof the totalamount of
fish sauceproduced. The consumptionoffish sauce has
increased from 20—30millionlitres in 1962to 40—80million
litres in 1967. The main reasonfor the increasingproductionis
the increasingconsumptionin the ruralareas. The improved
transportfacilitieshave openedthe rural areas for centrally
processed products.The averageconsumptionoffish sauceis
10—1 5 mi/head per day (estimates for the average consumption bythe military forces is 25 mI/head per day).
In 1969,Garby suggested fish sauce as a suitablevehiclefor
iron fortification to the WHO Nutritional Division for these
reasons:
Its low price;
withthe fortified fish sauce (Garbyand Areekul
1974). Absorptiontestsshowed that the iron present in the
food withthe fortified fish sauceis well absorbed.
meals prepared
Status: After laboratorytests were doneto identify a suitable
iron compound,a one-year field trial in two villages situatedin
the Central PlainofThailand was conducted. This area is
considered to be representative of the economic andsocial
structureofthe majority of Thai provinceswhere 80—90°/o of
the population are rice-growingfarmers. The area, however, is
not as severelyaffected by iron deficiencyanaemia as the
north-eastern provinces. The fish sauce, used in the field trial
was fortified with 6.56 mg NaFeEDTA.The results showedthat
because of the fish sauce fortification program it is possibleto
increase iron intake by 10—20 mgof Fe/person per day. The
trial duration (one year) is too short to provide optimal
beneficialresults but the results implythat a continuous
consumptionof the fortified fish sauce should be expected to
give goodanemia-reducing results.
Wide-spread consumption;
Fortificationlevel: One mg elementalFe/mIsauce, which
•
Fairlyconstantconsumptionlevel of 10-15 ml/person/
day; and
correspondents
•
Overallavailability inthe market.
of the productis highlyunlikely as its salt
contentlimits the amount that can be consumed without
Overconsumption
negative organolepticeffects.
with 6.56 mg NaFeEDTA/ml sauceextractionof
marine fish. The salt contentofthe productis 30g/l and the
iron content is 10 mg/I. The variance in fish saucequalitiesis
dependent ofthe degree of extraction, the cheaper qualities
beingdilutions ofthe high-extraction-rate qualities. Problems
with colour,taste,and odour, caused bythe iron fortificant,are
minimized by choosingthis highlyflavouredproductas the
Fortificants: Thefollowingiron fortificantswere tested in the
vehicle.
laboratory:
Technology,process, andequipment:A small factoryin
Bangkokwasaskedtofortifythe sauce for the pilot project.
The NaFeEDTAwasaddedto the fish sauce just before bottling.
The bottles were transportedto the villages once in every2
months. The village headman was responsiblefor storage and
distribution ofthe fish sauce tothe villagers when needed.
1.
Iron(III) SodiumEthylenediaminetetia-Acetate (NaFeEDIA).
2.
lron(IU) CholineHydroxideCitrate.
3.
Iron(II) GlycineSulphate.
4.
Iron(II) Digluconate.
5.
Iron(II) Succinate.
6.
Iron(II) Sulphate.
The fortification concentration was 0.5 and 1.0 mg elemental
iron/mi fish sauce.
Only the first iron compound(NaFeEDTA) provedsuitable as a
fortificant.Fish sauce is a clear brown liquidthat masks well
any discolorationcaused bythe addition of the iron fortificant.
Only the NaFeEDTA,however, did not changethe visual
appearance, whereasthe other fortificants (2 through 6) were
rapidly precipitated(from afew minutes to somehours).
The status of NaFe11 1EDTAas a recognized food additive is not
yetclear. JECFA(1993) has reached the conclusion that
NaFe11 1EDTA is safewhen used in supervisedfood fortification
programsin iron-deficientpopulationsand has given provisional approval for its use. NaFeEDTAdid not alter the pH of
the fish sauce. Further organoleptictests showedno significant
effect ofthe NaFeEDTAfortified fish sauce on the taste ofthe
Full-scaleproduction:No large-scale industrial fortification
program has beenreportedin the internationalliterature
(INACG 1993).
Product: Theproduct is a clearbrown liquidwith a pH of
about 5.5, produced by salt extractionof marine fish. The salt
contentofthe productis 30 g/I and the iron contentis 10 mg/I.
The variancein fishsaucequalities is dependent ofthe degree
of extraction, the cheaperqualitiesbeing dilutions ofthe highextraction-rate qualities. Problemswith colour,taste,and
odour, caused by the iron fortificant,are minimized by choosingthis highlyflavouredproductas the vehicle.
Cost effectiveness: The costsofthe fish sauce fortification
as suggested bythe field trial will increase the costsof the
product by 10—20%or by about 0.3—1 .0°/o of the average
monthly cashincomeofa Thai farmer. A less pure grade
(>97%),however,as is used in the agriculturalindustry as a
fortificant,is commerciallyavailableat less than halfthe costs
ofthe pharmaceutical NaFe1111EDTA (Ballot et al. 1989). The
Current Practices,Research,and Opportunities 55
costs of food fortification with Nafe111EDTA as a food additive
•
may also be reduced withthe alternative fortification mixture
Na2EDTAplus FeSO4in a molar ration of 0.5:1.0in diets
•
(INACG 1993).
Project/program evaluation: The active role ofthe fish
sauceprocessing industry is limited to one producerin
Bangkokwho providesthe fortified product. It is important to
includethe fish sauce processing industry as a wholein a very
early stage of the program to maximizetheir cooperation in
pilottests and full-scaleproduction.Viteri et al. (1981) and
Cookand Reusser (1983) report a large-scale fishsauce
fortification programbeingconducted in Thailand.
Future requirements/developments: The JECFA(1993)
stated that NaFeEDTAis safe when used in supervisedfood
fortification programsin iron-deficientpopulationsand has
given provisionalapprovalfor its use. A cheaperyetvery
promising alternativeis the use of Na2EDTAand FeSO4 in the
molar ratio ofEDTA to iron between 1.0 and 0.25 in meals of
low iron availability.In a large-scale/full-scale fortification
program both theseiron sources may be tested for efficacy.
CURRY POWDER (MASALA)
Project title:Fortification of curry powder with NaFe111EDTA.
Country:SouthAfrica.
Parties involved/cooperation: The MedicalResearch
Council (MRC), the University of Witwatersrand,the University
of Natal, and the Indian population of South Africa.
Targetgroup: The Indian population of Durban shows a
highprevalence of nutritional iron deficiency. Mayet (1972,
1976) found evidence of iron deficiencyin 20°/aof the male
and in 33% of the female population.In a later study,McPhail
et al. (1994) reportedIDA in 14°/a of the femalesin the
reproductiveage in the sameIndian population.A further 26°/a
wasshown to have depletedironstores and another 8% had
iron-deficienterythropoiesis(IDE). In a recentstudy, Ballot et al.
(1 989a) found evidence of iron deficiencyin 30°/a of the male
and 60% ofthe femaleIndian population in Natal. Of the
females, 24% had IDA, 13°/aIDE, and 16% had depleted
stores. This is ascribed to a high pregnancy rate and a diet in
which the bioavailability ofthe iron is low (Mayet1972;
McPhail 1981). The Indian population ofNatal was, therefore,
selected for a pilotprogram to establishthe feasibility ofa
fortification program using curry powder.
Vehicle: Thechoice of an appropriatevehiclewas complicatedby the fact that the black South Africanpopulation shows
a highprevalence ofironoverload,due to the traditional
method ofbeer brewing in cast-iron pots. Thisexcludes the
choice of a staple food like flour as the vehiclefor the iron
fortification (MRC 1978). Masalawasespecially suited to
servethe goal of the projectbecause it has the following
characteristics:
56 MicronutrientFortification of Foods
•
•
Regularconsumption,
Relativelyconstantamounts (average of 5.5 g/d)
consumed bya high percentage ofthe targetpopulation,
Not consumed by the nontargetpopulation,
Goodmasking qualities(dark colour and strong aroma),
and
•
Aslightironabsorption-enhancingeffectof the vehicle
(Lamparelli
et al. 1987).
Fortificants:
FeEDTA is the only known nonhaemiron
fortification source that resists the inhibitory effectof phytic
acid, a componentof cereals and grain legumes,which is the
main compoundofthe target group's diet. Studies have shown
thatthe iron absorptionfrom NaFe1111EDTA fortified foods is
significantly betterthan from other fortified foods. Mean
bioavailability of the fortificantwasabout 10°/a. Lamparelli
(1987) showedthat the mean iron absorptionfrom
NaFe111EDTA-fortifiedmasalawas almost twice that offerrous
sulphate,when eachwastaken togetherwith a traditional
vegetablemeal. An increase in the iron absorptionofapproximately 7 mg/daywas established. In the study, an absorption
increase of 12 pmol/d in iron-depletedwomen was demonstrated.No adverse effects in individuals with normal iron
status at the beginning of the experimentswas observed.
Fortificationlevel: 10mg NaFe111EDTA/gcurry powder,
which equals 1.4 mg Fe/gcurrypowder.
Product: Commercial masala was
purchased from a local
batches
of
fortified
masalawere
supplier. Experimental
the
in
a
prepared by
investigators
separate location.The local
supplier packagedthe experimentalbatches in the regular
packagingmaterial.The level of fortification was 10 mg
NaFe11 1EDTA/ g curry powder,which equals 1.4 mg iron/g
curry powder.Consumer acceptabilitywas assessed usinga
questionnaire. Acceptabilityin terms of taste and appearance
was high. The NaFe111EDTAshowedno tendencyto segregate,
the curry powder beingslightlysticky.Stability afterseveral
months of storage was good.
Technology:Process andequipment:No commercial
productionoffortified masalahas yet beenreported.Production is still at the laboratoryphase.
Status: Lamparelli (1987) describes an experimentthat was
designedto study the acceptabilityof curry powder as an iron
fortification vehicleand the suitability of NaFe111EDTAas the
fortificant.
Ballot et al. (1989b) describes a field study, which assesses the
effect offortification ofcurrypowder with NaFe11 1EDTAon the
iron status ofthe target population. No further investigations
and/or trials with NaFe111EDTAfortified currypowder have
beenreported. Investigationsare now concentrated on the
issueof the optimal molar ratio ofNa2EDTA to iron in mealsof
low bioavailability (McPhail etal, 1994).
Cost effectiveness: The pharmaceutical gradeNaFe111EDTA
used in the study raised the price of the fortified masalaby
1 5°Io, A less pure grade(>97°/o), however,as is used in the
agricultural industry as a fortificant, is commerciallyavailable
at less than half the cost of the pharmaceutical NaFe111EDTA
(Ballot et al. 1989).
The costs offood fortification with NaFe111EDTAas a food
additive may be reducedwiththe alternativefortification
mixture Na2EDTAplus FeSO4 in a molar ration of 0.5:1.0 in
diets (INACG 1993).
Projectiprogram evaluation: The status ofNaFe111EDTA
as a recognized food additive is notyet solved.JECFA(1993)
has reached the conclusionthat NaFe111EDTAis safe when
used in supervisedfood fortification programsin iron-deficient
populationsand has given provisionalapproval for its use.
Although the results of the field trials are verypromising,
introductionof a full-scale operational food fortification
program is not possible. Averypromising alternativeis the use
ofNa2EDTA and FeSO4in the molar ratio of EDTA to iron
between 1.0 and 0.25 in mealsof low iron availability.
Future requirements/developments: Thusfar, an active
role of the masala producers, with regardto adviseon the
feasibility of the process in the existing processing facilities,
packaging,price setting, and the marketability of the productis
not reported. When active cooperationofthe industry is
guaranteed, steps to develop a monitoring unit and a program
evaluationprocedure can be taken.
OTHER FOOD VEHICLES
Barley-sproutflour
Abstract: In an attemptto increase the iron contentofbarley
flour, seeds were soaked in distilled water for 6 hours and
grown hydroponicallyunder controlledconditionsin the dark
for 132 hours. Theywere sprayed automaticallyevery 4 hours
for 15 minutes witheither distilled wateror distilled water to
which iron as ferroussulfate had beenadded at 5, 7, and 10
ppm iron concentration. The sproutswere frozen,freezedried,
ground into flour, and analyzed for iron, Iron bioavailability
was evaluatedby the efficiency of convertingdietary iron to
haemoglobin.Increasingthe concentration in the iron in the
spray water resultedin marked increases in sprout iron levels,
but solutions of 7 ppm and above inhibited seed germination.
Iron from the sproutedbarley flourwassignificantly more
availablethan thatfromthe ungemlinated barley seed flour
(Alexander and Cudjoe 1989).
Cheese
Abstract:Dairyproducts contribute high-qualityprotein, calcium,
and other nutrients tothe humandiet butare low in iron. Zhang
and Mohoney(1991) fortifiedcheddar cheesewithFe-casein, Fewheyprotein, or FeCI3. lmn concentrations in the fortifiedcheese
were 40mg/kg, whereas the imn content ofthe unfortifiedcontrol
cheesewas 1—2 mg/kg.The qualitywas determined by
thiobarbituricadd assay and taste panel evaluation. After3
monthsofstorage no difference in oxidized off-flavouror cheese
flavour,texture, and qualitybetween the fortifiedand unfortified
cheesewas detected.
Results indicate that it is possible to produce good-quality, iron-
fortified processcheddarcheese.Similarresults were obtained by
Wong and LaCroix (1979)who fortifiedcottage cheesewithferric
ammonium citrate. This study demonstrated that milkproteindoes
not affect iron absorption and that the fortifiedcheeseiseffective in
restoring low haemoglobin. Jackson and Lee (1992) fortified
Havarti-style cheesewith microencapsulated iron. The cheesewas
fortifiedwithstearine coated microcapsules containingiron as
+ ascorbicacid,or FeCL3withupto 141 mgiron/kg
ofchese. Sensory evaluation indicated thatcheesewithencapsulated FeSO4 + ascorbicacid was indistinguishable from cheese
FeSO4 FeSO4
without imn.
Other iron-fortifiedcheese types had highinitial concentrations
of malonaldehydeand undesirableoxidizedflavours. Unencapsulated iron salts are not suitable as fortificantsdue totheir
reactivity. The rapid and simplestearineniicroencapsulation
methodallows fortification of dairy productsand other high fat
and highmoisturefoods with iron (Jackson and Lee 1992).
Coffee
Abstract: Coffee grounds were fortified with ferrousfumarate
and the resulting perkedcoffee was fed to rats (Johnson and
Evans 1977). Fe-fumarate mixes well with coffee grounds and is
undetectable after mixing. It did not siftout after 3 months of
storage.Taste panels could nottell the difference in organoleptic
propertiesoffortified and unfortified coffee. Bioavailabilityof
the iron was assessed with the extrinsiclabeltechnique. For
black coffee, coffee with sugar,coffee with nondairy creamer,
coffee with milk, and coffee with sugar and nondairy creamer,
bioavailability ofthe iron averaged 39 ± 12.1%. There wasno
significant difference in iron absorptionfromthe coffees.
Assuming that iron absorptionin rats and humansis similar,
coffee could supply a substantialamount of the daily iron
requirement. Ata level of 5 ppm in brewed coffee, four cups
(200ml each) wouldsupply 4 mg iron inthe diet. Layrisse
(1976) has reportedaddition of iron-fortifiedsugar to coffee
without adverse effects on its organolepticproperties.
Itis suggested thatiron fortification of coffeemight beafeasible
method ofincreasing iron intakesfor manypeople. Morcket al.
(1983), however, concluded thatwhen the coffeewas ingested
directly withorwithin an hour after a meal,iwn absorption was
reduced dramatically. No decreasein iron absorption occurred
when coffeewas consumed within an hourbefore ameal (Layrisse
etal. 1976; Johnson and Evans 1977; Morck et al. 1983).
Current Practices, Research, and Opportunities 57
Eggs
Abstract: Eggs are an important source of dietary protein and
potentially could add appreciablyto tile dietary iron absorption. The poorabsorptionfromegg yolk(100/0 of thatfrom
ferrous iron salt), however,detracts from theirvalue in this
respect. Another disadvantageof eggs in relation to iron
metabolismis their interference with iron absorptionfrom other
sources. Eggs do not, however,appearto interfere withthe
absorptionof iron fromhaemoglobin,which emphasizes the
importance of haem iron in iron nutrition. The addition of
orangejuice to the meal shows a highly significantpositive
effect on iron absorption (Callender et al. 1970).
Grain amaranthcereal
Abstract: Iron bioavailability in Nigean grainamaranth cetal
fortifiedbytwo iron compounds, sodiumethylenediaminetetraacetate (NaFeEDTA) and ferrousfumarate(FeC4H2O4), was
compared with that in cereal fortified with ferroussulphate.
Grainamaranthis important because of its potential as a cereal
for young children in Nigeria and other Third World countries.
Although haemoglobingain in all three groups fed fortified
cereal wassignificantly higher than that in the group given no
addediron, haemoglobingainwas highest in animalsfed
amaranthcereal with ferrousfumarate.High relativebiological
valuesand expected body weight gainindicated optimum iron
absorptionfrom the amaranthcereal. The study indicates that
ferrousfumarate is the iron fortifierof choice for grain amaranth cereal (Whittackerand Ologunde 1990).
pastes decreased when rinsed with water, whereas it increased
when rinsed withhydrochloricacid.Starchcontaining60—80
mg Fe/i00 g of dry matter was characterized by a lowered
susceptibilityto degradationbyalpha-amylasean
glucoamylase (Leszaynski 1985).
Othersingleiron-fortifiedfoods
The use of wheat flournoodlesfor iron and other micronutrient
fortification is currentlyunder considerationin Indonesia. The
main constraintis the lackof expertisein this technical area.
Kool-aidis an exampleofa beverage fortified with iron and is
under developmentin Egypt. Because of its dark colour,this
beverage could be a suitablevehiclefor iron fortification (Nestel
1993).
SINGLE FORTIFICATIONWITH VITAMIN A
FATS
Fats and oils are used directly oras food ingredients.Whereas
oils referto liquidproductslike oils from canola, corn,
cottenseed, coconut, olive, palm, peanut,safflower,soybean,
and sunflower,fats are solid productssuchas butter, lard,
shortenings,margarine,ghee, tallow, and vanaspati.Fats and
oils are suitable as vehiclesfor vitamin A because:
•
Vitamin A is more stablein fats and oils than in other
foods as theyare protected from aircontact,this delays
theiroxidation and prolongs their stability;
•
Dietary fat facilitates absorptionand utilization ofvitamin
A in the body, therefore, its fortificationwith vitamin A is
one of the most appropriatemeansofsupplying this
vitamin to a deficientpopulation; and
•
Fats and oils are used directly or are basicingredientsof
6
Potato starch
In spite ofthe fact that starch present in the diet
lowersthe assimilation ability of iron addedto food, for
technical reasons bread and flourproductsare most frequently
enriched with iron. This provides the possibility to enrich these
productswith a supplementofpotato starch after its saturation
with ferric salts.Starch saturatedwithferric chloride or ferric
citrate solutions and containing7—80 mg fe/i00 gof dry
matter was examined.
Abstract:
The increase in iron contentwas higher in thecaseofchloride
than of citrate and did notdependon the previousrinsing of
starch with water or 1/10 M hydrochloricacid.Simultaneously,
withthe increase ofiron content, the viscosityof 0.25°/o starch
58 MicronutrientFortificationof Foods
Vitamin A and provitamin Acompoundsare highlyfat
soluble and, when addedto fats or oils, distribute easily
and uniformly;
•
Maize meal
Maizecan be readily fortified withiron withoutany technical
problems.Dry-milled maize meal fortified with reducediron
(88 mg/kg) was stable after days of accelerated storage. To
date, maizemeal has not beenconsidered as a food vehiclein
developingcountriesbecause a considerable amountofthe
maizeconsumed is processed atthe home. Given the increasing numbers of urban migrants dependenton processed food,
however, it maybe appropriateto considermaize meal as a
primary vehiclefor iron in countrieswhere maizeis a staple
food (Nestel 1993).
AND OILS
most diets and are, thus, consumedby almost everyone.
High coverage of the population withfortified fats and oils
can, thus, be achieved.
Countries: A large number of developed and developing
countries. Commercial production of vitamin A fortified
margarinestarted as early as 1927
Organizations andgroups involved:
Fats and oils pro-
cessingindustry, MOH, Universityof Liverpool,Pennsylvania
StateUniversity,Universityof Sao Paulo, Hoffmann-La Roche,
Unilever, Universityof British Columbia, Procter & Gamble.
Vehides:
Edible oils: Vegetable oils from maize, olive, peanut,soybean
etc. Fortificationofrefined soybean oil is currently under trial in
Brazil (Favaro et al. 1991, 1992). In India, red palm oil is
addedto peanut oil and distributed as a concentrate providing
vitamin Acorrespondingto 100°Io of RDAof an adult male.
Lard, shorteningghee, vanaspati: Mixture of fats/oils.
Margarine:Ripened skim milkandmixture of fats/oils.
Table7-9. VitaminsA and D commonlyaddedto margarine.
VitaminA
Country
(lU/kg)
Product:
Margarine is an economical, nutritious, and palatablesubstitute for butter. It resembles butter in appearance, form, and
compositionusinga vegetable-based fat and oil mix. Shelfstable margarinethat does not requirerefrigerationis now
availablein many countries.
Vanaspatiis a hydrogenatedvegetablefat used as a butter
substitute in India.
Fortificants: Vitamin A acetate or palmitate ester(vitamin D
and E optional);The fortificant used for soybeanoil in Brazil is
retinol palmitate + antioxidants.
Fortificationlevel:
Edibleoil: VitaminAwasaddedat a rate of 200 IU/g of oil,
based on a daily consumptionof 15—30 g ofoil per personin
Southern Brazil. Fortification of edible oils ata level of 20 IU/g
wasmade compulsoryin Pakistanfor over 20years now. But
it is notenforced or monitored.Actuallevels, therefore, vary
from0 to 20 lU/g oil.
Vanaspati (hydrogenated fat):Fortificationwithvitamin A
(25,000lU/kg)was made compulsoryin 1953 in India.The
addition of vitamin D is optional, but most manufacturers
voluntarily add vitamin D.
Margarine: On average, about 30,000 IU of vitamin A and
3,000IU ofvitamin D are addedper kgof margarine.In Table
7-9, the fortification level in a number ofcountries is shown.
Recently, fortification of shelf-stable margarine in the Philippines has beenshown to be highly effective in improving the
vitamin A status ofpreschoolFilipino children (Solon et.al.
1994).
Technology:Processand equipment
Edible vegetable oils: Usedas salad oils orfor lightcooking
in household,vegetableoils can befortified with vitamin A.
After clarification,a vitaminA ester in the form of an oily liquid
concentration is addedand carefully agitatedfor uniformity.
Edibleantioxidantsmayalso be added to protectboth the
vegetable oil and the vitamin Aesterfrom oxidation.
