Venkatesh Mannar - Academia.edu (original) (raw)

Papers by Venkatesh Mannar

Journal of Nutrition, Jul 1, 2021

This paper reviews the factors governing the addition of iron along with iodine in salt, and the ... more This paper reviews the factors governing the addition of iron along with iodine in salt, and the conditions under which the micronutrients remain stable and efficacious with storage and use of salt during cooking. The criteria for assessment include organoleptic changes, iodine and iron stability, and consumer acceptability based on changes to color/taste of food that is prepared with the fortified salt. Double-fortifed salt (DFS) has been provided to some 100 million people, and it has become critical to establish the barriers to full acceptability of this technology. The paper identifies 4 key factors that have an impact on organoleptic and nutrient retention outcomes in DFS: iodine stability and interaction with iron, salt purity, the effect of stabilizers, and the fortification technology used. We can conclude based on different studies on DFS, including outcomes of the studies which were field-tested, a high-quality coating and physical barrier between iron and iodine will significantly affect the effectiveness and sensory attributes of the salt. However, a successful introduction of DFS must be accompanied by consumer education that explains the health benefits of iron and iodine intakes, notwithstanding the change in appearance of the salt and of food made with that salt.

Elsevier eBooks, 2018

Abstract In the first half of the 20th century, food fortification programs in Europe and the Uni... more Abstract In the first half of the 20th century, food fortification programs in Europe and the United States were highly successful in virtually eliminating micronutrient deficiency diseases such as goiter, cretinism, pellagra, rickets, and xerophthalmia which had caused high levels of morbidity and mortality particularly in children. This success gave the impetus to further fortify staple foods, including cereal flours, milk products, condiments, fats and oils in many other countries worldwide, the development of targeted fortified foods particularly for infants and young children, and the introduction of fortified manufactured foods such as breakfast cereals that are market driven as well as public health driven. The efficacy of these programs in improving intake and status of iodine, iron, folate, vitamin D, and vitamin A is proven. However widespread micronutrient deficiencies still occur particularly in low and middle-income countries. While large-scale fortification of staple foods is on the rise the overall coverage is still at a relatively low level. While the scientific and technical issues of fortification are well known, the implementation science for scaling up new national programs in low- and middle-income countries is still under development.

Food and Nutrition Bulletin, 1998

The purpose of this study was to assess the effect of humidity and packaging materials on the sta... more The purpose of this study was to assess the effect of humidity and packaging materials on the stability of iodine in typical salt samples from countries with tropical and subtropical climates, under controlled climatic conditions. Initially we examined eight samples. In the second phase we expanded the study to salts from 18 sources and attempted to correlate the observed stability with salt impurities naturally present in these samples. High humidity resulted in rapid loss of iodine from salt iodized with potassium iodate, ranging from 30% to 98% of the original iodine content. Solid low-density polyethylene packaging protected the iodine to a great extent. High losses were observed from woven high-density polyethylene bags, which are often the packaging material of choice in tropical countries. Impurities that provided moisture at the salt surface had the most deleterious effect. Although clear correlations were not obtained, the presence of reducing agents, hygroscopic compounds of magnesium, and so forth seemed to have the most adverse effects on the stability of iodine. Surprisingly, carbonates had little effect on stability over the range present in the samples. Packaging salt in low-density polyethylene bags, which provided a good moisture barrier, significantly reduced iodine losses, and in most cases the iodine content remained relatively stable for six months to a year. The findings from this study indicate that iodine can be highly unstable, and in order to ensure the effectiveness of local salt-iodization programmes, countries should determine iodine losses from local iodized salt under local conditions of production, climate, packaging, and storage.

