dsm nutritional products options to deliver fortified products to the public ilsi conference on...

DSM Nutritional Products

ILSI Conference on Micronutrient Fortification of Foods: Science, Application & Management

Options to Deliver Fortified Products Options to Deliver Fortified Products to the Publicto the Public

8 January 2011 - New Delhi, India

Dr. Manfred Eggersdorfer Senior Vice President Nutrition Science & Advocacy

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Options to deliver fortified products to the public: Agenda

I. The Need for Food Fortification

II. Options for Fortification

III. Regulatory and Market Factors

IV. DSM‘s Engagement

V. Summary and Outlook


I. The Need for Food Fortification

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Need for fortification: Worldwide ~ 2 billion people are affected by Hidden Hunger

Hidden Hunger Hot Spots

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Hidden Hunger is defined as ...Hidden Hunger is defined as ...

Worldwide, over one third of deaths among children under 5 years of age is associated with malnutrition.

“ Deficiencies in essential micronutrients (vitamins & minerals) in individuals or populations which negatively impact on health, cognition, function, survival, and economic development “

SIGHT AND LIFE Expert Panel, Bangkok 2009

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What is the impact of Hidden Hunger?What is the impact of Hidden Hunger?

1.1 mio children <5 years

600,000 stillbirths

115,000 women during pregnancy

Vit. A & Zinc deficiencies

Iron deficiency

anemia

Iron deficiency

anemia

Maternal iodine

deficiency

Vit. A deficiency

Maternal folate

deficiency

18 mio babies born mentally impaired

350,000 children go blind 150,000 babies

born with neural tube defects

Annual lives lost Annual lives impaired

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Global impact estimated by Unicef (2004)

Micronutrient deficiency is a huge financial burden…

„UNICEF and the Chinese Ministry of Health announced that China’s massive drive to reduce the damage done by vitamin and mineral deficiency, particularly to children, is paying rich dividends for China’s economy. It expects that efforts to protect its 250 million inhabitants now suffering from “hidden hunger” could boost GDP by $86 billion over the next ten years.”

Micronutrient deficiencies cost globally

180 bio US$ in the next 10 years: • in China 2,8 bn US$ and • in India 6,0 bn US$.

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… and is seen as the greatest challenge in the 21st century worldwide

More than 60 % of healthcare costs and disabilities are due to lifestylerelated diseases

Cardiovascular diseases, diabetes, high cholesterol, osteoporosis, overweight are some of the key health issues related to nutritional factors

These issues are not alone a topic of the industrialized countries like the US, Europe, Japan and so on, but also in India, China and all over the world

Prevention of chronic diseases and the compression of the disability period will be the greatest public health challenge of the 21st century.

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Micronutrients (vitamins and minerals) are essential for many functions and health

NormalGrowth

Healthy aging

Healthy Babies

Strengtheningimmune system

Good Health

Good Performance

Normal Brain Growth

Vitamins & Minerals that areonly needed in small amounts,

but are essential for …

They cannot be produced by the body and have to come from the diet

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Food fortification is a key approach to achieve adequate micronutrient intake

Codex General Principles for the Addition of Essential Nutrients to Foods

Fortification / Enrichment:

Addition of one or more essential nutrients to a food whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency of one or more nutrients in the population or specific population groups.

Any fortification program should be based on a demonstrated need for increasing the intake of an essential nutrient in one or more population groups, e.g.

• clinical or subclinical evidence of deficiency, • estimates indicating low levels of intake of nutrients or • possible deficiencies likely to develop because of changes taking place in food

habits

“ Probably no other technology available today offers as large an opportunity to improve lives and accelerate development at such low cost and in such a short time ” (source: Enriching Lives, The World Bank)

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Food fortification is powerful and can be implemented in existing diets

Advantages

• Potentially rapid improvements in micronutrient status of population

• Reasonable cost, especially with existing technology and local distribution networks

• Requires no changes in existing food patterns or in individual compliance

Requirements

• Fortified food consumed in adequate amounts by target population

• Fortificants that are stable and well absorbed, but do not affect sensory properties of foods

