Miller Magazine Issue 108 / December 2018

75 MAKALE MILLER / DECEMBER 2018 countries, but currently only 31 percent of the world’s indust- rially milled wheat flour is fortified, according to estimates from the Food Fortification Initiative (FFI). Using fortified flour has virtually no consequences for ba- kers. Internationally accepted guidelines outline types and amounts of nutrients to use in fortification without causing changes to the food’s sensory qualities. This has been tested in Africa and Asia, including shelf life studies with instant no- odles that were made with fortified wheat flour. Bakers can use fortified flour without reformulating their products. The nutrients used are essential to human health; they are not contaminants or allergens that require cleaning the producti- on lines after their use. One reason fortified flour has a great potential for impa- cting human health is that so many people eat flour-based foods. Consider pasta as an example. The United States leads the world in pasta consumption at 2.7 million tons a year, according to the International Pasta Organization. Italy is se- cond at 1.5 million tonnes. But the population of the United States is more than five times the population of Italy. On a per capita basis, Italy is the global leader in pasta consump- tion at 25.3 kilograms per year; Tunisia is second at 16 ki- lograms. About 14 million tons of pasta are produced annu- ally worldwide, according to the 2013 World Pasta Industry Status Report from the International Pasta Organization. Yet only half of the countries that produce more than 300,000 tonnes of pasta each year any of their wheat flour (Table 1). Flour Fortification and the Sustainable Development Goals Meeting the 17 Sustainable Development Goals (SDG) will require multiple strategies. Adding vitamins and minerals to flour contributes toward progress of some SDGs by improving cognitive development, maternal health, and productivity. SDG Goal No. 1 - No poverty Anemia occurs when the body lacks hemoglobin which car- ries oxygen from the lungs throughout the body. Anemia has many causes. The World Health Organization (WHO) esti- mates that 42 percent of anemia in children and 50 percent of anemia in women is related to iron deficiency. Folic acid, zinc, riboflavin, vitamin B12, and vitamin A deficiencies can also cause anemia. Vitamin A is more often added to cooking oil, margarine, or sugar, but the other nutrients can all be included in fortified flour. People who have had anemia say it is like being a zombie, walking in quick sand, or having jet lag all the time. Con- sequently, anemia reduces an individual’s work capacity, and a high prevalence of anemia among a population reduces the gross domestic product. Anemia is estimated to contribute to 17 percent lower pro- ductivity in heavy manual labor and 5 percent lower produ- ctivity in other manual labor. Additionally, children who are iron deficient do not develop their full mental capacity. This means iron deficiency in childhood affects individual’s aca- demic performance and future earnings potential. Consequ- ently, childhood anemia is associated with a 2.5 percent drop in wages in adulthood, affecting productivity and economic growth and contributing to poverty. SDG Goal No. 2 - Zero hunger Part of this goal is to end all forms of malnutrition. Global- ly, 45 percent of deaths of children under 5 years of age are attributed to malnutrition. This SDG specifically mentions stunting and wasting in children. Stunting is when children are more than two stan- dard deviations below the expected height for their age. Poor nutrition, repeated infections, and inadequate psycho-soci- al stimulation can cause it. Wasting is when children’s weight is too low for their height. It is usually from a lack of food or from an infecti- ous disease such as diarrhea. WHO estimates that 155 million children un- der 5 years of age are stunted, and 52 million children are wasted. Another 17 million children in this age group are considered severely wasted. Fortifying flour used to make biscuits or pasta that children often eat, such as Pastina, is one step toward preventing stunting and wasting and reaching this Sustainable Development Goal. SDG No. 3 - Good health and well-being This goal is split into sections including maternal and new- born health, infectious disease, and non-communicable dise- ases. Fortification helps to reach the goals in each of these categories. Maternal and Newborn Health Fortifying with folic acid greatly reduces women’s risk of having a pregnancy affected by a birth defect of the brain or spine. These birth defects develop within 28 days after conception. Women often do not realize they are pregnant during this time, and if they have not been planning a preg- nancy, they are not likely to be taking folic acid supplements. But fortification increases folic acid intake as people eat the- ir favorite foods. One meta-analysis showed that fortifying wheat flour with folic acid reduced the incidence of these severe birth defects by an average of 46 percent. Anemia during pregnancy increases the risk of death for the mother. Adding iron, riboflavin, folic acid, zinc, vitamin B12, and vitamin A to food during the milling process helps