Effect of iodized salt on organoleptic properties of processed foods: a systematic review.

Despite the global recommendation for fortification of salt with iodine, including salt used in food processing, most salt iodization programs have focussed only on iodization of household salt. Food manufacturers are frequently concerned about the potential instability of iodine and changes in organoleptic properties of their products if iodized salt is used instead of non-iodized salt. To address these concerns, this paper provides a comprehensive review of studies conducted to assess the effect of iodized salt on the organoleptic properties of processed foods and condiments. A comprehensive review was conducted of eligible studies identified by searching electronic databases (PubMed, Medline) and open Internet searches for studies examining the effect of salt iodized with either potassium iodide (KI) or potassium iodate (KIO3) on processed foods. A total of 34 studies on the effect of iodized salt on 38 types of processed foods are summarized. There is no evidence that the use of iodized salt in production of processed foods or condiments causes adverse organoleptic changes that will affect consumer acceptability or product quality. Universal salt iodization is widely recognized as the most cost-effective intervention to eliminate iodine deficiency. Taking into account increases in the proportion of dietary salt consumed through processed foods, and declines in salt consumed as household salt, iodized salt should be used in the production of processed foods as a means of assuring optimal iodine nutrition without the risk of affecting the organoleptic properties of foods.

Iodine Intake through Processed Food: Case Studies from Egypt, Indonesia, the Philippines, the Russian Federation and Ukraine, 2010-2015.

The current performance indicator for universal salt iodisation (USI) is the percentage of households using adequately iodised salt. However, the proportion of dietary salt from household salt is decreasing with the increase in consumption of processed foods and condiments globally. This paper reports on case studies supported by the Global Alliance for Improved Nutrition (GAIN)-UNICEF USI Partnership Project to investigate processed food industry use of adequately iodised salt in contrasting national contexts. Studies were conducted in Egypt, Indonesia, the Philippines, the Russian Federation, and Ukraine. In all cases, the potential iodine intake from iodised salt in selected food products was modelled according to the formula: quantity of salt per unit of food product × minimum regulated iodine level of salt at production × average daily per capita consumption of the product. The percent of adult recommended nutrient intake for iodine potentially provided by the average daily intake of bread and frequently consumed foods and condiments was from 10% to 80% at the individual product level. The potential contribution to iodine intake from the use of iodised salt in the processed food industry is of growing significance. National USI strategies should encourage co-operative industry engagement and include regulatory monitoring of iodised salt use in the food industry in order to achieve optimal population iodine status.

Piloting a Commercial Model for Fortified Rice: Lessons Learned From Brazil.

BACKGROUND: Two billion people worldwide have micronutrient deficiencies. Food fortification is a proven intervention to increase essential micronutrient availability in diets without requiring consumer behavioral change. Fortification of rice has high potential reach; however, cost, technology, market, and cultural constraints have prevented its wider adoption. OBJECTIVE: From 2010 to 2014, PATH and Global Alliance for Improved Nutrition implemented a pilot project in Brazil testing a model to scale up rice fortification through commercial channels. The project focused on 5 areas: (1) building fortified rice kernel production capacity; (2) supply chain development; (3) distribution channel and market development; (4) demand generation; and (5) advocacy and knowledge dissemination. METHODS: Primary data were collected in 2 rounds of quantitative research 6 months apart and conducted in 2 regions in Brazil. Secondary data were sourced from published literature, socioeconomic and demographic data, and sales figures from the project's rice miller partner. Postmortem analysis was conducted by the project team with input from external sources. RESULTS: Although the project successfully launched a fortified rice product and a category brand platform, it was unsuccessful in reaching meaningful scale. Market and industry dynamics affected producers' willingness to launch new fortified products. Consumers' strong attachment to rice combined with a weak understanding of micronutrient malnutrition hampered demand creation efforts. CONCLUSION: This project showed that a purely commercial approach is insufficient for sustainable scale-up of fortified rice to achieve public health goals in a 3- to 5-year period.

Public and Private Sector Dynamics in Scaling Up Rice Fortification: The Colombian Experience and its Lessons.

