MALNUTRITION: Indioa: Bid to check malnutrition through fortified flour

22 November 2011
The Madhya Pradesh Government is all set to distribute fortified flour from November 22 in a bid to counter malnutrition. There has been a lot of controversy regarding the benefits of enriched flour in relation to those of whole wheat flour. Although enriched flour does contain the similar amounts of vitamins as the unrefined flour products, it does not have the same nutritional benefits of whole wheat flour.

To counter the widespread malnutrition in Madhya Pradesh, the State Government is all set to distribute fortified flour in Madhya Pradesh from November 22. The similar project launched in Rajasthan last year was strongly opposed by the local people stating that despite being nutrients in the flour, the quality is poor.
The Global Alliance for Improved Nutrition (GAIN), which had advocated the campaign in this regard in Rajasthan and Gujarat, would launch a similar drive in Madhya Pradesh too.
The massive food fortification drive claims to bring down high levels of anaemia and Vitamin A deficiency that has been hampering the State's progress and economic growth for several years.
The World Food Programme (WFP) had earlier conducted a similar project on empirical basis in three districts of Madhya Pradesh- Shivpuri, Guna and Sheopur. For the purpose, the WFP is funding local voluntary organisations for fortification of flour and distributing it among the villagers.
Later, the project was withdrawn because the programme could not fulfill the objectives of collecting evidences and data.
However, it has been a debatable issue whether a written consent should be needed from consumers, who are consuming it.
If one goes by the latest human development report of Madhya Pradesh, the state of health in Madhya Pradesh is far from satisfactory. This is reflected from the latest estimate for longevity, measured as life expectancy at birth, which was 59 years for males and 58 years for females.
As per the latest estimate on longevity as quoted in the Human Development Report 2007, the life expectancy for males and females in Madhya Pradesh was the lowest among all the major States in India and a good four to eight years lower than the national average.
State Advisor to Supreme Court Commissioner in Right to Food case Sachin Jain said significantly, there is not a clear situation regarding fortification of flour with iron and folic acid. As per rules, the quantity of iron should be monitored, but it is not being monitored properly at several places and thus negative effects have been witnessed at several places.
In malaria-prone areas, iron fortification needs to be monitored properly because the patients may face problems with the iron fortified flour consumption, he added.
Jain informed that the concept of fortification has been a success only in the States where there is strong network of primary health centres, but in Madhya Pradesh this network is quite poor. "If anybody faces health disorders, he needs to immediately approach primary health centres, thus in the areas where PHCs are available, this has been a success," he informed. The flour fortification project that was launched in Gujarat has been challenged in Supreme Court, he said.
He further said that after fortification, the flour has medicinal components, but globally, natural food is considered as the best food. Thus, the Government should make efforts in making available natural foods to the people, he advised. Jain stated that the interests of MNCs are involved in the project, which need to be checked and the whole process should be in public interest.
General secretary of the Roller Flour Mills Federation of India (RMFI) Veena Sharma told that there has been no incident of ill effects of the fortified flour. She informed that it requires at least four to five months for positive results of the fortification, thus similar time would be required for the ill effects. Thus, the misconceptions if any are plainly on here say, she claimed. Regarding case pending in the Supreme Court against Gujarat Government, Sharma stated that it was regarding no reducing the quantity of grain provided through the PDS in Gujarat.

Difference in amount of fibre
One of the most significant differences is the amount of fibre. During the production of white enriched flour, a lot of the fibre-containing components (the bran and germ) are reduced or removed. Thus, products made from this type of flour contain smaller amounts of fibre than those made with whole wheat flour.
Another concern is the effect on blood sugar levels. Enriched flour products tend to be higher on the Glycemic Index, quickly raising blood sugar levels. In contrast, foods made from whole grains tend to be lower on the Glycemic Index. Because they contain higher amounts of fibre and other complex carbohydrates, they take longer to digest; therefore, sugars enter the bloodstream in a slow and more controlled manner.
However, experts feel that there are more benefits with the fortification of the flour and thus there is no worry to use it.

Vitamin and Mineral Deficiencies
Milk, milk products, fruits, vegetables, egg, fish, and meat are the best sources of micronutrients, ie vitamins and minerals. But in Madhya Pradesh, per-capita consumption of these micronutrient-rich foods across all socio-economic and demographic groups is very low. Hence MP has high levels of micronutrient malnutrition; especially anemia and vitamin A deficiency. According to theNFHS-3, prevalence of anemia is very high amongst all population and socio-economic groups. In MP, 74 per cent of children 6-59 months, 58 per cent women and 25 per cent men are anaemic. Anaemia and vitamin A deficiency are major contributors to the low-vitality and mortality, especially of women and of children under five.
http://www.dailypioneer.com/state-editions/bhopal/22268-bid-to-check-malnutrition-through-fortified-flour.html

MALNUTRITION: Getting the recipe right for US food aid

JOHANNESBURG, 13 May 2011 (IRIN)

