Food Fortification in India: A Literature Review.

ABSTRACT

Objectives: The purpose of this review was to identify and analyze single or multiple micronutrient (MMN) food fortification studies for their efficacy and effectiveness in India. Methods: A comprehensive fortification search (n=10 databases) was completed, and retrieved citations were screened by two independent researchers. Data were abstracted from selected published documents to summarize intervention designs and results on human health indicators (biological markers, anthropometry, cognition, morbidity). Results: Forty-seven published studies conducted in 13 Indian states and comprised mainly of randomized controlled trials (n=26) were included for analysis. The food vehicles were cereals (e.g. wheat, rice, (n=6)), oils and salts (n=18), and other (e.g. beverages, school meals, (n=23)). Children ≤12 y were the main targeted population (n=36). Improvements in one or more biological markers were reported in 76.9% of all publications and in 91.3% reporting MMN fortification. Improvements in ≥1 iron biomarker were noted in all documents (n=9) using iron as the sole fortificant. Eight of 18 documents showed a positive impact of fortification on anthropometry, of which 7 fortified with MMNs. Improvements in cognitive domains were observed in 3 of 7 publications, all of which were MMNs. Morbidity symptoms improved in 1 of 9 publications. Conclusions: Food fortification research in India suggests it effectively improves biological markers of nutritional status, particularly when fortifying with MMNs or iron. MMN fortification consistently improved anthropometric but not cognitive outcomes. Fortification had limited impact on morbidity symptoms. Evidence of fortification effects on other functional outcomes is scarce.