Transcript Options for Delivering Fortified Products to Public Lead

ILSI Conference on Micronutrient Fortification of Foods:
Science, Application & Management
Options to Deliver Fortified Products
to the Public
8 January 2011 - New Delhi, India
Dr. Manfred Eggersdorfer
Senior Vice President Nutrition Science & Advocacy
DSM Nutritional Products
Options to deliver fortified products to the public:
Agenda
I.
The Need for Food Fortification
II.
Options for Fortification
III.
Regulatory and Market Factors
IV. DSM‘s Engagement
V.
Summary and Outlook
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1
I. The Need for Food Fortification
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Need for fortification: Worldwide ~ 2 billion people
are affected by Hidden Hunger
Hidden Hunger Hot Spots
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Hidden Hunger is defined as ...
“ Deficiencies in essential
micronutrients (vitamins &
minerals) in individuals or
populations which negatively
impact on health, cognition,
function, survival, and
economic development “
SIGHT AND LIFE Expert Panel, Bangkok 2009
Worldwide, over one third of deaths among children under 5 years of age is
associated with malnutrition.
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What is the impact of Hidden Hunger?
Annual lives lost
1.1 mio
children <5 years
5
Annual lives impaired
18 mio babies born
mentally impaired
600,000
stillbirths
350,000 children
go blind
150,000 babies
born with neural
tube defects
115,000 women
during pregnancy
Vit. A & Zinc
deficiencies
Iron
deficiency
anemia
Iron
deficiency
anemia
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Maternal
iodine
deficiency
Vit. A
deficiency
Maternal
folate
deficiency
Micronutrient deficiency is a huge
financial burden…
Global impact estimated by Unicef (2004)
Micronutrient deficiencies cost globally
180 bio US$ in the next 10 years:
• in China 2,8 bn US$ and
• in India 6,0 bn US$.
„UNICEF and the Chinese Ministry of Health
announced that China’s massive drive to reduce
the damage done by vitamin and mineral
deficiency, particularly to children, is paying rich
dividends for China’s economy. It expects that
efforts to protect its 250 million inhabitants now
suffering from “hidden hunger” could boost GDP
by $86 billion over the next ten years.”
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… and is seen as the greatest challenge
in the 21st century worldwide
 More than 60 % of healthcare costs and disabilities are due to lifestyle
related diseases
 Cardiovascular diseases, diabetes, high cholesterol, osteoporosis, overweight are some of the key health
issues related to nutritional factors
 These issues are not alone a
topic of the industrialized countries like the US, Europe, Japan and so on, but
also in India, China and all over the world
Prevention of chronic diseases and the compression of the
disability period will be the greatest public health challenge of the
21st century.
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Micronutrients (vitamins and minerals) are
essential for many functions and health
8
Good Health
Normal
Brain Growth
Normal
Growth
Strengthening
immune system
Vitamins & Minerals that are
only needed in small amounts,
but are essential for …
Healthy Babies
Healthy aging
Good
Performance
cannot be produced by the body and have to come from the diet
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Products
Food fortification is a key approach to achieve
adequate micronutrient intake
Codex General Principles for the Addition of Essential Nutrients to Foods
Fortification / Enrichment:
Addition of one or more essential nutrients to a food whether or not it is normally
contained in the food, for the purpose of preventing or correcting a
demonstrated deficiency of one or more nutrients in the population or specific
population groups.
Any fortification program should be based on a demonstrated need for increasing
the intake of an essential nutrient in one or more population groups, e.g.
