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Arimond M.,University of California at Davis | Zeilani M.,Nutriset S.A.S. | Jungjohann S.,Global Alliance for Improved Nutrition | Brown K.H.,University of California at Davis | And 4 more authors.
Maternal and Child Nutrition | Year: 2015

The International Lipid-Based Nutrient Supplements (iLiNS) Project began in 2009 with the goal of contributing to the evidence base regarding the potential of lipid-based nutrient supplements (LNS) to prevent undernutrition in vulnerable populations. The first project objective was the development of acceptable LNS products for infants 6-24 months and for pregnant and lactating women, for use in studies in three countries (Burkina Faso, Ghana and Malawi). This paper shares the rationale for a series of decisions in supplement formulation and design, including those related to ration size, ingredients, nutrient content, safety and quality, and packaging. Most iLiNS supplements have a daily ration size of 20g and are intended for home fortification of local diets. For infants, this ration size is designed to avoid displacement of breast milk and to allow for dietary diversity including any locally available and accessible nutrient-dense foods. Selection of ingredients depends on acceptability of flavour, micronutrient, anti-nutrient and essential fatty acid contents. The nutrient content of LNS designed to prevent undernutrition reflects the likelihood that in many resource-poor settings, diets of the most nutritionally vulnerable individuals (infants, young children, and pregnant and lactating women) are likely to be deficient in multiple micronutrients and, possibly, in essential fatty acids. During ingredient procurement and LNS production, safety and quality control procedures are required to prevent contamination with toxins or pathogens and to ensure that the product remains stable and palatable over time. Packaging design decisions must include consideration of product protection, stability, convenience and portion control. © 2015 John Wiley & Sons, Ltd.

Oddo V.M.,Mathematica Policy Research Inc. | Rah J.H.,In.Sight | Semba R.D.,Johns Hopkins University | Sun K.,Johns Hopkins University | And 6 more authors.
American Journal of Clinical Nutrition | Year: 2012

Background: Many developing countries now face the double burden of malnutrition, defined as the coexistence of a stunted child and overweight mother within the same household. Objective: This study sought to estimate the prevalence of the double burden of malnutrition and to identify associated maternal, child, and household characteristics in rural Indonesia and Bangladesh. Design: A total of 247,126 rural households that participated in the Indonesia Nutrition Surveillance System (2000-2003) and 168,317 rural households in the Bangladesh Nutritional Surveillance Project (2003-2006) were included in the analysis. Maternal and child double burden (MCDB) and its association with individual and household characteristics were determined by using logistic regression models. Results: MCDB was observed in 11% and 4% of the households in rural Indonesia and Bangladesh, respectively. Maternal short stature [Indonesia (OR: 2.32; 95% CI: 2.25, 2.40); Bangladesh (OR: 2.11; 95% CI: 1.96, 2.26)], and older age were strong predictors of MCDB. Child characteristics such as older age and being female were associated with an increased odds of MCDB, whereas currently being breastfed was protective against MCDB [Indonesia (OR: 0.84; 95% CI: 0.81, 0.84); Bangladesh (OR: 0.55; 95% CI: 0.52, 0.58)]. A large family size and higher weekly per capita household expenditure predicted MCDB [Indonesia (OR: 1.34; 95% CI: 1.28, 1.40); Bangladesh (OR: 1.94; 95% CI: 1.77, 2.12)]. Conclusions: Double burden is not exclusive to urban areas. Future policies and interventions should address under- and overweight simultaneously in both rural and urban developing country settings. © 2012 American Society for Nutrition.

Pelto G.H.,Cornell University | Martin S.L.,Cornell University | Van Liere M.,Global Alliance for Improved Nutrition | Fabrizio C.S.,Global Health Associates
Maternal and Child Nutrition | Year: 2016

