Large-scale Staple Food Fortification as a Complementary Strategy to Address Vitamin and Mineral Vulnerabilities in India: A Critical Review

The slow improvement in micronutrient malnutrition globally and in India warrants a need for scaling?up scientifically proven, cost?effective public health interventions. The present review discusses the potential of staple food fortification as a complementary strategy to tackle micronutrient deficiencies, while addressing the current concerns raised regarding its implementation. The review indicates the below par status of current strategies like dietary diversity and supplementation to address multiple micronutrients deficiencies in India and the need for complementary strategies to tackle this problem. Based on systematic reviews and meta-analysis, global and national evidence has identified staple food fortification as a proven and recognized cost?effective solution to address micronutrient deficiencies. The Government of India has shown a strong leadership to promote this proven intervention. Further, the paper addresses the concern that large?scale staple food fortification (LSFF) may lead to excessive nutrient intakes when delivered together with other interventions, e.g., supplementation, dietary diversity, among the same populations. A key message that emerges from this review is that LSFF is safe with current dietary intake and deficiencies and low coverage of other interventions. Given the current situation of food and nutrition insecurity which the COVID-19 pandemic has further exacerbated, and the critical role that nutrition plays in building immunity, it is even more important that health and nutrition of the population, especially vulnerable age groups, is not only safeguarded but also strengthened. LSFF should be implemented without any further delay to reach the most vulnerable segments of the population to reduce the dietary nutrient gap and prevent micronutrient deficiencies. Effective monitoring and regular dietary surveys will help ensure these interventions are being deployed correctly.

Effect of Double Fortified Salt Supplementation on Iodine and Hemoglobin Status of School Children of Rural Vadodara, India.

Iron deficiency along with iodine deficiency affects the developing brains, physical and mental growth of the children. Multiple micronutrient deficiencies co-exists in developing countries at a higher rate due to monotonous diets with low nutrient density. Hence, food fortification has been used as a tool to increase the content of essential micronutrients. Aim Our study was aimed to assess the efficacy of DFS supplementation on iodine and hemoglobin status of the rural school children Methods Interventional study. Rural school children (6-15 yrs) randomly divided into experimental and control group. Experimental were supplemented with double fortified salt (DFS) and controls consumed adequately iodized salt (IS). Pre and post hemoglobin concentration (Hb) and urinary iodine (UI) recorded. Results Mean Hb increased in experimental (+0.42 g/dl) (p<0.001) and decreased in control group (-0.54 g/dl) (p<0.001). The intensity of anemia classification decreased in experimental group and increased in control group. UI increased significantly in both the groups (p<0.001). Hence, DFS is proven to be beneficial compared to IS.

To Assess Nutritional Status of Adolescents (10-12 Years) From Non Government Funded Schools (Private) of An Urban Indian City & Kap of Parents/ Teachers Regarding Healthy Dietary and Lifestyle Behaviors for Adolescents.

To assess nutritional status of adolescents (10-12 years) from non government funded schools (private) of Gujarat, India. Teachers & parents of adolescent children were assessed regarding their knowledge, attitude and practices of healthy dietary & lifestyle behaviours. School canteen services were also critically evaluated. Parent’s willingness, to start a nutrition program in the school was also assessed. A cross sectional study was conducted on adolescents (10-12 years) from two selected private schools. Anthropometric, biophysical and hemoglobin estimations were done on all children. Lipid and glucose profile was conducted only on over weight (including obese) children. Results reveal that canteen offered unhealthy food. Teachers and parents had insufficient knowledge about healthy behaviors. Most (53.5%) of the parents agreed to the changes proposed for canteen menus. About 3/4th of the subjects were malnourished (78.9%), with more (53.7%) being under weight than over weight and obese (25.2%). Similarly, more than half (55.1%) of the subjects were anemic. Central obesity as indicated by WHtR & WC was 21.6% and 9.0% respectively. The burden of sub optimal blood pressure was very high (26.3%) among adolescents (Pre hypertension 13.7% and hypertension 12.6%). Hence, malnutrition along with anemia and high blood pressure were significant problems in private schools. Schools being the best setting to approach adolescents and parents, multi disciplinary programs should be part of school policies to prevent and manage triple burden of malnutrition and its adverse consequences among the adolescents from private schools.

Seaweed supplementation to prevent iodine deficiency.

Iodine is considered as one of the essential elements for the proper functioning of the hormones of human and animal thyroid glands. In many parts of the world iodine deficiency disorders develop because of deficiency of iodine in water and food supply. An iodine deficient goitrous mother may give birth to a cretinous baby because the fetus requires an adequate secretion of thyroxine during the later stages of pregnancy. Seaweed has such a large proportion of iodine compared to dietary minimum requirements, that it is primarily known as a source of this nutrient. A trial study on supplementation of iodine rich seaweed Caulerpa racemosa availed from Gujarat coast was conducted on iodine-deficient or thyroid-insufficient (n=10) pregnant women. They were supplemented daily with 0.17 g of algae in 20 g wheat flour ladoo for one month so as to provide 50μg/day of iodine and 0.343 mg/day of iron. A slight non-significant increase (104.75 to 121.05 μg/L) in median urinary iodine concentration (UIC) was observed after one month of supplementation. No significant effect of supplementation was observed on thyroid function parameters of the subjects. They also showed slight increase in hemoglobin level. Prolonged supplementation needs to be carried out further to opine on the impact of algae.

Prevalence of iodine and iron malnutrition among rural school children of Gujarat, India.

Background-Iodine and iron deficiencies are responsible for reversible brain damage, mental retardation, stunted growth, development and low immunity in school children. The consequences are more severe when encompassed by malnutrition. Higher enormity of all may worsen the situation. Objective- To determine the magnitude of micronutrient malnutrition in rural school children of Gujarat, India Methods - 947 children, enrolled from 4 schools. Anthropometric measurements, urinary iodine excretion and haemoglobin were assessed. Results- Malnutrition was highly prevalent with 70% of children being underweight, 55% children suffered stunting and 45% had lower BMI, using WHO 2007 and CDC 2000. Prevalence of iron deficiency anemia was 99% where as iodine deficiency disorders was 30%. Mean haemoglobin level was 9.17± 1.22 g/dl and median urinary iodine excretion was 145.91μg/l. Adequately iodized salt was consumed by 82.4% population. Though majority of the subjects are consuming iodized salt, the prevalence of iodine deficiency is higher. Conclusion - Hence, there is a need to ensure best usage and storage practices for iodized salt. There is an interrelationship between stunting and micronutrient deficiencies. Children are in a transition phase of malnutrition; hence, there is a need to strengthen school meal program, health program and thorough awareness campaigning is required from ground level to the beneficiaries. There is a need to introduce a common vehicle for all; like double fortified salt; to address both the micronutrient deficiencies along with improving upon nutritional status.