Common Asian Wheat Flour-based Foods: Impact of Flour Fortification on Processing Factors and Organoleptic Properties.

Objectives: While Western foods have been made with fortified wheat flour for decades, foods commonly consumed in Asia are infrequently made with fortified flour. Hence, we coordinated a multi-country study on the processing factors and organoleptic impact of flour fortification on Asian foods. Methods: Researchers in China, India, Indonesia, Malaysia, the Philippines, and Sri Lanka produced fortified flour as per the 2009 World Health Organization Recommendations on Wheat and Maize Flour Fortification, and used this flour to make commonly eaten Asian wheat flour foods, including 15 kinds of noodles and breads. Each fortification premix included iron, folic acid, and vitamin B12; some also included vitamins A, B1, B2, and zinc, depending on country fortification standards. Researchers assessed processing factors, sensory and physical attributes through a panel of consumers and, where feasible, nutrient retention in the different foods. Results: Processing and organoleptic differences between fortified and non-fortified products were minimal. They were considered acceptable in all cases. Also no significant differences in processing and sensory characteristics were reported between the fortified products based on the different iron compounds, i.e. electrolytic iron, NaFeEDTA, ferrous sulphate, or ferrous fumarate. Studies on retention of nutrients showed that micronutrients appeared to be retained throughout the food preparation process. Conclusions: It is possible to fortify flour with enough vitamins and minerals to expect a health impact without changing consumer acceptance of Asian foods.

Regulatory Monitoring Systems of Fortified Salt and Wheat Flour in Selected ASEAN Countries.

Objectives: An increasing number of countries in the Association of Southeast Asian Nations (ASEAN) are adopting or in the process to adopt mandatory food fortification to overcome vitamin and mineral deficiencies. The objective of this study was to review regulatory monitoring systems for iodized salt and fortified wheat flour in selected ASEAN countries. Methods: Regulatory monitoring includes monitoring activities at production level, customs warehouses, and retail stores by regulatory authorities. Producers also monitor during production as part of quality control and assurance. We reviewed regulatory monitoring systems through desk reviews in Philippines, Indonesia, Cambodia, Viet Nam and Malaysia and through interviews with stakeholders in the Philippines and Indonesia. Results: Challenges in regulatory monitoring systems include inefficient and ineffective government monitoring, lack of legal definitions of roles and responsibilities of agencies and industry, and a focus on end-product testing rather than process control and internal quality assurance systems. Conclusions: Without appropriate enforcement and quality assurance mechanisms, i.e., regulatory monitoring, to create a safe and fair environment for food fortification, national legislation will not necessarily lead to high coverage of fortified products and associated health outcomes.

The Contribution of Wheat Flour Fortification to Reducing Anemia in Indonesia.

Objectives: Mandatory wheat flour fortification with iron, zinc, thiamine, riboflavin, and folic acid became effective in Indonesia in 2002. There are no evaluations of its effectiveness on reducing anemia. This study estimated the contribution of fortified wheat flour to changes in hemoglobin concentration and anemia prevalence from the period before to after the introduction of mandatory fortification. Methods: The Indonesian Family Life Survey is a longitudinal study that followed over 30,000 Indonesians. Data from 6,488 non-pregnant women of child-bearing age with hemoglobin measurements in 1997, 2000, and 2007 were analyzed. Anemia prevalence was calculated, adjusting for smoking status and altitude. Households were categorized by their food purchases. Logistic regression was used to predict the effect of covariates on anemia status, while linear regression was used for hemoglobin concentration. Results: Mean hemoglobin significantly increased (p<0.0001) and anemia prevalence significantly decreased (p<0.0001) from the pre-fortification period during 1997-2000 (12.35 g/dL & 34.0%) to the post-fortification period in 2007 (12.67 g/dL & 25.1%). The proportion of weekly household food expenditures spent on foods containing heme iron and flour remained constant from 1997 to 2007. The percentage of household-purchased foods containing heme iron and flour, only heme iron, only flour, or neither in the past week was not significantly associated with hemoglobin concentration or anemia status. Conclusions: Wheat flour fortification does not appear to have significantly contributed to the reduction in anemia prevalence among women of child-bearing age in Indonesia. It is recommended that the fortification iron source be changed from electrolytic iron to a more bioavailable form.