• Preferably, centrally processed food vehicles

• Government and food industry partnership


II. Options for Fortification

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Three types of food fortification are in place

Conventional fortification

• Staple foods (flour, sugar, milk, oil, rice)• Dairy (milk, yoghurt)• Spreads (margarine)• Condiments (salt)

Home fortification

• Crushable/soluble tablets• Powder• Spreads

Bio-fortification

• Agricultural products (rice, maize, sweet potato,…)

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Food fortification has a successful track record Food fortification has a successful track record an many countriesan many countries

Long history in many countries for successful control of deficiencies of vitamins A, D, several B vitamins, iodine and iron.

1923: Mandatory iodization of salt in Switzerland and USA; now available in most countries.

1933: Mandatory fortification of flour with Vitamin B1 in Canada and virtual elimination of Beriberi.

1941: Mandatory fortification of flour with Vitamin B3 in the USA and virtual elimination of pellagra

early 40ies: Fortification of cereal products with Vitamin B1, B2 and B3 became common practice in many countries.

1954: Flour fortified in Chile with B-vitamins and iron. Country has now very low prevalence for anaemia.

1974: Beginning of sugar fortification with Vitamin A in Guatemala. Vitamin deficiency diminished to one third.

1992: Wheat and maize flour fortification in Venezuela. Vitamin A sufficiency in general population and important reduction in anemia in children.

1998: Folic Acid fortification mandated in the USA. Now implemented in 60 countries.

2000: Vitamin D fortification of milk and dairy products in US and Canada started

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NutriRiceNutriRice® ® : from staple food to nutritious food: from staple food to nutritious food

Nutrients • Vitamin A (Retinyl-palmitate)• Vitamin B1 (Thiamine chloride HCl)• Vitamin B2 (Riboflavin)• Vitamin B12 (Cyanocobalamine)• Niacin• Iron

… and others

Inclusion levels: can be adapted to nutrient requirements

NutriRice® is made of natural rice with micro-encapsulated vitamins in reconstituted rice kernels via extrusion

• Looks, tastes and cooks exactly like ordinary rice.• Fortified kernels deliver the added micronutrients to the consumer.• Kernels can be customized in shape, color and micronutrient composition.

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Efficacy of NutriRice demonstrated in school children in India

Group 1MMN fortified

rice

Group 2MMN fortified rice

high iron

Group 3Unfortified rice

6 days/wk; Sep-Feb 2009/10

Total of 134 days

~300 g cooked rice

(=100 g dry uncooked rice)

Significant improvements in B-vitamin status, physical performance, and hemoglobin level among school children in Bangalore having consumed fortified rice for 6 months.

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Home fortification provides benefit of full micronutrient basket

• Since mid-1990s, efforts to add micronutrients to foods at household level; in particular to complementary foods for young children

• Micronutrient powder concept:

- Fortification of locally available food

- provides essential micronutrients

- no change in the color, texture or taste of the food

• Combination of supplementation and fortification

• Types of products: - Soluble or crushable tablets- Micronutrient powder (MixMe™)- Micronutrient-rich spreads (NutriButter™)

More costly than mass fortification but useful for improving local foods fed to infants and young children where fortified complementary foods are not available

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Bio-fortification is an emerging technology building on GM plants

• Breeding and genetic modification of plants to improve their nutrient content

e.g., cereals, legumes, potatoes, maize

• More science required to prove efficacy and effectiveness of bio-fortified foods

Current concerns about safety, cost,acceptability and impact on environment limit development and penetration

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A number of crops are currently investigated for bio-fortification

Crop Nutrient

Orange sweet potatoes β-carotene/pro-vitamin A

(‘Golden’) Rice β-carotene/pro-vitamin A, iron, zinc

‘Orange’ Maize β-carotene/pro-vitamin A

Bananas β-carotene/pro-vitamin A

Beans iron

Cassava β-carotene/pro-vitamin A

Pearl millet iron

Wheat zinc

However due to regulatory and other reasons most of the developments did not make it to the market yet.


