“It is not enough to simply mandate fortification at a national policy level. Appropriate quality assurance and quality control monitoring must take place within industry at the level of production. Additionally, regulatory bodies need to provide an adequate level of monitoring, support to industry, and enforcement measures if fortification is to be sustained long-term. BioAnalyt has made the process of monitoring fortification and measuring concentrations of various micronutrients in a wide variety of foods easier. In wheat and maize flours, BioAnalyt’s iCheck devices enable the rapid and reliable measurement of iron and vitamin A on-site and without the need for expensive laboratory equipment.”

Micronutrients, such as vitamins and minerals, are critical for each individual at every point in life, from conception to aging, especially including adolescents and pregnant and breastfeeding mothers. However, micronutrient deficiencies remain prevalent across the globe due to limited access and affordability of foods rich in these micronutrients.

Micronutrient deficiencies can cause a wide array of medical and developmental challenges. Iron deficiency is a leading cause of anaemia, which can double the likelihood of mortality during pregnancy and childbirth compared to non-anaemic women. A deficiency of folic acid (vitamin B9) can cause easily preventable birth defects of the brain and spine such as spina bifida, which often results in infant and child mortality or a lifetime of surgeries and disability for survivors. A multitude of micronutrient deficiencies can also lead to physical and cognitive development delays in young children, which hinders academic performance and their future earnings potential. ¹

FORTIFICATION OF WHEAT AND MAIZE FLOURS

Cereal grains, such as wheat, maize, and rice, are widely consumed and present in about 95% of all diets. However, modern processing of these grains removes most of the bran and germ, the parts of the grains that are naturally rich in vitamins and minerals. People relying on industrially processed grains to supply the majority of their daily energy needs are therefore at a greater risk of developing micronutrient deficiencies.²

Large-Scale Food Fortification (LSFF) is the addition of vitamins and minerals (e.g., iron, iodine, zinc, folic acid and other B vitamins, vitamin A, and vitamin D) to staple foods such as wheat or maize flour, edible oils and fats, salt, sugar, and rice. LSFF is considered to be one of the most cost-effective interventions to increase the consumption of critical micronutrients across entire populations. LSFF is a preventive and protective measure, elevating the baseline consumption of these micronutrients so individuals are more resilient to shocks, whether those are a localized poor harvest or a pandemic affecting global food supply chains.

LSFF is not a new intervention, but rather has been around for over a century. In the early 1900s, deficiencies in B vitamins were prevalent in the USA, attributed to widespread consumption of industrially processed wheat flour. To tackle these deficiencies, fortification of processed flours was introduced to replace the micronutrients that were lost during processing. In 1939, fortification of wheat flour and white bread, or enrichment as it is sometimes called, was mandated to include thiamine (B1), riboflavin (B2), niacin (B3), iron, and calcium.⁴ One year later, in 1940, the United Kingdom also mandated fortification of wheat flour with thiamine. Denmark followed in 1953 by making the addition of thiamine, riboflavin, and iron to wheat flour mandatory.² Today, 85 countries mandate wheat flour fortification, 17 countries mandate maize flour fortification, and 15 countries mandate both wheat and maize flour fortification.^{5, 6} Both flours are commonly fortified with iron, zinc, B vitamins including folic acid, and sometimes with vitamin A.

The process of fortification is often fairly simple for large-scale flour producers who are already commonly adding improvers and other ingredients to enhance the quality of the flour. To fortify, an additional micronutrient premix is added to the flour, using similar dosing equipment as is used for improvers. This premix is made of concentrated vitamins and minerals to meet relevant national quality standards and costs an average of US $4 per metric ton of flour being fortified, or about US $0.05-0.07 per person per year. ^{2, 6}

Furthermore, the benefits of fortifying flour with micronutrients far outweighs the cost of fortification. One in three people worldwide suffer from some type of malnutrition, which is linked to 45% of all deaths of children under 3 and 22% of premature adult deaths. Malnutrition also presents an economic challenge, as 11% of the gross domestic product (GDP) in Africa and Asia is estimated to be lost to malnutrition each year, primarily from worker productivity losses. However, for every dollar spent on flour fortification, US $84 is saved through reduction of anemia.⁶ Sustained flour fortification has also been associated with a 2.4% reduction in anemia prevalence among nonpregnant women of childbearing age, and an increase in serum retinol, a measure of vitamin A intake, in populations from 0.94 to 1.06 μmol/L.^{7, 8}

One of the most visible effects of flour fortification is the reduction of neural tube defects, such as spina bifida, in new-born babies caused by inadequate folic acid stores during early pregnancy. After Chile mandated flour fortification with folic acid in 2000, hospitals recorded a steady decrease in neural tube defects from 18.6 per ten thousand births in 1999 to 8.39 per ten thousand in 2009. ⁶

Measuring Iron and Vitamin A in Flours with iChecks

It is not enough to simply mandate fortification at a national policy level. Appropriate quality assurance and quality control monitoring must take place within industry at the level of production. Additionally, regulatory bodies need to provide an adequate level of monitoring, support to industry, and enforcement measures if fortification is to be sustained long-term. BioAnalyt has made the process of monitoring fortification and measuring concentrations of various micronutrients in a wide variety of foods easier. In wheat and maize flours, BioAnalyt’s iCheck devices enable the rapid and reliable measurement of iron and vitamin A on-site and without the need for expensive laboratory equipment.

iCheck Iron is a portable, single-wavelength photometer, that quantitatively measures iron in multiple food matrices. Similar to reference methods, iCheck Iron measures total iron in food samples including maize and what flour. Iron that is measured may be intrinsic iron as well as iron added during fortification as either ferrous fumarate, ferrous sulfate, NaFeEDTA, and/or ferric pyrophosphate. Intrinsic iron is natural iron present in organic samples, averaging between 10-60 mg/kg. The performance of iCheck Iron is comparable to reference laboratory methods. ¹¹

iCheck Fluoro is a portable, single wavelength fluorometer that quantitatively measures vitamin A in foods and biological substances. iCheck Fluoro measures added vitamin A as retinyl palmitate and retinyl acetate. The performance of iCheck Fluoro is also comparable to reference laboratory methods. ¹¹

About BioAnalyt

BioAnalyt develops field-friendly devices that deliver instant nutrient and health measurement. In partnership with organizations such as World Food Programme, Bill & Melinda Gates Foundation, DSM, BASF, Cargill, Global Alliance for Improved Nutrition and Food Fortification Initiative, the iCheck devices have been implemented in over 70 countries around the world making reliable measurement affordable and accessible.

References:

1 Food fortification Initiative website 2 Hoogendoom et al. 2FAS EC. 2016. 3 Klemm et al. Food Nutr. Bull. 2010. 4 Bashai & Nalubola. EDCC. 2013. 5 GFDx. 2020. 6 FFI, 2020. 7 Barkley et al. Br. J. Nutr 2015. 8 Dary, USAID. 2016. 9 Laillou et al, Food Nutr. Bull. 2014. 10 Jaeger A, FST Mag. 2014. 11 BioAnalyt internal data.