Fortification initiative: chance to pursue 'fundamental good'

by Josh Sosland
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PALM BEACH, FLA. — The challenges of convincing both the general public and policymakers of the value of enriched and fortified grains is a global phenomenon, said Scott Montgomery, director of the Food Fortification Initiative, Atlanta.

An executive with Cargill for 30 years, Mr. Montgomery has led F.F.I. since 2011. Describing involvement with F.F.I. as an “opportunity to be part of something that is fundamentally good,” he spoke about the group Oct. 24 at the annual meeting of the North American Millers’ Association at The Breakers in Palm Beach.

The idea for F.F.I., formerly known as the Flour Fortification Initiative, followed the public health success achieved with the iodization of salt to prevent thyroid problems and developmental disabilities, beginning in 1924. Established in 2002 and renamed in 2014 (to include rice), the group is an international partnership that advocates for the fortification in industrial mills of wheat and corn flour and rice.

In many respects the United States and Canada are cited as the leading example of efforts to convince other countries to mandate fortification, Mr. Montgomery said.

For example, pellagra, a disease that largely has been eliminated in the United States, caused 100,000 deaths between 1906 and 1940 with a total incidence of 3 million cases. The disease, which is prevented with adequate niacin intake, causes diarrhea, dermatitis and dementia, Mr. Montgomery said.

“In 1942, U.S. enrichment standards were established with War Food Order No. 1,” Mr. Montgomery said. “Enrichment of white bread was required beginning in 1952 and rice in 1958. Pellagra was eliminated, but it remains a big problem in parts of the world.”

“You make a product that is an excellent carrier of enrichment,” Mr. Montgomery told the millers.

Currently, 81 countries have passed legislation mandating fortification, and the F.F.I. has a “very detailed strategy for Africa and Southeast Asia,” parts of the world with large areas that do not yet require fortification, Mr. Montgomery said.

Pellagra is only one part of the problems addressed by enrichment (defined as the reintroduction of nutrients removed in the milling process) and fortification (the addition of nutrients beyond what is present in whole grain products). F.F.I. figures estimate vitamin and mineral deficiency contribute to more than a third of all deaths worldwide in children under the age of 5, stunting 195 million children under the age of 5 in developing countries and factoring in undeveloped cognitive capacity, productivity and earning potential.

Mr. Montgomery spoke enthusiastically about the success achieved through the fortification of grains with folic acid in recent years as a way to help prevent spina bifida and other diseases that strike newborns.

“Up to 60% of neural tube birth defects can be prevented,” he said.

Contrary to suggestions adequate folic intake is possible through healthier eating, Mr. Montgomery showed a slide with the large amounts of various foods needed to consume 400 micrograms per day. For example four slices of liver, 44½ medium tomatoes or 14½ cups of raw broccoli would provide a single day’s folic acid requiem net.

“‘Just eat more vegetables,’ the public is told,” Mr. Montgomery said. “It is not a true statement.”

Fortification in the United States prevents 1,000 neural tube birth defects per year, he said. The entire fortification program costs $3 billion per year, he said. Direct medical costs averted as a result equate to a payoff ratio of 48 to 1, he said.

Despite the compelling case for fortification, Mr. Montgomery conceded he has experienced frustration in discussions with nations reluctant to mandate programs. Such frustrations have even been a problem in the United States, where corn masa flour enrichment is not required by the Food and Drug administration.

“That was a miss,” he said. “Hispanic women are 20% more likely than non-Hispanic women to have a child with neural tube birth defects. A petition was filed with the F.D.A. in 2012, and we are hopeful fortification of masa flour will be mandated in 2015.”

Overall, the pursuit of mandatory fortification is central to the F.F.I. Strategy, Mr. Montgomery said. With 450 million tonnes of wheat, 371 million tonnes of rice and 122 million tonnes of maize produced for human consumption each year, Mr. Montgomery said the objective is to raise the proportion that is fortified.

Mr. McCarthy said absent fortification, it is nearly impossible to consume enough food from sources of folate to prevent neural tube birth defects.

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