Miller Magazine Issue: 136 April 2021

69 MILLER / aprıl 2021 COVER STORY fats, salt, sugar, and rice. LSFF is considered to be one of the most cost-effective interventions to increase the consumption of critical micronutrients across entire pop- ulations. LSFF is a preventive and protective measure, elevating the baseline consumption of these micronutri- ents so individuals are more resilient to shocks, whether those are a localized poor harvest or a pandemic affect- ing global food supply chains. LSFF is not a new intervention, but rather has been around for over a century. In the early 1900s, deficien- cies in B vitamins were prevalent in the USA, attributed to widespread consumption of industrially processed wheat flour. To tackle these deficiencies, fortification of processed flours was introduced to replace the micronu- trients that were lost during processing. In 1939, fortifica- tion of wheat flour and white bread, or enrichment as it is sometimes called, was mandated to include thiamine (B1), riboflavin (B2), niacin (B3), iron, and calcium. 4 One year later, in 1940, the United Kingdom also mandated fortifi- cation of wheat flour with thiamine. Denmark followed in 1953 by making the addition of thiamine, riboflavin, and iron to wheat flour mandatory. 2 Today, 85 countries man- date wheat flour fortification, 17 countries mandate maize flour fortification, and 15 countries mandate both wheat and maize flour fortification. 5, 6 Both flours are common- ly fortified with iron, zinc, B vitamins including folic acid, and sometimes with vitamin A. The process of fortification is often fairly simple for large-scale flour producers who are already commonly adding improvers and other ingredients to enhance the quality of the flour. To fortify, an additional micronutrient premix is added to the flour, using similar dosing equip- ment as is used for improvers. This premix is made of concentrated vitamins and minerals to meet relevant na- tional quality standards and costs an average of US $4 per metric ton of flour being fortified, or about US $0.05- 0.07 per person per year. 2, 6 Furthermore, the benefits of fortifying flour with micronutri- ents far outweighs the cost of fortification. One in three people worldwide suffer from some type of malnutrition, which is linked to 45% of all deaths of children under 3 and 22% of premature adult deaths. Malnutrition also presents an economic challenge,