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ILSI Conference on Micronutrient Fortification of Foods: Science, Application & Management Options to Deliver Fortified Products to the Public 8 January 2011 - New Delhi, India Dr. Manfred Eggersdorfer Senior Vice President Nutrition Science &


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Title: ILSI Conference on Micronutrient Fortification of Foods: Science, Application & Management Options to Deliver Fortified Products to the Public 8 January 2011 - New Delhi, India Dr. Manfred Eggersdorfer Senior Vice President Nutrition Science &

ILSI Conference on Micronutrient Fortification of
Foods Science, Application ManagementOptions
to Deliver Fortified Products to the Public8
January 2011 - New Delhi, IndiaDr. Manfred
Eggersdorfer Senior Vice President Nutrition
Science Advocacy
Options to deliver fortified products to the
public Agenda
  • The Need for Food Fortification
  • Options for Fortification
  • Regulatory and Market Factors
  • DSMs Engagement
  • Summary and Outlook

I. The Need for Food Fortification
Need for fortification Worldwide 2 billion
people are affected by Hidden Hunger
Hidden Hunger Hot Spots
Hidden Hunger is defined as ...
Deficiencies in essential micronutrients
(vitamins minerals) in individuals or
populations which negatively impact on health,
cognition, function, survival, and economic
development SIGHT AND LIFE Expert Panel,
Bangkok 2009
Worldwide, over one third of deaths among
children under 5 years of age is associated with

What is the impact of Hidden Hunger?
Annual lives lost
Annual lives impaired
Micronutrient deficiency is a huge financial
Global impact estimated by Unicef (2004)
  • Micronutrient deficiencies cost globally
  • 180 bio US in the next 10 years
  • in China 2,8 bn US and
  • in India 6,0 bn US.

UNICEF and the Chinese Ministry of Health
announced that Chinas massive drive to reduce
the damage done by vitamin and mineral
deficiency, particularly to children, is paying
rich dividends for Chinas economy. It expects
that efforts to protect its 250 million
inhabitants now suffering from hidden hunger
could boost GDP by 86 billion over the next ten
and is seen as the greatest challenge in the
21st century worldwide
  • More than 60 of healthcare costs and
    disabilities are due to lifestyle
  • related diseases
  • Cardiovascular diseases, diabetes, high
    cholesterol, osteoporosis, overweight are some of
    the key health issues related to nutritional
  • These issues are not alone a topic of the
    industrialized countries like the US, Europe,
    Japan and so on, but also in India, China and all
    over the world

Prevention of chronic diseases and the
compression of the disability period will be the
greatest public health challenge of the 21st
Micronutrients (vitamins and minerals) are
essential for many functions and health
Good Health
Normal Brain Growth
Normal Growth
Vitamins Minerals that are only needed in small
amounts, but are essential for
Healthy aging
Strengthening immune system
Good Performance
Healthy Babies
They cannot be produced by the body and have to
come from the diet
Food fortification is a key approach to achieve
adequate micronutrient intake
  • Codex General Principles for the Addition of
    Essential Nutrients to Foods
  • Fortification / Enrichment
  • Addition of one or more essential nutrients to a
    food whether or not it is normally
  • contained in the food, for the purpose of
    preventing or correcting a
  • demonstrated deficiency of one or more nutrients
    in the population or specific
  • population groups.
  • Any fortification program should be based on a
    demonstrated need for increasing
  • the intake of an essential nutrient in one or
    more population groups, e.g.
  • clinical or subclinical evidence of deficiency,
  • estimates indicating low levels of intake of
    nutrients or
  • possible deficiencies likely to develop because
    of changes taking place in food habits

Probably no other technology available today
offers as large an opportunity to improve lives
and accelerate development at such low cost and
in such a short time (source Enriching
Lives, The World Bank)
Food fortification is powerful and can be
implemented in existing diets
  • Advantages
  • Potentially rapid improvements in micronutrient
    status of population
  • Reasonable cost, especially with existing
    technology and local distribution networks
  • Requires no changes in existing food patterns or
    in individual compliance
  • Requirements
  • Fortified food consumed in adequate amounts by
    target population
  • Fortificants that are stable and well absorbed,
    but do not affect sensory properties of foods
  • Preferably, centrally processed food vehicles
  • Government and food industry partnership

II. Options for Fortification
Three types of food fortification are in place
  • Conventional fortification
  • Staple foods (flour, sugar, milk, oil, rice)
  • Dairy (milk, yoghurt)
  • Spreads (margarine)
  • Condiments (salt)
  • Home fortification
  • Crushable/soluble tablets
  • Powder
  • Spreads
  • Bio-fortification
  • Agricultural products
    (rice, maize, sweet potato,)

