Enriching Flour, Enriching Lives: The Flour Fortification Initiative


6. Flour Consumption and Fortification Benefit
Some people question whether many countries with high levels of iron and folic acid deficiency consume enough flour for flour fortification to be effective at preventing severe deficiencies. The answer is that flour fortification is only one arm of the strategy for controlling nutritional deficiencies: dietary diversification to include foods with high concentrations of nutrients and iron and folic acid tablet distribution to vulnerable members of society are also important. These two other arms are necessary as flour fortification only delivers part of a person's recommended daily allowance of nutrients and thus cannot be used alone to treat individuals with severe nutritional deficiency. In addition, the members of society with the most severe iron and folic acid deficiency are often the most socioeconomically disadvantaged (see Fig. 102) and thus do not consume large quantities of fortified flour (Darnton-Hill et al., 1999).
 
Fig. 102 : Benefit of flour fortification to populations by socioeconomic status (Darnton-Hill, 1999)
However, the members of a population with the most severe forms of iron and folic acid deficiency are not the only members of the population who are deficient. For example, anaemia in a population is only the tip of the iceberg, a sign that there are many more members of the population who are iron-deficient (Ramarkrishnan, 2001). Flour fortification protects the bulk of a nation's iron- deficient population, those who are able to afford the flour. The protection given them by the flour can prevent them from becoming anaemic in times of biological stress (Darnton-Hill, 1999). For example, a woman is more likely to become anaemic during pregnancy (vulnerable state) if she has mild iron deficiency before she becomes pregnant. Flour fortification can raise her normal level of iron and thus prevent serious deficiency during pregnancy (Salgueiro et al., 2002).

There are also other types of fortification directed towards economically and physiologically disadvantaged groups. South Africa is employing one such type of targeted fortification. During the initial food consumption analysis it was discovered that maize was consumed primarily by the members of society on the lower socioeconomic levels, and wheat by the higher socio-economic classes. The Republic of South Africa now fortifies both types of flour in order to fully cover the population (Bargriansky, 2003). In addition, baby food and baby formula is fortified at high levels in many countries in order to supplement the nutrient intake of children (Anon., 2002b) In the US, fortification of baby food and formulas has reduced anaemia rates in children under 2 to very low levels (Anon., 1998a).

Boosting of a population's usual iron consumption with general flour fortification translates into decreased numbers of people with anaemia over time, and decreased anaemia results in economic benefit for a nation. Only 52 of the approximately 189 countries of the world consume less than 20 kg/capita/year, which is approximately 41 g of flour/day. A country that consumes 41 g of flour/day and fortifies its flour with 60 ppm elemental iron can potentially decrease its prevalence of anaemia by 1% (Nystrom, 2003). In a country such as Nigeria, which only consumes 19.5 kg of wheat/capita/year, decreasing its anaemia rate by 1% through flour fortification could increase the nation's earning potential by 1.3 million USD yearly (Ross and Horton, 1998). Globally, as many as 46 million cases of anaemia could be prevented if the countries that do not currently fortify began to fortify with iron (Nystrom, 2003).


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