ANNEX 6 - REQUIREMENTS FOR EFFECTIVE FORTIFICATION IN FOOD AID PROGRAMMES

CONFORT6

FAO TECHNICAL CONSULTATION ON FOOD FORTIFICATION:
TECHNOLOGY AND QUALITY CONTROL
ROME, ITALY, 20-23 NOVEMBER 1995

Patricia Dexter

Nutritionist
Food Science Department
University of Arkansas
Arkansas, USA

Introduction

One of the primary goals stated for food aid is to combat world hunger and malnutrition and their causes. Fortification of food aid aims to contribute to the micronutrient intake of vulnerable groups, in particular young children and pregnant and lactating women. Greater attention is now being given to expanding the role of food aid in meeting the full nutrient needs of ever increasing numbers of refugees and displaced person in emergency situations. Fortification of food aid for displaced persons and refugees was endorsed at the ICN in the World Plan of Action for Nutrition which included the following recommendation:

"donor countries and involved organizations must... ensure that the nutrient content of food used in emergency food aid meets the nutritional requirements if necessary through fortification, or ultimately supplementation" (FAO/WHO, 1992a).

This paper examines requirements for effective fortification in food aid programmes. The extent that food aid commodities are currently enriched/fortified by food donors is reviewed based on available information. Criteria and limitations for food aid fortification are briefly discussed. Considerations for establishing quality control measures and international guidelines for fortified foods in food aid programmes are offered. These topics are presented as suggested by the organizers of this meeting (Annex 1).

Some Recent Trends in Food Aid

Food aid plays an integral part of many development programmes. It is estimated that approximately 60 percent of the total development aid budget of the US is comprised of food aid (USAID, 1994). Food aid is a key element of the European Union development policy, and The Union and its fifteen Member States are jointly responsible for 53 percent of the total world food aid for needy populations (EC, 1994). Although food assistance may include food aid in the form of concessional food sales to governments, this paper focuses on food aid provided as donations in support of regular programs such as maternal and child health, school feeding or food-for-work programs, or as part of relief and emergency programs.

Multilateral food donations channeled through the World Food Programme (WFP) have steadily increased since the late 1980s (WFP, 1995). However, compared to the eighties and early nineties, there has been a decline in new commitments for regular development food aid programmes to World Food Programme (WFP) due in part to the increased needs for emergency situations. The share of aid budgets devoted to disaster relief and humanitarian aid has increased by more than 500 percent since the early eighties (WFP, 1994). Much of the current discussion on fortification of food aid is focussing on the micronutrient adequacy of emergency and relief feeding programs. In 1994, over 40 percent of the total world food aid supported refugee or other relief operations. Of the new commitments made to WFP in 1994, 81 percent in value terms (73 percent in tonnage) were committed to emergency programmes (WFP, 1994). In the U.S., emergency food aid is the largest single component of overall disaster relief worldwide, in most years.

Attention to the micronutrient quality of food aid is not new. Vitamins A and D have been added to non-fat dried milk powder provided as food aid for many years. With a serious domestic shortage of nonfat dry milk in the mid-sixties, formulations were developed for fortifying a supplementary blended food (cornmeal, nonfat dry milk powder, soy flour, wheat flour) primarily for young children (Combs, 1967). The need to provide sufficient amounts of essential micronutrients in early child food supplements was well understood. The initial blended foods developed were corn-soy-milk (CSM) and wheat-soy-milk (WSM). These blends were fortified with eleven vitamins and six minerals. With a shortage of nonfat dry milk in the early 1970s, CSM was reformulated to what is known today as CSB (corn soy blend). Other processed cereal commodities have also been enriched or fortified with B vitamins, iron and vitamin A. Increased attention to vitamin A deficiency in the 1980s resulted in increased levels of vitamin A added to the processed cereals and soy-fortified cereals.

