Food Fortification pdf and also food adulteration

Food fortifications

1. MISSION MALNUTRITION FREE INDIA -2022
National Conference on Mission Mode to address Under-nutrition
19 September 2017
New Delhi
Efficacy and Effectiveness of Food Fortification –
Addressing Micronutrient Deficiencies
Prof (Dr) ChandrakantS Pandav,
President, ICCIDD &
Former Head, Centre for Community Medicine (CCM), AIIMS, New Delhi.
Dr KapilYadav,
Associate Professor, CCM, AIIMS, New Delhi

2. 2
Outline of Presentation
•Micronutrient Deficiencies –“Hidden Hunger”
•Strategy to address Micronutrient deficiencies
•Food Fortification
•Efficacy and Effectiveness
•Iodine
•Iron & Folate
•Vitamin A and D
•Take Home Message

3. 3
Take home message -Food Fortification : A complementary strategy
to tackle micronutrient deficiency (1)
•Hidden hunger a significantburden at global and national level
•Evidence for fortification strong, highly cost-effective strategy
•Nutrition, Health and Education are “meritgoods”
(not dependent upon ability to pay)
•Foodfortification complementary to food
diversification, supplementation & public health measures: access
to health care and WASH

4. 4
•India one of the first countries globally with mandatory fortification
of Vanaspati(1953) & Salt (1962)
•Transition from voluntary to mandatory fortification
•Address “values” of target beneficiary
•Food fortification to be integrated with existing nutrition program
Take home message -Food Fortification : A complementary strategy
to tackle micronutrient deficiency (2)

5. 5
World Hidden Hunger 2014
Two billion individuals globally affected
Alarmingly high burden in India

6. 6
Micronutrient Deficiencies of Public Health Significance in India
Iodine
Iron
Vitamin DVitamin A
Folate

7. 7
Strategy to Address Micronutrient Deficiencies
Dietary Diversification
Supplementation
FoodFortification
Public Health Measures
Access to Health Care
Water, Sanitation, Hygiene (WASH)

8. 8
Adequately Iodised Salt Coverage trends in India (1985–2015)
8
5
49 51
71
78
0
10
20
30
40
50
60
70
80
90
1985 1998 2005 2009 2015
Significant increase in adequately iodised salt coverage at
national level over three decades

9. 9
9
Impact of Success of Salt Iodisation
•Salt Iodisation in India alone has saved -
•4 billion IQ point since 1985
•300 million IQ points every year
•Another 75 million IQ points can be saved annually
if USI is attained
•Estimated to contributes to 1.4% GDP growth by
preventing Brain damage in children
•And all this at cost of only 0.2 Rupees per child per
year, with a cost benefit ratio of 1: 80

10. 10
“Panchsheel” of Partnership to Sustain USI
International, Bilateral,
National Agencies
Government Agencies
National/State
Private Sector
Academics /
Universities
Civil Societies

11. 11
2) Information
1) Health Problem/Issue
3) Institutional
structure for
decision making
4) POLICIES
The World in which Public Health Policies Were/Should be Made
Synthesis & Implementation of Program
Values
CORE VALUES
Ideologies, Ethics
INTERESTS
BELIEFS
Casual Assumptions

12. 12
CORE VALUES (IDEOLOGIES)
Gandhians–Salt as a icon of the freedom struggle
Is IDD a nationwide public health problem?
Do we need compulsory iodisation?
SJM –Globalization & Liberalization
Multinational Vs National
Import of iodine
Price of Iodised salt
INTERESTS –
Common and Iodised Salt manufacturers
PFA Act and its penalties, Loose Vs Packaged
Small Vs Big producers
BELIEFS of People / Casual Assumptions –
Sea salt is impure
Traditionally used to big crystal salt
Iodine not an essential nutrient
Revisiting The Policy Process: The Missing Link -Values
12

13. 13
Iron -Flour Fortification

14. 14
Iron -Rice Fortification29.89
15.29 15.00
27.47
24.18
26.67
0
5
10
15
20
25
30
35
baseline 3.5 months 7 months
Prevalence %
Fe
Control
•Am J ClinNutr; October 2006

15. 15
Iodine and Iron -Double Fortified Salt
•8 studies have shown efficacy of DFS in
reducing anaemia after consumption of
DFS over 8-12 months
•A review of these studies showed that
both anaemia prevalence and
hemoglobinlevels respond to DFS
consumption (review included all
formulations of DFS –ferrous
sulphate, fumarate and pyrrophosphate)
19
15
15
5

16. 16
Folic Acid-Wheat Flour Fortification
Food Fortification –Does it work
NTD before and after fortification

17. 17
Vitamin A and D-Milk fortification
Impact of vitamin D fortified milk supplementation on vitamin D status of healthy school
children aged 10-14 years.
KhadgawatR
1
, MarwahaRK, Garg MK, RamotR, Oberoi AK, SreenivasV, GahlotM, MehanN, MathurP, Gupta N

18. 18
Vitamin A -Fortification of Oils and Fats
Efficacy of vitamin A fortification

19. 19
Cost Effectiveness of Food Fortification
Iodine FortificationIron SupplementationVitA Supplementation Iron Fortification

20. 20

21. All India Institute of Medical Sciences, New Delhi
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