Fortifying food, fortifying health

Well, the term food fortification may sound unheard of, but it exists in our lives since the time you and I were probably born. Food Fortification is a century old practice prevalent in 137 countries. In India, food fortification started in 1953 with addition of Vitamin A & D to Vanaspati ghee, followed by mandatory addition of iodine to the table salt. Food fortification simply means addition of an essential micro-nutrients such as vitamins and minerals into the food to prevent or correct a nutritional deficiency in human population. Fortification commonly uses staples as vehicles to deliver micronutrients to target specific health conditions such as iodine deficiency through the iodisation of salt. Currently in India, milk, edible oil, wheat flour, salt and rice have been fortified with iron, folic acid, iodine, Vitamin A, D & B_12. Milk and edible oil are fortified with Vitamin A & D, wheat flour and rice are fortified with iron, folic acid and vitamin B₁₂ and salt is double fortified with iron and iodine.

Micro-nutrients deficiencies -

The deficiency of micro-nutrients causes low birth weight and high mortality rate in new born baby and in children of growing age, it may cause stunting (low height), wasting (too thin), reduced mental capacity and frequent infections. In pregnant women, it may result in increased perinatal complications and mortality. Elderly may face increased morbidity including osteoporosis and mental impairment owing to micro-nutrients deficiency.

Over 70% of the Indian population consumes less than half the daily recommended dietary allowance (RDA) of micronutrients with deficiencies affecting all population groups in India – urban, rural, rich, poor, old and young – but with women and children most at risk. Iron and vitamin A deficiencies are among the 15 leading causes of the global disease burden. Women in India have the highest prevalence of anemia globally caused by deficiency of iron. Vitamin A deficiency may further contribute to anemia through effects on iron metabolism and increased susceptibility to infection. One of the survey reports shows that overall mean vitamin A intake through food was about 42% of the recommended daily allowances by Indian population. This clearly shows that all age groups in India suffer from vitamin A deficiency. Deficiency of iron in kids below 2 years could lead to irreversible effects on brain development and learnings.

Animal foods are an important source of protein and of micronutrients such as iron, zinc, vitamin A, and vitamin B₁₂. Unfortunately, they do not find place in Indian daily diets, mainly due to food preferences and special diet such as vegan, thus resulting in micronutrients deficiency. Pregnant women with folic acid deficiency are at a risk of having a baby with neural tube defect. Vitamin D deficiency is prevalent among all age groups and can lead to rickets in children and osteoporosis in adults. Iodine deficiency in children may lead to goitre (enlargement of thyroid gland), growth retardation, mental retardation and low IQ in children.

Benefits of fortified foods -

No doubt, micro-nutrients deficiency was root cause of so many diseases, that 100 years back iodine deficiency was first handled through fortification of salt with iodine and now 137 countries are successfully practicing it. As a recent advancement, double fortification of salt has been started by adding iron along with iodine to meet the daily RDA.

If consumed on a regular and frequent basis, fortified foods can maintain body stores of nutrients more efficiently and more effectively than will intermittent supplements. Fortified foods are also better at lowering the risk of the multiple deficiencies, an important advantage to growing children who need a sustained supply of micronutrients for growth and development, and to women of fertile age who need to enter periods of pregnancy and lactation with adequate nutrient stores.

Rice fortification has an advantage to benefit to almost half of the world's population as it is consumed as main staple. Fortification of rice flour with iron, zinc, and folate allows children under 5 years old, having a rapid iron and zinc absorption, to improve their growth and micronutrient status. Food Fortification with key micronutrients like Iron can prevent iron deficiency and help children grow up to live smarter, stronger, and healthier lives.

Women who regularly consume foods fortified with folic acid are less likely to have a baby with a brain or spine birth defect, also called a neural tube defect (NTD). New findings show an estimated 62,670 brain and spine birth defects were prevented in 2019 due to flour being fortified with folic acid and that's an average of 172 healthier babies every day.

Recent study has shown that, in postmenopausal women and elderly, food fortification with calcium and vitamin D substantially improves vitamin D status, provides a greater prevention of secondary hyperparathyroidism and significantly reduces accelerated bone turnover. Vitamin D fortification may also prevent extraskeletal diseases such as respiratory tract infections, asthma exacerbations, pregnancy complications and premature deaths. Taking vitamin D reduces the risk of fractures, improves muscle function, and may even reduce the risk of death from some cancers. A large study with 7,000 patients found that women who take vitamin D during pregnancy have a lower risk of pre‐eclampsia, gestational diabetes, low birth weight and possibly postpartum haemorrhage. One study with almost 100,000 people found that taking vitamin D supplements reduces premature death by a small amount.

COVID-19 and Vitamin D fortified foods -

Recent studies have also established that over 80% of patients hospitalised with COVID-19 are vitamin D deficient compared with the general population. In a small study, a high dose of Vitamin D appeared to reduce the severity of COVID-19. 

Availability of fortified foods –

Until 2016, fortification of staples was done on very small scale mainly in fragmented form, though it had a mass potential to meet the nutritional requirement of the population. With the support and intervention of government, many food brands are now coming up with fortified products. The fortified food products can be easily identified by “+F” logo. Though there are many brands which offer fortified food products, 10 major brands are listed here which are often consumed and their fortified counterparts are also available –

1.TATA Salt plus

2. MOTHERDAIRY “MAA Shakti” Milk

3. FORTUNE refined oil

4. PATANJALI Double fortified salt 

5. DHARA oil

6. DAAWAT Sehat Basmati Rice

7. AASHIRWAAD Atta

8. NESTLE A+ Nourish Milk

9. Golden Harvest Atta

10. ASBAH Silver Basmati Rice

Conclusion -

Thus, it may be concluded that it is a wise thing to add fortified foods in our diet as it is impossible to meet daily recommended allowance of micro nutrients through our diet. Fortified foods are quite important for growing children, women in reproductive age and elderly people. One of the biggest advantages of fortification is that consumers can increase their nutrition without changing their eating, shopping or cooking habits or spending large amount of money. However, caution should be taken to avoid overdose of fortified foods. Too much fortified food should not be added into our diet and it shall be consumed as per the mentioned serving size. Children shall consume 25% of the adult RDA and fortified foods not recommended for children must be avoided. Care should be taken while consuming fortified foods, if health supplements are also being consumed.

 (Image source - www.fssai.gov.in)