ON FOOD fORTI - DOH Central Library - Department of Health

PREFACE·
The first ConsultativeMeeting with Food Manufacturers was conducted in 1993with
a principal concern: the promotion of food fortification among food manufacturers as a
strategy to eliminate micronutrient malnutrition in the country. This campaign against
HiddenHungerenjoyed the supportofPresidentFidel V.Ramos whoenjoined government
and non-government agencies, as well as private industry, towork together towards the
achievement of nutrition goals. .
In August 1993, another meeting was held with food manufacturers to generate
commitments on the fortification of their products. This was followed by a series of
meetings withspecialized groups,suchas salt producers (in April) and flour millers in July.
These efforts haveyielded positiveresults assome manufacturers ofjuice drinks, margarine,
noodles, and salt have positively responded to the call to fortify their products. However,
the potential for the involvement of food manufacturers in food fortification have not yet
been fully maximized. There is a need to reach out to more food manufacturers and make
them aware of their roles and available technologies in food fortification.
As an incentive to those food manufacturers who heed the call for food fortification.
government plans to confer the Sangkap Pinoy seal. The seal provides an assurance to
consumers that all products bearing this seal are fortified in accordance with established
standards.
The Second Consultative Meeting with Food Manufacturers washeld on June 8, 1995
at the Holiday Inn- Manila Pavilion Hotel as part of the.continuing advocacy for food
fortification. The objectives of this meeting were to:
• •
•
•
stimulate awareness about the importance offoodfortification amongfood manufacturers.
encourage food manufacturers tofortify their products with vitamin A, iron and iodine
encourage the use of iodized salt and other fortified materials of products in food
manufacturing .
discuss andarrive at the consensus on the proposed Sangkap Pinoy Seal Program
The meeting was attended by representatives from the government and nongovernment
agencies as well as from the private sector. The theme for this advocacy
meeting was: "Food Industry: Katulong sa Pagsulong", which further underscores the
importance of the industry as a contributor to the elimination of both overt and hidden
hunger in the country.

Preface
iv Programme
CONTENTS
1 Opening Remarks
Honorable Carmencita Noriega-Reodica
4 Opening Message
Mr. Keshab B. Ma.thema
7 National Nutrition Situationer
Ms. Elsa M. Bayani
14 State of the Art on Food Fortification
Dr. Chuan Kean Koh
18 Iron-Fortified Chocolate Drink
Dr. Haile Mehansho
22 Vitamin A Fortified Margarine (STAR)
Dr. Florentino S. Solon
24 Iron-Fortified Rice (FVRice)
Dr. Rodolfo F. Florentino
28 Iodine and Iron Fortified Fish Sauce and OtherCondiments
Mr. Hector Maglalang
32 The Partnership Between Government and Private
Food Sector in Micronutrient
Dr. Glen Maberl!(
35 The Sangkap Pinoy Seal
Ms. Adelisa Ramos
38 The Sangkap Pinoy Seal Program: A Primer
42 'Open Forum
48 Synthesis
Ms. AidaAguinaldo
50 Afterword
Ms. Adelisa Ramos
. 52 Closing Remarks
Mr. Vicente Lim
54 Participants
58 Working Committees,
III

PROGRAMME
8:00 Registration •
9:00 Opening Program
Invocation Ms. Iris Rowena A. Bernardo
Nutritionist Dietitian II
Nutrition Service, DOH
National Anthem Ms. Arlene A. Rebong
Officer-in-charge, NSD
National Nutrition Council
Opening Remarks Honorable Carmencita
Noriega-Reodica
Undersecretary for Public
Health Services, DOH
Opening Message Mr. Keshab B. Mathema
Representative, UNICEF
9:30 National Nutrition Situationer Ms. Elsa M. Bayani
Executive Director, NNC
and Yicc-Chairpereon, NMAT
10:00 State of the Art on Food Fortification Dr. Chuan Kean Koh
Area Technical Manager
Human Nutrition andHealth
Iron-Fortified Chocolate Drink
Roche, Hong Kong
-Dr.
Haile Mehansho
Research Scientist
The Procter and Gamble
Miami Valley Laboratories
Cincinnati, Ohio
Vitamin A Fortified Margarine Dr. Florentino S. Solon
(STAR) Executive Director
Nutrition Center of the Philippines
Member, NNC Governing Board

