Food processing to challenge malnutrition

1. Food processing to challenge malnutrition Symposium “food technology for better nutrition” Nutrition Foundation of India 30 Nov – 01 Dec, 2007 New Delhi, India Presenter: Bertrand Salvignol Commodity Quality Control Officer World Food Programme, Bangkok

2. Food processing Definition: Food processing is the set of methods and techniques used to transform raw ingredients into products for consumption by humans or animals … to produce attractive, nutritive, affordable, marketable food products and stabilized for storage over long periods. Benefits of food processing: • Improved food security • Creating sustainable livelihoods and economic development • Improved bio-availability and digestibility, toxin removal, preservation, flavor improvement, ease of marketing and distribution. • Increased seasonal availability and improved transportation of delicate perishable foods across long distances. • Improved quality of life for people with allergies, diabetics, and others who cannot consume some common food elements. • Enables the addition of extra nutrients (e.g. minerals and vitamins). • Increased shelf life, less susceptibility to spoilage than unprocessed foods. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

3. Brief history of food processing Prehistoric times: need for preservation techniques • Slaughtering, sun drying, salt preservation, fermenting • Then cooking: roasting, smoking, oven baking, and steaming Mesopotamian, Egyptian, Greek, Latin times: • … milling, brewing … Modern history: • 1809: Nicholas Appert – Vacuum bottling • 1810: Peter Durand - Canning / tinning • 1862: Louis Pasteur – Pasteurization • 20th century: spray drying, ice drying, extrusion-cooking, freezing, microwave, continuous treatments …, and addition of preservatives, colorants, enzymes, micro-nutrients, etc Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

4. Specifications of WFP’s food • Safe • Well packaged • Easy to transport and to store • Cost-effective • Versatile • Easy to target • Practical, easy to prepare, enabling fuel savings • Culturally acceptable • Legally authorized And • Nutritious … Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

5. Nutritionalquality of WFP’s food • Macronutrients and Energy contents: Protein / Fat / kcal • Micronutrient contents: % of RNI/RDA covered according to age, sex, physiological status and programme nutritional objectives • Nutrient bio-availability, food digestibility • Nutrient density: consistency (special food for young children), while avoiding displacement of essential nutrients • Nutrient availability at beneficiary level: preservation during storage, preparation, … … • In accordance with the Codex Alimentarius, National Regulations and WFP specifications. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

6. WFP’s processed foods Pre-cooking (roasting / extrusion-cooking / IR treatment) • Fortified Blended Foods: Wheat Soya Blend [Indiamix], Corn Soya Blend, Rice Milk Blend, … (multi-min/vit mix) Milling • Fortified flours: maize meal, wheat flour, atta (multi-min/vit mix) Baking • Fortified biscuits (multi-min/vit mix) Refining • Fortified oil (Vitamin A, Vitamin D) Grinding / mixing • Fortified salt (Iodine) Steaming / Frying • Fortified noodles (multi-min/vit mix) Roasting / Grinding / Blending • Emergency commodities (Plumpy Nut®, RUTF, RUSF, …) Practical, Versatile, Nutritious, cheap (cost-effective), easy to produce locally, easy to target, in accordance with WFP policy Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

7. WFP’s food processing activities in Asia (as WFP’s region) Fortified Blended Foods Fortified Biscuits Fortified Atta Fortified Blended Foods Fortified Oil & Ghee Fortified Biscuits (on going study) Fortified Blended Foods (RMB, CMB, CSM) Fortified biscuit Fortified Blended Foods (WSB & CSB) Fortified Biscuits Fortified Blended Foods (January 2006) Fortified Coconut Oil Fortified Noodles (since 2004) Fortified Biscuits ...and wheat flour fortification in Afghanistan, and Pakistan, FBF and biscuits production in Pakistan Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

8. Why food processing is now focusing on micronutrient fortification and not on food with protein & energy? Nutrition Science Pendulum is Swinging Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

9. The food nutrition pendulum (Soekirman 2006, modified from Martorell & Rivera, 2000, Advances in Nutrition Research, 100 yrs PAHO) Supplementation Fortification Fortification Supplementation Sprinkles RUTF / RUSF (2000’s) Ongoing Milk Proteins (50s-60s) Calories (70s-80s) Enough quantity, Micronutrients, Animal Protein, Energy Density, Fat quality and Active feeding Quantity Micronutrients (90s) Quality Balance Diet Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

10. Integrated Approaches to eliminate Micronutrient Deficiencies(V.Mannar, MI, 2003) Supplementation Public Health Measures Fortification Dietary improvement 2000 2005 2010 Relative contribution of interventions to eliminate MND Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

11. WFP policy (Executive Board, May 2004) • Careful attention to be paid to micronutrients in needs assessment and ration planning, • Programming donor-supplied or internationally procured fortified foods on an increasingly large scale, • Promotion and use of locally-produced and fortified commodities in at least 13 low income, food deficit countries, • Advocacy for fortification at national and international policy making levels Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

