I would be hardhearted. enough to let the sick die if you can tell me how to prevent others from falling sick NIN-DFS

Transcription

1 I would be hardhearted enough to let the sick die if you can tell me how to prevent others from falling sick

2 EVOLUTION OF THE NIN DOUBLE FORTIFIED SALT S. Ranganathan & B. Sesikeran National Institute of Nutrition (ICMR) Ministry of Health & Family Welfare (GOI) Hyderabad

3 OUT COME OF IRON DEFICIENCY Infant/Maternal: Increased mortality and morbidity. Poor reproductive outcome: Still birth, poor fetal growth, prematurity, low birth weight, intra uterine deaths, etc. Immuno Competence activity of WBC. : Reduced phagocytic Children & Adults: Poor work capacity.

4 In India, 75% of infants, 80% of adolescent girls, and 85% of pregnant & lactating women suffer from anemia.

5 IODINE DEFICIENCY Infancy & Childhood Still birth, abortions, Low Adults Hypothyroidism, Goitre, motor coordination, Low Increased apathy, Impaired scholastic performance mental function, Decreased (lowered IQ), Juvenile initiative, Decreased power hypothyroidism, Goitre, of decision making, Retarded physical growth. Reduced work output.

6 Iodine deficiency during pregnancy causes about 6.6 million babies a year to be born mentally impaired in India. TGR is about 26% in the country. IDD continue to be a public health problem not only in Sub-Himalayan region, but also in the peninsula. Calls for immediate action.

7 STRATEGIES TO OVERCOME IRON DEFICIENCY: Promotion of consumption of foods rich in iron? Bioavailability Sensitization/Awareness time consuming Folifer tablets supplement to risk group. Iron Fortified Salt for all.

8 STRATEGIES TO OVERCOME IODINE DEFICIENCY NO SUITABLE FOOD RICH IN IODINE IODIZED SALT

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11 IMPORTANCE OF SALT Salt is universally consumed Constant daily intake. Low potential for excessive intake. Production of salt is limited to few centers. Ideal vehicle for Iodine/Iron fortification. Iodine & Iron introduced through salt will be ingested by each individual at a uniform dosage throughout the year.

12 CHRONOLOGY OF DEVELOPMENT OF SALT FORTIFICATION TECHNOLOGIES AT NIN IRON FORTIFIED SALT (IFS) 1. FePO 4 & NaHSO 4 : AJCN 1975;28: FeSO 4 & OPA: AJCN 1978; 31: Multicentric Efficacy study: Hyderabad, Delhi, Madras, Calcutta. AJCN 1982; 35: (FNB). 4. FeSO 4 & SHMP: Colourless IFS. Food Chemistry 1992; 45: Large-scale production: J Food Sci Technol 1993; 30: Successful Transfer of Technology to TNSC (1991) MT/month. 6. FGS alone: Food Chemistry 1996; 57: Ultra-structural differences of IS, IFS & DFS: SCANNING. Journal of Scanning Microscopies 1998; 20:

13 CHRONOLOGY OF DEVELOPMENT OF SALT FORTIFICATION TECHNOLOGIES AT NIN (Contd..) IODIZED SALT (IS) Stable IS with KI or KIO 3 using CO 3 stabilizer 1. CaCO 3 : Dry mixing. Lab studies: Indian Food Industry 1986; 5: CaCO 3, MgCO 3 : Factory. Long distance transport. Asia Pacific J Clin Nutr 1997; 6: CO 3 of Na: Spray mixing. Factory. Long distance transport. Salt th Salt Symposium, Vol 2, RM Geertman, 2000; , Elsevier. 4. IS stable after 15 months even at high humidity. One more benefit of UIS is DFS

14 DOUBLE FORTIFIED SALT (DFS) DFS is edible common salt to which very small quantities of iodine and iron are added. DFS is iron fortified iodized salt. DFS looks like iodized salt and it is to be used in the same way as iodized salt.

15 COMMON SALT DFS

16 DFS Edible common salt [Mg: <0.1%; Moisture: <1.5%; NaCl: >98.0%] Sodium Hexa Meta Phosphate (SHMP): 1% FeSO 4.7H 2 O: 0.50% (Fe = 1000 ppm) KIO 3 : % (I = 40 ppm) [KI also can be used] Simple method of dry mixing Does not involve elaborate and expensive measures

