Assessment of Jordan's Wheat Flour Fortification External Monitoring System.

Objectives: To assess the performance of the external monitoring system utilized in Jordan according to the CDC criteria for surveillance systems. Methods: The performance of the external monitoring system was assessed qualitatively following the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems. Specifically, seven attributes of the system (simplicity, flexibility, data quality, acceptability, representativeness, timeliness, and stability) were assessed. Results: The monitoring system uses five key indicators that are representative, simple to collect, and collected in a flexible manner. Indicators include 1) monthly production of wheat flour, 2) monthly number of 25 kg premix boxes used, 3) average addition rate (calculated), 4) addition rate as a % of 250 g/MT target (calculated), and 5) iron concentration in flour sample. While data on production of fortified flour and premix utilization can be provided in a timely manner, on-site mill monitoring and flour sample collection are more challenging due to resource constraints. Conclusions: The frequent collection of a small number of indicators can provide program managers with timely information with which to base decisions, and successfully documents the performance of each mill and the whole fortification program. Moreover, the system is acceptable to participating agencies and millers and is stable due to mandatory fortification legislation which provides the legal framework for external monitoring. This system can serve as a model for other national fortification programs considering external monitoring approaches. Citation: Wirth JP et al. Nutrients, 11:4741-4759,2013.

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.

Fortification of Wheat Flour and Maize Meal with Different Iron Compounds: Results of a Series of Baking Trials.

Objectives: Flour fortification is a preventive food-based approach to improve the micronutrient status of populations. In 2009, the World Health Organization (WHO) released guidelines on addition levels for iron, folic acid, vitamin B12, vitamin A, and zinc at various levels of average daily consumption. To address food industry concerns about possible adverse effects from iron compounds, baking trials were undertaken to determine possible adverse interactions. Methods: Wheat flour and maize meal were sourced in Kenya, South Africa, and Tanzania, and the iron compound (sodium iron ethylenediaminetetraacetate [NaFeEDTA], ferrous fumarate, or ferrous sulfate) was varied and dosed at rates according to the WHO guidelines for consumption of 75 to 149 g/day of wheat flour and > 300 g/day of maize meal and tested again for 150 to 300 g/day for both. Bread, and other products were prepared locally and assessed on whether the products were acceptable under industry-approved criteria, by academic sensory analysis using a combination of trained and untrained panelists and in direct side-byside comparison. Results: Industry (the wheat and maize milling sector) scored the samples as well above the minimal standard, and under academic scrutiny no differences were reported. Side-by-side comparison by the milling industry did indicate some slight differences, mainly with respect to color, although these differences did not correlate with any particular iron compound. Conclusions: The levels of iron compounds used, in accordance with the WHO guidelines, do not lead to changes in the baking and cooking properties of the wheat flour and maize meal.