Current Status of Rice Fortification International Rice Congress 2014 31 st October 2014, Bangkok Karen Codling Executive Officer, Asia Secretariat Food Fortification Initiative (FFI) Karen.codling@ffinetwork.org
GLOBAL EXPEREINCE WITH FOOD FORTIFICATION
80 countries have mandatory wheat flour fortification
Folic acid fortification of wheat and maize flour reduces neural tube defects Neural Tube Defects (per 10,000): Pre and Post Fortification with Folic Acid 50 Prefortification NTD per 10,000 Postfortification NTD per 10,000 40 30 20 10 0 Brazil, Canada, Chile, Costa Rica, Iran, Jordan, Peru, Saudi Arabia, South Africa, USA Adapted from FFI 2013. Folic acid in flour ranged from 1.2-2.2 mg/kg.
Globally, three out of four households consume adequately iodised salt World Least developed countries Sub Saharan Africa Universal salt iodisa.on target 90% South Asia East Asia and Pacific 0 20 40 60 80 100 Ref: UNICEF State of the World s Children 2014
Ref: ICCIDD Global Network No of iodine deficient countries has been reduced from 110 in 2003 to 31 today
Selection of food vehicles for food fortification Consumed by a large proporgon of the populagon Consumed on a regular basis Suitable Vehicle May include cereals (wheat, corn, rice), oils, dairy products, beverages and condiments such as salt, sauces (e.g. soy sauce) and sugar Centrally processed Premix can be added easily and cheaply Ref: Adapted from WHO, 2006
Lessons Learned on Flour and Salt Fortification! Industry consolida.on is a key driver of success! Na.onal partnership and long- term industry and government commitment underpin successful programs! Mandatory legisla.on, based on evidence- based standards, yields best results but needs to be accompanied by adequate regulatory monitoring! Communica.on is important but cannot replace regulatory monitoring in the context of mandatory legisla.on
CURRENT STATUS OF RICE FORTIFICATION
Fortified Rice Delivery Options Mandatory rice forgficagon! Required by na.onal legisla.on and enforced; all rice is for.fied thus no issue of choice; price passed onto consumer; high poten.al for public health impact Voluntary rice forgficagon! Choice of producers; both for.fied and for.fied available and consumers must choose; price passed onto consumers; low poten.al for public health impact Social safety net rice forgficagon! Rice distributed through social safety nets (eg. school feeding, rice distributed to the poor) is for.fied on policy basis, cost bourne by safety net implementer; high poten.al for public health benefit
Current Status of Mandatory Rice Fortification Country Legislat- ion year Costa Rica 2001 Nicaragua 2009 Panama 2009 Papua New Guinea 2007 Philippines 2001 Rice Source, ForGfied Kernel Source & Milling Industry 40% imported; 2 domes.c for.fied kernel producers; 11 mills 80% rice domes.cally grown; 40+ mills, many small 40% rice imported; ini.al plan for govt to pay for kernels All rice imported; for.fied with imported kernels or in country of origin 13% imported; ~11,000 mills. For.fied kernels imported plus 3 domes.c producers. SSN rice ImplementaGon 100% for.fied Limited implementa.on Not being implemented yet At least 80% for.fied (market share of largest importer) 1-2% total rice for.fied 2006-2013. Currently <1%
Current Status of Voluntary Rice Fortification Country Start Year Brazil 2006 Colombia 2002 Dominican Republic 2011 Rice, Kernel Source & Milling Industry 0 imports; 2 domes.c producers of kernels; mul.ple rice millers 20% rice imported; rice is sprayed with vitamins; <100 millers; ~7 have ~75% market share 3% imported; unknown kernel source; assume mul.ple rice millers ImplementaGon About 1-2% coverage Several brands for.fying; about 50% total rice Unknown South Africa 2011-2014 100% imported rice; imported for.fied kernels; mul.ple large mills 1 brand for.fying about 4% of total rice USA 1998 21% imported; mul.ple large millers About 90% coverage Mandatory in 6 states
Current Status of Social Safety Net Rice Fortification Bangladesh Govt programmes: Vulnerable Group Feeding/ Development WFP school feeding Garment factory rice ra.on for workers Indonesia: RASKIN rice for the poor (pilot) Philippines: Na.onal Food Authority sells lower grade subsidised rice, intended for poor School feeding programme in India
Lessons Learned about Rice Fortification Delivery Options Mandatory rice for.fica.on offers the best opportunity for achieving high coverage and a public health benefit. Voluntary rice for.fica.on has only achieved high coverage in special circumstances. Social safety nets that distribute rice provide an excellent opportunity to reach vulnerable groups with for.fied rice. However considera.ons of feasibility of implementa.on are important for both mandatory and social safety
WORLD HEALTH ORGANISATION GUILDELINES ON RICE FORTIFICATION
F I A T I S PA N Global guidelines/recommendations on food fortification! Global guidelines current available on: Food for.fica.on in general Wheat and maize flour Salt for.fied with iodine Guidelines on food fortification with micronutrients Edited by Lindsay Allen, Bruno de Benoist, Omar Dary and Richard Hurrell Food and Agricultural Organization of the United Nations! WHO guidelines/recommenda.ons on food for.fica.on as a public health strategy (not for marke.ng purposes)...aim to ensure equitable access, esp for vulnerable popula.ons! All publica.ons containing WHO recommenda.ons are approved by the WHO Guidelines Review Commisee. Recommendations on Wheat and Maize Flour Fortification Meeting Report: Interim Consensus Statement PURPOSE This statement is based on scientific reviews prepared for a Flour Fortification Initiative (FFI) technical workshop held in Stone Mountain, GA, USA in 2008 where various organizations actively engaged in the prevention and control of vitamin and mineral