Lard,shorteningghee, vanaspatiand otherhydrogenatedfats
can likewise befortified technologicallyin a similar way.
MargarincThe productionof margarine is done in a batchor
continuous process. The oilyvitamins are mixed thoroughly in
warmoil (ratio 1:5) to producea uniform solution that is added
to the fat blend before the emulsifying process (see Fig. 7-2).
Status and resultsoffieldtrials:
Full-scale productionin
many countries.Fortificationofsoybean oil is currentlyunder
trial in Brazil with promising results.
Australiaa
Vitamin0
(lu/kg)
30,000
20,000
16,000
15,000—50,000
35,000
4,000
3,000
3,000
30,000
30,000
24,000
16,000
3,000
1,000
1,500
Israelc
20,000
25,000
25,000
30,000
Italyc
prohibited
prohibited
Japana
Mexicob
Philippinesa
30,000—40,000
20,000
20,000
20,000
22,000
2,000
3,000
2,500
1,100
Polandc
30,000
3,000
Portugala
20,000—35,000
875—1,000
SouthAfrica
Spain
20,000
20,000
30,000
1,000
3,000
3,000
30,000
20,000
2,700
1,000
Austriac
BeIgium
Brazilb
canadac
chileb
Colombiab
Denmark
FinIand
500—2,000
7,000
0,120—300
500
2,400
France
Gerniany'
Greecea
India (Vanaspati)
NetherIands
Norwayc
Swedenc
Swilzerlan&
Turkeya
3,000—4,000
uK
27,000—33,000
2,800—3,500
usA
30,000
2,100
aBauemfeindand
bNeI (1993).
Arroyave (1986).
Kubler(1973).
Qualityassurance:
Margarine:Storage ofvitaminA-fortifiedmargarinefor 6
months at 20—25°C results in minimal losses (O'Brien and
Robertonn.d.; Morton 1970). Heatingat 160°C, 180°C, and
200°C resulted in losses of max. 20%, 35°/o, and 50°/a
(Morton 1970). An average of 10°/a vitamin Aand 0 is more to
for distribution variations rather than heat
degradation.Losses occurringwouldbe due to oxidationofthe
oily vitamins, a process thatwouldcause rancidity ofthe fats at
the sametime. B-carotene (provitaminA) is addedas a colorant
but it is also a significantsource of vitamin A. Biological assays
demonstrate full availability ofadded vitamin A (Bauernfeind
and Arroyave 1986).
compensate
Current Practices, Research, and Opportunities
59
Fig. 7-2. Flow chart of vitaminenrichedmargarinemanufacturing.
Ripened skim milk
Mixture of oils/fats
Oilyvitamins
MARGARINE
Source; O'Brienand Roberton,n.d.
Ediblevegetable oils: Fortifiedoil was tested for acceptabil-
Marketing/distributionchannels: Through open market
ity in basicrecipes for mayonnaise, fried beans, fried potatoes,
channels.
soup, cookedrice, wheat tortillas, and fried meat. Consumers
were not able to detect the difference betweenproductspreparedwith orwithoutfortified oil. Fryingtestswith cottonseed
oil showed that the qualityofthe oilwas best preserved at 160—
180°C, and 60—80°Io ofthe vitaminA content was retained after
30minutesoffrying (Padenet al. 1979).
Cost and cost effectiveness: Margarine is cheaper than
butter withsimilar nutritional value. Soybean oil in Brazil costs
Research has beendone on specificaspects
ofthe stability of
vitamin A in oils. Vitamin A palmitate in soybean oil storedin
sealed cansin the dark retainedits activity after storagefor up
to 9 months.After 18 months, its vitamin activity was more
than halved,down to about 40°Io of the original concentration.
The vitamin A activity of oil storedin opencansbeganto
deteriorateafter 6 months of storage. Oil stored in the dark
retained 33°Ioof its vitaminA activity,whereasoil stored in the
light had a negligible amount ofvitamin A after 18 months.
Withnormal household cooking (boilingor pressure cooking)
the vitamin A activity remained nearly unchanged, but repeated
use of oil in fryinggradually destroyed the vitamin A (Favaro
et al. 1991, 1992; Desai et al. 1994;Dutra Olivieraet al.
1994; Universityof Dhaka 1994). Because of the stability of
vitamin A in oil, vegetableoil is used as a carrier by vitamin A
less than other oils and fats.
Project/program evaluation: Fully accepted in several
countries.In many countries,vegetableoil processingis often
centralized and controlledby large companies and cooperatives,thusfacilitating large-scale fortification with vitamin A.
Commercial vegetableoils are oftenpackagedand sealed in
metal cans and thus protected fromlight in storage.
ofmargarine in the Western worldcan be
with
that
ofvanaspati in India. The vanaspati
compared
is
one
of
the
industry
largestprocessed-food industries in India
The importance
today.
Vegetable
increasingrapidly throughout Brazil,especiallyamong the
lower economic sectors.
Observations: In somecountrieswatersoluble vitamins may
be added. In this case, the vitamins wouldbe dissolved in
pasteurized milk (ratio 1:20) and added to the aqueousphase
before pumping into the emulsificationchur.
manufacturers. Accordingto Hoffmann-La Roche "the stability
of the vitamins presentin afatis usuallythe same as the
general stability ofthe fat itself As the shelf life ofsuch
productsas cookingoils and margarineis about 6—12 months,
vitaminA losses in fortified oils can beexpected to be minimal
for this length of time. This compares favourablywith vitamin
A stability in solid food ingredients.
SUGAR
Countries: Fortificationofsugar with vitamin A has been
successfully implementedin various countriesin Central and
South America: Chile, Costa Rica, El Salvador, Guatemala,
Honduras, and Panama.
•
•
Shortening: In productsof low fat content(bread, biscuits,
cake), which are baked under moderateconditions,vitamin A
appearsto survive the baking process to the extent of 80—
100°Io (Rice et al. 1942;Paden et al. 1979). The stability of
vitamin A addedto fatty foods is shown in Table 7-10.
60 Mkronutrient Fortification of Foods
oil consumption,in particular soybean oil, is
Brazil (Araujo 1978): Bioavailabilitystudy;
Chile (Toro 1975): Bioavailability,field study, organolep-
tic analysis;
•
Guatemala (Arroyave 1987): Bioavailability,field study,
organolepticanalysis;
•
Panama (Navia 1983);
Table 7-10. Stabilityof vitamin Aadded to fattyfoods.
1)peofMWl
-
Period ofstorage
at20-25°C
Lossof
(months)
(%)
Margarine
1.ard
Cookingfat
vltaminA
3
10—12
6
15—20
2
2—7
4
6
10—15
2
0— 5
4
6
5—10
15—20
20—25
Source: Morton (1970); Klaui etal. (1970).
The International Sugar
Federation
at its May 1995 meeting in
Sao Paulo, Brazil,recommended sugar fortification with
vitamin A to all membercountrieswhere vitamin A deficiency
is prevalent:
Organizations and groupsinvolved:
Ministries of Health, INCAP (regional operating,program
development),Nationalagencies/research institutes/universities, InternationalSugarInstitute,and UNICEF.
Targetgroup: Originally, the program in Guatemalawas
targetedat the whole population (fortificationlevelsset
accordingto the RDAfor adults). As the primary goal of the
program was an adequate intake of vitamin A by preschool
children,the target group changedto the preschoolchildren,as
is reflected in the level offortification (Molina 1991).
Vehicles: Sugarwas chosen for the followingreasons:
•
Universaland fairlyconstant consumptionby the whole
population,
•
No organolepticinterference
of the fortificant with the
vehicle,
•
•
•
Longshelflife,
Economical feasibility (nosubstantial raise in the price
ofthe fortified productin comparisonto the nonfortified
product),and
Central processing facilities.
In Chile,80%of the sugar is producedin two plants. Refined
sugar is consumed in fairlyconstantamounts by the whole
population (Navia 1968; Arroyave 1987). In Guatemala, sugar
was chosen as a vehiclebecause it is producedthrough a
relatively centralized process and is consumedregularly by
adults and children. It is also added to liquidand cereal
mixturesprepared for younger children (UNICEF 1994). In
1974, the Guatemalan Congress enacted a law requiring
fortification withvitamin A of all sugar producedfor domestic
market. Regulations followed in 1975. Epidemiological
surveys followinga 2-year sugar fortification showed a
significantpositive impact on the vitamin A status of preschool
children.
Such results were reconfirmedwhen vitamin A deficiency rose
to its former level after fortification effortslagged.Since the mid
1980s, Nutrition Institute ofCentral America
and Panama
(INCAP), UNICEF, and other agencies have participatedin a
broad-based effort to ensureadequate vitamin A consumption
through sugar fortification,supplementation,and nutrition
education. Sugarfortification was revitalized during the 1987—
88 harvestfollowing a concerted effort by UNICEF, INCAP,the
NationalAssociationofSugar Producers of Guatemala, and the
Ministry of Health. Impact studies during the past5 years
indicatethat vitamin A deficiencylevels among preschool
children in Guatemala have significantly decreased.
Fortificants: Retinol palmitate 250-SD Hoffmann-La
Roche
(waterdispersible).
Retinolacetate 325-1 Hoffmann-La Roche (waterdispersible).
Fortificationlevel:
Based on the RDAsuggested by WHO
and the estimateddailysugar intake of Guatemalan
preschoolers (20 grams, or about 2 teaspoons), INCAP
recommended that sugar be fortified at a concentration of 15
micrograms(50 IU) of retinol pergram ofsugar or 300
micrograms per day.
Product: Stability ofthe retinol acetate 325-L under various
conditions(lowtemperature, room temperaturewith varying
humidity, and room temperature with highhumidity) was
good. The maximum decrease of the retinol acetate325-L was
20% after 8 months ofstorage.Paden (1979) reportsa 89—
90°/arecoveryofthe vitamin A in coffee and Incaparina after
cooking. Recovery during the preparationof cakes was
retained at 76°/o.
Organoleptic tests showedno effect on the taste ofproductsas
cakes and powderedjuices, but a slight"medicinal"off-taste
when mixed with coffee. No organolepticdifferences between
the fortified and the nonfortifiedsugarswas detected by the
population involved in the field study.
Technology:Processand equipment: The proportion of
retinol palmitate addedis 1100/a ofthat needed to fulfill the
lawand to compensate for any potentialsubsequentlosses of
potency. The proportionsand ingredientsused have been
modifiedslightlyover timebut, in 1994, a batchof concen-
trated premix consistedof: sugar (75°/o), vitamin A palmitate
(22%), sunflower or other peroxide-free oil to promote
adhesionofthe vitamin A compoundtothesugar crystals
(2,1%), and an antioxidant like Ronoxan (0.9°/a). These are
mixed in a drum mixeror other proven equipment. A number
of vitamin A sources have beeninvestigated:
Current Practices, Research,and Opportunities61
•
Premixof sugar (ofthe sameparticlesize as the final
product) and vitamin Aacetate 325-L (Toro 1975),
•
Premixof sugar (ofthe sameparticlesize as the final
product)and vitamin Apalmitate 250-SD (Paden
1979), and
•
Premixof sugar (ofthe sameparticlesize as the final
product)and retinyl palmitate beadlets 250 GA/S
The sole source ofvitaminAfor the newborn is mother's milk;
therefore, an adequate supply of vitamin A in themilkof a
lactating motheris imperativefor the health and appropriate
growth of her baby.Bioavailabilityof addedvitamin Ato sugar
in pregnantand lactating motherswasinvestigatedby
Arroyave (1974). Results indicatedthatlactation depletes
vitamin Astores of lactatingmothers.This depletion was
arrested bythe consumptionof the fortified sugar.
(Molina 1991).
Field studies have beendone in an isolated population ofa
The premix is baggedfirst in opaqueplasticbags and then
placed in fibre sacks, sewn togetherat the top to prohibit the
entrance of light,and deliveredto the millsas required.The
fibre sacks are marked for contentand with cautionagainst
human consumptionof the premix.
The fortification process involvesblending the premix withthe
regularwhitetable sugar. It is the responsibilityofthe production managerto ensurethat premix is addedto domestic
sugar.The premix can be introducedin the centrifugeat the
end ofthe washing cycle. The amount ofpremix to be added
must correspond with the chargeper centrifuge. The premix is
addedto sugar by designated sugar mill employees (afterthe
sugar emerges from the centrifuge and before it is dried), via a
"dosage"machine producedin Guatemala. The machineis
designedtovibrate as it works to spread the premix uniformly
throughoutthe sugar and thus ensurethe predetermined
concentration ofvitamin A in sugar.
very low socioeconomic level with a high prevalence of VAD.
The field study included:
•
•
•
A nutritional survey in the experimentalvillages,
A clinicalexamination,and
An assessment ofserum levelsof retinol and Bcarotene.
All the inhabitantsof the experimentalvillages were provided
with fortified sugar over a 3-month period (a blindstudy with
sugar consumptionad libitum). After 3 months,serum levels of
retinol and B-carotene were analyzedon the sameindividuals
as were analyzed inthe baselineperiod. During the following 3
months, regularsugar was provided,and after 3 months, the
sameparameterswere determinedin the population.
A significantincrease in blood retinol levels was observedafter
three months of receivingfortified sugar.Blood retinol levels
decreased after interrupting of the fortified sugarprovision.
During each 8-hour shift, an operatoroversees the addition of
the premix by pouring it into the hopper of the dosage
machine,which inturn integratesthe premix into the sugar as
it moves along a conveyorbelt. A bell has beenaddedto the
original dosagemachine;when the machineis running low on
premix the bell sounds, alerting the employee of the needto
add more premix (UNICEF 1994).The fortified sugar is then
placed inside 100-pound fibrous poly-propylenesacksin
which it is distributed.The sacksare tightlyclosed and each is
marked by weight, date,the name ofthe mill, and with a
notificationthat it containsfortified sugar.
BloodB-carotene levelsdid notchangeduringthe study
(carotene was exclusivelyingestedfromvegetablesources in
the ordinary meal). The incidence of clinicalsigns attributed to
VAD did notchangeduringthe (short)experimentalperiod.
The premix can also be introducedduring the transportationof
the sugar (eitherbefore orafterdrying). This process requires
an adjustableprecision fee mechanism,synchronized withthe
propulsion systemrate ofthebelt.
Cost effectiveness: At the concentration of 0.021 mg
retinol or 69.5 IU vitamin AIg table sugar the costs of vitamin
Afortification ofsugar was US$ 0.03/person peryear (WHO
1976). This relatively low cost was a major factor in the
decision by the Central Americansugar manufacturers to
Stabilityand resultsoffieldtrials:Toro (1975) reportson
the laboratorystudies toverify the absorptionof retinol acetate
Qualityaspects: Homogenousdistribution ofthe vitamin A
in the final product is assured bythe goodmanufacturing
practice when preparingthe premix. Rapid quantitative
methodsfor determining vitamin A distribution in the sugar
havebeen developed for the sugar manufacturers.These
instructionsare distributed to the manufacturers through easyto-readpublications(Molina 1991).
absorbthe costs ofthe food fortification program.
325-L in normal human individuals and on the fortified sugar
stability tests. Absorbabilityof retinol acetate 325-L was
significantlyhigher when the dose wasadministeredtogether
witha meal compared to the administrationof retinol acetate
325-1withouta meal. Both experiments showed an increase of
serumretinol levels, at 50°/oand 11 5°Io of the basal value,
Project/program evaluation: Full-scale national programs
have beenoperationalin Costa Rica, Guatemala,Honduras,
and Panama. The achievements are outstanding in the history
of public health.Economical andpolitical constraints are now
respectively.
countries.
62 MicroriutrientFortification of Foods
hindering the continuity ofthe programs. Recently, these
programshave received renewed attention in several of these
Fortificationof refinedtable sugar with retinol is legislatedin
Costa Rica, Guatemala, Bolivia, Panama and Honduras. The
blood retinol levels (in 1965—1967)were in Costa Rica
32.5°/o, in Guatemala 26.2°/o and in Honduras32.5%. In El
Salvadorthe percentage ofserum retinol levelsof<20 pgJdl
were 50% in 1965—1967. In 1977—1980,the prevalence of
serum retinol levels<20 pg/dl were: Costa Rica, 1 .60/0;
Guatemala, 9.2%; and Honduras, 9.2°Io. Panama has not
continuedthe compulsoryfortification of sugar (Arroyave
1987). By 1994,63% of sugar for human consumptionwas
fortified in Honduras.
Future requirements: Sugaris a pure carbohydrateand
does not containtile co-factors needed for its metabolism.
Sugarmetabolismis dependent, therefore, on provision of the
co-factors involved in carbohydrate metabolism,such as
thiamineand niacin,provided by other foods in the diet. The
total dietary compositionis ofessentialimportancewhen the
decision for thefortification of sugar is taken. Monitoring of
sugar consumptionpatternsis essential. An increase in sugar
consumptioncan lead to dilution of the nutritional quality of
the diet and dental carries. The national sugar fortification
programshave,therefore, opted for the policy that does not
promotesugar consumption(compare the promotion policy in
the MSG programs).Any type of advertisement or incentive to
increase sugar consumption,and any emphasisto increase the
consumptionofsugar between meals, has to be avoided.Even
if dietary modificationsresult in a decreased sugar consumption, this can easilybe compensated by increasingthe fortification concentration.
MILKAND MILKPOWDER
Countries: In the ProteinAdvisory Group (PAG)bulletin
(WHO 1976), manycountries are listed where vitamin A
deficiency is a public health problemand where fortified milk
powder is needed. Food aid in the formoffortified dry skim
milk (DSM) comes from Australia, Canada, the Netherlands,
and the US. In the US, fortification has become mandatoryfor
lowfat milks. India has introducedfortification of milkwith
vitaminA in all major urban dairies.
Organizations andgroups involved:WHO, FAO, UNICE F,
FAD, USDA, FNB—NRC,CFN—AM, HPB—CDNHW; Hoffmann-La
Roche Inc., Phillips-Duphar(main suppliers).
Targetgroup: The target groups are particularly children
and women of child-bearingages in developingcountries,but
WHO's recommendation is to have a universalfortification
rather than only covering groups at risk ofvitaminA deficiency.
Vehicles: Because vitamin A deficiencymostly affects young
children,the UnitedNations PAG recommended that DSM
distributed by UNICEF andWHO in their programsbe fortified
withvitamin A (and vitamin D). This started in the 19605.
Usually, vitamin D is also added. In 1989, the UnitedNations
High Commissioner for Refugees (UNHCR)and WFPissued
guidelines on the use ofmilkpowderas afood aid or in feeding
programs. Based on these, driedskimmedmilkhas to befurtified
withvitamin Abefore it can be acceptedfor distribution.
The Food and Nutrition Boardselected milkas the ideal vehicle
for vitaminAbecause it provided 10 % ofthe American
customers'food energy and would not create an imbalanceof
the essentialnutrients.Pasteurized and UHT low fat milks are
fortified with vitamin A.
Fortificants: Vitamin A naturally occurs as retinyl esters
(retinyl palmitate) in milk. B-carotenes are also present in milk
buttheirvitaminA activity is lower.The levelsdecrease by
defatting the raw milk. Retinyl palmitate is commonlyused to
increase vitaminA in (partially)skimmed milks. Retinylacetate
can also be used.
Because ofrecommendations
of PAG, vitamin Afortification of
milk (mainlyDSM for developingcountries) usually goes
togetherwith fortification withvitamin D, which is also a fatsoluble vitamin.
Fortificationlevel: The fortification level of 5,000IU
vitamin All00 gdry skim milk (about 1,500pg retinol) is
used globally, based on a daily intake of 40—80g DSM/
subject. Adding an averageof20 % is common.
In the US, addition of vitamin A to whole milk is optional, but
when added it must be presentat a level of 2,000 lU/quart
(about 2,100 lU/I). Formilkswith less fat, addition of vitamin
A is mandatory,using the samelevel.Using the information in
the Canadian Food and Drug Act, a recommended fortification
level of 1,400—3,000lU/i 00 g, can be calculated, which
corresponds to a daily intake of 1,200—2,500IU vitamin A
frommilk (deManet al. 1986).
Springand summermilk has the highest and winter milkthe
lowestvitaminA activity. To obtain uniform levels of vitamin A,
periodiconline monitoring and periodicalterationsin the level
of fortification atthe processing plant will be necessary to
makeup for seasonal fluctuations in the vitamin A level of
milk, DifferentamountsofvitaminA addition for skim milkand
lowfat milk is also necessary for obtaining uniform levels.
Technology:Processand equipment:Two main methods
are usually used for fortifyingmilk withvitaminA: a dry
methodand a wet method (Fig. 7-3).
Dry method: For the dry method,skim milkpowder is
mixed with beadlefs of encapsulated vitamin A; therefore, a
premix is usually added onlineto the milkpowder afterleaving
the dryingtowerjust before enteringthe end cyclone(continuous process), or it can be blendedafter processing in a separate
mixer(batch process). The latter is not commonbecause it
requiresspecial machinery.
For the premix, dry-stablevitamin A beadlets (100,000 lUlg)
are blendedwith DSM at a rate of 1:50 to 1:85, resultingin a
Current Practices, Research, and Opportunities63
premix of 200,000—1 20,000 lU/l00 g. The premix is added
totheDSMatarateofl:2Oto 1:50.
Mol et al. (1976) made an exampleofmanufacturing4,600 kg
DSM: The required amount ofvitaminA is diluted in 2 Litresof
The beadlets are littledrops of a vitamin solution in oil, coated
with, for example,gum arabicand/orlactose. This coating
protects the vitamin against oxidation.Thesebeadletsshould
never be used in fluid milk; although it has good solubility in
cold water(or milk), the vitamin A is veryunstable in solution.
For this kind of dry fortification,specialattention should be
oil orfat (both at 40—50°C), homogenizedin 40 Litres of milk
(pressure about 15 MPa), and mixed with a batchof 50,000
kg milk, or addedcontinuously.Finally,the concentrated milk
is spray-dried.The amount ofadded fat is controlledto about
0.1—0.2%, so that the fat contentof the productdoes not
exceed permissablelevelsfor skim milkpowder. It is important
to ensurethatno parts ofthe machinerycan causecopper
contamination.Adisadvantageofthe wet method can be that
given to homogeneity.
Wet method For the wet method, vitamin A can be addedto
the thin milk before all processing, or addedto the concentrated milkwhen it has leftthe vacuum installation (before
entering the dryingtower). The wet method using concentrated
milk is the most common,but both methods show the same
retentionafterprocessing. Today, it is possibleto keepvitamin
A stable, notwithstanding the detrimental process conditions
during spray drying. For this wet method, an oil-based vitamin
A premix is used,stabilizedwith antioxidantslike BHA and
BHT. It should be addedas an emulsion,therefore, the vitamin
is diluted withan oil (for examplebutter oil or coconutfat) and
homogenized in some milk, requiringemulsifiersand a
homogenizer. The quality ofthefat used is important for
vitaminA stability (it should have minimum peroxidevalue).