•
Iron Fortified Rice (FVRice)
.. Iodine and Iron Fortified Fish
Sauce and other Condiments
The Partnership Between
Government and Private
FoodSector in Micronutrient
12:30 LUNCH
1:30
2:30
Open Forum
The Sangkap Pinoy Seal
3:30 Open Forum
4:30
4:45
Synthesis
Closing Remarks
Dr. Rodolfo F. Florentino
Director, Food and Nutrition
Research instituteChairman,
NNC Technical Committee
Mr. Hector Maglalang
Fortification Consultant, DOH
Dr. Glen Maberly
Director, Program Against
Micronutrient Malnutrition
Rollins School of Public Health
Emory University,
Atlanta, Georgia, USA
Ms. Aida Aguinaldo
Supervising Science Research
Specialist, FNRI"DOST
Ms. Adelisa C. Ramos
Director, Nutrition Service,DOH
Member, NNC Technical Committee
Ms. Aida Aguinaldo
Supervising Science Research
Specialist, FNRI-DOST
Mr. Vicente Lim
President, Philippine Chamber
of Food Manufacturers
Emcee: Ms. Maria Lourdes A. Vega, NNC

A Report on Food Fortification
OPENING REMARKS
Honorable CARMENCITANORIEGA-REODICA
Undersecretary for Public Health Services
Department of Health
. .
In the Department of 'Health the
health of women, mothers and children
is a priority program.. For that reason
we have the Women's Health and Safe
Motherhood Program, as well as the Early
Child Development Program as two of
the major public health programs of the
DepartmentofHealth in the nexttenyears.
This wasalreadyapprovedby the cabinet.
We will soon launch the Women's Health
and Safe Motherhood Project and we are
. now developing the Early :Child
Honorable Undersecretary Reodica , "It is .high time
that we focus and consolidate our efforts to come
up with a long term and sustainable strategy such
as food fortificatIon, nutrition education, and diet
diversification".
Development Program. When we were
trying to conceptualize how the project
. should shape up - both the Women's
Health and the Early Child Development
Project - there was one common
denominator that kepton recurring: when
we were trying to pinpoint what really
is the majorhealth problem of women,
mothers and children.that constitutes the
basic underlying cause of all they are
suffering from, everybody was in
agreement that itreally was malnutrition,
protein-energy malnutrition, and ·of
COUl'6e, micronutrient malnutrition.
Therefore, these two projects will be very
heavy on these two components of
nutrition. As such, the department has
engaged in several short-term strategies
such as food supplementation, and
micronutrientsupplementation. Itis high
time that we focus and consolidate our
efforts to come up with a long-term and
sustainable strategy such as food
fortification, nutrition education-and diet
diversification.
1

2
We have taken major steps towards
food fortification. My good friend Mr-,
Johnny Khong Hun has helped us a lot
in the salt iodizahon program. We have
also metwith food manufacturers to ask
their help to fortify the products they sell
to the buying public. Food fortification
is really the basic strategy we mustadhere
to becausesupplementationwill notreally
solve the problem. Of course, our donor
agencies, especiallyUNICEF,have always
been with us, and beside us in this
undertaking.
While our department isa serviceoriented
organization, you in the private
sector, have to admit that you are on the
profit-oriented side. Buteven though you
are profit-oriented you also have service-
A Report on Food Fortification
orientationand social orientation because
in this way, your products will be more
salable. We can work together. We will
help you in advocacy, and you will help.
us in uplifting the nutritional status of
women, mothers and children, and you
will be helping the nation as a whole.
Why food fortification?:
We are taking the crucial step to reach
out to the food industry to work together
and share responsibility to pursue our
goal. This consultative meeting is a part
of a continuing dialogue between the
government and the private sector so that
we can forge a partnershipthatwill sustain
and improve the nutritional status of our
fellowmen. We encourage you therefore,
during this conference to give your views
and comments on the presentations of
our international and local experts which
we should consider both as a learning
process and an eye opener. We in
government, cannot solve the problems
alone, in the sameway thatyou, the private
sector cannot solve the problems of this
-country
alone. We need each other. So,
instead of the private sector asking: "what
Gin we do?" r maybe it's high time that
we should joinhandsand think andreflect
togetherso thatwe can solve theproblems
of our country, in terms of nutritional
status. We are not trying to solve the
5pratleys issue or the more controversial
issue of migrant workers. Let's justfocus

, on the Issue of improving the nutritional
status of the women, our mothers, and
ourchildren. InmymeetingwithSenator
Shahani yesterday, she was so much
interestedin the girl-child, the adolescent,
and the elderly; who have peculiar or
special nutritionalneeds. Youmight want
to consider this in your conference.
May this meeting usher in the
beginning of a fruitful and meaningful
collaboration that will bring about the
gains ofPhilippines2000. Yesterdayagain,
when they were using the term Philippines
2000, people were whispering to each
other, "Do you understand what
A Report on Food Fortification 3
Philippines 2000 is all about?". It is about
NIC or a Newly Industrialized Country;
about sustainable development, about
people empowerment. But how can we
'talk about' all this when we are not
nutritionally healthy, we don't have the
IQ points, we don't have bright'eyes; we
don't have the mental alertness and the
physical vigor to perform our jobs and
be productive. ' I'm sure you realize we
can contribute much to the realization
of-the goal of Philippines 2000. Finally,
I welcome you on behalf of the Secretary
ofHealth and thank you for joining us.
, I wish you luck.

