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Dary O.,Abt Associates | Dary O.,Health-U | Rambelson Z.,Monitoring and Evaluation | De la Cruz V.,Instituto Nacional Of Salud Publica Insp | And 2 more authors.
Annals of the New York Academy of Sciences | Year: 2014

The objective of this work was to present a generic model for estimating fortification contents when several food vehicles are being considered simultaneously. It is based on approximating the magnitude of the nutritional inadequacy of the population (nutrient gap), the optimal use of the combination of food vehicles (fortifiable food energy, FFE), and the upper intake level to decrease the possibility that individuals with the highest combined intake of all food vehicles will exceed it. The model is intended to be used when only per capita food and micronutrient intake information, not detailed food intake data, are available. Food consumption survey data from Mexico and Kampala (Uganda) were analyzed for adult women, assuming that their intake may be similar to general per capita values. General adjustment factors for estimating the lowest and highest FFE and micronutrient intake for satisfying the requirements of other family members were calculated. These factors were used to estimate the additional effective content and the maximum allowable content, and then the recommended nutrient contents at the consumers' level were chosen on the basis of technological compatibility and cost. The method should be used in other contexts to test its validity as well as its application to nonstaple foods. © 2014 New York Academy of Sciences.


Fiedler J.L.,International Food Policy Research Institute | Afidra R.,Flour Fortification Initiative | Mugambi G.,Ministry of Public Health and Sanitation | Tehinse J.,Independent food and nutrition consultant | And 7 more authors.
Annals of the New York Academy of Sciences | Year: 2014

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.19 in Zambia to $4.41 in Uganda. Assuming all incremental costs are passed onto the consumer, fortification in Zambia would result in at most a 0.9% increase in the price of maize flour, and would increase annual outlays of the average maize flour-consuming household by 0.2%. The increases for Kenyans and Ugandans would be even less. Although the coverage of maize flour fortification is not likely to be as high as some advocates have predicted, fortification is economically feasible, and would reduce deficiencies of multiple micronutrients, which are significant public health problems in each of these countries. © 2013 New York Academy of Sciences.


Pachon H.,Flour Fortification Initiative | Pachon H.,Emory University | Kancherla V.,Emory University | Handforth B.,Flour Fortification Initiative | And 2 more authors.
Nutrition Bulletin | Year: 2013

Neural tube defects (NTDs) annually affect an estimated 320 000 newborns worldwide. Folic acid (FA), provided through supplementation and fortification, is an effective primary-prevention strategy for NTDs if consumed in the periconceptional period. However, the potential impact of FA supplementation is tempered by low compliance. Countries that mandate FA fortification of wheat flour report an average reduction of 46% in NTD birth prevalence and favourable benefit : cost ratios of 12-48:1. Despite the well-documented benefits of fortification and the new evidence that provides a better understanding of purported risks associated with FA, European countries have yet to embrace this public health initiative. Viable primary-prevention strategies are needed given that an estimated 4500 NTDs occur in the 27 countries of the European Union annually, of which 72% end in terminations. Many existing factors will facilitate the success of FA flour fortification programs in the region: widespread consumption of wheat-based products, a technologically advanced milling industry, experience adhering to and monitoring food safety measures, and familiarity with mandatory food fortification. © 2013 British Nutrition Foundation Nutrition Bulletin.


Hurrell R.,ETH Zurich | Ranum P.,Micronutrient Initiative | De Pee S.,World Food Programme | Biebinger R.,ETH Zurich | And 3 more authors.
Food and Nutrition Bulletin | Year: 2010

Background: Iron fortification of wheat flour is widely used as a strategy to combat iron deficiency. Objective: To review recent efficacy studies and update the guidelines for the iron fortification of wheat flour. Methods: Efficacy studies with a variety of ironfortified foods were reviewed to determine the minimum daily amounts of additional iron that have been shown to meaningfully improve iron status in children, adolescents, and women of reproductive age. Recommendations were computed by determining the fortification levels needed to provide these additional quantities of iron each day in three different wheat flour consumption patterns. Current wheat flour iron fortification programs in 78 countries were evaluated. Results: When average daily consumption of lowextraction (≤ 0.8% ash) wheat flour is 150 to 300 g, it is recommended to add 20 ppm iron as NaFeEDTA, or 30 ppm as dried ferrous sulfate or ferrous fumarate. If sensory changes or cost limits the use of these compounds, electrolytic iron at 60 ppm is the second choice. Corresponding fortification levels were calculated for wheat flour intakes of < ISOglday and > 300 g/day. Electrolytic iron is not recommended for flour intakes of < I5O g/day. Encapsulated ferrous sulfate or fumarate can be added at the same concentrations as the non-encapsulated compounds. For high-extraction wheat flour (> 0.8% ash), NaFeEDTA is the only iron compound recommended. Only nine national programs (Argentina, Chile, Egypt, Iran, Jordan, Lebanon, Syria, Turkmenistan, and Uruguay) were judged likely to have a significant positive impact on iron status if coverage is optimized. Most countries use non-recommended, low-bioavailability, atomized, reduced or hydrogen-reduced iron powders. Conclusion: Most current iron fortification programs are likely to be ineffective. Legislation needs updating in many countries so that flour is fortified with adequate levels of the recommended iron compounds.


van den Wijngaart A.,Flour Fortification Initiative
Food and nutrition bulletin | Year: 2013