deficiencies and various other relevant stakeholders met and discussed specific practical recommendations to guide flour fortification efforts being implemented in various countries by the public, private and civic sector. This joint statement reflects the position of the World Health Organization (WHO), Food and Agriculture Organization of the United Nations (FAO), The United Nations Children s Fund (UNICEF), Global Alliance for Improved Nutrition (GAIN), The Micronutrient Initiative (MI) and FFI. It is intended for a wide audience including food industry, scientists and governments involved in the design and implementation of flour fortification programs as public health interventions. BACKGROUND WHO and FAO published in 2006 the Guidelines on Food Fortification with Micronutrients (WHO/FAO, 2006). These general guidelines, written from a nutrition and public health perspective are a resource for governments and agencies implementing or considering food fortification and a source of information for scientists, technologists and the food industry. Some basic principles for effective fortification programs along with fortificants physical characteristics, selection and use with specific food vehicles are described. Fortification of widely distributed and consumed foods has the potential to improve the nutritional status of a large proportion of the population, and neither requires changes in dietary patterns nor individual decision for compliance. Technological issues to food fortification need to be fully resolved especially with regards to appropriate levels of nutrients, stability of fortificant, nutrient interactions, physical properties and acceptability by consumers (WHO/FAO, 2006). Worldwide, more than 600 million metric tons of wheat and maize flours are milled annually by commercial roller mills and consumed as noodles, breads, pasta, and other flour products by people in many countries. Fortification of industrially processed wheat and maize flour, when appropriately implemented, is an effective, simple, and inexpensive strategy for supplying vitamins and minerals to the diets of large segments of the world s population. It is estimated that the proportion of industrial-scale wheat flour being fortified is 97% in the Americas, 31% in Africa, 44% in Eastern Mediterranean, 21% in South-East Asia, 6% in Europe, and 4% in the Western Pacific regions in 2007 (FFI, 2008). THE FFI SECOND TECHNICAL WORKSHOP ON WHEAT FLOUR FORTIFICATION Nearly 100 leading nutrition, pharmaceutical and cereal scientists and milling experts from the public and private sectors from around the world met on March 30 to April 3, 2008 in Stone Mountain, GA, USA to provide advice for countries considering national wheat and/or maize flour fortification. This Second Technical Workshop on Wheat Flour Fortification: Practical Recommendations for National Application was a follow up to a FFI, the US Centers for Disease Control and Prevention (CDC) and the Mexican Institute of Public Health, first technical workshop entitled Wheat Flour Fortification: Current Knowledge and Practical Applications, held in Cuernavaca, Mexico in December 2004 (FFI, 2004). The purpose of this second workshop was to provide guidance on national fortification of wheat and maize flours, milled in industrial roller mills (i.e. >20 metric tons/day milling capacity), with iron, zinc, folic acid, vitamin B 12 and vitamin A and to develop guidelines on formulations of premix based on common ranges of flour consumption. A secondary aim was to agree on the best practices guidelines for premix manufactures and millers. Expert work groups prepared technical documents reviewing published efficacy and effectiveness studies as well as the form and levels of fortificants currently being added to flour in different countries. The full reviews will be published in a supplement of Food and Nutrition Bulletin in 2009 and the summary recommendations of this meeting can be found in http://www.sph.emory.edu/wheatflour/ atlanta08/ (FFI, 2008). RECOMMENDATIONS FOR WHEAT AND MAIZE FLOUR FORTIFICATION Wheat and maize flour fortification is a preventive food-based approach to improve micronutrient status of populations over time that can be integrated with other interventions in the efforts to reduce vitamin and mineral deficiencies when identified as public health problems. However, fortification of other appropriate food vehicles with the same and/or other nutrients should also be considered when feasible. Wheat and maize flour fortification should be considered when industrially produced flour is regularly consumed by large population groups in a country. Wheat and maize flour fortification programmes could be expected to be most effective in achieving a public health impact if mandated at the national level and can help achieve international public health goals. Decisions about which nutrients to add and the appropriate amounts to add to fortify flour should be based on a series of factors including the nutritional needs and deficiencies of the population; the usual consumption profile of fortifiable flour (i.e. the total estimated amount of flour milled by
Why Develop Guidelines for Rice Fortification?! Vitamin and mineral deficiencies are important public health concerns world wide! Food for.fica.on is and effec.ve and cost- effec.ve interven.on! Rice represents a suitable vehicle for for.fica.on! No systema.c assessment of benefits and harms of rice for.fica.on has been conducted to inform policy making
WHO Evidence-Informed Guideline Development Process
Cochrane Review on Rice Fortification To determine the benefits and harms of rice for.fica.on with vitamins and minerals (iron, vitamin A, zinc, folic acid) on micronutrient status and health- related outcomes WHO rice for.fica.on guidelines expected in 2015