On April 8, this year, the cabinet approved a scheme to supply fortified rice kernels (FRKs) through Public Distribution System (PDS) shops, Anganwadi centres and schools. In the first phase, rice in mid-day meals, renamed as PM-Poshan 2.0, served to pre-primary children and students of Classes I to VIII in government and government-aided schools, was to be replaced with FRKs by March-end this year. In the second phase, FRKs were to replace rice in rations given under the Targeted Public Distribution Scheme (TPDS) and other welfare schemes by March 2023 in 291 districts with a high burden of stunting—that is, height-to-age well below the World Health Organisation’s Child Growth Standards median. And in the third phase, rationed rice was to be replaced with FRKs across the country by March-end 2024.
FRK is rice reconstituted with micronutrients like iron, folic acid, and Vitamin B12. These micronutrients are mixed with ground rice and extruded under heat to form kernels of the same size and shape as normal rice. The Food Safety and Standards Authority of India (FSSAI) says one kg of FRKs can be blended with 50 to 200 kg of milled rice. There is no change in cooking procedure. Its website says children served with rice mixed with FRKs did not find it very different in taste, texture, colour, and smell from normal rice.
Another way of providing micronutrition is through biofortification or by breeding cereal and pulses crops with adequate levels of the desired nutrients. Last year, Prime Minister Narendra Modi “dedicated to the nation” 35 crop varieties with special traits that had already been released for cultivation. These included a pearl millet (bajra) variety and a hybrid with 42 parts per million (ppm) iron and 32 ppm zinc. The PM also flagged a quality protein maize (QPM) hybrid and a biofortified maize hybrid, both rich in provitamin A and amino acids like lysine and tryptophan. There were four wheat varieties as well, some or all of which were rich in protein, iron, and zinc.
Ashok Kumar Singh, a well-known rice breeder and director of the Indian Agricultural Research Institute (IARI), casts his vote for biofortified cereals. He says their nutrients are part of the food matrix, so the body readily absorbs them. He says the Indian Council of Agricultural Research (ICAR), of which the IARI is a part, has released 87 biofortified varieties and hybrids of 16 crops, of which wheat and rice have the biggest share. But the iron content in rice is lost during polishing because the nutrient is in the bran. So very little is available after milling. Singh says the IARI has identified a wild rice variety (or landrace) with 49 ppm zinc. The next step would be to identify the genes that control zinc production and transfer them to high-yielding varieties. As a short-term measure, however, Singh says, factory fortification is advisable to overcome stunting, wasting and anaemia.
WHAT IS RICE FORTIFICATION
Fortification is a process of artificially adding micronutrients to improve the nutritional value of rice. Micronutrients such as iron, zinc, folic acid, and vitamins are added to rice flour, which is then turned into kernels called Fortified Rice Kernel (FRK). These kernels are then blended with regular rice for cooking. It’s claimed that fortified rice is an easy way to address the problems of malnutrition and anaemia.
Biofortified cereals are poor yielding, says Deepak Pental, geneticist and former vice-chancellor of Delhi University. Pental led a team of scientists who developed a genetically modified mustard hybrid, which the regulators recommended in 2017 for cultivation but has not been allowed by the government. He says a lot of genes are involved in the production of zinc and iron. Improving the yield of high zinc and iron rice and wheat will take many years of breeding. The crops also get affected by the environment. Some soils are rich in the minerals, so their uptake will be better. It will be poor in depleted soils. “Industrial fortification is a much better idea,” he says.
Monica Garg, a scientist at the National Agri-Food Biotechnology Institute at Mohali, near Chandigarh, says grain yield is a major challenge in the anthocyanin-rich blue, purple, and black wheat she has developed. Anthocyanins are biologically active compounds that are considered nutraceutical agents for the protection they offer against metabolic syndromes like obesity, hypertension, diabetes, and high amounts of lipids in the bloodstream. Garg released the varieties for cultivation in 2018 after 10 years of research. She says the coloured wheat varieties are rich in antioxidants and have anti-inflammatory properties. But they are 20% lower yielding than white wheat. Rigorous breeding would be required to disrupt the linkages associated with traits contributed by landraces (wild wheat lines) to create lines with high anthocyanin content and satisfactory yield levels. This would take another 10 years of breeding, she said. Genome editing tools would not help because thousands of nucleotides are involved. These cannot be muted through gene editing.
Another way of providing micronutrition is through biofortification or by breeding cereal and pulses crops with adequate levels of the desired nutrients
NITI Aayog member Ramesh Chand says the market should compensate for the “yield penalty” of high-nutrient cereals by paying a premium. This was the idea behind the three farm laws, which the government repealed last November after more than a year of agitations by farmers. Those laws would have made Indian agriculture market-oriented. Private players would have differentiated cereals for their unique properties and marketed them.
Garg says FSSAI has approved her coloured wheat varieties as antioxidants. They are being grown by some farmers in Punjab and are being distributed by the women and child welfare department of the Chandigarh administration. But consumers are not aware of them, she says.
