Importance of Food Fortification

Lutang, lampa at lambutin -- These are some of the hurtful words particularly in the pre-millennium, to describe a person (mostly children) suffering from micronutrient deficiency. Most of them were subject to bullying in their childhood due to low self-esteem arising from lack of physical and mental vigor.

Nowadays, we have come so far in terms of fighting the culture of bullying, but still, micronutrient deficiency remains a serious problem because it affects the overall disposition of a person suffering from it. Let us delve into this issue and find ways on how to solve it.

In a world population of 7 billion or so, around 2 billion suffer from micronutrient deficiencies1. This means a considerable fraction of the world population is still not receiving the required daily intake of essential vitamins and minerals despite industrial advances. Therefore, micronutrient deficiency is an urgent concern because it can lead to certain diseases, and multiplied by certain factors. Looking through a bird’s eye view, a weakened nation arising from poor health is threatening the next generation. The most common deficiencies worldwide are those of  Vitamin A, iron, zinc, and iodine2, and these can lead to impaired brain development and growth in children, poor cognitive function, and impaired immunity; poor pregnancy outcomes among pregnant women;  and impaired work capacity.

In the Philippines, iron-deficiency anemia (IDA) is one of the most prevalent micronutrient deficiencies. Around 26% of pregnant and 14% of lactating mothers are anemic, while 8% of adolescents have the same condition3. One out of 10 (14%) children aged six months to five years old also suffer from IDA. These numbers are of mild to moderate public health significance and are certainly alarming, looking at how the future generation is faring in terms of nutrition.

It is especially concerning that anemia and other conditions caused by micronutrient deficiencies are easily preventable with consumption of a well-balanced diet, but sadly, procuring foods that balance the plate is not achievable, especially at the margins due to economic constraints. Thus, food fortification has been hailed as an effective solution because of its dual role: efficient delivery of nutrients, and covers to large segments of the population without radical changes in food habits and patterns. In 2000, the Philippine Food Fortification Law (RA 8976), which requires staple food manufacturers to fortify their products, including rice, with iron, was signed. This ramped up the journey of fortification4.

Fortifying rice with iron is an effective strategy in addressing the high prevalence of anemia in the Philippines. Pinoys eat rice on a daily basis, and this is true across socioeconomic classes. Rice is therefore one ideal vehicle for iron. Other staples that are being used as vehicles for micronutrients are flour (for vitamin A and iron) and edible oil (for vitamin A)4. As to the level of these micronutrients, they are required to supply at least one-third of the RDA or RENI of the target consumer, with the exception of Vitamin C, which is required to be supplied at 100% via juices and flavored drinks.

One needs to be familiar with fortification to fully understand how it has become the preferred tool in the fight against nutritional deficiencies across nations.

Fortification entails a fortificant and the food vehicle. The fortificantis the substance that is added to the food vehicle, which is usually the staple food, in order to fortify it4. In the case of iron-fortified rice, iron is the fortificant and rice is the vehicle. There is more than one approach to fortification: there is mass fortification, which refers to adding micronutrients to staple foods; targeted fortification, which aims to fortify foods that are intended for consumption by a target population or subgroups; and market-driven fortification, in which a food manufacturer initiates fortification of their own product.

Fortification does not mean simply mixing micronutrients and food in a vat. Under food fortification, strategy is king. One strategy is industrial fortification, wherein one or several nutrients are added to the final product. The added nutrients may already be naturally occurring in the food product or not. The other strategy, called biofortification, is more complicated and broad. Biofortification covers agronomic practices, conventional plant breeding, and even modern biotechnology. The aim is to ultimately produce nutrients in raw crops. To further distinguish these strategies, industrial fortification is done during the latter stages of food production, whereas biofortification methods start at the beginning of or even before the crops’ life cycles (such as in genetic engineering).

Enhancing the nutritional profiles of foods confers positive effects on consumers. Improved function of the body can have a secondary effect in families (mothers will give birth to healthier children) and in society in general (improved function can mean less sick days, preventing loss of income). According to the World Bank (1994), “The control of vitamin and mineral deficiencies is one of the most extraordinary development-related scientific advances of recent years. 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”5.

There have been questions regarding the standing of fortification, such as its safety, if it is enough, and its applications. As to its safety, fortification is safe because levels of the added nutrients have been calculated to be appropriate. The estimated consumption of the foods being used as vehicles for the nutrients has also been estimated. Therefore, the nutrient levels do not reach beyond the upper intake levels in humans.

Despite the large number of foods that can be fortified, it has to be acknowledged that fortification will not eliminate all nutritional gaps in diets across population segments. The contribution of fortification, although significant, has to work in tandem with other nutritional efforts, such as conscious efforts of households to consume a variety of foods with the right amount and quality. 

Another misguided notion about food fortification is that it is only important to lower socioeconomic classes. The opposite is true, because both ends of the socioeconomic spectrum are experiencing nutritional deficiencies as founded by the Department of Science and Technology - Food and Nutrition Research Institute (DOST - FNRI). 

The DOST - FNRI has made a lot of headway in terms of fortification and research surrounding fortification. Products, such as ‘Iron Rice Premix’, which is iron-fortified rice; ‘Tubig Talino’, which is iodine-fortified water6; and ‘Micronutrient Growth Mix (MGM)’, a powdered mix that can be added to foods to increase vitamin and mineral intake of children7. At the laboratory scale, FNRI formulates the product so that it meets nutritional recommendations, as well as consumers’ tastes and preferences. Once the product gets into the pilot scale, it undergoes trials to ensure effectiveness and feasibility for the intended market. The last step, called the technology transfer, the product is transferred to interested investors or industries, to be accessible by consumers. Transferring from the laboratory to the investors, and finally the consumer is always coupled by social marketing, which raises public awareness with the of view of realizing behavior transformation.

In the end, healthy food should not be seen as an added expense. They are affordable to procure, and in the long run will save households from future expenses like medical costs incurred during sick days because the body is so weak to fight infections due to nutrient deficiencies. It only takes awareness of FNRI’s efforts on food fortification and innovative product development of nutritious products and the support from other healthcare professionals in the field of nutrition to inform the public that fortification is a gift. Fortification is proof that innovation works in small, seemingly unseen ways but can cause huge improvements across all segments of the Filipino population.