1. OD-2011-03-India-Priorities1 Three Priorities in Food Fortification Conference on Micronutrient Fortification of Foods: Science, Applications & Management Three Priorities in Food Fortification Omar Dary 8-January-2011 Conference on Micronutrient Fortification of Foods: Science, Applications & Management

2. OD-2011-03-India-Priorities2 Objective of Food Fortification = Increase intake Total Abs.Initial absorption+ Additional Abs.  TechnologyBehavior INTAKE INTAKE=  [Nutrient content] x amount consumed  [BIOAVAILABILITY BIOEFFICACY  & BIOCONVERSION ] x INTAKE EAR TERTIARY (Clinical signs) SECONDARY (Metabolic biomarker) PRIMARY (Biomarkers of intake) QUATERNARY (Functional signs) OUTCOMES

3. OD-2011-03-India-Priorities3 TERTIARY (Clinical signs) SECONDARY (Metabolic biomarker) PRIMARY (Biomarkers of intake) QUATERNARY (Functional signs) Total Abs.Initial AbsorptionAdditional Abs. Vit. AVit. B 12 FolateIronZincIodine Xeroph- thalmia NTD’s Anemia NTD’s Anemia StuntingGoiter Serum retinol Megalo- blastic anemia RBC- folate Serum ferritin Serum zinc Thyroid hormones Breast- milk retinol Serum Vit. B 12 Serum folate -- Urinary iodine Goal of micronutrient programs= Outcomes OUTCOMES

4. OD-2011-03-India-Priorities4 Monitoring and Evaluation Total Absorption Initial Absorption Additional Abs. Access (Coverage) Adherence (Utilization) Change in behavior (Awareness) Monitoring outputs Science and assessment Control and Enforcement Implementation/ Distribution Policies/ Standards Fortified Product (Provision) Monitoring inputs TERTIARY (Clinical signs) SECONDARY (Metabolic biomarker) PRIMARY (Biomarkers of intake) QUATERNARY (Functional signs) Evaluating outcomes

5. OD-2011-03-India-Priorities5 Predicting micronutrient deficiencies Diet low in fresh fruits and vegetables Vit. C,  - carotene Diet low in seeds and vegetable oils Vit. E Diet low in eggs and milk Vit. A, B-2, B-12, calcium Living in high latitudes, o covering the body Vit. D Diet low in marine fish Iodine Diet depending on cereals Iron, zinc Diet depending on sugar, oil and refined cereals B-1, niacin, B-6 Diet low in pulses (beans, lentils, peas) Folate

6. OD-2011-03-India-Priorities6 Milk is a good source of calcium, B-12 and B-2. Impact of fortified milk in Chile

7. OD-2011-03-India-Priorities7 Conclusions: 3 priorities in food fortification 1.Establish simple, reliable and permanent monitoring and evaluation systems for assessing intervention outputs and program* outcomes. 2.Promote consumption of fortified milk (including in adults). 3.Use fermentation or phytases in cereal processing (for increasing mineral bioavailability).