Current Practices and Use of Fortified Food Commodities

Enriched or fortified food aid commodities presently provided through the WFP include blended foods such as corn soy blend, processed cereals (including wheat flour, corn(maize) meal, soy-fortified processed cereals), vegetable oil, HEP biscuits, dried skim milk powder, and salt (iodized). (P. Dijkhuizen/WFP. Personal communication. August 1995). These commodities are either donated by donor countries or purchased by WFP. Nearly half of the food commodities distributed by WFP in 1994 were purchased by WFP of which sixty percent were obtained from developing countries (WFP, 1994).

The largest share of fortified and enriched food aid commodities originates from the United States, primarily under the Public Law 480 (PL 480) Title II commodity programme. The U.S. government donates agricultural commodities to support emergency and non-emergency or regular food aid programmes under the PL 480 Title II programme managed by USAID. Under amendments made to the PL 480 in 1966, the U.S. government is allowed to pay for enriching, fortifying, and blending donated foods. This placed greater emphasis on the use of food commodities as nutritional supplements, particularly for young children, pregnant women, and lactating mothers. The specifications for enrichment and fortification are provided in the announcements issued by the U.S. Department of Agriculture. These announcements include information on required levels and forms of fortificants to be added to various commodities, and on blending, packaging and labeling requirements. The vitamin and mineral premixes added the processed cereals and blended foods are specified in the announcements. Table 1 indicates the premixes currently added to various PL 480 Title II commodities.

Current enrichment and fortification practices of food aid donors are generally not well documented and information from food donors regarding these practices is not readily available. A recent review of the fortification and enrichment practices of the PL 480 Title II programme however was conducted by USAID (Combs, et al 1994). The following summary by commodity draws from that review with additional information from other donors and agencies when available.

Blended Foods

Blended foods purchased from developing countries by WFP must meet guidelines established by WFP for processed cereals. Product specifications for precooked fortified blended foods ordered by UNHCR/UNICEF/WFP are based on the Guidelines on Formulated Supplementary Foods for Older Infants and Young Children of Codex Alimentarius (FAO/WHO CAC, 1991). The Guidelines provide reference daily nutrient requirements that should be considered in formulating supplementary food and indicate that 100 grams of the supplementary food should provide approximately 2/3 of the reference daily requirements. The vitamin/mineral premix developed for this purpose was referred to as UNIMIX. Levels of vitamins and minerals included in UNIMIX to are listed in Table 2. Since its original formulation, levels of added vitamins and minerals have been adjusted (D. AInwick/UNICEF. Personal communication. September, 1995) resulting in a new specification known as Super Unimix. Currently WFP maintains a listing of blended foods that are acceptable.

The United States contributes over 70 percent of the blended foods provided through WFP. Corn Soy Blend (CSB)* and to much lesser extent Wheat Soy Blend (WSB) are provided by the U.S. through the Title II PL 480 programme. The current fortification levels of CSB and WSB are based on original formulations developed in the 1960s. Eleven vitamins and six minerals were added at levels which were to provide at least half of the National Academy of Sciences-National Research Council (NAS-NRC) Recommended Dietary Allowances for a one to three year old child. Vitamin B 12 was added at a level to provide 100 percent of the RDA at that time. Some changes have been made to the fortification levels of CSB since the original formulations were developed. These have included increasing the levels of added vitamin A, changing the source of calcium from calcium sulfate to TCP (tricalcium phosphate), and using a more stable form of vitamin C. In addition, recommendations have been made to change the level and source of iron, however agreement has not yet been reached to implement suggested changes. Current levels of vitamins and minerals added CSB are listed in Table 2. Most blended foods are produced under batch process conditions. Dry ingredients are preblended together. Vitamin and mineral premixes are added individually and then blended for uniform distribution (Barret and Ranum, 1985).

* Although the term CSB is sometimes used generically to refer to all blended foods, in this paper CSB refers specifically to the blended food formulated in accordance with the USDA specifications and made available through the Title II PL 480 program.

The European Commission provides a precooked cereal based weaning food suitable for infants and young children 4 months and older. Levels of vitamins and minerals in the final product are specified as listed in Table 2.

