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Technologies in Large Scale Food Fortification:
Fortification is the process of adding essential micronutrients to food. These micronutrients are added over and above what would naturally be available in the food that is consumed. When this activity is done at a national or state level under a certain program, we call it Large Scale Food Fortification (LSFF). In this article we will look at the technologies currently in use for LSFF.

Background:
It has been estimated that roughly 2 billion people around the world are affected by micronutrient deficiencies. The common cause for the same is usually lack of diversity in their regularly consumed food. There could also be other reasons for lack of nutrients in the staple food of a region such as the soil type. This lack of essential micronutrients in staple food is termed as hidden hunger. This hidden hunger results in different diseases that arise out of micronutrient deficiencies such as neural tube disease, poor growth, impaired cognitive development, anemia etc. These diseases put a heavy burden on the health care expenses of a country. LSFF is identified as an effective strategy to reduce healthcare expense at a fraction of the cost by providing a preventive means of handling the root cause of these diseases i.e. hidden hunger. It is quite evident that the success of LSFF programs require the use of staple foods or commonly consumed food for fortification in a country/ targeted region. The commonly used food vehicles under LSFF are Wheat, Rice, Edible Oil, Milk and Salt etc. In this article we will look at some of the technologies that are commonly used in Large Scale Food Fortification.

Micronutrients Used in LSFF:
The common micronutrients that are used in LSFF are folate, iodine, iron, vitamin A, and zinc etc. Health programs that implement LSFF in a country or region usually have an idea about which micronutrient is lacking in the general public of the region. Along with this there is a clear idea on which staple food is largely consumed in the area. As a result, there can be targeted mixing of micronutrients with a chosen staple food for a region. Countries tend to have their fortification standards mentioned clearly for the stakeholders who carry out LSFF. Now the stakeholders could be government bodies for a safety net program or they could be private players who want to capture new market by creating fortified products. These fortification standards mention clearly how much quantity of a particular micronutrient can be put in one liter or one KG of the chosen food vehicle. For example, in India milk can be fortified with vitamin A at a rate of 270 – 450 μg/ liter.

The commonly used micronutrient in different food vehicles are as follows:

 * 1) Rice : Iron, Folic acid, Vitamin B12, Vitamin A, Zinc, Thiamine, Niacin, and/or Vitamin B6
 * 2) Wheat: Iron, Calcium, Zinc, Folic acid, Vitamin B12, Vitamin A, Zinc, Thiamine, Niacin, Vitamin B6, and/or Vitamin D
 * 3) Maize: Iron, Calcium, Zinc, Folic acid, Vitamin B12, Vitamin A, Zinc, Thiamine, Niacin, Vitamin B6, and/or Vitamin D
 * 4) Oil: Vitamin A, Vitamin D, and/or Vitamin K
 * 5) Milk: Vitamin A and/or Vitamin D
 * 6) Salt: Iodine, Iron

Food Vehicle wise Technologies used in LSFF:
LSFF is also called industrial or mass fortification. The technologies used are meant to ensure addition of one or more vitamins and/or minerals to staple foods at the point of processing.

Salt:
Iodization of salt has been the common program used across 150+ countries in the world. A new fortified food product in use is the Double Fortified Salt (DFS). This is an innovative product meant to deliver small but essential amounts of iodine and iron in the regular diet. The target usually is to deliver 100% requirement of iodine and roughly 30% to 60% requirements of iron by making use of the DFS. In the salt iodization process, drip feed equipment is used to dose potassium iodate solution to the raw salt. It is then moved to the dewatering, drying and packing system. DFS technology adds another layer including a ribbon blender to blend the iron compound to iodized salt. DFS is produced by mixing the iodized salt with either ferrous sulphate or encapsulated ferrous fumarate. Ferrous fumarate is encapsulated with soya stearin to prevent any kind of interaction between iron and iodine. Similarly for ferrous sulphate sodium hexametaphosphate is used as a stabilizer. These technologies not only ensure DFS is stable it also ensures that it is indistinguishable from the regular salt as well.

