Enriching Flour, Enriching Lives: The Flour Fortification Initiative

5. Current National and Regional Fortification Programmes
Many governments and in some cases private enterprises or individual companies have adopted some kind of wheat flour fortification programme. At the UN Special Session on Children in 2002, nations were asked to improve children's nutrition through a number of mechanisms including food fortification (Anon., 2002), and forty-eight countries are currently enacting fortification programmes through voluntary or mandatory legislation (Fig. 101). Twenty-eight of these countries fortify with iron and folic acid. Through the efforts of these governments and the private milling industry, 15% of the approximately 400 million tons of flour consumed each year is fortified with these essential nutrients (Nystrom, 2003).
Fig. 101: Percentage of countries in each region with national mandatory or voluntary flour fortification programmes

In response to the low percentage of total flour fortified every year and the severe global problem of iron and folic acid deficiency, the Flour Fortification Initiative (FFI) was inaugurated in May 2002. FFI is sponsored by the Micronutrient Initiative based in Ottawa, Canada, the Centres for Disease Control and Prevention in Atlanta, Georgia, and the United Nations Children Fund. Its goal is to move flour fortification ahead in parts of the world in which it would be beneficial for human health.

FFI acts on the assumption that fortification is an industrial process which occurs in a flour mill. In addition, what flour millers choose to add to milled flour is influenced by a variety of factors including the government, the scientific health processing, and the beliefs of the flour miller about what is best for the consumer. As flour milling is influenced by a variety of public, private, and civic organizations, FFI seeks to build partnerships between these sectors. So flour fortification moves forward through agreement between all the partners on the benefits and cost effectiveness of flour fortification. FFI considers the following to be important for an effective fortification programme:
• Use of iron and/or folic acid as a minimum
• Use of roller flour mills producing refined white flour with an extraction rate of less than 82 percent
• Collaboration with existing national fortification efforts
• National determination of fortifications and fortification levels

Advocacy of current guidelines published by international public health agencies with the nutritional goal of providing 400 μg per day of folic acid per person and restoring iron in flour at least to pre-milling levels.
For more information on FFI, please see www.sph.emory.edu/wheatflour/Main.htm

Most of the current flour fortification programmes involve restoration of iron and other nutrients in the flour to the same raw level as was present in the original grain. This is done, in part, to preserve the quality of the finished flour product. Folic acid, however, is fortified above the level normally found in grain, since the usual grain raw folate levels are too low to prevent birth defects. Other factors that determine which fortification levels a nation or company chooses include the nutrient deficiencies present in the population, how much flour a population consumes, the cost of the premix, and the fortification guidelines of primary trade partners (Ranum and Wesley, 2003). For country guidelines, please see www.sph.emory.edu/wheatflour/Main.htm.


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