17 10g/day IRON 1/3 RDA (10 mg) IODINE 100% RDA (150 g) PROPHYLACTIC

18 DFS Lab studies Factory studies Safety evaluation Acceptability studies Impact & Efficacy studies EXCELLENT RESULTS

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20 STABILITY (6 STUDIES) Study Lab Year , 1997 Quantity (MT) Mfr. (sample) Period (Year) Sample tested (n) Iodine ( 15 ppm) (%) Iron (1000 ppm) 0.1 (1 kg) Factory 1984, (50 kg) Tribal (1 kg) School (50 kg) 1 12 Multi centric stability 100 (2) 50 (1) (1 kg) (0.5 kg)

21 IODINE (ppm) IRON (ppm) STABILITY 45 Iodine Iron MONTH

22 ACCEPTABILITY Chappati, Puri, Parotta, Lemon rice, Coconut rice, Dal, Chutney, Potato curry, Mixed vegetables curry, Idli, Dosa, Upma, Pongal, Vada, Pakodi, Bajji, Samosa, Vegetable Salad, Lemon/Orange juices, Butter milk, Fruits slices, Pickles, Sambar, Rasam, Egg omelet, Fish/Prawn, Chicken/Mutton. DFS IS Acceptability Score No difference in colour or appearance or texture or flavour or taste

23 BIOAVAILABILITY ANIMAL STUDY (RAT MODEL, n = 24) Hb (g/dl) GROUP 2 weeks 4 weeks 9 months DFS 11.4 ± ± ± 1.1 CONTROL 6.8 ± ± HUMAN STUDY (n = 8, Rice meal, 55 Fe/ 59 Fe) GROUP Fe Absorption (%) UIE DFS 6.1 ± 1.29 No difference CONTROL 3.9 ± 0.38

24 SAFETY P intake about 30mg/day. No change in bone integrity and histopathology of tissues; no impairment in Ca & P balance in rats fed with DFS for 9 months. No change in Ca & P homeostasis of children who consumed DFS for 2 years. No undesirable effect, allergy or toxicity over 2 years of consumption of DFS in the tribal study and residential school study. 100% compliance in all the studies.

25 IMPACT: Iodine status

26 Prevalence (%) IMPACT: Iron status (anemic children) Anaemia (%) (Rural) Anaemia (%) (Urban) IS:Urban: Before 54%; After 47% 0 Before After

27 DFS: MEAN (95% CI) RISE IN Hb 0.72 (0.43, 1.01) g/dl IN COMPARISON TO IS WELL WITHIN THE RANGE OF GLOBAL EXPERIENCE

28 FACTORY PRODUCTION 0.5 TO 60 MT (1) Hyderabad, AP (2) Chennai, TN (3) Valinokkam, TN (4) Alathur, TN (5) Thirupporur, TN (6) Mithapur, Gujarat (7) Bhubaneswar, Orissa (8) Gandhidham, Gujarat; (9) Tiruchengode, TN

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37 COST (Rs.) OF 1 kg = 1.00 IS DFS

38 AVERAGE COST OF SALT IODIZATION & DOUBLE FORTIFICATION Component Range per kg (Rs.) Salt - - Average cost per kg (Rs.) IS DFS IS DFS Chemicals Processing - - Packing material - - Overheads - - Amortization - - Total: A Profit margin: Factory - - Dealer - - Whole Sale - - Retail - - Total: B - - Transport: C - - Total (A + B + C)

39 With an average consumption of 10g salt per day, additional cost of DFS over IS will be about 1 Paise/head/day

40 Elimination of IDA & IDD through DFS is a worthwhile investment In addition to health benefits, if benefits related to education, increased productivity of the population, human resource development and increased productivity & yield of livestock (egg, milk, wool, etc) are included then, cost benefit ratio is very high.

41 MESSAGE 1. is a low-cost technology. 2. All the ingredients are easily available. 3. Its stability, acceptability, bioavailability, safety, large-scale production in several factories & distribution to remote areas, impact and efficacy have been proved successfully. 4. It is as effective as Iodized Salt in controlling IDD & as effective as Iron Fortified Salt in controlling IDA.

42 APPRAISAL DR. MK BHAN COMMITTEE REPORT, 2006: Approved only of convincing evidences. because Other DFS formulations were lacking scientific evidence.

43 APPRAISAL NIN wrote letters to the Secretaries of Women Development and Child Welfare Department and Department of Health of all the States & UTs in the country (35 each) advocating the introduction of in nutritional programmes of the States & UTs. PFA & BIS Standards

44 WHAT IS NEW? MoU: Free Technology Transfer: No charges. Dossier with Manual for Factory Production. DFS through PDS: Minimum 20% to PDS.

45 CONCLUSION DFS is the result of two decades of untiring efforts of NIN Scientists without compromise on quality. Dr. Bhan Committee, GOI cleared only. Now the benefits should reach the people with no further delay. With the ARMOUR, the country is geared up to combat the double burden of IDA & IDD.

46 THANK YOU