Any contaminationswith copper or oxidation productsshould
be prevented.
the fat-soluble vitamins could be removed during fat-separation.Karinen (1989) patented such a wet methodclaiming that
used emulsionwill not phase separate. Both methodsare
suitable for fortifying DSM. The dry methodseems to result in
somewhatmore stable vitamin levels, but is also more
expensive.
Product: Customers do not have a preference for vitaminA
fortified orunfortified milk. Old milk flavours were noticed in
storedmilk before significant decrease ofvitaminA occurred.
Qualityaspects: General requirements for a fortified premix
for DSM are:
•
•
•
Homogeneous distribution of vitamin A in the premix;
Appropriatesize and densityto preventsegregation;
Guaranteed and controlledvitamin content;
Fig. 7-3. Flowchart ofvitamin incorporationin liquidmilk and spray-driedmilk.
Bulk milk
Partmilk
Oily
vitamins
I
I
Homogenization
P su
Homogenization
Aeration
H
Pasteurization
Bulk skimmedmilk
t
UHTtreatment
Dry vitamins
Cooling
conce trating
Buffer tank
H
Packaging
FINISHED PRODUCT
Source: OBrien and Robertson,nd.
64 MicronutrientFortification of Foods
Spray drying
Mixing
1
]
FINISHED
PRODUCT
•
Adequate stability for use in DSM, also in tropical
circumstances. After storage for 6 months at 30°Cthe
level of vitamin Ashould still be above the required
level of 5000 Ri/i00 g; and
•
General requirements
for human products (directlyfrom
Slump (1976).
Rapidtestto detect vitaminA: Because not all DSM for
food aid is fortified with vitamin A, and this is not always noted
on the label, a simple field test to check is describedby Dustin
(1977). A reagentshould, therefore, be prepared by dissolving
50 g crystallinereagentgradetrichloroaceticacid in 5 ml
distilled water. Heatingup to 60°C will assist, the reagentis
highly light sensitive.If a few drops of reagentturn blue in a
teaspoonofDSM, vitamin A is present. To checkfor falsenegative results 2 x 15 g DSM should be put in 2 cups, 15 ml
ofwatershould be addedto one and 15 ml reagentto the
other.Stir, and if after about a minute, a pale blue or green
colour shows up (compared to the blank) vitamin A is present.
The final fortification level is often not controlledenough.This
mightcause someproblemsespeciallywith DSM orfluid milk
fortified bythe wet method. If vitamin A is added to the raw
milk, most ofthe added fat soluble vitamins could be stripped
from the milk during fat separation. This also results in
excessive vitaminA levelsin productswith highfat contentlike
cream. Tanneret al. (1988) report that in the US this often
results in label claims of vitamin A in low fat and skim milk
that do not agreewith practice.
Cost and cost effectiveness: The cost ofvitamin A fortification of DSM in the 1970swasabout $2 per metric tonne.
Dependingon the price per tonne,this was 0.2—i°/o of the
costs of DSM. For a manufacturingcountry, itmaybe much
cheaper to enrich all of its food-aid donationsthan to do it only
for thoseconsignmentsdestinedto countriesor areas where
high prevalence ofxerophthalmiademandsenrichment. The
dry method is usuallysomewhatmore expensive than the wet
method.
Project/program evaluation: It is known that adequately
enriched DSMcan effectively preventxerophthalmia.Current
understandingofthe disease entails the moral obligation to
it wherevera food-aid program providesthe opportunityto do so. Such policy will certainly savethe sightof many
childrenwho mightotherwisehave beenamong the 100,000
xerophthalmia-caused cases of blindnesseveryyear. (WHO
1976;Dustin 1977).
prevent
Observations:
Storage stability ofvitaminA in fortifiedmilkpowder:
Several studies showthat it is now possibleto manufacture
highly stablevitamin A fortified DSM. The wet method seems
to result in somewhatless stable DSM, but this difference will
not be decisive. Within a year,losses of less than 20°/acan be
In the early storageperiod (first 6 months),usually
the greatestlosses can be expected. Manycircumstances,
however,can causedeviationofthis general storage stability.
At highertemperatures (>35°C) losses ofmore than 50%
within a year are reported. When humidity increases, especially
accompanied with heat,stability dramaticallydecreases.
Exposureto light also has negative effects on vitamin A
retention in DSM. Oxygen-free packagingdoes not really seem
to affect vitamin A stability (Bauernfeind and Praman 1964;
Mol et al. 1976;DeManet al. 1986;Woollard and Edmiston
expected.
1983).
Storage stabilityofvitamin A in reconstitutedmilk:
The vitamin A in milk reconstituted fromfortified nonfat
milkpowder (DSM) is stablefor several days, at room and
cooling temperature. Only a few percentage loss and littleoffflavour were reported. Heatingthe reconstituted milk up to 30
minutes (common processing in manycountries) caused losses
of about 20%.Addition offat can preventmain cooking losses
(Anantakrishnanand Conochie 1958;Wilkinson and Conochie
1958; Bauernfeind and Praman 1964).
Storage stabilityofvitamin A in fortified milk:
Defatting has a negative effecton vitamin A stability in fluid
milk. Vitamin A stability in lowfat milkis betterthan in skim
milk. Exposure to light causes obviousoxidation ofvitamin A,
resulting in off-flavours. Afew days lightexposurecan reduce
vitamin A yield by 30°/ain whole milk, and up to 95°/ain skim
milk. Addition of B-carotene can preventoxidation. Darkness,
however,does not guarantee preventionof vitamin A losses,
and significant loss (roughly, 20—40°/a) can always be
expected over a period of time. With UHT milk, which can be
storedfor much longer at higher temperatures than pasteurized
milk, losses of 0—70°/awithin half a year are reported, withthe
greatestloss happeningin the first 2 months (DeMan 1981;
Woollard and Fairweather1985; McCarthy et al. 1986;
Fellman
etal. 1991;Zaharetal.1992).
RICE (ULTRA RICE)
Riceis the main dietary staple in manypopulationswith
vitamin A deficiency. Fortification ofrice with vitamin A can,
thus, make a significantcontribution to preventionand
correction of vitamin A deficiency.
Projecttitle: Ultra rice fortified with vitamin A.
Countries: Brazil, Philippines.
Organizations andgroups involved: Federal University of
Pernambuco, MOH (Brazil); PhilippinesFood and Nutrition
Institute (FNRI), MOH (Philippines); MI (Canada); Bon Dente
Nutrition (BDN) (supplier),Iowa State University,PAMM, PATH/
USA, USDA, USAID(USA).
Vehicles: Broken rice grains.
Fortificant: Stabilizedall-transretinyl palmitate.
Current Practices, Research,and Opportunities65
Fortificationlevel: Vitamin A palmitateata level of 800
pglg premix.
Technology:Process
Rice flourmade frombroken rice
mixed
with
a
grains is
premixcontainingall-transretinyl
palmitate,a small amount ofmaizeoil, and a fatsource for
vitaminA stabilization.Previously, lard was used with good
results.Recently,coconutand peanut oils have been used to
avoid the use oflard and animal fats. Alpha-tocopherol and
ascorbicadd are added at 1 mg/g premix(see Fig. 7-4).
Status and resultsoffieldtrials:
laboratory tests (Brazil,
Philippines).
Product: The reconstitutedbroken rice is not distinguishable
fromwholerice grains.The recentresults of an informal taste
test ofvitaminA-fortifiedultra rice in Indonesiashowed that
the 10 tasters were able to detectdifferences betweentwo
types of rice used (Rojolete and Bulog), but onlytwo outof 10
were able to detectdifferences between fortified and
nonfortified samples.
Qualityaspects: The vitamin A proved stabletostorageand
cooking. The enriched rice proved to benontoxic and had the
same sensorycharacteristicsofordinary tice. Some advantagesof
ultra rice arethat it is cooking quicker,canbe augmentedwith
flavours,spiced, and will last for hoursona steamtable.
Cost and cost effectiveness: When local productionis
establishedand depending on productionquantities,the local
retail priceoffortified rice is estimatedat US$0.20/personper
year. If the premix has to be importedfrom the US,the retail
priceis estimated at US$0.30/personperyear.
Project/program evaluation: Bioavailabilitystudies have
been conducted in Brazil.Similar confirmingtests are underway
in the Philippines.Results indicate that the bioavailabilityisgood.
Storagetests indicatethat vitaminA half life will be a year or
more.Underan MI-funded pilot project, thefeasibilityofintroducingultra rice in one area in Indonesia is underinvestigation.
Because rice is a staple that is produced,milled, and consumed
underconditionsthat varyfrom communityto community, the
deliveryofvitaminA-fortifiedrice will notbe simple,and only
a carefully developedpublic health initiative is likely to meet
with success.This initiative must include IEC (information,
education,communications), publicpolicy dialogue,interactions with local NGO5, socialmarketing,and all the other tools
to assist introduction, implementation, and sustainabilityof
such activities.
Observations: Itis the goal of BonDente(BDN) to support
the transfer of technologyto developingcountriesto providea
local sourceofsupply as well as minimize productioncosts.
Futurerequirements/developments:
Ambitious plansfor
a major test-marketintroductionin Indonesiaand Brazilhave
been well received by the governmentofficials,but not yet
approved, Initially,ultra rice will be fortified with vitaminA.
Preliminary laboratorytests have been successfullycompleted
with iron and iodine.Multiple fortification is being explored.
The technology is alsoapplicableto mixers ofmaize and ultra
rice to make a higher protein product.
TEA
The first suggestion of using tea as a vehicle for vitamin A
fortification is describedin a US patent of 1943 (Buxton and
Harrison1943).
Countries: Pakistan,India,Tanzania.
Organizationsand groups involved: India: USAID, New
Delhi (experiments carried out in 1971/1972);Pakistan:
Governmentof Pakistan, USAID (experiments carried out in
1973/1974); Tanzania: TFNC,Ministry of Minerals, Waterand
Energy, MOH, Muhimbili Medical Centre, Tea Authority,
Tanzania Tea Blenders, UNICEF (Tanzania); UppsalaUniversity
(Sweden), IAC(Wageningen); and PAMM (Atlanta) (Temalilwa
and Momburi 1992).
Fig. 7-4. Flow chartof production of ultra rice fortified withvitaminA.
Broken
VitaminA
gins
FINISHED
PRODU
66 Micronutrient Fortification of Foods
•
Targetgroup:
India:The entire Indian population. Ofthe total estimated
population of 15.9 millionin the age group of 0—4 years (UN
population projectionin 1995) 86.9'millionare at risk of
vitamin A deficiency(WHO 1995).
Pakistan: The children and pregnant tmen of the lower
incomegroups. The nutrition survey ofWest Pakistanindicated
an apparentdeficiencyin \4tamin A in the Pakistan diet,
especiallyamong the childrenand pregnant and lactating
women ofthe lower incomegroups.
Tanzania:Theentire population ofTanzania. The sentinel
xerophthalmiasurveillancesystem (started in 1982) discloses
a severeVAD in children under five. Ofthe children under five,
30% are affected and ofthe total population 6%.
Vehicles: Nutritionsurveysin severalofthe Indian states
revealed that tea is the obviousvehiclefor a laige-scale foodfortification program. It meets all the general criteriafor a
suitablevehicle.
Researches in several ofthe Indian states have pointed out the
following chaiacteristics. Tea is the national drink, consumed
by all agegroups, irrespective ofsocioeconomic status, and in
both rural and urban areas.Even veryyoung children aie given
1—2cups oftea per day. The price ofthe consumerpioductis
sufficientlyhighto absorbthe costsof the added nutrient. The
stability of the vitaminA during processingand in the finished
productis high (Bn)oke and Cort 1972). In Pakistan, an
additional criterion was formulated — supplies (except vitamin
A) and machines are to be availablein the national market
(Fulleret al. 1974). In India, Pakistan, and Tanzania tea is
centraHy plDducedorprocessed.
The tea to be fortified wasoftwo grades.First, is tea dust (the
term dustrefers to the size ofthetea particles, which consistof
the smallest particlessecured in the grading process excluded
the waste products,i.e., fluff and chalk).
dust is used to
a
dark
brew
or
it
is
blended
with
bioken
provide strong,
is
tea
leaves
used
to
a
grades. Second,
provide light or pale
colour and flavoury brew.
'a
Fortificants: The characteristics offourtypes ofvitamin A
fortificant were tested:
•
Forstability reasons, the 50°/o sucrosesolution waschosen as
the best medium for dilution of the palmitateoracetate
emulsion. Stabilityof the vitaminAsolutions in the final
product was tested usingpalmitate250-SD powder for tea
dustand a water-solubleoil ofvitamin A palmitate,a palmitate
emulsion, and an acetate emulsion. The retention ofthe
vitamin A in tea after5 minutes ofboilingtime and one hour of
boilingtimewas 100%forboth the palmitate(both the
powdered formand the diluted emulsionform).
The investigatorsin Pakistan includedsegregation tests,
shipping tests, brewing tests, (accelerated) stogetests, and
taste tests pertrmedby a professional panel of experienced
tasters in the laboratoryphase and the pilot phase of the
program.No organolepticdifferences between fortified tea (at
levelsof 125, 250, 375, and 1,125 lU/cup) could be determined bythetaste panel.
Fortificationlevel: The targetlevel of fortificationwasset at
125 IU/g for vitamin A percup ofbrewed tea. This targetwas
based on the assumptionthat for the productionof one cup
(150 ml) ofbrew, 3 g ofdry tea materialsare used.Daily
consumptionoftea was establishedat 3 cups/person.Thus,
the fortified tea wouldsupply 1,125 lUs of vitamin A, about
40% ofthe averageRDA(according tothe 1970Nutrition
of VVest Pakistan). The 1972 RDA for India, are 1,000
for
lu/day childrenand 2,500 lU/day for age 16 and up. A
child given 1—2cups oftea per day tould thus receive 375—
750 lU/day, an adult would ingestabout 45% ofthe average
RDA(Brookeand Cort 1
About 27% ofthe vitamin A
fromthe fortified tea was available within 5 minutes of
Survey
2).
brewing.
Storagetests in Pakistan showed an average loss of vitamin A
of about 47°/oafter12 teks ofstorage. The initial fortification
level should compensate for theselosses. The tea was,
therefore, fortified at 250 IU/g. The level of antioxidantis
decisivefor the relativelyhighstability ofthe Pakistan product
Powder: Retinolpalmitate 250-SD from Hoffmann{a
(Paden et al. 1979).
Roche (waterdispersible),a palmitate estherofvitamin
Technology: Processand equipment:
Aat 250,000IU/g.It is a fine,dr stabilizedwhite
powder,containing250,000 IU ofvitaminA pergram.
•
To provide a fortification solution with a contentof
10,000 IU vitamin A/g tea the emulsion was diluted (2 g
of emulsion plus 98 g ofsolution) in water, in a 20°/o
dextrin solution and in a 50°/osucrose solution, The
results are summarizedin Table 7-12.
Oftheretinol palmitate250-SD powder and of vitamin
Aacetatean emulsion ofretinol palmitate in an acacia and
water-based solutionat 400,000IU/g was made to be
used for fortifying tea leaves. (The Pakistan investigators
report this emulsion containingBHTand dl-alphatocopheml as antioxidantsand sodium benzoateas
preservative.)
The technologydevelopedin India forthe fortification oftea
was:
•
Dry mixingof tea dustand vitamin A Palmitate 250-SD,
and
•
Spray mixing ofthe diluted emulsion by splayingthe
solution onto the tea as itemeiges fromthe drying
chamberand subsequentlydryingat 60°Cduring one
hour.
Current Practices, Research,and Opportunities
67
Table 7-12. Stabilitytests ofvitamin A fortificantsin tea dust and tea leaves.
Dust
Palmitate 250 SD powder
Leaves
Palmitate or acetate emulsion
Leaves
Palmitate or acetate emulsion diluted
in water
Dry mixing
1 yr, room temperature
85
Sprayed
1 mth, room temperature
50
Sprayed
1 mth, room temperature
85
in 200/o dextrinsolution
Leaves
Same
Sprayed
6 mth, room temperature
43
Leaves
Same
Sprayed
6 mth, 37°C
20
Leaves
Palmitate or acetate emulsion diluted
Sprayed
1 mth, 37°C
98
Sprayed
6 mth, 37°C
90
in 500/0sucrose solution
Leaves
Same
Source: Brookeand Cort (1972).
The technologytested in Pakistan for the fortification oftea
was:
•
Dry mixing oftea and powderedvitamin A,
•
Sprayingtea materialwith glycerine (adhesive) and
subsequentdry mixing oftea and powderedvitamin A,
•
Sprayinga vitamin A emulsion diluted in a coftonseed
oil solution onto tea material, and
•
Sprayinga vitaminA emulsion diluted in a 500/0
sucrosesolution onto tea material.
As a result of the test in Pakistan the following tea fortification
process wasdeveloped.
Batch productionof a fortified tea concentrate in a pan coater:
•
Dilution of 25 g vitamin A emulsionin 75 g of 500/0
sucrose to producethe vitamin A spray solution, and
•
Air sprayingof 25 g ofthe spray solution onto 975 g of
tea material in a pan coater(45 seconds, airspray gun)
to producethe fortified tea concentrate.
The fortified tea concentrate (100g at 2,500 lU/g)was used as
the vitamin A carrierto be one ofthe inputs for a tea blend. The
fortification ofthe final productwascarriedout in a PKtwinshell blenderduringa blendingtimeof one hour.
The technologyof dry blending tea material ortea material
plus glycerine was abandoneddue to excessive segregation.
The fortified tea plus glycerine showeda lower level of
segregationthan the fortified dry tea. This process, however,
requiresthe applicationoftwo unit operationsto arrive atthe
desired product,whereasthe vitamin A emulsion in 50°/o
sucroserequiresone unitoperation only. Figure 7-5 shows a
flow chart of vitamin A enrichedtea manufacturing.
68 MicronutrientFortification of Foods
The vitamin A-collonseed applicationwas rejected for organolepticreasons; the final brew yielded an oily appearance.
The oil-sprayprocess was discardedalso for occupational
safety reasons (dispersed oil being potentially explosive).
Status:
India: Laboratory tests have resulted in the developmentof
the fortificant and the processingtechnology.Pilot trialson a
commercial scale and a producerand consumeracceptance
survey havebeen finished.Taste panels fromthe tea producing
industry and consumertaste panels were not able to detectany
difference in taste,odour, colour,clarity,or other characteristics
ofthe brewedtea. No regional or national field trials have been
reported.
Pakistan: Laboratory tests and pilot plant tests have been
completed. The results have beenpresentedon a model scale
to tea-processing manufacturers throughoutthe country.
Detailedprocess descriptions, productioncharacteristics, and
plant definitions for severalproductioncapacities have been
prepared as well as the housing, equipment,and operating
costsbudgets.
A projectimplementationstrategywas developed in which four
private tea-processing enterpriseswould participate.Before
implementation,investigationsinto tea purchaseand consumption behaviourand vitamin Astatus of children and
pregnant womenwill assistin establishingthe fortification
level.The industrial projectwill be complemented by research
into storageunder industrial productionconditions,effecton
the vitamin Astatus in the samplepopulation, and industrialscale productionfeasibility.Although the technology developed
is verypromising in terms ofcostsof fortification and incorporation in local productionfacilities, no further mention ofthe
projecthas appearedin the internationalliterature.
Tanzania: Theprojectin Tanzania is still beingformulated.
The cooperation of the tea industry has beengained in the very
Fig. 7-5. Diagrammaticflowsheetfor fortification oftea withvitamin A.
FLOOR
SCALE
WAREHOUSE
first stageofthe program.Test runs in the tea plant and
developmentof the properpackagingand labelling is now in
progress.
Future requirements/developments: When considering
vitamin A fortification oftea, a note of cautionshould be made.
Drinking tannin-containingbeverages (tea) with meals may
contributeto the developmentofiron deficiencyifthe diet
consistslargely of vegetablefoodstuffs(Disleret al. 1975).
MONOSODIUMGLUTAMATE (MSG)
Countries: The Philippines,Indonesia.
Organizations and groupsinvolved: MOH, Union
Chemicals (The Philippines); MOH, PT Sasa Inti (Indonesia); the
CoatingPlace, Iowa State University, Helen Keller Int, (USA).
Target group: Inthe Philippines,the baselinesurvey
indicated a highprevalence of low or deficientserum vitamin A
levels(47%ofthe children between one and 16 yearsof age).
Some 4.5°/o ofthe children between one and 16 yearsofage
showed clinicalsigns ofxerophthalmia.The first MSGfortification field trial was conducted in the island ofCebu. This
small-scale fieldtrial was followed by a tn-provincesfield trial
(Solon et al. 1984).
In Indonesia, the national xerophthalmiasurvey of 1978
showedxerophthalmiaand vitamin A deficiencyas a significant public health problem,waybelow the WHO limitfor
defining the presence ofa significantpublic health problem.
Almost 0.64 per 1,000 preschool children suffered from severe
blinding eye disease as a result ofvitamin A deficiency, one per
100 sufferedfrom mild xerophthalmia,and a majority ofthe
children had a low vitamin A status.
Vehicles: MSG (C5H8N04.Na.H20) is a crystalline,"snowwhite" product, difficult to fortifybecause ofmoisture retention
and discoloration, The MSG particlesare large, elongated
("needle") crystals. When shaken,the productproducesa
crystallinesound indicatinga dry, free-flowingcontent, which
is consideredto be an important marketing characteristic.
In the Philippines,three products (salt, flour,and MSG) were
candidates for food fortification because oftheir consumption
frequency, and MSG was found suitablefor food fortification
(Bauernfeind 1991) because it is centrallyproduced. Only two
manufacturers produceMSG,ofwhich one produces 95%of
the totalmarketed production.Food-frequency surveysshowed
that, on average, 94°/aofthe children consumed MSG at least
once a week. The MSG was sold in packages of 2—4 g.
Current Practices, Research,and Opportunities69
of two packages a day, with a
maximum ofthree packages a day. MSG consumptiondoes
not influencesalt consumptionpatterns (Solon et al. 1979).
250,000IU/g Hoffmann-LaRoche). The average potency loss
was 3% per month during the first 6 months.Afterthis period,
In Indonesia,four products(white sugar,flour, MSG, and salt)
were candidates for the vitamin Afortification projectand,
among them, MSG had most of the generalcriteria required
As some objectionsagainstthe powdered,fortified MSG arose
during the Cebu fieldtrial,the fortificant chosen for the second
tn-provincesfield trial was a dry vitamin A beadlet (vitamin A
acetate 3251, 325,000lU/g Hoffmann-LaRoche). The vitamin
A 325Lis less soluble than the vitamin A 250-SD.