We describe features of the landscape of behaviour change communication (BCC) practice devoted to infant and young child feeding (IYCF) in low- and middle-income countries by practitioners in international development organizations. We used an iterative, snowball sampling procedure to identify participants, and the self-administered questionnaire contained pre-coded questions and open-ended questions, relying primarily on content analysis to derive generalizations. Highlights of findings include (i) IYCF-specific BCC is usually delivered within the context of other public health messages and programmes; (ii) technical assistance with programme development and implementation are primary activities, and evaluation-related work is also common; and (iii) formative research and evaluation is universal, but process evaluation is not. With respect to scaling up nutrition: (i) use of mass media and digital technology generally play only a minor role in BCC activities and are not currently an integral part of BCC programming strategies and (ii) only 58% of the participants report activities related to communication with policy makers. The individuals who comprise the community of BCC leaders in the area of IYCF are a diverse group from the perspective of academic backgrounds and nationalities. In addition to nutrition, public health, agriculture and adult learning are common disciplinary backgrounds. In our view, this diversity is a source of strength. It facilitates continuing growth and maturation in the field by assuring inputs of different perspectives, theoretical orientations and experiences. © 2016 John Wiley & Sons Ltd.

Pelto G.H.,Cornell University | Armar-Klemesu M.,University of Ghana | Siekmann J.,Global Alliance for Improved Nutrition | Schofield D.,Global Alliance for Improved Nutrition
Maternal and Child Nutrition | Year: 2013

The concept of a focused ethnographic study (FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts (Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children (IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements (LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities. © 2012 Blackwell Publishing Ltd.

Fabrizio C.S.,Global Health Associates | van Liere M.,Global Alliance for Improved Nutrition | Pelto G.,Cornell University
Maternal and Child Nutrition | Year: 2014

As stunting moves to the forefront of the global agenda, there is substantial evidence that behaviour change interventions (BCI) can improve infant feeding practices and growth. However, this evidence has not been translated into improved outcomes on a national level because we do not know enough about what makes these interventions work, for whom, when, why, at what cost and for how long. Our objective was to examine the design and implementation of complementary feeding BCI, from the peer-reviewed literature, to identify generalisable key determinants. We identified 29 studies that evaluated BCI efficacy or effectiveness, were conducted in developing countries, and reported outcomes on infant and young children aged 6-24 months. Two potential determinants emerged: (1) effective studies used formative research to identify cultural barriers and enablers to optimal feeding practices, to shape the intervention strategy, and to formulate appropriate messages and mediums for delivery; (2) effective studies delineated the programme impact pathway to the target behaviour change and assessed intermediary behaviour changes to learn what worked. We found that BCI that used these developmental and implementation processes could be effective despite heterogeneous approaches and design components. Our analysis was constrained, however, by the limited published data on how design and implementation were carried out, perhaps because of publishing space limits. Information on cost-effectiveness, sustainability and scalability was also very limited. We suggest a more comprehensive reporting process and a more strategic research agenda to enable generalisable evidence to accumulate. © 2014 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.

News Article | December 1, 2016
Site: www.bbc.co.uk

Global food policy needs to shift way from focusing on feeding people calories to nourishing people with healthy diets, say leading experts. They state that poor diets were responsible for more of the global health burden than sex, drugs, alcohol and tobacco combined. While almost 800 million people are hungry, they say two billion people are either overweight or obese. Their comments have been published in the journal Nature. One of the experts, Lawrence Haddad, executive director of the Global Alliance for Improved Nutrition (Gain), said the need to address the problem of global hungry remained but poor diets was a much bigger problem. "It is one that we are blind to," explained Mr Haddad. "We estimate that on-in-three people have really poor diets," he told BBC News. "This is causing a whole host of malnutrition problems that has massive health consequences as well as economic consequences. "We are saying to people, especially policymakers and research funders, we now need to move away from a world thinking about malnutrition as hunger but to think of it as hunger and poor quality of diet. "Instead of feeding the world, we need to think about nourishing the world." Mr Haddad and colleagues, including former UK government's chief scientific adviser Prof Sir John Beddington, used the commentary in Nature to call for "urgent interdisciplinary research is needed to support concerted policy action". In another commentary in Nature, UN goodwill ambassador Pavan Sukhdev and fellow authors highlighted how current production and consumption patterns were not sustainable. "Food systems are now the source of 60% of terrestrial biodiversity loss, 24% of greenhouse emissions, 33% of soil degradation and 61% of the depletion of commercial fish stocks," they wrote. "And the increasing homogenisation of food sources worldwide is narrowing the genetic diversity in animals and plants that is crucial to secure human nutritional needs against climatic and other changes." They add that the agriculture sector was a globally significant player economically, employing about 1.3 billion people. "Small-scale agriculture provides subsistence, employment and most of the food directly consumed by urban residents throughout the developing world," they observed. They warned that current metrics for agriculture did not take into account the sector's costs and benefits. "The emphasis on yields or profits per hectare is as reductive and distorting as is gross domestic product, with its disregard for social and natural capital," they wrote. "Food metrics must be urgently overhauled or the UN's Sustainable Development Goals (SDGs) will never be achieved." Adopted in September 2015, the UN SDGs replaced the international Millennium Development Goals and included targets to end world hunger, and improve wellbeing and health of the global population. Mr Haddad said that improving "food metrics" would be one of the first things he would look to improve in order to shift global food policy on to a sustainable footing. "Diet data is abominable," he said. "We only have a clue that our diets are so terrible is because of the outcomes, because there is so much micronutrient malnutrition and calorie deficiency, and obesity. "We have some diet data and it does not tell us a great story." He added: "If policymakers are really going to figure out what is going to be the first, second or third thing they are going to do then they are going to need some good data to carry out some diagnostic work." Writing in Nature, Mr Haddad and his colleagues said: "Policymakers urgently need to recognise that diets are compromising economic productivity and well-being as never before. Delegates to the upcoming G20 and G7 meetings in 2017 should take collective responsbility for fixing our failing food system."