Blended foods have been used primarily as supplementary food for young children and pregnant and lactating women through Maternal and Child Health programmes. Over 50 percent of the blended foods provided through the PL 480 Title II programme has been used by the large Integrated Child Development Service (ICDS) programme in India. Originally designed to provide approximate 25 percent of the energy of young children and pregnant and lactating women, more recently blended foods have been considered for distribution in general rations for emergency situations and refugee feeding.

Although food fortification is not to be considered a universal panacea in alleviating nutritional deficiencies among refugees, it has been considered to be important in the short term (Henry and Seaman, 1992). Several recent workshops and meetings have highlighted the importance as well as some of the limitations of fortification of food aid commodities for these purposes (Golden, 1995; Toole, 1994; ACC/SCN, 1994; ACC/SCN 1993, Refugees Studies Program, 1991). WFP has developed ration and food aid requirements which include the recommendation that a suitable blended food, fortified with essential vitamins and minerals be included wherever possible when fresh foods are lacking (WFP, 1991). Blended foods are to be obtained locally in some countries (e.g. faffa in Ethiopia) or imported as food aid. In a recent Memorandum of Understanding between UNHCR and WFP, it is stated that "to assist in preventing micronutrient deficiencies, WFP will provide a micronutrient fortified blended foods to populations wholly dependent on food aid" (WFP/UNHCR, 1994). WFP and UNHCR are in the process of revising a set of single definitive nutritional guidelines and are exploring mechanisms to provide blended foods including diversified donor supply, emergency stockpiling and increased local production in recipient countries.

Arriving at acceptable levels of fortification for blended foods is receiving a great deal of attention. UNICEF and WFP are currently engaged in a dialogue to best determine specifications for use of blended foods in emergency feeding programmes (D. AInwick/UNICEF. Personal communication, October 1995). A recent report submitted to the Canadian International Development Agency (CIDA) in response to a request by WFP provides a detailed discussion of key issues in establishing nutrient criteria for fortified blended foods to be used in refugee feeding programmes, including using nutrient density as a basis for fortification levels (Beaton, 1994). A subsequent CIDA report points out that although blended foods originally designed for feeding programmes for young children have been used in refugee feeding programs with apparent benefits in preventing outbreaks of classical deficiencies such as scurvy and pellagra, the current composition of these foods could be better tailored to the overall nutrient needs of the refugee population. Local fortification using centralized mills or at the community-level or if needed the household level using a fortification mix is recommended. This is viewed as more cost-effective than importing costly fortified blended commodities, with the associated high costs of packaging and transport. Costs of local milling and processing are also examined. The report notes that local milling capacity to support refugee feeding in Africa needs to be assessed and that some work is currently underway by FAO, the Micronutrient Initiatives programme and UNICEF to gather this information (Beaton, 1995). Consideration of local fortification and enrichment in special circumstances under carefully controlled conditions was recommended in the review made of the PL 480 Title II programme (Combs, et al, 1994).

A recent meeting convened by the Action International Contre la Faim (AICF) also examined ways of improving the micronutrient content of supplementary foods, particularly for refugees (Golden, 1995). This group noted that numerous blended foods using various vitamin and mineral formulations have been used in supplementary feeding programmes with very little information available on the rationale for the formulations used or evaluations of the products. The meeting agreed that it is important to develop the capacity of regional food industries to boost the production of high quality blended foods in areas where food crisis are likely to occur however, in the first few months of emergency operations imported foods would still be required (Golden, 1995).

Processed Cereal

Generally, processed cereal food aid commodities include wheat flour, cornmeal, bulgur, rice, and soy-fortified cereals (eg. bulgur, cornmeal, sorghum). Processed cereals are used for distribution in food-for-work programs, maternal and child health programs and emergency relief. Over 50 percent of the processed cereals provided through the PL 480 Title II were used for emergency programmes in 1993.

Wheat flour made available through PL 480 Title II is enriched in accordance with standards of identity for enriched wheat flour established by the US Food and Drug Administration. The standard of identity for enriched wheat flour specifies minimum and maximum levels of iron, thiamin, riboflavin and niacin per pound of flour. In addition to the these nutrients, vitamin A and calcium are added according to the USDA/ASCS specifications.

