New Delhi: Last week, civil society groups raised an alarm over the Modi government’s massive push to supply iron-fortified rice under its public food schemes.
The Right to Food Campaign and policy advocacy group Alliance for Sustainable and Holistic Agriculture have warned that a major concern relating to mass fortification is that it puts patients suffering from thalassemia and sickle cell disease at risk of an iron overload, which can cause damage to the heart, the liver and the endocrine system.
A statement issued on 22 August by these groups said: “Iron-fortified foods are contra-indicated for other conditions too, including acute infections, acute malnourishment, certain stages of malaria and tuberculosis, or even diabetes.”
It also said that there are no checks in place to ensure that patients suffering from the above diseases do not consume iron-fortified rice which is usually sold in unpackaged form.
Anura V. Kurpad, former head of the department of physiology at St John’s Medical College, Bengaluru, and a fellow of the Royal College of Physicians, London, told ThePrint, “Ideally, India should implement targeted programmes [such as providing iron tablets to pregnant and lactating mothers], to give iron to those who need it…But the entire population, or even half of them, do not need it.”
The problem, he explained, is that one could get too much iron as a result of fortification, particularly men, because they don’t lose (excess) iron the way women do (via menstruation). Any excess of iodine, in comparison, is usually excreted with urine.
But is large scale fortification as contentious as it is made out to be? ThePrint takes a closer look.
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Why fortify staple food?
India is giving a massive push to fortify daily staples like cereals and milk with minerals and vitamins as a solution to micronutrient deficiency.
So far, India has developed fortification standards for rice, wheat, edible oils, salt and milk.
Data from the National Family Health Survey 2019-21 shows that 57 per cent of women in the reproductive age group (15-49) are deficient in iron. Moreover, studies have shown that about a fifth of the children (0-5 years) who do not have access to a nutritious and diversified diet suffer from vitamin-A deficiency, while vitamin-D deficiency has been termed a silent epidemic.
Last year, Prime Minister Narendra Modi announced that all rice provided under food security schemes will be fortified with iron and folic acid by 2024. The government distributes over 30 million tonnes of rice under public food programmes, about a fourth of India’s annual rice production.
How is rice fortified with iron?
Under the fortification scheme, milled broken rice is ground to dust and a premix of vitamins and minerals is added to it. Thereafter, an extruder machine is used to produce fortified rice kernels (FRK) resembling rice grains. The kernels are then mixed in a 1:100 ratio with regular rice to produce fortified rice. The cost to the consumer is estimated to be less than 50 paisa per kg.
According to the food ministry, the fortification programme aims to cover 291 aspirational and high burden (nutrient deficient) districts across the country by March 2023, for which 9 million tonnes of fortified rice has been produced.
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Is fortification the only way to address micronutrient deficiency?
The government admits that a diversified diet and regular intake of fruits and vegetables is an important source of micronutrients. But a large section of the population may not be able to afford a diversified diet regularly. So, adding iron to a widely-consumed staple like rice was adopted to reduce iron deficiency within a short span of time.
“Worldwide, studies have shown that fortification of rice with iron is beneficial in improving haemoglobin levels and reducing the levels of anaemia. Rice is a good delivery vehicle for iron since close to 70 per cent of the population in India eats rice, and anemia is not confined to the poorer sections,” Arun Singhal, CEO at the Food Safety and Standards Authority of India (FSSAI) told ThePrint.
Singhal added that in some states, anaemia has gone up in the past few years, which is a matter of great concern, and 35-40 per cent of anaemia cases can actually benefit from consuming iron-fortified rice.
“But a diversified diet and a healthy lifestyle is the most desirable objective. That remains the gold standard…But many families may not be able to access or have financial resources to eat a diversified diet comprising fruits and vegetables. Food fortification, therefore, is a supplementary strategy in addition to dietary diversity,” Singhal said.
What experts have to say
Despite the intended benefits, some experts have expressed concerns regarding mass fortification.
“Men can see a variety of bad effects. An increase in serum ferritin levels is associated with increased risk of chronic diseases like diabetes and hypertension. Iron requirements for Indians, which have been revised down, can be met with a reasonably diversified diet,” Kurpad, quoted earlier, said. Only about a quarter of men in the 15-49 age group are anaemic in India.
Kurpad also warned against the strategy of pushing fortification in a covert manner, where a lot of people do not even know what is going into their food.
However, FSSAI has a warning in place. It has mandated that every packet of food fortified with iron should be sold with the following disclaimer: “People with thalassemia may take under medical supervision and persons with sickle cell anaemia are advised not to consume iron fortified food products.”
“I strongly endorse the intentions of the government and the scientific community as the standards have been thoughtfully designed to provide between 25-30 per cent of recommended daily allowance of micronutrients (to prevent any overdose or toxicity),” said Tarun Vij, country director at the Global Alliance for Improved Nutrition, which works closely with government agencies and businesses to promote food fortification.
However, Vij added that fortification is not a panacea for removing all nutrient deficiencies. “We also need to promote diversified diets. But that’s easier said than done. Fruits and vegetables can be expensive and there is an over-marketing of non-nutritious, unhealthy and over-processed (junk) food.”
(Edited by Zinnia Ray Chaudhuri)
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