4
Let me provide some information
about the background of this meeting.
In November 1990, 71 world leaders and
over 120government representatives met
iTI. New York to discuss the broad social
agenda for children with a set of goals
.to be achieved by year 2000. The
Philippines was represented in the
meeting, the first meeting that ever took
place in New York with such a number
of leaders. One of the main points of
the discussion was this whole .issue of
micronutrient malnutrition in the world,
a problem that has been there for a very
long rune, whichcauses mentalretardation
and poor health, low productivity, a low
educational capacity of students,
blindness, prenatal death, and a whole
lot of problems.
On the basis of this World Summit
for Children,each countrywhichattended
the occasion developed its own plan of
action for children. The Philippines,
developed its own Philippines Plan of
A Report on Food Fortification
OPENING MESSAGE
Mr. KESHAB B. MATHEMA
Representative, UNICEF
Action for Children (PPAC), which was
launched by then President Aquino, and
later endorsed by President 'Fidel V.
Ramos, with a timetable to achieve all
those social goals, about 27 of them, by
2000. Then, the government of the
Philippines decided thatsomeof the goals
perhaps could be advanced and met by
the end of 1995. Among those goals are:
Universal lodization of Salt, Elimination
of Iodine Deficiency Disorders, Vitamin
A .and iron deficiencies.
-The economy cost of the deficiencies
is enormous, and the social cost is even
greater. We have here among us very
well-known experts in the subject, so I
will notdeal on the subject here. Professor
Glen Maberly who comes from Emory
University in Atlanta, heads the Program
Against Micronutrient Malnutrition, and
we have of course Dr. Florentino Solon,
Mrs. Ramos from the Department ot'
Health, andmanyotherswhocan provide
you with the needed information.
We are very pleased indeed to forge
this new alliance with our new partners,

6
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Flavier and Dr. Florentino Solon, were
trying to develop a strategy to discuss
this issue with President Ramos when
he was about to launch the micronutrient
programin the country. Dr. Maberly came
up with his recent findings on the
community, that a child born to an iodine
deficient mother may lose as much as
13 IQ points. The economic and social
consequences were so incredible that we
devised a way to calculate these in terms
,.'of actual numbers. We came up with
the fact that Philippines was losing
A Report on Food Fortitication
something like seven and a half million
IQ points every year. If you' put these
in economic terms 'the harm .is really
enormous, . let alone the social costs.
I am pleased that all of you could
find time to come this morning to attend
this important day of briefing on
fortification. I wish you all the best and
on behalf of UNICEF and my colleagues
here, we want to extend our warm
greetings to all of you, and any support
we can give to this noble endeavor.
•

. The phrase "hidden hunger" has
become a buzzword in the nutrition
community. It refers to deficiencies in
essentialnutrientsnamelyvitaminA,iron
and iodine. The hunger is "hidden"
because symptoms of these deficiencies
are not readily visible until it is too late.
The consequences of deficiencies of these
nutrients are not immediate, but they are
extremely damaging to both the
individual and the nation as manifested
by reduced mental performanceandwork
productivity;physicaldisabilities; mental
retardation; and death; apart from the
untold suffering of affected families.
A Report on Food Fortification --,.....;,.-'-__7
HIDDEN HUNGER
- in the Philippines
Ms. ELSA M. BAYANI
Executive Director, National Nutrition Council
THE MAGNITUDE OF HIDDEN
HUNGER Ms. Elsa M. Bayani, "Iron deficiency anemia affects
28.9% of the population or about 19 million Filipinos".
Vitamin A Deficiency (VAD)
Vitamin A is essential for healthy
eyes, resistance to infection and illnesses,
and growth and development. It can
be found in plant and animal foods. In
plants, vitaminA ispresentas provitamin
A or beta-carotene. Thus, oil or fats are
needed to enhance the conversion and
absorption of vitamin A to a form which
can be used effectively by the body.
Vitamin A deficiency is determined
by notingchangesin the eyes, whichstarts
with the symptoms of nightblindness,
developing into more specific signs of
Bitot's spots and when the deficiency is
mostsevere, permanentblindness occurs.
The latest (1993) national nutritionsurvey,
shows that 0.1 percent of children, 6 mos
- 19 years of age, pregnant and lactating
women have corneal scars due to VAD.
While these figures seem to be low,
specific surveys done by the Department

