Concerns, myths and misconceptions of rice fortification Helena Pachón Senior Nutrition Scientist Food Fortification Initiative helena.pachon@emory.edu
Is rice fortification safe? EAR RDA / RNI UL EAR: Estimated Average Requirement; RDA: Recommended Dietary Allowance / RNI: Recommended Nutrient Intakes; UL: Tolerable Upper Intake Level Definitions from IOM 2000, p. 3
Is rice fortification safe? 10 8 6 4 2 0 Percent of Non-pregnant Adults (>19 Years) in USA with Folic Acid Intake above Tolerable Upper Intake Level (UL) 2.7 0 0 Overall Mandatory Mandatory + voluntary 5.5 Mandatory + supplements 9.4 Mandatory + voluntary + supplements Mandatory folic-acid fortification of cereal grains (including rice) is safe Only people consuming supplements had intake levels above the UL Yang 2010; It is recommended that pregnant women consume 400 mcg folic acid daily; Mandatory: wheat flour, maize flour, rice; Voluntary: ready-to-eat foods
Is rice fortification safe? Fortification with iron is safe for people with blood disorders Fortification with folic acid does not mask vitamin B12 deficiency cc licence by flickr. Picture by Michael Sean Gallagher. ç Fortification is safe cc licence by flickr. Picture by Alpha Grant 2012; Mills 2003; MPI 2012
Can rice fortification eliminate all micronutrient deficiencies? Percentage of Mexican Women with Iron Deficiency after Six Months of Consuming Fortified Rice or Milled (unfortified) Rice 35 32.7 22.7 26.5 27.5 30 25 20 15 10 5 0 Fortified rice Milled rice Baseline Endline Hotz 2008 Rice fortification will help reduce micronutrient deficiencies Rice fortification will not eliminate micronutrient deficiencies in their totality Population should strive to eat a healthy diet Some population groups will need additional interventions
What is the difference between fortified and bio-fortified rice? Added nutrients When Fortified During industrial processing Bio-fortified During its development via plant breeding or genetic modification (GM) Time frame Now After breeding/gm (years-decades) Which Virtually any can be added Levels Higher Lower Iron 1, zinc 1, beta-carotene 2 (mainly) These are complementary strategies to reduce micronutrient deficiencies Nestel 2006; Ye 2000; 1 Through plant breeding; 2 Through genetic modification: Golden Rice
mg/100 grams rice Why not eat parboiled rice or brown rice instead of fortified rice? 8 7 Milled rice Brown rice Parboiled white rice 6 5 4 3 2 1 0 Iron Zinc Thiamin Niacin Vitamin B6 Brown rice and parboiled rice are more micronutrient-rich than milled rice USDA Nutrient Data Bank; fortified rice as USDA commodity requirements 2014; Vitamin A, folate, vitamin B12 content is negligible in milled, brown or parboiled rice
mg/100 grams rice Why not eat parboiled rice or brown rice instead of fortified rice? 8 7 6 5 4 3 2 1 0 Milled rice Brown rice Parboiled white rice Fortified rice* Iron Zinc Thiamin Niacin Vitamin B6 Fortified rice is more micronutrient-dense than milled rice, brown rice and parboiled rice USDA Nutrient Data Bank; * Fortified rice per USDA (2014) requirements for international food assistance programs; Vitamin A, folate, vitamin B12 content is negligible in milled, brown or parboiled rice; can be significant in fortified rice
Why not eat parboiled rice or brown rice instead of fortified rice? Percent of USA Population Consuming at least 3 Whole Grain Ounce Equivalents per Day Adults (>19 y) 7.7 Children (2-18 y) 2.9 0 10 20 30 40 50 60 70 80 90 100 Despite recommendations, consumption of whole grains is low Reicks 2014
Is fortified rice only needed by lowincome groups? Percent of Non-pregnant Vietnamese Women (15-49 Years) with Iron Deficiency, by Socioeconomic Status (SES) 25 20.7 20 15.1 15 11.9 11.9 11.2 10 5 Laillou 2012 0 1 (lowest SES) 2 3 4 5 (highest SES) Nutrient deficiencies affect all socioeconomic strata All could benefit from fortified rice
Image: dreamstime.com Can any variety of rice be fortified? Any variety of rice can be fortified Requires tailoring of fortified kernel
