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“ I would be hard- hearted

“ I would be hard- hearted enough to let the sick die if you can tell me how to prevent others from falling sick”. NIN-DFS.

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“ I would be hard- hearted

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  1. “I would be hard- hearted enough to let the sick dieif you can tell me how to prevent others from falling sick” NIN-DFS

  2. EVOLUTION OF THE NIN DOUBLE FORTIFIED SALT S. Ranganathan & B. Sesikeran National Institute of Nutrition (ICMR) Ministry of Health & Family Welfare (GOI) Hyderabad – 500 007 NIN-DFS

  3. OUT COME OF IRON DEFICIENCY Infant/Maternal: Increased mortality and morbidity. Poor reproductive outcome: Still birth, poor fetal growth, prematurity, low birth weight, intra uterine deaths, etc. Immuno Competence : Reduced phagocytic activity of WBC. Children & Adults: Poor work capacity. NIN-DFS

  4. In India, 75% of infants, 80% of adolescent girls, and 85% of pregnant & lactating women suffer from anemia.

  5. IODINE DEFICIENCY NIN-DFS

  6. Iodine deficiency during pregnancy causes about 6.6 million babies a year to be born mentally impaired in India. • TGR is about 26% in the country. • IDD continue to be a public health problem not only in Sub-Himalayan region, but also in the peninsula. Calls for immediate action. NIN-DFS

  7. STRATEGIES TO OVERCOME IRON DEFICIENCY: • Promotion of consumption of foods rich in iron ? Bioavailability • Sensitization/Awareness – time consuming • Folifer tablets supplement to ‘risk’ group. • Iron Fortified Salt – for all. NIN-DFS

  8. STRATEGIES TO OVERCOME IODINE DEFICIENCY • NO SUITABLE FOOD RICH IN IODINE • IODIZED SALT NIN-DFS

  9. NIN-DFS

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  11. IMPORTANCE OF SALT • Salt is universally consumed • Constant daily intake. Low potential for excessive intake. • Production of salt is limited to few centers. • Ideal vehicle for Iodine/Iron fortification. • Iodine & Iron introduced through salt will be ingested by each individual at a uniform dosage throughout the year. NIN-DFS

  12. IRON FORTIFIED SALT (IFS) FePO4 & NaHSO4: AJCN 1975;28: 1395 - 401. FeSO4 & OPA: AJCN 1978; 31: 1112 - 14. Multicentric Efficacy study: Hyderabad, Delhi, Madras, Calcutta. AJCN 1982; 35: 1442 - 51. (FNB). FeSO4 & SHMP: Colourless IFS. Food Chemistry 1992; 45: 263 - 67. Large-scale production: J Food Sci Technol 1993; 30: 166 - 68. Successful Transfer of Technology to TNSC (1991). 200 - 300 MT/month. FGS alone: Food Chemistry 1996; 57: 311 - 15. Ultra-structural differences of IS, IFS & DFS: SCANNING. Journal of Scanning Microscopies 1998; 20: 271 - 73. CHRONOLOGY OF DEVELOPMENT OF SALT FORTIFICATION TECHNOLOGIES AT NIN NIN-DFS

  13. CHRONOLOGY OF DEVELOPMENT OF SALT FORTIFICATION TECHNOLOGIES AT NIN (Contd..) IODIZED SALT (IS) Stable ‘IS’ with KI or KIO3 using CO3 stabilizer • CaCO3: Dry mixing. Lab studies: Indian Food Industry 1986; 5: 122 - 24. • CaCO3, MgCO3: Factory. Long distance transport. Asia Pacific J Clin Nutr 1997; 6: 92 - 94. • CO3 of Na: Spray mixing. Factory. Long distance transport. Salt 2000 – 8th Salt Symposium, Vol 2, RM Geertman, 2000; 1051 - 56, Elsevier. • IS stable after 15 months even at high humidity. One more benefit of ‘UIS’ is DFS NIN-DFS

  14. DOUBLE FORTIFIED SALT (DFS) • DFS is edible common salt to which very small quantities of iodine and iron are added. • DFS isiron fortifiediodized salt. • DFS looks like iodized salt and it is to be used in the same way as iodized salt. NIN-DFS

