While the more affluent have the wherewithal to exercise the choice of consuming more nutritious food, those who are economically more vulnerable often cannot afford to buy green leafy vegetables, fruit, milk, and meat, the intake of which is recommended to fulfil our dietary needs. India's Public Distribution System is largely grain-dependent (rice and wheat) and these do not provide adequate protein and micronutrients like Vitamin A and D, the absence of which can contribute to micronutrient malnutrition and increased vulnerability to diseases. If this same diet were to be augmented through the fortification of key staple foods with micronutrients, it would greatly help in closing this gap. Fortification is a scientifically proven method that allows these micronutrients to be taken daily in low doses to fulfill the body’s requirements.[1]
The effect of any pathogenic disease depends on the body's immunity, and micronutrients have a proven role in boosting immunity. Numerous studies have shown an increase in either susceptibility to or severity of various viral infections in nutritionally deficient individuals.[2] Micronutrients play a crucial role in the development and maintenance of physical barriers (skin and mucous membranes) and the production of antimicrobial proteins. They also influence the activity of immune cells and the mediation of inflammatory processes.[3]
Research shows that Vitamin D helps in the regulation of both innate and adaptive immune responses against viral infections.[4] Clinical investigations and in vitro studies reveal that Vitamin A is the main regulator of mucosal immunity and could affect immune responses to mucosal infections.[5]
In food fortification, micronutrients (vitamins and minerals like Iron, Folic acid, Vitamin B12, Vitamin A, D, etc) are added to staple foods like rice, wheat flour, milk, and edible oils. Food fortification is considered as an effective strategy of delivering micronutrients affordably and sustainably to reduce the prevalence of micronutrient deficiency diseases like anaemia, night blindness, neural tube defects, Vitamin D deficiency disorders, etc. Food fortification is a complementary strategy and not a replacement for balanced, diversified diets to address malnutrition. Dietary diversification is indeed the best choice, but it may be difficult to achieve by everyone, therefore a more universal approach is needed to address the issue.
The Food Safety and Standards Authority of India (FSSAI) is framing policies and guidelines and is engaging with the food processing industry and food business operators (FBOs) for the fortification of cereals, oil, and milk with suitable micronutrients so that the fortified staples are easily available in the open market and to the state governments for distribution through the Public Distribution System (PDS), Integrated Child Development Services (ICDS) and the Mid-Day Meal (MDM) schemes.
The packaging of fortified products has a blue-coloured +F logo indicating that it is fortified, and the nutrition label on the packed product indicates the various added micronutrients and their quantities, as specified by the FSSAI. Non-fortified products cannot use this logo.
Consumption of fortified food can address key micronutrient deficiencies in the population and contribute to a healthier immune system, which is crucial as we prepare to face COVID-19 and other health threats, including future pandemics.
Mr Tarun Vij, India Country Director, GAIN says, "As the world and India grapple with COVID 19, the importance of micronutrients to boost immunity is well recognized. Fortified staples deliver needed micronutrients such as Vitamins A and D (in edible oil and milk) and Vitamin B12, folic acid, and iron (in wheat-flour) to the population, and most importantly, to the poor and vulnerable communities to the extent of 25% to 30% of the required daily allowances, thereby contributing to mitigating the severe consequences of micronutrient deficiencies."
“GAIN is committed to supporting the scale-up food fortification in the country through building the capacity of industries for producing quality assured fortified staples; and promoting the inclusion of fortified staples in the social protection schemes such as PDS, ICDS, and MDM in states and their increased availability in the open market for consumers at large. GAIN's Large-Scale Food Fortification programme is reaching 884 million beneficiaries through one or more fortified staples (edible oil, milk, and wheat flour), based on average per capita household consumption."
Mr Mohan HL, Chief Executive Officer, KHPT adds, "Our work with GAIN to provide technical support to the FSSAI for wide adaptation of wheat flour, milk and oil fortification by industries has had a tangible impact at the population level in 15 states. Fortification is associated with little cost and behaviour change on the part of the consumer, and fortified staples must be made widely available to boost health and immunity, especially for the well-being of the most vulnerable populations."
[1] Food Fortification Resource Centre (FFRC-FSSAI).(2020). Daily Recommendations and Food Fortification. https://ffrc.fssai.gov.in/assets/news/file/daily_recommendations_food_fortification.pdf
[2] Beck MA, Matthews CC. Micronutrients and host resistance to viral infection. Proc Nutr Soc 2000; 59:581–5.
[3] McAuliffe S, Ray S, Fallon E, et al. Dietary micronutrients in the wake of COVID-19: an appraisal of evidence with a focus
on high-risk groups and preventative healthcare. BMJ Nutrition, Prevention & Health 2020;0. doi:10.1136/bmjnph-2020-000100
on high-risk groups and preventative healthcare. BMJ Nutrition, Prevention & Health 2020;0. doi:10.1136/bmjnph-2020-000100
[4][4]Medrano M, Carrillo-Cruz E, Montero I, Perez-Simon JA. Vitamin D: effect on haematopoiesis and immune system and clinical applications. Int J Mol Sci 2018; 19:2663.
[5] Kunisawa J, Kiyono H. Vitamin-mediated regulation of intestinal immunity. Front Immunol 2013; 4:189.
