Food Fortification Program - Department of Health

Objectives:

1. To provide the basis for the need for a food fortification program in the Philippines: The Micronutrient Malnutrition Problem

2. To discuss various types of food fortification strategies

3. To provide an update on the current situation of food fortification in the Philippines

Fortification as defined by Codex Alimentarius

“the addition of one or more essential nutrients to food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiencyof one or more nutrients in the population or specific population groups”

Vitamin A, Vitamin A Deficiency (VAD) and its Consequences

Vitamin A – an essential nutrient as retinol needed by the body for normal sight, growth, reproduction and immune competence
Vitamin A deficiency – a condition characterized by depleted liver stores & low blood levels of vitamin A due to prolonged insufficient dietary intake of vit. A followed by poor absorption or utilization of vit. A in the body
VAD affects children’s proper growth, resistance to infection, and chances of survival (23 to 35% increased child mortality), severe deficiency results to blindness, night blindness and bitot’s spot

Prevalence of Vitamin A Deficiency:
1993, 1998, 2003, 2008
(DOST – FNRI, NNS)

Physiological State	1993	1998	2003	2008
6 months – 5 yrs.	35.3	38.0	40.1	15.2
Pregnant	16.4	22.2	17.5	9.5
Lactating	16.4	16.5	20.1	6.4

WHO Cut – off Point to be considered a public health problem = >15%

Iron and Iron Deficiency Anemia (IDA) and its consequences

Iron – an essential mineral and is part of hemoglobin, the red protein in red blood cells that carries oxygen from the lungs to the cells
Iron Deficiency Anemia – condition where there is lack of iron in the body resulting to low hemoglobin concentration of the blood
IDA results in premature delivery, increased maternal mortality, reduce ability to fight infection and transmittable diseases and low productivity

Prevalence of anemia by age, sex and physiologic state: Philippines, 2008

Source: NNS:FNRI

Iodine and Iodine Deficiency Disorders (IDD)

Iodine -a mineral and a component of the thyroid hormones
Thyroid hormones – needed for the brain and nervous system to develop & function normally
Iodine Deficiency Disorders refers to a group of clinical entities caused by inadequacy of dietary iodine for the thyroid hormone resulting into various condition e.g. goiter, cretinism, mental retardation, loss of IQ points

Progress in the Philippines towards the Elimination of IDD, 1998-2008

Indicator	Goal*	Achievements
Indicator	Goal*	1998	2003	2008
Proportion of Households using Iodized Salt, %	>90	9.7	56.0	81.1
Median Urinary Iodine, ug/L
6-12 yrs.	100-200	71	201	132
Lactating Women	100-200	–	111	81
Pregnant Women	150-249	–	142	105
Proportion < 50µg/L, %	< 20
6-12 yrs.		35.8	11.4	19.7
Lactating Women		–	23.7	34.0
Pregnant Women		–	18.0	25.8

*ICC-IDD 2007

Policy on Food Fortification

ASIN LAW

Republic Act 8172, “An Act Promoting Salt Iodization Nationwide and for other purposes”, Signed into law on Dec. 20, 1995

Food Fortification Law

Republic Act 8976, “An Act Establishing the Philippine Food Fortification Program and for other purposes” mandating fortification of flour, oil and sugar with Vitamin A and flour and rice with iron by November 7, 2004 and promoting voluntary fortification through the SPSP, Signed into law on November 7, 2000

Status of the Philippine Food Fortification Program

Status and Recommendations for the Sangkap Pinoy Seal Program

There are 139 processed food products with SangkapPinoySeal with 83% with vitamin A, 29% with iron and 14% with iodine (2008)
37% of the products are snack foods
Most of the products FDA analyzed are within the standard
Based on 2003 NNS Households’ awareness of SPS- and FF-products is 11% and 14%, respectively, in 2008 awareness is 11.6%
Although awareness is low, usage of SPS-products is 99.2%

Recommendations:

Review voluntary fortification standards as standards were developed prior to mandatory fortification
Conduct in-depth analysis of the coverage of SangkapPinoySeal of the 2008 NNS
Update list of Sangkap Pinoy Seal products as some companies have stopped using the seal in their products
Intensify promotions of Sangkap Pinoy Seal

Status and Recommendation on Flour Fortification with Vitamin A and Iron

Status:

Based on FDA monitoring all local flour millers are fortifying with vitamin A and iron
94% and 92% of all samples tested by FDA in 2009 were fortified with vitamin A and iron respectively while 77% and 99% were fortified with vitamin A and iron respectively. In 2010 decrease in vitamin A due to non-fortified imported and market samples flour.
58% of samples from local mills for vitamin A and 67% of imported flour for iron were fortified according to standards.

Recommendations:

Review fortificantsfor iron and possible other micronutrients to be added to wheat flour
Continue monitoring wheat fortification
Assist flour millers to improve quality of fortification
Need to show impact of flour fortification

Status and Recommendations on Mandatory Fortification of Refined Sugar with Vitamin A

Status:

Non – fortification by industry due to the unresolved issue of who will bear the cost of fortification brought about by the quedansystem of transferable certificates of sugar ownership.
Lack of premix production
Fortification of refined sugar would benefit mainly those in the high income group.

Recommendations:

Continue discussions with sugar industry to explore a compromise for fortification ie. fortification of washed sugar
Review policy on mandatory fortification of refined sugar

Status and Recommendations on Rice Fortification with Iron

Status:

NFA is fortifying 50% of its rice in 2009 and 2010
With the non – fortification of NFA rice, private sector has an excuse for non – fortification of its rice.
There is limited commercial/private sector iron rice premix and iron fortified rice production and distribution mostly in Mindanao (Region XII and XI) with Gen San having the only commercial iron rice premix plant in the Philippines and Davao City implementing mandatory rice fortification in food outlets
NFA conducted communications campaign for its iron fortified rice thru the so called “I-rice” campaign though issues remain on the acceptability of its product

Recommendation:

Review of mandatory fortification of rice with iron

Status and Recommendations on Cooking Oil Fortification with Vitamin A

Status:

Based on the samples analyzed by FDA in 2009 and 2010, more than 90% are fortified (91% in 2009 and 94% in 2010)
Samples monitored were labeled and packed
FDA is not monitoring “takal”

Recommendations:

To increase frequency of monitoring by FDA and other agencies such as PCA and LGU’s, to ensure all oil refiners and repackersare monitored at least once a year
Monitoring of “takal” oil, use of test kit
Monitoring imported oil, FDA and BOC to coordinate
Review policy of mandatory fortification of oil to possibly limit to those mostly used by at risk population (coconut and palm oil)

Status and Recommendations on Salt Iodization

Status:

Based on the 2008 NNS, 81.1% of households were positive for iodine using Rapid Test Kit (RTK)
In the same survey for Region III, 55.7% were positive for RTK but only 34.2% and 24.2% have iodine content >5ppm and >15ppm respectively using WYD Tester
For FDA monitoring in 2010, 88% were >5ppm while 44% were >15ppm
FDA started implementing localization of ASIN Law with General Santos City as the 1stto have a MOA with FDA on localization

Recommendation:

FDA to expand localization of ASIN Law
Set – up iodine titration for testing iodine in salt
Continue to intensify monitoring particularly imported and takal salt

Food Fortification Day Theme 2010:

EO 382 declares November 7 as the National Food Fortification Day

Program Coordinator:

Ms. Liberty Importa

National Center for Disease Prevention and Control – Family Health Office

Phone: 651-7800 local 1726-1728

Email: [email protected]