Families consumean average
(Muhilal 1984, 1988a, 1989).
The selection criteriain both the Philippinesand Indonesiacan
be summarizedas follows:
•
•
•
CWS (250,000
centrallycontrolledand monitored);
yellowish beadlets.
Reaches the largestproportion ofthe target children;
MSG is marketedin Indonesiaas a perfectlywhite, crystalline
powder.As a result, the slightlyyellowish colour ofthe vitamin
A fortificant should not be visible, anda technologyto produce
"white" vitamin A particles, not detectable in the final product
wasdeveloped. To mask the yellow colour ofthe tortificant,the
powder was coated with finelyground MSG dust (Muhilal
1988a). A more recentdevelopmentwasthe productionof
"white" vitamin A bycoatingthe beadlets withwhitetitanium
dioxide (Muhilal 1989).
Consumed
in substantialamounts by the target
•
Consumed with relatively small variation;
•
Permitsan adequate fortification level without affecting
the consumeracceptance;
•
Marketed in small packages to the families at risk, which
enabledtargeted fortificationto the poorestand highest
risk (low socialand economic) segmentsofsociety;
•
Indonesia:The fortificant chosen for the field trial was 250IU/g,cold-waterstorage, Hoffman-La Roche),
Produced centrally (therefore, fortification can be
children;
•
potencylosses were markedly declined.
Sanitary handling and someenvironmentalprotection
(marketed in small plastic sachets); and
A shortturnover period.
Flour and sugar consumptionwas highlyvariable, andthere
wasno speciallysizedpackage targetedat the high-risk
families in the market. Both flour and sugar were rejected as
vehiclesbecause ofthe difficulties in defining the fortification
level. Salt was rejected because this vehicle was already
"claimed"in the iodizationprogram and because of its highly
hygroscopiccharacter, which would affectthe vitamin A
stability (Muhilal 1988b, 1989).
is generallyconsidereda safeadditive. The maximum
permissibledaily intake is 150 mg/kgbody weight (WHO
1974). When addedto food as an enhancer, there is an optimal
concentration (up to 0.8°/o ofa food, by weight). As the
palatability ofthe food decreases beyondthis concentration, the
use is self-limiting (Bauemfeind 1991). The average consumption of MSG for preschoolchildren was 18 mg/kgbody weight,
andthemaximum recorded intakes rarely exceed 85 mg/kg
MSG
body weight.
Turnoverof the productis generally in the rangeof between 2
and 4 months. The productreaches the consumerabout 2
months afterthe manufacturingdate (Solon et al. 1985).
Fortificants:
The Philippines: The fortificant chosen for the Cebu field trial
was a dry vitamin A 250-SD (vitamin Apalmitate 250-SD,
70 MicronutrientFortification of Foods
To producethe premix, 800 g of vitamin A 250-CWSwas
mixed with 60 g of hydroxypropylcellulose dissolvedin 450
ml ethyl alcohol (toserveas binding agent). To this mixture
was added 3,200gof 100-meshMSG powder,so thatthe
MSG powder would stickto the vitamin A, and the final premix
was dried by fanning.The resulting premixwas"dust free" and
free flowing.
The premix was combinedwith commercial grade MSG in a
ratio of 5:95 and mixed until homogeneous. The final fortified
productcontainedabout 3,000lU ofvitamin A/g (Muhilal
1988b).
Vitamin A 250-CWSis sensitive to oxygen,hightemperatures,
moisture,and light.It retains more than 50°/aof its potency
when storedfor more 18 months at 25°Cand for more than 7
months under dark, humid conditions.
Fortificationlevel:
ThePhilippines:The fortification level chosen for the Cebu
and the tn-provincesfield trialswas 15,000 lU vitamin A/
of 2.4 g MSG. Because of manufacturingconstraints,
the variation in the mean vitamin A contentof the sachets at
various points ofthe distribution chain is significant. Underthe
normal marketing and environmentalconditions,however,the
level offortification can be reasonablymaintained.
package
Indonesia: The vitamin A consumptionsurvey revealed a
dietary intake ofvitamin A equivalentto 700 lU/day. Main
sourceswere greenleafy vegetables and oil. The fortified MSG
should contain sufficientvitamin Ato provide between25%
and 50°/a of the RDA. Given a consumptionof0.23 ± 0.20 g
MSG/day,the fortification level was set at 700 lU/0.23g MSG.
Technology/processconditions:
The Philippines: To overcome segregationproblems dueto
physiochemical differences ofthe MSG crystals and the vitamin
A, the MSG was reduced in size (100mesh)and a free-flowing
agentwasadded.All ingredientswere blendedin a Nauta
mixer and the final productwas heat sealed in plastic sachets.
In the second (tn-provinces) field trial,the manufacturer did not
considerthe total amountoffortified product as justification for
the installation of new mixing equipment. Mixing was,
therefore, a manual process. The vitaminA 325Lbeadlets were
weighed in a polyethylenebagtogetherwith the MSG.The bag
wastumbleduntil even distribution ofthe components was
achieved. The contentwasthen gravity fed through the chute of
the packagingmachinefor sachet fillingandsealing. This
choice oftechnologysuggests
a rather large variability in
vitaminAconcentration per package.
Indonesia: Before the beginning ofthe field trials, cooperation
was sought from the MSG manufacturingindustry.The
companythat controlled80°!oofthe market in the test area, PT
Sasa lnti, Surabaya, waswillingto cooperate on the condition
that fallingsalesvolumes would entitle the companyto
withdraw from the program.
The premixwasmixed with commercial grade MSG crystals,
using a Patterson Kelly blender (East Stroudsburg,PA) until the
fortified productwas homogeneous.
Product:
The Philippines: During the Cebu field trial some objections
to the quality of the fortified productarose,from the point of
viewofthe MSG producer:
•
•
The fine particlesofthe MSG could cause fouling ofthe
seals, thus causinga higher percentage of rejects and!
or caking of the product; and
The producerpreferred the needle-likelarge crystals
over the powder formof the milled fortified product.
The MSG fortified withthevitaminA 3251beadlets in a batch
mixing process showeda larger degreeof inhomogeneitythan
the powderedfortified productand a tendencyto segregation.
The package size, however,and the largenumber of packages
purchased over a long-term,should approach the average
desirablefortification level, and the experimentalproductwas
considered adequate for the field trial.The labelling on the
packages was similar to the labelling on the regularMSG with
the exception of adding +A to the brand name (Aji-no-moto+A)
and statingthe fortification level of 15,000 IU vitamin A.
The process conditions in the tn-provincesfield trial (mixing
the dust-free vitamin A premix with MSG crystals) guaranteed
the watertight heat seal ofthe plastic packages. This improves
the stability ofthe vitamin A under normal marketing conditions. Stability of the vitamin A in the fortified productshowed
a retentionof 80°Ioafter 2 months and a retentionof 50%
after 11 months.When the product is protected from light,the
fortified MSG showed a retention of50°!o after 2 yearsof
storage at 35°C. Turnoverrates of the productare 2—4 months.
The level offortification atthepoint of consumption,therefore,
is satisfactory.
The standarddeviation ofmean vitamin A contentat the point
ofprocessingindicated someproblemswith the homogeneity
ofthe product. The package size, however,and the large
number of packages purchased over a longterm should
approach the averagedesirable fortification level.
One ofthe problemsthat hadto be solvedwas the masking of
the yellow colour ofthe vitamin A in the white MSG. The
marketing and distribution figuresfrom the producershowed
no changein sales of the fortified productafter the startof the
field trial.Neither did consumptionofthe fortified product
change. The constantsales volumesproved that the fortified
product did not differ in organoleptic qualitiesfromthe
nonfortifiedproduct.
Qualityaspects: In further field trialsin Indonesiaunder the
auspices of HKI in 1989, problemswith regardtothe stability
ofthe whitecoating (and thus the whitecolour ofthe MSG-A)
evolved.A newly developed white coating did result in a
dramatic impairmentof vitamin A potency. It was discovered
that the whitevitamin A beadlets should approximatethe size
ofthe MSG crystals. An agglomerationstep in the production
process of the premix had to be developed. In the following
years, new vitamin A prototypesand new coatingshavebeen
tested for bioavailability;stability; resistance to moisture,heat,
and light;dissolvability;and organolepticcharacteristics.
Blendingof the whitevitaminAandthe MSG need special
aftentionas the vitamin A is only 2% of the final product
(Wilbur 1991).
Marketing/distributionchannels: The fortified MSG was
marketedin the samepackage size as the nonfortified product,
alongthe normal marketing/distribution channels ofthe
manufacturer in the test area. The label mentionedtheaddition
of vitamin A to the productas MSG-A.
Costand cost effectiveness: The target of the programwill
be fortification of 35—50%ofthe MSG that reaches the rural
areas. There will be a difference in price between the fortified
and the nonfortified MSG. The initial subsidy will gradually be
withdrawn and the cost offortification ofthe MSG will passon
to the consumer of all MSG produced,regardless ofpackage
size. The actualcostsoffortification, 13% of the cost ofthe
nonfortifiedproduct, will bespread over all consumers, thus
increasingthe costsofthe MSG and MSG-A by a marginal 7%
over a period ofseveral years.
Project/program evaluation: The results ofthe field trials
in both the Philippinesand Indonesiashowedmultiple benefits
for preschool children:
Current Practices, Research,and Opportunities71
•
Improvementin serum retinol levels,
•
Reductionin the low and deficientserum retinol levels,
•
Reduction
in the prevalence ofxerophthalmia,
Improvementin growth,
•
•
Increase in haemoglobinlevel, and
Reduction
in the mortality rate.
Not all the children in the field trial area consumed MSG,and
of thosewho did, 200/0 did not receive the fortified brand.
Mandatoryfortification ofall MSG marketed to poor, rural
communitiesshould have an even greaterpositive impact on
health,growth, and survival ofthe children.
In the phase followingthe field trialsin Indonesia(1987—
1991),the marketing of fortified MSG will be expanded. The
differentindustries that will have to cooperate in a nation-wide
fortification programwill thus become familiar with the
productionand marketing ofMSG-Aand adapt theirproduction procedures in time, before a national fortificationproject is
started.
The logical continuation ofthe program would be a full-scale
MSG fortification program aimed at the poor rural areas.
Unfortunately,the safetyof MSG as a vehicle has beensubject
to debate. Furthermore, manufacturers were reluctantto
introducethe technologybecause oftheir doubtsthatthe
process wouldguarantee a sufficientlywhiteproduct.
Observations: The pioneeringwork done in the Philippines
and in Indonesiahas demonstratedthat fortification ofMSG
and marketing the fortified productthrough the normal
channels can be an effective strategyfor controllingVAD.The
MSG fortification projectin Indonesiais an example of a
successful food-fortificationprogram in progress, although it
has not yet been implementedon a nation-widescale. Issues
related to MSG as a carrierand associated health results,
however,remain to be solved. Most importantly from the
industrialists'point ofviewis that the projectis notdependent
on the good will of industry to cooperate, but it is designedto
become financially self-supportingafter the initial years of
subsidy. forthose countries in Asia where VAD is a public
health problem,fortification ofMSG can be an adequate
strategythat could be implementedin a relativelyshortperiod
using the experiences of the Philippineand Indonesiatrials.
OTHER VEHICLES
Cerealgrain products:
Abstract: In 1974, the Food and Nutrition Board of the
National Research Council of the US proposed a newfortification formula for cereal grain products (wheatflour, semolina
(from durum), maizeflour, maizemeal).Vitamin A was added
as retinol palmitate or dry retinyl palmitate.The added level
72 MicronutrientFortification of Foods
was5,000 lU/pound of flour, which is a 150/0averageofthe
NAS fortification level of4,333 lU/pound (= 1.3 retinol
equivalents). No vitamin A is originally found in flour,withthe
exceptionofmaizeflour thatcontains someprovitamin A
activity from carotenoids(Parrish et al. 1980).
The carrierfor vitaminAwasmaizestarch,about 40°Io of the
premix weight. Vitamin and mineral enrichmentmaterialswere
premixedwith 5 pounds offlour by "fluidizing" (shaking)in a
closed plastic bagfilled withair. Flourswere mixed in 100 or
200 pounds lots in a Wengerdouble-ribbonhorizontalbatch
mixer. Equallydivided portions ofthe premix were distributed
on the top of each 50 pounds of flour after itwasspreadout in
the mixer. Flour and premix were blepdedfor 1 5 minutes
(Parrishet al. 1980).
It is also possibleto add fortification materialsduring flour
making in a productionmill. Parrish et al. (1980) used a
Sterwinenrichmentfeeder and found no differences in vitamin
A contentcompared to the mixing method.
Losses ofvitamin A during storage
of flours (made ofwheat
and durum) were up to 10°/o in 6 months at cooling and room
temperature(i.e., 3°C and 21—32°C). Losses in maizeflour and
meal were a little more — over 20°/o. An averageof 1 5% of the
proposedlevelsmightbe more than needed under normal
conditions.Storage at 40°Cshowed losses of about 50°Ioin all
flours.
This is confirmedby other workers,but the loss stabilizes
probably after3 months.Yellow maizecontainsnatural
carotenoidswith provitamin A activity.Their loss during
storagetestswas about twice that ofstabilizedvitaminA
(Parrish etal. 1978, 1980).
The bioactivity ofthe remainingvitamin A did not change
during storage(Lan-Ing Liu and Parrish 1989). No losses were
reportedduring pneumaticconveyingor simulatedshipping
and handling (Parrish et al. 1980).
Wheat, the leastpreferred staplein Bangladesh, is generally
eaten bythe verypoor. Wheataid goes to the particularly
disadvantaged through programstargetedat thosemostin
need. The mixingof syntheticvitamin A powder withwheat
flourhas beenconsidered butrejected as inappropriate
because Bangladeshi householdstend to buy locally milled
whole wheat grain in the market. Thus, fortification ofwhole
wheat withvitamin Awas considered. A premix of concentratedvitaminA attachedto wheat grain was added to the
regular grain in the proportions1:400.But the projectto
demonstrate the technical feasibility offortification and its
nutritional impact was not approvedbythe government(Nestel
1993).
Peanut butter:
Abstract: As early as 1954,experiments were carried out in
the US to fortifypeanut butter withvitaminA palmitate.The
peanut butterprepared containedhydrogenatedpeanut oil,
salt, and peroxide-free peanut oil. Syntheticvitamin A palmitate
wasdissolvedin peanutoil in an amountcalculated to ensure
at least 71 USP unitsofvitamin A/g of peanutbutter. Firstgrade, shelled peanuts were roasted, split-blanched,and
sorted. Through special feeders, the materials were deliveredto
the grinder. Differences in temperatureof processing 140—
180°F (60—82°C) were notfound to have an appreciable effect
on the contentof vitamin. The content of the vitaminA incorporated in the peanut butterwasfound to remain satisfactorily
high, although reduced, afterstorageofthe product for 6
months at 80—100°F(27—38°C) (Willichet al. 1954).
Salt:
Abstract: Fortificationofsaltwith vitamin A has beentried
under laboratoryconditions.The fortificant used wasdry
vitaminA palmitateType250-SD protected by a lipid. For a
moisture contentlowerthan 2°Io, the protection ofvitaminA
activity was satisfactory. Administrationofsalt fortified with
vitaminA in a concentration of 440 IU/g of salt over a 6-month
period was found to be effective in improving vitamin A status
among preschool-age children. Impurities in the salt and
nonuniform crystalsdestabilize vitamin A. Because salt is
hygroscopic,it must contain a desiccant and/or must be
packagedin a moisture-resistantcontainerto preventit from
absorbing moisture (Nestel 1993).
Yoghuit
Abstract:Plain and raspberry-flavouredlow-fat yoghurt
sampleswere fortified withvarious commercial forms of
vitamins A and C under actualproductionconditions(Ilic and
Ashoor 1988) (see Fig. 7-6). Immediatelyafter processing,
yoghurt sampleswere keptat 3°C for 6 weeks and were
analyzed biweekly for pH, titratable acidity, and vitamins Aand
C. Datarevealed that both vitamins decreased gradually in
fortified yoghurt withvitamin C decreasing at a higher rate
than vitamin A. At a level of fortificationof 10,000 IU of
vitamin A, however,and 300 mgofvitamin C per227 g
containerofplainor flavouredyoghurt providedat least 100%
oftheUS RDAup to 6 weeks of storageat 3°C.Thislevel of
fortification did notsignificantly changepH, titratableacidity, or
sensory characteristics of yoghurt samples. After 6 weeks of
storage,however, a light yellow taintwasnoted in plain
yoghurt samplesfortified withvitamin C or withvitamin A+C.
Fig. 7-6. Flow chart of yoghurt productionand points ofvitaminaddition.
(1) Vitamins
Milk
Dry ingredients
Starterculture
Vitamins (3)
Flavours
(2) Vitamins
fruit concentrate
flavours
Source: O'Brienand Roberton, nd.
Current Practices, Research,and Opportunities73
The taintwas absent in yoghurt fortified withvitaminA alone
or in raspberry-flavoured yoghurt fortified with vitamin c,
vitamin A, or both.
Dependent
on the method of manufacturingto fortifythe
productand preferredstageof addition of vitamins, there are a
number of possibleroutes.Temperatures and times ofprocessing varyfromprocess to process. The two basicmethods of
adding vitamin A toyoghurt are:
•
Addition as a dry premix to the base ingredientat initial
mixing stage, and
•
Addition to the fruit conserve via the fruit supplier.
iC.; Arroyave, G. 1986. Control ofvitamin A deficiency by
the nutrificationapproach. In Bauernfeind, J.D., ed., Nutnent
additionstofood. Academic Press, London, UK.
Bauemfeind,
iC.; Parman, G.K. 1964. Restoration ofnonfatdry milk
with vitaminsA & D. Food Technol (Nutrition), February,
Bauernfeind,
52—57.
Bon Dente (BDN). 1993. Ultra Rice Newsletter 1(1). Bon Dente.
Bradley, C.K.; Hillman, L.; Rothman, S.A.; Leedy, D.; Cordano, A. 1993.
Evaluation oftwoiron-fortified,milk-based formulasduring
infancy. Pediatrics 9(5), 908—9 14.
Brooke, C.L.; Coil,W.M. 1972. VitaminAfortificationoftea. Food
Technol, 50, 52, 58.
Brune, M.; Rossander-Hultén, L.; Hallberg, L; Gleerup, A.; Sandberg,
AS. 1992. Ironabsorptionfrom bread in humans:
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Current Practices, Research,and Opportunities79
80 MicronutrientFortification of Foods
8.
OPPORTUNITIES FOR MULTIPLE
FORTI FlCATION
DOUBLE FORTIFICATIONWITH IODINEAND IRON
months. If, however, magnesiumchlorideis present, the
SALT
samples discolour.
Countries: India,Thailand,Canada.
Organizations and groupsinvolved:National Institute of
Nutrition (India); Departmentof Radiology, Mahidol University,
MON (Thailand);
Ml, and University ofToronto
(Canada).
The productcould be made availableuniver-
Targetgroup:
sallyto large populationsor targetedat particular consumers
or customers, and through special deliverychannels,e.g., for
pregnantwomen and young children.
Vehicles: Fromthe standpoint of fortification,the quality of
salt in developingcountrieswouldbroadly fall under the
following three categories:
•
iodate with SNMP improves iodine retentionto 73°Ioafter 6
The UniversityofToronto has recentlydeveloped a stable
formulation ofsalt (double fortified with iodineand iron) under
a study sponsoredby MI and the InternationalDevelopment
Research Centre (IDRC) (L.L. Diosady, personalcommunication).
A new techniqueof dextrin microencapsulation has helped
create a barrier between the iron and iodine compounds
(ferrous fumarateand potassiumiodate)and retain them in
stableformunder varying environmental conditions.Invitro
and in vivostudies on this formulation to test their absorption
are under wayand will be followed by a multicentricfield trial
to assess their impact on iodine and iron statusand consumer
Refined: The salt is already refinedand well packed to
matchthe requirements for fortification.
acceptability.
•
Semirefined:The salt is partially refined but does not
meetspecifications for fortification.
KI (40 ppm),and polyphosphate(1O/),
which provides 1,000ppm Fe and 20 ppm 12. Mannar etal.
•
Unrefined: The salt is not refined.
Fortificants: Mannaretal. (1989) reportedthat ferrous
fumarateand potassiumiodide represent a workable combination without stabilizers. Salt fortified with ferrousfumarate and
potassiumiodide is of a very light brownish colour and does
not deteriorateovertime, provided itis kept sealed in waterproof packing.The formula proposedis ferrousfumarate3,200
ppm (Iron content 1,000ppm); Potassium iodide 65 ppm
(Iodinecontent 50 ppm).
NarasingaRao (1990) has proposeda formula using ferrous
sulphate(1000 ppm Fe), potassiumiodide (20 ppm Iodine) and
a stabilizer (a chelatingpolyphosphate). He has reportedthat
the bioavailabilityand stability ofthe double-fortifiedsalt under
differentconditions of storageand acceptabilitywere found to
be good. The formula proposedby Rao is Ferrous Sulphate
3,200ppm;PotassiumIodide 40 ppm; Stabilizer(Sodium
hexameta-phosphate 1O/o)
The National Instituteof Nutrition (NIN) has recentlyreported
(V. Reddy, Personal communication)that a dry mixing technique was found superiorto the spray mixing techniqueused
earlierto mix the additiveswith the salt.
Work done by Diosady and others at the UniversityofToronto
(unpublished) has shown that the NIN formula (FeSO4 + SHMP
+ Kb3)workswell in pure salt but shows heavy iodine losses
in the presence of magnesiumchloride impurity in the salt. It
has beendeterminedthat encapsulationofthe potassium
Fortificationlevel: Rao (1990) proposed a mixture of
FeSO4 (3,200ppm),
(1979) proposeda mixture of ferrousfumarate (3,200 ppm)
and KI (65 ppm),which pmvides1,000 ppm Fe and 50 ppm 12
Technology:Processand equipment The hydromilling
process (Fig 7-1) is commonlyused for refining the salt. This is
essentiallya physical upgradingprocess in which the salt is
ground and washedseveral times using saturated brine. This
process producesa productthat is comparable in most respects
to recrystallized salt and, to a customer, the difference between
the two varieties may be indistinguishable.
The processing required for differentgradesofsalt is: For
unrefined—grindingand washing, centrifugingand
drying, fortification and packaging;for semirelined—centrifuging and drying, fortification and packaging;and for refined—
fortification and packaging. For a detaileddescriptionof each
process see Chapter 7 under "SingleFortificationwith Iodine:'
Status: A pilot fortification program in the northeastregion in
Thailand was proposed in 1979, but its implementationhas
not been reported. The fortified productwas availableon a
large scale, but an effective distribution and educational system
was lacking. Moreover, universalfortificationwasnot considered a suitable approach dueto financialconstraints and
possible iron overloadfor the healthypartof the population.
