Feature

SOUTH AFRICA TO ESTABLISH MANDATORY FOOD FORTIFICATION OF STAPLE FOODS IN 2002

Dr Philip Randall

Following extensive consultation with the public health, medical and scientific community as well as the milling industry and consumer groups, the Department of Health is set to publish draft legislation in the next few months with final legislation planned for very early 2002 regarding the mandatory fortification of wheat flour and maize meal. Fortification is cost effective strategy to address alarming and widespread deficiencies in critical vitamins and minerals throughout the South African population.

Fortification with Vitamin A, Thiamin, Riboflavin, Niacin, Folic Acid, Vitamin B6, Iron and Zinc will make this the most extensive fortification programme attempted in the region.

BACKGROUND

The National (South African) Food Consumption Survey in 1999 clearly indicated that "at least 1 in 3 children had a nutrient intake of approximately half of the recommended level for a number of important nutrients. Indeed the great majority of children consumed a diet deficient in energy and of poor nutrient density to meet micronutrient requirements". More details can be found at the following web sites:

www.sahealthinfo.org and www.sun.ac.za/nutrition

The realisation that the growth and survival of children as well as the prevention of degenerative diseases in adults may be addressed by attention to the dietary requirements of our children is becoming ever more apparent. School performance, productivity and work capacity are also affected by vitamin and mineral deficiencies. Combine this with an increasing population, rising unemployment, a more stressful lifestyle and increased pressure on our health services (both financially and skills wise) and we are forced to conclude that action is required immediately.

The Department of Health has accepted recommendations from national and international experts (especially Micronutrient Initiative who can be found at www.micronutrient.org) that food fortification be implemented as part of an integrated nutritional policy. Within this policy are programmes that directly, as well as indirectly, impact on the nutritional status of the nation. Nutrition education programmes will target health care workers and the consumers to raise awareness of just how preventable some of the conditions caused by malnutrition are. Further programmes will help to raise awareness, and demand, for fortified products.

By far the most efficient method for increasing the nutritional status of the nation is through fortification of widely consumed and accessible staple foods. The 1999 National Food Consumption survey indicated that the most widely consumed foods were maize, sugar, tea, milk, bread, rice and margarine - the same survey also found these same items to be "most frequently found in the house". For any fortification programme to be successful, the consumption pattern must be adequate, widespread and reach the vast majority of the population - especially the high risk groups. The above food items clearly satisfy those criteria. 

Unfortunately technical issues preclude certain foods from being utilised as fortification vehicles. Factors such as the stability of the fortificant during processing and food preparation; the bioavailability of the fortificant; changes to the taste and/or colour of the vehicle. Others, such as the relative cost of the fortificant compared to the vehicle cost, the import/export situation and the ability to monitor the programme are also important. Possibly the most important factor, however, is identifying food vehicles that are consumed in the greatest amounts by those at the greatest risk - in a study by the Bureau of Market Research, funded by the Department of Health, maize meal and wheat flour were found to offer the most favourable distribution.

A fortification programme adding the following micronutrients is currently being proposed.

The RDA (Required Daily Allowance) "goal" is what will remain after processing and takes into account factors such as retention of the micronutrient after heating etc. and includes levels naturally present

It can be seen that the two vehicles i.e. wheat flour and maize meal have different formulations in 3 possible areas: the amount of riboflavin, folic acid and iron to be added. Riboflavin levels are reduced in maize meal on the basis of consumer resistance to the resultant increased yellow appearance of the meal. The issue of the levels of the other two micronutrients, folic acid and iron, however, remain in contention regarding the final formulation of the micronutrient cocktail. The amount of Folic Acid to be added was decreased for the same reason as the riboflavin - a belief that the yellowness would increase. The yellowing effect of the Folic Acid has subsequently been proven to be very minor and considerable pressure will be placed on the maize milling industry to reverse its position, due to the nutritional benefit of Folic Acid. The second issue is that Iron level was reduced because of conflicting results from a trained taste panel where some experts could detect the presence of iron in some of the maize meal products. Consumer trials have failed to repeat this finding and, again, pressure will be placed to move to the higher level.

The fortification of sugar with Vitamin A is also under extensive debate. Sugar, however, is extensively traded across international boundaries and unless a regional approach to sugar fortification can be agreed upon then our local sugar industry will, reluctantly, have to fight the proposal on the basis of cost competitiveness.

The past few years have seen collaboration between experts and special interest groups at a level I never thought possible. It is my firm belief that that those hundreds of thousands of hours spent have laid the foundation for a healthier and more vibrant nation.

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