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Measuring the Benefits of Fortification: Thailand’s Battle Against “Hidden Hunger”

Bangkok. The Asian continent remains one of the world’s largest concentrations of poverty and hunger. Yet some countries have made remarkable progress in eliminating both protein and calorie malnutrition. Incomes and living standards across most of Thailand have risen dramatically in recent decades, and the protein-energy malnutrition that was once widespread has been drastically reduced.

Noodle Packages

But that’s not good enough to satisfy the dedicated staff at the Institute of Nutrition at Mahidol University on the outskirts of Bangkok. Leading scientists here are hungry for new knowledge and technologies that can serve the battle against “hidden hunger” for the benefit of Thais and people across the developing world.

“We still have pockets of malnutrition and micronutrient deficiencies in Thailand, especially in the impoverished North and Northeast” explains Professor Emorn Wasantwisut of the Institute. “It’s our responsibility to develop creative and practical ways of addressing these problems through our research and collaborative activities.”

One way the Institute has been pursuing better nutrition for all income groups is through fortifying foods that are staples in the Thai diet. Experiments in adding basic micronutrients to various popular foodstuffs began in the early 1990s, and a special public-private sector committee was assembled under the chairmanship of the Ministry of Public Health to facilitate the commercialization of the best fortification formulas.

“Our initial work focused on triple-fortification of pre-packaged instant noodles, because it is a “fast food” that many Thais eat regularly - rich and poor alike,” explains Dr. Visith Chavasit, Deputy Director of the Institute. “We convinced several manufactures of the marketing value of noodle seasoning fortified with iron, iodine, and Vitamin A, and they readily assumed the challenge of making their products more nutritious. Now 60 to 70 per cent of all noodle packets are triple fortified.”

As any food chemist knows, however, adding nutrients to a foodstuff can alter the taste and appearance and turn consumers away. “When elemental iron was added to the duck flavoured noodle sauce, it turned dark and made the taste rather unpalatable,” explains Dr. Chavasit. “We continued our search for the best food source for delivering essential micronutrients.”

Adding complexity to the fortification process is the key issue of “bioavailability”—that is what portion of the additive is actually absorbed and utilized by the human body. For example, there are numerous forms of iron to choose from, and scientists need to experiment with various dietary combinations to see what forms are useful from a nutritional perspective, are cost effective, and remain appealing to consumers. For instance, inexpensive elemental iron is absorbed at a 10 to 50 per cent rate; while more costly ferrous sulfate provides iron than is close to 100 per cent absorbed.

Beginning in 1999, the Institute researchers began collaborating with the IAEA through a regional project involving seven Asian countries, all involved in analyzing the bioavailability of micronutrients supplied from fortified staple foods.

“Fish sauce is the most universal ingredient of Thai cuisine,” explains Dr. Wisantwisut. “We surmised that if we could come up with the right formula for fortifying inexpensive mixed fish sauce with iron and iodine, we would have the right vehicle for improving the diet and health of even the poorest Thais.”

During the last two years, the Institute staff has thus been experimenting with nine different forms of iron fortificants in fish sauce. Testing includes not only the taste and appearance of the enhanced product, but also how it stands up in real life settings. The Institute team prepared and tasted some 1,200 local dishes to scrutinize the improved sauces.

“The formula for fish sauce is centuries old, and the product is manufactured by numerous small and large companies,” says Dr. Chavasit. “We found four producers that were willing to work along with us in the experimental phases.

One of those companies is Rayong Fish Sauce Industry Ltd., a family owned and operated producer with 40 years of experience. “We started working with the Institute on sauce fortification almost five years ago, and now we’re aiming toward commercializing the product within a year,” says Kawin Yongsawasdigul, director of marketing. “The value of fortification is not well understood,” he says. “More public education is needed about nutrition. The private sector cannot do that job alone.”

Infant mortality rate

Infant mortality has fallen dramatically in Thailand due to improved child nutrition and health care. Isotope techniques are helping to enhance understanding of nutrition in children and child-bearing women.

“Squid Brand” fish sauce is the second most popular sauce in Thailand. It’s maker, the Thai Fish Sauce Factory, has also gotten involved in the Institute’s pioneering research. “This kind of fortification is new for us and very good for the Thai people,” says Ms. Poraya Jiramongkollarp, the assistant managing director. “We are getting excellent technical support and co-operation from our colleagues at Mahidol.”

But the proof is in the pudding—or in this case, the sauce. The final measure of which formula is most nutritionally effective will launch the Institute into a new phase of its research.

“Our tests on human subjects will measure the bioavailability of iron in the best fortificants for fish sauce,” says Dr. Wisantwisut. “It will be the first time that we’ve worked with stable isotopes as tracers,” she explains. “We are truly excited about acquiring these new capabilities as isotopic analysis is really the state-of-the art in our field.”

Floating market

The trials will be conducted on women of childbearing age, the segment of the population that is most vulnerable to iron deficiency anemia. “What might take years to learn by observation can be achieved in weeks using isotopes,” says Dr. Wisantwisut. “Policy people don’t want to hear ‘Maybe’ when they ask a scientific question. Using isotopes, we’ll soon be able to give them answers with assurance.”

The collaborative work of the Institute of Nutrition and the IAEA has captured the attention of the Asian Development Bank (ADB), which is already helping some 14 Asian nations to use combinations of fortification and bio-fortification to meet both macro- and micro-nutrient needs.

As ADB’s Dr. Joseph Hunt explains, “We are inviting the IAEA to join the ADB food-based regional projects as an advisor and partner; that will open up new possibilities of using stable isotopes to measure nutrient content of all processed foods and bio-fortified seeds for rice, wheat, and other staples; and will aid in the burgeoning biotechnology industry. The nutrient pathway analysis is IAEA’s special contribution to the ADB efforts in the region, and ADB in turn needs a partner that can create analytical skills and methods here in the region.”

  Focusing Science on the Health Problems of the Poor

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Measuring the Benefits of Fortification: Thailand’s Battle Against “Hidden Hunger” Full Story...
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Scientists at Thailand’s Institute of Nutrition are working with private companies and the IAEA to introduce fish sauce fortified with both iron and iodine. Above is Dr. Visith Chavasit.

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