BACKGROUND: Fortification of cereal grains with at least iron or folic acid is legislated in 85 countries worldwide. Relative to wheat and maize flour, rice fortification is relatively new and provides an opportunity to deliver essential micronutrients to populations that consume rice as a dietary staple. OBJECTIVE: To describe miller and public sector experiences and perspectives on rice fortification with micronutrients in Colombia and offer recommendations for policy makers. METHODS: Interviews with Colombian rice millers, research and development personnel, and public sector leaders; desk review of key documents. RESULTS: In Colombia, rice fortified with micronutrients is market driven and a few very large rice millers, currently representing about 35% of the market, have voluntarily fortified rice since 2002. The technology used (spraying) is unique to Colombia and to date there is no independent verification of nutrient retention after washing and cooking rice fortified through this technology. Millers are unwilling to switch to more proven methods, such as extrusion or coating, which will incur higher capital investment and recurring costs. Despite interest from multiple stakeholders between 2002 and 2011, mandatory rice fortification is not part of the Colombian government policy as of July 2015. CONCLUSION: Rice fortified with micronutrients through spraying technology has achieved moderate coverage in Colombia, but the technology is unproven, its effectiveness unknown, and public health impact likely limited. For rice fortification to be an effective nutrition intervention to improve micronutrient status, policy makers should explore standards to guide industry and improvements to regulatory capacity.

saltPAD: A New Analytical Tool for Monitoring Salt Iodization in Low Resource Settings.

We created a paper test card that measures a common iodizing agent, iodate, in salt. To test the analytical metrics, usability, and robustness of the paper test card when it is used in low resource settings, the South African Medical Research Council and GroundWork performed independent validation studies of the device. The accuracy and precision metrics from both studies were comparable. In the SAMRC study, more than 90% of the test results (n=1704) were correctly classified as corresponding to adequately or inadequately iodized salt. The cards are suitable for market and household surveys to determine whether salt is adequately iodized. Further development of the cards will improve their utility for monitoring salt iodization during production.

Micronutrient Deficiency Control in Vietnam from Policy and Research to Implementation: Keys for Success, Challenges and Lessons Learned.

Micronutrient deficiencies are still a public health problem in Vietnam. The Government of Vietnam has taken several steps to improve the situation through issuing supportive policy documents over the last several decades. Food fortification is an important complementary strategy to help bridge the nutrient gap in the population. Currently technical regulations are in place and food fortification is taking place on a voluntary basis, along with other complementary targeted programs including home fortification of complementary foods with micronutrient powders and a communications campaign to reach adolescent girls. These have been built on innotative partnerships with industries on a voluntary, market basis. Other innovative targeted nutrition programs are also being piloted, including a micronutrient supplement project in four provinces and a campain to reach adolescent girls through sports. High level political commitment and resources is a crucial element to scale up in Vietnam. A micronutrient survey planned in 2015 will help provide the evidence to support a possible mandatory decree on food fortification. Vietnam has built a solid foundation in order to scale up its national food fortification program in the future to reach the majority of the population with improved intakes of iron, vitamin A, zinc, and iodine.

Evidence of the effectiveness of flour fortification programs on iron status and anemia: a systematic review.

CONTEXT: More than 80 countries fortify flour, yet the public health impact of this intervention on iron and anemia outcomes has not been reviewed. OBJECTIVE: The objective of this systematic review was to review published and gray literature pertaining to the impact of flour fortification on iron and anemia. DATA SOURCES: A systematic review was conducted by searching 17 databases and appealing for unpublished reports, yielding 1881 documents. STUDY SELECTION: Only studies of government-supported, widely implemented fortification programs in which anemia or iron status was measured prior to and ≥12 months after initiation of fortification were included. DATA EXTRACTION: Details about the design, coverage, compliance with national standards, and evaluation (e.g., anemia prevalence before and after fortification) of flour fortification programs were extracted from the reports. DATA SYNTHESIS: Thirteen studies describing 26 subgroups (n = 14 for children ≤15 y, n = 12 for women of reproductive age) were included. During the period from pre- to postfortification (and as difference-in-difference for those studies that included a control group), there were statistically significant decreases in the prevalence of anemia in 4 of 13 subgroups of children and in 4 of 12 subgroups of women of reproductive age as well as significant decreases in the prevalence of low ferritin in 1 of 6 subgroups of children and in 3 of 3 subgroups of women of reproductive age. CONCLUSIONS: . Evidence of the effectiveness of flour fortification for reducing the prevalence of anemia is limited; however, evidence of effectiveness for reducing the prevalence of low ferritin in women is more consistent.

Estimation of population iodine intake from iodized salt consumed through bouillon seasoning in Senegal.