Un milliard et demi de personnes environ, soit près du tiers de la population mondiale, vivent da... more Un milliard et demi de personnes environ, soit près du tiers de la population mondiale, vivent dans des regions oü sévit Ia carence en iode. Au nombre des consequences que peut avoir ce quil est convenu dappeler les troubles de la carence en iode (TCI), ii importe de mentionner: l'arriération mentale irreversible; le goitre; Ia défaillance reproductive; une mortalité infantile accrue; et la stagnation socio-économique. Pour toutes ces afflictions, ii suffirait d'introduire suffisamment diode dans le régime alimentaire des populations. En fait, il est genéralement admis que lélimination de la carence en iode est Pun des objectifs les plus faciles a atteindre parmi ceux que sest fixes pour Pan 2000 le Sommet mondial pour les enfants en 1990. Liodation du sel est le meilleur moyen de servir les populations qui souffrent de cette carence. II sagit d'une intervention physiologique, simple, pratique, et efficace. Le present ouvrage offre une breve introduction non technique a la production et a lutilisation du sel iodé. Les premieres sections brossent Ia toile de fond des TCI. Nous décrivons ensuite Ia production et liodation du sel, le contrôle de Ia qualité, la surveillance, et Ic marketing. Dautres chapitres traitent du role essentiel du sel iodé dans les plans nationaux pour lélimination des TCI. Ce document est destine aux producteurs et distributeurs de sel, aux fonctionnaires qui, au sein des secteurs industrie, commerce et sante, sont responsables des programmes de lutte contre Ia carence en iode, mais egalement aux organismes nationaux et internationaux pertinents, et enfin a tous les particuliers qui sintéressent 0 cette question de carence et de prevention. Une de ce manuel a présentée a lAtelier international de formation des consultants en matière de sel qui sest tenu au Centre de conferences de Papendal, aux Pays-Bas, en juin 1994. Nous avons bien profité des suggestions recues des participants, notamment de M. Pan 0. Varghese, M. S. Sundaresan et M. S. Mukerjee. Nous remercions nos collègues du Conseil international pour Ia lutte contre les troubles de Ia carence en iode (ICCIDD), du Fonds des Nations unies pour lenfance (UNICEF), de lOrganisation mondiale de Ia sante (OMS), et de lInitiative pour les micronutriments, qui nous ont prodigué conseils et soutien dans Ic cadre de cc projet. Nous avons une dette particulière a

The American Journal of Clinical Nutrition, Apr 1, 2007

Background: Children participating in the Integrated Child Development Service (ICDS) in India ha... more Background: Children participating in the Integrated Child Development Service (ICDS) in India have high rates of iron and vitamin A deficiency. Objective: The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi, a rice and dal mixture, in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency, anemia, and vitamin A deficiency. Design: This cluster, randomized, double-blind, controlled trial was initiated in 30 Anganwadi centers (daycare centers) in West Bengal state, India. Children aged 36-66 mo (n ҃ 516) attending villagebased ICDS centers were randomly assigned to receive either a fortified or a nonfortified premix for 24 wk. Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin, serum ferritin, and serum retinol. Results: The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups (P 0.001). Prevalence rates of anemia, iron deficiency, and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group (P 0.001). There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified-and nonfortified-khichdi groups. Conclusion: A premix fortified with iron, vitamin A, and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia.

Food and Nutrition Bulletin, 1999

An assessment of the severity of iodine-deficiency disorders and of the iodized salt programme in... more An assessment of the severity of iodine-deficiency disorders and of the iodized salt programme in Laos was undertaken in 1996 through a field study among 957 schoolchildren in seven schools of different regions in Laos. Urinary iodine concentrations in 225 samples were remarkably lower in schools from the north than in those from the south, a finding similar to that from a national survey in 1993. However, in 1996 the median concentrations of urinary iodine were much higher than in 1993: 85 versus 5 µg/L in the northern sites and 195 versus 22 µg/L in the southern sites. The prevalence of consumption of iodized salt, introduced only six months to one year before, had increased from 69% to 91%, levels that could explain the nearly normal and normal urinary iodine concentrations. The wide range of mild to very severe iodine-deficiency disorders found by palpation of goitre most likely reflected a delay in the regression of the thyroid gland due to the rather recent introduction of iodized salt and due to the varying severity of iodinedeficiency disorders in the different sites before the start