Milk:
Vitamin A and D usually gets lost when milk fat is removed during processing. It is important to add it back and it has been made mandatory in many countries to do so. The technology used here is fairly simple. All the vitamins and minerals that can be added are usually available in powder form or in liquid form as a premix. One doesn’t need any sophisticated equipment for this; however, it is important that all nutrients are evenly mixed in the milk. It is ensured that liquid milk is fortified right before pasteurization. This simple method ensures that the cost of fortification is pretty low for milk. In India it is estimated to be roughly 2 paisa per litre.

Oil:
Similar to milk, edible oil is widely used as a vehicle to address vitamin D and vitamin A deficiencies in the general population. The helpful part about it is these vitamins are fat soluble. This ensures effective mixing of the vitamins and no requirement of specialized machinery only for this purpose. A temperature of 40o C to 45o C is maintained for uniform mixing. For oils like soybean oil this temperature is even lower at 25. In any case dosing technology for adding antioxidants and other micronutrients are already in place for oil. The addition of vitamin D and A doesn’t require any additional personnel ensuring a low cost of fortification here as well.

Wheat:
Wheat flour is a commonly consumed staple and hence a very cost-effective method of preventing nutritional deficiency in the population. Usually during the milling process nutrient losses take place for wheat and fortification methods are used to add these nutrients back along with other targeted nutrients. The technology requires a premix feeder to add necessary vitamins and minerals into the wheat flour. There is a requirement of a blender to ensure uniform mixing of the micronutrients in the wheat flour. The other important thing to note is the presence of a robust quality control system to ensure proper blending ratio is maintained in the mills that partake in the program. The premix contains a uniform mixture of micronutrients, and it is fed accurately via a volumetric feeder into the flour. There would be a motor rotating feed screw that will ensure uniform blending. They either make use of simple gravity or a pneumatic system to dispense the micronutrient premix in the wheat flour. To achieve uniform blending, it is desired that the feeder should be centrally located with respect to the conveyor belt carrying the wheat flour.

The common thread in all of the above technologies is the fact that the food items are either consumed in liquid or powder form. This makes the technology for Large Scale Food fortification for these staples slightly unsophisticated. But one of the major staple items is Rice which is not consumed in powder or liquid form. Now the idea of LSFF is to add the micronutrients in the staple while ensuring the final product remains indistinguishable from a non-fortified version of the same product. In staples that are consumed in liquid or powder form it is simple to attain indistinguishability. We now look at the technology used in fortifying rice.

Rice:
The technology for rice is more complicated than the food vehicles discussed above, owing to the fact that it is consumed in the form of kernels compared to the powdered form of wheat or liquid form of milk/ oil. Cost-effectiveness is the biggest selling point for LSFF. Now there are multiple methods of fortifying rice as well and some methods are cheaper making them more appealing in some cases. However, for cheaper methods, their effectiveness in delivering micronutrients to intended targets is questionable.

1) Dusting:
A fine powder micronutrient premix is added to milled rice. In a bag of fortified rice, all of the rice will be dusted in this technology. It is the cheapest method and the least effective. Since at the time of cooking one is bound to wash the rice.

2) Coating:
Coated fortified kernels are produced by coating rice grains, which are typically head rice, with a liquid fortificant mix. Additional ingredients, such as waxes and gums, are used to ‘fix’ the micronutrient layer on the rice grain. In large rotational drum or pan coating machines, whole or head rice is evenly spray coated with micronutrients and other ingredients to preserve the coating. The coated kernels are then dried to yield fortified kernels. This technology concentrates the micronutrients on the surface of the rice grains. It is also susceptible to methods of cooking. One needs to use rinse – resistant coatings to ensure micronutrient retention during the regular cooking process where rice is washed & cleaned. Now usage of rinse resistant coating is going to add more cost and compromise the affordability of the method.