National Institute of Nutrition (NIN) proposesto conduct
multicentrictrialsin six centres in India to test impact of its
double fortified salt and its acceptabilityand bioavailability.The
study is expected to take 2—3 years.
Current Practices, Research,and Opportunities81
The stability testsat UniversityofToronto (supported by Ml!
IDRC) are complete. Efficacy trials will be completed by June
1996.The main focus of thesetrialswill be on biochemical
impact and consumeracceptance.
Product:
Rao (1990) reportedthat the bioavailabilityand
stability ofthe double fortified salt under differentconditions of
storage and acceptabilitywere found to be good. Mannar et al.
(1989) reportedthat ferrousfumaratedoes not impart any
noticeable colour to the salt and does not deteriorate with time
in salt. Owing.to the fine particlesize (200mesh), itcan be
addedin a dry form as a rich mix and still get evenly dispersed
in the salt. Its toxicity is less than thatof ferrous sulphateand
the effect on stomach lining is also less than ferroussulphate
or ferrousgluconate. A test report on iron and iodine levelsin
the doublefortified saltestimatedthat 8 weeks afterpreparation therewasno depletion.
Qualityaspects: The purityofsalt used fordoublefortification with iron and iodine is a critical factorto ensurethe
stability and bioavailabilityofthe iron and iodine compounds.
Presence ofmoisture in the salt hastens hydrolysis of the
ferroussalts and imparts a brown colour to the salt. This also
accelerates iodine losses. The presence of a high level of
magnesiumchloride in the salt increases its hygroscopicity
(tendency to absorbmoisture)and aggravates the problem.
Salt used for iron fortification will requirea minimum purityof
99% (dry basis), a maximummoisture contentof 0.5°/a, and a
maximum magnesiumlevel of 0.05°/a. The salt should be fine
grained and of uniform size (0.5—1 mm).
Costeffedivenes On the basis ofprevailing pricesin India
(1990),the cost ofmachineryfor a saltfortification unit
producing 2 ton/hour has beenestimatedat US$40,000—
US$300,000 dependingon the extent ofprerefining facilities
required.The cost of processing fortified salt including the cost
of chemicals and packagingare estimatedat US$90/ton.Iron
fortification adds 50°/o—200% to the cost of salt and costs
US$0.30—US$0.65/head peryear.The currentprice of ferrous
fumarateand potassiumiodide is US$8/kg and US$20/kg,
respectively.
Observations For the mutual coexistence of iron and iodine
in doublefortified salt, it was necessary to lookfor suitable
stabilizers.Iron is stable in an acidicmedium, whereas the
iodine salt is alkaline.When mixed, oxidation ofthe iodide/
iodateto free iodine takes place.The free iodine vaporizesand
is lost. Alternatively,stable and neutral salts of iron had to be
identifiedthat are compatiblewith KI or Kl03 in a slightly
alkaline medium.
Future requirements/developments: The formulations
needfurther testing for stability under a variety of environmental conditions.This will needto be followedby absorptiontests
in rats and humans to establish the efficacyofthe productto
controliodine and iron deficiency. The successful testing and
82 MicronutrientFortificationof Foods
large-scale applicationof availabletechnologyfor the double
fortification of saltwould representa majorbreakthroughfor
the global alleviation of the problemsof iron and iodine
deficiency.
FISH SAUCE
Country: Thailand.
Organizations andgroups involved: Mahidol University
and Ministry of Health,Bangkok,Thailand.
Targetgroup: The NortheastRegionofThailand probably
presents one of the most affected areas with respect to iron
deficiencyanemiabecause of, among other factors,the relative
isolation ofvillages, extremepoverty,and poorlivingconditions. Iodine deficiencyis common in Thailand.Prevalence
surveysundertakenby the Nutrition Division, MO Fl, in 1992
found prevalence ratesofgoitre (grade1ato 3) ranging from
1.42%to almost 40% ofthe population tested.Thirty-four of
the 39 provinces tested had fallen intothe WHO categoryof
severelyaffected by iodine deficiency.
Vehicles: Although crystallinesalt was the main source,the
people also commonlyate salt in the form of "Nampla" (sauce
extractfrom fish fermented in brine) and to a lesserextent "Plara" (a condimentextracted from fish fermentedwith salt,
roasted rice, or rice bran).
Future requirements/developments: The formulations
needfurther testing for stability under a variety of environmental conditions.Thiswill needto befollowed by absorptiontests
in animals and humansto establishthe efficacyofthe product
to control iodine and irondeficiency.
DOUBLE FORTIFICATIONWITH IRON AND
VITAMINA
RICE
Countries: Brazil,Japan, Philippines,Puerto Rico, Thailand,
and the USA. Fortificationofrice is an accepted practicein
many countriesbutis legally enforced in only a few.
Organizations andgroups involved:
FDA, FNB-NRC,
PHS
MOHW
USDA, USAID,
(USA); FNRCC, FNRI;
(Japan);
Hoffman-La Roche; Merck Co.; Wright EnrichmentCo.; RCL;
Takeda Chemical IndustriesLtd, Ajinimoto Company
ofJapan.
Vehicles: Rice is the staple diet of roughly one-thirdto onehalf of the world's population.Out ofthe two edible whole
grain forms,brown and white, there has been a worldwide
trend to eat whiterice in preference to the more nutritious
brown. White rice is primarily a carbohydratesource,the bran
layer has been removed during milling. White rice is mostly
associated withthewidespreadoccurrence of beriberi, caused
bythiamin-deficiency. The loss ofother vitamins andminerals,
however,also has detrimental effects on human health.
Undermilling,parboiling, acid-parboiling,conversion, and
malekizing can prevent (some) nutrient loss, butsuch rice is
less accepted. Enrichmentis a logical step.
Fortificants: Rice is usuallyfortified with more than one
Powderenrichment To the rice a preblended powder
nutrient. In the early days, only B-vitaminsand iron were
added. Later on, other nutrients like vitamin A were built in.
mixture is addedata rate of 1:3,000—6,000.This type of rice
should not bewashed before cookingas most of the fortificants
will be lost. Also,cooking in excess waterwill removemost of
the fortificants. Powderenrichmentis most effective when
appliedsoon after millingand sifting. Because ofthe heat and
moistureat the grain surface, the powder adheres to the grain
well atthis point.
Virtually all iron salts are strongly colouredor darken rapidly
by oxidation and hydration (particularunder tropicalconditions). Ferric sulphategivesthe rice an off-white to yellow
colour,which is undesirableto somecustomers. Reduced iron
has the potentialtoturn rice grey to black. Because of its white
colour,ferric orthophosphateor ferricpyrophosphateis most
suitable for addition to rice but their bioavailability is arguable.
When theseferric salts are oxidizedorcontain excessive
moisture,theycan turn tan, yellow, purple, and/orblack. Their
stability, however, is much betterthan ferroussulphate.
Fortification withvitamin A is usuallydonewithretinyl palmitate
250-SD, a stabilizedvitaminA. Murphy et al. (1992) used initially pure retinol palmitate as vitamin Asource,but its stability
wasnot satisfactory. Retinyl palmitate was a better alternative.
Fortification level: Inthe US, manystates followedthe federal
regulations of 1990whereby each kg of enriched rice should
contain4.4—8.8 mgthiamin,2.6—5.3 mgriboflavin,35—70 mg
niacinorniacinamide, 29—57 mg iron, 1,100—2,200 mgcalcium,
and 550—2,200USP units ofvitamin D. Calcium andvitamin D
are optional, ifadded,the levels must agree withthe federal
regulations. Becauseofcolourproblems, riboflavinis oftennot
added.There is no standard forbrown rice.
In Thailand,23,700IU vitamin A/kgand 80 mg iron/kg are
in rice. Some rice fortification programsalso use
amino acidsor proteinsfor fortification.
recommended
Table 8-1 shows fortification levelsof vitamin A and iron in rice
in several studies to illustratethe used levels.
Technology:processandequipment: Two types of
enrichmentare currently available— powder enrichmentand
grainenrichment.
Table 8-1.
The method of mixing nutrients at the timeof cookinghas the
sameprinciple.A mixture of nutrients (powdered orin tablets)
should be dissolvedin the cookingwater. The water must be
absorbed totallyby the rice. This method is onlysuitablefor
mass cooking.
Grain enrichment This typeof enrichmentis known as
premix and is the most common way to fortifyrice. It consists
ofgrains ofrice thathave beentreated with vitamins and
mineralsthat will not rinse off the rice when washed.Usually,
the grains are highlyconcentrated and must be blendedwith
ordinary white rice, mostly at a rate of 1:200. Several methods
have beendeveloped over the last 50 years. The most simple
method ofgrain enrichment isto apply a concentrated powder
blend to milled rice and then coat the rice with a waterinsoluble,food-grade materialthat cannotbe rinsed off.
The first patented method in the US (19405), was the HoffmanLaRochemethod For this, a premix (a sulphuricacid solution
ofthiamin hydrochlorideand nicotinamide) is sprayed onto the
surfaceof tumbling whiterice containedin a horizontalrotating
drum ortrumbol. Riceis dried, assisted by hotair. A protective
coating (an ethanol or isopropanolsolution ofzein,fattyacid
(palmiticor stearicacid),and abieticacid) is applied, immediately followed by an applicationof talc and ferric orthophosphate powder.After drying, the latter process is repeated until
the requirediron level is reached. The finished productis
sieved,packaged, and distributed for blending. Addition to
Levels of iron and vitamin A in unfortified and blendedfortified rice.
Furteretal. (1946)
Hunnel! eta!. (1985)
Furter eta!. (1946)
Hunne!! et a!. (1985)
White rice
6.6—8.8
White rice
5
Brown rice
Brown rice
15—18
Coated (Hoffman-l.a Roche)
28
—
Furter et a!. (1946)
Coated basedon Hoffman-La Roche
55
Coated based on Wright
Coileta!. (1976)
Coileta!. (1976)
Coated (RCL-method)
88
20
13,200
16,000
—
Coated
—
Bramall (1986)
Rubin eta!. (1977)
Coated
6
9,250
2,400
Infused (Japanese Shingen)
11
—
Artificialrice grains
Artificialrice grains
—
12,500
4,075
11
20
Peil eta!. (1981)
Hunne!! eta!. (1985)
Murphy eta!. (1992)
Gershoff etal. (1977)
Current Practices, Research, and Opportunities 83
plainwhiterice occurs at the rate of 1:200 (Furter et at. 1946).
This method has improvedduringthe yearsbut it isstill a
basicmethod used today for rice fortification.
The Merck Co. method, patented in 1955, is the other main
basicmethod used. The samesortof rice premix concentrate is
manufactured withan acetone/watersuspensionofthiamin
hydrochloride,nicotinamide,an iron salt, and ethyl cellulose.
When this coatingdries, several coats of an alcoholic shellac
solution containinga whitening agent are appliedtoyield a
glossy whitegrain. Again blending has to be doneat a rate of
1:200with untreatedwhiterice.
The Wright EnrichmentCo. methodproducesa fortified rice
premix usinga process based on a combinationofthe
Hoffman-La Roche and the Merck Co. process.
An even more stablepremix was claimedby Peil et at. (1981).
Theyfound a coatingthat is moreresistantagainst cooking/n
excess waterthan othersand soluble at 37°C. The best they
found was made by 1.2°/a (w/w)methylceltuloseA 15, 3.6%
hydroxypropylmethylcelluloseF50, 28.5°/a ethanol (95°/a),
and 66.7°/owater. This polymer solution is sprayedon rice and
dried in six layers:
1.
0.8 mg thiamin and 6.66 mg niacin/g polymersolution,
2.
7.3 mg riboflavin/g polymer solution,
3.
Reduced iron powder was sprayedalternatelywith
polymersolution in a rate of 37 mg/g polymersolution,
4.
A layer of unfortified polymer solution to separate,
5.
VitaminA (250-SD)was sprayedalternatelywith polymer
solution in a rate of 455 IU/g polymer solution, and
6.
Alayer ofunfortified polymersolution to seal the coating.
In 1981,a new, simpler method was developed by
Ricegrowers'Co-operative Limitedas an answerto the lessaccepted Hoffman-La Roche rice premix (RCL-method).A
surfaceadhesive techniquehas to be used and discoloration
has to be preventedby using ferric orthophosphate.An acid
was usedto dissolve iron, thiamin, and niacin.This solution
does not react with the iron salt and, therefore, preventsthe
colourchange. It generates a thin, sticky sugar layer by
reaction withthe surfacestarch of the rice particles. The ferric
orthophosphate is bound to the rice in the sugar coating.After
applying the solution to the rice (in trumbot), it is dried and the
premix is ready for blending (Bramall 1986).
In Japan, for many yearsmostly thiamin/riboflavin enriched
rice was eaten.Since 1981,multinutrient enriched rice has
beenmarketed inJapan.It is called Shingen,which means
"brown rice in the new age:' The rice is manufactured using
infusion bya combinationof acid-parboilingbefore coating.
Polished rice, therefore, is soaked in a 10/0aceticacid solution
containingwater soluble vitamins (thiamin, riboflavin, niacin,
pantothenic,acid and pyridoxine).The soakedrice is then
steamed, dried, and coated withvitaminE, calcium, and iron
separately in different layers. Finally, a protective coating
material is applied to preventlosses through washing. The
coatingmelts at 70°C, but is insoluble in cold water (In Japan,
the usual cooking method is with total waterabsorption.)It is
differentfromthe coatingof Furteret at. (1946). The premix is
packedunder CO2 (to preventvitamin E destruction) and ready
for blending in a rate of 1:200 (Hunellet at. 1985; Misaki and
Yasumatsu n.d.).
Liuzzo et at. (1992) claimto have a more stablepremix with
their cross-linkedgrains. The rice is incubatedwith an aqueous
vitamin (thiamin, riboflavin, niacin,and pyridoxine)-sotutionat
pH 2.3—2.5 for 30 minutes,then acetaldehyde (the crosslinkingagent) is addedand incubationat 60°C for 45 minutes
follows. After washing with tap water and neutralizingwith
ascorbicacid,the grains were air-driedto a moisturecontentof
10—14%.
84 MicronutrientFortification of Foods
Atotallydifferentbasicmethod of the grain typeof enrichment
is the manufacturingof artifidalrice. Attempts are made here to
manufacture enriched artificial rice (simulatedrice kernels)that
is mixed with regularly milled rice. The cookedrice containing
the artificial rice often had a poorappearance. By now, itis
possibleto make acceptable grains of a dough offortificants
and a binder of starch (e.g., rice flour) or proteins, using an
extrusion process. Temperatures of 100—200°C are used. Also,
a coatingis often addedto preventlosses through washing.
Usually,heat-labile vitamins as vitamin A and thiamin are
sprayedon the artificial rice because ofthe high temperature
during the extrusion process.
Status and resultsoffieldtrials: Most of the rice sold in
the US is enriched, fortified rice is normally availablein Japan
and Puerto Rico.
Field trials in the Bataan province of the Philippines,which
provided fortified rice accordingto Furteret at. (1946), reported
76—94%decrease in the incidence of beriberiwithin a few
years (Salcedo et at. 1950). Also, someJapanese studies
reported positive effects ofrice fortification programs.Increased
thiamine blood levelsand numbersof red blood cellswith
subjects fed with multinutrientfortified rice were observed.
Misaki and Yasumatsu (n.d.) and Gershoffet at. (1977) could
not find an improvementofgeneralhealth during a 4-year
feeding program in Thailand with rice fortified with vitamin A,
iron, thiamin, and amino acids. The investigatorswere unable
to explain the results obtained.
Qualityaspects: A fortified rice premix should look like rice,
cook like rice, taste tike rice, and maintain its nutrient qualities
through rinsing and cooking. If the premix grains look different, they will be picked out by the consumers. That is why
riboflavin is often not added, itforms brightyellow spots in the
cookedrice. It is possibleto hide the colour in grains fortified
with riboflavin, but itstilt forms the yellow colour during
cooking, which is notacceptable to many consumers. In Japan,
theyellow colour ofthe rice premix has beenaccepted sincethe
19505. Talc is also usedto obtain the right,whitecolour.
Consumerhabitshave a significantinfluence on the availability
of the nutrients in the meal. For example,whether the rice is
rinsed before cookingand whether it is cookedwith a measuredamountof water, which is completelyabsorbed, or with
excess water, which is drainedoff and thrown away.
In the US, the standard requires that the label on enriched rice
includesthe statement:"To retain vitamins, do not rinse before
or drain after cooking The statement is not required if>85°Io
of the minimum levelsremain after cookingby a prescribed
method. In South Asia, it is common practice to cook rice in
excess water. The PhilippineFood and Nutrition Institute (FNRI)
judged a washing loss ofvitaminAof 10—20°/o as unacceptable. Fifty-percent cooking stability is the minimum.
Costand cost effectiveness: Powderenrichmentis less
expensive than other forms. Coatingis slightlymore expensive.
Accordingto Yong(1979) pricesfor totalenrichedrice (including amino acids) would be US$0078, 0.080,and 0.073per
kg fortified rice fora surface coatingmethod, an infusion
method, and artificial rice, respectively. One reasonto develop
the RCL-method wasthat the Hoffman-La Roche production
tooktoo muchtime. Because ofthe simplicity ofthis method it
is muchcheaper.
Observations:
Storage stability: The mineralsand vitamins in powderenrichedrice are less stableandtheycan easily reactwith
other food compounds.The most-usedrice fortification
methods seems to be adequate for storage. The RCL premix
(containingthiamin, niacin,ferric orthophosphate) showedno
significantcolour changeand no loss ofnutritional quality after
12 months under tropicalstorageconditions.It was developed
because the Hoffman-La Roche rice was found to be easily
distinguishedfromplainwhiterice, and it rapidly darkenedin
colour under tropicalstorageconditions.
An exceptionhas to be made for vitaminA. Stabilizationis the
main problem withthefortification process (Hoffpauer 1992).
Coil etal. (1976) made fortified rice based on the Hoffman-La
Roche methodand on the Wright method. The Hoffman-La
Roche methodshowed storage losses of 12°/o vitamin A,
whereas the Wright methodonly showed 1% loss. Rubin et al.
(1977) found a 13%loss ofvitamin A and no loss of iron
during storageof rice premix based on Hoffman-La Roche.
Vitamin A in artificial rice grains accordingto Gershoffet al.
(1975) had lost 50°/oof its activity during processingand
storage.
Murphy et al. (1992) found a vitamin A half-life of238—408
days in artificial grains (at T=25°C, a=0.1 1). Storagestability
was affected by the presence of several antioxidants and oils. If
no ascorbate is present, an increased humidityis detrimental.
In a humidatmosphere,however, artificial rice usually clumps
togetherwhen stored. Combinationsof more saturatedoils,
tocopherol, and ascorbate are recommended for adequate
preservationof vitamin A in the artificial rice grains,particularly in tropical environments. Unfortunately, there was no
correlationbetweenstorage stability and cooking retention.
Retentionafterwashing: Ordinarywhiterice lose about
60% of its iron (and vitamins) through washing because what
is left after millingis usually close to the surface (Furter et al.
1946). Ifpowder enrichmentis used,20—100°/o ofthe
enrichmentwill wash offthe rice.
Because most consumers insist on washing rice before
cooking, it is important that any method of enrichmentof white
rice protectthe added nutrients againstwashing.Today,
coatingmethods seemto be adequate, although Murphy et al.
(1992) found washing losses of 10—20% with vitamin A
fortified rice enrichedby Wright Enrichment, Inc. Rubin et al.
(1977), however,found washing losses ofonly 1.10/o of
vitamin A and none of iron withfortified rice based on the
Hoffman-La Roche method.Artificial rice used by Murphy et al.
(1992) showed no loss of vitamin A through washing. The
cross-linked method (Liuzzo et al. 1992) claims to have less
loss during rinsing, cooking, or processing, but they did not
fortifywith iron orvitamin A.
Retention aftercooking: Cooking losses canbe verylittle if
rice is cooked in a suitable amountofwaterthat can be absorbed
totally.Coil etal. (1976)madefortifiedrice based on the HoffmanLa Roche method and on the Wrightmethod,addingthiamin,
pyridoxine, niacin, vitamin E, vitamin A,folic acid, iron, calcium,
zinc, and talc. Cooking losses in both methods wereonly 1%
Stabilityofvitamin Aricethatwas cooked was stronglydecreased, even on coolingtemperatures. That agrees withthe
results ofMurphy etal. (1992) who reported a detrimental effect
on vitamin Astabilityundermorehumid storage conditions. The
artificial rice grains ofMurphy etal. (1992) showed vitaminA
cooking retention of 55—96°/o,affected bythe presenceofseveral
antioxidants andoils. Cooking in excesswaterresulted in 81%
loss ofvitamin Aofthe fortifiedrice based on the Hoffman-La
Rochemethod(Rubin etal, 1977). Peil et al. (1981) improved the
coating, andthey managed to lose only 30°/o vitamin A.
Bioavailability: As described in Chapter 7 (Single Fortification
of Iron inWheatflour and Bread),the presence ofascorbic acid
has an enhancing effect on iron absorption, not only in bread but
also ifiron is eaten withrice. The presenceofriceitself inthe diet
inhibitsiron absorption, as most vehicles do. Additionofascorbic
acid to fortifiedricemay be an improvement to beconsidered. If
the ascorbic acid is oxidized during longorexcessiveheatingof
the food,thiseffect is reduced.This might occur during rice
cooking (Sayers etal. 1974; Guiroetal. 1991). Incorporation of
glucose inthe ricediet seems tohavean inhibiting effect on iron
absorption. Incorporation of starch or lactose seems tohavethe
Current Practices,Research, and Opportunities85
leastinhibiting effect,whereas sucrose orfructose were in
between (Snehalata andReddy 1985).
SUGAR
An approachto controliron deficiency and vitamin Adeficiency
where dietary availability of the two micronutrientsis low is to
fortifya vehicle consumedby all the deficientpopulations.This
has been tested in a double-blindfield study in four highlands
and lowlands, semirural, low-incomecommunitiesin Guatemala (Viteri et al. 1995).
Countries: Guatemala.
Organizations andgroups!nvolvet INCAP, University
of California, Berkeley;PAHO/WHO; Kellogg's Latin America;
USAID.
Vehicles: Sugarhas alreadybeenshown to be an adequate
vehiclefor vitamin A fortification in Guatemala, and it does not
impair iron absorption (Layrisse etal. 1976).
Fortificants: In this field research, sugar wasdoubly fortified
with retinyl palmitate and FeNaEDTA.
Fortificationlevel:
One gram FeNaEDTA/kg sugar,provid-
ing 130 mg Fe/kgsugar and 15 mg vitamin A/kgsugar.