News Article | November 30, 2016
Site: www.nature.com

Around 57 of the 129 countries that have data on undernutrition and obesity are struggling with both1. Everywhere, the consumption of vegetables, legumes, fish, nuts, seeds and fruits is much below that recommended by the World Health Organization (WHO). Meanwhile, people are consuming too much fat, processed meat, salt and sugary drinks. Global food systems are failing to keep us all fed, let alone healthy. How food is grown, distributed, processed, marketed and sold determines which foods are available, affordable and desirable. These factors have a crucial role in the quality of people's diets, and hence play a vital part in health. Diet is the number one risk factor in the global burden of disease2. Poor diets are responsible for more of the global burden of ill health than sex, drugs, alcohol and tobacco combined. In the next few decades, food systems will be under further stresses from population and income growth, urbanization, globalization, climate change and increasingly scarce natural resources. Although 795 million people are undernourished and lack essential vitamins and minerals3, obesity is behind many of the chronic diseases that are sweeping the globe, from type 2 diabetes to heart disease. One in three people is malnourished. Almost one-quarter of children under five have stunted growth, with diminished physical and cognitive capacities. Across Africa and Asia, the impact of undernutrition on gross domestic product is 11% annually1. At the same time, 2 billion adults worldwide — more than 1 in 4 — are overweight or obese. This is not a problem that countries can overcome through growth or development. As economies expand, many social factors improve, but the quality of diets does not. Hunger and famine have fallen substantially, thanks to rapid poverty reduction and rising agricultural productivity. But progress remains too slow in many respects. Moreover, middle- and low-income countries are now following the well-worn, highly damaging path from undernutrition to obesity. The efforts required from the international community are equivalent to those marshalled to tackle HIV/AIDS, malaria and smoking. In particular, urgent interdisciplinary research is needed to support concerted policy action. That is our conclusion from compiling a report commissioned by the Global Panel on Agriculture and Food Systems for Nutrition and published in September4. It includes a call to scientists, governments and donors to work out how to craft and sustain food systems to provide nutritious diets for all. As the United Nations Food and Agriculture Organization (FAO) and the WHO meet to discuss the UN's Decade of Action on Nutrition in Rome this week, researchers, governments, industry experts and funders must commit to meeting these challenges — which are inextricably knitted with the Sustainable Development Goals, especially goal 2 (zero hunger) and goal 3 (good health and well-being). Piecemeal action will not do: the trends are so large and interconnected that the entire food system needs overhauling. No single government ministry or sector 'owns' the quality of diets available to the consumer. The lack of well-defined public-sector responsibility in many countries is all too clear. Here we set out a new global research agenda for nutrition. It is aimed mainly at researchers, funders and governments, but has important messages for all stakeholders. Identify entry points for change. Food systems are dynamic; they comprise production, storage, transport and trade, processing, transformation and retail and the interactions between these. We need to understand how each part of the system can contribute in an integrated way to making high-quality diets more available, affordable and appealing. For example, how can we reduce food spoilage in storage, minimize nutrient losses during transformation and improve food quality with minimal processing? Studies should involve multi-country and site-specific appraisals, qualitative research and mapping, and thorough analyses of value chains. Donors and funders should promote initiatives that are interdisciplinary, involve consumers and policymakers, and analyse which incentives cause actors in the food system to behave differently. Make more data on diets widely available. It is currently difficult to compare diets across cultures, geographies and time. This has hampered a global consensus on what constitutes a healthy diet. A pilot project — the FAO/WHO Global Individual Food consumption data Tool (FAO/WHO GIFT; see go.nature.com/faogift) — aims to answer some elements, but has too few resources to be truly effective. The project needs a larger team to collate many