Why Fortified food is no magic bullet

Synopsis: Fortification of food is not a panacea to India’s problem of malnutrition. Fundamental causes of inadequate dietary intake need to be addressed instead.

Background

– Read this first: Food Fortification in India

Note: Please proceed further only after going through the above article. The points already covered in the above article have not been repeated here.

What are some problems with fortified foods?

The development of these foods has produced at least three undesirable results:

– a further blurring of the distinctions between foods, supplements, and drugs

– a further erosion of the ability of federal regulators to protect the public from harmful substances in foods; and

– most important, a further increase in public confusion about how best to achieve recommended diets

2010 National Institute of Nutrition dietary guidelines that formed the basis for fortification standards for daily intake of iron and vitamins was revised down sharply in 2020, meaning these deficiencies can be met through a normal diet.

What are some issues with iron-fortified foods?

Ideally, iron is best used as a supplement under medical supervision to targeted groups such as pregnant women and children. Iron-fortified food increases the severity of infection in tuberculosis and malaria patients.

Haemoglobin is not formed just by iron, but being a dense molecule, it requires proteins, copper, and magnesium, among others. And it’s not just about the synthesis of haemoglobin.

Even before iron reaches the bone marrow or the liver, absorption is a challenge, and this can only be improved by the consumption of animal or haem proteins (organ meats) or if an iron-rich diet is complemented with vitamin C rich fruits and vegetables, which can aid absorption.

To push iron into the body without this additional dietary support is a futile exercise.

Scale of fortification in India

According to FSSAI, 80 brands of edible oils (accounting for about 70% of the packaged oil market) now comes fortified with vitamin A and D. Likewise, 55 milk brands accounting for close to a third of the packaged milk sales have been fortified so far.

In addition, 12 wheat flour and two rice brands (amounting to 3.4 million tonnes of packaged cereals) are fortified with iron every year. At least 16 states and union territories are also supplying fortified rice via their food safety net program.

What is India consuming?

As per a 2017 study titled What India Eats by the Indian Council of Medical Research and the National Institute of Nutrition,

– Indian households consuming above recommended levels of cereals was a staggering 97% in rural areas and 69% in urban regions. Over 65% of the calories consumed in rural parts came from cereals compared to the recommendation of 45%.

– Increased availability of cheap cereals has reduced hunger, but at the expense of dietary diversity and the replacement of local foods. While not everyone is able to access (or afford) a diverse micronutrient-rich diet, foods that are high in salt, sugars, saturated and trans fats have become cheaper and are more widely available.

– For the elimination of all forms of malnutrition, there is an urgent need to create awareness among households for inculcating healthy dietary practices and improve (the) consumption of locally grown and available protective foods.

Source: This post is based on the article “Why Fortified food is no magic bullet” published in Livemint on 30th Sep 2021.