Appendix 1
Technical guide: Developing fortified rice standards
The goal of fortification is to increase the regular nutrient intake of a target population, but not so much that high consumption levels will put them at risk of excessive intake. Although this guide focuses on methodologies recommended to develop standards for fortified rice specifically, fortification of any staple food shouldn’t be seen in isolation but rather in coordination and harmonization with fortification of other staples, current and future. It will be important to identify the proportion of staple food consumption and micronutrient deficiencies of highest public health concern to determine the micronutrients to be added to rice, their quantities, and the suitability of rice as a vehicle for that specific micronutrient.
Fortified rice standards globally
Countries that have already embarked on the journey to develop rice fortification standards provide guidance and benchmarks on the set of micronutrients used and the target levels to be added (Table 1).
Table 1: Examples of national fortified rice standards
*Optional
Source: Adapted from: Rice Fortification: Evidence, Status, and Lesson’s Learned in Grain Fortification, Tsang B.L, Pachan H, Sight & Life supplement – Rice Fortification in Latin America
Based on WHO recommendations for wheat and maize flour fortification, various levels of micronutrients have been recommended according to per capita rice consumption (10) (Table 2). WFP has developed the standards it uses when procuring fortified rice distributed in food assistance programmes, offering a good benchmark for nutrient selection and proposed levels of fortification.
Table 2: WFP standards for nutrient levels proposed for fortified rice at moment of consumption
Source: Adapted from: De Pee, Annals of New York Academy of Sciences, 2014
Methodology
For the majority of micronutrients, the highest recommended intakes are for adult males, with the notable exception being iron for women of reproductive age. The adult male subgroup usually has the lowest risk of micronutrient deficiencies due to higher food intake and lower micronutrient requirements per unit of body weight. Individuals most at risk of not meeting their RNI are infants, young children, and women of reproductive age, especially pregnant and breastfeeding women. Some of these groups (e.g., pregnant and breastfeeding women) have higher requirements for specific nutrients than do adult men.
Various national and international bodies, including FAO and WHO, have specified dietary requirements for specific micronutrients aimed at minimizing the risk of nutrient deficit or excess. Two sets of dietary reference values are traditionally used to develop fortification standards:
- The recommended nutrient intake (RNI), which is defined by FAO/WHO as the daily dietary intake level that is sufficient to meet the nutrient requirement of almost all (i.e., 97–98 percent) healthy individuals in a particular age, gender and physiological status group; and
- The estimated average requirement (EAR).
The EAR cut-point (i.e., cut-off point, the limit at which something is no longer applicable) approach is different from the past practice of using the RNI of a nutrient as the desirable or ‘target’ intake. As suggested in the WHO/FAO 2006 Guidelines on Food Fortification with Micronutrients (11), the RNI approach is valid for deriving the desired nutrient intake of an individual, but not that of a population. This is why the approach recommended in the WHO/FAO guidelines for setting fortificant levels in foods is the EAR cut-point method.
The most appropriate reference value for determining safe levels of micronutrient intakes of population subgroups (i.e., the levels at which there is no risk of excessive intake), is the tolerable upper intake level (UL). This is the highest average intake that will not pose a risk of adverse health effects to most of the population. The risk of adverse effects increases at intakes above the UL.
The methodology suggested to develop and set fortification levels is based on the approach recommended in the WHO/FAO guidelines mentioned above. In particular, the recommended intakes for each of the micronutrients studied are based on the EAR, except for iron, for which the RNI is recommended as reference. The recommended levels of EAR and RNI and the ULs can be found in detail in the “Food fortification: An effective and safe way to fight micronutrient malnutrition and its consequences” document (12). It is important to note that the intake estimates and the calculated ULs do not consider the distribution of micronutrient intake from other sources such as the diet or supplementation programmes.
Defining nutritional targets
The suggested values (percent of EAR) presented in Table 3 can be used as guidance to define the nutritional targets for each selected micronutrient. Based on these suggested levels, various alternative formulae can be designed and assessed in terms of their calculated impact on a particular segment of the population and their cost. The percentage of EAR for females aged 15–50 years, who have high micronutrient needs, constitutes a good benchmark.