III. Regulatory and Market Factors

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Intended reach and target groups define fortification approach

• Mass/universal fortification

Wide consumption by general population; often mandatory.

• Targeted fortification

Consumption by specific population subgroup, e.g. for children or displaced populations; mandatory or voluntary depending on public health problem

• Market-driven fortification

Food manufacturers voluntarily fortify foods; always voluntary, but governed by regulatory limits.

WHO/FAO Guidelines 2006

Choice between mandatory or voluntary fortification depends on national/regional circumstances

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Six key factors determine whether mandatory or voluntary fortification is the most appropriate option

Factor Mandatory Voluntary

Public health risk Higher / more affected Lower / fewer affected

Food industry Centralized, well organized Smaller, more diverse

Consumer awareness/ demand

Not necessary Essential

Political environment (choice)

Not necessary Essential

Food consumption patterns Fortified food widely consumedVariety and accessibility essential

Fortification approach Mass/universal Market-driven

Criteria governing the selection of mandatory or voluntary fortification

Proactive communication and advocacy on role of fortification is a joint task of policy makers, regulatory bodies, food industry and nutrition scientists

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Costs for fortification are low relative to achievable benefits

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FOOD PROCESSORS

Manufacture and sell

FORTIFIED FOODSINSTITUTIONAL CHANNEL

WORKPLACE, HOSPITALS, SCHOOLS

buy and distribute

FOOD ASSISTANCE CHANNEL

(WFP, NGOs, PDS*)

buy and distribute

Three market channels offer different dynamics and solutions

PDS: Public Distribution System, in India =Integrated Childhood Development Service (ICDS) delivered in Anganwadi Centers

RETAIL CHANNELS

sell to consumersHOUSEHOLDS


IV. DSM’s engagement

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WFP and DSM partnered to fight malnutrition: Objectives of partnership

1. WFP and DSM Increase Micronutrient in WFP food basket

2. WFP Advocacy and awareness

3. DSM ‘DSM Pride’ – Engaging employees and their families

Employee Development

Strengthen DSM’s Corporate and Brand Reputation

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DSM brings nutrition competence, WFP global reach and distribution management into the partnership

2007 2010-2013

20-25% WFP FOOD

FORTIFIED

70-100% WFP FOOD

FORTIFIED

Enriching General Enriching General Food Baskets* with Food Baskets* with

MicronutrientsMicronutrients

* * Include cereals, pulses, legumes, fortified blended food, oil, salt

Micronutrient Powder(+Phytase)

Specially

formulated,

fortified foods

Fortified Blended Food (CSB+,CSB++)

Staple Food

Fortification

(NutriRice)

DSM is playing a critical strategic role in enabling WFP to launch the approach at the global level

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Jointly with IOF we develop a global Vitamin D deficiency map and actions to overcome issue

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In summary: DSM is balancing business and In summary: DSM is balancing business and social responsibilitysocial responsibility

Recognition

InvolvementPartnering

Business

Nutrition Improvement Program


V. Summary and Outlook

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Summary and Outlook

• Faster and more sustainable progress is needed to overcome Hidden Hunger and to achieve MDGs by 2015

• Food Fortification can be the most sustainable and cost-effective option to enhance micronutrient consumption in a population

• Technologies for mandatory and voluntary food fortification are available

• A joint approach by policy makers, regulatory bodies, nutrition scientists and private companies is required

Options to deliver Fortified Products to the Public

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Back upBack up

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Conventional fortification has a strong track record

• Long history in industrialized countries for successful control of deficiencies of• vitamins A and D• several B vitamins (thiamine, riboflavin and niacin)• iodine• iron

• Salt iodization introduced in early 1920s in both Switzerland and USA; now available in most countries

• From early 1940s, fortification of cereal products with thiamine, riboflavin and niacin became common practice

• Margarine fortified with vitamin A in Denmark

• Milk fortified with vitamin D in USA

• Foods for young children fortified with iron - substantially reduced risk of iron-deficiency anemia in this age group

• Folic acid fortification of wheat adopted by Canada, USA and Latin America

• In the less industrialized countries, fortification is an increasingly attractive option

• Success of programs to fortify sugar with vitamin A in Central America - vitamin A deficiency reduced considerably; similar initiatives in sub-Saharan Africa.

