‘Let thy food be thy medicine and medicine be thy food’

Dr Chandrakant Sambhaji Pandav

Contd from previous issue

As per the World Health Organization (WHO), known measures to control anaemia include i) Dietary Diversification, ii) Supplementation iii) Food Fortification iv) Biofortification v) Public health measures and vi) Nutrition and Health Education so as to change knowledge, attitude, practices and behaviours.

Diet diversity primarily involves consuming diversified diet across multiple food groups, and that too daily. They provide enough nutrients through a healthy diet. Dietary diversification, although desirable depends on the availability, accessibility, affordability, and stability of different varieties of food. As a society, we must continue our thrust to improve all aspects of dietary diversity, especially their coverage under subsidized Government food policies and through innovative initiatives such as “Poshan Vatikas”.

Supplementation with iron and other micronutrients, is an effective strategy to address micronutrient malnutrition. With schemes such as National Iron Plus Initiative, Weekly Iron Folic Acid Supplementation, the availability of iron supplements in public institutions has improved. However, the strategy has been largely ineffective in addressing anaemia due to low utilization rates (NFHS-5).

Bio-fortification is the process of improving the nutritional quality of food crops. This can be achieved through agronomic practices, conventional breeding, or biotechnology-based approaches. The current evidence on bio-fortified crops suggests that, only limited micronutrients both in numbers as well as concentration can be provided through bio-fortified crops. However, this could emerge as an important cost-effective intervention in the near future.

Food fortification is the process of deliberately increasing the micronutrient content of food. It improves the nutritional quality and provides a public health benefit with minimal risk to health. It is regarded as one of the top-three priorities for developing countries as per the Copenhagen Consensus Statement, 2008 and well acknowledged under the Sustainable Development Goals (SDGs) for reducing micronutrient malnutrition.

Fortified foods are not new to India. In India, consumption of Iodized Salt, also a type of fortified food, has led to the reduction in prevalence of Iodine Deficiency Disorders and diseases such as Goitre. As per the India Iodine Survey, carried out in 2018-19, the household coverage of adequately iodized salt (>15 parts per million (ppm) at the national level was 76.3%. The target for achievement of Universal Salt Iodization (USI) is more than 90%. As per the report, the coverage of salt iodised with some iodine, equal to or more than 5 ppm at the household level was 92.4 per cent, estimated to have reached 1.28 billion people. The recent Government announcement on introduction of fortified rice in the food-based safety nets in phased manner with a view to addressing anemia is a viable and welcome step and aims to replicate the successes of Iodized salt.

India’s food safety net schemes, namely the Targeted Public Distribution System (TPDS), Pradhan Mantri Poshan Shakti Nirman (PM POSHAN) (erstwhile Mid-Day Meal Scheme) and the Integrated Child Development Services (ICDS) Scheme reach out to more than 800 million people, with subsidized food grains and coarse cereals. The food safety nets provide an excellent opportunity to provide nutritional benefits to the most vulnerable populations reached through the food safety net schemes by bridging the gap between the actual intake and the requirement of a particular nutrient. Rice being the cereal of choice for distribution as well as utilization among most Indian people (As per the National Sample Survey Office (NSSO) report, 2011 – 65% Indians consume rice as a staple cereal), its fortification could be a “game- changer” for the country.

Fortifying rice by adding micronutrients is a scientifically proven, and cost-efficient way to improve body stores of Iron, in order to address micronutrient malnutrition. More so, it does not involve any behaviour change on part of the consumer. There are multiple studies from the global as well as Indian context, including large-scale pilot projects in India,which have examined the operational feasibility, acceptability and impact of rice fortification in reducing micronutrient deficiencies. Several of these have been conducted by United Nations agencies and development partners in Odisha, Uttar Pradesh, Kerala, Karnataka and Gujarat through the Government food safety net schemes. Further, fortification of staple foods as a strategy is mandatory in 84 countries around the world.

In an initiative led by the Department of Food and Public Distribution, Government of India; between 2019-21; the Centrally Sponsored Pilot Scheme for Distribution of fortified rice through PDS was successfully operationalized across 11 districts/States in the country. In its plans to scale-up fortified rice distribution, in accordance with the vision of the Hon. Prime Minister, Shri Narendra Modi, fortified rice distribution has been operationa- lized under ICDS and PM-POSHAN schemes across the country as Phase-1 which ended on Mar-22.

(To be contd)