Nutrition Improvement Program

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Vehicles for Fortification, Single vs. Multiple Fortification, Technology and Cost:

Fortification of Cereals, Rice, Oil and Sugar

Héctor Cori

New Delhi, 7 January 2011.

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Why fortify?

The Micronutrient Initiative, 2004.

*Derives mainly from Vitamin A**Derives mainly from iron nutrition***Derives mainly from iodine sufficiency

Preventing up to four out of ten childhood deaths*

Lowering maternal deaths by more than one third**

Increasing work capacity up to 20%**

Improving population IQ by 10-15 points***

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Why staple food fortification

• affordable

• easy

• effective

• no change of staple food in color or taste.

• no change in dietary habits

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Fortification of Cereal Flours

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Fortification of Sugar

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Fortification of Sugar

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Fortification of Fats and Oils

Dilution

Batch

Co

nt.

Flo

w

8

Shellac Coating Natural kernel Extruded

Rice fortification technologies

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Extrusor

Fortification of Rice

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Where is fortification implemented?

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Food fortification through premixes

Heterogeneous System

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Homogeneous and stable system

Premix quality depends on homogeneity

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Homogeneity depends on equipment

Design and construction that guarantees safety and efficiency

SOPs for operation and cleaning of each one

Preventive maintenance program

Optimal mixing time validation

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Premix Quality depends on Plant Quality

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Plant quality depends on setup quality

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Premix quality also relies on plant hygiene

Avoid external contamination

Avoid cross contamination

Ease cleaning

Adequate humidity and temperature

Clean air

Area separation

Restricted access

Microbiological monitoring

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Premix quality depends on ingredient quality

Physical Form Concentration Dispersibility Esterification Antioxidants Excipients

Oil 100.000 IU/g Non dispersible Acetate BHA/BHT Gelatins

Emulsion 250.000 IU/g Dispersible Palmitate Tocopherol Starches

Powder 325.000 IU/g Emulsion   Others Gums

  500.000 IU/g     No antioxidants Others

  1.000.000 IU/g        

  1.700.000 IU/g        

  2.300.000 IU/g        

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Effectiveness will depend on adequate stable vitamin forms

100%

84.8%

0%

20%

40%

60%

80%

100%

120%

Initial 3 weeks

Initial

3 weeks

Spec

DSM Nutritional Products: Internal trials, 2000-2001.

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Stability will also depend on packaging

Hygienic process

Protection material• Physical• Microbiological• Humidity• Oxygen

Exact weighing

Labeling• Identification• Lot• Best use before date• Others

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Premix quality is preserved through adequate storage

• Separate areas• Temperature and humidity

control• Inventory rotation• Cleaning and plague control• QA approved product entry

only• Correct labeling

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Premix quality is guaranteed through Quality Assurance

Content control

Mixer control

Supplier control

Auto-inspections

Validations• Analytical methods• Mixing times• Homogeneity

Counter samples

Traceability

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Premix quality is proved through documentation

Internal• Manufacturing order• Weight control• RM addition sequence• Equipments used• Operations description• Annotations• Authorizations• Analytical controls

External• Specifications• Certificate of analysis• Others

Composition Sheets Manufacturing principlesSpecifications and TestsProduct Data SheetsStability data Safety Data SheetsResidual solvents GMO statementsBSE statements Order Manual Kosher/Halal certificates

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Premix quality is certified through external referents

ISO norms

GMP

HACCP

Codex Alimentarius

Other international directives

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No compromise on quality

Low quality micronutrients are not only deceiving the customers.

They deceive the most vulnerable, the malnourished.

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Avoid Tunnel Vision Nutrition

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Chances for success are maximized depending on which MNs are used

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Vitamin A fortification of sugar improves serum iron in preschool children (Guatemala)

0

5

10

15

20

25

30

35

40

45

Per

cen

tag

e D

istr

ibu

tio

n

Initial 2 Years

<50 µg/dl50-75 µg/dl>75 µg/dl

Mejía, LA, Arroyave, G, 1982.

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How much do fortificants cost?

Nutrient Cost/RDAVit. A (250 CWS) 3000 IU 0.00079$ Vit. D (100 CWS) 200 IU 0.00011$ Vit. E (50% CWS) 22.35 IU 0.00250$ Thiamin 1.2 mg 0.00004$ Riboflavin 1.3 mg 0.00005$ Pyridoxine 1.3 mg 0.00005$ Niacin 16 mg 0.00026$ Folic Acid 400 µg 0.00008$ Vitamin B12 2.4 µg 0.00010$ Vitamin C 90 mg 0.00257$ Fe (FeSO4 x 1H2O) 8 mg 0.00008$ Total 0.00662$

Male RDA

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Estimated Fortificant Costs to Reach Nutritional Goals Through Food Fortification

1: Includes processing and storage overages. Source: Modified from Omar Dary A2Z- 18 Sept. 2007

Women Nutritional CostEAR Goal per person1

(mg/day) (% EAR) (US$/year)

Calcium Solid-Food 833.333 60 0.584Iron-NaFeEDTA Flour 13.243 80 0.193

Vitamin E Dry Food 6.250 60 0.162Vit. C Beverage 34.615 40 0.142Vit. A Flour or sugar 0.357 80 0.087

Iron-electrolytic Flour 40.524 80 0.045Vit. A Oil 0.357 80 0.031

Vitamin D Dry Food 0.005 80 0.028Vit. B-3 (Niacin) Flour 10.769 40 0.021

Zinc Flour 8.167 80 0.020Vit. B-12 Flour 0.001 80 0.014

Vit. B-9 (Folate) Flour 0.188 80 0.015Vit. B-2 Flour 0.917 60 0.009Vit. B-6 Flour 1.083 40 0.008Vit. B-1 Flour 0.917 40 0.005Iodine Salt 0.107 100 0.002

Micronutrients Vehicle

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Benefit: Or the costs of malnutrition

20982

1441

0

5000

10000

15000

20000

25000

Estimated economic lossto VMD (US$ mio)

Fortification cost (US$mio)

Based on the UNICEF/MI publication: “Vitamin & Mineral Deficiencies: A global damage assessment report, 2004Fortification Cost: 100% coverage at 50% daily requirement of A, B1, B2, PP, B12,I + 100% of FA and Fe

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Effective fortification is affordable,ineffective fortification is expensive.

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Public Health Benefit as a Function of the Quality of the Program

Time

Pub

lic H

ealth

Ben

efit

Minimal Intervention

Optimal Intervention

Thank you.