Nutrition Improvement Program
Vehicles for Fortification, Single vs. Multiple
Fortification, Technology and Cost:
Fortification of Cereals, Rice, Oil and Sugar
Héctor Cori
New Delhi, 7 January 2011.
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Why fortify?
Preventing up to four out of ten
childhood deaths*
Lowering maternal deaths by
more than one third**
Increasing work capacity up to
20%**
Improving population IQ by 10-15
points***
The Micronutrient Initiative, 2004.
*Derives mainly from Vitamin A
**Derives mainly from iron nutrition
***Derives mainly from iodine sufficiency
2
Why staple food fortification
• affordable
• easy
• effective
• no change of staple food in color or
taste.
• no change in dietary habits
3
Fortification of Cereal Flours
4
Fortification of Sugar
5
Fortification of Sugar
6
Fortification of Fats and Oils
B
a
t
c
h
7
Dilution
Rice fortification technologies
Shellac Coating
8
Natural kernel
Extruded
Fortification of Rice
Extrusor
9
Where is fortification implemented?
10
Food fortification through premixes
Heterogeneous System
11
Premix quality depends on homogeneity
Homogeneous and stable system
12
Homogeneity depends on equipment
Design and construction that
guarantees safety and efficiency
SOPs for operation and cleaning
of each one
Preventive maintenance program
Optimal mixing time validation
13
Premix Quality depends on Plant Quality
14
Plant quality depends on setup quality
15
Premix quality also relies on plant hygiene
Avoid external contamination
Avoid cross contamination
Ease cleaning
Adequate humidity and
temperature
Clean air
Area separation
Restricted access
Microbiological monitoring
16
Premix quality depends on ingredient quality
Physical Form
Concentration
Dispersibility
Esterification
Antioxidants
Excipients
Oil
100.000 IU/g
Non dispersible
Acetate
BHA/BHT
Gelatins
Emulsion
250.000 IU/g
Dispersible
Palmitate
Tocopherol
Starches
Powder
325.000 IU/g
Emulsion
Others
Gums
No antioxidants
Others
500.000 IU/g
1.000.000 IU/g
1.700.000 IU/g
2.300.000 IU/g
17
Effectiveness will depend on adequate stable
vitamin forms
120%
100%
100%
84.8%
80%
Initial
3 weeks
Spec
60%
40%
20%
0%
Initial
DSM Nutritional Products: Internal trials, 2000-2001.
18
3 weeks
Stability will also depend on packaging
Hygienic process
Protection material
• Physical
• Microbiological
• Humidity
• Oxygen
Exact weighing
Labeling
• Identification
• Lot
• Best use before date
• Others
19
Premix quality is preserved through adequate
storage
• Separate areas
• Temperature and humidity
control
• Inventory rotation
• Cleaning and plague control
• QA approved product entry only
• Correct labeling
20
Premix quality is guaranteed through Quality
Assurance
Content control
Mixer control
Supplier control
Auto-inspections
Validations
• Analytical methods
• Mixing times
• Homogeneity
Counter samples
Traceability
21
Premix quality is proved through
documentation
Internal
• Manufacturing order
• Weight control
• RM addition sequence
• Equipments used
• Operations description
• Annotations
• Authorizations
• Analytical controls
External
• Specifications
• Certificate of analysis
• Others
22
Composition Sheets
Manufacturing principles
Specifications and Tests
Product Data Sheets
Stability data
Safety Data Sheets
Residual solvents
GMO statements
BSE statements
Order Manual
Kosher/Halal certificates
Premix quality is certified through external
referents
ISO norms
GMP
HACCP
Codex Alimentarius
Other international directives
23
No compromise on quality
Low quality micronutrients
are not only deceiving the
customers.
They deceive the most
vulnerable,
the malnourished.
24
Avoid Tunnel Vision Nutrition
25
Chances for success are maximized
depending on which MNs are used
26
Percentage Distribution
Vitamin A fortification of sugar improves serum iron in
preschool children (Guatemala)
45
40
35
30
<50 µg/dl
50-75 µg/dl
>75 µg/dl
25
20
15
10
5
0
Initial
Mejía, LA, Arroyave, G, 1982.
27
2 Years
How much do fortificants cost?
Nutrient
Vit. A (250 CWS)
Vit. D (100 CWS)
Vit. E (50% CWS)
Thiamin
Riboflavin
Pyridoxine
Niacin
Folic Acid
Vitamin B12
Vitamin C
Fe (FeSO4 x 1H2O)
28
Total
Male RDA
3000 IU
200 IU
22.35 IU
1.2 mg
1.3 mg
1.3 mg
16 mg
400 µg
2.4 µg
90 mg
8 mg
$
$
$
$
$
$
$
$
$
$
$
$
Cost/RDA
0.00079
0.00011
0.00250
0.00004
0.00005
0.00005
0.00026
0.00008
0.00010
0.00257
0.00008
0.00662
Estimated Fortificant Costs to Reach Nutritional
Goals Through Food Fortification
Micronutrients
Vehicle
Calcium
Iron-NaFeEDTA
Vitamin E
Vit. C
Vit. A
Iron-electrolytic
Vit. A
Vitamin D
Vit. B-3 (Niacin)
Zinc
Vit. B-12
Vit. B-9 (Folate)
Vit. B-2
Vit. B-6
Vit. B-1
29 Iodine
Solid-Food
Flour
Dry Food
Beverage
Flour or sugar
Flour
Oil
Dry Food
Flour
Flour
Flour
Flour
Flour
Flour
Flour
Salt
1: Includes processing and storage overages.
Women
EAR
(mg/day)
833.333
13.243
6.250
34.615
0.357
40.524
0.357
0.005
10.769
8.167
0.001
0.188
0.917
1.083
0.917
0.107
Nutritional
Goal
(% EAR)
60
80
60
40
80
80
80
80
40
80
80
80
60
40
40
100
Cost
per person1
(US$/year)
0.584
0.193
0.162
0.142
0.087
0.045
0.031
0.028
0.021
0.020
0.014
0.015
0.009
0.008
0.005
0.002
Source: Modified from Omar Dary A2Z- 18 Sept. 2007
Benefit: Or the costs of malnutrition
25000
20982
20000
15000
10000
1441
5000
0
Estimated economic loss
to VMD (US$ mio)
Fortification cost (US$
mio)
Based on the UNICEF/MI publication: “Vitamin & Mineral Deficiencies: A global damage assessment report, 2004
Fortification Cost: 100% coverage at 50% daily requirement of A, B1, B2, PP, B12,I + 100% of FA and Fe
30
Effective fortification is affordable,
ineffective fortification is expensive.
31
Public Health Benefit
Public Health Benefit as a Function of the Quality of
the Program
Optimal Intervention
Minimal Intervention
Time
32
Thank you.