Philippines: Large-Scale Market Trial Completed in the Philippines
A province-wide market trial of iron-fortified rice was successfully completed in Zambales Province in October 2011. The rice premix (rice and iron compound) was produced and blended with ordinary rice to produce the fortified rice near Manila and the rice was marketed in the province for one year. The trial is under evaluation and a complete report is due in April. A strategic plan for implementing a fortified rice program on a nationwide basis was developed by FNRI and government agencies with support from ILSI.

Vietnam: Efficacy Study on Fortified Rice under Evaluation in Vietnam
As reported in the last newsletter, the study showed that regular intake of the iron fortified rice is efficacious in improving iron deficiency anemia. In the study, the impact of iron fortification of rice on the bioavailability of zinc, selenium and vitamin A was also evaluated. The results will be reported in April.

India: Survey on Feasibility of Fortification of Rice with Iron and Lysine
A review meeting was held in July in Bangarole which included members from ILSI India and scientists who specialize in this area. It was agreed that double fortification of iron and lysine is effective in improving nutrition and that rice would be a good vehicle for fortification in southern states. It was decided to pursue an efficacy study utilizing a school lunch program (Mid-Day-Meal) in Karnataka. For this purpose a rice premix will be developed, which meets Indian cooking practices.

Feasibility study (1997-1998)
The National Anemia and Nutrition Risk Factor Survey (1995) reported that anemia is highly prevalent (40-50%) among children and women of reproductive age. The study concluded that more than 80% of the national population consumes commercially produced fish sauce regularly. Also the study concluded that NaFeEDTA has high potential as an iron fortificant in fish sauce due to favorable taste, color and smell.

Storage and stability test and sensory evaluation (1999)
The storage and stability test concluded that the addition of NaFeEDTA makes fish sauce slightly darker, but this color change occurs to ordinary fish sauce by a natural degradation process. Also the study recommended using amber glass bottles or clear bottles under indirect or limited sunlight to prevent accelerated degradation1. The bioavailability trial confirmed that daily intake of iron fortified fish sauce positively influenced the iron status of the study participants2. The sensory evaluation was conducted using 85 Vietnamese women, who compared the color, flavor, taste and overall acceptability of iron-fortified fish sauce (5mg Fe/10ml) and ordinary fish sauce. No significant difference in sensory profile between two types of fish sauce was found.

Efficacy Study (April to October, 2000)
A randomized controlled trial was conducted with 152 anemic women in the Red River Delta of Vietnam. The study participants received either 10mg iron as NaFeEDTA / 10ml fish sauce or non-fortified fish sauce with lunch, six days per week for 6 months. At the conclusion of the trial, hemoglobin and serum ferritin concentrations were found to have improved in the intervention group. The study identified that regular consumption of fish sauce fortified with NaFeEDTA improved iron status significantly and decreases the prevalence of anemia3.

Effectiveness study / market trial (2001-2003)
A randomized double blind village-based intervention study was conducted over 18 months. All families of two communes (an estimated 14,000 people) received iron fortified fish sauce (5mg/10ml). Results obtained from selected group of 288 women verified that the hemoglobin concentration increased and the prevalence of anemia decreased following daily intake of iron fortified fish sauce4.

National launch (2005-2009)
Based on these findings, NIN received financial support from GAIN (Global Alliance for Improved Nutrition) to initiate the national launch of an iron fortified fish sauce program. The program called for 10 large fish sauce factories to produce iron fortified fish sauce over 5 years. The program consisited of production/distribution, quality assurance, social marketing/consumer education and monitoring/surveillance. ILSI Japan CHP provided professional support to ensure a successful national launch. By the end of the program, more than 575,000 people had access to iron fortified fish sauce nationwide.

Feasibility study (2004)
According to the Demographic Health Survey (2000), the anemia prevalence is approximately 57% among children, and 62% among women of reproductive age. The study conducted in Kampot province showed that 62% of families used fish sauce 7 days a week, for an average of 26ml/meal/family. The study concluded that the fish sauce is an appropriate food vehicle for fortification with iron in order to decrease the high prevalence of anemia in Cambodia.

Storage and stability test and sensory evaluation (2004)
The storage and stability test conducted in Japan showed that the iron fortified fish sauce darkened the fish sauce slightly, particularly fish sauce made with river fish which start as a clear amber color. The sensory evaluation was conducted using 90 Cambodian people using iron fortified soy sauce and iron fortified fish sauce. There was no difference in the preference scores between iron fortified soy sauce and ordinary soy sauce. For the iron fortified fish sauce, the preference scores of aroma, color, and taste were significantly higher than those of ordinary fish sauce.

