Food Fortification by Dn javeria Dawood J

By dn javeria Dawood

1. Food Fortification By: group#4-HND- 5 th -e Submitted TO: Mam Kanwal Hafeez khan

2. Group Members: 1. Sehar Waseem ` 15011 2. Javeria Dawood 15032 3. Hajra Batool 15034 4. Aqsa Khan 15036 5. Aqsa Shahzadi 15037 6. Maleeha Javaid 15040 7. Hira Anwar 15062

3. Food Fortification-Concept: “A process in which nutrients are added to food at higher level than the original food actually provides.” For Example: Fortification of wheat flour with iron and folic acid . Edible oil and ghee are required to be fortified with vitamin A .

4. Purpose: This is done to address micronutrients deficiencies across populations, countries and region. Fortification of staple foods with essential vitamins and micronutrients is to improve micronutrient deficiencies. To provide certain technological functions in food processing. Reduce nutritional disorders. Fortification for body building. Fortification for medical treatment.

5. Relating Food Fortification with Nutrition Emergency: Nutrition Emergencies includes man created emergencies like wars etc., nature created emergencies like earthquakes,floods,drought etc. as well as some nutrition emergency cases like underweight children, anemic mothers,marasmic babies, vitamin deficiency diseases etc. Concept of food fortification comes important in the above cases, when we have to opt in the specific nutrient for the person, who is deficient with.

6. Importance: A n important nutrition intervention to fight micronutrient deficiencies and to reduce their incidence in low income countries. Fortification can be used : To balance the total nutrient profile of a diet To restore nutrients lost in processing To appeal to consumers looking to supplement their diet.

7. Benefits: Eliminate malnutrition . Provide extra nutrition at affordable costs. To preserve the inherent characteristics of food. The process of fortification is cost effective.

8. Vulnerable groups for food fortification: Vulnerable groups are kids, pregnant women and older people. Children are particularly vulnerable to nutrient deficiencies. Without added vitamins and minerals, many children and teens don’t meet daily nutrient requirements . A dults also avoid vegetables which they needed to fulfill their nutrients requirement . However, many adults are not getting enough nutrients . calcium magnesium dietary fiber Vitamins A, D, E, and C.

9. People with special diets also need to be aware of potential vitamin deficiencies. Vegans, for example,  can benefit from foods fortified with vitamin B-12 . While fortified and enriched foods can certainly add to a healthy diet, they aren’t enough by themselves. You still need to eat a well-rounded, varied diet that is loaded with vegetables and other whole foods . You cannot rely on fortification or enrichment to get all of the nutrients you need.

10. Methods of Food Fortification: i. Commercial and Industrial Fortification: It refers to adding micronutrients and minerals to industrially process . Example Include salt, wheat and maize flours, edible oils and sugars Bio Fortification: A process of breeding crops with higher levels of vitamins, minerals, proteins and fat content . Example: Atlas 66 is a wheat variety which has high protein content and vitamins.

11. iii. Home Fortification: An innovation aimed at improving diet quality of nutritionally vulnerable groups, such as young children .

12. Role of Food Fortification: To increase the intake of particular micronutrients in targeted population. An effective tool for persons with; Poor Quality Diets With compromised micronutrient status due to any disease. Can increases a particular mineral and vitamin composition. Fortification in milk benefits to maternal status and pregnancy outcomes. Fortified beverages having multiple micronutrients are seen to improve anemia.

13. Food Fortification Programs & Implementation: Main goal is to correct inadequate micronutrient intakes , as well as preventing or reducing the severity and prevalence of micronutrient deficiencies.

14. Fortification Programs: In order to design a successful fortification program, gathering of the date is necessary; Biochemical/chemical data on nutritional status. Data on dietary patterns. Detailed information on dietary intake of micronutrients of interest.

15. Types of Fortification Programs: Mass (Universal) Fortification: Foods consumed by the general population are fortified. Most appropriate in developing countries. Targeted Fortification: Specific foods for a specific population are fortified . Targeted groups are those who are most at risk for micronutrient deficiencies . Commonly seen in both developing and developed countries.

16. iii. Marketed or I ndustry driven Fortification: When food manufactures voluntarily fortified selected foods on the market.

17. Basic Steps in Fortification Programs: I. To define the nutritional status and fortification need. II. Selection of adequate micronutrient mix. III. Selection of food vehicle. IV. Acceptability in appearance, taste and shelf life of the fortified food and meals containing it. V. Micronutrients bioavailability from fortified food and meals. VI. Field studies.

18. VII. Implementation of the program. VIII. Impact on health. IX. Monitoring and evaluation of the program.

19. Implementing Fortified Programs: Implementing a fortification program is complicated by the fact that national programs consist of numerous components, such as : Preliminary assessment of nutrient deficiencies . The development of fortification standards and legislation. The acquisition of equipment by industrials. The communication strategies and social marketing activities. The quality assurance and control system. The assessment of the impact of the fortification program on health.