 Photo: Manoocher Deghati/IRIN
More of all the good things - protein and vitamins

Changing the food the US government supplies as aid could deliver better results and still save money, a new study says. The review for the US Agency for International Development (USAID) by researchers at the Tufts University Friedman School of Nutrition Science and Policy has been welcomed by NGOs and US food aid experts, but the findings have also come in for some criticism.
The two-year review considered if USAID food aid was up to date with current science, especially in its use of blended food and whether programmes matched the right products with expected outcomes.
"What we're recommending is approaches to enhance the many great things already being done with US food aid under the most difficult circumstances imaginable," Amelia Reese Masterson, research coordinator of the review, wrote to IRIN, referring in part to USAID’s budget pressures.
The review came up with 20 recommendations on some of the food products and programmes under Title II of the US Food for Peace Act, which covers food aid provided in emergency and non-emergency situations.

Getting the ingredients right
The Tufts review addressed the issue of the source of protein in food products for children, pregnant and lactating women, and undernourished people on HIV medication.
Médecins Sans Frontières (MSF) has noted that US food aid destined for children usually comprises fortified flours based on grains and pulses such as corn-soya blend (CSB) or wheat-soy blend (WSB) and has lobbied for the inclusion of other sources of protein, vitamins and minerals.
Recent scientific evidence shows that animal-source proteins such as milk, better promote the growth of muscle tissue and resistance to infections, and are critical to children recovering from severe malnutrition, the Tufts review agreed. It also acknowledged that ready-to-use therapeutic foods (RUTF), usually lipid-based spreads, whose ingredients typically include nuts and milk powder, have led to a radical change in the way severe malnutrition is treated.
The review recommended that a wider range of products, offering varying quantities and types of nutrients for different programmatic contexts, be made available.
It is here that the review has contradicted itself, Nathalie Ernoult, Stephane Doyon and Susan Shepherd, members of the MSF's nutrition team, maintained in a written submission to the Tufts academics.
"The report itself states that there can be no 'one-size-fits-all' food supplement, and we could not agree more," the MSF team said, yet it "focuses primarily on how to improve the nutritional value of fortified blended flours."
The Tufts study argued for a single formulation for a cost-effective, enhanced CSB, which they dubbed CSB14, to meet the minimum nutritional requirements of three key target groups: infants from 6 to 11 months; children between one and three years; and pregnant women.
The MSF team said at least two enhanced CSB formulations would be necessary: one tailored to the needs of infants and young children and those affected by moderate acute malnutrition; the other for older children and adults.
UN organizations the World Food Programme (WFP) and the UN Children's Fund (UNICEF) are also considering experimenting with different formulations of CSB.
"As a field-level agency and occasional implementing partner for UNICEF and WFP, we [MSF] cannot over-emphasize the need for coherence in the nutritional supplements on offer for a given category of beneficiary," the MSF team said. "If the fortified foods provided by WFP, UNICEF and USAID for similar programmes are not interchangeable, nutrition programmes will simply become confused and ineffective."
MSF maintained that the formulation for younger children should have a higher protein content from animal-sourced food; and that the proposed fortification levels of iron and zinc were also too low.
Zita Weise Prinzo of the World Health Organization (WHO) said they were recommending that the diets of moderately malnourished children contain animal-sourced foods, without specifying how much. WHO is expected to release its guidelines for food formulations for moderately malnourished children in June 2011.
According to MSF, the proposed second formulation for older children and adults, would not require animal-sourced ingredients, and the current CSB recipe, with some adjustments to its vitamin and mineral content, would serve the purpose.
However, a senior nutritionist who preferred not be named told IRIN that in many instances it would be hard to imagine relief agencies successfully distributing two or more similar looking products for different segments even within a single family.
"Most large-scale programmes using CSB-type products involve take-home rations. It would be difficult for a programme to ensure the proper use of several similar products at home. The solution could be to have one ‘generic’ option used by most big programmes, similar to that proposed by the [Tufts] paper, and then several other options that would be used by ‘speciality’ programmes."
The CSB14 formulation depends on the addition of oil fortified with vitamin A to provide enough of the vitamin. "Our experience shows that it is difficult to count on the prescribed amounts of oil being added to the porridge in the home, not to mention all the logistical difficulties encountered with the distribution of multiple commodities to constitute a single ration," the MSF team pointed out.
The chemical forms of micronutrient supplements proposed by Tufts also differed from those on the list approved by the WFP, the biggest dispenser of US aid. "It is very important to come to common agreement on a list of acceptable chemical forms for all additives," the MSF team noted.

PEPFAR food
Programming should "be evidence-based, not driven by simple data on tonnages and 'hungry people fed', but by an understanding of the unit cost of impact," and this included HIV/AIDS-related programmes, said the review. It found that orphans and vulnerable children, and HIV-positive pregnant and lactating women, identified for priority food assistance in the US President's Emergency Plan for AIDS Relief (PEPFAR), were receiving not getting priority compared to other HIV-positive women and adults.