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Folic acid fortification of flour is a success story for many countries

Decline in the prevalence of neural tube defects (NTDs) following folic acid fortification of flour

South Africa: -31%

USA: -26%

Canada: -54%

Australia: -26%

Saudi Arabia: -60%

Chile: -43%

In 2009, 51 countries had regulations written for mandatory wheat flour fortification programs that included folic acid.

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Rice

Innovations drive new opportunities in staple food fortification

Sugar fortification

To insure a fortification level of 50,000 IU/g of vitamin A in sugar a novel vitamin A palmitate formulation is attached to the surface of sugar crystals.

Rice fortification (NutriRice)

• With micro-encapsulated vitamins in re-constituted rice kernels via extrusion;

• the concentrated vitamin/mineral „rice premix“ can be mixed with natural rice grains (1:100);

• good organoleptic properties (shape, taste, color) and high vitamin retention during cooking

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Efficacy of NutriRice demonstrated at Dandelion Migrant Worker School, China

Fortified food commodities consumed: NutriRice (B1, B2, FA, niacin, Zn, Fe,BC), NaFeEDTA-fortified soy sauce, VA-fortified cooking oil: 8 mo feeding

• Malnutrition rate -50%• B-vitamin deficiencies • VAD -51%, iron deficiency anemia -82%, zinc deficiency -58%• Improved school attention, cognitive & academic performance and physical

strengths including aerobic capacity

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… the only implemented example is Orange Sweet Potatoes (OSP) in Africa

http://sacatomato.com/sweet-potato-festival-and-botany-lesson

Daily consumption of 100 g of Orange Sweet Potatoes can provide 125 g of RAE, approx. 50% EAR for a young child

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A number of technical and societal pre-requisits A number of technical and societal pre-requisits have to be fulfilled for successful bio-fortificationhave to be fulfilled for successful bio-fortification

• Increased micronutrient content of food staples through plant breeding (GM and non-GM)

• Growing bio-fortified plants must be a financially attractive for the farmer compared to traditional plants

• Consumption of bio-fortified foods has to result in measurable and significant improvement of nutritional status

• Bioavailability of extra micronutrients bred into the food staples has to be established

• Bio-fortified crops have to be culturally and sensory acceptable to target population

• Poor malnourished people have to eat bio-fortified foods in sufficient quantities

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Both, mandatory and voluntary fortification require regulatory guidance

• We see a diversity in national public health goals with different approaches to regulation of food fortification

• In most industrialized countries, food fortification parameters are established by law

• At other end of spectrum, fortified foods are produced without any form of governmental guidance or control at all

• Generally it is recommended that all forms of food fortification is appropriately regulated to ensure safety and health benefit to target groups

By providing a higher level of certainty, mandatory fortification is more likely to deliver a sustained source of fortified food for the relevant population group and, in turn, a public health benefit

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Costs for fortification are low relative to achievable benefit

Copenhagen Consensus 2008

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UN WFP Executive Director Josette Sheeran:“We are really pleased that DSM wants to share its outstanding expertise to address

malnutrition with us. You can help increase awareness on the issue of global hunger, as will the active involvement of DSM employees in the partnership.”

Secretary General of the UnitedNations Ban Ki-Moon:“the private sector is among the main stakeholderson hunger and nutrition. Nearly 1 billion people gohungry every day – an unprecedented number.Business is a partner from emergency food aidto long-term agriculture, from our road map fornutrition to our Committee on World FoodSecurity”.

Feike Sijbesma receives 2010 Humanitarian of the Year Award

DSM‘s commitment to CSR honored by WFP and UN

dsm nutritional products options to deliver fortified products to the public ilsi conference on...

Documents

fortified products

food fortification slide

outlook slide

impact of hidden hunger

application management

public ilsi conference

mio children

life expert panel