20. Other key elements for successful implementation of food fortification programs include: Presence of a viable food industry. Available channels for food marketing and distribution. A health care system to identify and monitor micronutrient malnutrition . Institution for education Treatment and evaluation of the impact of the program Continuous and effective input into the planning, implementation, monitoring and evaluation of the intervention

21. Pakistan National Survey 2011 Data collection began in January 2011 and was completed on 30 June 2011. The target population included: Women of reproductive age (15-49 years ) Children (6-59 months) Elderly persons (>50 years )

22. 36.5% mentioned that green leafy vegetables contained iron while 20 % mentioned meat . Mothers were having poor knowledge about zinc deficiency problems. 73% of mothers did not even know about zinc sources. 7% mentioned meat and meat products while 2.3% mentioned watermelon seeds as a source of zinc . (58%) in Pakistan did not know which food contain vitamin A vitamin D deficiency among children at national level was 40 %.

23. NNS 2011, Vitamin A deficiency was assessed among children, the data showed that: 54% of children in Pakistan were vitamin A deficient. 20.9% were severely deficient . 33.1 % were moderately deficient.

24. Assessment of Food Fortification: The fortification rapid assessment guidelines are designed to help them examine food consumption patterns in order to, • First , decide whether fortification could be considered as a viable public health intervention. • Second , to identify potential food vehicles .

25. Fortification Assessment Coverage Toolkit S u rvey in Pakistan The 2017 Pakistan Fortification Assessment Coverage Toolkit (FACT) survey is a cross-sectional survey, comprised of a provincially-representative household assessment in three provinces (Balochistan, Punjab, and Sindh) and a market assessment in four provinces (Balochistan, Punjab, Sindh, and Khyber Pakhtunkhwa). The aim of the survey was to provide data on household coverage and consumption of fortifiable and fortified foods among children (less than five years of age) women (18-49 years of age)

26. This survey provided evidence that fortification of salt and oil/ghee could have a large impact on the intakes of iodine and vitamin A among young children and women of reproductive age. For wheat flour, the potential for impact from large scale fortification is more limited considering its much lower coverage in a fortifiable form. Additional analysis into the feasibility of the wheat flour fortification programme is needed .

27. Cost Effectiveness: It is defined as the cost of achieving a specified outcome . In the case of food fortification, example of the desired outcome might include: averting one case of sub clinical vitamin A deficiency. The method which benefits the product at lower cost. Cost effectiveness and cost-benefit analyses have shown that : Both iodine and iron fortification have the potential to achieve high cost benefit ratios. Food fortification with vitamin A is highly cost effective in reducing mortality in children, as is supplementation with iron in pregnant women.

28. Monitoring & Evaluation: Monitoring refers to the continuous collection, review and use of information on programme implementation activities. Purpose of monitoring is To ensure that the fortified product is made available and is accessible to Consumers. Evaluation refers to the assessment of effectiveness and the impact of a program on the target population . Purpose of evaluation is providing evidence that the program is needed reaching its nutritional goals.

29. a- Categories of Monitoring: Regulatory Monitoring: It compromises of three parts: i-a) Internal Monitoring: Refers to the quality control and quality assurance (QC/QA) practices, conducted by producers, imported and Packers. i-b) External Monitoring: Refers to the inspection and auditing activities carried out at production and importation sites.

30. i-c) Commercial Monitoring: Similar to external Monitoring. Purpose is to verify that the fortified products comply with standard . Main purpose is t o ensure that the fortified Foods meat nutrient quality and safety standards throughout their shelf-life from factory to retail stores.

31. i i- Household Monitoring: It refers to that the fortified food established through regulatory monitoring also reaches with a similar quality to the household or individuals . Purpose is to access Provision Utilization Coverage

32. b- Categories of Evaluation: i- Impact Evaluation: The main purpose of evaluating any intervention is to determine whether or not it is reaching its overall goal. The results of impact evaluations are nevertheless important decision-making tools providing assurance to important questions .

33. Impact Evaluation Design: A number of different ways are there in which the evaluation of the impact of food fortification program can be tackled . Adequacy Evaluation: To assess whether the intake of specific micro nutrients is acceptable . Plausibility evaluation: To be able to state that it is plausible that food fortification was the cause of changes in nutritional status. Probability evaluation To determine with a level of probability that was established before the evaluation that observed changes in nutritional Status are due to Fortification.

34. Purpose of Impact Evaluation: To assess impact on outcomes of interest such as • Consumption of fortified food • Intake of specific nutrients • Nutritional Status (i.e. biochemical indicators) • Health • Other functional outcomes(e.g. growth , cognition)

35. References: www.who.int Allen C, et al. (2006) Nutrition international articles www.nutritionintl.com www.healthline.com www.karger.com Onlinelibrary.wiley.com gain.health.org Guidelines on food fortification with micronutrients Richard Hurrell ,  World Health Organization