Photo: Jason McLure/IRIN
US food aid is evolving

The review suggested stronger links between ongoing antenatal, Prevention of Mother-to-Child Transmission (PMTCT), and Maternal and Child Health (MCH) services, and with programmes treating malnourished children.
PEPFAR country coordinators reported that requests to approve the use of funds for food were "commonly met with caution", the review said, which "contributes to low coverage of food assistance within programmes", and PEPFAR needed to send a stronger signal on supporting the allocation of funds to food in HIV support.

Saving money
Budget-constrained donors were "facing hard trade-offs between feeding as many people as possible and providing higher quality foods to improve nutritional impact per person," said Christopher Barrett, a food aid expert who teaches development economics at Cornell University in the US.
Scarce resources should be put to work more efficiently, and the Tufts review contributed significantly to improving understanding of these tradeoffs by policymakers, operational agencies and commercial suppliers, Barrett commented.
"It's important to move beyond a dollar-per-ton of food metric - the conventional way of looking at things - since that does not take into account exactly what kinds of foods are used for what purposes," said Patrick Webb, principal investigator of the Tufts review project.
"If we become more efficient in treating or preventing malnutrition, then it's the cost per case of malnutrition treated or prevented that matters, and that will go down when the appropriate tools (foods)are used in the right ways, even if unit costs of products rise slightly... because less is needed (over a shorter period of treatment)."
Some of the Tufts recommendations would cost more money - the addition of dairy products, new smaller packaging of some products for mothers and infants to prevent it from being consumed by the entire family - but Webb said the costs would be offset by improved targeting of the enhanced products.
Barrett noted that "With greater bang for the buck, it also becomes easier to defend valuable food aid programmes against those looking to trim budgets."
The review, the issues it covers and its recommendations will be debated at the US government's annual conference on food aid in June.
http://www.irinnews.org/Report.aspx?ReportID=92717

MALNUTRITION: With a Little Innovation -- Bread Is (a Better) Life

January 8, 2011Marc Van Ameringen: Executive Director of the Global Alliance for Improved Nutrition

The sight of stacks of baladi bread piled high in market places is a common one in Egypt. This mainstay of Egyptian diets, while tasty, cheap and filling, provides calories but not necessary micronutrients. Millions of Egyptians suffer the effects of poor nutrition, including preventable miscarriages, birth defects and delayed physical and cognitive development. Iron and folic acid deficiencies lead to many health problems, most significantly anemia and neural tube defects in children which can be life-threatening and cause-life long disabilities.
Malnutrition remains arguably the world's most serious, but least addressed, global health issue. More than 2 billion people are impacted globally and more than 3.5 million young children die each year from lack of proper nutrition. For those that survive, inadequate nutrition during the early years of life has permanent and life-long consequences. Research shows that adequate maternal and child nutrition during the first 1,000 days -- from conception through year two -- shapes a child's physical and mental capabilities for their lifetime. We can't "go back" or address deficiencies later in life - damage done during this window is permanent.
For millions in Egypt, baladi bread is a critical part of daily sustenance; a key staple food that is deeply ingrained in the Egyptian culture. But what if this daily bread could not only satisfy hunger but also improve the cognitive and physical potential of the next generation?
That is indeed what is happening. The Global Alliance for Improved Nutrition (GAIN), World
Food Programme (WFP) and Egypt's Ministry of Social Solidarity are fortifying baladi bread with
micronutrients like iron and folic acid which are vital to a child's development. Millions of Egyptians are benefiting and this newly fortified baladi bread has the potential to protect entire generations. The government, global health community, businesses and civic organizations are all realizing that it is access to nutritious, quality food for the poor -- and not just access to quantities of food - that is critical.
The focus is no longer simply to eat, but to eat well. This is a factor which affects not only the poor, but increasingly the well off in every society. This past year, in the U.S., one in four children endured hunger and food insecurity. It is likely that the 17 million children who face hunger in this country will suffer life-long consequences as a result of having limited access to quality food. Without nutritious foods they are more likely to suffer from weak immune systems, colds, behavioral difficulties and impaired academic performance. Nutritious food, whether here, or Egypt, is fundamental to unlocking human potential.
While serious, malnutrition is entirely within our grasp to prevent. There are well-tested and cost-effective approaches common in rich countries, such as fortification with vitamins and minerals of staple crops and condiments, and ensuring pregnant mothers and babies six months and older have access to nutritious products. GAIN is working with hundreds of local companies to create nutritious products that are as varied as fortified flour in Africa, soy sauce in China and biscuits in India.
Nevertheless, today there remains a market failure in poor countries. Simply put, the majority of poor people do not have access to readily available and affordable nutritious food. For those children under two, who are most at risk from irreversible mental and physical damage from malnutrition, we need to stimulate business to produce affordable products that can make the difference for the rest of their lives.
Targeting these areas will promote innovation. It is innovation, like the fortified baladi bread reaching 52 million Egyptians every day, that will make the difference between surviving and thriving.
http://www.huffingtonpost.com/marc-van-ameringen/with-a-little-innovation-_b_806102.html