Deficiencies in three micronutrientsiodine, iron, and vitamin Aare widespread affecting more than... more Deficiencies in three micronutrientsiodine, iron, and vitamin Aare widespread affecting more than a third of the world's population. Individuals and families suffer serious consequences including learning disabilities, impaired work capacity, illness, and death. They could waste as much as 5°Io of gross domestic product (GDP). Addressing them comprehensively, using an array of low-cost solutions, could cost less than 0.3°Io of GDP. In the words of the World Bank in its recent publication "Enriching lives"".. . No other technology offers as large an opportunity to improve lives. .. at such low cost and in such a short time Many national governments at the World Summit for Children set the target to eliminate deficiencies in micronutrients in populations throughout the world by the year 2000. The basic objective of all national micronutrient programs is to ensure that needed micronutrients are available and consumed in adequate amounts by vulnerable populations. Strategies should be appropriate to the need and should use existing delivery systems and available technologies where they serve that need. A combination of interventions involving the promotion of breastfeeding, dietary modification (e.g., improving food availability and increasing food consumption), food fortification, and supplementation may need to be emphasized and implemented. The fortification of commonly eaten foods with micronutrients is one of the main strategies that can be used to improve micronutrient status. Fortification should be viewed as part of a range of measures that influence the quality of food including improved agricultural practices, improved food processing and storage, and improved consumer education to adopt good food preparation practices. Today, in deveJoped countries where there is a high dependence on processed foods and industries are streamlined and automated, food fortification has played a major role in the health of these populations over the last 40 years, and several nutritional deficiencies have been eliminated. In the developing countries too, fortification is increasingly recognized as a measure to improve the micronutrient status of large populations. When fortification is imposed on existing food patterns, it may not necessitate changes in the customary diet of the population and will not call for individual compliance. Thus, fortification can often be implemented and sustained over a long period. It can, therefore, be the most cost-effective means of overcoming micronutrient malnutrition. The food industry is playing an increasingly critical and complex role throughout the world. In the developed countries, changes in living and marketplace patterns have stimulated changes in food industry practices, resulting in a diversity of food-processing technologies and ever-changing numbers and types of foods on the market shelves. As the food industry is increasingly driven by market forces into the global marketplace it is faced with a significantly different scenario. In marked contrast to the developed world, most developing countries are grappling with fundamental issues of providing adequate food supplies to feed their expanding populations. Simple nutritional and technological solutions to the problems of micronutrient malnutrition exist but are often complicated by economic, social, and political factors. Intervention strategies must take these factors into account. This is the challenge, as well as the opportunity, for the food industry to play a key role in improving the physical, social, and economic well-being of billions of people. This manual has been prepared to facilitate and encourage large-scale implementation of fortification programs in countries where micronutrient malnutrition is prevalent. It responds to a long-felt need for a comprehensive documentation of technologies and opportunities for fortification. Given that technologies are in different stages of development and application, an attempt is also made to review critically the status of these technologies and identify the steps involved in refining them for large-scale application. In addition, the manual appraises their technological feasibility, practicability, cost effectiveness, and consumer acceptability. An annotated bibliography on food fortification, containing more than 500 references with abstracts, including the references mentioned in this manual, will be published as a companion volume. It is hoped that this manual will be a useful reference for national micronutrient program managers and food Micronutrient Fortification of Foods vii industry managers to plan and expand food fortification as a long-term and sustainable solution to the global problem of micronutrient malnutrition. This document is a product of a unique collaboration between the International Agricultural Centre (IAC) in the Netherlands and the Micronutrient Initiative (Ml) in Canada. It has also evolved out of experience gained in organizing the short-term training course in food fortification at the IAC. The authors are grateful to Ms i. Cervinskas (Ml), and Ms F. de Boer (IAC) for overall technical review of the document.