Food fortification has a successful track record
an many countries
  • Long history in many countries for successful
    control of deficiencies of vitamins A, D,
  • several B vitamins, iodine and iron.
  • 1923 Mandatory iodization of salt in Switzerland
    and USA now available in most countries.
  • 1933 Mandatory fortification of flour with
    Vitamin B1 in Canada and virtual elimination of
  • 1941 Mandatory fortification of flour with
    Vitamin B3 in the USA and virtual elimination of
  • early 40ies Fortification of cereal products
    with Vitamin B1, B2 and B3 became common practice
    in many countries.
  • 1954 Flour fortified in Chile with B-vitamins
    and iron. Country has now very low prevalence for
  • 1974 Beginning of sugar fortification with
    Vitamin A in Guatemala. Vitamin deficiency
    diminished to one third.
  • 1992 Wheat and maize flour fortification in
    Venezuela. Vitamin A sufficiency in general
    population and important reduction in anemia in
  • 1998 Folic Acid fortification mandated in the
    USA. Now implemented in 60 countries.
  • 2000 Vitamin D fortification of milk and dairy
    products in US and Canada started

NutriRice from staple food to nutritious food
  • NutriRice is made of natural rice with
    micro-encapsulated vitamins
  • in reconstituted rice kernels via extrusion
  • Looks, tastes and cooks exactly like ordinary
  • Fortified kernels deliver the added
    micronutrients to the consumer.
  • Kernels can be customized in shape, color and
    micronutrient composition.
  • Nutrients
  • Vitamin A (Retinyl-palmitate)
  • Vitamin B1 (Thiamine chloride HCl)
  • Vitamin B2 (Riboflavin)
  • Vitamin B12 (Cyanocobalamine)
  • Niacin
  • Iron
  • and others

Inclusion levels can be adapted to nutrient
Efficacy of NutriRice demonstrated in school
children in India
Group 1 MMN fortified rice
Group 2 MMN fortified rice high iron
Group 3 Unfortified rice
6 days/wk Sep-Feb 2009/10 Total of 134 days
300 g cooked rice (100 g dry uncooked
Significant improvements in B-vitamin status,
physical performance, and hemoglobin level among
school children in Bangalore having consumed
fortified rice for 6 months.
Home fortification provides benefit of full
micronutrient basket
  • Since mid-1990s, efforts to add micronutrients to
    foods at household level in particular to
    complementary foods for young children
  • Micronutrient powder concept
  • - Fortification of locally available food
  • - provides essential micronutrients
  • - no change in the color, texture or taste of
    the food
  • Combination of supplementation and fortification
  • Types of products
  • - Soluble or crushable tablets
  • - Micronutrient powder (MixMe)
  • - Micronutrient-rich spreads (NutriButter)

More costly than mass fortification but useful
for improving local foods fed to infants and
young children where fortified complementary
foods are not available
Bio-fortification is an emerging technology
building on GM plants
  • Breeding and genetic modification of plants to
    improve their nutrient content
  • e.g., cereals, legumes, potatoes, maize
  • More science required to prove efficacy and
    effectiveness of bio-fortified foods

Current concerns about safety, cost, acceptability
and impact on environment limit development and
A number of crops are currently investigated for
  • Crop Nutrient
  • Orange sweet potatoes ß-carotene/pro-vitamin A
  • (Golden) Rice ß-carotene/pro-vitamin A,
    iron, zinc
  • Orange Maize ß-carotene/pro-vitamin A
  • Bananas ß-carotene/pro-vitamin A
  • Beans iron
  • Cassava ß-carotene/pro-vitamin A
  • Pearl millet iron
  • Wheat zinc

However due to regulatory and other reasons most
of the developments did not make it to the market
III. Regulatory and Market Factors
Intended reach and target groups define
fortification approach
  • Mass/universal fortification
  • Wide consumption by general population

    often mandatory.
  • Targeted fortification
  • Consumption by specific population

    subgroup, e.g. for children or displaced
    populations mandatory or voluntary

    depending on public health problem
  • Market-driven fortification
  • Food manufacturers voluntarily fortify

    foods always voluntary, but governed

    by regulatory limits.
  • WHO/FAO Guidelines 2006

Choice between mandatory or voluntary
fortification depends on national/regional

Criteria governing the selection of mandatory or
voluntary fortification
  • Six key factors determine whether mandatory or
    voluntary fortification is the most appropriate

Proactive communication and advocacy on role of
fortification is a joint task of policy makers,
regulatory bodies, food industry and nutrition
Costs for fortification are low relative to
achievable benefits
Three market channels offer different dynamics
and solutions
and distribute
FOOD PROCESSORS Manufacture and sell
RETAIL CHANNELS sell to consumers
SCHOOLS buy and distribute
PDS Public Distribution System, in India
Integrated Childhood Development Service (ICDS)
delivered in Anganwadi Centers
IV. DSMs engagement
WFP and DSM partnered to fight malnutrition
Objectives of partnership
  • WFP and DSM Increase Micronutrient in WFP food
  • WFP Advocacy and awareness
  • DSM DSM Pride Engaging employees and their
  • Employee Development
  • Strengthen DSMs Corporate and Brand

DSM brings nutrition competence, WFP global reach
and distribution management into the partnership
Fortified Blended Food (CSB,CSB)
Staple FoodFortification(NutriRice)
DSM is playing a critical strategic role in
enabling WFP to launch the approach at the
global level
Enriching General Food Baskets with
Specially formulated, fortified foods
Micronutrient Powder(Phytase)
Include cereals, pulses, legumes, fortified
blended food, oil, salt
Jointly with IOF we develop a global Vitamin D
deficiency map and actions to overcome issue
In summary DSM is balancing business and social
V. Summary and Outlook

