Micronutrient malnutrition is one of the most significant challenges we face globally. Vitamin and mineral deficiencies impact the health of people and limit their contribution to their communities and developing countries’ economic well-being.

Diets low in vitamins and minerals are associated with poor health outcomes, birth defects, and impaired cognitive development, which negatively impact the economy of developing countries. Fortification of Staple foods is one of the most measurable, cost-effective interventions to combat malnutrition

According to National Micronutrient Survey (NMS) 2019 Bangladesh, the usual diet is typically deficient in one or more micronutrients, notably vitamin A, iron, iodine, and zinc.

Statistical Overview of Deficiency

Bangladesh is a developing country that has experienced rapid economic growth during the last 20 years. Additionally, poverty, malnutrition rates, and poor nutritional status is still a major problem. The Bangladesh Demographic and Health Survey (2021) estimated that 30.8% of the children under 5 years of age have stunted growth, and 21.9% are underweight. Undernutrition is further aggravated by poor dietary diversity, with 70 percent of the diet comprising cereals inadequate protein, and micronutrient intake. Moreover, in National Micronutrients Status Survey (NMS) 2019 found a high prevalence of micronutrient deficiencies among preschool children and nonlactating, nonpregnant women. Among them, 21% of the children and 5% of the women were Vitamin A deficient, 11% of the children and 7% of the women were iron deficient, and 45% of the children and 57% of the women were deficient in zinc. In addition, 9% of the women were deficient in folate and 6% of the women were vitamin B12 deficient.

Source: https://www.statcompiler.com/en/

https://www.usaid.gov/sites/default/files/documents/Copy_of_tagged_Bangladesh-Nutrition-Profile.pdf

Need for Food Fortification

The major underlying cause of micronutrient deficiencies in Bangladesh and the necessity of food fortification is;

● Poor quality diets and dietary diversity (predominantly plant-based with a minimal amount of animal foods).

● Low socioeconomic status and household food insecurity, lack of knowledge about the optimal diet and hygiene practices along with infections and infestation.

● Micronutrient-rich foods are poorly known; only a few affordable diversified food sources especially animal sources; are unaware of the health benefits of adequate micronutrient intake.

● Poor bioavailability of micronutrients from plant sources.

● Energy intake and dietary diversity are significantly associated with micronutrient intake in women and children.

Several micronutrients, including iron, zinc, folate, vitamin A, and vitamin B12, are not enough to meet the needs of children and women in Bangladesh. Food fortification especially rice fortification with iron and zinc; fortification of edible oils with vitamin A, has the potential to fill a significant portion of the nutritional gap since these foods are widely consumed and in large quantities. As a result, it is recommended food fortification through rice and oil be fortified to address the large gap in micronutrient intakes.

In Bangladesh, preventing vitamin D deficiency among high-risk population groups is yet to receive enough attention, and must be integrated into the strategy of multiple micronutrient supplementation.

Common Micronutrient Deficiencies in Bangladesh

● Vitamin A deficiency is widespread and the most serious leading to corneal lesions, partial or total blindness associated with reduced resistance to infectious disease, and increased morbidity and mortality.

● Nutritional anaemia from iron deficiency is a significant cause of maternal deaths and has been linked to reduced resistance to infections.

● Iodine deficiency disorder is most prevalent due to frequent flooding, soil is deprived of iodine.

● Riboflavin deficiency is frequently seen in young children and pregnant and lactating women.

● Prevalence of zinc deficiency in infants and pre-school children.

A study among women in a northern rural Bangladeshi area reported a 28 percent prevalence of thalassemia and found an association between the prevalence of thalassemia and the risk of anaemia.

Therefore, food fortification is necessary for developing countries to ensure essential nutrients in processedfoods and improve their suitability for human nutrition. Studies indicate that these measures have positive results in preventing micronutrient deficiency in vulnerable populations, particularly women and children.

Consequently, food fortification could be a viable intervention and preventive strategy to alleviate malnutrition by providing the population with adequate micronutrients through widely consumed staple foods.

Current Interventions

National Strategy for Prevention and Control of Micronutrient Deficiencies in Bangladesh (NSPCMD) 2015-2024, is being implemented with the following food fortification measures:

1. Iron folic acid supplementation (IFA) program for pregnant women – food fortification for preschool children, school-aged children, adolescent girls, and women of reproductive age was recommended.

2. Micronutrient powder (MNP) supplementation for young children. The National Strategy for Prevention and Control of Anaemia has recommended the use of MNP for 6 – 23 months old children and for 2 – 5 years children to prevent anaemia and other micronutrient deficiencies.

3. Zinc supplementation through (MNP) Micronutrient powder and rice fortification with six micronutrients – vitamins A, B1, and B12, zinc, folic acid, and iron.

4. Food fortification with Vitamin A - edible oil and rice are the promising food staples in Bangladesh to combat malnutrition in the larger population.

5. Home food fortification for infants and pregnant women.

Food Fortification Solutions for Staples

❖ Staple food fortification oil, rice, salt, and wheat flour are the most suitable fortificants in Bangladesh.

❖ In Bangladesh, deficiencies are notably high, impairing proper physical and cognitive development. It aims to break the vicious cycle of malnutrition through dairy fortification - fortified milk and milk products (milk, cheese, butter, and yogurt) with iron, zinc, vitamin A and iodine.

❖ Food fortification as Micronutrient fortified biscuits will help in school-based feeding programs for children and the use of #fortified beverages can contribute to the improvement of nutrient status in rural Bangladesh.

❖ Food fortification through Therapeutic foods (RUTF) are critically important for Bangladesh, as six lakh children under the age of five are suffering from severe acute #malnutrition (SAM) and around one million of them die every year, according to the International Centre for Diarrhoeal Disease Research (ICDDR) Bangladesh.

Currently, the government does not provide any community-based programs to care for these children due to a lack of ready-to-use therapeutic food (RUTF).

Source: https://www.thedailystar.net/frontpage/miracle-food-made-bangladesh-94309

https://pubmed.ncbi.nlm.nih.gov/29258336/

Large-scale fortification of food (LSFF) - Fortifying widely consumed food items (staples and condiments) to address micronutrient deficiency and improve nutrition outcomes for poor and marginalized people who lack access to these nutrients. (Raghavan et al., 2019). While private sectors have the potential to contribute to nutritional outcomes, to play a substantial role in providing nutrient-rich food to poor and marginalized people.

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