Food fortification in five Southeast Asian

countries: SMILING project

Pattanee Winichagoon, Ph.D

On behalf of the SMILING team

Presented at the SMILING Symposium

20th International Congress of Nutrition, Granada, Spain

September 16, 2013

Food fortification in SMILING countries

• A 3d-workshop on Food fortification -- compiled

information on food-based strategies, including

food fortification:

– target groups, food vehicles, fortificants

– existence of specific policy and

implementation

– strengths & weaknesses of policy and

programs

• A 2d advocacy meeting – consensus and

recommendations on further actions to improve

effectiveness of food fortification programs.

Current food fortification

• All countries: Mandatory iodization of salt; Vietnam

temporarily stopped, soon to be resumed

• Mandatory fortification exists in Indonesia and Thailand

– Indonesia: iron & zinc fortification of wheat flour, multiple

fortified complementary foods, and vitamin A fortification of

cooking oil.

– Thailand: iodization of fish/soy sauce and vitamin A

fortification of sweetened condensed milk

• Voluntary fortification in 4 countries: condiments, staples

and complementary foods as a public health strategy

• All countries: Food-based strategies (malnutrition of all

forms)

– food-based dietary guidelines

– food security for nutrition

– nutrition education communication

Lessons learned from

country’s experiences

Cambodia

– National Sub-Committee for Food

Fortification (NSCFF) – oversee all food

fortification projects/programs

– NSCFF in cooperation with RACHA

(national NGO) -- implementing a five-year

program on Fe-fortified fish/soy sauce

– To be expanded: piloting Vegetable oil

fortified with Vitamin A

5

Mandatory salt Iodization:

– Potassium Iodate

– Minimum acceptable level: 40-60 mg/kg at

factory level; >20 mg/kg at household level

– Regulating body: FDD of MOH

– Legislation since 1995: Prime Minister’s

Decree on Universal Salt Iodization

– Coverage: 79.5%

Food Fortification: Laos

Planned FF with WFP In LAO PDR 2011-2015

1. Potential food vehicles:

- Soybean and peanut oil

- Fortified noodle production

- Nutri-rice, a grain-like capsule of

micronutrients mixed in with normal rice

- Lipid based, low-cost ready-to-use food

2. WFP to support the fortification of the products

& marketing

3. Social marketing and sensitization on

appropriate storage and handling are needed

FF experiences in Indonesia

1. Salt – Iodine: Mandated 1994

2. MSG - Vitamin A – Voluntary 1980-1990, then

discontinued)

3. Wheat Flour -- Fe, Zn, FA, B1, B2: Mandated

2002

4. Vegetable (palm) Oil – Vitamin A: in process for

mandatory (2013/2014)

5. Rice for the Poor (being planned)

6. Sugar – not yet feasible

Scaling up towards mandatory palm oil fortificatin

Mandatory

1

2

3

• Baseline data: prevalence, effectiveness study

0

2012/13

2010-11

2009 2008

• Strengthening research and communication

Among parties & advocacy to establish “ppp”

• Pilot project

- Develop standard QA/QC & Capacity

building for Provincial level

- Advocacy and social marketing - Voluntary fortification by industry

- Develop mandatory FF Endline data analysis

on impact

Thailand FF experiences

1. Mandatory fortification of vitamins A & D in

sweetened condensed milk

2. Mandatory salt iodization (1994)

3. Mandatory iodization of fish/soy sauce (2010)

4. Voluntary multi-micronutrient fortification:

1. Seasoning powder of instant noodle

2. Quick cooking rice for complementary food

Voluntary food fortification in Thailand

• Private-public-academic collaborative initiative

• Product development with instant noodle industry to include vitamin A, iron and iodine in the seasoning mix

• Reduced tariff for the premix (30% to 2-3%)

• Product distribution by private companies

• Nutrition education through government on importance of micronutrients

• Long latent period for industry to agree to commercialize

– Market viability i.e., business risk

• Similar experience with multi-fortified quick cooking rice for complementary food

Lessons learned

1. Public Private Partnerships (PPP)

– crucial for success and sustainability of FF

– common social goal

– continued partnership and building trust

2. Recognizing the differences in shared

responsibility and benefits

– Public sector – government provision of

fund/investment for public responsibility

– Private sector– business investment and

profit returns + social responsibility

3. Technical vs commercial feasibility & market

viability:

– cost, production feasibility

– consumer acceptability –fit in habitual diets

4. Research support

– Bioavailability – selecting fortificant

– Consumer acceptance and actual uses of FF

– Product development

– Shown impacts on nutrition, health and

functions

Food Fortification in Vietnam

Management and implementation

Steering committee

(MOH, MOIT, MOARD)

Production and distribution

Technical regulations and quality control

Social marketing Monitoring and

evaluation

Management board

(National Institute of Nutrition)

Voluntary Food fortification in Vietnam

No Food

Vehicles Micronutrient

Cost for

premix Dose

1 Edible oil Vitamin A 1.365.000

VND/kg 75 IU/g

2 Fish sauce Iron 150.000

VND/kg

2.5 mg/

10 ml

3 Soya sauce Iron 150.000

VND/kg

2.5 mg/

10 ml

4 Granules

(MNP) Zinc

150.000

VND/kg

75 mg

Gluconate/

kg

Government supports to food producers on FF

• Contact point for purchasing micronutrients

• Support 50% total amount of micronutrient in the

first year of participation

• Training, technical support for food fortification

• Develop logo and application for patents on

micronutrient fortified foods

• Communication, marketing for micronutrient

fortified foods for consumers

• Supports for product registration and monitor

micronutrient fortified foods

Summary & Recommendations

• Food fortification (FF) -- based on Optifood results, FF likely

be a choice for all countries: universal or targeted

• National FF guidelines – mandatory vs voluntary

• National body on FF is crucial for success

– SC of the National nutrition committee

– Independent FF committee for all commodities vs individual

– A functional and active secretariat is essential

• coordinate the multi-sectoral efforts

• partnering with academic, non-government & international

organizations

• Food fortification be advocated to the existing ASEAN

committee on food security

– Sharing knowledge & resources e.g., laboratory for quality

assurance

– Capacity building on FF for the ASEAN

Key challenges

• Scaling up as a national program

– A functional national food fortification

committee to formulate and oversee the

program

– Laboratory capacity & Monitoring system for

quality assurance and capacity building in FF

– Impact/effectiveness evaluation

• Harmonizing efforts in FF among ASEAN

countries beyond SEA/SMILING countries

Thank you