when it comes to nutrition, or more specifically micronutrient malnutritionThere is an urgent need to address the distortions that poor nutrition can inflict on the public, especially given India’s diverse population.
Malnutrition adds to the magnitude of the public health crisis we face, and is India’s most pressing challenge and concern. As per National Family Health Survey-5 data, every second Indian woman is anaemic, every third child is stunted and malnourished, and every fifth child is wasted. According to the FAO Food Security Report for 2021, India ranks 101 out of 116 countries in the Global Hunger Index 2021, with 15.3% undernourished population, the highest proportion of stunted children (30%), and wasted children (17.3%).
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The picture from the Global Nutrition Report 2021 is a cause for concern, given that stunting among children in India is much higher than the Asian average of 21.8%.
Since the 1920s, developed countries and high-income countries have successfully addressed the problem of malnutrition through food fortification. Of late, low and middle income countries like India have adopted food fortification as one of the strategies to combat micronutrient malnutrition. Simply put, food fortification is the process of adding nutrients to food. For example, rice and wheat are rich in iron, folic acid and B vitamins. 12, and salt fortified with iron and iodine. Iodized salt is being used for the last few decades.
Rice Program and Anemia
Pilot projects on distribution of fortified rice have been initiated in select states including Maharashtra (Gadchiroli district) as part of the Targeted Public Distribution Program to the public. The program has been successful in curbing cases of anemia – from 58.9% to 29.5% – within a two-year period, prompting the central government to announce an increase in the distribution of fortified rice, a staple of 65 people. There is diet. % of population through existing platform of social safety net like PDS, ICDS and PM-Poshan.
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The experiences of various states on the fortified rice project, so far, match the results of global programs that use fortified food as a cost-effective strategy. The health benefits of food fortification have led 80 countries to legislate for fortification of cereal flour and 130 countries for iodized salt, where 13 countries have mandated fortification of rice. The encouraging results of the pilot program in Gadchiroli have inspired a proposed large-scale food fortification programme, including fortified rice in all safety net government schemes. The study found a promising reduction (29.5%) in the prevalence of anemia among women, adolescent girls and children in Gadchiroli district.
mid day meal scheme in gujarat
In Gujarat, an eight-month long study on multi micronutrient fortified rice intervention for school children (six-12 years) in 2018-2019, as part of the mid-day meal scheme, increased hemoglobin concentration, decreased anemia prevalence by 10% found a reduction in, and, more importantly, an improvement in, the average cognitive score (by 11.3%).
Iron deficiency anemia is a major public health concern, as it accounts for 3.6% of disability-adjusted life years or DALYs (loss of life due to premature mortality and lives with disability) according to the World Health Organization (WHO). years) – that is, the loss of 47 million DALYs, or years of healthy life due to disease, disability, or premature death (2016).
According to NITI Aayog (based on a WHO meta-analysis on the impact of rice fortification), a rice fortification budget of about ₹2,800 crore per year could save 35% of the total, or 16.6 million DALYs per year, with no known risk of toxicity Is. The cost of one DALY due to iron deficiency anemia (IDA) in India is approximately ₹30,000, whereas the cost of avoiding an IDA-related DALY is only ₹1,545, resulting in a cost-benefit ratio of 1:18. Rice fortification, which costs less than 1% of the food subsidy bill (2018-19), has the potential to prevent 94.1 million anemia cases, saving Rs 8,098 crore over a five-year period.
need for precautions
Despite the program’s proven efficacy, activists have expressed concern that additional iron overload from fortified rice is dangerous for Jharkhand’s tribal population suffering from sickle cell anemia and thalassemia. Fortified rice has iron levels ranging from 28 mcg to 42.5 mcg, folic acid levels 75 mcg-125 mcg and B vitamins 12 Levels from 0.75 mcg to 1.2 mcg (FSSAI norms). Considering the per capita intake, the additional intake is 2.45 mg of iron in a family of three members consuming about 60 grams of rice per person. It actually compensates for our daily loss of iron from the body, which is 1 mg-2 mg per day.
Food fortification, according to nutrition veterans, is a cost-effective supplement strategy to address deficiencies in many micronutrients. Thus, given its proven efficacy and cost-effectiveness, food fortification can help us reduce micronutrient deficiencies and address overall health benefits. A careful intervention is the key to the issue of malnutrition that the country is grappling with.
Sirimavo Nair is Senior Professor in the Department of Food and Nutrition, Maharaja Sayajirao University of Baroda, Gujarat