Miller Magazine Issue: 124 April 2020

53 COVER STORY MILLER / APRIL 2020 fordable nutritious food, reduce healthcare costs and boost economic growth. Selecting and implementing the most effective and compliant solutions, however, can be a chal- lenge for governments, non-governmental organizations (NGOs) and donors. Improving public health with staple food fortification One of the most effective, safe and cost-efficient ways to tackle deficiencies in populations, fortification can en- hance the nutritional value of staple foods by adding or replacing essential vitamins and minerals that may have been lost during processing. A long term investment for all stakeholders, staple food fortification can improve the health and wellbeing of individuals, and society as a whole. When fortification programs are successfully implemented, governments can quickly see tangible results — while mill- ers can engage in socially responsible projects that will not only improve the health status of populations, but also, in turn, will see them benefit from consumers’ increased pur- chasing power, resulting from people’s increased capability to earn a living. For fortification programs to be successful, it is crucial that regional and demographical preferences are considered when selecting the food vehicle. The selected food must be widely consumed by the target population to ensure nutrients can be delivered without altering existing dietary habits. Staple foods, such as flour and rice, are widely used for global fortification programs. 1. FLOUR More than 600 million metric tons of wheat and maize flour are milled annually and it is widely consumed in ev- eryday foods, such as breads, biscuits, pasta and noodles. 6 Both wheat and maize flour enjoy widespread consumer acceptance worldwide, but are particularly popular in Af- rica, the Middle East, South and South-East Asia and the Americas. 7 Due to their versatility and availability, wheat and maize flour are considered highly suitable for fortifi- cation to deliver micronutrients to large consumer groups. A significant proportion of the essential vita- mins and minerals naturally available in wheat and maize are removed during the milling pro- cess. Replacing some of the micronutrients lost through milling is recognized as an effective way to improve the nutritional profile of flour — without affecting taste — and effectively combat hidden hunger. In countries where large numbers of individuals consistently do not con- sume sufficient quantities of specific vitamins and minerals, the World Health Organization (WHO) recommends not just replacing lost mi- cronutrients, but also adding additional ones through fortification. Compulsory wheat and maize flour fortification is becoming increas- ingly common across the world; there are now 70 countries, including Canada, the US and UK, South Africa, Mexico and the Philippines, where it is mandatory to fortify at least one industrially milled ce- real grain, such as maize or wheat. 8,9 Depending on the fortification program, the cost that is passed to the consumer can be as little as USD$ 0.01 per 5 kg of flour, meaning that flour fortification is much less ex- pensive than generally assumed. For millers, micronutrient premixes represent a cost-effective way to fortify flour. For example, a premix containing iron, folic acid and several B vitamins usually costs no more than USD$ 3 per metric ton of flour. 10 Overall, the benefits of flour fortification significantly outweigh the investment required. Adding fo- lic acid to the volume of flour consumed in the US each year could, for instance, prevent 767 live births with spina bifida. 11 While the costs of fortifying this amount of flour total just over USD$ 4 million a year, this intervention saves around USD$ 607.3 million a year in healthcare costs. 12 In this case, this represents a return on investment (ROI) of almost USD$ 152 per USD$ 1 spent. 2. RICE Rice is another staple food that can be found in many diets around the globe, including in Asia where individuals con- sume around 150 kg of milled rice annually. Although it is a great source of energy, processed (white) rice has a low overall nutritional value beyond carbohydrates and protein after milling. This is because the milling process removes the fat, as well as the more nutrient-rich bran layers. A wide variety of vitamins, minerals and other nutrients such as amino acids can be added to rice post-harvest through a range of fortification methods, such as dusting, coating or hot extrusion, to help fill the nutrient gap. WHAT IS HOT EXTRUSION? Hot extrusion is considered the most robust method of rice fortification; broken rice grains are ground into rice flour, and mixed with water and the required nutrients to pro- duce a dough. The fortified dough is then passed through an extruder to produce the fortified kernels, which are blended with regular rice, typically at a ratio of 0.5 to 2%. The temperature at which the extrusion takes place de-