Universal salt iodization (USI) is the main global strategy to eliminate iodine deficiency. Regulation of USI programs often omits salt used in processed foods, despite their increasing contribution to salt intake. In West Africa, bouillon seasoning is a widely consumed source of salt and is therefore relevant to USI effectiveness. To develop program guidance around iodine in bouillon, iodine retention in 13 bouillon brands commercially available in Senegal was measured over 6 months. Iodine content was measured in broth using various water volumes and cooking times, as well as in rice cooked in the broth. Average iodine loss in bouillon over 6 months in 95% humidity at 40-40.5 °C was 4.5% (13.6% for cubes and 0.8% for powder sachets). Iodine was retained in broth with cooking times of up to an hour and in rice cooked in broth. Modeling of contribution to iodine intake revealed that bouillon is an important source of dietary iodine in Senegal. Results may inform salt iodization standards and regulation in Senegal and countries with similar bouillon consumption levels.

The growing importance of staple foods and condiments used as ingredients in the food industry and implications for large-scale food fortification programs in Southeast Asia.

BACKGROUND: Food fortification is a viable strategy to improve the nutritional status of populations. In Southeast Asia, recent growth and consolidation of the food industry provides an opportunity to explore whether certain widely consumed processed foods could contribute to micronutrient status if they are made with adequately fortified staples and condiments. OBJECTIVE: To estimate the potential contribution certain processed foods can make to micronutrient intake in Southeast Asia if they are made with fortified staples and condiments; e.g., via the inclusion of iodized salt in various processed foods in the Philippines, fortified wheat flour in instant noodles in Indonesia, and fortified vegetable oil in biscuits in Vietnam. METHODS: For Indonesia, the Philippines, and Vietnam, a review of consumption trends, relevant policies, and industry practices was conducted using publicly available sources,food industry market data and research reports, and oral communication. These informed the estimates of the proportion of the Recommended Nutrient Intake (RNI) that could be delivered via select processed foods. RESULTS: In the Philippines, Indonesia, and Vietnam, the processed food industry is not always required to use fortified staples and condiments. In the Philippines, dried salted fish with iodized salt would provide 64% to 85% of the iodine RNI for women of reproductive age and 107% to 141% of the iodine RNI for children 1 to 6 years of age. In Indonesia, a 75-g pack of instant noodles (a highly consumed product) with fortified wheat flour would provide 45% to 51% of the iron RNI for children 4 to 6 years of age and 10% to 11% of the iron RNI for women of reproductive age. In Vietnam, biscuits containing vegetable oil are increasingly popular. One 35-g biscuit serving with fortified vegetable oil would provide 13% to 18% of the vitamin A RNI for children 4 to 6 years of age and 12% to 17% of the vitamin A RNI for women of reproductive age. CONCLUSIONS: Ensuring that fortified staples and condiments such as flour, salt, and vegetable oil are used in widely consumed processed foods would ensure that these foods contribute to improvement in micronutrient intake among populations in Southeast Asia, particularly as the consumption of these foods is increasing. Policymakers and nutrition program managers should consider the contribution to nutritional intake that fortified staples and condiments can provide through processed foods, in addition to being used for cooking in the home, and ensure that the food industry is required to use these fortified staples and condiments rather than nonfortified foods.

Processed foods as an integral part of universal salt iodization programs: a review of global experience and analyses of Bangladesh and Pakistan.

BACKGROUND: Despite the reference to salt for food processing in the original definition of universal salt iodization (USI), national USI programs often do not explicitly address food industry salt. This may affect program impact and sustainability, given the increasing consumption of processed foods in developing countries. OBJECTIVE: To review experience of the use of iodized salt in the food industry globally, and analyze the market context in Bangladesh and Pakistan to test whether this experience may be applicable to inform improved national USI programming in developing countries. METHODS: A review of relevant international experience was undertaken. In Bangladesh and Pakistan, local rural market surveys were carried out. In Bangladesh, structured face-to-face interviews with bakers and indepth interviews with processed food wholesalers and retailers were conducted. In Pakistan, face-to-face structured interviews were conducted with food retailers and food labels were checked. RESULTS: Experience from industrialized countries reveals impact resulting from the use of iodized salt in the food industry. In Bangladesh and Pakistan, bread, biscuits, and snacks containing salt are increasingly available in rural areas. In Bangladesh, the majority of bakers surveyed claimed to use iodized salt. In Pakistan, 6 of 362 unique product labels listed iodized salt. CONCLUSIONS: Successful experience from developed countries needs to be adapted to the developing country context. The increasing availability of processed foods in rural Bangladesh and Pakistan provides an opportunity to increase iodine intake. However, the impact of this intervention remains to be quantified. To develop better national USI programs, further data are required on processed food consumption across population groups, iodine contents of food products, and the contribution of processed foods to iodine nutrition.