• clinical or subclinical evidence of deficiency,
• estimates indicating low levels of intake of nutrients or
• possible deficiencies likely to develop because of changes taking place in food
habits
“ Probably no other technology available today offers as large an
opportunity to improve lives and accelerate development at such low cost
and in such a short time ”
(source: Enriching Lives, The World Bank)
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Food fortification is powerful and can be
implemented in existing diets
Advantages
• Potentially rapid improvements in micronutrient
status of population
• Reasonable cost, especially with existing
technology and local distribution networks
• Requires no changes in existing food patterns
or in individual compliance
Requirements
• Fortified food consumed in adequate amounts by
target population
• Fortificants that are stable and well absorbed, but
do not affect sensory properties of foods
• Preferably, centrally processed food vehicles
• Government and food industry partnership
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II. Options for Fortification
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Three types of food fortification are in place
Conventional fortification
•
•
•
•
Staple foods (flour, sugar, milk, oil, rice)
Dairy (milk, yoghurt)
Spreads (margarine)
Condiments (salt)
Home fortification
• Crushable/soluble tablets
• Powder
• Spreads
Bio-fortification
• Agricultural products
(rice, maize, sweet potato,…)
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Food fortification has a successful track record
an many countries
13
Long history in many countries for successful control of deficiencies of vitamins A, D,
several B vitamins, iodine and iron.
1923:
Mandatory iodization of salt in Switzerland and USA; now available in most
countries.
1933:
Mandatory fortification of flour with Vitamin B1 in Canada and virtual
elimination of Beriberi.
1941:
Mandatory fortification of flour with Vitamin B3 in the USA and virtual
elimination of pellagra
early 40ies: Fortification of cereal products with Vitamin B1, B2 and B3 became common
practice in many countries.
1954:
Flour fortified in Chile with B-vitamins and iron. Country has now very low
prevalence for anaemia.
1974:
Beginning of sugar fortification with Vitamin A in Guatemala. Vitamin
deficiency diminished to one third.
1992:
Wheat and maize flour fortification in Venezuela. Vitamin A sufficiency in
general population and important reduction in anemia in children.
1998:
Folic Acid fortification mandated in the USA. Now implemented in 60 countries.
2000:
Vitamin D fortification of milk and dairy products in US and Canada started
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NutriRice® : from staple food to nutritious food
NutriRice® is made of natural rice with micro-encapsulated vitamins
in reconstituted rice kernels via extrusion
• Looks, tastes and cooks exactly like ordinary rice.
• Fortified kernels deliver the added micronutrients to the consumer.
• Kernels can be customized in shape, color and micronutrient composition.
Nutrients
• Vitamin A (Retinyl-palmitate)
• Vitamin B1 (Thiamine chloride HCl)
• Vitamin B2 (Riboflavin)
• Vitamin B12 (Cyanocobalamine)
• Niacin
• Iron
… and others
Inclusion levels: can be adapted to nutrient requirements
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Efficacy of NutriRice demonstrated in
school children in India
Group 1
MMN fortified
rice
~300 g cooked rice
(=100 g dry uncooked rice)
Group 2
MMN fortified rice
high iron
15
Group 3
Unfortified rice
6 days/wk; Sep-Feb 2009/10
Total of 134 days
Significant improvements in B-vitamin status, physical performance, and
hemoglobin level among school children in Bangalore having consumed
fortified rice for 6 months.
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Home fortification provides benefit of full
micronutrient basket
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• Since mid-1990s, efforts to add micronutrients to foods
at household level; in particular to complementary
foods for young children
• Micronutrient powder concept:
- Fortification of locally available food
- provides essential micronutrients
- no change in the color, texture or taste of the food
• Combination of supplementation and fortification
• Types of products:
- Soluble or crushable tablets
- Micronutrient powder (MixMe™)
- Micronutrient-rich spreads (NutriButter™)
More costly than mass fortification but useful for improving local foods fed
to infants and young children where fortified complementary foods are not
available
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Bio-fortification is an emerging technology
building on GM plants
• Breeding and genetic modification of
plants to improve their nutrient content
e.g., cereals, legumes, potatoes, maize
• More science required to prove efficacy
and effectiveness of bio-fortified foods
Current concerns about safety, cost,
acceptability and impact on environment
limit development and penetration
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A number of crops are currently investigated
for bio-fortification
Crop
Nutrient
Orange sweet potatoes
β-carotene/pro-vitamin A
(‘Golden’) Rice
β-carotene/pro-vitamin A, iron, zinc
‘Orange’ Maize
β-carotene/pro-vitamin A
Bananas
β-carotene/pro-vitamin A
Beans
iron
Cassava
β-carotene/pro-vitamin A
Pearl millet
iron
Wheat
zinc
However due to regulatory and other reasons most of
the developments did not make it to the market yet.
