“It has never been more important for millers, rice brand owners, private sector partners, governments, donors and non-governmental organizations (NGOs) to work together and find long-term solutions that combat malnutrition and improve immune health globally. From large-scale public health nutrition strategies, and school feeding and workforce nutrition programs, to accessible commercial products, fortified rice can be implemented into the daily diets of millions of people across the world to support their immune systems, helping to keep the world’s growing population healthy.”

Yannick Foing Global Lead Nutrition Improvement, DSM

Good immune health is one of the key pillars of overall health and wellbeing, and consumer awareness of its importance has only increased during COVID-19. In fact, it has become a top consumer priority; a recent DSM survey, that interviewed 18,000 consumers across 24 countries, found that 60% of people worldwide now worry about their immunity, and 40% are concerned about their resistance to epidemic disease. The pandemic is also likely to generate new pockets of food insecurity and could increase world hunger by 12% to 20% (83 to 132 million people). Rising malnutrition rates mean that people, particularly the most vulnerable population groups like women and children, may be more susceptible to infection due to weakened immune systems. At a time when immune health is so crucial, it is important that the public and private sectors come together to help support immunity on a global scale.

One of the most effective ways to accomplish good immune health is through optimal nutrition. The World Health Organization’s (WHO) recent dietary guidance, in the context of the COVID-19 pandemic, states that good nutrition is crucial for health, especially in times when the immune system might need to fight back. A balanced diet that provides both sufficient calories and micronutrients can play a significant role in optimizing the immune system, with vitamins A, B6, B12, D, E, folic acid, zinc, iron and magnesium being particularly important.

However, the recommended amounts of these vitamins and minerals are not always easily obtained through a diversified diet alone, especially in regions where nutrient-rich food isn’t affordable or accessible. Staple foods such as rice, for example, make up a large proportion of global diets, but many naturally occurring nutrients are lost during processing. Meanwhile, the main source of vitamin D comes from UV rays, with few foods naturally containing the vitamin, and vitamin D insufficiency and deficiency estimated to be 88% and 37%, respectively, globally.5

Nutrition has the power to improve immune health worldwide, but how can the public and private sectors ensure that all people, including the most vulnerable, have access to the nutrition they need to stay healthy and thrive? And how can this be achieved in a way that is safe, efficient and affordable?

The far-reaching benefits of large-scale food fortification

Food fortification programs have been shown to be one of the most successful and cost-effective ways of improving the nutritional intake of large population groups across the globe, and these initiatives can also help accelerate progress towards achieving the UN Sustainable Development Goals (SDGs) 2 (Zero Hunger) and 3 (Good Health and Wellbeing). The WHO recommends fortifying rice as a public health strategy with a range of micronutrients, including iron, folic acid and vitamin A6, and it is currently mandatory to fortify rice in a variety of countries including Costa Rica, Nicaragua, Panama, Papua New Guinea, the Solomon Islands, the Philippines and parts of the US.7 Some countries, such as India and Peru, have also introduced, or are in the process of launching, standards for rice fortification.

School feeding programs are a good example of nutrition interventions in action. Millions of school children are chronically lacking the nutrients they need for optimal physical and cognitive health and development.8 The World Food Programme (WFP) estimates that around 305 million primary school kids in low- and middle-income countries currently benefit from school feeding initiatives.9 However, 73 million children across 60 countries still live in extreme poverty with no access to national school feeding programs, and school closures due to the COVID-19 pandemic are likely to have further increased the number of malnourished children globally.10 An investment in future generations, school feeding initiatives provide meals fortified with multiple micronutrients at school to help improve children’s nutrient intake, support their immune systems and ensure optimal health, cognitive and physical development.11 For example, school meals fortified with multiple micronutrients improved the iron, zinc, vitamin A, vitamin B1 and vitamin B2 status of children attending a Chinese school and thereby reduced anemia.12 According to a study conducted in a Cambodian school, multiple micronutrient-fortified rice may also improve cognitive function in children.13 This can increase children’s potential to learn, as well as their performance academically and later in life.

