section 1: introduction why fortify? overview of fortification process fortification’s public...
TRANSCRIPT
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Section 1:
Introduction
Why Fortify?
Overview of Fortification Process
Fortification’s Public Health Impact
Minerals and Vitamins Used in Flour Fortification
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Why Fortify?
Health and Economic Benefits
• Prevent iron deficiency, neural tube birth defects, and other health concerns
• Improve the national economy by increasing productivity and decreasing healthcare expenditures
FFI photo
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Why Fortify?Leverage Existing Infrastructure to Reach Population
Siemer flour millhttp://www.siemermilling.com/Locations/125/a/159
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Overview: Wheat’s Natural Iron
• Bran contains 55% of wheat’s natural iron
• Germ contains 5% of wheat’s natural iron
The bran and germ are primarily used for animal feed.
Percentages calculated from USDA Nutritional Database
Image courtesy of the Wheat Foods Council
Bran
Germ
Endosperm
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Wheat’s Mineral Loss in MillingMineral loss at 75-80% extraction
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Overview: Wheat’s Natural Vitamins
Bran
Germ
Endosperm
VitaminFound in Bran (%)
Found in Germ (%)
Folic Acid (B9) 33 12
Niacin (B3) 86 2
Thiamine (B1) 33 64
Riboflavin (B2) 42 26
Pyridoxine (B6) 73 21
Pantothenic Acid (B5) 50 7
Percentages calculated from USDA Nutritional Database
Image courtesy of the Wheat Foods Council
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Wheat’s Vitamin Loss in MillingVitamin loss at 75-80% extraction
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Overview: Fortification ProcessPowdered vitamins and minerals are added to flour during the milling process using equipment called feeders.
A large mill may use a “feeder bank” such as this set of four. One feeder is for fortification and three are for other flour improvers.Photo courtesy of Research Products Company
Smaller mills may use a single feeder for fortification.Photo copyright: David Snyder / CDC Foundation
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Impact on Health: Iron
Burden of Deficiency
• Reduced productivity• Iron deficiency anemia• Undeveloped mental
capacity• Maternal mortality• Pre-term births
Health Benefits
• Increased productivity• Fully developed mental
skills• Improved maternal and
child health
“Iron deficiency affects more people than any other condition, constituting a public health condition of epidemic proportions.”
-World Health Organizationhttp://www.who.int/nutrition/topics/ida/en/
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Success of Fortifying with Iron
Four studies of the effectiveness of fortifying with iron all showed improvement in iron status:
Country Population studied
China Women
Iran Women and men
Venezuela School-age children
Fiji Women
FFI review December 2012. Photo from istockphoto.com
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Results of Insufficient Folic Acid (vitamin B9)
• Children born with neural tube birth defects (NTDs) such as spina bifida
• Permanently disabling or fatal
• More than 300,000 NTDs occur every year globally*
* Global Report on Birth Defects, March of Dimes Birth Defects Foundation, 2006
Photo of child with spina bifida from Google images
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Impact of Fortifying with Folic Acid
• Reduce risk of NTDs 31% to 78%
• Healthcare savings from averted surgeries and therapy
• Cost: benefit ratios reported when spina bifida is prevented:o 1:12 in Chile
o 1:30 in South Africa
o 1:48 in the United States Photo from istockphoto
Risk reduction from Blencowe, H: Folic acid to reduce neonatal mortality form neural tube disorders. International Journal of Epidemiology. April 2010 (suppl_1):i110-i121Cost benefit data from:Llanos, A., et. al., Cost-effectiveness of a Folic Acid Fortification Program in Chile. Health Policy 83 2007:295-303.Sayed, A., et.al., Decline in the Prevalence of Neural Tube Defects Following Folic Acid Fortifcation and Its Cost-Benefit in South Africa. Birth Defects Research 82 2008:211-216.Grosse, Scott, et. al., Reevaluating the Benefits of Folic Acid Fortification in the United States: Economic Analysis, Regulation, and Public Health. American Journal of Public Health 95 2005:1917-1922.
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Minerals and VitaminsUsed in Flour Fortification
Minerals Vitamins
• Iron• Zinc
• Folic Acid (B9)• Thiamine (B1)• Riboflavin (B2)• Niacin (B3)• B12• Vitamin A• Vitamin D
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Types of Iron Used In Fortification
Elemental Iron(reduced iron or electrolytic iron)
Ferrous Sulfate
Ferrous Fumarate Sodium Iron EDTA (NaFeEDTA)
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Factors for Choosing Iron Compound• Bioavailability (absorption)
– Water soluble compounds have the highest relative bioavailability because they are very soluble in gastric juices.
– The size, shape and surface area of the iron particle affects bioavailability, as does composition of food made with fortified flour.
• Sensory changes– High levels of some iron compounds could cause coloration or
rancidity of the flour.• Cost:
– Highly bioavailable forms of iron are more expensive, but less is needed per metric ton of flour for fortification to have a health impact.
• Magnets:– Iron salts (ferrous sulfate, ferrous fumarate and iron EDTA) will not
be attracted to magnets that may be used in milling process
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Other Minerals in Flour FortificationZinc
• Zinc oxide is most commonly used
• Inexpensive• No sensory concerns• Use higher levels in high-
extraction flours due to higher phytic acid content
Calcium
• Calcium sulfate and calcium carbonate are both used
• No sensory concerns• Not included in premix
with other nutrients because levels are far higher than other nutrient additions
• Not usually included in fortification standards
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B Vitamins in Flour Fortification
Folic Acid (B9)
• Folic acid is preferred source
• No sensory concerns• Relatively stable with
some loss from exposure to light and food preparation
• More bioavailable than B9 in natural food sources
Thiamine (B1)
• Thiamine mononitrate is preferred source
• No sensory concerns• Susceptible to losses
from exposure to light and heat and alkaline conditions (pH over 7)
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B Vitamins in Flour Fortification
Riboflavin (B2)
• Orange crystalline powder
• Use only food grade material exceeding 97% purity
• Unstable in light
Niacin (B3)• Commonly used source:
nicotinic acid (commonly just called niacin) and nicotinamide.
• No sensory concerns• Nicotinic acid can cause
reddening in the skin on exposure
• Both niacin compounds are very stable in heat and light
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B Vitamins in Flour FortificationPyrodoxine (B6)
• Pyrodoxine hydrochloride is preferred source
• No sensory concerns
• Stable to heat, but sensitive to UV light.
Cobalamin (B12)
• Cyanocobalamin is common source
• No sensory concerns• Relatively stable in heat, but
unstable in alkali and strong acidic environments
• Difficult and expensive to test for the small amounts used in fortification
• More bioavailable than B12 in natural food sources
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Other Vitamins in Flour Fortification
Vitamin A•Retinyl acetate and retinyl palmitate are recommended.•Beta-carotene’s yellow color makes it undesirable for flour.•Available in encapsulated forms that do not cause sensory concerns•Significant losses can occur on storage if the encapsulation and antioxidant protection system is poor. A standard stability test at 45°C on the raw material should show losses no greater than 20% after 21 days.•Countries often fortify edible oil or sugar rather than flour with vitamin A
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Other Vitamins in Flour Fortification
Vitamin D•Form used in fortification: D3 Cholecalciferol•Countries often fortify dairy products with vitamin D in combination with vitamin A•Currently only a few countries fortify flour with vitamin D
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More Information
• Health, productivity and economic benefits of flour fortification: http://www.ffinetwork.org/why_fortify/index.html
• World Health Organization recommendations for wheat and maize flour fortification: http://www.who.int/nutrition/publications/micronutrients/wheat_maize_fortification/en/