Innovations in Food Fortification and Supplementation

Micronutrient deficiencies (a lack of critical vitamins and minerals) afflicts more than two billion people globally (FAO 2015).  Children from 6 — 24 months old are acutely susceptible to the harmful effects of micronutrient deficiency resulting in serious physical and cognitive consequences.  Decades of foundational research funded by USDA, USAID and the National Institutes of Health has supported innovations to improve nutrition via food fortification and micronutrient supplementation.  Continuing investment by USAID, the Bill & Melinda Gates Foundation and other donors seeks to fill the evidence gap to support scaling of the most promising innovations and approaches. In this independent dialogue, two topics of continuing innovation were presented by experts.

• Small Quantity Lipid-Based Nutrient Supplementation (SQ- LNS): Experts reviewed a meta-analysis of SQ-LNS trials around the world, presenting evidence for the relative risk reduction in mortality and lower prevalence of stunting, wasting and other indicators of poor growth from interventions among children aged 6 to 24 months. Experts highlighted continuing gaps in evidence that need to be filled in order to scale SQ-LNS.
• Micronutrient Fortification of Bouillon Cubes: Case Studies from Ghana, Cameroon and Haiti: Experts discussed research and projects underway using bouillon cubes as a vehicle for industrial food fortification in multiple markets, highlighting successes and continuing gaps in evidence.

The economic and policy implications for the LNS and bouillon fortification programs are reviewed in the final expert presentation. This presentation includes review of an economic optimization model that compares the relative cost-effectiveness of alternative micronutrient intervention programs to find the most cost-effective set of intervention programs at the national level; report summary measures of nutritional benefits; and reports costs and cost savings across alternative sets of interventions.

Expert discussants posed a number of questions comparing food fortification interventions with other approaches to nutritional improvement along various dimensions including: affordability (in comparison to high cost animal-sourced foods); relative demands for behavioral change at the individual or household level; and other implementation challenges.  Experts stressed also the fundamental role of in-country collaboration and policy engagement, without which neither the necessary scientific research nor effective program delivery are possible.

Expert Panelists: The session was moderated by Gerald Shively (Purdue University, USA). Presenters were Seth Adu-Afarwuah (Univ. of Ghana, Ghana); Robert Bertram (USAID, USA); Reina Engle-Stone (UC Davis, USA); Christine  Stewart (UC Davis, USA) and Stephen Vosti (UC Davis, USA).  Additional experts were Elodie Becquey (IFPRI, Senegal); Kathryn Dewey (UC Davis, USA); Kendra Byrd (World Fish Center, Malaysia); Kimberly Ryan Wessells (UC Davis, USA); Lynn Brown (IFPRI, USA); Mark Manary (Washington Univ. in St. Louis, USA); Mduduzi Mbuya (GAIN, USA).