Under the PL 480 Title II programme other processed cereals (except rice) are also fortified with iron, calcium, thiamin, niacin, riboflavin and vitamin A. These nutrients are added in the form of an "enrichment ingredient" mix as specified in the USDA announcements. Soy-fortified cereals including soy-fortified bulgur, cornmeal, sorghum grits, wheat flour, and instant corn soy masa flour are also fortified with the "enrichment ingredient" premix. See Table 1.

Vegetable Oil

Compared to fortifying blended foods with vitamin A, fortification of vegetable oil is less costly and studies indicate that vitamin A added to vegetable is more stable. Sweden was the first country to provide vegetable oil fortified with vitamin A. Recently Canada has also made available to WFP cannola oil fortified with vitamin A. Vegetable oil distributed through the Title II programme is used primarily for emergency programs, and maternal and child health programmes. Approximately 20 percent of the vegetable oil distributed in the Title II programme is monetized. Title II vegetable oil is not currently fortified with vitamin A, although recommendations to do so have been made. (Combs, et. al, 1994).

High Protein Biscuits

Levels of essential vitamins and minerals in high protein biscuits provided by the EC are specified. The biscuits made of cereals, vegetable fats, sugar, vegetable or diary proteins, dried milk and added vitamins and minerals are to provide 60-80 percent of the RDA per 100 grams.

Dried Skim Milk Powder

Current WFP policy regarding the use of dried skim milk powder in non dairy development projects is that it must contain vitamin A. UNHCR policy is to accept, supply and distribute dried skim milk only if it has been fortified with vitamin A. Non fat dry milk shipped under the Title II programme of PL 480 contains vitamins A and Vitamin D. Skimmed milk powder made available through the EC must contain vitamin A and D.

Salt

It is UN policy that all salt programmed for food aid and distributed to beneficiaries has to be iodine fortified. Only iodized salt is purchased and accepted from donors. (WFP Memorandum, 1994b).

Whole Grains

Procedures exist to enhance the micronutrient content of whole grains and milled rice. However because of disadvantages in using whole grains as a vehicle for fortification and substantial costs, whole grain fortification has not been recommended for food aid programmes. (Combs, et. al, 1994).

Costs and Nutritional Impact of Fortification of Food Aid

The costs of enrichment and fortification ingredients used for PL 480 Tide II commodities was found to be relatively low compared to the total value of the commodities (Combs, et. al, 1994). It was estimated that the costs for the fortificant ingredients were less than 2.5 and 5.0 percent of the value of the processed cereal and blended foods, respectively. However, these costs only reflect the costs of the fortificants, other costs associated with the enrichment, including blending, packaging, and quality control measures were not included in these estimates.

Ideally food stuffs should be available to the target groups which can provide a wide range of naturally occurring essential nutrients. When this is not possible, fortification becomes an option. Supplementation for high risk groups may still be needed. For example, it is recognized that fortified food stuffs cannot be expected to provide the levels required to meet the increased nutrient needs of pregnant and lactating women. The role that fortified food commodities plays in preventing and controlling micronutrient deficiencies may be direct through increased consumption of micronutrient rich foods or indirect through transfer of income to poor people. In refugee feeding programs, fortification can play an important role reducing the risk of micronutrient deficiencies (Henry and Seaman, 1992; Toole 1992).

Few impact studies have been conducted, although it is generally recognized that providing increased levels of micronutrients known to be limited in the diets of recipients will contribute to improved micronutrient status. Recently, fortification of maize meal with niacin was shown to be effective in controlling pellagra in Malawi (Toole, 1994). To estimate the micronutrient contribution made by fortified commodities, calculations have been made based on nutrient content of various enriched and fortified foods consumed in recommended amounts within a locally available diet (Beaton, 1995; Combs, 1994; Toole, 1994). Calculations indicate that fortified blended foods make an important contribution towards meeting the recommended nutrient allowances for targeted groups (young children, pregnant and lactating women, and refugees) for essential nutrients which would otherwise be limiting in a cereal based diet. Information on actual food intakes is limited however, and it is recognized that fortified foods targeted for consumption by various vulnerable groups are shared among other family members or may be traded.