more national surveys and develop guidelines for future surveys. Other initiatives include the Global Dietary Database project and a proposed World Gallup Poll initiative to include questions on diet quality. Such efforts are poorly funded and piecemeal. What is needed are open-access portals for diet data, such as the WHO's global database on child malnutrition. This incorporates hundreds of surveys of child heights and weights, and has proved invaluable for documenting progress and holding stakeholders accountable. Agree on what constitutes a healthy diet. People do not choose nutrients, they select combinations of foods in differing amounts. Pairings of single foods and diseases are the basis of risk-factor analysis in global burden studies, but tell us little about diets as a whole. Although there are studies on the value of, say, the Mediterranean diet, there are few from low-income countries. And even the nutritional profile of many important indigenous foods remains poorly known. A better understanding of dose–response relationships is needed. Is it better to eat a little of each food category frequently, or a large amount less often? Food researchers need to be more creative and research funders bolder in assessing the health implications of common combinations of foods. Tackle different forms of malnutrition simultaneously. Credible information on what works to reduce both undernutrition and obesity (and related diseases) is essential if governments and industry are to scale up investments aimed at improving diets. Successful programmes that tackle undernutrition tend to be on a small scale5. Evidence on how to address unhealthy diets associated with obesity are often population-based and thus harder to evaluate. There is analysis on the effect of interventions to improve the availability, affordability and appeal of food, such as taxes, school-food standards and nutrition labelling6. But the impact of these on population subgroups or on obesity is little studied. The most serious gap concerns interventions farther back in the food system, such as standards and new incentives for more-effective transport and retail of nutritious foods (see also 'Identify entry points for change'). Understand the role of chain length. In 'short-chain' models, food passes directly from those who grow or rear it to those who eat it, such as in subsistence-farming contexts, at farmers' markets, or where school-meals programmes source food from family farms. In 'long-chain' systems, foods travel great distances or go through multiple transactions to reach consumers. What combination of these systems ensures high-quality diets — enough of the right kind of food at the right price, for all? Research must probe sustainability concerns, such as how to reduce food waste and greenhouse-gas emissions, and investigate the social and economic benefits of different types of system (see also 'Fix metrics'). Analyse business incentives. Apart from consumers, the most numerous stakeholders in global food systems are private entities — from farmers to food processors, wholesalers and retailers. In 2015, just 4 of the top 25 food and drinks firms made one-third of the total sales. Thus, the private sector could help to tilt food systems towards higher-quality diets, and could respond innovatively to targets and regulations. We need to understand what incentives will tip these levers in a healthier direction. We need better mechanisms for public–private dialogue to shape and implement research priorities. Collaborations between competitors during the early development of commercial products could shift sectors collectively and overcome disincentives for single firms to act in isolation. One such example hosted by the Global Alliance for Improved Nutrition is a programme called Business Platform for Nutritious Research, which seeks to substantially increase business investments in nutritious products and services by addressing evidence gaps that limit companies' willingness and ability to make such investments. To strengthen accountability, research is needed on which public–private partnerships improve diets most. Such research exists in the health field7. Account for climate. Global warming will affect the availability of different foods from land and sea, and their nutritional value. Diet changes will also drive significant shifts in land and water use and in greenhouse-gas emissions8. How might diversification of local food systems address agricultural resilience and nutritional diversity? The consumption of some of the most micronutrient-dense foods — including fruits, vegetables and animal proteins — must be increased in poor communities, but such foods place substantial demands on