8
A Report. on Food Fortification
Prevalence of clinical signs and symptoms of vitamin A deficiency' by
age group and physiologic state, Philippines, 1993
Age/Physiologic Total Nightblindness Bitot's Spot Comneal Corneal
Sfate Number Ulceration Scar
Examined
6 mos.- 6 years 5,049 0.4 0.1 0.1
7 - 14 years 4,578 1.3 0.1 0.1
15 - 19 years 1,593 1.1 0.2 0.2
.Pregnant 783 0.5 0.2 0.2
Lactating 1,053 1.0 0 0.3 0.4
TOTAL 13,056 0.8 0.1 n 0.1
Source: Fourth National Nutrition Survey, Philippines, 1993, DOST-FNRl
of Health and Helen Keller International
indicate that the problem is severe in farflung
rural and urban poor communities
as xerophthalmia was observed in 1 - 4
of every 100 pre-schoolers in these
communities. These are indicative of a
public health problem according to. the
standards of the WHO.
Iron Deficiency Anemia (IDA)
Iron is a mineral needed by the body
and is necessary for the formation of red
blood cells and is a carrier of oxygen
from the lungs to body tissues.
Iron deficiency anemia affects 28.9%
of the population or about 19 million
Filipinos. Most affected are infants, young.
.children, pregnant and lactating women,
women of child-bearing age, the early
adolescents, and the elderly. The
prevalence of IDA decreased to 37.2% in
1987;yet its magnitude cannotbe ignored
as millions continue to be affected. .
Iodine Deficiency
Iodine is a mineral component of
the thyroid hormones neededfor the brain
and the nervous system to develop and
- function normally. Iodine can be found
in water and food from the sea such as
fishes, shellfishes, and, seaweed, among
others.
Iodine. deficiency is. usually
determined through the prevalence of

. A Report' on Food Fortification
Prevalence of Iron deficiency anemia by age group and physiologic state,
Philippines, 1987 and 1993
Age/Physiologic
State
1987 1993 1987 1993 Decrease
6 mos. - < Iy 240 400 70.4 49.2 (21.2)**
1-6y 2,895 4,514 38.7 26.7 (12.0)**
7·12y 1,533 2,135 41.2 30.8 .(1004)**
13-19 y, male 688 834 26.3 20.0 (6.3)**
13-19 y, female@ 672 737 36.9 23.9 (13.0)**
20-59 v. male 1,727 2,125 21.3 12.7 (8.6)**
20-59 y, female@ 1,632 1,691 38.9 24.0 (14.9)**
60 years and above 536 1,067 46.9 45.6 (1.3)ns
Pregnant 274 782 45.2 43.6 (1.6)ns
Lactating 522 1,043 50.6 43'{) (7.6)**
Total 10,719 . 15,328 37.2 28.9 (8.3)**
Source: Fourth National Nutrition Survey, Philippines, 1993, DOST-FNRl
@ excluding pregnant and lactating
highly significant
ns not significant
--
goiter or enlargement of the base of the
neck. -Based on the latest surveyof the
FNRI, 6,9% of the population 7 years and
.older have goiter but females are more
affected than males. Furthermore, the
1993 prevalence is double the observed
prevalence of 3.5% in 1987,
There are some areas in the country
where the deficiency is more severe; so
severe that even animals have goiter and
that among humans, having goiter is
considered "normal"and "beautiful";and
not having it as "abnormal" and "ugly"
CAUSES OF HIDDEN HUNGER
Like protein-energy malnutrition,
hidden hunger is caused by a web of
interrelated factors.
1. Poor dietary practices; i.e, low intake
of foods rich in vitamin A, iron and
iodine
2.. Infections like paeumonia, measles,
diarrhea increase both the need and
use of vitamin A and iron
.:rhese direct or immediate causes
of hidden hunger are linked to other
underlying causes which, among others,
include low income coupled with
relativelyhighprices of foods andservices;
agriculture, trade and infrastructure
policies which affect production,
marketing, and distribution of foods rich
in vitamins and minerals; and investment
policies and priorities which determine
the allocation of funds to services.
9
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10.
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A Report on Food Fortification
Prevalence of goiter by sex, age, and physiological state, Philippines, .1993
Age/Sex/Physiologic State
Males
7-14 Y
15-20Y
. 21 Yand over
Females
. 7-14 Y
15-20Y
21 Yand over
Pregnant
13-20Y
21-49 Y
Lactating
13-20Y
21-49 Y
TOTAL
Total Subjects
2,383
994
4,244
Total with Goiter
0.7
3.1
1.5
2,195 4.5
841 15.2
3,666· 10.3
84 26.5
693 23.0 -'
76 24.2
962 18.1
16,138 6.9
Source: Fourth National Nutrition Survey, Philippines, 1993, DOST-FNRI
Even environmentaldegradationhas
serious implications on hidden hunger
as soil erosion brings with it the iodine
which is found in the topsoil.
CONSEQUENCES OF HIDDEN
fJUNGER
Hidden hunger results in various
degrees ofphysical andmental deformities
and abnormalities such as:
VitaminA Deficiency: blindness, increased
risk of infections which are often more
severe among those deficient in the
vitamin, increased risk of deaths among
women and children, and growth
retardation.
Iron Deficiency Anemia: poor growth,
sickness, poor school performance, more
low birth weight babies who face a higher
risk of getting sick, being malnourished
and even dying prematurely, more child
andmotherdeaths, low workproductivity.
Iodine Deficiency: results in a wide range
of physical and mental abnormalities .
which are collectively called iodine
deficiency disorders: growth retardation,
low learningability, increased risk of death
among children, pregnancy wastage as

