Flour fortification:malnutrition and health effects of whole grains

FLOUR FORTIFICATION : MAL-NUTRITION
& HEALTH EFFECTS ON WHOLE GRAINS
Malik Tariq Sarwar Awan,
Food Technologist & Consultant,
Chairman Research Wing to Pakistan Flour Mills Association,
Editor, Wheat Milling News, PFMA .
Member Pakistan Society of Food Scientists and Technologists

FLOUR FORTIFICATION : MAL-NUTRITION & HEALTH
EFFECTS ON WHOLE GRAINS
Flour fortification Significance
• Fortification involves the addition of nutrients
to foods that are excluded during processing
or for any other reason addressing the main
health conditions under subject to Mal-
Nutrition of masses.
• In other words, the aim of fortification is
retaining stability in socio-economic
parameters.

• Milling depletes Essential Nutrients from
Wheat

MALNUTRITION:
• Deficiency of
essential nutrients
leading to diseases
and mortality.

Malnutrition can take a number of forms:
• Stunting
• Wasting and
• Micronutrient deficiency

FLOUR FORTIFICATION : MAL-NUTRITION &
HEALTH EFFECTS ON WHOLE GRAINS
• Stunting: is a result of a child having a poor
diet – too few calories or too little nutritious
food, or both. Stunting refers to a child who is
too small for their age because they have not
developed properly

FLOUR FORTIFICATION : MAL-NUTRITION &
HEALTH EFFECTS ON WHOLE GRAINS
• Wasting : results from a severe, and often
sudden, lack of food or disease.
• In total, 55.5 million children – around 9% of
all children globally – are wasted

• Micronutrient deficiencies : represent a
serious risk to a child’s health.
• They account for one-third of all malnutrition-
related child deaths, and 10% of all children’s
deaths.

Health Effects of Whole Grains:
• Heart disease
Studies have consistently found that
individuals with three or more servings of
whole grain foods per day have a 20 to 30
percent lower risk for atherosclerotic
cardiovascular disease compared to
individuals with lower intakes of whole grains

• Cancer
Whole grains appear to be associated with a reduced risk of
a number of gastrointestinal cancers as well as several
hormone-dependent cancers.
A review of 40 studies on gastrointestinal cancers found a
21 to 43 percent lower cancer risk with high intake of
whole grains compared to low intakes.

• Gastrointestinal health
The effect of promoting normal intestinal
regularity makes whole- and high-fiber grain
products integral components of diet plans to
help alleviate constipation and decrease the
risk of developing diverticulosis and
diverticulitis.

• Diabetes
The American Diabetes Association Guidelines for
the Prevention and Treatment of Diabetes recognizes
the role of whole grains and fiber in reducing the risk
of diabetes and maintenance of blood glucose levels.
Major epidemiological studies show a reduced risk of
20 to 30 percent for type 2 diabetes associated with
higher intakes of whole grain or cereal fiber

• Weight management
Studies show that people who include whole grains as
part of a healthful diet are less likely to gain weight over
time.
The mechanisms by which whole grains may support
weight management include enhanced satiety to lower
energy intake, prolonged gastric emptying to delay the
return of hunger, and increased insulin sensitivity to
lower insulin demand.

Wheat flour – 67 countries
Wheat flour and rice – 3 countries
(Nicaragua, Panama, Philippines)
Rice – 1 country
(Papua New Guinea)
Wheat flour, maize flour, and rice – 2 countries
(Costa Rica and the United States)
Wheat flour and maize flour –12 countries No grain fortification legislation
* Legislation has effect of mandating grain fortification with at least iron or folic acid.
Legislation status from the Food Fortification Initiative (www.FFInetwork.org) March 2016
Industrially Milled Flour and Rice
Fortification Legislation

Fallacies Facts
Healthy people do not need to
eat fortified flour or bread
products.
Everyone in Pakistan should eat
fortified flour everyday and for a
lifetime as it works as a
preventative measure.
The taste and texture of fortified
flour is different than unfortified
flour.
Fortified flour has the same taste
and quality of unfortified flour.
Eating fortified flour puts people
at risk for consuming too much
iron and making them sick.
No side effects on health have
been reported in the studies
published on fortified flour. In
addition, iron and folic acid do
not accumulate in the body.
Excess of these nutrients come
out in a person’s waste.

Fallacies Facts
Fortified flour can cause obesity. Fortified flour is not cause of
obesity than unfortified flour.
Vitamins and minerals in flour
decay when bread is baked.
Baking has no effect on the
vitamin and mineral content in
flour.

Common Concerns:-
1. What do iron and folic acid do for the body?
Iron helps in the production of red blood cells and carries oxygen to the
body cells, helps in synthesis of DNA and electron transport. Iron
metabolism helps to protect the body against infections and promotes
efficient functioning of the brain, aids in physical activity and productivity.
It prevents some premature births.
Folic Acid, also known as Vitamin B9, helps to produce and maintain new
cells and therefore prevents neural tube defects. It also helps to make
normal red blood cells and thus prevents one type of anemia.

