October 04, 2016

05/10/2016: Grain fortification, birth defect estimates highlight two key growth areas

by Sarah Zimmerman, Food Fortification Initiative

In 2015, an estimated 35,500 serious birth defects of the spine and brain were prevented because wheat and maize flours were fortified with folic acid, according to research published in July 2016.

While the figures above are a tremendous accomplishment, the study noted that the total only represents 13.2 percent of the birth defects that could be prevented by adding folic acid to grain products.

“The difference between what is being done and what could be done points out two areas for growth related to flour fortification – increasing political support for fortification and monitoring for quality and compliance,” said Scott J. Montgomery, Director of the Food Fortification Initiative (FFI).
  “As we make progress in each of these areas, more children will be born healthy. And, as flour fortification usually includes iron, we’ll greatly reduce the risk of anemia from iron deficiency.”


Folic acid is a form of vitamin B9 used in flour fortification. Its color does not affect flour’s sensory properties, and the nutrient content is stable when exposed to heat.

Women who have enough folic acid prior to conception and in the early days of their pregnancy are less likely to have infants with neural tube defects (NTDs) of the spine such as spina bifida.

Infants born with anencephaly, another NTD affecting the brain, die shortly after birth.
Anemia is defined as low hemoglobin. It causes debilitating fatigue, which reduces productivity.

Anemia also keeps children’s minds from developing fully which limits their future earning potential.

Anemia while women are pregnant creates multiple risks for the mothers and the infants.

Iron deficiency is the single most common cause of anemia.

Increasing Political Support
Most countries in the Americas have fortified wheat flour with iron for decades, and folic acid was added 20 years ago.

Several countries in the Middle East began fortifying flour in the late 1990s. Countries in Africa are adapting fortification, and maize flour and rice are beginning to be fortified as well. But countries in Europe and Asia are fortifying very little of their cereal grain products.

To make progress in those regions, policy makers will need to be convinced of the value of fortification.

Fortification is a long-term process to improve nutrition. Some of the health problems it addresses, such as anemia, are invisible.

As a result, it can be difficult to convince politicians to introduce and support legislation for fortification. Governments also need to provide the human and financial resources required for regulatory monitoring.

Cost effectiveness is the message most likely to motivate policy makers, according to an advocacy working group formed in 2015 in response to a Global Summit on Food Fortification.

The working group included representatives from FFI, the Global Alliance for Improved Nutrition (GAIN), the International Federation for Spina Bifida, the Iodine Global Network, and the Bill and Melinda Gates Foundation.

For governments, fortification represents a significant savings in healthcare dollars. This is particularly true with spina bifida. In the United States, fortifying wheat flour, maize flour, and rice with folic acid has reduced the number of live-born infants with spina bifida by at least 614 annually.

Infants born with spina bifida will undergo a lifetime of surgeries and face many health issues. Consequently preventing spina bifida by fortifying grains in the US represents a net savings of US$ 603 million annually.

When anemia is prevented, people are more productive and children are more successful in school. One study found that fortification yields $84 for every dollar spent on reducing iron deficiency anemia prevalence.

“We recognise that millers usually the buy premix for fortification, while the government or insurance program enjoys the savings from averted  healthcare expenditures,” Montgomery noted.

“We always encourage governments to exempt premix from import taxes to give millers a little financial relief. We also encourage countries to make fortification mandatory to make the costs equitable among millers.”

Read the full article HERE.

The Global Miller
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which is published by Perendale Publishers Limited.

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