India has a high prevalence of health issues related to micro-nutrient deficiency. A lack of uniformity in food distribution and socio-economic variations further contribute to a disproportionate number of deficiencies.
Food fortification, as a strategy for improving public health, has been supported by several studies. The history of food fortification in India dates back to 1953, when the fortification of vegetable oil with vitamin A and D became a mandate.
The Government of India has recommended fortification in each of the 10th, 11th and 12th five year plans. Initiatives such as ICDS, Mid-day meal and PDS are aimed at those at the highest risk for malnutrition: pre-schoolers, pregnant and lactating women, schoolchildren, and poor and under-served sections of the population.
In 2013, the Micronutrient Initiative and the Indian Flour Fortification Network – bodies that actively advocate for flour fortification – succeeded in expanding this effort from two to nine states, with support from the Government.
In the current literature on food fortification attempts in India, there are more 1,000 reports that describe efforts and products such as home fortification, bio-fortified crops, genetically modified foods, foods fortified with other foods, Ready-to-use Therapeutic Foods (RUTF), spreads, and fortification with pre- and pro-biotics as as well as fortification of breast milk, drugs, macronutrients, oral rehydration salts, and enteral/parenteral feeds.
Research in India suggests that food fortification improves biological markers. Iron and hemoglobin levels especially improve when fortified with MMN (multiple micronutrients) or iron. MMN fortification is reported to have a better impact on health than use of a single fortificant. Iodine status is shown to be enhanced through salt iodization. Current government nutrition programs, especially those that target children, are good avenues for implementing such beneficial food fortification.
There is a great emphasis on R&D in bio-fortification as a means to improving health. Although breeding crops for increasing the micronutrient content is a relatively new approach it is expected to yield long-term solutions. Transgenic technologies are already attempted all over the world, particularly in developing countries.
In India, the Harvest Plus Challenge program was initiated in 2012 with a a focus on developing high zinc varieties of wheat and rice as well as high iron varieties and hybrids of pearl millet. ICAR is conducting bio-fortification research on wheat, rice and other crops such as beta carotene-rich sweet potato and cassava.These programs are supported by the Department of Biotechnology (DBT).
Given the consequences of zinc deficiency in various age groups, it is hoped that zinc bio–fortification can save 0.6 – 1.4 million Disability Adjusted Life Years (DALY) each year in the country. DALY is a measure of disease burden, expressed as the number of years lost due to ill health, disability or death.
In the quest to combat nutritional deficiencies and boost overall public health in India, food fortification clearly plays an important role