  15. COMMON SALT DFS NIN-DFS

  16. DFS • Edible common salt [Mg: <0.1%; Moisture: <1.5%; NaCl: >98.0%] • Sodium Hexa Meta Phosphate (SHMP): 1% • FeSO4.7H2O: 0.50% (Fe = 1000 ppm) • KIO3: 0.0067% (I = 40 ppm) [KI also can be used] • Simple method of ‘dry mixing’ • Does not involve elaborate and • expensive measures NIN-DFS

  17. IRON 1/3 RDA (10 mg) IODINE 100% RDA (150 g) DFS @ 10g/day PROPHYLACTIC NIN-DFS

  18. DFS • Lab studies • Factory studies • Safety evaluation • Acceptability studies • Impact & Efficacy studies “EXCELLENT RESULTS” NIN-DFS

  19. NIN-DFS

  20. NIN-DFS STABILITY (6 STUDIES)

  21. STABILITY NIN-DFS

  22. ACCEPTABILITY Chappati, Puri, Parotta, Lemon rice, Coconut rice, Dal, Chutney, Potato curry, Mixed vegetables curry, Idli, Dosa, Upma, Pongal, Vada, Pakodi, Bajji, Samosa, Vegetable Salad, Lemon/Orange juices, Butter milk, Fruits’ slices, Pickles, Sambar, Rasam, Egg omelet, Fish/Prawn, Chicken/Mutton. NIN-DFS

  23. BIOAVAILABILITY NIN-DFS

  24. SAFETY • P intake about 30mg/day. • No change in bone integrity and histopathology of tissues; no impairment in Ca & P balance in rats fed with DFS for 9 months. • No change in Ca & P homeostasis of children who consumed DFS for 2 years. • No undesirable effect, allergy or toxicity over 2 years of consumption of DFS in the tribal study and residential school study. 100% compliance in all the studies. NIN-DFS

  25. IMPACT: Iodine status NIN-DFS

  26. IMPACT: Iron status (anemic children) IS:Urban: Before 54%; After 47% NIN-DFS

  27. DFS: MEAN (95% CI) RISE IN Hb 0.72 (0.43, 1.01) g/dl IN COMPARISON TO ‘IS’ • WELL WITHIN THE RANGE OF GLOBAL EXPERIENCE NIN-DFS

  28. FACTORY PRODUCTION 0.5 TO 60 MT (1) Hyderabad, AP (2) Chennai, TN (3) Valinokkam, TN (4) Alathur, TN (5) Thirupporur, TN (6) Mithapur, Gujarat (7) Bhubaneswar, Orissa (8) Gandhidham, Gujarat; (9) Tiruchengode, TN NIN-DFS

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  37. COST (Rs.) OF 1 kg 6.85 – 5.85 = 1.00 NIN-DFS

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  39. With an average consumption of 10g salt per day, additional cost of DFS over ISwill be about 1 Paise/head/day NIN-DFS

  40. Elimination of IDA & IDD through DFS is a worthwhile investment • In addition to health benefits, if benefits related to education, increased productivity of the population, human resource developmentand increased productivity & yield of livestock (egg, milk, wool, etc) are includedthen,cost benefit ratio is very high. NIN-DFS

  41. MESSAGE • NIN-DFS is a low-cost technology. • All the ingredients are easily available. • Its stability, acceptability, bioavailability, safety, large-scale production in several factories & distribution to remote areas, impact and efficacy have been proved successfully. • It is as effective as Iodized Salt in controlling IDD &as effective as Iron Fortified Salt in controlling IDA. NIN-DFS

  42. APPRAISAL DR. MK BHAN COMMITTEE REPORT, 2006: • Approved only NIN-DFS because of convincing evidences. • Other DFS formulations were lacking scientific evidence. NIN-DFS

  43. APPRAISAL • NIN wrote letters to the Secretaries ofWomen Development and Child Welfare Department and Department of Healthof all the States & UTs in the country(35 each) advocating the introduction of NIN-DFS in nutritional programmes of the States & UTs. • PFA & BIS Standards NIN-DFS

  44. WHAT IS NEW ? • MoU: Free Technology Transfer: No charges. • Dossier withManual for Factory Production. • DFS through PDS: Minimum 20% to PDS. NIN-DFS

  45. CONCLUSION • DFS is the result of two decades of untiring efforts of NIN Scientists without compromise on quality. • Dr. Bhan Committee, GOI cleared only NIN-DFS. • Now the benefits should reach the people with no further delay. • With the ‘NIN-DFS ARMOUR’, the country is geared up to combat the double burden of IDA & IDD. NIN-DFS

  46. THANK YOU

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