Twelve sugar sampleswere obtained sequentiallyatthe
packagingsite, coveringthe productionperiod of each offive
sugar batches produced for thestudy.
Technology:Process: FeNaEDTAwas addedby a sugar
factoryin the lowlands of Guatemala to the vitamin A-fortified
sugar alreadybeing producedby the factory. This addition, as
describedby Viteri etal. (1995), was achieved by manually
delivering, in a sweepingmotion, the yellow powder to the last
centrifugationof refinedsugar while itstill had about 2%
humidity. The amount was addedto the sugar load that each
centrifugedelivered.The sugar discharged byeach centrifuge
fell into a conveyingscrew thatcarried and mixed the sugar to
its final drying and further mixing stagebefore packaging.This
process did not alter the normal flowof sugar production.
Status and resultsoffieldtrials: Iron stores in the
fortified communitiesincreased significantlyexcept for women
18—48 yearsof age in one lowland community.Iron stores in
the controlcommunity remainedunchanged exceptfor a rise in
adult males. It is highlyimprobablethatthis is caused by a
possibleeffectof vitamin A fortification of sugar,which has
beenconsumed in this and all other communitiesfor several
years.
Qualityaspects: The doubly fortified sugar was verystable
except for a slowprogressionof brownish discolorationin
6
extreme conditions that was noticeable after months of
storage under the most severe environmentalconditions.No
settling of NaFeEDTAor vitamin Ato the bottom of the sacks
storedunder natural storageconditions in tropical, humid
environments was noted.Acceptabilityand organoleptic
propertiesof commonlyused food recipes were completely
satisfactory. A qualitative test to detect iron in sugar wasalso
introducedto reinforce the exchange of unfortified sugar for the
fortified one when the formerwasoccasionallyfiltered intothe
fortified communities.
Cost: Cost—benefitanalysis ofsugar fortified with iron and
vitamin A provedto be extremelyfavourable.
Observations: A systematic monitoring of complianceand of
changes in nutritional status should be established. This
should includeserum ferritin determinationsin well-defined
samplesof adult malesto preventany long-term risk of iron
overload, although,currently, this isa veryremote possibility.
BLENDED/FORMULATED FOODS
Blended/formulatedfoods are made byblending several
componentingredientsto producea food that is nutritionally
improved compared to any of the individual components.The
formula usually contains a staple cereal (like wheat, rice, corn,
groundnut,sorghum) and a high-qualityprotein source such a
soybean,milkpowder,whey, and the like.
Many differentvarieties have been developed around the
world. Examples of infantfoods fromEthiopia, Nigeria, India,
and Tanzania are described in Table 8-2. There are many more
examples,however, ofdouble-fortifiedinfant foods in many
other countries.The ingredientsmay be milled or undergo
Table 8-2. Nutritional value per 100 gproduct.
1,700KJ
15.Og
1,600 Ki
42.Og
1,700KJ
20.Og
1,500KJ
18.Og
25.0°/a
14.8°/a
44.00/0
20.0°/a
20.0°/a
6.00/a
27.0°/a
20.0°/a
14.0°/o
19.0°/o
3,000 IU
3,000 IU
1,430 IU
Energy
Protein
1,400 KJ
21,Og
Protein-energy-°/a
Fat-energy-°/a
Iron
15.0mg
VitaminA
a=
Dependingonadded vitamin/mineralmix.
Source: CaritasNeerlandica (1983).
86 MicronutrientFortification of Foods
somesort of further processing (heating,parboiling, rolling,
extruding, etc.). Nutritional value is enhanced byfortification of
blendedfoodswith mineralsand vitamins and, to increase
their acceptability, sugar is usually added to the formula. These
foodsmaybe cookedand servedas a meal or made into a
drink and theycan be usedto supplementanother less
nutritious food, e.g., cassava (Barreft and Ranum 1985).
Countries: Ethiopia(Faffa), India (Balahar, multi purpose
food),Nigeria (Soy-Ogi), Tanzania (Lisha).
Organizations andgroups involved: ENI (Ethiopia),
CFTRI (India),FIIRO (Nigeria),TFNC (Tanzania), WFP.
Targetgroup:
Infants and pregnantand lactatingwomen.
Vehicles: Infant foods consistofa cereal (wheat,maize),a
high-quality protein compound(soybean, chickpea,DSM), and
afat component(groundnut,soybean).
Fortificants: VitaminAand iron (see Table 8-3).
Technology:Process:The chickpeas in Faffaare precooked
before millingto increase digestibility.
Soy-Ogi:Maizeand soybeansare selected and washed.Maize
issoaked overnightand wet-milled into a slurry. Soybeans are
Qualityaspects:Soy-Ogiis kept for 3—6 months in
polyethylenebags,packedin cartonboxes, or kept 9—i2
months in tins. The keeping quality of groundnutsused for
Balaharis a major problem because ofaflatoxin contamination.
For the other products,the keeping quality is notmentioned
and generally is not a primary concern.
Marketing/distributionchannels:
Faffawas originally distributedthrough retail trade in the
1960s—70s.Then,for a fewyears, itwasmainly used for
emergency relief. In the 1980s, commercial salesincreased
again. Production now istaken over by a governmentcompany.
Balahar:Almost all production is distributed throughsupplementaryedingprograms. In 1976, a production of 40,000tons
was mentioned. Commerdal marketingnever succeeded.
MPFwas used almost solely in supplementaryfeeding
programs. Product promotionwasneglected and the product
has never reached retail shops.
Soy-Ogi:Distribution is donethrough the governmentand
retail shops. The productionin 1980 was 17 tons.
heated, dehulled,cooked (10 minutes),and wet-milled into a
slurry. The maize, soybeans, and mineralsare mixed and
Lisha: Commercially
pasteurized.
Faffa: The cost was US$0.90/kg (1982). Sold at a subsidized
Itis spray dried and the powder is mixed with a
vitamin/mineral premix.
Lisha: A mixture of maizeandsoybeansis made into a thick
pasteby a low-cost extrusioncooker,the pulpis dried and
milled. The powder is mixed withmilkpowder and the vitamin!
marketed.
Costand cost effectiveness:
price ofUS$0.50/kg.
Balahar: Little is known about the actualprice.A cost price of
US$0.40/kg was mentionedin 1965.
MPF:Actualpricesare not known. A cost price ofUS$0.33—
0.72,dependingon packagingmaterial,was mentionedin
mineral premix.
Status: Full production.
1972.
Product: The compositionof the various infantfoods are
shown inTable 8-3. Vitamins and mineralsare addedfor
fortification and sugar for flavouring. Local ingredientsareused
Soy-Ogi:Productioncost was US$1.70/kgand wholesale
price was US$2.18 (1982).
Lisha: Retail price was US$1.96/kg (1980).
(see also Chapter 7).
Table8-3.Composition of some infantfoods.
Faffa
Balahar
MPF
SoyOgl
Lisha
Wheatflour
570/s
65°/o
—
—
—
Soyaflour
Groundnutflour
18%
—
—
30°/a
—
—
25°/a
—
—
—
Chickpeas
100/a
100/a
25°/o
—
—
Maizeflour
—
—
—
70°/o
—
Maize grits
—
—
—
—
65°/a
Hulled Soybean
DSM
—
—
—
—
28°/o
5°/o
—
—
—
5°/a
Sugar
Salt
8°/o
—
—
—
—
1°/a
—
—
—
—
Vitamin A + iron
Detailedpeanut
1°/o
<1°/a
<1°/a
<10/
1a/
—
—
75°/o
—
—
Source: CantasNeerlandica(1983).
Current Practices, Research,and Opportunities87
Projectiprogram evaluation:
Faffa was marketed in 1967for the first time. In 1969,the
compositionwaschangedas a result ofmarket plus acceptability studies.It is betteraccepted by womenwith higher education and families with a steady income.Market studies (1982)
showedthat 75% ofthe userswere from low-incomegroups.
Balaharwas developed to replaceCSM. No market or acceptability studies preceded the introduction.A large proportion of
the target group (preschool children) was not reached.
MPFhad been tested in 300 institutionson acceptability and use
before production startedin 1960. MPFhas never reached retail
shops, andthe use in supplementary feedingprograms has
decreased because of imported free donations ofotherfoods.
Soy-Ogimarket surveysshowedgood acceptance and a high
demand for Soy-Ogi.
Lishaproductdevelopmentwaspreceded by a seriesof
surveys on traditional weaning food practices and recipes.
Initial mixturesofmaizewith beans, fish, or meatwere tested
but the productswere too expensive. Soybean proved to bethe
bestaccepted legumethat has beentried.
MAIZE
Countries: Some Africancountries,Canada, Chile,Guatemala, South Africa,the US.
Organizations andgroups involved: FDA, NAS/NRC,
USDA/CSRS, USDA/ARS, IAEA, SAAEB, SASA, WT, UNU, and
Hoffman-La Roche Inc.
Vehicles: Maizegrits, fine and coursemaize, degerminated
and soyahave beenused for fortification.
Fortificants: Maize meal and commercial grits are fairly
similar to wheat flour in moisture contentand are normally
sufficientlyshelf stable. Multiple fortification is oftenperformed
in a similar fashionto fortification ofwheat flourand bread. For
the enrichmentofmaizemeals and grits, however, elemental
iron powder is the preferred iron sourcebecause soluble
reactiveiron salts such as ferroussulphateare prone to
rancidity.
Even stabilized ferroussulphate,the so called bio-iron, causes
rancidity soonerthan elementaliron. The latterdoes notcause
functional problemsof separation, colour,or rancidity. Ferric
phosphateor ferric sodium pyrophosphate could also be used
withoutfunctional problems,buttheir bioavailabilityis less
than that of reduced iron (Anderson 1985). Just like wheat
flour, fortification with vitamin A is usually performedwith
retinyl palmitate,a stabilizedform of vitamin A.
Fortificationlevel: The original iron levels in maizeare 24
mg/kgwhole meal unbolted,18 mg/kgbolted meal, 11 mg/kg
degerminatedmeal,and 10 mg/kgmaizegrits. The FDA
standardsfor enrichment are 28—57 mg iron/kgfor maize
88 MicronutrientFortification of Foods
meal and flour, 46—57mg/kgfor grits, and none for whole
corn meal, which does not have an enrichmentstandard
(Ranum and Loewe 1978).
Maize does containvitaminA activity that is presentnaturally,
whereasother cereals do not. The recommended level of
fortification withvitaminA in maizemeal and related products
in the US is 22,000—26,000 lU/kg, but this is nota federal
standard. In most studies,the added amount of vitamin A is
lower (11,000—16,000lU/kg, dueto olderrecommendations
(Cortet al. 1976;Rubin et al. 1977; Yong 1979;Parrish et al.
1980a).
Technology:Processand equipment: When the maize is
milled and consumed withoutrinsing ordiscardingthe cooking
water, itcan be fortified inthe same ways as wheat.
Forwet-milled maize, there is no needto siftthe product into
particlesizes. It can be fortified simplyby adding a fortification
mixture by hand or witha feeder. Powdered premix, therefore,
is sufficient and there is no needfor palletization of the premix.
The more humid conditions,however,mightaffectthe stability
ofvitamin A, which is particularlyunstable in such circumstances.
Maizegritspresentmore fortification problemsthan wet milled
maize-dough because theyare often rinsed before cooking.
Technologies likethose for fortifying milled rice may be
suitable (Yong 1979).
For tortillas, maize is cooked in water with limestoneand
washedto remove the outer hull before grinding. The iron
contentof the dough is affected by the grinding process —the
grindingstones used in the villages of Guatemala increase the
iron content in dough comparedto dough made by hand orby
motorized mills. Other circumstances did notaffectthe iron
level (Krause et al. 1993).
Status and resultsoffield trials: In the US, most ofthe
maizemealsand commercial grits are enriched, usually with
reduced iron. Because vitaminA is not included infederal
regulations,fortificationof corn productswith vitamin A is not
commonin commercial products.In studies, it is often added
as an extensionofbreadfortification studies.
Observations:
Bioavailability:The bioavailability of iron in maizeproducts
is not totallysimilar to thatin breadbecause processinghas a
great influence on availability.Absorptionof nonhaeme iron is
still low;Derhamet al. (1977) report 3.8%absorptionof
ferroussulphatefrom maize-meal porridge. MorOnet al.
(1989) studied extruded maize—soybean fortified with iron,
vitamin A and others.Iron absorption (ferrous fumarate) varied
between2.4°/a and 6.8°/a.
Inhibiting/enhancement: Derhametal. (1977) reported
the inhibitory effect oftanninin tea, mentionedearlier in
Chapter 7 (Single Fortificationwith Iron in WheatFlour and
Bread). A strong enhancing effectof ascorbic acid is seen in
maizemeal porridgeby Derham et al. (1977) and Sayers et al.
(1 973). The processing temperatures were low enoughto
preventoxidation of the ascorbic acid (as is seen in bread), to
avoid depressingits enhancingeffect.
Storage: Stability of vitamin A in milled maize (meal and
grits) at room temperatureis not as good as in wheat flour.
tosses were up to 200/o in 6 months, but the moisture content
was an important factor, A 6.5°/o moisturecontentshowed
hardly any loss, whereas 11.40/0 in maize grits lost one-fifth of
vitamin A. Also at higherstoragetemperatures, vitamin A
losses increase — up to 40°/o loss in 3 months at 45°C. These
valuesdo not really differfromresults found in wheat flour. A
150/0averagevitamin A in milled corn will provide for storage
losses atwarehouseconditions (Cort et al. 1976;Rubin et al.
1977; Parrish et al. 1980a).
Iron addedas reduced iron was found to be stableatboth
temperatures in all milled maize. When stabilizedferrous
sulphateis used, deteriorationoccurred. If iron levelsincreased
(from 88 to 440 mg/kg) off-flavoursshowed upwith all iron
sources. In soya-fortifiedmaize, stabilized ferroussulphatewas
found to be an acceptable iron sourcefor fortification.Segregation of iron sources in milled maizewas not noted (Anderson et
al. 1976; Rubin et al. 1977; Anderson 1985).
Processingretention: Processingthe maize meal or grits
causes losses ofvitamin A— the longerthe cooking temperature the greaterthe loss. tosses upto 30°/owith 30 minutes
cooking were reported. Making maizebreadcauses the usual
processing loss, butstoragestability is lithe lessthan in wheat
flour bread(Rubin et al. 1977; Parrishet al. 1980b).
WEANING RUSK
Organizations andgroups involved: Institute of Nutrition
and Food Hygiene, Academyof Preventive Medicine, (China);
MRC Dunn Nutrition Centre, Dept ofTrade and Industry,United
Biscuits, and APV Baker (UK).
Targetgroup: Weanlingchildren.
Vehicle: Rusk made from wheat flour,sugar,and vegetable
oil.
Fortificants: Vitamin A and iron as ferricammonium citrate.
The lafter proved to be muchmore palatableand acceptable
than cheaper iron salts.
Technology: The micronutrientcomponents were prepared
as a premix, before being used for ruskmanufacturing.
Status and resultsoffieldtrials: During the field trial,
palatability and compliance appeared to be good. Despitethe
plant acids in the flour, the ruskwasshown to be an effective
and, thus, an availablesource of iron. The iron addedto the
rusk is likelyto be bioavailable.
Fortificationlevel:See Table 8-4.
Product: Theruskis a biscuit productthat has low residual
moistureand is rapidly soluble in warm liquids.
Qualityaspects: Theadvantageofthe ruskweaning food is
the longshelf life.
Costand cost effectiveness: The costof productionwas
1.4 renminbi (yuan)/1 00 g, which seems to be reasonable. On
the assumptionthat one ruskwould be eaten everyday, a
typical rural familywouldspend 4°/o of its incomeon the rusk.
Observations: The rusk(one per child per day) was eaten
either dry ortaken in liquidform, after dispersionin water.
Some evidence
Countries: China.
of interaction between iron and vitamin E was
shown. It was stated that other antioxidantmicronutrients,like
Table8-4. Nutrient contentoffortified rusk.
Protein
Fat
Sugar
Energy
Vitamin A
Iron
Calcium
Zinc
Cholecalciferol
Thiamine
Riboflavin
Niacin
Cyanocobalamin
Folic acid
60.0 mg
80.0 mg
310.0mg
9.2 KJ
13.2 pg
0.29 mg
17.6mg
180.0 pg
0.22 pg
0.009pg
12.0 pg
147.0pg
0.018pg
1.47 pg
lOg
2—4 g
1.4g
5.3g
156.OKJ
224.0 pg
5.0mg
300.0 mg
3.0mg
4.Opg
0.15 pg
200.0 pg
2.5 mg
200.0 pg
10.0mg
600.0 mg
5.0mg
10.0 pg
10.0 pg
400.0 pg
4.0mg
0.3pg
25.0 pg
aperkgbodyweight.
Current Practices, Research,and Opportunities89
vitamin C and carotenoids, could not be includedbecause of
their instability during baking.The compositionofthe premix
could be varied to make it suitablefor differentregions.
Future requirements/developments: The optimum
compositionofthe supplementmay requirefurther study.
Inclusion of vitamin E as a protectivesubstanceand heat-stable
antioxidant needs to be considered.
OTHER VEHICLES, e.g., MONOSODIUM GLUTAMATE
(MSG)
Countries: Philippines.
Organizations andgroups involved: Ministry of Health,
Philippines;Hoffman-La Roche, USA.
Targetgroup:See Chapter7 "Milk and MilkpowdeC
Fortificants: The preferred sourceofiron to be added to MSG
should have good bioavailability,have a blandtaste, and be
nearly whitein colour. It should be low in cost and available
commercially.
Micronized ferric orthophosphate(produced by Joseph Turner
Co.) and zinc stearate-coated ferroussulphate(produced by
Durkee'sIndustrial Foods Group) have beenaddedto MSG
alongwith stabilizedvitamin A palmitatetype250-SD.
Durkees-coated ferrous sulphateis a light-coloured,tasteless,
relatively nonreactive, free-flowing powder varying in particle
size (100—200mesh).The coating protects the ferrous
sulphateup to a temperatureof 122°C, the melting point of the
encapsulatingmaterial. For characteristics offerric orthophosphate,see Chapter 7.
Fortificationlevel: Sachets comprising2.4 g fortified MSG
contained15,000 IU vitamin A and 50 mg iron.
Technology:Processand equipment:See Chapter 7,
"Milk and Milkpowder'
Status and resultsoffield trials:Laboratory.
Qualityaspects: Products were found to have favourable
colour,taste,bioavailability,and particlesize characteristics,
Storage trialsindicatedthatthe iron did not influence vitamin A
activity.
Future requirements/developments: Large-scale
productiontrialsand field testing needto be carried out.
MULTIPLE FORTIFICATIONWITH IODINE,IRON, AND
VITAMINA
CEREAL BASED FLOUR
Countries:USA.
Organizations andgroups involved: CSRS (Parrishet al.
1978); FNB-NRC.
Targetgroup:All Americansociety.
Vehicles:Wheat flour, semolina(from durum), maizeflour,
maizemeal.
90 MicronutrientFortification of Foods
Fortificants: Vitamin A was added as retinol palmitate or dry
retinyl palmitate.For total fortification of the flour, iron (as
ferroussulphate and electrolyticallyreduced iron) and other
vitamins and mineralswere also added.
Fortificationlevel: In 1974, the Food andNutrition Boardof
the NationalResearch Council/USA proposeda new fortification for cereal grain products. The addedvitaminA level was
5,000 lU/pound flour, which is 150/0coverage of the NAS
fortification level of4333 lU/pound (= 1.3 retinol equivalents).
Technology:Processand equipment: The carrier for the
vitamin-iron premix was maizestarch, about 400/0 of the
premix weight. Vitamin and mineral enrichmentmaterialswere
premixedwith 5 pounds of flour by "fluidizing" (shaking)in a
closed plasticbagfilled with air. Flours were mixed in 100-or
200-pound lots in a Wengerdouble-ribbonhorizontalbatch
mixer. Equallydivided portions of the premix were distributed
on the top ofeach 50 pounds offlour after it was spread out in
the mixer. Flour and premix were blendedfor 1 5 minutes
(Parrish et al. 1980).
It is also possibleto addfortification materialsduringflour
making in a productionmill.Parrish et al. (1980) used a
Sterwin enrichment feederand found no differences
in vitamin
A contentcomparedto the mixing method.
Status and resultsoffield trials:Laboratoryscale.
StabilityofvitaminA: Losses ofvitaminA during storage
offlours(made of wheat and durum) were up to 10%in 6
months at cooling and room temperature(i.e., 3°C and 21—
32°C). Losses in maizeflour and meal were a littlemore: over
20°/a. An average of 15% of the proposedlevelsmightbe
morethan needed under normal conditions.Storage at 40°C
showed losses ofabout 50°/oin all flours. This is confirmedby
other workers; the loss stabilizesprobably after 3 months,
Yellow maizecontainsnatural carotenoidswith provitamin A
activity. Their loss during storagetests was about twice that of
stabilized vitamin A (Parrish et al. 1978, 1980). The bioactivity
of the remainingvitaminA did not changeduring storage(Liu
and Parrish 1979). No losses were reportedduring pneumatic
conveyingor simulatedshipping and handling (Parrish et al.
1980).
INFANTFOODS/FORMULAS
Project title: Newapproach to low-costweaning food
production.
In 1986,the Royal Tropical Institute(KIT)presentedthe
blueprint for a "new approachto low-costweaning food
production" (KIT 1987). This approach wasdeveloped in a
research projecton low-costweaning food productioncarried
out in cooperation with the CHNO in Benin (Altesand Merx
1985). In this approach,emphasisis given to the self-sustainingcharacter and the gradualexpansionpossibilities of
planned activities.Since its introduction,22 productionunits
ingredients.See also chapters 7 and this chapterunder "Infant
have beenimplementedin 13 projects in 12 different countries
in Africa,Asia, and Latin America. Theseprojectshave shown
that a low-investment,labour-intensiveprojectfor manufacturing weaning foods on a semi-industrialscale fromindigenous
raw materials can be successful (Dijkhuizen 1992).
Foods/Formulas:'
Fortificants: Although addition ofmicronutrientsin most
cases wasnot considered, there are no technological con-
straintsfor multiple fortification oftheseweaning foods.
Countries, organizations, andparties involved:
Projects were carried out undertheauspicesofthe Netherlands
Technology:Processand equipment: Cereals and pulses
are cleaned by meansofa mechanical winnower and/or by
hand. If needed, the cereals are washedwith clean water and
dried, Pulses like soybeanmay undergoa special soaking/
steamingtreatmentto inactivate the antitrypsineenzymeand
government(Benin, Burundi, Mozambique, Niger), EC (Sierra
Leone), CaritasNeerlandica (Dominican Republic, Ghana,
Jamaica), NOVIB (Ghana), and WFP(Bangladesh, Kenya,
Malawi, Nepal). Also see Table 8-5.
preventflatulence. Groundnuts are selected manuallyand may
undergo a specialtreatment(dipping in boiling, saltedwater
and drying) to removethe mould infested groundnutsthat
discolourafterthis treatment. The roasting is done in either a
scorcher, electricoven, or rotating drum. After cooling,the
ingredientsare mixed, milled in a hammermill,and packed.
