“For fortification programs to be a success, it is crucial that regional and demographical preferences are considered when selecting the food vehicle. This is because the selected food must be widely consumed and accepted by the target population to ensure vitamins and minerals can be delivered to individuals without a change in dietary habits. As one of the most widely distributed foods globally, wheat flour is a popular choice for fortification, but other foods, such as rice, sugar, maize flour and vegetable oils are also effective options. For example, the Chinese population consumes the most rice worldwide (just under 143 million metric tons in 2017/18), making rice an ideal choice for China, whereas other cereals, such as maize or wheat flour, may be more appropriate in other countries.”    Sarah LOUIS Nutrition Improvement Segment Manager DSM Human Nutrition and Health Shortages in adequate vitamin and mineral intake have led to a rising incidence of ‘hidden hunger’ across the globe, a phenomenon where an individual has a chronic lack of essential micronutrients in their diet. Such deficiencies continue to plague populations worldwide, in both developing and developed countries. With governments and non-governmental organizations alike looking for ways to tackle this issue, the fortification of staple foods has proven to be an effective method of improving the nutritional profiles of individuals across the globe. Technological advances mean a wide range of foods can now be fortified, so those planning programs can take into consideration the cultures and dietary preferences of different populations to select the most effective vehicle. Hidden hunger: a global epidemic Inadequate nutrition can have a major, long-lasting impact on human physical health and development, with deficiencies related to a wide range of health issues. In particular, poor nutrition in pregnant women and infants can have dire consequences. Stunting, for example, where children suffer from impaired growth and development is often associated with micronutrient deficiencies and badly affects both developed and developing nations. In Turkey, for example, nearly one in ten children are stunted1. A healthy, balanced diet is always recommended to improve nutritional status but, in many cases, this is simply not achievable - particularly in countries where people have limited access to affordable, nutritious foods. In these instances, the fortification of staple food provides a safe, effective and proven method of addressing hidden hunger. Food fortification is the process of adding or replacing essential vitamins and minerals that may have been lost during processing, helping individuals to address shortfalls of vitamins and minerals in their diet. The practice began in the 1970s and the Middle East was one of the earliest regions to adopt it, with Saudi Arabia implementing wheat flour fortification in 19782. The fortification of certain staples with selected vitamins and minerals is now mandatory in a number of countries across the world. For fortification programs to be a success, it is crucial that regional and demographical preferences are considered when selecting the food vehicle. This is because the selected food must be widely consumed and accepted by the target population to ensure vitamins and minerals can be delivered to individuals without a change in dietary habits. As one of the most widely distributed foods globally, wheat flour is a popular choice for fortification, but other foods, such as rice, sugar, maize flour and vegetable oils are also effective options. For example, the Chinese population consumes the most rice worldwide (just under 143 million metric tons in 2017/18), making rice an ideal choice for China, whereas other cereals, such as maize or wheat flour, may be more appropriate in other countries3. Why wheat? Wheat is the most widely produced cereal in the world, most of which is used for human consumption in a variety of forms – from bread and biscuits to pasta and noodles. Its widespread popularity, stability and versatility make it an ideal vehicle for fortification. In Turkey, for example, 44% of the average person’s daily energy intake comes from wheat flour, with 484 grams eaten per day. When fortified, this would mean that nearly half of a Turkish individual’s diet would be providing additional vitamins and minerals. In its natural state, wheat is a good source of vitamins B1, B2, B6, E, and niacin, as well as iron and zinc. However, a lot of the nutritional value is lost during the milling process. How the fortification process works The process of fortifying flour is relatively simple, when supported by the right expertise. A successful fortified product is achieved by incorporating the selected micronutrient premix through a volumetric feeder that is located towards the end of the milling process. The most common feeder consists of a rotating feed screw that is driven by a variable speed motor. The screw rotates inside a chamber that contains the premix and pushes it through an outlet spout. The amount of premix added to the flour can be adjusted by changing the motor speed. The concentration of premix added to the flour can be calculated by weighing the premix deposited by the feeder in a one-minute period and then dividing it by the volume of product flowing underneath, during the same amount of time. The premix can be fed directly into the flour by two methods: gravity, or air convection using a pneumatic system. The homogeneity of micronutrients in fortified