Importance of Fortification & Fortified Foods
to combat the global burden of disease

By: Deepak Gunvante

Malnutrition is by far the biggest risk factor for the global burden of disease. Every country, every age group and every socio-economic class is impacted. While there are 2 billion people who lack key micronutrients such as Iron and Vitamin A, equally there are 2 billion people who are overweight or obese. WHO and FAO, after years of experience of engaging to tackle micronutrient malnutrition, have concluded that food fortification is the most sustainable public health strategy. However, there is still a long way to go. And this responsibility cannot be and should not be rested only with governments and policy makers or few stakeholdersAfter all, who is better equipped to understand & address the consumer needs than the consumer-focused food & beverage companies?

Malnutrition facts

Over 150 million children under 5 years of age are Stunted#1. And Over 52 million children are Wasted#2. And on the other hand, 41 million children are overweight or obese and this number is only increasing. A staggering 88% of countries face either two or three forms of malnutrition simultaneously.

The economic consequences represent losses of 2% – 5% GDP in low and middle-income countries, whereas preventing malnutrion delivers $16 in returns on investment for every $1 spent.

Annually, 40-60% of children 6-24 months of age in LMIC are at risk of impaired cognitive development due to iron deficiency. Maternal Iodine Deficiency is a cause of 35 million newborns who are intellectually impaired with a potential IQ loss of 7.4 to 15. Deficiency of Vitamin A has been a cause of at least 250000 cases of childhood blindness every year. While all efforts have been on from multi-sectoral involvement to address this ‘Hidden Hunger’, in parallel, there has been an upsurge of obesity and non-communicable diseases (NCD) such as Diabetes, Cardiovascular disease (CVD), Cancer, which is indeed a cause of immense concern.

UN Sustainable Development Goals & Malnutrition

The United Nation Sustainable Development Goals (SDGs) are the blueprint to achieve a better and more sustainable future for all by addressing current global challenges including those related to poverty, inequality, climate, environmental degradation, prosperity, and peace and justice. There are in all 17 SDG’s and these goals are interconnected, with 12 of these having indicators that are highly relevant to Nutrition. In 2015, UN SDG’s have set the target of “ending all forms of malnutrition,” by 2030 for all people, challenging the world to think and act differently on malnutrition.

So far, we are off course to attain targets for nutrition. Anaemia, for example, is declining so slowly that at current rates we will reach the global target closer to 2130 than 2030. Obesity and overweight, far from declining, are on the rise, putting global nutrition milestones at risk.

We will not be able to achieve this, if we continue business as usual. There is a clear sense of urgency & commitment required, by ALL stakeholders.

Micronutrient Deficiency

There is increasing evidence of a common thread running through all forms of malnutrition – and that is of micronutrient deficiency.

The importance of right nutrition during the first 1000 days of life can never be underestimated – between a woman’s pregnancy and her child’s second birthday. This provides a unique period of opportunity when the foundations for optimum health and development across the lifespan are established.

Approximately one third of children under the age of 3 are stunted, a reflection of chronic malnutrition in first 1000 days. It is known that micronutrient malnutrition causes stunting. The effects of stunting last a lifetime, leading to impaired brain development, lower IQ and weakened immune systems. And as paradoxical as it may seem, there is growing evidence that stunting predisposes individuals toward later obesity & greater risk of NCD’s in later life.

Separately, review of studies amongst overweight & obese children has shown that Iron deficiency is associated significantly with overweight and obesity in children. Also, micronutrient deficiencies are found to be very common among adults who are obese, with vitamin D deficiency being the most prevalent one. Other common deficiencies observed in overweight and obese adults are Calcium, magnesium, vitamin B6 & Iron.

Vitamin D deficiency is also associated with increased insulin resistance, thus correlated with people with Type 2 Diabetes Mellitus (T2DM). There is clinical evidence supporting other deficiencies including Chromium, Biotin, Thiamine and Vitamin C in T2DM & Obese individuals.

Vitamin K2 has emerged as an important nutrient. Vitamin K2 has been shown to reduce the risk of T2DM. Furthermore, studies appear to show that vitamin K2 is promising in the areas of cancer and osteoarthritis.

Reviews have concluded that deficiencies in key antioxidant micronutrients tend to promote oxidative stress, creating an environment in which the incidence and severity of diseases such as diabetes, CVD, and cancer are increased.

Thus, it may be fair to summarize that micronutrient deficiencies are not only inherent in different forms of malnutrition but in fact some of these deficiencies tend to exacerbate the risk of NCDs.

Call to Action

Considering that there is a huge task at hand of addressing malnutrition in all its forms, micronutrient fortification clearly is a very important pillar in this endeavor.

WHO and FAO, after years of experience of engaging to tackle micronutrient malnutrition, have concluded that food fortification is the most sustainable public health strategy because it can reach wider at-risk populations through existing food delivery systems without requiring major changes in existing consumption patterns. This intervention has yielded very good and sustained results e.g. universal Salt Iodization has led to the prevention of as many as 750 million cases of goitre in the past 25 years. The cost benefit ratio has far out-weighed the investment, besides our collective ethical responsibility. Nobody deserves to suffer due to micronutrient deficiencies.

However, there is still a long way to go. And this responsibility cannot be and should not be rested only with governments and policy makers or few stakeholders. As the scale of malnutrition is mind boggling, it is time for all food manufacturers and marketers to step up and be an integral part of the solution, partnering with relevant stakeholders, through appropriate fortification of packaged foods aligning with the micronutrient deficiencies of the target segment.

After all, who is better equipped to understand & address the consumer needs than the consumer-focused food & beverage companies? They only need to take that extra effort of building in appropriate fortification by understanding the micronutrient deficiencies of their product specific target segments (whose behavior & lifestyle they already understand the best). This can potentially make a world of difference to the lives of consumers in the long run. And this can surely be a very important step in our war against malnutrition.

*1: Stunted:  “height for age” value less than two standard deviations of the WHO Child Growth Standards median
*2: Wasted:  “weight for height” value less than two standard deviations of the WHO Child Growth Standards median

Are you interested in learning more about the important topic of fortfication? On Septemebr 11, Deepak Gunvante will lead a seminar on Fortification opportunities between 11.00-13.15 at Vitafoods Asia in Singapore.

Moreover;  don’t miss the opportunity to meet up for a discussion with HMT during Vitafoods Asia to find the opportunities for YOUR BRAND to make this happen. You will find us at stand F37 in the Industry Advice Zone.

The Author:

Deepak Gunvante
Expert Consultant (APAC Region) & Partner for India
The Healthy Marketing Team
Singapore