environmental resources. Research on less-polluting production of these, in the context of rapidly changing livestock systems, is crucial. Research could also identify ways of achieving big wins for environments and diets. Evidence suggests, for instance, that the adoption of WHO guidance on healthy diets could reduce global mortality by 6–10% and food-related greenhouse-gas emissions by 29–70% compared with a reference scenario in 2050 (ref. 9). Study supply and demand. The availability of food is influenced by consumer preferences, relative prices and supply. Processed foods and sugar-laden beverages are found in remote areas of Nepal and Ethiopia; a choice of vegetables, fruits and fish is not. In part, this is because investment in improving the production and availability of agricultural commodities has for decades been focused on a small number of cereals. Funding in global public-sector research institutions is still focused mostly on rice, wheat, maize (corn) and other grains. About 45% of private-sector agricultural research investment is on maize10. Public and private research on neglected nutritious commodities — including fruits and vegetables such as mangoes, carrots and spinach, pulses such as lentils, fish products and seeds and nuts — needs to increase with a focus on their yield and resilience to pests, diseases and climate change. This is an important message for the global research community, broadly led by the Consultative Group on International Agricultural Research (CGIAR). Donors should support the CGIAR's 2014 commitment to mainstreaming nutrition in all crop-breeding programmes, and its attempts to direct more research to healthy agriculture and food systems. Promoting supply has to be coupled with promoting demand. More research is needed to educate, inform and encourage consumers to make positive choices for healthful diets — in low- and high-income settings. Identify the economic levers for change. Every US$1 spent on successful nutrition programmes offers roughly $16 of benefits1. But we do not know enough about where in the food system we should invest in any one policy, regulation or programme to generate the largest net pay-offs. Policymakers in many countries, including Indonesia, Rwanda and Peru, are calling for such evidence. The economic gains from improving the food system and diet quality must be calculated for different sectors and sub-systems under various scenarios — increased demand, climate change, industry innovation and shifts in consumer preferences. Fix metrics. Raising diet quality through food systems cannot be at the expense of other Sustainable Development Goals. Calls to price the 'real' cost of water consumption or carbon production have promoted understanding of the economic externalities of individual and government choices. We need the same approach for diets. We must be able to answer questions such as how the overall benefits and costs of consuming locally sourced fruits and vegetables compares with importing them. The relationship between health, energy use, water use and greenhouse-gas emissions involves trade-offs, but the variety of foods in each category means there is great scope for finding wins — if fine-grained analyses are done. We urgently need effective methods for measuring both the sustainability and nutritional value of diets. Current work on the carbon footprints of commodities should be extended to analyses of the whole food system. Also essential is transparent annual accounting of what countries are doing to improve different points in the food system and with what effect. There is a real opportunity for the FAO, African, Asian and Latin American development banks and the World Bank to develop scorecards to track how nutrition-sensitive national urban and rural food systems are. The era of commodity research aimed at feeding a starving world is over. A new era has begun that requires us to nourish everyone in ways that can be sustained environmentally, economically and culturally. Policymakers urgently need to recognize that diets are compromising economic productivity and well-being as never before. Delegates to the upcoming G20 and G7 meetings in 2017 should take collective responsibility for fixing our failing food system. Funders who support agriculture and nutrition research must focus much more of their resources accordingly, doubling their current allocations to more-nutritious food systems by 2020. Scholars and journals must become more pluralistic in the methods and approaches that they support. We can only fix problems in our food systems if we diagnose them correctly. If we do not, the world's future health and economic problems will be very much greater than they are today.