Quality Assurance and Quality Control Measures

At the ICN it was recognized that some of the main concerns of food fortification activities are related to technical and distribution problems, and the lack of adequate legislation and effective control systems for the fortification process (FAO/WHO, 1992b). Establishing an effective quality assurance programme relevant for food aid programs appears to be a particular challenge. It is often not clear who is responsible and at what point for ensuring the micronutrient quality of the rations provided. Ideally, quality control measures for levels of micronutrients added to fortified and enriched commodities would be in place from point of manufacture of vitamin/mineral premixes, through processing, blending, packaging, transport, storage and distribution to consumption of the particular fortified commodity.

Quality control measures are included in the USDA announcements for the various types of food purchased and include or reference all requirements that contractors must meet. One of the requirements is that all products must be inspected at the contractor's facility . USDA publishes the policies and procedures for sampling, inspecting and certifying processed commodities along with the routine tests required and fees (USDA, 1994). Routine laboratory tests including moisture and ash analyses are specified for each commodity. "Spot" tests are performed on fortified commodities to determine the presence of iron in those commodities with added iron. Analyses are also performed to determine the presence of calcium in those products with added calcium, if the calcium source is not TCP. Some studies on nutrient stability have indicated that poor blending of the premix into the processed cereal may be responsible for varying levels of micronutrients in the final product (Combs, et al, 1994). USDA is currently examining additional measures which may be taken to assess the fortification and enrichment levels of other added nutrients.

Conformity to vitamin content requirements of skimmed milk powder provided by the EC is to be monitored using reference methods established within Commission Directives for vitamin A content and AOAC methods for vitamin D.

In addition to analyzing micronutrient content, monitoring the moisture content of fortified commodities is also important to assess the potential for loss of micronutrients. Low moisture content of foods retards losses in the micronutrients, spoilage from molds and insects, and adverse changes in flavor and color. USDA announcements specify that the moisture content of CSB should not exceed 10 percent. Studies have indicated that low moisture content can be accomplished and it has been recommended to keep moisture of blended foods at 8.5 percent or less (Combs, et. al, 1994). The specifications by the EC for cereal based weaning food require that the moisture content be governed by good manufacturing practices to ensure minimum nutritive loss and to prevent the multiplication of microorganisms. (Official Journal of the European Communities, 1991).

Criteria for Fortification of Food Aid and Limiting Factors

Criteria for effective food fortification in food aid programmes should be based on criteria similar to that for general food fortification: These have been identified as *:

* Taken from joint statement issued by the Council on Food and Nutrition of the American Medical Association and the Food and Nutrition Board of the National Research Council. Improvement of the Nutritional Quality of Food. J. Am. Med. Assoc. 205:868-869

i) The intake of the nutrient is below the desirable level in the diets of a significant number of people.

ii) The food used to supply the nutrient is likely to be consumed in quantities that will make a significant contribution to the diet of the population in need.

iii) The addition of the nutrient is not likely to create an imbalance of essential nutrients

iv) The nutrient is stable under proper conditions of storage and use.

v) The nutrient is physiologically available from the food.

vi) There is reasonable assurance against excessive intake to a level of toxicity.

The above criteria related to efficacy, nutrient stability, safety and quality assurance are complicated by a number of limiting factors associated with food aid programs. These include:

1. Varying uses of a given fortified commodity: The use of a particular fortified food aid commodity may vary by programme. Logistically, it is difficult for large food donors to tailor similar fortified commodities for a given target group. For example, under the PL 480 Title II programme most vegetable oil is used in emergency and MCH programmes but approximately 20 percent is monetized. Although fortification of oil used in monetized programs may not be warranted, it is not considered feasible to handle both fortified and unfortified oil since diversions of food stuffs in emergency situation is common. Fortified foods targeted for one specific group may be diverted to another programme or population group with varying needs.

2. Unknown consumption levels of various food aid commodities: Estimates of actual intakes of the various fortified commodities are needed to better determine acceptable and safe levels of various fortificants. Given the lack of readily available information on consumption of various food aid commodities, assumptions have been made for the actual intakes.

