Food Fortification

WHAT ARE MICRONUTRIENTS AND WHY ARE THEY IMPORTANT?

Vitamins and minerals, called micronutrients, play a very important role in our health even though they only make up a very small part of the foods that we eat each day (that is why they are called vital micronutrients). Diets which do not contain adequate amounts of vital micronutrients, often result in deficiency diseases including blindness, mental retardation and reduced resistance to infectious disease, depending on the particular micronutrient. For example Vitamin A is essential for eyesight while Niacin is essential for the metabolism of carbohydrates and the mineral zinc helps maintain a healthy immune system. Deficiency diseases do not only occur in poverty stricken communities. In affluent societies deficiency diseases also occur often as the result of poor choice of food or unhealthy eating habits, often coupled with our lifestyles.

It is estimated that one in every three people in the world is at risk for one or more micronutrient deficiencies, thereby impacting on their nutritional status. Our nutritional status has an important impact on our health, productivity and quality of life in general.

The people who are most at risk of developing micronutrient deficiencies are women of childbearing age, young children, the elderly and those recovering from an illness.

In order to prevent and address the problem of micronutrient deficiencies, several strategies are used: food has specific and scientifically identified micronutrients added to it (known as fortification), people might be given micronutrient supplementation in the form of a pill containing the micronutrients, people are encouraged to expand the variety of foods eaten to ensure they eat foods containing the micronutrients (known as dietary diversification) and governments also often develop nutrition education programmes to teach people about the importance of micronutrients and in which foods they are found. It is important to know that different foods contain different amounts of micrnutrients - some are high in certain micronutrients but low in others. For example carrots are a good source of vitamin A but do not give the body much of the mineral zinc That is why nutritionists always recommend a balanced diet containing a variety of foods - to ensure that you get all the micronutrients that your body needs.

Food fortification has been practiced worldwide for nearly 80 years and has proved to be one of the most cost-effective ways of improving the health of a nation. It is also a very efficient way of using public resources to promote health for all.

Food fortification is simply the addition of specific micronutrients (vitamins and minerals) to specific foods. The type and amount of micronutrients are determined by the nutritional status, and therefore nutritional needs, of the population while the food/s to be fortified depend on the eating habits of the population. The food/s to be fortified are generally called the "food vehicle". Both the micronutrients added and food vehicles selected must have a sound scientific basis if the population is truly to benefit them.

Food fortification has been applied with success in both developed and developing countries to address and prevent micronutrient deficiencies. Due to varying eating habits and type of deficiency disease, the food vehicle, the micronutrient added and the amounts that are added will not be the same for each country.

Mandatory food fortification has been made law for the following four food types in the following countries:

USA, Canada, Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Trinidad and Tobago, Venezuela, UK, Malawi, Nigeria, South Africa, Zambia, Australia, Bahrain, Indonesia, Philippines, Saudi Arabia.

USA, Canada, Brazil, Costa Rica, Guatemala, Honduras, Mexico, Venezuela, Malaysia, Philippines, Thailand.

USA, Canada, Chile, Colombia, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Peru, Belgium, Denmark, Netherlands, Portugal, Sweden, Turkey, UK, Nigeria, South Africa, Australia, India, Indonesia, Malaysia, New Zealand, Pakistan, Phillipines, Singapore.

Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Malawi, Nigeria, Zambia, Philippines.

When fortification of a food vehicle is being considered, there are certain worldwide principles which apply:

• There must be evidence that there is a need for the micronutrient to be added
• The food selected must be consumed by the population who are most likely to be at risk of developing deficiencies due to lack of micronutrients in the food they eat
• The food/s selected for fortification must be eaten regularly
• The fortified food must have an acceptable shelf life under normal conditions of storage, distribution and use
• The micronutrient(s) added must be available to the body to use from the food
• Fortification should not produce undesirable changes to the taste, texture and smell of the food
• Fortification should not substantially increase the price of the food
• The process of fortifying food should not be expensive
• Methods of measuring, controlling and/or enforcing the levels of micronutrients should be in place.

Although not defined as a micronutrient, many countries add iodine (in the form of iodate) to salt. South Africa is one of the countries which has laws in place for the mandatory iodation of salt and follows a recommendation by the World Health Organisation (WHO).

Prior to 2003, only margarine and salt were required by law to be fortified in South Africa. Of course, many products like bread, maize meal, breakfast cereals and fruit juices, just to name a few, have been, and still are, fortified with various micronutrients on a voluntary basis. There are certain laws that give details on the type of package labelling required for voluntary fortification.

Several local studies over the past number of years have shown that micronutrient deficiencies pose a serious health problem in this country. As a result, the Department of Health held a number of workshops to discuss the situation and formulate a direction on food fortification for South Africa. A Food Fortification Task Force, involving all role players, was formed by the Department and many international organisations with experience in food fortification also assisted.

A National Food Consumption Survey (NFCS) was carried out by a group of nine South African universities. The results showed serious deficiency problems amongst a large percentage of the South African population and it was recommended that a mandatory food fortification programme be planned.

The Department of Health realised that all role players had to be involved from the start and that consensus had to be reached by all parties. This resulted in a series of intense meetings and discussions where the different views of the Department of Health, Nutritionists, the Milling Industry, Consumer Groups and Micronutrient Suppliers were heard. In the end agreement on a National Food Fortification Programme was reached. Legislation covering all aspects, including the levels of fortification, the food vehicles, a fortification logo, a consumer education programme and strict requirements for the manufacture and sale of the micronutients to be added was developed.

On 7 April 2003 the National Minister of Health launched the National Food Fortification Programme for South Africa and the legislation was published ("Regulations relating to the Fortification of Certain Foodstuffs"). As a result of these regulations from the 7^th October 2003 all maize meal and bread flour in South Africa will be fortified with the following nutrients

All products that are part of the fortification programme will be able to inform consumers by carrying the fortification logo, that looks like this:

The good news for all South Africans is that as a result of the National Food Fortification Programme, we will address a serious health problem in this country and hopefully improve the quality of life of many South Africans.

For more information, please visit the website of the Department of Health at www.doh.gov.za  
and click on SEARCH and then input "food fortification".