As biofortified rice is not available in adequate quantities, FRKs are the default option. The FSSAI says rice fortification is a cost-effective and culturally appropriate strategy to address micronutrient deficiency in India because it is consumed by 65% of the people. It says fortification increases the retail price by 40 paise to ₹1.30, depending on the nutrients added and logistics. Some branded rice sellers also market blended FRKs as Asbah Silver, Daawat Sehat Mogra and Sri Lohitha Nutri-rice. A brand of pure FRKs sells on Amazon.in for ₹399 per 300 grammes.
What is the evidence that fortified rice helps alleviate anaemia? The National Institute of Nutrition (NIN), Hyderabad says its study of pre-school children in the Anganwadi centres of 22 Telangana villages showed reduction of anaemia within six months accompanied by higher iron stores. This was a cluster-randomised, double-blind, placebo-controlled study. The children were fed a micronutrient formulation comprising iron, folic acid, B12, B2, zinc, Vitamins A and C which was blended with a food supplement being provided to them. This study was published in the institute’s 2015-16 annual report.
Another study of schoolchildren given iron fortified extruded rice kernels in a rice-based meal regularly for eight months improved the body’s iron stores and reduced iron deficiency significantly compared to those consuming natural rice. This was a 2006 study.
But food fortification is a short-term measure to relieve micronutrient deficiency in targeted groups, said Hemalatha R., director, NIN, in a phone interview to Tatsat Chronicle from Hyderabad. She said there is “no clear-cut evidence” that it works, because efficacy trials of fortified rice in real life have not been conducted. So the benefit is not fully understood. She said a diversified diet provides all necessary nutrients.
For a diverse diet, according to NIN guidelines, a woman indulging in moderate activity should eat 330 grammes of cereals a day, 90 grammes of pulses, 300 ml of milk and milk products, 200 grammes of roots and tubers, 100 grammes of green leafy vegetables, 200 grammes of other vegetables, 100 grammes of fruits, 30 grammes of sugar and 25 grammes of fat. Such a diet would not be affordable for those in the target groups.
The NIN director referred to the institute’s study of 2017-18 in Alair taluk of Nalgonda district. The inclusion of guava in meals provided to children aged two to five for 140 days in the Anganwadi centres of 16 villages significantly improved their iron status. The institute said this could be adopted as a strategy to address iron deficiency among children.
In an interview with the news agency PTI last September, Hemalatha said efficacy studies show that supervised feeding of iron fortified rice in school mid-day meals improved iron stores of children and reduced anaemia. But she also said that supervised feeding and deworming in the case of unfortified rice also improved haemoglobin levels and reduced anaemia.
Another study of schoolchildren given iron fortified extruded rice kernels in a rice-based meal regularly for eight months improved the body’s iron store
In the same interview she also said food fortification is considered to be “one of the practical approaches by policymakers and implementation agencies as it does not require behavioural modification, which is difficult to achieve across population groups”. It is obvious from this quote that food fortification does not have her unqualified endorsement. She said that FRKs do require behavioural change communication as they float when rice blended with them is washed.
According to the fifth National Family Health Survey conducted in 2019-20 and published in December 2020, 35.5% of children under five are stunted compared to 38.4% in 2015-16. There is a slight decrease in the share of children who are wasted (weight well below the mean for the age group). But anaemia among children aged six months to 59 months was widespread and had increased from 58.6% to 67.1% between the two surveys. Anaemia among all women between 15 and 49 years has also increased from 53% five years ago to 57%.
An opinion piece in the Indian Express last August questioned the rationale behind iron fortification. The authors of the piece, Anura Kurpad, professor of physiology and nutrition in St John’s Medical College, Bengaluru, and Harshpal Singh Sachdev, paediatrician and specialist in clinical epidemiology at Sitaram Bhartia Hospital, Delhi, said the iron density in the Indian vegetarian diet of about 9 mg per 1,000 kCal could meet most requirements. Mandatory iron fortification for the entire target population was not necessary. They said many other nutrients and non-diet factors, including the environment, are involved in preventing anaemia. If the iron present in Indian foods is not well-absorbed, it is unlikely that added iron will be taken in. The NIN has lowered an individual’s daily iron requirement by 30% to 40% in its 2020 recommendations from its 2010 guidelines after studies found that added iron in food increases the risk of toxicity.
The 2020 NIN Dietary Requirements acknowledge that anaemia is a serious public health problem affecting all segments of Indians. It admits that “despite supplementation programmes being in operation for decades, there has been no perceptible decrease in the prevalence of anaemia”. It further adds that the conventional wisdom is that iron deficiency in the diet is the main cause of anaemia in all age groups.
It quotes “recent analysis” which concludes that the risk of inadequate intake of iron is lower than previously thought. The analysis emphasised that simultaneous implementation of supplementation and fortification programmes could increase the risk of breaching the tolerable upper limit of 45 mg/day of iron. The NIN director referred to this as ‘layering’. It happens when a person who eats, say, FRKs also uses iron fortified salt in higher than recommended amounts.
To sum up, the benefits of rice fortification do not appear to be clear-cut.