Wieringa F.T.,IRD Montpellier | Laillou A.,United Nations Childrens Fund | Guyondet C.,United Nations Childrens Fund | Jallier V.,Global Alliance for Improved Nutrition | And 2 more authors.
Annals of the New York Academy of Sciences | Year: 2014

Fortified rice holds great potential for bringing essential micronutrients to a large part of the world population. However, it is unknown whether differences in cooking methods or in production of rice premix affect the final amount of micronutrient consumed. This paper presents a study that quantified the losses of five different micronutrients (vitamin A, iron, zinc, folic acid, and vitamin B12) in fortified rice that was produced using three different techniques (hot extrusion, cold extrusion, and coating) during cooking and five different cooking methods (absorption method with or without soaking, washing before cooking, cooking in excess water, and frying rice before cooking). Fortified rice premix from six different producers (two for each technique) was mixed with normal rice in a 1:100 ratio. Each sample was prepared in triplicate, using the five different cooking methods, and retention of iron, zinc, vitamin A, vitamin B12, and folic acid was determined. It was found that the overall retention of iron, zinc, vitamin B12, and folic acid was between 75% and 100% and was unaffected by cooking method, while the retention of vitamin A was significantly affected by cooking method, with retention ranging from 0% (excess water) to 80% (soaking), depending on the cooking method and producer of the rice premix. No systematic differences between the different production methods were observed. We conclude that different cooking methods of rice as used in different regions of the world do not lead to a major loss of most micronutrients, with the exception of vitamin A. The factors involved in protecting vitamin A against losses during cooking need to be identified. All production techniques of rice premix yielded similar results, showing that coating is not inferior to extrusion techniques. Standard overages (50%) for vitamin B12 and folic acid are too high. © 2014 New York Academy of Sciences.

Bhagwat S.,Global Alliance for Improved Nutrition | Gulati D.,Global Alliance for Improved Nutrition | Sachdeva R.,Global Alliance for Improved Nutrition | Sankar S.,Global Alliance for Improved Nutrition
Asia Pacific Journal of Clinical Nutrition | Year: 2014

The burden of micronutrient malnutrition is very high in India. Food fortification is one of the most cost-effective and sustainable strategies to deliver micronutrients to large population groups. Global Alliance for Improved Nutrition (GAIN) is supporting large-scale, voluntary, staple food fortification in Rajasthan and Madhya Pradesh because of the high burden of malnutrition, availability of industries capable of and willing to introduce fortified staples, consumption patterns of target foods and a conducive and enabling environment. High extraction wheat flour from roller flour mills, edible soybean oil and milk from dairy cooperatives were chosen as the vehicles for fortification. Micronutrients and levels of fortification were selected based on vehicle characteristics and consumption levels. Industry recruitment was done after a careful assessment of capability and willingness. Production units were equipped with necessary equipment for fortification. Staffs were trained in fortification and quality control. Social marketing and communication activities were carried out as per the strategy developed. A state food fortification alliance was formed in Madhya Pradesh with all relevant stakeholders. Over 260,000 MT of edible oil, 300,000 MT of wheat flour and 500,000 MT of milk are being fortified annually and marketed. Rajasthan is also distributing 840,000 MT of fortified wheat flour annually through its Public Distribution System and 1.1 million fortified Mid-day meals daily through the centralised kitchens. Concurrent monitoring in Rajasthan and Madhya has demonstrated high compliance with all quality standards in fortified foods.

De-Regil L.M.,World Health Organization | Pena-Rosas J.P.,World Health Organization | Laillou A.,Global Alliance for Improved Nutrition | Moench-Pfanner R.,Global Alliance for Improved Nutrition
Annals of the New York Academy of Sciences | Year: 2014

Fortification of staple foods and commonly used condiments with vitamins and minerals has been considered one of the most cost-effective interventions to prevent and control micronutrient deficiencies. Because of its wide local consumption, acceptability, reach, and quantum of consumption, rice (Oryza sativa) far exceeds the requirements of a staple food vehicle that can be considered for fortification purposes at a population-level intervention. The World Health Organization (WHO) has the mandate to develop evidence-informed guidelines for the fortification of staple foods as a public health intervention, including rice fortification with micronutrients. The WHO, in collaboration with the Global Alliance for Improved Nutrition (GAIN), convened a consultation on "Technical Considerations for Rice Fortification in Public Health" in Geneva, Switzerland on October 9-10, 2012 to provide technical inputs to the guideline development process, particularly with reference to feasibility and implementability. The industrial and regulatory technical considerations in rice fortification, as well as the considerations for implementing it as a public health strategy and assuring equitable access and universal coverage, were reviewed in this consultation. This paper summarizes the discussions and priority research areas for the forthcoming years. © 2014 The New York Academy of Sciences The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

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