Table 3: Suggested nutritional objectives for increasing micronutrient intakes
In locations where skin exposure to sunlight is low.
Source: The Food Fortification Formulator: Technical Detemination of Fortification Levels and Standards for Mass Fortification Omar Dary and Michael Hainsworth
Suggested formulation scenario for fortified rice The micronutrients used to fortify rice include minerals such as iron and zinc and vitamins such as A and the B vitamins (B1, B2, B3, B6, folic acid, B12). However, two vitamins need to be carefully considered before finalizing the formulation for rice, particularly given the sensitivities and importance of this staple in the diet of Asian populations.
From an organoleptic perspective, it has been documented that vitamin B2 (riboflavin) colours fortified kernels, which can prove unacceptable to consumers, and vitamin A, which is costly and highly sensitive to heat and oxidation, is already recommended in many countries for addition to vegetable oils. It is advisable to put forward formulations that include the following micronutrients:
• Vitamin B1 as thiamine mononitrate
• Vitamin B3 as niacinamide
• Vitamin B6 as pyridoxine hydrochloride
• Folic acid
• Vitamin B12 as cyanocobalamin
• Iron as micronized ferric pyrophosphate
• Zinc as zinc oxide.
References
- FAO, IFAD, UNICEF, WFP and WHO. 2022. The State of Food Security and Nutrition in the World 2022. Repurposing food and agricultural policies to make healthy diets more affordable. Rome, FAO.
- Afshin A et al. 2019, Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet [Internet]. 2019 [cited 2021 Jan 10];393: 1958–72. Available from: http://dx.doi.org/10.1016/ Jayawardena R, Jeyakumar DT, Gamage M, Sooriyaarachchi P, Hills AP. Fruit and vegetable consumption among South Asians: A systematic review and meta-analysis. Diabetes Metab Syndr Clin Res Rev. 2020;14: 1791–800.
- Harding KL, Aguayo VM, Webb P. 2018. Hidden hunger in South Asia: a review of recent trends and persistent challenges. Public Health Nutr. 2018 Mar;21(4):785-795.
- De Pee S. 2015. Scaling up Rice Fortification in Asia. Sight and Life. July 2015
- Joint FAO/WHO Codex Alimentarius Commission. Codex Alimentarius: General Principals for the Addition
of Essential Nutrients to Foods (CAC/GL 9-1987). Adopted in 1987. Amendment: 1989, 1991. Revision: 2015. https://www.fao.org/fao-who-codexalimentarius/sh-proxy/en/?lnk=1&url=https%253A%252F%252Fworkspace. fao.org%252Fsites%252Fcodex%252FStandards%252FCXG%2B9-1987%252FCXG_009e_2015.pdf. - FAO/WHO. 2004. Vitamin and mineral requirements in human nutrition.
- World Health Organization. 2022. Guideline: fortification of wheat flour with vitamins and minerals as a public health strategy. Licence: CC BY-NC-SA 3.0 IGO.
- WFP. 2021. The Journey of Scaling Up Rice Fortification in Asia: Connecting food systems with social protection to enhance diets of those who need it most. https://docs.wfp.org/api/documents/WFP-0000148858/download/?_ga=2.187126752.919626717.1693798255-281546121.1642498389
- WFP. 2022.The proof is in the pilot: 9 insights from India’s rice fortification pilot to scale approach. https://docs. wfp.org/api/documents/WFP-0000141611/download/
- De Pee S. 2014. Proposing nutrients and nutrient levels for rice fortification. Annals of the New York Academy of Sciences. 2014 Sep;1324:55-66. ISSN 007-8923.
- WHO. 2006. Guidelines on Food Fortification with Micronutrients. https://www.who.int/publications/i/
item/9241594012 - WFP. 2022. Food fortification: An effective and safe way to fight micronutrient malnutrition and its consequences. https://newgo.wfp.org/documents/food-fortification-brochure
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