Common Concerns:-
2. Who are the most vulnerable to micronutrient deficiencies?
Why?
Children and women of reproductive age are most vulnerable,
but generally everyone needs nutrients for good health.
Children need to eat nutritious meals several times a day,
because their bodies are growing. Women of reproductive age
require extra nutrients during pregnancy and while
breastfeeding. These nutrients are needed for the mother’s
wellbeing, the development of the fetus during pregnancy,
and for the baby during breastfeeding.

Common Concerns:-
3. How can you identify flour that is fortified?
Look for fortified flour logo on your bags of flour.
4. What can you say to patients who are upset that fortified flour has
increased the price of bread?
While fortifying flour has caused a small increase in the price of bread,
these added vitamins and minerals in bread helps people to be smarter,
stronger, and healthier.
Improving nutrition through these added vitamins prevents diseases,
strengthens immune systems, and improves productivity. Thus money is
saved in lower healthcare costs, and money is made in increased
productivity.

Common Concerns:-
5. Fortification v/s Supplements :-
• Fortification is more Effective than Supplementation.
• Fortification does not cause people to consume more than the tolerable
upper intake level (UL) of folic acid and iron whereas, Supplements
exceeded the Upper Limit (2.7%).
• Folic acid fortification does not cause cancer or mask B12 deficiency
whereas, High doses of supplemental folic acid reportedly enhance the
inflammatory response in the human colon, which is thought to
predispose individuals to colon cancer.

Common Concerns:-
5. Fortification versus Supplements :-
• Fortifying with iron does not contribute to iron overload in beta
thalassemia and may contribute slightly to the risk of iron overload in
individuals with hemochromatosis. This risk is counterbalanced by the
developmental benefits of iron in children.
• Supplements are based on individual health due to which have greater risk
for surpassing the UL (Upper Limit) when subjected to masses whereas
Fortification is subjected to masses’ health as whole.

Common Concerns:-
6. Enrichment versus fortification:-
• Restoration or enrichment of wheat flour returns nutrients lost in the
milling process to their original levels. For iron, this is generally around 35
ppm.
• 25 Iron fortification is the addition of extra iron, usually up to 55–65 ppm,
as is practiced in most Latin American countries.

Enhancement done in Wheat Flour by:-
• Improvers: increase the speed of the baking
process, strengthen dough.
• Reducing agents-break down gluten
• Enzymes-supplement inherent enzymes and
minimize variations caused by nature
• Emulsifiers-improve loaf volume, crumb
structure, softness
• Bleaching agents-enhance whiteness of flour

• Relationship between Mal-nutrition and
Socio-economic stability

Business Impact Assessment : New Frontiers for
Retailing
• To spur growth, many specialty retailers will
follow extension avenues that help maximize
customer value and leverage organizational
skills.
• Do-it-for-me service and solution offers will
surge as retailers strive to capture a share of
the growth in spending on services.

Business Impact Assessment : New Frontiers for
Retailing
• More retailers will leverage their brand license
into the realm of services, making the next
concept in their portfolio one that sells services,
not products.
• Tools and technology will change the balance of
power in retailing, shifting the power to the
people. Consumers will have almost perfect
information access about products and pricing.

Marketing Strategies for Retail Value Curve
• Air a commercial that educate people on flour fortification.
• Have the flour fortification campaign covered by the news.
Have government representatives and the Association for
Protection of Consumers Rights representatives speak about
the campaign.
• Use a trial run with bakers using fortified flour as a media
opportunity to show that fortified flour has the same baking,
taste, feel, and smell as unfortified flour. This could also be
covered by the news or it could be done on a popular cooking
show

Marketing Strategies for Retail Value Curve
• Highlight millers’ commitment to fortifying flour and their
social responsibility in a news story.
• Going on a talk show to discuss flour fortification.
• Educate women as they are most likely to purchase flour and
handle the family’s healthcare needs.

Commercial Advertisement Video on Fortified
Wheat Flour
• Published on Feb 3, 2016
https://www.youtube.com/watch?v=_VYNvxX1YoI
• Published on Nov 2, 2015
https://www.youtube.com/watch?v=Cma__88WCR
U

REFERENCES
• http://www.foodinsight.org/Whole_Grains_Fact_Sheet
• http://www.ehfg.org/intranet/app/webroot/uploads/presentations/files/
uploads/4316f29e178adeb7774c3cabf728dd.pdf
• http://www.ehfg.org/intranet/app/webroot/uploads/presentations/files/
uploads/4316f29e178adeb7774c3cabf728dd.pdf
• http://www.who.int/nmh/publications/ncd_report_full_en.pdf
• http://www.savethechildren.org.uk
• www.FFInetwork.org
• http://ffinetwork.org/about/stay_informed/newsletters/images/Armenia_
Comm_Report.pdf

THANK YOU
Malik Tariq Sarwar Awan,
Food Technologist & Consultant,
Chairman Research Wing to Pakistan Flour Mills
Association,
Editor, Wheat Milling News, PFMA .
Member Pakistan Society of Food Scientists and
Technologists

Flour fortification:malnutrition and health effects of whole grains

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Flour fortification:malnutrition and health effects of whole grains