Many things have been said about the necessity for mandatory iron fortification of foods in India.

Iron fortification

• Iron fortification of food is a methodology utilized worldwide to address iron deficiency.
• A critical problem in some food fortification programs is the lack of bioavailability of iron compounds.

Why need iron fortification?

Ans. Prevalence of Anaemia

• Iron deficiency anaemia is due to insufficient iron.
• National Family Health Survey (NFHS)-5 provides insights into anaemia prevalence in the country, indicating that 57.2% of women ages 15 to 49 are anaemic, up from 49.7% in NFHS-4.
• Without enough iron, the body can’t produce enough of a substance in red blood cells that enables them to carry oxygen (hemoglobin).
• Severe anemia during pregnancy increases your risk of premature birth, having a low birth weight baby and postpartum depression.
• Some studies also show an increased risk of infant death immediately before or after birth.

Concerns over iron fortification

Ans. Fear of diabetes and heart ailments

• Iron increases the risk for many non-communicable diseases like diabetes, hypertension and even high blood cholesterol.
• A US based survey shows that high ferritin level had a four-fold higher risk of having diabetes.
• The Comprehensive National Nutrition Survey of Indian adolescents to resulted in such scary outcomes.
• There was a clear and significant risk for each of these conditions as serum ferritin increased.

India’s vulnerability

Ans. India is world capital of diabetes and hypertension

• No less than 50% of Indian children, aged 5-19 years, already had a biomarker of either high blood sugar or high blood lipids, even when thin or stunted.
• Thus, the risk of chronic disease is already very high in our children.
• Thus mandatory cereal fortification has severe hazards for India.

Why mandatory fortification is not a feasible option?

• Occurrence of deficiencies: We do not even know if anaemia is as rampant to warrant such mandatory measures.
• Manipulating food choices: When mandatory fortification is enforced in parts of the population that do not need this, it removes their choice of foods, or autonomy.
• Morbidities due to excess: It could even be unethical if the risk of other morbidities is increased.
• No successful example: Rice fortification has not been shown to work in a combined analysis.

Conclusion

• Food fortification is not a magic bullet.
• It should be viewed as a complementary strategy for the prevention and control of micronutrient deficiencies.
• As dietary patterns and deficiency states change, monitoring and periodic evaluation will be essential in helping to make necessary changes.

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