Need for micronutrient fortification in India
Modern India is a fast-growing economy, with progress in many aspects of life. This includes fulfillment of the basic needs of food, clothing and shelter for many Indians. However, particularly in marginalised communities, the NFHS-4 and CNNS data show significant poor health status of infants, children, adolescents and women in India, primarily due to deficient diets.
Micronutrients such as iron, zinc, iodine, selenium, copper, and vitamin A, B2, B6, B9, B12, C and D are of known health importance. Micronutrient deficiencies can have grave implications on the well-being of an individual as well their progeny (result of malnourished deficient mothers). Vitamin A and B9 deficiencies in pre and during pregnancy can cause neural tube defects and night-blindness, respectively in progeny. During our field study the tribal areas of Palghar district, Maharashtra the malnutrition status and micronutrient deficiencies in adolescent girls (future-mothers-to-be) were found to have strong link to higher incidents of infant mortality rates.
The scanty accessibility, knowledge and affordability cause deficiencies among rural or poor population. The Niti Aayog and UNICEF emphasise on addressing micronutrient deficiencies through various strategies and plans. Interventions from governmental and non-governmental bodies have improved the situation; however, it is a long way ahead. This necessitates micronutrient fortified diets to tackle malnutrition countrywide.
Current fortification techniques
Food fortification either voluntary or mandatory is a promising way to reach out to the target population. It is a century old-practice, initiated by developed countries followed by developing countries to fortify salt, rice, wheat flour or oil with iron, iodine, folate, niacin and so on. Micronutrient fortified milk, flour, salt and edible oil are available in India. Following are some of the challenges that call for different techniques in micronutrient fortification:
Staple chosen for fortification- Dietary patterns change with region in India, staple cereal/millet flour chosen is crucial for acceptability and consumption
Minimal interaction between staple-micronutrient- Eg., Iron-fortified salt could cause oxidation of food
Minimal effect of staple processing i.e,. cooking losses of folate, niacin content during
chapatti, bread making
Masking off-taste, colour of micronutrient- Iron is a crucial micronutrient as 53% of Indian women (15-49 years) suffer from anaemia, albeit its off-taste affects acceptability
Novel and upcoming techniques of micronutrient fortification
Micro- and nano-encapsulation has been practised widely in pharmaceutical and nutraceuticals sector for delivery of drugs and bioactives. The cost-effective techniques of spray drying or spray-cooling for water- or oil-soluble vitamins, respectively can be effectuated at industrial scale using micronencapsulation.
Co-encapsulation of two or more vitamins in a single matrix is another method to formulate multi-vitamins. Indigenously produced wall materials such as gum acacia, modified starches, guar gum, oils can be used in co-encapsulation of water- and oil-soluble vitamins in one-go. These can fortify the desired foods. The advantage of encapsulation is reduction in loss during cooking of fortified premix/flour, thus improving availability.
Encapsulation and conjugation of iron and various other minerals has also been researched to mask the off-taste, improve stability, and decrease interactions with other components in the matrix. Minerals such as iron, calcium and zinc conjugated with organic or amino acids have demonstrated better bioavailability. Such conjugated minerals can be added to staples to mask taste, improve stability and subsequently enhance absorption in body after ingestion. Hence, more research needs to be focussed at developing such more bioavailable forms of micronutrients in cost-effective manner to cater to these specific needs.
The low acceptability of certain micronutrient fortified foods being served to specific population is also a reason for prevalence of deficiencies. This indicates the need for culture- centric food approach. Fortifying culture-centric foods will have minimal impact on daily dietary pattern of the people and will improve acceptability.
Preparing premixes of culture-centric foods that have been fortified with micronutrients in above-mentioned manner can lead to highly probable improvements. Indigenous foods such as ambil, vadi, crepes, upma, bhakari, sattu, dried-fish powder can be selected for the same. Premixes can be formulated and fortified with micronutrients. Most indigenous foods are prepared locally from available cereals, millets or legumes. Substituting with more legume or millets in diet can simultaneously help address protein and mineral needs. Bhakari is generally prepared from rice or sorghum and partial substitution with moong or soy flour will improve protein intake.
Sprouting and malting are age-old processing techniques that improve taste and vitamin B-complex content of cereals, legumes and millets, reduce content of anti-nutritional factors such as phytates, oxalates to improve bioavailability of minerals. These processing techniques should hence be considered before fortifying with minerals.
Initial costs of setting decentralised processing units involve incorporating mixing equipment, raw materials, achieving and maintaining quality control, and sustaining, monitoring and distribution systems are some challenges.
Thus, premix formulations targeting specific populations, pan-India, need to consider culture-inclination, malted flours to reduce anti- nutritional factors and encapsulated micronutrients for an overall better implementation of proposed methodology. The social responsibility cells and various non-profit organisations can take up such activities in collaboration with researchers to understand feasibility of techniques in bringing about a significant improvement in the micronutrient status of current Indian population and generations to come.
(Shah is professor and Nirali is post-doctoral and Pujari is Ph D student at CTARA, IIT Bombay, Mumbai. They can be contacted at prof.narendra.shah@gmail.com)