hands with grains

The Role of Fortification in Hunger Relief

Micronutrient deficiency affects an estimated 2 billion people worldwide or more than one-quarter of the population.1 This so-called “hidden hunger” can occur when people don’t have access to a diverse diet. Foods rich in vitamins and minerals may be simply unavailable or may be too expensive to buy. In some parts of the world, the problem is compounded by poor nutrient absorption due to parasitic infections.

Those suffering from micronutrient deficiencies often depend on starchy foods for the bulk of their calories. This can create significant nutrient gaps with potentially serious health consequences.

Food fortification plays an important role in bridging nutrient gaps and alleviating hidden hunger. Americans have benefited from iodized salt, vitamin D-fortified milk, and flour enriched with iron and the B vitamins niacin, thiamine, riboflavin, and folic acid. Based on the successes of fortification programs like these, many developing countries have committed to implementing their own programs. Fortification is a key component to hunger relief efforts all over the world. 

Strategies to Reduce Hidden Hunger 

Increasing dietary diversity of the population is generally considered to be the optimal solution to hidden hunger but one that is often not possible in the short-term, especially in developing countries and in remote rural areas. More immediate strategies are the use of supplementation programs and food fortification programs. Although implementation is more complex, food fortification programs have a broader reach and are more sustainable than supplement delivery programs. According to the Food Fortification Initiative (FFI), “Fortification is successful primarily because it does not require consumers to change their behaviors. Governments and industries, however, need to make systematic changes to maximize fortification’s health benefits.”2

Types of Fortification Programs

Food fortification may be voluntary or mandatory as legislated by the government. There are three major types of fortification programs:

1. Mass fortification: The fortification of foods consumed by the general population

2. Universal fortification: The fortification of foods consumed by people and animals

3. Targeted fortification: The fortification of foods for a specific subpopulation

An example of mass fortification is iron-fortified flour, whereas iodized salt is often a universal fortification. Targeted fortification includes school feeding programs and refugee situations. 

The Ideal Fortified Food

Choosing which foods to fortify and with which nutrients requires careful consideration. Any fortified food for use in a fortification program should have the following characteristics:3

  • Regularly consumed by the target population
  • Included in most meals
  • Low risk of excess consumption
  • Good storage stability
  • Relatively low cost
  • Minimal stratification of the nutrient
  • No interaction between the nutrient and the food
spices

Commonly Fortified Foods

These foods are most commonly used in fortification programs:

  • Wheat flour
  • Cornmeal
  • Rice
  • Cooking oil
  • Salt
  • Sugar
  • Condiments 

Examples of Fortified Foods4

Iron

Cereals, cookies, milk products, sugar, curry powder, soy sauce
Iodine Salt
Vitamin A Oils, margarine, milk, cereals, sugar
B-Complex Vitamins Cereals
Vitamin C Fruit juice and juice drinks, milk products, breakfast cereals
Vitamin D Oils, margarine, milk products
Vitamin E Oils, margarine, breakfast cereals

Top Micronutrient Deficiencies Worldwide

Globally, the most prevalent forms of micronutrient malnutrition are iron, iodine, and vitamin A deficiency.5 Other micronutrient deficiencies of concern are zinc, calcium, vitamin D, and folate. The health of pregnant women and their babies are particularly impacted by deficiencies in calcium, vitamin D, folate, and iron. 

Too little iron can cause anemia which increases the risk of infection for both mothers and babies, increases the risk of hemorrhaging during childbirth, and can delay development and learning in children. Folate deficiency in mothers can cause congenital disabilities in infants.

Iodine deficiency is the leading cause of preventable brain damage in children, while vitamin A deficiency is the main cause of preventable childhood blindness. In children, vitamin A deficiency also increases the risk of death from common infections by weakening the immune system. Immune function is also reduced by a deficiency of zinc which increases the risk of gastrointestinal infection and death from diarrheal diseases.

Organizations Combating Micronutrient Deficiency: WHO, FAO and FFI

As the public health agency of the United Nations, the World Health Organization (WHO) is involved in addressing all forms of malnutrition, including micronutrient malnutrition. The WHO monitors the nutritional status of the global population to provide actionable data that can be used for nutrition interventions, in addition to providing guidance to governments and organizations on issues of malnutrition. Especially valuable to the international public health community is the WHO’s repository of research on effective nutrition interventions such as supplementation and fortification.6

The WHO works closely with the Food and Agriculture Organization (FAO), the United Nations’ food and agriculture agency, on numerous issues including food fortification strategies. The WHO and FAO frequently combine their expertise to jointly produce valuable guidance documents such as Guidelines on Food Fortification with Micronutrients which summarizes research and best practices in food fortification.7

The FFI is a public, private, and civic partnership based at Atlanta’s Emory University’s Rollins School of Public Health. Their commitment is to help countries with the practicalities of food fortification of specifically grain products. They work with leaders to plan, implement and monitor industrially milled wheat flour, maize flour, and rice. 

