Concerns, myths and misconceptions of rice fortification

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Fortification with iron is safe for people with blood disorders. ▫ Fortification with folic acid does not mask vitamin
Concerns, myths and misconceptions of rice fortification Helena Pachón Senior Nutrition Scientist Food Fortification Initiative [email protected]

Is rice fortification safe? EAR RDA / RNI

UL

EAR: Estimated Average Requirement; RDA: Recommended Dietary Allowance / RNI: Recommended Nutrient Intakes; UL: Tolerable Upper Intake Level

Definitions from IOM 2000, p. 3

Is rice fortification safe? Percent of Non-pregnant Adults (>19 Years) in USA with Folic Acid Intake above Tolerable Upper Intake Level (UL) 9.4

10 8 5.5

6

4

2.7

2 0

0 Overall

Mandatory

0 Mandatory + voluntary

Mandatory + supplements

Mandatory + voluntary + supplements

Mandatory folic-acid fortification of cereal grains (including rice) is safe Only people consuming supplements had intake levels above the UL Yang 2010; It is recommended that pregnant women consume 400 mcg folic acid daily; Mandatory: wheat flour, maize flour, rice; Voluntary: ready-to-eat foods

Is rice fortification safe?  Fortification with iron is safe for people with blood disorders  Fortification with folic acid does not mask vitamin B12 deficiency cc licence by flickr. Picture by Michael Sean Gallagher. ç

Fortification is safe Grant 2012; Mills 2003; MPI 2012

cc licence by flickr. Picture by Alpha

Can rice fortification eliminate all micronutrient deficiencies? Percentage of Mexican Women with Iron Deficiency after Six Months of Consuming Fortified Rice or Milled (unfortified) Rice 32.7

26.5

22.7

27.5

35 30 25 20 15 10 5 0

Fortified rice

Milled rice Baseline

Endline

Rice fortification will help reduce micronutrient deficiencies Rice fortification will not eliminate micronutrient deficiencies in their totality Population should strive to eat a healthy diet Some population groups will need additional interventions Hotz 2008

What is the difference between fortified and bio-fortified rice? Added nutrients

Fortified

When

During industrial During its development via plant processing breeding or genetic modification (GM)

Time frame Which

Levels

Bio-fortified

Now After breeding/GM (years-decades) Virtually any can Iron1, zinc1, beta-carotene2 (mainly) be added

Higher

Lower

These are complementary strategies to reduce micronutrient deficiencies

Nestel 2006; Ye 2000; 1Through plant breeding; 2Through genetic modification: Golden Rice

Why not eat parboiled rice or brown rice instead of fortified rice? 8

Milled rice

Brown rice

Zinc

Thiamin

Parboiled white rice

mg/100 grams rice

7 6 5 4 3 2 1 0 Iron

Niacin

Vitamin B6

Brown rice and parboiled rice are more micronutrient-rich than milled rice USDA Nutrient Data Bank; fortified rice as USDA commodity requirements 2014; Vitamin A, folate, vitamin B12 content is negligible in milled, brown or parboiled rice

Why not eat parboiled rice or brown rice instead of fortified rice? 8

Milled rice

Brown rice

Parboiled white rice

Fortified rice*

mg/100 grams rice

7 6 5 4 3 2 1

0 Iron

Zinc

Thiamin

Niacin

Vitamin B6

Fortified rice is more micronutrient-dense than milled rice, brown rice and parboiled rice USDA Nutrient Data Bank; * Fortified rice per USDA (2014) requirements for international food assistance programs; Vitamin A, folate, vitamin B12 content is negligible in milled, brown or parboiled rice; can be significant in fortified rice

Why not eat parboiled rice or brown rice instead of fortified rice? Percent of USA Population Consuming at least 3 Whole Grain Ounce Equivalents per Day

Adults (>19 y)

7.7

Children (2-18 y)

2.9 0

10

20

30

40

50

60

70

80

90

100

Despite recommendations, consumption of whole grains is low Reicks 2014

Is fortified rice only needed by lowincome groups? Percent of Non-pregnant Vietnamese Women (15-49 Years) with Iron Deficiency, by Socioeconomic Status (SES) 25

20.7

20

15.1 11.9

11.9 15

11.2

10

5

0 1 (lowest SES)

2

3

4

Nutrient deficiencies affect all socioeconomic strata All could benefit from fortified rice Laillou 2012

5 (highest SES)

Image: dreamstime.com

Can any variety of rice be fortified?

