The Telegraph
Sunday , February 5 , 2017

Fortification plan for food

New Delhi, Feb. 4: The Centre has proposed making food fortification mandatory for all staples like rice, wheat flour, edible oil and milk to fight malnutrition but some experts have urged a cautious approach, warning of hidden costs and unproven health benefits.

The Telegraph had reported in January 2016 that Prime Minister Narendra Modi had pushed the idea of universal fortification - addition of key vitamin and minerals to foods to improve their nutritional value and address nutritional gaps in the population - in meetings with top officials of the ministries of agriculture, food and public distribution, commerce, health and women and child development.

Since then, the women and child ministry and the Food Safety and Standards Authority of India (FSSAI) held a series of meetings with experts and have now come up with a draft proposal.

Under the proposal, the government will try to push fortified products to counter disorders like stunting, overweight and anaemia - the major causes of maternal and child deaths. About 70 per cent of pre-school children and over 50 per cent of women suffer from anaemia, caused by iron deficiency, National Survey data show.

According to the proposal, the cost of fortification, to be undertaken in a phased manner, will range from 10 paise to Rs 3 per kg or litre of food, with no additional packaging and transport costs.

In the first phase, the government aims to promote double fortified salt in school midday-meals and in the Integrated Child Development Scheme (ICDS) by December 2018, followed by fortified edible oil and wheat flour by December 2019.

By 2020, the Centre aims to achieve the target of universal availability of fortified food, supplying such items through the public distribution system and the open market.

But some have questioned the Centre's cost estimates. "How much is the increase in the cost (of food) because of fortification? We must include all costs like the cost of procurement, storage, mixing, infrastructure, distribution, labour, quality control, machinery and equipment," said Umesh Kapil, professor of public health nutrition at the All India Institute of Medical Sciences (AIIMS), New Delhi.

According to Kapil, such estimates often include only the cost of micronutrients but not all the other allied expenses. "In fact, there is no cost data available which includes all the above parameters."

The fortification drive comes against the backdrop of government estimates which show that intake of micronutrients in daily diet is far from satisfactory and over 70 percent of the population consumes less than 50 per cent of the recommended dietary nutrients for healthy people.

At present, 86 countries have mandated fortification of at least one industrially milled grain - wheat flour, maize, or rice. In India, fortification of salt with iodine was started in 1962.

Some other steps have been, too. The FSSAI has formulated standards for flour fortification. Food products like wheat and rice are already being fortified in some states like Gujarat, Madhya Pradesh, Maharashtra and Karnataka. Rice fortified with iron is available and is distributed in 1,450 schools in Odisha's Gajapati district. Many commercial entities sell varieties of fortified wheat flour in the market.

But Kapil, the AIIMS professor, and some experts on the Right to Food Act have argued that such interventions should not be undertaken unless there are proven health benefits and pointed out that similar initiatives in some areas in the past have not shown the desired gains.

"We do not have adequate scientific evidence on the health benefits of wheat flour with iron, folic acid, Vitamin B12. Less than 1gm of double fortified salt will be used for ICDS (the child scheme) food. This will provide only 1mg of iron and is unlikely to help prevent or control anaemia. We do not have any evidence, for instance, so far to show the impact of double fortified salt," said Kapil.

The professor also questioned the wisdom of mass fortification when many people did not get two square meals a day. "The poor do not consume fats and oil. Around 28 per cent of the population, which is below the poverty line, is unable to buy enough cereals to meet their calorie needs. Fats and oils are last things be purchased by them because of the high costs."

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