3. Lack of information on nutrient stability for specific food aid commodities under varying storage/relative humidity conditions, and preparation methods: Additional information is needed on the stability of added nutrients, particularly vitamins A and C. Studies conducted on nutrient stability and interactions, and sensory evaluation are limited for fortified food aid commodities.

4. Varying fortification/enrichment policies and practices by donor countries: Similar commodities used for the same programme may or may not be fortified depending on the practices of the food donor country. Lack of consistency in various agency guidelines and donor policies make planning programmes difficult particularly when multiple sources of commodities are used in combination to meet needs of target groups such as in emergency feeding of refugees or displaced persons.

5. Poor bioavailability of added nutrients in diets of food aid recipients: Since cereal grains high in phytates are often the primary source of calories for food aid recipients the bioavailability of nutrients, particularly of iron may be limited. Increased rates of parasitic infections and other infections and illnesses compromise the nutritional status of beneficiaries and also reduce the absorption and availability of added nutrients. Consideration of these factors have been taken into account in some recent calculations for fortification levels in supplementary foods to be used by moderately malnourished persons (Golden, 1995). Bioavailability issues will effect the selection of the most appropriate fortificant.

6. Costs associated with delivering micronutrients through processed fortified food commodities: Although the costs of fortificant ingredients is relatively low compared to the overall cost of processed cereals, costs of packaging, labeling, handling, and appropriate quality control measures needs to be considered in evaluating the costs of fortification as an effective means to provide limiting nutrients in the diets of vulnerable groups. As discussed earlier, local fortification may reduce these costs.

Need for International Guidelines

As mentioned earlier, some guidelines exist for enrichment of food commodities including the addition of vitamin A to dried nonfat milk and the addition of iodine to salt. WFP provides some guidance on appropriate levels of nutrients to be added to blended foods produced locally. Codex Guidelines for Formulated Supplementary Foods for Older Infants and Young Children serve as a basis for the UNIMIX specifications. Product specifications have also been developed by UNICEF for a precooked fortified blended food known as "Super UNIMIX" which has been manufactured in Kenya for use in Somalia. UNICEF and WFP are currently engaged in discussions to revise nutrient specifications for blended foods. There are, however no overall international guidelines for the enrichment and fortification of food aid commodities.

The role of an FAO/WHO Expert Panel or existing Codex Committees in establishing guidelines for food aid commodities needs be examined. The Codex Alimentarius Commission was established to implement the Joint FAO/WHO Food Standards Programme with the purpose to protect the health of the consumer and to ensure fair practices in food trade. The various specialized Committees of the Commission have established more than 200 individual commodity food standards and numerous guidelines. Codex is cited as the international organization whose standards, guidelines, and recommendations should be the basis for harmonizing food quality and safety measures. Under the recent GATT agreement. Codex standards and guidelines are recognized as a trade reference by the World Trade Organization. Guidelines established for food aid commodities should not impinge on the ability of food donors to respond to emergency requests.

Some of the ongoing work by Codex committees may contribute to efforts to establish international guidelines for optional fortification of various food aid commodities, although the relevance of existing standards to food aid commodities have not been specifically discussed by Codex committees (S. Doyran/FAO. Personal communication. September, 1995). The 19th Session of the CAC(1991) adopted the Guidelines on Formulated Supplementary Foods for Older Infants and Young Children, with the objective of facilitating the preparation of supplementary foods from locally available material. Processed cereal-based foods are best known and most widely used. The Guidelines included guidance on technical nutritional aspects including the addition of vitamins and minerals. Reference daily requirements for older infants and young children are provided in the guideline. In addition, a Standard for Processed Cereal-Based Foods (CODEX STAN 74-1981) has been developed for foods prepared essentially from one or more cereals and/or starchy root products that are used as supplementary foods. Vitamins and minerals and iodized salt are to be added in conformity with national legislation where the product is sold. To avoid overlap between the Guideline and the Standard, there was discussion to integrate the Guideline into a single Standard. The Commission however, later proposed that they remain separate and that the Standard for Processed Cereal Based Foods be revised.