Considerable efforts have been made over the past decade to address vitamin and mineral deficiencies. An increasing number of countries in the Association of Southeast Asian Nations (ASEAN) are adopting mandatory food fortification as one of the primary strategies to overcome these deficiencies. Experience shows that fortified foods can reach large parts of the population, including the poor, if the fortification is done on a mandatory rather than a voluntary basis and if the food vehicle is widely consumed. To review the importance of regulatory monitoring as an essential component of food fortification efforts in selected ASEAN countries, with special focus on the available information on regulatory monitoring systems for iodized salt and fortified wheat flour. The role of regulatory monitoring in strengthening food fortification programs was discussed during a joint regional meeting of the World Health Organization, UNICEF, the Flour Fortification Initiative, the Global Alliance for Improved Nutrition, the Micronutrient Initiative, and the World Bank on regulatory monitoring of salt and wheat flour fortification programs in Asia, which took place in Manila, Philippines, on 27-29 September 2011. This paper reviews the regulatory monitoring systems of selected ASEAN countries that participated in this meeting. Problems and challenges in regulatory monitoring systems for iodized salt and fortified wheat flour in selected ASEAN countries are identified, and a description of the role of regulatory monitoring in strengthening food fortification initiatives, particularly of salt and flour, and highlights of areas for improvement are presented. Regulatory monitoring consists of monitoring activities conducted at the production level, at customs warehouses, and at retail stores by concerned regulatory authorities, and at the production level by producers themselves, as part of quality control and assurance efforts. Unless there are appropriate enforcement and quality assurance mechanisms in place to stimulate compliance by food producers, i.e., regulatory monitoring, having national legislation will not necessarily lead to increased coverage of fortified products and associated outcomes.


Handforth B.,Flour Fortification Initiative | Hennink M.,Emory University | Schwartz M.B.,Yale University
Journal of the Academy of Nutrition and Dietetics | Year: 2013

Food banks are the foundation of the US emergency food system. Although their primary mission is to alleviate hunger, the rise in obesity and diet-related diseases among food-insecure individuals has led some food bank personnel to actively promote more nutritious products. A qualitative interview approach was used to assess nutrition-related policies and practices among a sample of 20 food banks from the national Feeding America network. Most food bank personnel reported efforts to provide more fresh produce to their communities. Several described nutrition-profiling systems to evaluate the quality of products. Some food banks had implemented nutrition policies to cease distributing low-nutrient products, such as soda and candy; however, these policies were more controversial than other strategies. The obstacles to implementing strong nutrition policies included fear of reducing the total amount of food distributed, discomfort choosing which foods should not be permitted, and concern about jeopardizing relationships with donors and community partners. Empirical research is needed to measure how food bank nutrition policies influence relationships with food donors, the amount of food distributed, the nutritional quality of food distributed, and the contribution of food bank products to the food security and nutritional status of the communities they serve. © 2013 Academy of Nutrition and Dietetics.


Dary O.,Abt Associates | Dary O.,Us Agency For International Developments Bureau For Global Health | Afidra R.,Flour Fortification Initiative | Rambeloson Z.,FHI 360
Annals of the New York Academy of Sciences | Year: 2014

Corn flour and maize meal fortification can benefit the consumer when the added nutrient contents are in amounts appropriate to address nutrient gaps. Legislative instruments (standards and regulations) are needed to provide guidance to the producers and food control authorities. We reviewed a number of national standards and regulations of fortified corn flour and maize meal and identified constraints; contrary to current belief, the practice of using minimum contents or ranges of nutrients has caused confusion, misinterpretation, and conflict, and should therefore be abandoned. On the basis of the findings, a model of fortification legislation is proposed, in which the additional content and the expected average nutrient content in a final product are recommended as the main parameters for quality control and enforcement. For labeling, the average content, or one adjusted to the expected content of the product at the market, can be applied. Variation in micronutrient contents should still be checked to ensure homogeneity but with adherence to clear procedures of sampling and testing, which should be part of the standards and regulations. © 2014 New York Academy of Sciences.


PubMed | Flour Fortification Initiative
Type: Journal Article | Journal: Food and nutrition bulletin | Year: 2013

Considerable efforts have been made over the past decade to address vitamin and mineral deficiencies. An increasing number of countries in the Association of Southeast Asian Nations (ASEAN) are adopting mandatory food fortification as one of the primary strategies to overcome these deficiencies. Experience shows that fortified foods can reach large parts of the population, including the poor, if the fortification is done on a mandatory rather than a voluntary basis and if the food vehicle is widely consumed.To review the importance of regulatory monitoring as an essential component of food fortification efforts in selected ASEAN countries, with special focus on the available information on regulatory monitoring systems for iodized salt and fortified wheat flour.The role of regulatory monitoring in strengthening food fortification programs was discussed during a joint regional meeting of the World Health Organization, UNICEF, the Flour Fortification Initiative, the Global Alliance for Improved Nutrition, the Micronutrient Initiative, and the World Bank on regulatory monitoring of salt and wheat flour fortification programs in Asia, which took place in Manila, Philippines, on 27-29 September 2011. This paper reviews the regulatory monitoring systems of selected ASEAN countries that participated in this meeting.Problems and challenges in regulatory monitoring systems for iodized salt and fortified wheat flour in selected ASEAN countries are identified, and a description of the role of regulatory monitoring in strengthening food fortification initiatives, particularly of salt and flour, and highlights of areas for improvement are presented.Regulatory monitoring consists of monitoring activities conducted at the production level, at customs warehouses, and at retail stores by concerned regulatory authorities, and at the production level by producers themselves, as part of quality control and assurance efforts. Unless there are appropriate enforcement and quality assurance mechanisms in place to stimulate compliance by food producers, i.e., regulatory monitoring, having national legislation will not necessarily lead to increased coverage of fortified products and associated outcomes.

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