Any variety of rice can be fortified—Requires tailoring of fortified kernel

Is fortified rice acceptable to consumers? Acceptability Scores for Fortified and Non-fortified Rice: Sensory Evaluation by Indian Children 8-11 Years 5

No statistically significant differences between fortified & non-fortified rice

4 3 2 1

0 Appearance

Color

Texture

Fortified rice

Odor

Taste

Non-fortified rice

Fortified rice tastes, looks and smells like non-fortified rice Radhika 2011; extruded rice

Overall

Are the nutrients in fortified rice retained after preparation and cooking? Percent Retention of Nutrients Exposed to Different Preparation and Cooking Methods: Average for Coating, Cold Extrusion & Hot Extrusion 120

30 min soaking before boiling in excess water and discarding water

100 80 60

Boiling in excess water and discarding water

Excess

Boiling and letting rice absorb water

Boiling

40 20

0

Washing before boiling and letting rice absorb water Frying before boiling and letting rice absorb water Zinc

Excess + soaking

Iron

Vit. A

Vit. B12

Boiling + washing Frying

Folic acid

In fortified rice made through coating and extrusion technologies, there is good retention of most nutrients (except Vitamin A) over a wide variety of washing and cooking methods Wieringa 2014

Conclusions (1)  Rice fortification is safe  Rice fortification will increase nutrient intake but cannot eliminate all micronutrient deficiencies  Rice fortification & bio-fortification are different and complementary interventions  Fortified rice is designed to be more micronutrientrich than brown, parboiled or milled rice

Conclusions (2)  Rice fortification can benefit all strata of society who have nutrient deficiencies (or are at risk)  Any variety of rice can be fortified  When properly produced, fortified rice tastes, smells and looks the same as non-fortified rice  Most nutrients (except Vitamin A) in fortified rice (coating, extrusion) are retained after preparation and cooking

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Thank you

Terima kasih

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ឣរគុណ

Salamat Po

References • Grant A. Evidence for the safety of fortifying flour with iron in the presence of thalassemia and other blood disorders (presentation). 2012. http://ffinetwork.org/about/calendar/2012/Documents%202012/TurkeySummary.pdf • Hotz C et al. Efficacy of iron-fortified Ultra Rice in improving the iron status of women in Mexico. Food Nutr Bull. 2008;29:140-9. • Institute of Medicine. Dietary reference intakes: Applications in dietary assessments. Washington DC, National Academy Press, 2000. [http://www.nap.edu/catalog.php?record_id=9956]. • Laillou A et al. Micronutrient deficits are still public health issues among women and young children in Vietnam. PLoS ONE 7(4): e34906. doi:10.1371/journal.pone.0034906 2012. • Mills JL et al. Low vitamin B-12 concentrations in patients without anemia: the effect of folic acid fortification of grain. Am J Clin Nutr 2003;77:1474-7. • Ministry for Primary Industries (MPI). Voluntary folic acid fortification monitoring and evaluation report. MPI Technical Paper No: 2012/01. MPI: Wellington, MPI, 2012. • Nestel P et al. Biofortification of staple food crops. J Nutr 2006:136;1067-7. • Radhika MS et al. Micronized ferric pyrophosphate supplied through extruded rice kernels improves body iron stores in children: a double-blind, randomized, placebo-controlled midday meal feeding trial in Indian schoolchildren. Am J Clin Nutr. 2011;94:1202-10. • Reicks et al. Total dietary fibre intakes in the US population are related to whole grain consumption: results from the National Health and Nutrition Examination Survey 2009-2010. Nutrition Research 2014. • USDA. USDA commodity requirements: MR24 milled rice and fortified milled rice for use in international food assistance programs. USDA, 2014. www.fsa.usda.gov/Internet/FSA_File/mr23.pdf • USDA Nutrient Data Bank. http://ndb.nal.usda.gov/ndb/search/list • Wieringa FT et al. Stability and retention of micronutrients in fortified rice prepared using different cooking methods. Ann NY Acad Sci 204;1-8. • Yang Q et al. Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003–2006. Am J Clin Nutr 2010;91:64-72. • Ye X et al. Engineering the provitamin A (b-carotene) biosynthetic pathway into (carotenoid-free) rice endosperm. Science 2000;287:303-5.