Evaluation of certain food additives and contaminants by the Joint FAO/WHO Expert Committee on Food additives may also effect the use of fortificants. Most recently the provisional use of NaFeEDTA has been viewed as an opportunity to encourage the use of this fortificant more widely in food aid commodities (INACG, 1993).

Developing international guidelines would provide food donors with guidance on acceptable and safe enrichment and fortification practices. Guidelines could aim to encourage similar ranges of fortification levels for food aid commodities to be used for similar purposes and would facilitate their proper use. The relevance of existing Codex guidelines and standards including those related to use of food additives should be identified and in particular terminology in use should be clarified. Providing criteria for labeling of enriched and fortified food aid products that is appropriate for areas receiving commodities would be helpful. Guidelines on minimum acceptable quality control measures to assure presence of added nutrients, ie "spot tests" or other semi-quantitative measures could also be provided. Increased costs associated with establishing guidelines would need to be considered. For example, costs associated with changes in processing, labeling, packaging and technical oversight would need to be evaluated. Possible constraints that guidelines may place on food donors also need to be examined to avoid any unnecessary restrictions on current food donor policy.

Conclusion

Increased attention is being given to fortification of food aid commodities, particularly for foods targeted for emergency and refugee feeding. Shrinking resources allocated for international development is driving discussions on determining the most cost effective means to improve the micronutrient status of vulnerable groups and assessing the role that food aid may play. As the need for emergency food aid increases, there will be greater significance to establishing criteria for fortification of these commodities for both imported and locally fortified commodities. Decisions on fortification and enrichment practices would be facilitated with better information than is currently available on the use of various commodities. Much more attention needs to paid to improving quality control measures to better assure the micronutrient content in the final product.

Acknowledgements: The writer would like to acknowledge the following persons providing information/background reports for this paper: Anne-Marie De Backer, European Commission; Pieter Dijkhuizen, World Food Programme; Selma Doyran, Joint FAO/WHO Food Standards Programme; David AInwick, UNICEF; Robert Moore, U.S. Food and Drug Administration, Washington DC; Sonya Rabeneck, Canadian International Development Agency; Peter Ranum, Atochem, Buffalo NY; John Sharpe, USDA/FGIS, Washington DC. The writer also thanks Gerald F. Combs Sr., University of Southern Mississippi, who kindly provided comments for the paper. The writer however, accepts full responsibility for interpretations and recommendations offered.

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Annex 1.

Requirements for Effective Fortification in Food Aid Programmes

i) To what extent are foods fortified with micronutrients currently used in food aid programs and to what extent should they be used?

ii) What factors limit the use of food fortification in food aid programmes?

iii) Is fortification being used effectively to meet the nutrition needs of target populations. What procedures have been established to determine whether the micronutrient requirements of target populations are readily met?

iv) Does the existence of different fortification practices in various donor countries have a negative impact on the effective implementation of food aid programmes?

v) What quality assurance methods for fortified foods are required at various stages of the process, from manufacturer to consumption by the target population. To what extent are they in place?

vi) Would the development of international standards for fortified foods facilitate the more effective use of such foods in international food aid programmes. What problems might be envisaged in achieving this? vii) What further work needs to be done to optimize the use of food fortification in food aid programmes?