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III. Regulatory and Market Factors
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Intended reach and target groups define
fortification approach
• Mass/universal fortification
Wide consumption by general population;
often mandatory.
• Targeted fortification
Consumption by specific population
subgroup, e.g. for children or displaced
populations; mandatory or voluntary
depending on public health problem
• Market-driven fortification
Food manufacturers voluntarily fortify
foods; always voluntary, but governed
by regulatory limits.
WHO/FAO Guidelines 2006
Choice between mandatory or voluntary fortification depends on
national/regional circumstances
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Criteria governing the selection of mandatory or
voluntary fortification
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Six key factors determine whether mandatory or voluntary fortification is the
most appropriate option
Factor
Mandatory
Voluntary
Public health risk
Higher / more affected
Lower / fewer affected
Food industry
Centralized, well organized
Smaller, more diverse
Consumer awareness/
demand
Not necessary
Essential
Political environment
(choice)
Not necessary
Essential
Food consumption patterns
Fortified food widely consumed
Variety and accessibility
essential
Fortification approach
Mass/universal
Market-driven
Proactive communication and advocacy on role of fortification is a joint task
of policy
makers,Products
regulatory bodies, food industry and nutrition scientists
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Costs for fortification are low relative to achievable
benefits
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Three market channels offer different dynamics
and solutions
23
FOOD ASSISTANCE
CHANNEL
(WFP, NGOs, PDS*)
buy and distribute
FOOD
PROCESSORS
RETAIL CHANNELS
Manufacture
and sell
HOUSEHOLDS
sell to consumers
FORTIFIED FOODS
INSTITUTIONAL
CHANNEL
WORKPLACE, HOSPITALS,
SCHOOLS
buy and distribute
PDS: Public Distribution System, in India =
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Integrated Childhood Development Service (ICDS) delivered in Anganwadi Centers
IV. DSM’s engagement
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WFP and DSM partnered to fight malnutrition:
Objectives of partnership
1. WFP and DSM
2. WFP
3. DSM
Increase Micronutrient in WFP food basket
Advocacy and awareness
‘DSM Pride’ – Engaging employees and their families
Employee Development
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Strengthen DSM’s Corporate and Brand Reputation
25
DSM brings nutrition competence, WFP global reach
and distribution management into the partnership
2007
20-25% WFP
DSM
is playing a
FOOD
FORTIFIED to launch
2010-2013
70-100% WFP
Enriching
General
critical
strategic
role in enabling
WFP
FOOD
Baskets* with
theFood
approach
at the global level
FORTIFIED
Micronutrients
* Include
cereals, pulses,
legumes, fortified blended food, oil, salt
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Products
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Jointly with IOF we develop a global Vitamin D
deficiency map and actions to overcome issue
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In summary: DSM is balancing business and
social responsibility
Partnering
Involvement
Nutrition Improvement Program
Business
Recognition
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V. Summary and Outlook
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Options to deliver Fortified Products to the Public
30
Summary and Outlook
• Faster and more sustainable progress is needed to overcome Hidden
Hunger and to achieve MDGs by 2015
• Food Fortification can be the most sustainable and cost-effective option
to enhance micronutrient consumption in a population
• Technologies for mandatory and voluntary food fortification are available
• A joint approach by policy makers, regulatory bodies, nutrition scientists
and private companies is required
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Back up
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Conventional fortification has a
strong track record
32
• Long history in industrialized countries for successful control of deficiencies of
• vitamins A and D
• several B vitamins (thiamine, riboflavin and niacin)
• iodine
• iron
• Salt iodization introduced in early 1920s in both Switzerland and USA; now available in
most countries
• From early 1940s, fortification of cereal products with thiamine, riboflavin and niacin
became common practice
• Margarine fortified with vitamin A in Denmark
• Milk fortified with vitamin D in USA
• Foods for young children fortified with iron - substantially reduced risk of iron-deficiency
anemia in this age group
• Folic acid fortification of wheat adopted by Canada, USA and Latin America
• In the less industrialized countries, fortification is an increasingly attractive option
• Success of programs to fortify sugar with vitamin A in Central America - vitamin A
deficiency reduced considerably; similar initiatives in sub-Saharan Africa.
