Hello again, today i will write a bit about how to improve the food content and its nutritional value. You may have heard about futuristic methods like biofortification - crops breeded to improve their nutritional value (completely different than genetic modification). But supplementation? Anyone know something about it. There are two types of supplementation therapeutic (curing a deficiency - vitamin D in the winter) and prophylactic (preventing a deficiency - vitamin C before flu season). The main issues with this is that can cause side effects and it is not solving the cause (inadequate diet). 

How and when? Vitamin A supplementation for children under 5 is biannually, in areas where vitamin A deficiency is a concern, and it can reduce mortality by 25%. Iron supplementation, for pregnant women daily iron and folic acid is needed to reduce the risk of low birth, maternal anaemia and iron deficiency. For women menstruating the iron and folic acid reduces the risk of anaemia. Where malaria is endemic, children should get iron supplements after the malaria treatment. Delayed cord clamping can improve iron levels in neonates, if you do it beyond 1 minute instead pf 15-30 seconds as usual, as blood loss is prevented and the infant gets extra iron supply. 

For children between 6-23 months, MNP (micronutrients powder - having minerals and vitamins) can be sprinkled over food. We also have Ready to use Therapeutic Foods (RUTF) - to alleviate acute malnutrition - for severely malnourished children, like Plumpy'nut, Plumpy'doz, which are peanut based pastes with high energy and nutrient content, and F100, solid milk based food. They are used in areas with sudden disasters, nutritional rehabilitation clinics, people living with HIV/AIDS. 

Lipid based Nutrient Supplements (LNS) are used for people lacking essential fats and high quality protein (young children, pregnant and lactating women). Unlike RUTF ( replacing meals) the LNS are used additionally to the normal daily intake (20-50g). This is the supplementation bit. 

Next on the list, fortification, is the process of adding vitamins or minerals to processed foods to increase the nutrients intake. We have

• mass fortification - universal fortification of a basic food consumed by most of the people of one country,
• targeted fortification - meant for a specific population group like children or pregnant women, the two of them being usually government initiated and guided by legislation and policies. 
• market driven fortification - when food companies decide to add micronutrients to a food (heavily limited by specific legislation)

In order to initiate a fortification, the deficiency prevalence needs to be known, and the inadequate daily amount at first. Secondary, a food vehicle that is centrally processed needs to be chosen. Tertiary, food producers to be approached and the technology needs to be implemented. Fourth, policies and guidelines need to be created. 

Fortification requires no effort, no habit change and it is more sustainable, independent of the health system. Salt iodization is the oldest and best example of food fortification. At the moment, there are 128 countries engaged in salt iodization. The total number of people exposed to iodine deficiency decreased from 1.5 B to 0.5 B from 1990 until now. Salt iodization started in 1921/22 in US and Northern Switzerland. It is still done today in all the Switzerland, as the country soil is very poor in Iodine. In 1990 only 20 countries had iodization programs, but today we have only few countries still needing it (Sudan, Morocco, Angola).

Flour fortification with iron started to be practiced at scale in 1990 also, and right now 84 countries are fortifying flour with folic acid and iron (mostly in America, Africa and Asia). Rice fortification, mixing fortified rice kernels with original rice grains, is done in 6 countries right now (like Philippines, China and Indonesia). Oil and Sugar with vitamin A - is mandatory in Latin America and African countries (Guatemala was first, Zambia and Nigeria also followed. There was even a market driven initiative trial to fortify the bouillon cubes with iodized salt and iron. 

And finally, we have the agro-fortification, a part of the biofortification technology, working on the development of nutrient dense food. This is done with the addition of the nutrients from fertilizer application or by foliar spraying, improving soil quality (using tillage techniques, ween mana cement, water supply techniques, use of ash or animal dung, PH control). There is also biofortification through breeding and selection (gene pool is screened for lines with naturally higher nutrient content). This was used for centuries, and we got many fortified crops (cassava in Nigeria, Congo, Kenya, sweet potatoes, pearl millet, sorghum, rice, wheat, maize and beans - all of them having more vitamin A, zinc or iron). 

This was the last bit related to micronutrients, so until i engage in some new project, there is nothing left to write about how to improve our health. I hope i will find something exciting to write about again at some moment in the future.

I declare the 'Micronutrients and Malnutrition' series finished for now.

Yours truly,
George

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Disclaimer: This text is also re-published on my personal blogs, such as this one.