12. Copenhagen consensus • The world’s leading economists ranked the solutions that would offer the biggest bang for the buck, micronutrients came in just near the top. • It would cost about 25 cents to help each individual suffering from iron deficiencies, yet the benefits in terms of increased productivity, run to as much as $50 per person/year. • In other words, we could do more than 200 times as much good as we spend. Bjørn Lomborg (director of the Copenhagen Consensus Center) in Foreign Policy, June 2007. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

13. Controlling and Preventing micronutrient deficiencies There are two ways to control micronutrient deficiencies: By reducing the demand for a specific micronutrient Or By increasing the supply of micronutrients. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

14. Reducing the demand for micronutrients Reducing the demand is possible by NON-FOOD interventions: • Improvement of hygiene. • Improvement of prophylaxis (e.g. by conventional immunisation). • Improvement of treatment of infectious diseases. • De-worming to control anaemia. • Malaria control to combat anaemia. • Health measures such as sun exposure to protect against vitamin D deficiency. WFP in Asia: Collaboration with MOHs, NGOs, UNICEF Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

15. Increasing the supply of micronutrients There are several ways to increase the supply of micronutrients : • Supplementation (including Sprinkle strategies), • Food-based approach (including Fortification of foods), Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

16. Increasing the supply of micronutrients The supplementation approach consists of: • Distribution of Vitamin A capsules or Iron/Folate tablets; low-cost, successful but not necessarily cost effective approaches. • New approaches: Sprinkles (also called home-fortification) Distributing micronutrients often delivers only a few micronutrients, and as they are highly targeted approaches they may reach only a limited population and have low compliance rate. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

17. Increasing the supply of micronutrients The food-based approach consists of: • Increasing the food production by more efficient agricultural practices (e.g. India, Vietnam, China, etc.). • Increasing the micronutrient content of foods by improving the plant genome (bio-fortification). • Increasing consumption of specific foods by nutrition education, lowering food prices, improving access to the market, subsidizing foods, and other similar measures. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

18. Increasing the supply of micronutrients Fortification approach (included in a food-based approach) refers to the addition of essential micronutrients to food. • Fortification of food with vitamins and minerals was introduced in the 20’s in western countries (e.g. salt iodisation in Switzerland started in 1923). • The efficiency of these programmes were extensively analysed and documented. In the USA flour fortification in 1938 reduced mortality due to pellagra from 3,000 per year in 1938 to zero in 1950. • In the developed countries a wide range of products are fortified with minerals and/or vitamins (e.g. breakfast cereals, oil/margarine, flours, etc.). Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

19. Cost of Food Fortification • Salt: US$ 0.1 / MT • Wheat Flour: US$ 1 - 4 / MT • Fortified Biscuits: US$ 9 - 20 / MT • Fortified Blended Foods: US$ 15 - 17 / MT The cost includes fortificant cost, investment in new equipment, quality assurance at factory level, monitoring cost at the State Level (e.g. Atta fortification at village level in Gujarat is costing Rp 0.10/kg) Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

20. Cost-effectiveness of different interventions(from WHO-FAO, 2006) 250 Water disinfection Oral rehyd. 200 150 Cost per DALY saved Zn suppl. 100 Pneumonia manag. 50 Fe suppl. Fe fortif. Vit. A & Zn fortif. 0 Fortification is the most cost effective strategy … but does it work? NB: DALY: cost per disability-adjusted life-year saved. Context: West Africa Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

21. Evaluation (Efficacy)in controlled conditions Ghana: Comparison of 3 fortified supplement / RCT. “ …All 3 supplements had positive effects on motor milestone acquisition by 12 mo compared with no intervention…”. (Adu-Afarwuah et al, AJCN 2007) Kenya: Maize meal / RCT. “ … consumption of whole maize flour fortified with NaFeEDTA caused modest, dose-dependent improvements in children’s iron status …”(Andang’o et al, Lancet 2007) Pakistan: Wheat flour fortification with lysine.These results indicate that lysine fortification of wheat flour can significantly improve sensitive indicators of nutritional status in a population consuming a diet in which 58% to 65% of the protein, depending on age and sex, is supplied by wheat. (Hussain et al. Food Nut Bull 2004) Vietnam: “… 6-month efficacy trials have established that fortification of fish sauce with iron can significantly improve iron status and reduce anemia and iron deficiency…” (Thuy et al. AJCN 2003). Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