Options to deliver Fortified Products to the
  • Summary and Outlook
  • Faster and more sustainable progress is needed to
    overcome Hidden Hunger and to achieve MDGs by
  • Food Fortification can be the most sustainable
    and cost-effective option to enhance
    micronutrient consumption in a population
  • Technologies for mandatory and voluntary food
    fortification are available
  • A joint approach by policy makers, regulatory
    bodies, nutrition scientists and private
    companies is required

Back up
Conventional fortification has a strong track
  • Long history in industrialized countries for
    successful control of deficiencies of
  • vitamins A and D
  • several B vitamins (thiamine, riboflavin and
  • iodine
  • iron
  • Salt iodization introduced in early 1920s in both
    Switzerland and USA now available in most
  • From early 1940s, fortification of cereal
    products with thiamine, riboflavin and niacin
    became common practice
  • Margarine fortified with vitamin A in Denmark
  • Milk fortified with vitamin D in USA
  • Foods for young children fortified with iron -
    substantially reduced risk of iron-deficiency
    anemia in this age group
  • Folic acid fortification of wheat adopted by
    Canada, USA and Latin America
  • In the less industrialized countries,
    fortification is an increasingly attractive
  • Success of programs to fortify sugar with vitamin
    A in Central America - vitamin A deficiency
    reduced considerably similar initiatives in
    sub-Saharan Africa.

Folic acid fortification of flour is a success
story for many countries
  • Decline in the prevalence of neural tube defects
    (NTDs) following folic acid fortification of
  • South Africa -31
  • USA -26
  • Canada -54
  • Australia -26
  • Saudi Arabia -60
  • Chile -43

In 2009, 51 countries had regulations written for
mandatory wheat flour fortification programs that
included folic acid.
Innovations drive new opportunities in staple
food fortification
Sugar fortification To insure a fortification
level of 50,000 IU/g of vitamin A in sugar a
novel vitamin A palmitate formulation is attached
to the surface of sugar crystals.
  • Rice fortification (NutriRice)
  • With micro-encapsulated vitamins in
    re-constituted rice kernels via extrusion
  • the concentrated vitamin/mineral rice premix
    can be mixed with natural rice grains (1100)
  • good organoleptic properties (shape, taste,
    color) and high vitamin retention during cooking

Efficacy of NutriRice demonstrated at Dandelion
Migrant Worker School, China
  • Fortified food commodities consumed NutriRice
    (B1, B2, FA, niacin, Zn, Fe,
  • BC), NaFeEDTA-fortified soy sauce, VA-fortified
    cooking oil 8 mo feeding
  • Malnutrition rate -50
  • B-vitamin deficiencies ?
  • VAD -51, iron deficiency anemia -82, zinc
    deficiency -58
  • Improved school attention, cognitive academic
    performance and physical strengths including
    aerobic capacity

the only implemented example is Orange Sweet
Potatoes (OSP) in Africa
Daily consumption of 100 g of Orange Sweet
Potatoes can provide 125 ?g of RAE, approx. 50
EAR for a young child
A number of technical and societal pre-requisits
have to be fulfilled for successful
  • Increased micronutrient content of food staples
    through plant breeding (GM and non-GM)
  • Growing bio-fortified plants must be a
    financially attractive for the farmer compared to
    traditional plants
  • Consumption of bio-fortified foods has to result
    in measurable and significant improvement of
    nutritional status
  • Bioavailability of extra micronutrients bred into
    the food staples has to be established
  • Bio-fortified crops have to be culturally and
    sensory acceptable to target population
  • Poor malnourished people have to eat
    bio-fortified foods in sufficient quantities

Both, mandatory and voluntary fortification
require regulatory guidance
  • We see a diversity in national public health
    goals with different approaches to regulation of
    food fortification
  • In most industrialized countries, food
    fortification parameters are established by law
  • At other end of spectrum, fortified foods are
    produced without any form of governmental
    guidance or control at all
  • Generally it is recommended that all forms of
    food fortification is appropriately regulated to
    ensure safety and health benefit to target groups

By providing a higher level of certainty,
mandatory fortification is more likely to deliver
a sustained source of fortified food for the
relevant population group and, in turn, a public
health benefit
Costs for fortification are low relative to
achievable benefit
Copenhagen Consensus 2008
DSMs commitment to CSR honored by WFP and UN
  • UN WFP Executive Director Josette Sheeran
  • We are really pleased that DSM wants to share
    its outstanding expertise to address malnutrition
    with us. You can help increase awareness on the
    issue of global hunger, as will the active
    involvement of DSM employees in the partnership.

Secretary General of the United Nations Ban
Ki-Moon the private sector is among the main
stakeholders on hunger and nutrition. Nearly 1
billion people go hungry every day an
unprecedented number. Business is a partner from
emergency food aid to long-term agriculture, from
our road map for nutrition to our Committee on
World Food Security.
Feike Sijbesma receives 2010 Humanitarian of the
Year Award