Fortifying rice is scientific, cost-effective, will address nutritional deficiencies
One of the most cost-effective interventions to address the global challenge of micronutrient inadequacies is large-scale food fortification (LSFF). In this backdrop, Prime Minister (PM) Narendra Modi, in his Independence Day speech, announced the fortification of all rice under the Public Distribution System (PDS) by 2023.
Food fortification refers to the process in which micronutrients are added to commonly eaten staples to enrich and enhance their nutritional value. Rice is an ideal vehicle for fortification. Broken rice kernels are ground into flour, following which it is mixed with water and vitamins and minerals to make dough. The dough is then passed through an extruder to produce fortified kernels. The fortified rice is blended into regular rice in the ratio 1:100. These look, cook and taste like regular rice kernels.
Fortified staples have many benefits. One, it is a part of the solution to address micronutrient inadequacies. The lack of education, incorrect eating practices, poor bioavailability of nutrients, and other environmental and financial constraints lead to nutrient-deprived diets. LSSF strategies can reduce deficiencies in low-income groups.
Two, although the etiology of anaemia is multifactorial, about half of the cases are caused due to iron deficiency. Consumption of rice fortified with iron can be extremely beneficial for the most vulnerable, especially pregnant women and young girls.
Three, it is cost-effective. The Centre launched a scheme in 2019 for three years to introduce fortified rice through PDS in 15 districts, with a financial commitment of $23.43 million. The additional cost per kg is no more than ₹0.60-0.80. The incremental cost is low, when seen in relation to the health benefits.
Four, it is scientific. A case-controlled, quasi-experimental study, conducted over eight months in 2019, showed the effects of a multiple micronutrient fortified rice intervention among school children (6–12 years) through the midday meal programme in Gujarat. The intervention significantly reduced anaemia prevalence by 10% and improved cognitive score by 11.3 points. In Karnataka, in 2016-18, a total of 450,000 children were fed fortified rice in 2,600 schools. The intervention, which also included behaviour change education, resulted in a 9% decline in proportion of underweight children, 3.8% decline in stunting and a 3% decline in incidences of diarrhoea. Overall, 42.8% of students showed improvements in cognitive mean scores.
Some have asked if there is a risk of nutrition overdose by adding fortified staples to one’s diet. Food Safety and Standards Authority of India has set the level of fortification based on food consumption patterns, strong scientific evidence, and through a transparent consultative process, steered by Indian scientists in the food, nutrition and public-health domain. The standards only allow for 30-40% of Recommended Dietary Allowances (RDA) of micronutrients to be added to staples to meet the missing nutrients needs. Therefore, there is no question of iron overload when consuming fortified rice. Moreover, if the programmes are well-designed, implemented based on data and monitored well, fortification carries no risk of toxicity. Globally, no risk has been reported till date. There is, however, a case to be made for a universal approach. Given the scale of food and nutrition insecurity, a targeted approach would leave some at a disadvantage. India’s success in eliminating iodine deficiency was due to population-based interventions, which made universal production of edible salt fortified with iodine mandatory. Strong monitoring and punishment to offenders helped India achieve the goal of universal salt iodisation and eliminate iodine deficiency. Just like iodised salt, fortified rice too brings a nutritional revolution to India.
Dietary diversification is necessary to combat micro- and macro-nutrient deficiencies. Fortified rice is an economical option to be included in one’s diet along with pulses and vegetables. But it is critical to emphasise that there is no one solution to address malnutrition. The PM’S announcement is a good start.