Health experts call for manadatory flour additives

11/05/06 Nutritional health experts have called on the Chinese government to legislate for mandatory nutritional additives to flour in order to remedy many of the country's major health problems.

The simple and inexpensive addition of nutrients in flour -- consumed in the Chinese staple of steamed buns, or man tou -- could significantly improve national health standards, an international forum in Beijing heard.

More than 200 experts heard evidence of the benefits of flour fortification at the Forum on Fortification of Wheat Flour hosted by the Chinese Cereals and Oils Association and the Center for Public Nutrition and Development of China.

Nutrition deficiency was a major issue in China, said Alan Court, director of programs with the United Nation Children's Fund(UNICEF).

UNICEF and the Ministry of Health jointly launched a Vitamin and Mineral Deficiency Damage Assessment in September 2004, which found that iron deficiency disrupted the mental development of 40 to 60 percent of the nation's six-to-24 month-old children.

Each year, up to 1,000 young women die in pregnancy and childbirth from severe iron deficiency anaemia. Folic acid deficiency causes about 35,000 to 40,000 birth defects in China annually, including infantile paralysis.

Under-nutrition resulted in lack of strength and vulnerability to chronic diseases, said Yu Xiaodong, director of the Public Nutrition and Development Center of China.

The fortification of staple foods was "a safe, efficient and controllable, with low costs and long-term effects", said Liu Fuhe,head of the State Council Leading Group Office on Poverty Alleviation and Reduction.

He said the addition of nutrients would cost just 0.04 RMB per kilogram of flour. "People don't need to change their cooking anddietary habits to improve their health and nutrition levels -- it can be done for them."

A three-year trial program was begun by the Health Ministry andthe National Grain Administration in 2002. Fortified flour was provided to farmers as compensation for converting arable land into forestry in Chengde, north China's Hebei Province, and Lanzhou, capital of the northwestern Gansu Province. The flour wassupplemented with vitamins A, B1, B2, folic acid, nicotinic acid, iron, zinc and calcium.

Doctor Huo Junsheng, of the Chinese Center for Disease Control and Prevention, said the results were significant.

Before the introduction of fortified flour, the center's surveyof women in Lanzhou showed daily vitamin A intake was 491 micrograms, 61 percent of the recommended international daily consumption; vitamin B1 was 0.8 milligrams, or 50 percent of recommended levels; vitamin B2 1.1 milligrams, 69 percent; and nicotinic acid 12.8 milligrams, or 80 percent.

After a year of fortified flour, the villagers' nutritional indices had all increased: vitamin A intake had risen 25 percentage points to 86.5 percent of international standards; vitamin B1 by 31 percentage points to 81 percent; vitamin B2 to 100 percent; and nicotinic acid to 106 percent.

The situation in Chengde was similar: after three years with fortified flour, the prevalence of anemia had declined by 4.7 percent; the deficiency rate of vitamin A had dropped by 28.2 percent; while zinc levels were up by 0.04 mg per liter of blood.

A survey by the Public Nutrition and Development Center showed 74 mills in China producing fortified flour in August last year and 18 out of 31 provinces had it on the market.     

The center is experimenting with fortifying rice, another Chinese staple, but there are no successful international precedents.

"The promotion of flour fortification in China still faces manychallenges," said the center's Doctor Chai Weizhong, whose research in Gansu showed 83.4 percent of people had never heard offortified flour. Most consumers rated taste the top priority in choosing a flour and a third the whiteness of the the flour.

Chai believed technical and skills obstacles in flour-producingenterprises and fears over food safety had retarded the spread of fortified flour. "Some people think fortified flour isn't as goodas 'natural' flour," he said. "Others wondered if any harmful chemical additives were added."

Participants in the forum are urging the government to legislate in favor of enhanced flour.

Representatives from Australia, Indonesia and Jordan discussed their experience of mandatory flour fortification. The United States and United Kingdom have been adding nutritional additives to flour since the 1940s and more than 70 countries have since followed.

China legislated the addition of iodine to salt in 1996 when less than 40 percent of salt contained iodine. Today, more than 95percent of the population eats iodine-enhanced salt, according to a Health Ministry report, which revealed that goiters among children aged eight to 10 had fallen from 20.4 percent in 1995 to 5.8 percent in 2002.

"Now that food nutrition has been written into the eleventh five-year plan, it is time to legislate for flour fortification," said Yue Songdong, director of the Development Research Center of the State Council.

"The National Grain Administration has formulated the National Standard for Fortified Flour, which has been submitted for approval," says Chen Jiaji, head of the macro-management division of the State Grain Administration. "Based on that, we will issue guiding principles on the management of flour fortification in order to standardize the practices of companies, and to promote flour fortification effectively."