Is fortified rice acceptable to consumers? Acceptability Scores for Fortified and Non-fortified Rice: Sensory Evaluation by Indian Children 8-11 Years 5 No statistically significant differences between fortified & non-fortified rice 4 3 2 1 0 Appearance Color Texture Odor Taste Overall Fortified rice Non-fortified rice Fortified rice tastes, looks and smells like non-fortified rice Radhika 2011; extruded rice
Are the nutrients in fortified rice retained after preparation and cooking? 120 100 80 60 40 20 0 Percent Retention of Nutrients Exposed to Different Preparation and Cooking Methods: Average for Coating, Cold Extrusion & Hot Extrusion 30 min soaking before boiling in excess water and discarding water Boiling in excess water and discarding water Boiling and letting rice absorb water Washing before boiling and letting rice absorb water Frying before boiling and letting rice absorb water Zinc Iron Vit. A Vit. B12 Folic acid Excess + soaking Excess Boiling Boiling + washing Frying In fortified rice made through coating and extrusion technologies, there is good retention of most nutrients (except Vitamin A) over a wide variety of washing and cooking methods Wieringa 2014
Conclusions (1) Rice fortification is safe Rice fortification will increase nutrient intake but cannot eliminate all micronutrient deficiencies Rice fortification & bio-fortification are different and complementary interventions Fortified rice is designed to be more micronutrientrich than brown, parboiled or milled rice
Conclusions (2) Rice fortification can benefit all strata of society who have nutrient deficiencies (or are at risk) Any variety of rice can be fortified When properly produced, fortified rice tastes, smells and looks the same as non-fortified rice Most nutrients (except Vitamin A) in fortified rice (coating, extrusion) are retained after preparation and cooking
ಧನ ಯವ ದ ধন যব দ धन यव द ຂ ຂອບ ໃຈ ທ ານ Thank you Terima kasih ଧନ ୟବ ଦ ឣរគ ណ ඉස ත ත Salamat Po
References Grant A. Evidence for the safety of fortifying flour with iron in the presence of thalassemia and other blood disorders (presentation). 2012. http://ffinetwork.org/about/calendar/2012/documents%202012/turkeysummary.pdf Hotz C et al. Efficacy of iron-fortified Ultra Rice in improving the iron status of women in Mexico. Food Nutr Bull. 2008;29:140-9. Institute of Medicine. Dietary reference intakes: Applications in dietary assessments. Washington DC, National Academy Press, 2000. [http://www.nap.edu/catalog.php?record_id=9956]. Laillou A et al. Micronutrient deficits are still public health issues among women and young children in Vietnam. PLoS ONE 7(4): e34906. doi:10.1371/journal.pone.0034906 2012. Mills JL et al. Low vitamin B-12 concentrations in patients without anemia: the effect of folic acid fortification of grain. Am J Clin Nutr 2003;77:1474-7. Ministry for Primary Industries (MPI). Voluntary folic acid fortification monitoring and evaluation report. MPI Technical Paper No: 2012/01. MPI: Wellington, MPI, 2012. Nestel P et al. Biofortification of staple food crops. J Nutr 2006:136;1067-7. Radhika MS et al. Micronized ferric pyrophosphate supplied through extruded rice kernels improves body iron stores in children: a double-blind, randomized, placebo-controlled midday meal feeding trial in Indian schoolchildren. Am J Clin Nutr. 2011;94:1202-10. Reicks et al. Total dietary fibre intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009-2010. Nutrition Research 2014. USDA. USDA commodity requirements: MR24 milled rice and fortified milled rice for use in international food assistance programs. USDA, 2014. www.fsa.usda.gov/internet/fsa_file/mr23.pdf USDA Nutrient Data Bank. http://ndb.nal.usda.gov/ndb/search/list Wieringa FT et al. Stability and retention of micronutrients in fortified rice prepared using different cooking methods. Ann NY Acad Sci 204;1-8. Yang Q et al. Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003 2006. Am J Clin Nutr 2010;91:64-72. Ye X et al. Engineering the provitamin A (b-carotene) biosynthetic pathway into (carotenoid-free) rice endosperm. Science 2000;287:303-5.