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2005/4/12
update
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Project IDEA
(Iron Deficiency Elimination Action)
The difficulty in maintaining
a variety of food sources results
in malnutrition and micronutrients
deficiency in the worlds developing
countries. Iron deficiency anemia,
one of the most prevalent threats
to public health, impairs brain
development, immune system functioning,
and learning ability in infants
and children. It can also be a
major cause of death among pregnant
women, and dramatically reduces
productivity among working adults,
which in turn hinders the struggle
against poverty. The UN ACC/SCN
(the United Nations Administrative
Committee on Coordination/ Sub-Committee
on Nutrition) reports that 3.5
billion people are suffering from
iron deficiency anemia, and they
have been less successful in fighting
it than in overcoming other micronutrient
deficiencies.
Project IDEA works to reduce iron
deficiency anemia (IDA) in the
people of developing countries
by adding iron to commonly-eaten
and commercially-produced foods
such as condiments and staples,
according to the dietary patterns
of each county.
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 In
China,
in collaboration with CDC China, ILSI
Focal Point in China added iron (NaFeEDTA)
to soy sauce, which is consumed by
70% of population, and found that
iron deficiency anemia was reduced
among the entire population, regardless
of age or gender. This confirmed the
feasibility of iron-fortified soy
sauce.
Based on the effectiveness of iron-fortification,
a national launch program started
from spring of 2004. At present, 11
plants of soy sauce manufactures started
manufacturing and marketing of the
fortified soy sauce. A baseline survey
was conducted in Guizhou and Jiangsu
provinces. A social marketing program
to educate consumers through media
is planned to communicate about the
benefits of iron fortified soy sauce.
They expect that more than 100
million people will benefit from
this program in several years.
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 In
Vietnam, in collaboration
with the National Institute of Nutrition,
Vietnam, we have pursued iron-fortification
(NaFeEDTA) of fish sauce which
is consumed by 70% of the population.
First, we confirmed the feasibility
of stability and acceptability of
the fortified fish sauce.
Efficacy Study:
In 2000 it was proved through an
efficacy study for 6 months that
regular consumption of iron fortified
fish sauce (10mg Fe /day) significantly
improved anemia prevalence in Vietnamese
female population.
Effectiveness Study: A
large scale of an intervention program
with 14,000 population was conducted
in rural areas from 2001. The areas
were randomized into two groups;
one group (10 villages) is a control
and the other is an intervention
group consuming the fortified fish
sauce (7.5mg Fe /day average). Female
subjects (580 subjects of age 16-49
years old) were subjected to hematological
analysis in terms of hemoglobin,
serum ferritin and transferring
receptor to evaluate the improvement
of iron deficiency anemia. As a
result, the intervention group
significantly improved the anemia
prevalence (Hb < 120g/L)
from 24.7% to 8.5% and the iron
deficiency (SF <12μg/L) from
22.3% to 4.0%. It was also observed
that the stored iron was significantly
improved up to 12 months and no
excess iron was stored after 12
months.
National Launch of Iron Fortified
Fish sauce: Based on the
series of research and investigation,
a national plan was developed to
implement national launch of the
iron fortified fish sauce from 2005
so that high risk population of
IDA could regularly consume the
fortified fish sauce.
The national launch program will
be conducted in 5 years, which is
composed of
1) Production & Distribution,
2) Quality Assurance, 3) Social
Marketing & Education, and
4) Monitoring & Surveillance.
1) Production & Distribution:
The fortification will be applied
to low and medium quality of
fish sauce. In the first year,
2 large plants in the north and
center of Vietnam will introduce
the fortified fish sauce. The launch
program will be expanded to top
30 plants and will eventually cover
80% of the whole fish sauce produced
in Vietnam.
2) Quality Assurance: The
quality assurance programs both
in the plants and in the market
will be implemented under Ministry
of Health to assure the fortification
program. New quality management
systems such as GMP (Good
Manufacturing Practice) and HACCP
(Hazard Analysis and Critical Control
Point) will be introduced to improve
quality management of the fish sauce
industry.
3) Social Marketing &
Education: An extensive
social marketing program will be
developed and implemented to educate
and communicate with consumers
as to how important iron is to health,
what foods are good in iron intake
and how important the fortified
fish sauce is to consumers.
4) Monitoring & Surveillance:
A monitoring network will be established
to assure that the national launch
is properly implemented. A surveillance
program will be developed to evaluate
improvement of IDA and improvement
of food consumption in Vietnam.
ILSI CHP will provide
professional support in the areas
of manufacturing management (GMP),
quality assurance (HACCP), monitoring
& surveillance by sending experts.
Once the national program is established,
we expect that 42 million people
will benefit from this program within
several years.
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 In
the Philippines,
we are working with FNRI (the Food
and Nutrition Research Institute)
on stability and acceptability of
several alternatives on iron fortification
of rice, the national staple.
The overall evaluation indicates that
extruded rice with ferrous sulfate,
extruded rice with micronized ferric
pyrophosphate and coated rice with
micronized ferric pyrophosphate were
selected as promising fortification
methods.
An efficacy study has been conducted
for 6 months since July 2004 through
an intervention program with those
three alternatives using primary school
pupils of 6-8 years old in Metro Manila.
Regular rice and 3 types of different
fortified rice are supplied to 4 groups
(control and 3 fortification groups)
randomized out of 240 anemic school
children. The program is designed
so that subjects receive launch containing
10mg Fe /day for the fortification
groups. We are evaluating improvement
of anemia and IDA by regular feeding
of iron-fortified rice at 3 and 6
months.
Once this efficacy is proved, a national
plan to introduce iron-fortified rice
will be developed and implemented.
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 In
Cambodia, as fish sauce
is consumed as major condiment, we
believe that the experience and technology
of iron fortification could be utilized.
In July, ILSI CHP Japan and ILSI Southeast
Asia Region together with NIN Vietnam
visited Cambodia and conducted a feasibility
study. In August we attended a workshop
on food fortification held by Cambodia
government and GTZ (Germany International
Development) and made a presentation
on iron fortification of fish sauce.
As a result, it was agreed that a
joint efficacy study be conducted
with GTZ to confirm the efficacy of
fortified fish sauce in Kampot city.
Preparations are underway to carry
out the study from January 2005 for
6 months. |
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| Complementary
Foods |
Fortification of complementary foods
is critically important to children
of 6-24 months during a transition
period from breast milk to regular
foods. Adequately fortified complementary
foods help in preventing iron deficiency
and improving nutrition status to
attain proper physical growth and
mental development of children. Although
a variety of complementary foods are
marketed, we find little complementary
foods which are scientifically evidenced
and are affordable to the low income
population.
WHO and UNICEF in the joint publication
on “Complementary feeding of young
children in developing countries:
A review of current scientific knowledge”
suggests the necessity for the development
of scientifically-sound complementary
foods to optimize children’s dietary
intake and enhance their nutritional
status by creating networks that are
able to plan common research protocols
and share relevant experiences and
results.
ILSI CHP and ILSI Southeast Asia Region
held a workshop on needs of complementary
foods with attendance of 4 countries
representatives (China, Vietnam, Philippines
and Indonesia) in Manila in November
2004. The representatives reported
complementary foods under development
and planning, and identified the needs
of scientific research work and social
marketing programs.
ILSI CHP plans to develop a consolidated
research and development proposal
based on the specific proposals from
the 4 countries to establish the scientific
base for complementary foods.
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