Meanwhile, workforce nutrition programs provide an opportunity for governments and employers alike to distribute fortified, nutritious food throughout the workplace to ensure workers receive both the calories and micronutrients they need for optimal immune health, as well as mental and physical performance. This has the potential to improve employee productivity and decrease absenteeism – benefitting the workforce, employers and society as a whole. In fact, ensuring optimal nutrition and quality of life for today’s workforce creates a better return on investment of up to US$ 6 per US$ 1 invested in workforce nutrition for employers.14 Large-scale food fortification initiatives, from workforce and school feeding programs to staple food fortification strategies targeting entire nations, have the potential to improve nutrient intake at scale and thereby support the immune health – and therefore overall health – of the global population, decrease healthcare costs and support brighter futures for all.

Rice fortification: methods and their uses

As the world’s most consumed staple food, rice is the perfect vehicle for fortification. The WHO recommends that, through post-harvest fortification, millers, rice brand owners and governments can add nutrients or replace a range of vitamins and minerals that are often lost during processing.15 There are a variety of methods for rice fortification, including coating, dusting, and hot extrusion.

Rice coating involves a fortified solution being coated onto the rice kernels using ingredients such as wax or gum. When using the coating method, it is vital that the rice kernels are rinse-resistant, so the fortified coating will remain fixed to them during washing or soaking. Dusting involves using an electrostatic force to bind a dry micronutrient powder to the surface of the grains. Using this method means that the fortified powder can be lost during washing, or due to excessive contact with water during the cooking process, so consumers would need to receive education on proper preparation in order to fully reap the benefits of the added nutrients. Finally, hot extrusion is the most robust way of fortifying rice. It involves grinding and mixing rice flour obtained from broken grains with added nutrients such as fibers and amino acids to form a fortified dough, which is then passed through an extruder and mixed in with the non-fortified rice at a low additional rate of typically 1%.

What are the benefits of hot extrusion rice fortification?

For millers, rice brand owners and the public sector alike, there are three main benefits to utilizing hot extrusion rice fortification: stability, acceptability and flexibility. Using this method, the stability of the fortified rice kernels is increased due to the embedding of the nutrients into the grains. This means that there is no need to further educate consumers on how to cook these products at home without removing the added nutrients. Hot extrusion also ensures that fortified rice maintains the same taste, texture and visual appeal to ensure consumer acceptance.

Hot extrusion rice fortification also offers immense flexibility due to the wide range of rice types and added nutrients that can be used. There are hundreds of varieties of rice on the market, and most of these can be fortified – including the most common products such as jasmine rice. This means that manufacturers are able to provide more choice to consumers by offering the nutritionally dense product in a range of rice types. Hot extrusion rice fortification is also fully customizable, as the mix of nutrients can be tailored to include whichever vitamins and minerals are most needed for the target consumer group and its health needs, such as energy and immunity support.

Why is public and private sector collaboration vital?

It has never been more important for millers, rice brand owners, private sector partners, governments, donors and non-governmental organizations (NGOs) to work together and find long-term solutions that combat malnutrition and improve immune health globally. From large-scale public health nutrition strategies, and school feeding and workforce nutrition programs, to accessible commercial products, fortified rice can be implemented into the daily diets of millions of people across the world to support their immune systems, helping to keep the world’s growing population healthy. Indeed, the evidence for the link between rice fortification, optimal nutrition and public health is strong; multi-micronutrient fortified rice has been shown to reduce anemia, infections such as colds and fevers, and homocysteine (a marker of cardiovascular disease) in a range of low-income regions, including India and Bangladesh. ,

DSM has decades of experience in rice fortification, helping public and private sector allies to introduce effective food fortification interventions that improve the nutritional status of populations worldwide. Alongside these programs, DSM supports the implementation of education and behavioral change initiatives on a global and local level to raise awareness about the benefits of these solutions among communities, healthcare workers, beneficiaries and consumers. This makes DSM the perfect end-to-end innovation partner for developing, launching and advocating for nutritionally dense rice products that have the potential to improve immune health, quality of life and societal prosperity globally.