See Figure 8.1 for a flowchart ofthe KT approach in infant
food manufacturing.
Targetgroup: Infantsand pregnantand lactatingwomen.
Vehicles: The infantfood is generallycomposed of 80%
cereals (wheat,rice, maize, sorghum), 10% pulses (soybean,
cowpea,mungbean), and 100/0oilseeds (groundnut,sesame
seed). Vitamins and minerals can be addedfor fortification and
sugar for flavouring. Local ingredientsare used.The result is a
nutritionally improvedformula comparedto any of the single
Table8-5.
Countries and partiesinvolved in infantfood production.
Africa
Benin
Farine Bbé
Burundi
Musalac
Ghana
Vitalmix
Nutrimix
1/100
6/800
1/100
KIT/DGIS
1979—
KIT!DGIS
1985 —
KIT/NOVIB
1987—
1/25—75
KIT/Caritas
1987—
Kenya
U-mix
2/1,000
KIT/WFP
Malawi
Likundi Phala
4/600—800
KIT/WIP
1992 —
1991 —
Mozambique
Niger
Sierra eone
Farina Lactea
1/500—1,000
1/30—100
KIT/DGIS
1993—
Bitamin
KIT/DGIS
Bennimix
1/250—250
KIT/EC
1990—
1989—
Bangladesh
Unknown
Unknown
1/250
1/250
KIT/WfP
Nepal
Prosur
1/30—1 00
KIT/Caritas
Unknown
1/500—1000
KIT/Caritas
Asia
KIT/WFP
1994—
1993—
Latin America
Dom.Republic
Jamaica
Note: KIT= Royal Tropical Institute,DGIS=DutchDirectorate General International,NOVIB
WPF=World Food Programme,EC =European Community.
= Netherlands
1990—
1993—
OrganizationforInternationalDevelopment Cooperation,
Fig. 8-1. Flow chart "KIT approach"infantfood manufacturing.
Current Practices,Research,and Opportunities91
Status and resultsoffieldtrials: Full production.Good
acceptabilityofthe products.
Product: The productis used as a porridge. Boiling with
water for about 15 minutes is necessary to get a smooth porridge. On adding cold water, lumps will beformed sinceit is
children in Mexico.A similar chocolate powder mix fortified
with iron, vitamin A, and iodine has also beenproducedfor
addition to milk and is currentlyunder evaluation in the
Philippines.
Fortificants:
Iron, iodine, and vitamin A as well as other
not an instant product.
micronutrienfs.
Qualityaspects: The producthas a nutritional composition
of400 Kcal/1 00 g, 13°/a protein, and 7°/a fat. The product
quality is excellent.
Fortificationlevel: When 25 g oforange-flavouredpowder
is addedto 200 ml ofwater, it providesmicronutrientsatthe
following levels, vitamin A at 35°/a of RDA, iodine at 35°/aof
RDA, iron at 35°/a of RDA, and vitamin C at 100°/aof RDA. The
exactamounts ofthesemicronutrientscan be readily adapted
tomeet the recommendations of local experts.
Tests have shown that the product is microbiologicallysafe.
Dependingon the typeof packagingmaterialand storage
conditionsthe shelflife of the flouris 2 weeks to morethan 4
months (in polyethyleneand aluminium laminatefoil, respectively).
Marketing/distributionchannels: The infantfoods are
either distributed byfeeding program or by sale on the open
market. In Burundi, e.g., marketing is done bywomen vendors
who earn commissions and are obligedto provide nutrition
education.
Cost and cost effectiveness: An average 100-ton project
has an annual turnover of US$60,000with a required investmentof US$ 60,000. The rate ofreturn is 10—20°Io.The price
is half or less the price of importedweaning foods.
Project/program evaluation: Overthe pastfew years, the
low-costweaning food projects have proven their economic
value. The Musalacprojectwas awardedthe WHO annual prize
in 1989 for the most innovativeprimary health care project.
Observations: The advantageofthis productcomparedto
the importedinstant productsis not only price but also the necessityto cookthe flour to make it consumable. Oftenthe projects are attached to a hospital or health centre. The Musalac
projectis supportedbythe Netherlandsgovernmentto operate
as a training centre for low-costfood production in Africa.
PROCESSEDBEVERAGES
Countries: Mexico (Tanzania and Philippinesare testing new
products) and the US.
Producer: Various companies in the USA. Procter and
GambleCo., Cincinnati,Ohio, USA has beeninvolved in producing fortified beverages for Mexico,the Philippines,and
Tanzania.
Targetgroup: Different parts ofTanzania where several
micronutrientdeficiencies coexist,for the use of children,
women, and the wholefamily.
Technology:Processand equipment: Ready-made
premixesare producedby private companies for use by
beverage manufacturers. Technologies for productionofsuch
premixesare usually notdisclosed.
Status and resultsoffield trials: Currentlyin process of
beingfield-testedin Tanzania.
Product: The powder is near whiteand rapidly dissolvesin
water. The drink is orangecoloured and is palatable.It is made
for addition to water because milk is not widelyused by rural
children in Tanzania.
Qualityaspects: The productcan be storedfor up to a year
withoutsignificantdeterioration.
Observations: It is suggested thatthis productbe offered as
a new approach to reducingmicronutrientdeficiencies in
conjunction,but not in place, of other currentstrategies.
Future requirements/developments: Research into
factors that determinesuccess and reporting on successes in
fortification programsimplemented.
FORTIFICATION OF FOODAID
The inadequacy of both quantity and quality ofthe food
distributed to refugee populations has beenwidelydocumented.A typical refugeeration is composed of only a few
commoditiessuchas cereals, sugar, and oil, If refugees are
unableto supplementtheir rations,theyare proneto a variety
of nutrient deficiencies.
Prolonged refugeefeedingsituations are speciallyprone to
micronutrientdeficiency problems.The developmentof
xerophthalmia,iron deficiency anemia,scurvy, and pellagra
among refugees in camps have beenreported (Toole 1994).
Tanzania.
In somespecificcases, deficiencydiseases have been controlled, at leastintermittently,by supplying appropriatefoodstuffs.
Yet, to help preventand alleviatesuch deficiencies from
occurring, fortification offood aid has been suggested.
The Company has alreadyproducedan iron-fortified,chocolateflavouredmixture for addition to milk for use by iron-deficient
Accordingto the recommendations ofthe International Conference on Nutrition (World Declaration and Plan ofAction for
Vehicles:A fine orange-flavoured powder near whitein colour
that can be made into a fortified drink under field-testingin
92 MicronutrientFortificationof Foods
Nutrition 1992), donor countriesand involved organizations
must ensure that the nutrientcontentof emergencyfood aid for
refugeesand displacedpersons should "meet the nutritional
requirements, if necessarythroughfortification or ultimately
through supplementation"(Para. 40m, p. 30.). Also, "governments, in collaboration withthe international community,
should providesustainable assistanceto giving high priority to
the preventionofmalnutrition,and the outbreak of micronutrientdeficiency diseases" (Para. 37a, p. 26). Suchfortification
should includeiodine; iron;vitaminsA, B, and C; and other
micronutrientsdepending on the local situations and risk of
various deficiencies.
Potential vehicles for micronutrient additionare cereals,oil,
pulses, salt, and, occasionally, sugar. Henry(1995) has
identified the following opportunitiesfor micronutrient additions to refugee foods:
Vehicle
Fortificant
Cereals
B vitamins,iron, calcium, and zinc
Oil
Vitamin A
Sugar
Iron and vitaminA
The possibility of using fortification of bulk food aid commodities to improvethe quality ofrefugeerations is being explored
by some donors. For instance, Canada and the US provide
significantquantitiesof edible oil as food aid for many
countries. Thesesupplies can readilybe fortified with vitaminA
at sourcein the countriesoforigin. Fortification ofprocessed
cereals with vitaminA should be given priority, particularly if
sufficient quantitiesofblended foods are not available. Iron and
B-complex vitaminscan be added to cereal flour.Whole grains
should be provided to displacedpeople or refugeesunder
emergency situations,onlyifcentralized milling is available
and in-country fortification is feasible. In such cases, uniform
mixingofpremixeswith milled commodities should be
ensured.
Where distribution and consumptioncan be more closely
monitored,cereals are the most feasible vehiclesfor food
fortification. In other situations,edible oils are good alternatives. For instance,in the Integrated Child Development
Services (ICDS) feedingprogramin India, fortification of
vegetable oils withvitaminA has been foundto be more cost
effective thanfortification of a corn-soyblend (CSB) (Atwood et
al. 1994). Shipmentlosses were reportedto be 35% for CSB,
but only 15°/afor oil. Also, additionofvitaminA to oil costs
less thanfortifying flourwith vitaminA (OMNI 1994).Thisis
because vitaminA is fat-soluble and is readily dispersed in oil
and the cost ofconvertingitto powderfor additionto flour is
saved.
In other situationsas in Ecuador, however, oil is not consumed
withblended foods at maternaland childhealth centresand,
therefore, vitaminA-fortifiedblended foods should bemade
available. The choice between fortifying vegetableoil or
blended foods withvitaminA would, therefore, depend on the
particularneedsof recipientcountries.
Whenfoodstuffs are provided in nonemergencyfood aid
programs,e.g., food- for-work or supplementaryfeeding
programs,they should be fortified with micronutrients that are
known to be deficient in the populationin question. In Guatemala, a biscuit made from the commodities providedby the
WFP is distributedto 1.3 million primaryschool studentsevery
day. Usingtechnologydevelopedby the Institute of Nutrition in
Central America and Panama (INCAP), thebiscuit isfortified
withvitamin A, some B vitamins,iron, and iodine.In Malawi, a
food fortification plant, has been establishedto produce
fortified maize meal for both refugeeand domesticpopulations.
The WFP reportsdistribution of iodizedsalt, vitaminA-fortified
skim milk,and vitamin-and mineral-fortified cereal-legume
blends in somecountrieswithpopulationsatrisk of these
deficiencies.
Food aid will be requiredon an increasingscale duringthe
1990s both as emergency nutritionintervention and when
indigenousfood supplies are limited.Thereis a definiteneed
for a new blended food, producedspecifically for relief
programsand nutrition rehabilitation centres.In many refugee
feedingsituations,blended foods are included in the rationfor
their micronutrient content. Both WFP and UNHCRhave taken
actionto includeblended foods in thegeneral refugeeration
(WFP/UNHCR1994).
Thereare severaltypes of blendedfoods available, most of
whichhavebeen designed as a supplementto the available
local diet to target the youngchildrenand pregnant womenas
well as refugeesand displacedpeople.The composition of
someexisting/proposedblended foodshas beensummarized
by Beaton (1995). The Milk Marketing Board, UK, has recently
producedan instant blended food (IBF)that has been tested for
acceptability by six NGO5 operatingnutrition programsin
Rohingya,Bangladesh, with reported successful results.This
productrequires no cookingand has good storageand
handling properties.IBF is fortified with vitaminA, iron, and
iodinealong with someother micronutrients. The questionis
whether a universalblend can be designed for use in different
feedingprogramsor whether different blendswill be necessary
for specific applications.
Recently, the CanadianInternational Development Agency
(CIDA)commissioneda study to developspecifications for a
micronutrient premixto be addedin circumstances where
blended foods are intendedfor general distribution.The final
report of the study (Beaton, August1995) has identified three
distinct optionsto fortificationofthegeneraldietofrefugees çrable
8-6):
•
•
Centralized fortification ofthe staple cereals,
Community level fortification of cereals, and
Current Practices, Research,and Opportunities93
Tab'e 8-6. Some possiblefortificationpoints: Advantagesand disadvantages.
Nationalor regionalmilling
and fortification
Likely to bemost efficientand effective
Presents increased handling and shippingcosts.
Theshortened shelflife of milled cereal more
likelyto bea problem.
Milling and/or fortification of milled
communitylevel
Very likelytobe effective. Used soon
enoughthat shelflife notproblematic
Increased difficulty of qualitycontrolcereal at
Grindingandfortificationat
Less likelytobe effective (but likely tobe
household level
better than present blendedfoods).Recognizes
Requires substantialeducation component.
Effectiveness depends upon conscious action
(AFTERDISTRIBUTION OF
WHOLE GRAINCEREAL)
the reality ofthe existingsystem.
by individuals.
manyfacilities.Needequipment and training.
(BEFOREDISTRIBUTION)
Table 8-7. Interim specificationfor a cereal fortification premix for refugees in Africa (applicable to maize-,wheat-, and sorghum-basedrations).
Nutrient
In 1900kcal ration
Suggested source
Proportionactive(°/o)
Amount per kgpremix
VEt A
960 ug°
Encapsulated
retinyl Palmitate
75°/a
0.750g
VEt D
10 ug
Commercial food
0.25°/a
2.343 g
grade source
Coated ascorbic acid
97.5°/a
Commercial food
1°/a
66.08 g
0.088g
VitC
Vit B12
110 mg°
1.5 vga
grade source
Folate
Riboflavin
0.3mg
0.84 mg
Niacin
6.5 mg
Pantothenate
1.7mg
Calcium
—
100°/a
—
100°/a
Nicotinamide form
100°/a
O.176g
0.492 g
3.807 g
—
100°/a
0.996g
570 mg
Calcium carbonate
40°/a
843.6 g
8mg
15 ug
18 mg
NaFeEDTA
13°/a
36g
—
100°/a
Zincsulphate
23°/a
0.0087 g
45.94 g
lodineb
Iron
Selenium
Zinc
Note:This premix is basedon estimated normativenutrient requirements. Itwould beusedat arate of 4.22kg! MTof maize.
aindudesprovisionfor a 25°/aloss during storage(addedlevel is 33°!o over target).
blodinenotincludedonbasisofassurancethatWFPdistributesiodizedsalt; if
uncertain,add potassiumiodate.
Household-level fortification using a multiple-fortified
premix.
All three approaches mentionedin the foregoing would make
use ofthe samefortification premix, but the degree ofdilution
and dispensationwould differ in each case.The report contains
interim specificationfor a cereal fortification premixfor refugees
in Africa (Table 8-7).
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9. IMPLEMENTATION ISSUES AND
RESEARCH NEEDS
and applicationoffortification technologiesstill exists.
In certaincases, the technology still needs to be refined
and/or tested for productstability, absorption, and
consumeracceptabilitybefore it can be appliedon a
large scale. Micronutrientutilization fromthe fortified
foodsalso needs to be carefullyevaluated. Oftenthe
technologythat is alreadydeveloped is not available to
countriesthat need it most.
IMPLEMENTATION ISSUES
Witha few notable exceptions,national programsfor micronutrientfortification of food have notas yet beenimplementedin
developingcountriesorhave notbeenverysuccessful. There
are a number ofconstraintsthatjeopardizethe success of a
fortification program.Identificationofsuch constraints is an
urgent priority:
•
Inadequate awareness among both governmentand
In many countries, the choice of appropriatevehicles
that are widely and consistentlyconsumed by the
populationsat risk is limited, Local dietary habits
industry ofthe extent and severityof micronutrient
deficiencies and, hence, lackof commitmentfor their
elimination;
•
should be taken into account. The identificationofsuch
foods, including condimentsand snackfoods and their
Need for, and role of, food fortification is not clearly
defined;
•
•
•
Limitedchoice of suitablevehicles;
Nonexistentor ineffective monitoring and evaluation
systems;
•
Price differences between fortified and unfortified foods.
This often leadsto lack of demandfor fortified products;
•
•
•
Legislationmandatingfood fortification to add a
measure ofcompulsion not enacted or, where in place,
inadequatelyenforced;
Lackoflogoor seal ofapproval; and
Weakcoordinationand linkage between the health and
industry sectors.
Key issues to be considered are:
•
•
consumptionpatterns,is an urgent priority. Fortified
foodsthat have provento be viable in a controlled
environmentshould be considered in countrieswhere
consumptionlevels of the food vehicleare known.
Barriersto technologytransfer;
Although considerable progress has beenmade in
initiating and streamlining control programsin several
countries,logistic problemsand bottlenecksdo remain.
The challengeis to identify and tackle theseconstraints
systematicallyatthe regional and country level through
•
From a nutritional and economic
pointof view, the
search for suitable micronutrientmultimixes,incorpo-
rated in suitablefood vehicles, should be supported.To
reduce the cost offortification,fortificant productionat a
national orregional level should be explored.
RESEARCHNEEDS
Research needsspecificto each
of the three micronutrientsare
discussed below.
Iodine: In the case of iodine, problemsyet to be resolved
relate mainly to the stability of the addedcompoundunder
differentstorageand cooking conditions.The stability of iodine
compoundsin salt can be significantly improvedby better
refining procedures and packaging. Applicationsfor fortifica-
tion offish sauce, soyasauces, pickledpreserves, salted
preserves, fish curing,meat curing etc., with iodizedsalt
should be investigated.
effective advocacy, coordination,and monitoring.
Research is needed into factors that determinesuccess.
Field research is needed to solvethe problem of low retention
The successes of fortificationprograms in execution
needto be reported, e.g., reporting on successful salt
iodization, vitamin-fortifiedsugar, or iron-fortified cereal
could providevaluable lessonsto be used in planning
strategiesfor the other micronutrientfortification
programs.Similary, reasons for program failuresshould
be identifiedand carefully evaluated.
storage, including in-house iodine losses. Anotherfield that
could be investigatedisthe use ofiodine (or iodizedsalt) in
oral rehydrationsalts.
Research and developmenteffortshave enhanced
to be overcome for fortification ofsuch diets with iron because
effectiveness offortification technology.
the potential vehicles are notcentrally processed and the iron
compoundsreactwithseveral food ingredients.
In spite ofthese
developmentefforts,a large gap betweenknowledge
of iodine, e.g., losses of iodine during handling, transport,and
Iron: Cereals are the major staple foods consumed by many
of the poorerpopulationsof the world. Iron in cereal-based
vegetariandiets is poorly absorbed and, in consequence,
nutritional iron deficiencyis prevalent. Many constraints need
Current Practices, Research,and Opportunities97
The buff-coloured,insoluble iron phosphatecompoundsare
stableunder a variety ofstorageconditions but are poorly
absorbed. Addition of ascorbic acid has proven to be a suitable
wayto improve iron bioavailability.The soluble iron salts like
ferroussulphate arewell absorbed but could easily produce
discolourationthrough reactingwith other food ingredients.
Stabilizers have beenadded alongwith the iron compoundto
retain it in an absorbable form, and the structureof certainiron
compoundshas beenmodified to improveabsorption.
•
date analysis procedures.
•
cheese with iron may be a suitabletechnologyto allowiron
fortification ofother dairy productsandfoods with high fat and
moisture content.
VitaminA: Currently, some experimentalworkhas been
undertakento retard the loss of potencyofvitamin A-fortified
foods on storage. Field research is needed into the problem of
stability of the addedcompoundunder differentstorageand
cooking conditions.
More attentionshould be given to locallyavailablesources of
vitamin A for fortifyingmeals. B-Carotene is a good fortificarit
withverylittletoxicity limitations. When vitamin A-rich fruits
and vegetables are seasonally availableand are in excess,
improvedtechnologiesare required for their preservation for
later use in foods as condiments,flavourants,and colourants.
The refiningofred palm oilwithout significantloss of B-carotene
hasbeena recent breakthrough. Thistechnology needs tobe
adopted by all palm oil refineries.
Overallsome knowledgegaps in food fortification are:
•
Simplesemiquantitativeassay to measure iron and
vitamin A in foods.
•
Simplefeeding and mixingequipmentfor powder
fortification.
Selection and specificationof simple mixing/feeding
equipment(largeand small scale).
•
Developtechnologyto improvevitA/iodine stability and
interaction with iron (e.g., antioxidant).
•
Development of a computermodel to project
bioavailability ofdifferent iron sources.
Research should be focusedon the identificationofa form of
iron thatis adequatelyabsorbed and yet does not alter the
appearance or taste ofthe food vehicleselected. The rapid and
simple stearine microencapsulation methodas used to fortify
for quality assurance and monitoring for:
simple semiquantitiveassay systemand sampling and
Standards
RECOMMENDATIONS
The global controlof micronutrientdeficiencies is a realizable
goal, notwithstanding the magnitude ofthe task and the many
challenges and constraints that remain to be resolved. The
developmentof successful programsfor micronutrientfortification offoodscalls for active collaboration between several sectors:
the sdentificcommunity, nationaland local governments, NGO5,
private industry, media, consumer gmups,and donoragencies.
The scientificcommunity will needto developand provide
workable technologiesthat can be implementedin the developing countries. Nationaland local governmentsmust have the
politicalwill, providethe administrativesupport, and prescribe
the framework within which the solutions can be implemented
and regulated. Private industry needs to be motivated to become
an active partner in this effort recognizingthe economic and
social benefits thatitcould derive. The media should be used to
educate the population on the problemsof micronutrient
malnutritionand onthe importance andsafetyoffortifiedfoods.
The consumershould be educatedregardingthe benefitsand
low cost offortified foodsto create a "demandpull" to which
industry will haveto respond. Internationaland bilateral aid
agencies could provide the link and the coordinationbetween
the differentsectors to implementthe programsand make
them self-supportingand sustainable.
The following recommendations are made with a viewto
identifying and promoting opportunities for food fortification as
an important componentofthe strategiesto eliminatemicronutrientmalnutrition:
•
Typeof iron sources as relatedto compatibility and
bioavailability in differentdiets.
•
Organolepticpropertiesofthe productsmade from
fortifying foods.
Food fortification is a unique example where industry and
trade, working in a largely commercialenviroment,are
•
Stability of vitamin A and iron, under a variety of storage
required
and processing
conditions.
•
Stabilityand interaction between ironand vitamin C in bread.
•
Safety data for some iron sources, e.g., FeEDTA.
Furtherresearch/knowledge in the following areas would
aid program implementation:
•
to participateand play a leading role in a health
interventionendeavour. To have an effective and sustainablefortification program, it is vitalthat the health and
industry sectors work in closecollaborationand explicitly
understandand recognize each other'sviewpoints,
concerns, and interests.
Standardfor fortification (minimum requirement).
98 MicronutrientFortification of Foods
•
The food fortification strategyshould be linked with other
interventionstrategieslike supplementationand nutrition
education.
•
The establishmentand sustenance ofan effective
micronutrientdeliverysystem callsfor a multisectoral
effort that will involverelevantsectors likegovernment,
industry, and consumergroups in planning and implementation.The food industry should be motivatedto
should be enforced for noncomcomply and penalties
•
pliance.