There are countless other organizations taking on the task of reducing micronutrient deficiencies and hunger relief across the globe. Let’s take a look at some recent case studies highlighting the benefits of food fortification in hunger relief efforts: 

Case Study #1: Fortified Wheat Flour in Tajikistan

The Geneva-based organization Global Alliance for Improved Nutrition (GAIN) recently closed its three-year project in Tajikistan to implement a national wheat fortification program. This project, funded by the United States Agency for International Development (USAID), allowed GAIN to coordinate food fortification activities with partners in Tajikistan. These activities led to wheat flour fortification legislation, the provision of laboratory equipment and training for regulatory agencies, and the establishment of a national congenital disabilities registry to track food fortification impacts over time. 

In addition, twenty flour milling companies in Tajikistan now have the capacity to fortify wheat flour. Tajikistan’s very high rates of micronutrient deficiencies, especially in iron and folate, made this project a public health priority for its government. Moreover, the national flour fortification program is expected to have a nine-fold return on investment.8

Case Study #2: Fortified Cooking Oil in West Africa

Hellen Keller International (HKI), a New York-based nonprofit organization, worked with several donors and partners on an initiative to make vitamin A-fortified cooking oil available across the eight countries of West Africa. HKI coordinated the efforts of public sector, private sector, and nonprofit partners to achieve the mandatory fortification of cooking oil across the West African regional trade bloc, as well as to develop the supply chain and commercial capacity for fortification.

About half of children in West Africa are at risk of vitamin A deficiency, and 70% of the at-risk population consumes industrially-produced oil.9 The cost of this program is one cent per liter of oil and is expected to prevent about 100,000 child deaths annually, in addition to averting cases of childhood blindness. 10

Case Study #3: Fortified Chickpea Paste in Pakistan

The World Food Programme (WFP), the United Nations’ humanitarian food assistance arm, provides emergency food aid to those suffering from natural disasters or armed conflicts. When millions were affected by severe flooding in Pakistan, the WFP provided a fortified, ready-to-eat chickpea paste designed to prevent malnutrition in children during times of crisis.

Although peanut paste is traditionally used in such situations, the WFP wanted to find a substitute that was culturally appropriate and could be locally sourced. The WFP assessed the capacity of local food manufacturers to produce this product and worked with them to ensure the product met WFP vitamin and mineral fortification requirements. The WFP’s ability to source locally reduced the transit time of emergency food aid and gave a much-needed boost to Pakistan’s economy in a challenging time.

Fighting Hunger Globally and Locally

Here at Glanbia Nutritionals, we are working to deliver better nutrition for every step of life’s journey. Not only do we make custom premix solutions used to fortify foods and make them healthier, but we also work to improve access to healthy foods in our communities. To learn more about our commitments to our society, check out our sustainability page

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References

1. Von Grebmer, K., Saltzman, A., Birol, E., Wiesmann, D., Prasai, N., Yin, S., . . . Sonntag, A. (2014). 2014 Global Hunger Index: The Challenge of Hidden Hunger. Retrieved from https://www.ifpri.org/publication/2014-global-hunger-index
2. Food Fortification Initiative. (2021). Why Fortify? Retrieved from https://www.ffinetwork.org/savelives
3-4. FAO. (1997). Food Fortification: Technology and Quality Control. Retrieved from https://www.fao.org/docrep/W2840E/w2840e03.htm
5. WHO/FAO. (2006). Guidelines on Food Fortification with Micronutrients. Retrieved from https://www.who.int/publications/i/item/9241594012 
6. WHO. (2018). e-Library of Evidence for Nutrition Actions (eLENA). Retrieved from https://www.who.int/elena/health_condition/en/
7. WHO/FAO. (2006). Guidelines on Food Fortification with Micronutrients. Retrieved from https://www.who.int/publications/i/item/9241594012
8. GAIN. (2018). Technical support project to reduce micronutrient deficiencies in Tajikistan: project compendium 2014-2017.  Retrieved from https://www.gainhealth.org/resources/reports-and-publications/technical-support-project-reduce-micronutrient-deficiencies
9-10. Sablah, M. et al. (2012) Thriving public–private partnership to fortify cooking oil in the West African Economic and Monetary Union (UEMOA) to control vitamin A deficiency: Faire Tache d’Huile en Afrique de l’Ouest. Food Nutr Bull. 2012 Dec;33(4 Suppl):S310-20. Retrieved from https://journals.sagepub.com/doi/pdf/10.1177/15648265120334S307 
11. WFP. (2011, February 17). Homespun Response To Malnutrition Deployed In Pakistan. Retrieved from https://reliefweb.int/report/pakistan/homespun-response-malnutrition-deployed-pakistan
 

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