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Fortification of milk to fight against a ‘Silent Epidemic’
While each and every one of us is willing to connect and contribute to the vision of a healthy and disease-free life, a major section of the population is probably not aware of the spreading of a silent epidemic all around the country in the guise of micronutrient malnutrition. Micronutrients are mainly the vitamins and minerals that are essential for the normal functioning of the human body. They are different from familiar macronutrients like proteins, carbohydrates and fats - the more complex molecules. As a result, apparently, micronutrient deficiency does not look like an urgent and important issue to address. But one cannot ignore the gradual and certain potential health risks from micronutrient deficiencies that include a host of nutrient deficiency diseases, as well as early onset of cardiovascular diseases, osteoporosis, increased chances of fractures, bone and muscle ache, eye disorders and anaemia, among other possible ailments. Traditionally, malnourishment in India is usually discussed as a problem of the underprivileged, rural population. But a growing body of research is linking the micronutrient malnutrition also to the well-off segment of the urban population - interestingly, the very same segment that also faces the rising rate of obesity.
As per the selected state-wide surveys conducted by the National Nutrition Monitoring Bureau (NNMB) of National Institute of Nutrition (NIN), Government of India, almost 62% of Indian population has low serum blood levels of vitamin A and 50% - 94% of people in different states across India, suffer from vitamin D deficiency. Hence, the focus has been set on two of the most important micronutrient deficiencies in India, namely Vitamin A and D.
The easy answer to this challenge may be having a balanced diet containing recommended dietary allowance (RDA) of all the micronutrients. Incidentally, the prevailing ecosystem is not at all compatible with such simple solution primarily because of our socio-economic condition, customs, practices, etc. The task at hand is to do what is possible without ignoring what is necessary. Food fortification, a scientifically proven, cost-effective, scalable and sustainable intervention is considered as a workable pragmatic way that addresses the issue of micronutrient deficiencies. Globally it has been used for successful control of micronutrient deficiencies since 1920 as per WHO guidelines.
Importance of Vitamin A:
Vitamin A is an essential nutrient required for maintaining immune function, eye health, vision, growth and survival of human beings. Vitamin A deficiency is a major controllable nutritional problem. It is estimated that 30-40,000 children in India, may lose their eyesight because of vitamin A deficiency. The published literature linked vitamin A insufficiency with specific child mortality due to measles, diarrhoea, malaria and other infectious diseases and to all-cause maternal mortality.
International donors and agencies including the Canadian International Development Agency (CIDA), United Nations Children’s Fund (UNICEF), United States Agency for International Development (USAID), the World Health Organization (WHO) and others have actively supported both national and global level initiatives to raise awareness about the problem of vitamin A deficiency and to promote efforts to implement effective and affordable solutions.
Importance of Vitamin D:
Vitamin D a hidden threat (since it is not available in the natural foods), is a vital nutrient required for strong bones because it helps the body use calcium from the diet. Traditionally, vitamin D deficiency has been associated with rickets, a disease in which the bone tissue doesn't properly mineralize, leading to soft bones and skeletal deformities. But increasingly, research is revealing the importance of vitamin D in protecting against a host of health problems like increased risk of death from cardiovascular disease, Cognitive impairment in older adults, severe asthma in children and Cancer. Research suggests that vitamin D could play a role in the prevention and treatment of a number of different conditions, including type1 and type 2 diabetes, hypertension, glucose intolerance, and multiple sclerosis.
Milk Fortification with Vitamin A and D:
Improving the nutrition scenario of India has been a key challenge. India is at 97th place out of 118 countries on Global Hunger Index, 2016. Over 70% of India’s population still consumes less than 50% of RDA for micronutrients. One-third of about two billion people who are suffering from vitamin and micronutrient deficiencies globally, are in India. Despite four decades of a national supplementation programme, little progress has been made to reduce critical nutrient deficiencies in India.
Food Safety and Standards Authority of India (FSSAI) has been promoting food fortification in a big way since 2016 for complementing diet diversification to help complete a person’s daily nutritional needs. FSSAI and Food Fortification Resource Centre (FFRC) is going for a strategic shift in collaboration with development partners like TATA Trusts, GAIN, PATH, WFP, World Bank and NI and is rallying stakeholders across government, industry, food businesses, development partners, scientists, and academia to come together. Ministry of Women and Child Development and The Ministry of Human Resource Development of Government of India has also started to block the far-reaching effects of such menace. These are all encouraging steps taken by various organisations and the government but considering the magnitude of the problem needs further supplementation.
Milk in India, with its high volume of production, widespread distribution network, low budget affordability and all-around acceptability in the daily food habit can be singled out as the best vehicle in India to combat Vitamin A and D deficiency mainly for three specific reasons.
Firstly, it has been successful since long in other countries. Globally mandatory milk fortification legislation was first introduced in 1935. Currently, there are 14 countries that have mandated milk fortification. Among these 14 countries, 11 countries fortify milk with both vitamins A and D. Secondly, there has been a rapid rise in aggregate consumption of milk, from 178 grams per day in 1990-91 to 337 grams per day by 2015-16. This sustained growth in the availability of milk and milk products for a growing population offers an excellent opportunity to address vitamin A and D deficiencies through fortification. Thirdly, fortification of milk is highly affordable and cost-effective, costing less than 3 paise per litre. The dairy industry is equipped to fortify milk and does not require any additional investment.
The need is now to fortify three axes awareness in regards to ensure supply, enforceable regulatory mechanism and effective consumer awareness. Businesses are basically shapers of demand, often for unhealthy foods, it is time now to steer the demand for the wellness of the people in India.
We firmly pledge to promote Vitamin A and D fortification of Milk for fighting against the silent epidemic of micronutrient malnutrition and taking a step forward towards food and nutrition security and building a healthy and developed India.