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Folic acid fortification of flour is a success story
for many countries
33
Decline in the prevalence of neural tube defects (NTDs) following folic acid
fortification of flour
South Africa:
-31%
USA:
-26%
Canada:
-54%
Australia:
-26%
Saudi Arabia:
-60%
Chile:
-43%
In 2009, 51 countries had regulations written for mandatory wheat flour
fortification programs that included folic acid.
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Innovations drive new opportunities in staple
food fortification
34
Sugar fortification
To insure a fortification level of 50,000 IU/g of
vitamin A in sugar a novel vitamin A palmitate
formulation is attached to the surface of sugar
crystals.
Rice fortification (NutriRice)
• With micro-encapsulated vitamins in reconstituted rice kernels via extrusion;
• the concentrated vitamin/mineral „rice premix“
can be mixed with natural rice grains (1:100);
• good organoleptic properties (shape, taste,
color) and high vitamin retention during cooking
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Rice
Efficacy of NutriRice demonstrated at
Dandelion Migrant Worker School, China
Fortified food commodities consumed: NutriRice (B1, B2, FA, niacin, Zn, Fe,
BC), NaFeEDTA-fortified soy sauce, VA-fortified cooking oil: 8 mo feeding
•
•
•
•
Malnutrition rate -50%
B-vitamin deficiencies 
VAD -51%, iron deficiency anemia -82%, zinc deficiency -58%
Improved school attention, cognitive & academic performance and physical
strengths including aerobic capacity
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… the only implemented example is Orange
Sweet Potatoes (OSP) in Africa
Daily consumption of 100 g of Orange Sweet Potatoes can provide 125 g
of RAE, approx. 50% EAR for a young child
http://sacatomato.com/sweet-potato-festival-and-botany-lesson
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A number of technical and societal pre-requisits
have to be fulfilled for successful bio-fortification
37
• Increased micronutrient content of food staples through plant breeding (GM and
non-GM)
• Growing bio-fortified plants must be a financially attractive for the farmer
compared to traditional plants
• Consumption of bio-fortified foods has to result in measurable and significant
improvement of nutritional status
• Bioavailability of extra micronutrients bred into the food staples has to be
established
• Bio-fortified crops have to be culturally and sensory acceptable to target
population
• Poor malnourished people have to eat bio-fortified foods in sufficient quantities
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Both, mandatory and voluntary fortification
require regulatory guidance
38
• We see a diversity in national public health goals with different
approaches to regulation of food fortification
• In most industrialized countries, food fortification parameters are
established by law
• At other end of spectrum, fortified foods are produced without any form
of governmental guidance or control at all
• Generally it is recommended that all forms of food fortification is
appropriately regulated to ensure safety and health benefit to target
groups
By providing a higher level of certainty, mandatory fortification is more
likely to deliver a sustained source of fortified food for the relevant
population group and, in turn, a public health benefit
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Costs for fortification are low relative to
achievable benefit
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Copenhagen Consensus 2008
39
DSM‘s commitment to CSR honored by WFP and UN
40
UN WFP Executive Director Josette Sheeran:
“We are really pleased that DSM wants to share its outstanding expertise to address
malnutrition with us. You can help increase awareness on the issue of global
hunger, as will the active involvement of DSM employees in the partnership.”
Secretary General of the United
Nations Ban Ki-Moon:
“the private sector is among the main stakeholders
on hunger and nutrition. Nearly 1 billion people go
hungry every day – an unprecedented number.
Business is a partner from emergency food aid
to long-term agriculture, from our road map for
nutrition to our Committee on World Food
Security”.
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Feike Sijbesma receives 2010 Humanitarian of the
Year Award