For more information about how partnering with DSM can help you to innovate in the rice fortification market, visit www.nutritionimprovement.com.

REFERENCES

1 DSM Global Health Concerns Survey 2021. 2 Food and Agriculture Organization, ‘As more go hungry and malnutrition persists, achieving Zero Hunger by 2030 in doubt, UN report warns’, 2020, http://www.fao.org/news/story/en/item/1297810/icode/, accessed on 8 April 2021. 3 World Health Organization, ‘Food and nutrition tips during self-quarantine’, https://www.euro.who.int/en/health-topics/health-emergencies/ coronavirus-covid-19/technical-guidance/food-and-nutrition-tips-duringself-quarantine, accessed on 16 June 2020. 4 DSM, ‘The role of nutrition and fortified rice to support a healthy immune system/function’, 2020. 5 J Hilger et al., ‘A systematic review of vitamin D status in populations worldwide’, Br J Nutr., vol. 111, no. 1, pg. 23-45, 2014. 6 World Health Organization, FORTIFICATION OF RICE WITH VITAMINS AND MINERALS AS A PUBLIC HEALTH STRATEGY, https://www.who.int/nutrition/publications/guidelines/rice-fortification-executive-summary.pdf?ua=1. 7 Sight and Life, ‘Scaling Up Rice Fortification in Latin America and the Caribbean’, [website], 2017, https:// sightandlife.org/wp-content/uploads/2017/07/ScalingUp-Rice-Fortification-WFP-Rice-Fortification-ENG.pdf. 8 United Nations, ‘WHO Hunger Statistics’, https://un.org.au/2014/05/14/who-hunger-statistics/, 2014. 9 World Food Programme, ‘A chance for every schoolchild, Partnering to scale up School Health and Nutrition for Human Capital’ https://docs.wfp.org/api/documents/WFP0000112102/download/, January 2020. 10 Ibid. 11 Global Child Nutrition Forum, ‘ARE SCHOOL FOOD PROGRAMS GOOD INVESTMENTS?’, https://gcnf.org/wp-content/uploads/2017/09/Evidence-based-Support-for-School-Meal-Programs-GCNF-August-15-2017.pdf, 2017, accessed on 30 April 2021. 12 J Huo et al., ‘School Food Fortification Improves Nutrition Status of Students from Poor Migrant’, https://www.scitechnol.com/peer-review/school-food-fortification-improves-nutrition-status-of-students-from-poor-migrant-vxq2.php?article_id=1906, J Food Nutr Disor, vol. 3, no. 2, 2013. 13 M Perignon et al., ‘Impact of Multi-Micronutrient Fortified Rice on Hemoglobin, Iron and Vitamin A Status of Cambodian Schoolchildren: a Double-Blind Cluster-Randomized Controlled Trial’, https://pubmed.ncbi.nlm.nih.gov/26751473/, Nutrients., vol. 8, no. 1, pg. 29, 2016. 14 C Nyhus Dhillon et. al, ‘The evidence for workforce nutrition programmes’, Global Alliance for Improved Nutrition, 2019 https://www.gainhealth.org/sites/default/files/publications/documents/evidence-for-workforce-nutritionprogrammes-overview-2019.pdf. 15 WHO, ‘Fortification of rice’, https://www.who.int/elena/titles/rice_fortification/en/, 2019. 16 Gulshan Ara, ‘Effectiveness of micronutrient-fortified rice consumption on anaemia and zinc status among vulnerable women in Bangladesh’, PLoS One, 2019. 17 Prashanth Thankachan, ‘Multiple micronutrient-fortified rice affects physical performance and plasma vitamin B-12 and homocysteine concentrations of Indian school children’, Journal of Nutrition, 2012.