FORTIFICATION

Grain
fortification
Rice fortification seen as next
frontier in grain fortification

by Sarah Zimmerman, Food Fortification

initiative

he familiar FFI initials took on

new meaning in 2014 as the Flour
Fortification Initiative changed its name
to the Food Fortification Initiative. The
change was due to FFI adding rice to
its work. Since rice is mostly eaten as
whole kernels, it was not reflected in
FFIs original name.
We must find practical solutions
for rice fortification because literally billions of people live in
countries where health burdens are high and rice is a staple food,
said Scott J. Montgomery, FFI Director. Rice is the new frontier
in food fortification, and with our partners we are discovering
ways to make fortifying it feasible, he added.
Wheat flour, maize flour, and rice are most commonly fortified
with iron and folic acid to prevent anemia caused by iron
deficiency and neural tube birth defects caused by insufficient
folic acid. These are both significant health problems. Anemia
results in reduced productivity, contributes to maternal mortality,
and impairs a childs cognitive development. The most common
neural tube defect is spina bifida in which the babys spine does
not form correctly. It causes some loss of movement or severe
paralysis plus varying degrees of loss of bowel and bladder
control. While iron deficiency anemia can be cured, spina bifida
cannot be cured, and fortification is a successful prevention
strategy.
One measure of global progress towards fortifying grains
for healthier lives is the number of countries with fortification
legislation. Currently 82 countries have mandates requiring
fortification of wheat flour, maize flour, and/or rice with at least
iron or folic acid. This compares to 44 countries with such
legislation in 2002 when FFI began.
Another measure of progress is the percent of industrially
milled flour and rice that is fortified globally. In 2014, FFI
estimated that 30 percent of industrially milled wheat flour,

36 | Milling and Grain

48 percent of industrially milled maize flour, and 1 percent of

industrially milled rice were fortified.
For these estimates, FFI begins with data about the amount
of grain available for human consumption from the Food and
Agriculture Organization of the United Nations (FAO). For
wheat and maize, FFI then applies a formula with each countrys
average extraction rate to estimate the amount of flour available.
This is not needed for rice as FAO data represents the milled rice
equivalent.
FFIs focus is on industrially milled grains because that is where
fortification is most feasible. FFI assumes that 100 percent of
wheat flour is industrially milled, with the exception of countries
with a large number of small mills such as India, Nepal, and
Pakistan. In contrast, FFI assumes that 0 percent of maize flour
and rice is industrially milled unless it has country specific data to
indicate otherwise.
Using these formulas, FFI estimates that in 2014 the following
amounts of each industrially milled grain were available for
human consumption:
290 million metric tons of wheat flour
16 million metric tons of maize flour
222 million tons of rice
FFI then contacts national governments, milling associations,
non-governmental organizations and UN agencies to estimate
how much of each grain is fortified in their country. Those
country responses are then compiled into the global estimate.
In 2004, about 18 percent of the worlds industrially milled
wheat flour was fortified. FFI does not have previous estimates
of the amount of industrially milled maize flour or rice that was
fortified, but FFI will estimate fortification of each of these grains
in the future.
As another way to understand if fortification programs are
achieving their maximum health benefit, in 2014 FFI asked
leaders in countries with fortification legislation about six
components of their monitoring programs. The answers and

F
In 2014 Nicolas Tsikhlakis, Chief
Operations Officer and Partner
at The Modern Flour Mills and
Macaroni Factories in Jordan,
requested information from
the Food Fortification Inititative
because some country leaders
were considering removing
folic acid from the wheat flour
standard. FFI connected Nicolas
with experts at the US Centers for
Disease Control and Prevention
(CDC) and the regional World
Health Organization (WHO) office.
With the information provided,
the country opted to continue
fortifying with folic acid.
Photo by Andrew Gorman
for FFI.

Des Devenport, Mill Manager

at Delite Flour Mill in Solomon Islands,
discusses plans to expand his wheat
milling capacity and include fortification.
The mill plans to be fortifying by May
2015. FFI photo by Helena Pachn.

documentation provided will help FFI and partners produce

an outline of what should be included in effective monitoring
programs.
In addition, FFI, the United Nations Childrens Fund
(UNICEF), and the US Centers for Disease Control and
Prevention (CDC) created case studies on the flour fortification
monitoring programs in Chile, Indonesia, and South Africa. These
showed that the internal monitoring in each country was rigorous,
while the other type of monitoring were inconsistent. Differences
are expected as not all monitoring components (internal, external,
commercial, and import) are needed for every program. But all
national fortification programs need at least internal and external
monitoring to help ensure success.
FFIs role is to support national leaders working towards

grain fortification. The support provided through multi-sector

collaboration includes:
Advocacy resources on the benefits of fortification
Technical assistance for planning, implementing, and
monitoring sustainable fortification programs
Tracking progress at the country and global levels
Such support is often provided through workshops and training
meetings, visits with key decision makers in specific countries,
and addressing individual requests for information. In 2014, the 13
members of FFIs staff led or participated in 26 workshops, made 18
country visits, and addressed 47 individual requests for information.
The full FFI report can be accessed at:
http://www.ffinetwork.org/about/stay_informed/
releases/2014Review.html

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April 2015 | 37