Efficacy Study (Jan-Jun 2005)
The randomized controlled trial was conducted with 140 anemic school children (6-21 years old) in Kampot province. 10ml of fish sauce were served as lunch meal for 17 weeks. The study indicated that regular consumption of iron fortified fish sauce under strict control significantly improved iron status among anemic school children7.

Effectiveness study / market trial (2007-2009)
A market trial using iron fortified fish sauce and soy sauce was conducted in Kampot province, Siem Reap province and Phnom Penh for 2 years. Three fish sauce and soy sauce factories at each study site installed fortification facility and produced iron fortified fish sauce and soy sauce containing 4mg Fe/10ml. The iron fortified fish sauce and soy sauce were distributed through normal market channels, its quality was checked in provincial laboratories. The social marketing and health education was provided through RACHA's network. The result demonstrated that the consumption of fortified fish sauce and soy sauce significantly reduced anemia prevalence and improved iron status among anemic people.

National launch (2010〜)
In July 2010, the workshop was held to develop consensus among stakeholders on action necessary to sustain and expand iron fortification programs using fish sauce and soy sauce as a strategy for reducing IDA throughout Cambodia. A proposal for a national launch was agreed to by the Global Alliance for Improved Nutrition (GAIN) in March 2011. Inviting industries and government officials, the national workshop for launching project iron fortified fish sauce and soy sauce was held in Novermber 2011. A national kick-off meeting will be held in 2012.

India
Partner: ILSI India

Flour/ Rice fortification with iron and lysine

Feasibility study (2012)
To be up-dated

Fidler, et. al., Photostability of Sodium Iron Ethylenediaminetetraacetic Acid (NaFeEDTA) in Stored Fish Sauce and Soy Sauce, Journal of Food Science, Dec 2004, Volume 69, Issue 9, pages S380-S383.

Fidler et. al., Iron absorption from fish sauce and soy sauce fortified with sodium iron EDTA, Am J Clin Nutr. 2003 Aug;78(2):274-278.

Pham et. al., Regular consumption of NaFeEDTA-fortified fish sauce improves iron status and reduces the prevalence of anemia in anemic Vietnamese women, Am J Clin Nutr. Aug 2003, Vol. 78, No. 2, 284-290.

Pham et. al., The Use of NaFeEDTA-Fortified Fish Sauce Is an Effective Tool for Controlling Iron Deficiency in Women of Childbearing Age in Rural Vietnam, J Nutr. 2005 Nov;135(11):2596-601.

Angeles-Agdeppa et. al., Efficacy of iron-fortified rice in reducing anemia among schoolchildren in the Philippines, Int J Vitam Nutr Res. 2008 Mar;78(2):74-86.

Angeles-Agdeppa et. al., Pilot-scale commercialization of iron-fortified rice: effects on anemia status, Food Nutr Bull. 2011 Mar;32(1):3-12.

Under the LiSM10!® program for the prevention of lifestyle-related diseases in the worksite, CHP is currently carrying out its final intervention study at Nichirei Corporation, after performing intervention studies at five plants belonging to Suntory Limited and Meiji Dairies Corporation. In anticipation of the obligation to provide health guidance to insured persons of age 40 or older starting in 2008, preparations are well underway for the implementation of the Health Guidance Program LiSM10!®. This is in accordance with the Standard Medical Checkup and Health Guidance Program, which are guidelines of the Japanese Ministry of Health, Labour and Welfare.

The project began by targeting 2,500 households in three communes in northern Vietnam as model districts: Tan Hiep (Ha Noi), Daimo (Ha Noi), and Quang Trung (Nam Dinh). In order to secure safe water, the project is comprised of three components. The first activities consist of two approaches: 1) residents obtain knowledge relating to water, nutrition, and health / sanitation, and apply the knowledge at home, and 2) the operation of the water treatment facilities are optimized, and safe water is supplied. The third component involves follow-up implementation with the participation of residents. This aims to create mechanisms and models for sustaining the IEC (Information, Education and Communication) as well as for continuing safe water supply.

The Health Guidance Program LiSM10!® to prevent lifestyle-related diseases, is now entering its third year of intervention research and will try out the introduction of a new management system that includes security management of personal information. Effectiveness of tools developmed will also be confirmed at the same time, along with identification of actual problems in the field. The securing of LiSM10!® Counselors is indispensable for project implementation. As a high level of skill is necessary, there are only about 10 to 20 counselors certified so far. Further personnel training will be carried out for future expansion. Together with manual preparation, the final adjustments will be accelerated in order for project implementation.