Food Fortification in a Globalized World, 2018

Abstract Micronutrient deficiencies in industrialized countries are being controlled effectively ... more Abstract Micronutrient deficiencies in industrialized countries are being controlled effectively by food fortification but deficiencies are still widespread in many low- and middle-income countries (LMIC). The introduction of national fortification programs in many LMIC has become a major strategy to combat deficiencies that negatively effect health. Most of the basic science and technologies exist to effectively fortify staple cereals, edible oils, condiments, and a range of voluntary fortified manufactured food products. The successful programs with iodized salt, folic acid-fortified cereals, and vitamin D-fortified dairy foods that have markedly improved the health of consumers are being consolidated and extended. The same beneficial impact on health is now expected for the iron, zinc, vitamin A, and vitamin B12 fortification programs that are in place or being established. To ensure the successful consolidation and expansion of fortification programs, a multisectoral approach is needed. The public sector has recognized the need to engage and stimulate the private sector to contribute to the public good and, in LMICs, governments, development agencies, nonprofit organizations and the private sector are now collaborating through public–private partnerships to scale up programs and increase funding. It may be additionally necessary to find points of integration between fortification programs and biofortification programs, infection control, improved hygiene, and better sanitation while carefully monitoring changes in micronutrient malnutrition caused by rapid urbanization, changing lifestyles, globalization, and climate change. Additionally, clear communication on health benefits is needed to create and maintain consumer demand. The safety of adding micronutrients to the food supply will also remain an important consideration. Consumer demand depends on the demonstration of a positive health impact with little potential risk. National fortification programs should thus be well controlled to achieve health benefits while avoiding excessive intakes, especially if micronutrient supplementation is also practiced and fortified manufactured foods are available. Optimizing food fortification for impact moving forward will be facilitated by improved accuracy of micronutrient intake and status data at the national level, a continued extension of the scientific and technical base, and overcoming the current bottlenecks in LMICs that include targeted advocacy to build new programs, improved regulatory monitoring, additional resources, increased transparency and accountability, and more evidence of impact.

The Journal of Nutrition, 2021

ABSTRACTBackgroundThe alleviation of iron deficiency through iron supplementation has not effecti... more ABSTRACTBackgroundThe alleviation of iron deficiency through iron supplementation has not effectively reduced anemia in India, mainly due to low compliance. Food fortification with iron is considered a viable alternative, and the provision of double-fortified salt (DFS; with iron and iodine) has been mandated in public health programs. Limited evidence exists on its benefit–cost ratio.ObjectiveIn this study we sought to estimate the economic benefit in terms of increased wages in relation to introduction of DFS in reduction of anemia and the cost of doing so.MethodsThe economic benefit of introducing DFS in India was derived using a series of mathematical, statistical, and econometric models using data from national surveys capturing earnings and dietary iron intake of the population. Anemia status was predicted from data on dietary intake, sanitation, and for women, menstrual losses. The impact of iron deficiency anemia (IDA) on wages was estimated using a Heckman Selection model a...

The Journal of Nutrition, 1993

Participants in a November 1991 workshop concluded that coordinated strategies for controlling ma... more Participants in a November 1991 workshop concluded that coordinated strategies for controlling malnutrition due to iodine, iron, vitamin A and other micronutrients deficiencies are technically feasible and should be given consideration in planning control efforts. Coordinated surveys involving clinical, biochemical and dietary assessment of multiple micronutrients are feasible. Multiple fortification is also possible using such vehicles as salt, processed rice or sugar. Supplementation efforts can be integrated with existing health care programs. Food-based strategies are also effective. The best examples have been community-based and have included a strong nutrition and health education component designed to change food consumption patterns, improve food preservation and preparation practices, and link income-generating activities with food production activities. Successful coordinated efforts will require a strong political commitment and a supportive infrastructure. Specific recommendations include the formation of national coordinating bodies for micronutrient deficiency control, establishment of a micronutrient information network and expansion of technical exchange and training.

Maternal & Child Nutrition, 2021

Double fortified salt (DFS) has proven efficacy in addressing iron deficiency and anaemia, thus i... more Double fortified salt (DFS) has proven efficacy in addressing iron deficiency and anaemia, thus improving maternal and child nutrition outcomes. However, DFS delivery in large‐scale settings is less understood, with limited documentation of its fidelity of implementation (FOI). We assessed the FOI of the DFS intervention in Uttar Pradesh, India, to improve the design and implementation of such programmes that aim to reduce the anaemia burden, especially in women of reproductive age (WRA). We conducted in‐depth interviews with DFS programme staff (n = 25) and end‐user WRAs (23), guided by a programme impact pathway. We transcribed and thematically analysed the interviews and used an adapted analytic framework to document FOI across four domains—objects of intervention, implementation staff, implementation context and target of implementation. DFS utilisation remained low due to a combination of factors including poor product quality, distribution challenges, ineffective promotion and...