22. Evaluation (Effectiveness)in real conditions • Indonesia: Home fortification in emergency. “… providing micronutrients [sprinkles] … is feasible. (de Pee et al, Food Nut Bull 2007) • Central America: Sugar fortification in Guatemala and Honduras. “ …prevalence of low plasma retinol decrease over time …”. (ADB, WHO – 2004) • South Africa: Fortified biscuits. “… fortification of a biscuit … at a level of 50% of the RDA is enough to maintain serum retinol concentrations from day to day …”.(van Stuijvenberg et al. Pub Health Nut 2001) • Haiti: Donated CSB. “…CSB was key to achieving the recommended iron and zinc densities of complementary foods for children 12 to 23 months of age …” (Ruel et al, Food Nut Bull 2004) • Morocco: “ … double-blind effectiveness trial in Moroccan schoolchildren has demonstrated that the dual fortification of salt with iron and iodine can improve both iron and iodine status (Zimmermann et al.Eur J Endo 2002) Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

23. Product studies WFP STUDY: Micronutrient losses in FBF at factory and household level (gruel preparation) • Vitamin A, 5 minutes of boiling reduced the content by about 42% percent, which is in line with 50% retention of vitamin A reported in gruels made from maize meal (Johnson, 2004) • Vitamin C, 5 minute of boiling, vitamin C content dropped from 348 mg/kg to below the detection limit. Other WFP studies: • Retention of micronutrient in biscuits and noodles at factory level in Bangladesh and Indonesia • Shelf-life study of Rice-Soya-Blend in Thailand • Digestibility, Energy-density, Destruction of anti-nutritional factors, microbiology, rancidity of Fortified Blended Foods produced by different processes (by Kemin Industry Ltd.) Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

24. Product study: WFP study of micronutrient losses in atta at mill and household level (roti preparation) ± Most likely due to contaminant sources of minerals, i.e. dirt, cooking utensils, etc. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

25. Achievement in India: Small-scale atta fortification in Surendranagar district, Gujarat • Developed appropriate premix composition (diluted) for small-scale fortification, Village Chakkis and Home Chakkis • Increased nutrition awareness on the importance of fortification with an intensive IEC campaign in 400 villages • Enhanced the local capacity to produce fortified flour (bajra or wheat) by training 446 Chakki Wallahs on fortification • Improved access to fortified food for 90% of Gujaratis • Demonstrated how to maintain the premix pipeline • Devised a monitoring system for premix and fortified atta • Provided a replicable model for small-scale atta fortification in Gujarat and India Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

26. Achievement in India: School feeding • Fortified biscuits • Distributed to 674,360 school children • Produced in India and used in WFP operations in Afghanistan • Efficacy study results: Reduction in anemia status and Improved serum retinol levels • On-site fortification with micronutrients (new strategy) • Add micronutrients directly to traditional foods cooked in the schools • Build capacity of 2,400 school cooks to add micronutrients • Build capacity of 1,200 school teachers to report utilization • Develop distribution pipeline for micronutrients • Create nutrition awareness among school staff and parents Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

27. Achievement in India: INDIAMIX: • In 2006, WFP distributed 23,555 MT to 1.4 million beneficiaries • Extruded fortified blended food, produced in 7 factories across India • Versatile product that can be adapted for different target populations • Distributed to children, pregnant and lactating women, and adolescent girls thru the ICDS • Wheat (50%), Soya (25%) Sugar (20%) + Micronutrients • Distributed to people receiving ART treatment • Wheat (75%), soya (25%) + More Micronutrients • Indiamix is now distributed by 6 State governments Improvement for the future: • Enhance palatability, digestibility, better micronutrient composition and stability, improved product shelf-life, etc. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

28. Future challenges • Access to (potable) water • High commodity prices (due to bio-fuels, meat consumption, etc.) “forcing” poor people to subsist on diet consisting of staple foods such as starchy roots and tubers and little else. • Pressure from population growth and poverty • Increased urban population • More targeted interventions (People Living With Hiv/Aids, elderly, etc.) • New pandemics (e.g. Avian Human Influenza) • New food rules and regulations (i.e. local and international) • New technologies (e.g. processing, analytical, etc.) • New products, packaging, etc. • Mainstreaming fortified foods into large scale nutrition-feeding programmes and demand generation at the consumer level WFP needs to keep up with innovations and to collaborate with organizations (e.g. research institutes, FAO, GAIN, MI, etc.) as well as the private sector (e.g. DSM, Kemin, etc) to propose sustainable, viable, and cost-effective solutions to fight against malnutrition. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

29. Integrated approaches A food-based approach is the most sustainable way of meeting the nutritional needs of populations • It empowers individuals and households to take ultimate responsibility over the quality of their diet through their own production of nutrient-rich foods and informed consumer choices. • It can address multiple nutrients simultaneously, including dietary energy, protein and various micronutrients, without the risk of antagonistic nutrient interactions or overload. In the meantime, food technology (incl. fortification processes) must be part of this integrated approach to enhance food nutritional quality, as well as its safety. Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007

30. Thank you Symposium Food Technology for better nutrition. New Delhi, 30 Nov – 01 Dec, 2007