•
A detailed,technical, problem-solvingexercise should
be carried outto confirm thatthe fortification process is
feasibleand does not alter the vehicle in any wayand
that nutrient losses on storage and cookingare within
tolerablelimits. Industry should be involvedin technology development, production,and quality control.
Companies with R&Dfacilities could provide a rich source
oftechnicalexpertise.Internationalexpert groups on
iodine, iron, and vitamin A issues need to take the lead.
•
•
Fortificationprogramsshould be planned to dovetail
into existing food-productionand distribution systems
within a country or region withminimum disruption
and cost. Mechanisms like subsidiesneedto be
identifiedto reducecoststo consumers.Such costsare
marginal for iodine and vitamin Abut become more
significantfor iron.
•
product.
•
ofexternalinput,nothing can succeedwithout
an adequatenucleus of well-trainedpeople.Specialized
training is especiallycalled for in the assessment, fortification,quality control, and monitoring/evaluationproceRegardless
dures.
•
There is a needto coordinatedevelopmentof multiple
fortification programs.Technology is now availableto a
limited extent, and more extensiveand coordinated
research and developmentis needed. Technology
developmentwill haveto be followed up with field trials
and pilot commercial trialsto evaluate the
technoeconomic feasibility and consumeracceptability
ofthe product.There should be a mechanismfortransfer
oftechnologyfrom availablesources to countries!
companies that needthem.
The importanceof socialcommunicationcannotbe overstressed, All availablemedia should be used to educate
the population on the problemsof micronutrientmalnutrition and on the importance and safety of fortified foods.
Consumers should be educated to demand a better
productand be readyto pay a slightly higher price for that
•
As programsget underway, effective monitoring of
process and outcomevariables is critical.Measurement
offood quality and fortificant levels in the foods at
differentlevelsfrom productionto consumptionis an
essential step to ensurethat adequate quantities of the
nutrient are reachingthe population.This must be
combinedwith periodicestimationof clinical and biochemical indicatorsto evaluate the impactofthe intervention. Programs should be envisionedas longtermwith
evaluationas an essential component to identify progress,
problems,and needs.
Intersectoral and internationalmechanisms
of coopera-
tion and coordinationshould be establishedto control
distribution and marketing of fortified foods. In SubSaharan Africa, regional initiativeshave beendeveloped
to iodize salt at the productionsourcesothatall
recipient countrieswill benefit.A similar initiative may be
called for to ensurethatall wheatflour, dryskimmed
milkpowder,salt, and processed foods exportedto the
developingcountriesis fortified withmicronutrientsat a
level thatthe importing country may specify.
Food quality should be regulatedthrough legislation
and effectivelyenforced. In countrieswhere there is no
political will, food adulterationis commonand consumers accept tampering as the norm, it maybe difficult to
enforce legislation.Consumerunions can play an
important role in ensuring thatthe food sector complies
withfood legislation by informing the consumers about
the importance of fortification and lobbying the government and food industry to fortifyfood.
Current Practices, Research,and Opportunities99
APPENDIX 1
heavy-dutypolyethylenebag of 50 kg net and is availableat
US$770/kg FOB Valparaiso (in 1995 prices).
POTASSIUM IODATE PRODUCERSAND QUALITY
SPECIFICATION
PRODUCTION OF POTASSIUM IODATE
Potassium iodate
The major iodineproducersare Japan and Chile. Many
manufacturers produceand supply potassiumiodate, both in
developed and in developingcountries.Some ofthem are:
reaction
of
iodine with potassiumhydroxide. The chemical reaction
equation is: 3 12 + 6 KOH —> Kb3 + 5 KI + 3 H20. The
process involves dissolving iodine in caustic potash solution
and subjectingthe solution to electrolysis, usingsuitable
electrodes. About 80% of Kb3 crystallizesfrom the reaction
mixture, which is separated. One kg ofiodine will yield 1.55
kg of potassiumiodate.The process know-how can be
obtained from the National Research Development Corporation
of India, New Delhi.
INQUIM (Chile)
Helm (Hamburg, Germany)
•
•
•
is producedby the electrochemical
ACF Chemie (Maarssen, The Netherlands)
William BlytheLtd (Lancashire, UK)
MBI Chemicals (Madras, India)
QUALITY SPECIFICATIONSFORPOTASSIUM IODATE
UNICEF's Supply Division based in Copenhagen, Denmark,
has entered into a long-termarrangementwith INQUIM. The
The specifications ofthe "standard" potassiumiodate are listed
in the followingandconformtotheFood Chemical Codex
product is packagedin new fibre drums with a sealed,
(FCC):
QUALITY SPECIFICATIONSFORPOTASSIUM IODATE
1.
2.
3.
4.
5.
6.
Physical appearance
Particles retained on 100 mesh B.S. sieve
Solubility
Reaction
Iodine
Sulphate
7. Heavy
8.
9.
metals (as Pb)
Iron
Bromate, bromide,chloride and chlorate
10. Insolublemafter
11. Loss on dryingat 105°C
12. Assay
13. Packaging
Source: Mannarand Dunn (1995). See p. 76forfullreference.
100 MicronutrientFortification of Foods
-
(Almost) whitecrystallinepowder
Max 5°/a (w/w)
Soluble in 30 partswater
A 5% solution in watershall be neutral to litmus
Max 0.005°/o (w/w)
Max0.02°/a (w/w)
Max2O ppm
Maxloppm
Max0.5°/o (w!w)
Max0.5%(w/w)
Max0.5%(w/w)
99°/opotassiumiodate (dry base)
Plastic bag or paper drums with closed seal (50 kg)
Mm
APPENDIX 2
A. COMMERCIALLYAVAILABLE IRONCOMPOUNDS AND THEIR RELATIVE COSTS
IodvehWe#
O/ iron
content
r
Bioavailabilitya
cost
Relative
Cereal
Salt
Sugar
Infant
food
age
factorb
Human
(milk)
Animal
Freelywatersoluble
5.0
8.3
5.3
5.5
±
±
+
+
+
+
+
+
n/a
—
—
±
+
+
÷
±
—
—
+
±
1
—
n/a
n/a
n/a
n/a
n/a
1
—
n/a
—
—
n/a
n/a
n/a
33
15
17
22
35
34
1
1
—
—
3
2
17.6
±
±
±
+
1
3.0
6.6
±
1
±
3
1
—
2
1
13.6
6.6
2
1
33
35
22
24
1
1
1
1
2
2
2
2
25
28
15
3
3
3
3
3
96
96
98
97
70
62
35
2
13
Ferrous sulphate
20
1
1
Ferrous gluconate
12
1
1
Ferrous lactate
19
18
14
14
1
1
1
1
n/a
Ferric ammonium citrate
Ferrous ammoniumsulphate
Ferric cholinecitrate
Slowly soluble
Driedferroussulphate
Ferric glycerophosphate
Ferric citrate
Ferric sulphate
Ferricsaccharate
Ferric chloride
+
+
±
±
±
—
—
—
—
+
n/a
n/a
n/a
+
3.0
2.8
9.0
8.4
+
+
+
—
—
—
—
—
—
n/a
n/a
n/a
n/a
n/a
n/a
±
±
n/a
±
+
+
+
+
+
+
+
—
—
—
±
3
12.0
10.7
20.0
—
—
—
—
—
2
2.1
±
±
±
±
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
—
Poorly soluble
Ferrous fumarate
Ferrous succinate
Ferrous tartiate
Ferrous citrate
Bever-
±
+
(Almost) insoluble
Ferricpyrophosphate
Ferricorthophosphate
Sodium iron pyrophosphate
Reduced elemental iron:
-by hydrogen (10—45 pm)
-by carbonmonoxide
-carbonyl iron
-by electrolysis (—20 pm)
Ferric oxide
Ferric hydroxide
Ferrous carbonate
2
2
2.1
2
2
2
2
2.1
3
3
3
3
—
—
—
—
—
3
3
4.2
4.8
8.5
—
—
—
—
—
1
1
7.7
+
n/a
+
±
±
2.1
Ironcomplex compounds
Sodium ferric EDTA
1 =good; 2
fair; 3 =poor;n/a = info notavailable.
aRating:
bRelative costfactor forhumans=[ (Bioavailabilityx 100)+ /o iron contentI. Equivalentcoston bioavailabilitybasis = [relative costfactorfor compoundxprice/kg
ofiron compound1.
Wehicles: +=recommended; ±= variable; —=notrecommended; n/a = info notavailable.
Source: Adapted fromINACG (1990). Seep. 23 forfull reference.
Current Practices, Research,and Opportunities 101
B. RELATWE COSTS OF COMMONLY USED IRON SOURCES
Ferrous sulphate, dried
Hydrogen-reduced
Electrolytically reduced
Carbonyl-reduced
Ferric orthophosphate
Sodium iron pyrophosphate
Ferrous fumarate
Source: Bauemfeind and Lachance (1991). Seep.23 forfull reference.
102 MicronutrientFortification of Foods
APPENDIX 3
COMMERCIALLYAVAILABLE VITAMINA AND CAROTENOIDSIN FOOD FORTIFICATION
A. VITAMIN A USED IN FOOD FORTIFICATION.
LIQUID PRODUCTS
Vit. A palmitate
Vit. A palmitate
Vit. A palmitate
Edibleantioxidant;
no oil diluent
Where maximumconcentration is required;with
1.65—1.8
no oil diluent
Noantioxidant;
Where maximumconcentration isrequired;with
1.0
Edibleoil;
1.65—1.8
Recommended for general use;withstabilizers
1.0
Edibleoil diluent;
no antioxidant
Forspecific uses
0.5
Emulsifiers; antioxidants;
Fortification
-palmitate
Vit. Apalmitate
stabilizers
edible antioxidant
TypePIMO/BH)
Vit. Aacetate or
stabilizers
emulsion
preservative
ofcereals, milk products, potatoflakesand
productsthat require specific processing techniques
DRY PRODUCTS
Vit Apalmitatebeadlets,
preservative
Forproductsnot dispersed in cold water wherehigh
resistance to moistureand heat required, e.g.
extrudedfoods
0.25
Gum acacia; carbohydrates;
modifiedfood starch; antioxidants
Water dispersable; fordryproductsto bereconstituted
before use, e.g. sugar
0.25
Gelatin;dextrose; modifiedfood
starch;coconut oil;sorbitol;
sodiumcitrate; antioxidants
Water dispersable; free flowing beadlels to help meet
thestringentflavourneeds ofmilk based products and
Acacia; carbohydrate; modified
starch; aipha-tocopherol;
Water dispersable fine beadlet product forpremixes
0.5
Type500
Vit. A palmitatebeadlets,
phosphate; antioxidant;
Type 250-CWS
Vit A palmitatebeadlets,
Type 250-S
Vit. Apalmitatebeadlets,
Gelatin;carbohydrate; tricalcium
0.25
Type250-T
otherbeverages
preservative
Vit. Apalmitate
Type250-SD
0.25
Acacia; lactose; coconut oil;
preservatives
Forproductuse wherevery fine particle size is desired,
i.e. maize flour, vitamin premixes, drymilk, sugar,
beverage powders
Source: Bauemfeindand Arroyave(1986). See p. 23forfull reference.
Current Practices, Research,and Opportunities103
B. SOME APPLICATIONSOF CAROTENOIDSAS VITAMINA PRECURSORS
30°/o B-carotene liquid
Micronized B-carotene suspension in
suspension
food-grade vegetable oil; pourable at
>24°C; semisolid at 4-16°C; no anti-
oxidants;dissolves readily inwarm oil
24°/o B-carotene
Micronized B-carotene in
semisolid
hydrogenated vegetable oil;
pourableat> 38°C;semisolid at
suspension
Colouringfat and oil products,
margarine,process cheese, frozen
and dried eggyolk, winter butter
and other fat-base products
Micronized B-carotene in food-
liquid suspension
grade vegetable oil; pourable at
>24°C; semisolid at 4-16°C;
2 gofsuspension to480ml
products
dissolve.
warm vegetable oil; stirring to
1
ml = 1 mg B-carotene
Colouring popping oil, heatstressed cookingoils, fat-base
2 gofsuspensionto440ml
products where greater carotene
todissolve.
1 ml = 1 mg B-carotene
stabilizedwithanti-oxidants;
dissolves readily in wamioil
stability is required
3.6°/o B-carotene
6-carotene in orange oil and
Especially designed
liquid emulsion
brominated vegetable oil
orange-flavoured drinks and
fruit juices blends; adjusted for
specific gravity in clear glass
emulsifiedin a hydrolysed protein
base; pourable at 24°C; specific
gravity, oil phase 1.053 ±0.003
(12.5—1 3.6°Brix);stabilized with
1.5 gofsuspensionto 450 ml
Colouringfatand oil products,
margarineand otherfat-base
21-32°C;noantioxidants;dissolves
readilyin warm oil
22°/c B-carotene HS
—
forcolouring
warm vegetable oil;stirring
3 gofemulsionto 108 mIs
water;stirring to disperse.
1
ml = 1 mg B-carotene
or opaque container
antioxidants
gof beadlelsof 96 ml of
warm water;stirring to disperse.
ColloidB-carotene in agelatincarbohydrate matrix; stabilized with
antioxidants;readily dispersible, with
stirring in warm water (54°C) water
Colouringwater-based foods
and beverages for dry products
tobe reconstituted inwarm
1
Dry B-carotene
B-carotene in vegetable oil emulsified
ina gelatin-carbohydrate matrix;
Colouring juice drinks, dry
beverage bases, beverages and
other water-base liquidor dry
4 gofbeadlets of 100 ml of
beadlets 2.4°/o
Dry B-carotene
beadlets 100/0
stabilized with antioxidants; readily
dispersible in water (24°C)
Dry B-carotenepowder
B-carotenein diy powderform;
1°/o CWS
indextrin, acacia carbohydrate;
ascorbate +tocopherol asanti-
= 1 mgB-carotene
1 ml
warm water;stirring to disperse.
1
ml = 1 mgB-carotene
foodsto bereconstituted in water
Colouring dairy products, baked
goods, sauces, icing, puddingsetc
logofpowderto 100 ml of
warm water;stirring to disperse.
1
ml = 1 mg B-carotene
1
gof suspension to 200ml
oxidants; readilydispersible
in water
B-carotene blendwith
vitA (and D)
Micronized B-carotene suspension
in vegetable oil; with dissolved
vitA+D
infood
20°Jo Apo-carotenal
Micronized suspension
liquidsuspension
graded vegetable oil; pourable at
24°C;no addedantioxidants;
semisolidat4-16°C;dissolves
readily in warm oil;
Apo-carotenal solution
2°/o
Apo-carotenal (1.4°/c) +B-carotene
(0.6°/c) dissolvedinafood-grade
modifiedvegetable oil composition;
+B-carotene
Simultaneous colouringand
vitamin Afortificationof
margarine,mellorine,etc.
Colouringfat and oilproducts,
saladdressing, processed cheese
and otherfat-base foods
Colouringprocess cheese, salad
dressings and otherfat-base
foods
Apo-carotenal solution
Apo-carotenal
#73
dissolvedinafood-grade modified
Colouringprocess cheese,salad
dressings and other fat-base
vegetable oil composition; stabilized
foods
to disperse.
1 ml= 1 mgapo-carotenal
5 g ofsolutionto 100ml of
vegetable oil; stirring to dilute
1 ml = 1 mg apo-carotenal
5 g ofsolution to 100 ml of
vegetable oil, stirring to dilute
1 ml = 0.7 mgapo-carotenal
+ 0.3 mg B-carotene
with antioxidant
in a food-
Apo-carotenal solution
Apo-carotenal dissolved
40/s
grade modifiedvegetable oil
composition
warm vegetable oil; stirring
witha-tocopherol
Source: AdaptedfromKlaeuiand Bauemfeind(1981).
104 MicronutrientFortification of Foods
Colouring process cheese, salad
dressings and otherfat-base
foods;dryspice 8breadmixes
5 gof solutionto 200 ml of
vegetable oil, stirring todilute.
1 ml= 1 mgapo-carotenal
APPENDIX 4
COMPOSITION OF SOME FORTIFICATIONPREMIXES PRODUCED BY DIFFERENT MANUFACTURERS
Atochem N-richment-Acerealfortification premixes (fortificationlevel per kg flour).
Thiamine(vit B1)
4.9mg
2.6mg
5.7mg
3.3mg
Riboflavin(vit B2)
4.0 mg
2.2 mg
Niacin
31 mg
46mg
Iron
26mg
2,340 IU
37mg
11 mg
2,340 IU
2,340 IU
Vitamin A
Parched, crushedwheat aspreparedand usedasa dietarystaple inTurkeyand someother countries.
Roche rovifarin 955 fortification premix.
Thiamine(vitamin
B1)
Riboflavin(vitaminB2)
Roche precision premix.
4.45 mg
2.65 mg
Niacin
35.62 mg
Iron
29.28 mg
Vitamin A250 SD
Iron electrolyte
24.00
19.10
Potassium iodide
243.00
Ascorbic acid FR
78.00
22.00
2.78
1.96
Niacinamide
Pyridoxine hydrochloride
Riboflavin, typeS
Thiaminemononitmte
1.73
0.70
Vitamin B12 1°/a SD
Vitamin E 50°/o CWS/F
Vitamin D3 100 SD
Folicacid
69.00
4.80
0.48
D-calcium pantothenate SD
12.54
Biotin
Di-cal phosphate anhydrous
Copper gluconate
Zinc oxide
0.36
0.00
15.70
20.00
Current Practices, Research,and Opportunities 105
APPENDIX 5
ACRONYMS AND ABBREVIATIONS
AACC
AmericanAssociation of Cereal Chemists
AAP
AmericanAcademy of Paediatrics
AAS
Atomic absorptionspectrophotometer
AMA
AmericanMedicalAssociation
ARS
BDN
BHC
BM(G
CAR
CCP
CDNHW
HIC
HNI
HPLC
HaemIron Concentrate
Human Nutrition Institute
Bristol-MyersInternationalGroup
Central African Republic
Critical Control Point
Canadian Departmentof NationalHealthand
IDD
Welfare
INACG
High pressure liquid chromatography
Health Protection Board (CDNHW)
InternationalAgriculturalCentre
InternationalAtomic EnergyAgency
InternationalCouncil for the Control of IDD
Iron Deficiency Anemia
Iodine Deficiency Disorders
InternationalDevelopmentResearch Centre
InternationalLabour Organization
InternationalLife Science Institute
InternationalNutritional AnaemiaConsultative
INCAP
Group
Nutrition Institute of Central America and
AgriculturalResearch Service (USDA)
Bon DenteNutrition, Inc.
Bovine Haemoglobin Concentrate
CESNI
Centre of Studies on Infant Nutrition
CFN
CFOP
Council
of Food and Nutrition (AMA)
HPB
IAC
IAEA
ICCIDD
IDA
IDRC
ILO
1151
ComplexFerric Ortho-Phosphate (microcrystal-
Panama
INTA
Chilean Public HealthInstitute for Infant Foods
CFTRI
line)
Central Food Technological Research Institute
IVACG
CHNO
Centre Horticoleet Nutritionnel de Ouando
IU
CIDA
CMAFP
Canadian InternationalDevelopment Agency
Committee on MedicalAspects of Food Policy
JECFA
CN
Committee on Nutrition (AAP)
Consejo Nacional de Investigaciones
KIT
InternationalVitamin A Consultative Group
InternationalUnit
Joint FAO!WHO ExpertCommittee on Food
Additives
Royal Tropical Institute
MFP
Multi Purpose Food
Cientificas y Tecnicas
Ml
Canadian Paediatric Society
Chilean Public HealthInstitute for Infant Foods
Cooperative Research Service (USDA)
MJNG
MicronutrientInitiative
Mead Johnson Nutritional Group
MicronutrientMalnutrition
CONICET
CPS
CPHIIF
CSRS
CWS
Corn-Soyabean-Milk mixture
ChampionTrust
ColdWater Soluble
DGIS
Dutch Directorate General International
EC
Development Cooperation
European Community
CSM
Cr
EDTA
ENI
ESPGAN
Ethylene-Diamine-Tetraacetic Acid
EthiopianNutrition Institute
Societyfor Pediatric Gastroenterology and
Nutrition
MM
MON
MOHW
MRC
MSG
MSI
NAS
NDC
NGO
Ministry ofHealth
Ministry ofHealthandWelfare
MedicalResearch Council
Monosodium Glutamate (C5H8N04.Na.H2O)
Mineral Safety Index
National Academy ofSciences
US National Dairy Council
NIH
NIN
NNRGP
NOVIB
Nongovernmentalorganization
US National Institutesof Health
National Institute of Nutrition
Nestlé Nutrition Research Grant Programme
NetherlandsOrganizationfor International
FAO
Food and AgricultureOrganization
FCC
Food Chemical Codex
FCR
Foundationfor Chemical Research
NRC
Development Cooperation
US NationalResearch Council
FD
Food Diversification
US Food and Drug Administration
ORS
Oral RehydrationSalt
FDA
PAG
FF
Food Fortification
PAMM
FFWF
Fonds zur Forderung
ProteinAdvisory Group
Programme Against MicronutrientMalnutrition
PATH
Program
FIIRO
FNRCC
Forshung
Federal Institute of Industrial Research, Oshodi
PhilippineNational Riceand Corn Corporation
FNRI
Philippine Food and Nutrition Institute
PPM
FPR
Foundation
GMP
GoodManufacturingPractices
derWissenschaftlichen
for Pediatric Research
106 MicronutrientFortification of Foods
PHC
PHS
QA
QC
for AppropriateTechnology in Health
Primary Health Care
US Public Health Service
Partspermillion
Quality assurance
Quality control
RCL
RDI
RE
SAAEB
SARCDC
Ricegrowers'Co-operative Limited
Recommended Dietary Intake
Retinol Equivalent
South African Atomic Energy Board
Swedish Agencyfor Research Cooperation
with DevelopingCountries
SASA
South AfricanSugarAssociation
SD
Spray Dried
SCFAR
Swedish Council for Forestry and Agricultural
Research
SECYT
TFNC
TOOL
TOM
Argentina Secretaria de Ciencia y Tecnica
Tanzania Food and Nutrition Centre
Transfer ofTechnologyfor Development
Totalquality management
WFP
WHO
WIC
Universidadde Buenos Aires
UnitedNations Development Programme
UnitedNations Children'sFund
UnitedNations University
USAgencyfor InternationalDevelopment
US Departmentof Agriculture
US Pharmacopea
Vitamin Adeficiency
World Food Programme
World HealthOrganization
Women, Infantsand Childrenprogramme
WPC
Wheat-Protein Concentrate
WSD
WT
Whey-SoyaDrink
UBACYT
UNDP
UNICEF
UNU
USAID
USDA
USP
VAD
Welcome Trust
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108 MicronutrientFortification of Foods
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