flour is largely dependent on the location of the feeder and it is very important that the micronutrients are mixed well with the flour. In a gravity driven system, the best point for adding micronutrients is often before the midpoint along the screw conveyor that collects flour from the mill passages, just before bulk storage or sacking. If the feeder is placed towards the beginning of the screw conveyor, the amount of flour in the conveyor will be too little. However, if the feeder is located towards the end of the screw conveyor, the required homogenization will not be achieved. In a pneumatic system, on the other hand, feeders can be placed in a remote centralized location. It is essential that the micronutrients are well mixed to achieve an even distribution throughout. Poor mixing could result in some individuals receiving too little of the premix to improve their health, thus compromising the impact of the intervention. A question of quality High-quality fortification programs need to take a range of factors into consideration, to ensure a program design that can deliver tangible results. In addition to selecting the most effective vehicle to deliver micronutrients to particular populations, it is important that fortification programs also deliver the right nutrition. There are a range of vitamins and minerals that can be used in fortification programs and choosing the correct combination is vital for ensuring better health worldwide. For this, an understanding of the micronutrient deficiencies of particular populations is critical. In Turkey, besides the fortification of wheat flour with folic acid and iron, the addition of other vitamins and minerals have the potential to have a further health impact. For example, vitamin A deficiency is a leading cause of blindness, and can contribute to high rates of childhood mortality and serious birth defects. Meanwhile, vitamin D is well known for its role in calcium absorption and supporting both the immune system and cardiovascular health, with deficiencies potentially contributing to rickets in children and osteoporosis in adults5-6. The fortification of staple foods with such micronutrients may therefore help to improve lives in the region and reduce healthcare costs associated with deficiencies. Of course, the quality of the premixes is also of upmost importance. For a staple food fortification program to be successful, it must help to reduce micronutrient deficiencies. The quantities of micronutrients added to the food must remain consistent during production, last throughout shelf life and be made available to the consumer in the end product. From baking to packaging, there are a range of factors that can have a negative effect on the stability of vitamins, so selecting a high-quality premix is key to ensuring no nutrition is lost. Poor quality vitamins can not only negatively impact the nutritional value of products, but also the taste and appearance of the food, which in turn reduces consumer acceptance. If consumers reject fortified foods due to the flavor, texture or look of a product, then fortification programs are unable to improve the nutrition of such individuals. Partnering with companies that have a long history in fortification to benefit from their knowledge and expertise is vital for millers and brand owners looking to improve public health as part of such programs. DSM has been involved in staple food fortification since such initiatives began and remains a trusted leader in this area, providing technical knowledge, scientific expertise and a wealth of experience to its partners. With its Quality for LifeTM promise, DSM offers a broad range of high-quality, reliable and traceable premixes to add to staple food and, in doing do, works to improve public health in a safe and sustainable way. In addition to ingredients, DSM has a long history of collaborating with partners to plan and deliver successful fortification programs across the globe. Ensuring global good nutrition Hidden hunger continues to be a major public health concern across the globe, with devastating long-term impacts on the wellbeing and development of individuals, societies and nations worldwide. Staple food fortification is a proven method of getting key micronutrients to those in need safely and effectively, and can be tailored to meet the specific requirements and preferences of particular cultures. The success of fortification initiatives relies on a good understanding of target populations. When programs are able to provide increased levels of vitamins and minerals in foods that people already consume, mitigating the need for any behavior, lifestyle or dietary change, the potential for improvement in human health is unparalleled. REFERENCES 1 The World Bank, ‘Prevalence of stunting, height for age’, [website], 2017 https://data.worldbank.org/indicator/SH.STA.STNT.ZS?locations=TR 2 Food Fortification Initiative, Middle East, [website], 2016 http://ffinetwork.org/regional_activity/middle_east.php. 3 Statista, Rice consumption worldwide in 2017/2018, by country, [website], 2017 https://www.statista.com/statistics/255971/top-countries-based-on-rice-consumption-2012-2013/ 4 A. Sommer, ‘Vitamin A Deficiency and Its Consequences: A Field Guide to Detection and Control. Geneva’: World Health Organization, 1995 5 Vitamin D council, What is vitamin D? [website], 2011 https://www.vitamindcouncil.org/about-vitamin-d/what-isvitamin-d 6 C. R. Paterson, ‘Vitamin D deficiency, rickets and osteomalacia’, Reference Module in Biomedical sciences, 2017