3) Extrusion Technology:
This is the current universal standard for most rice fortification programs across the world. First a dough is formed combining water and a fortificant mix with rice flour. The rice flours are created from grinding lower value and non-contaminated broken rice. The dough is passed through an extruder, producing a fortified kernel visually similar to a non-fortified rice grain. The extruded fortified kernels are dried, reducing the water content to 14% or less, thus increasing stability during storage. Emulsifiers can also be used during storage. Micronutrients are equally distributed inside the fortified kernel reducing exposure to the environment and hence micronutrient degradation.

There are 3 types of extrusion:
 * Cold Extrusion (30o – 50o C) : Opaque kernels, softer texture
 * Warm Extrusion (60o – 80o C): Translucent kernels
 * Hot Extrusion (80o – 110o C): More energy, more sophisticated machines, larger quantity & more variety in terms of quality.

Fortified kernels made by either warm or hot extrusion are similar to non-fortified rice in their uptake of water during cooking, cooking time, and firmness. When produced using extrusion or rinse-resistant coating technologies, fortified rice will retain nutrients through various preparation and cooking conditions, including washing and cooking in excessive water that is later discarded. However, when fortified rice is produced using dusting or coating that is not rinse-resistant, nutrients will be lost.

Impact of LSFF:
LSFF have been attributed for positive impact on various micronutrient-based diseases:
 * A) Salt iodization: Goiter
 * B) Flour fortification with vitamin B: Pellagra and Beriberi
 * C) Milk fortification with vitamin D: Rickets
 * D) Cereal grain with folic acid: Neural tube defects

It is regarded as one of the best development interventions due to the high benefit to cost ratio it provides.

Global Experience in LSFF:
Globally, mandatory or voluntary fortification legislation is currently in effect in 147(126) countries for salt, 104(91) countries for wheat flour, 21(19) countries for maize flour, 17(8) countries for Rice and 43(34) countries for oil.

Delivery via safety net is regarded as one of the most effective ways to implement LSFF as it reaches the section of the society that is the most vulnerable to malnutrition. e.g., Bangladesh Government’s Vulnerable Group Feeding Development program Rice.

Political will, investment in industry to build capacity & proper enforcement for quality checks & audits need to be in place for the success of these programs. There are examples of countries where even with a mandatory legislation in place LSFF initiatives failed to bear any fruit. e.g., Nicaragua, Panama for Rice.

In terms of examples of LSFF in India, we have mandatory Salt fortification and voluntary fortification for Rice, Wheat Flour, Milk & Oil. Salt fortification has been mandated since 1988 via legislation.

References:

 * 1. GAIN Discussion Paper Series 10 - Transforming food systems to deliver nutritious foods [Feb, 2022]
 * 2. Canadian Public Health Association (CPHA). Food fortification with vitamins and minerals [Internet]. 2015 [cited 2020 Nov 5]. Available from: https://www.cpha.ca/food-fortification-vitamins-and-minerals
 * 3. Global Fortification Data Exchange. Map: Fortification Legislation [Internet]. 2021 [cited 2020 Nov 3]. Available from: https://fortificationdata.org/interactive-map-fortification-legislation/
 * 4. Food Fortification Resource Center https://ffrc.fssai.gov.in/
 * 5. WFP report: Scaling up Rice Fortification in Asia
 * 6. WHO Guideline: Fortification of wheat flour with vitamins and minerals as a public health strategy
 * 7. Public and Private Sector Dynamics in Scaling Up Rice Fortification: The Colombian Experience and its Lessons; Food and Nutrition Bulletin 2016, Vol. 37(3) 317-328
 * 8. https://dfpd.gov.in/Centrally_Sponsored_Pilot_Scheme.htm
 * 9. https://the-ken.com/story/the-weak-supply-chain-links-in-indias-us350m-year-rice-fortification-plan/