Food fortification in five Southeast Asian countries: SMILING project Pattanee Winichagoon, Ph.D On behalf of the SMILING team Presented at the SMILING Symposium 20 th International Congress of Nutrition, Granada, Spain September 16, 2013
Food fortification in SMILING countries A 3d-workshop on Food fortification -- compiled information on food-based strategies, including food fortification: target groups, food vehicles, fortificants existence of specific policy and implementation strengths & weaknesses of policy and programs A 2d advocacy meeting consensus and recommendations on further actions to improve effectiveness of food fortification programs.
Current food fortification All countries: Mandatory iodization of salt; Vietnam temporarily stopped, soon to be resumed Mandatory fortification exists in Indonesia and Thailand Indonesia: iron & zinc fortification of wheat flour, multiple fortified complementary foods, and vitamin A fortification of cooking oil. Thailand: iodization of fish/soy sauce and vitamin A fortification of sweetened condensed milk Voluntary fortification in 4 countries: condiments, staples and complementary foods as a public health strategy All countries: Food-based strategies (malnutrition of all forms) food-based dietary guidelines food security for nutrition nutrition education communication
Lessons learned from country s experiences
Cambodia National Sub-Committee for Food Fortification (NSCFF) oversee all food fortification projects/programs NSCFF in cooperation with RACHA (national NGO) -- implementing a five-year program on Fe-fortified fish/soy sauce To be expanded: piloting Vegetable oil fortified with Vitamin A 5
Food Fortification: Laos Mandatory salt Iodization: Potassium Iodate Minimum acceptable level: 40-60 mg/kg at factory level; >20 mg/kg at household level Regulating body: FDD of MOH Legislation since 1995: Prime Minister s Decree on Universal Salt Iodization Coverage: 79.5%
Planned FF with WFP In LAO PDR 2011-2015 1. Potential food vehicles: - Soybean and peanut oil - Fortified noodle production - Nutri-rice, a grain-like capsule of micronutrients mixed in with normal rice - Lipid based, low-cost ready-to-use food 2. WFP to support the fortification of the products & marketing 3. Social marketing and sensitization on appropriate storage and handling are needed
FF experiences in Indonesia 1. Salt Iodine: Mandated 1994 2. MSG - Vitamin A Voluntary 1980-1990, then discontinued) 3. Wheat Flour -- Fe, Zn, FA, B1, B2: Mandated 2002 4. Vegetable (palm) Oil Vitamin A: in process for mandatory (2013/2014) 5. Rice for the Poor (being planned) 6. Sugar not yet feasible
Scaling up towards mandatory palm oil fortificatin Pilot project - Develop standard QA/QC & Capacity building for Provincial level - Advocacy and social marketing - Voluntary fortification by industry - Develop mandatory FF 3 2012/13 Mandatory Endline data analysis on impact 2010-11 2 1 2008 0 2009 Strengthening research and communication Among parties & advocacy to establish ppp Baseline data: prevalence, effectiveness study
Thailand FF experiences 1. Mandatory fortification of vitamins A & D in sweetened condensed milk 2. Mandatory salt iodization (1994) 3. Mandatory iodization of fish/soy sauce (2010) 4. Voluntary multi-micronutrient fortification: 1. Seasoning powder of instant noodle 2. Quick cooking rice for complementary food
Voluntary food fortification in Thailand Private-public-academic collaborative initiative Product development with instant noodle industry to include vitamin A, iron and iodine in the seasoning mix Reduced tariff for the premix (30% to 2-3%) Product distribution by private companies Nutrition education through government on importance of micronutrients Long latent period for industry to agree to commercialize Market viability i.e., business risk Similar experience with multi-fortified quick cooking rice for complementary food
Lessons learned 1. Public Private Partnerships (PPP) crucial for success and sustainability of FF common social goal continued partnership and building trust 2. Recognizing the differences in shared responsibility and benefits Public sector government provision of fund/investment for public responsibility Private sector business investment and profit returns + social responsibility
3. Technical vs commercial feasibility & market viability: cost, production feasibility consumer acceptability fit in habitual diets 4. Research support Bioavailability selecting fortificant Consumer acceptance and actual uses of FF Product development Shown impacts on nutrition, health and functions
Food Fortification in Vietnam Management and implementation Steering committee (MOH, MOIT, MOARD) Management board (National Institute of Nutrition) Production and distribution Technical regulations and quality control Social marketing Monitoring and evaluation
Voluntary Food fortification in Vietnam No Food Vehicles Micronutrient 1 Edible oil Vitamin A 2 Fish sauce Iron 3 Soya sauce Iron 4 Granules (MNP) Zinc Cost for premix 1.365.000 VND/kg 150.000 VND/kg 150.000 VND/kg 150.000 VND/kg Dose 75 IU/g 2.5 mg/ 10 ml 2.5 mg/ 10 ml 75 mg Gluconate/ kg
Government supports to food producers on FF Contact point for purchasing micronutrients Support 50% total amount of micronutrient in the first year of participation Training, technical support for food fortification Develop logo and application for patents on micronutrient fortified foods Communication, marketing for micronutrient fortified foods for consumers Supports for product registration and monitor micronutrient fortified foods
Summary & Recommendations Food fortification (FF) -- based on Optifood results, FF likely be a choice for all countries: universal or targeted National FF guidelines mandatory vs voluntary National body on FF is crucial for success SC of the National nutrition committee Independent FF committee for all commodities vs individual A functional and active secretariat is essential coordinate the multi-sectoral efforts partnering with academic, non-government & international organizations Food fortification be advocated to the existing ASEAN committee on food security Sharing knowledge & resources e.g., laboratory for quality assurance Capacity building on FF for the ASEAN
Key challenges Scaling up as a national program A functional national food fortification committee to formulate and oversee the program Laboratory capacity & Monitoring system for quality assurance and capacity building in FF Impact/effectiveness evaluation Harmonizing efforts in FF among ASEAN countries beyond SEA/SMILING countries
Thank you