Table 1
Enriched and Fortified P.L. 480 Title II Commodities Shipped in 1993

	Enrichment and Fortification Ingredients					Commodity Total (MT)
	Vitamin A and Calcium	Vitamins A and D	Vitamin Premix(a)	Mineral Premix(b)	Enrichment Ingred.(c)
Processed Blended Foods
Corn soy milk	-	-	x (d)	x	-	3892
Instant corn soy milk	-	-	x	x	-	0
Wheat soy milk	-	-	x	x	-	691
Wheat soy blend	-	-	x	x	-	21728
Corn soy blend	-	-	x	x	-	282739
Instant corn soy blend	-	-	x	x	-	N/A
Soy Fortified Cereal Foods
Soy-fortified bulgur	-	-	-	-	x	57479
Soy-fortified cornmeal	-	-	-	-	x	13861
Soy-fortified sorghum grits	-	-	-	-	x	9262
Soy-fortified wheat flour	-	-	-	-	x	0
Soy-fortified rolled oats	-	-	-	-	-	0
Instant corn soy masa flour	-	-	-	-	x	6123
Processed Foods - Other
Rice	-	-	-	-	-	215765
Bulgur	-	-	-	-	x	109395
Cornmeal	-	-	-	-	x	48085
Wheat flour(e)	x	-	-	-	(e)	270003
Rolled oats	-	-	-	-	-	0
Vegetable oil	-	-	-	-	-	173360
Whole grains
Corn	-	-	-	-	-	128478
Wheat	-	-	-	-	-	452913
Sorghum	-		-	-	-	72817
Dairy Products
Nonfat dried milk	-	x	-	-	-	38
Dried Beans/Pea
Beans	-	-	-	-	-	65261
Peas	-	-	-	-	-	22315
Lentils	-	-	-	-	-	42298
TOTAL SHIPPED						1,996,401

Adapted and updated from Table 2.7 in (Combs, et. al, 1994)

Source: USDA/ASCS Specifications - given in Announcements, February 1994, and community shipment data from USAID/BHR.

(a) "Vitamin Premix" includes thiamine, riboflavin, vitamin C (stabilized ethyl-cellulose coated), pyridoxine, niacin, pantolhenate, folic acid, vitamin B-12, vitamins A (palmitate-stabilized), D and E.

(b) 'Mineral Mix" includes calcium, phosphate, zinc, iron, and iodine in iodized salt.

(c) "Enrichment ingredients' include vitamin A, iron (fumarate), calcium, thiamine, niacin, and riboflavin.

(d) "x" indicates the addition of nutrients or premix.

(e) Wheat flour used in PL 480 Title II must be enriched in accordance with latest standards of identity for enriched wheat flour, ie iron, thiamin, riboflavin and niacin are added at levels which are similar to levels provided in the enrichment ingredients specified by USDA/ASCS. In addition, USDA/ASCS specifies that calcium and vitamin A must be added.

Table 2: Levels of Vitamins and Minerals in Blended Foods (per l00g dry wt.)

	CSB(a)	UNIMIX(b)	EC(c)
Vitamin A (IU)	2314	1300	250-750 mcg
Vitamin D (IU)	198	-	5-15 mcg
Vitamin E (mg)	7.5	-	3-9
Vitamin C (mg)	40.1	30	20 (min.)
Thiamine (mg)	0.28	0.1	0.5 (min.)
Riboflavin (mg)	0.39	0.4	0.3 (min.)
Vitamin B6 (mcg)	0.165	-	0.3 (min.)
Niacin (mg)	5.9	5	6 (min.)
Panto. Acid (mcg)	2.75	-	-
Folic Acid (mcg)	198	50	25 (min.)
Vitamin B12 (mcg)	3.97	1	0.7 (min.)
Calcium (mg)	774	100	600 (min.)
Phosphorus (mg)	400	-	-
Iron (mg)	15.2	8	10 (min.)
Zinc (mg)	0.9	5	10 (min.)
Iodine (mcg)	45.5	-	-
Sodium (mg)	-	-	300 (max.)

Source:

(a) Corn Soy Blend. USDA/ASCS specifications for vitamin/mineral content of premix added to CSB. Calculations made from mg/pound to mg/100 grams are taken from Combs, et al (1994). Product contains approximately 376 Kcal per 100 g.

(b) Information provided by WFP. Product Specification for Precooked Fortified Blended Food. Specifications for 'UNIMIX" blended foods ordered by UNHCR/UNICEF/WFP, based on providing at least 2/3 of the reference daily requirements listed in CODEX Guidelines on Formulated Supplementary Foods for Older Infants and Young Children. Product to contain not less than 400 Kcal per 100 g.

(c) European Community - Cereal Based Weaning Food - for infants and young children 4 months and older. Official Journal of the European Communities. No. C 114 of 29 April 1991. 5th Amendment to Commission communication on the characteristics of products to be supplied as food aid (93/C 34/03). Final product is to contain levels listed.