12
o
with vitamins A and C, iron and
iodine. Fortification is the addition
of nutrients to food products which
are highly acceptable and widely
consumed, Intensified dialoguewith
the food manufacturingindustryhas
resulted in more and more food
companies becoming aware of the
importance (nutritional and
economic) ofthe threemicronutrients
and actually testing the market with
fortified food products.
Specific brands of margarine,
hot-dogs, noodles, chocolate drinks,
snack foods, and carbonated drinks
werefortified withbeta-caroteneand
iron; and fortification was used as
a marketing angle. Furthermore, a
salt producer has ventured into the
productionandmarketingofiodized
salt. Today, 14 salt iodization plants
are operating in various parts of the
countryandmanymoreare expected
to be operational before the end of
the year.
c. Dietary Modification
A Report on Food Fortification
Considered the bestandthe most
practical strategyto eliminatehidden
hunger permanently is for Filipinos
to develop good eating habits, i.e.
for each Filipino to eat a variety of
foods everyday;more vitaminA and
iron-rich foods as dark green leafy
vegetables, yellow and orange fruits
and vegetables; iodine-rich foods like
seaweedsandseafoods; increased fat
intake of young children to enhance
absorption of vitamin A; increased
vitamin C intake to enhance iron
absorption; iodized salt and other
fortified foods.
In additionto this, full and prolonged
breastfeeding is encouraged. So is the
improvedaccessandavailabilityofpotable
water to help prevent infections.
Educational and social marketing
programs are important in this regard.
d. Home food production
Growing fruits and vegetables
in horne, community, and school
_ gardens; andthe raising andgrowing
of small animals are encouraged to
increase the household supply of
foods rich in vitamins and minerals.
Of course translating all of these
strategies into action has required a lot
of advocacy work.

•
A Report on Food Fortification
CONCLUSION
13
Westill have a long way to"go before
we can be free from hunger; both overt
and hidden. With the help of the food
industry and other sectors; we will not
only be able to achieve.NfChood in the
economic sense; but also in the sense of
being a Nutritionally Improv"edCo{rntry.
We need to work together, so we
can achieve more. President Ramos says,
"Kung sama-sama, kayang-kaya"; our
rejoinder is "Let us. have UST; Unity
Solidarity, .and Teamwork.

14 A Report on Food Fortification
STATE OF THE ART IN FOOD FORTIFICATION
Dr. CHUAN KEAN KOH
Area Technical Manager
Human Nutrition and Health
Roche, Hong Kong
My talk is on food fortification and
the public health measures but Lwould
also addresssomeareas on the technology
side. As I go along, there will be some
questions on some aspect of technology
that we can address.
My presentation will cover food
fortification from a historical perspective,
andan overviewon the fortification status;
and micronutrientdeficiencies todayfrpm
the W,HO perspective. We would then
look at the health impact of vitamin
intervention. Since time is limited, I will
talk mainly on food fortification, taking
a look at its cost-benefits.
Now the historical perspective. At
the turn of the century, developed
countries realized that they had some
micronutrientdeficiencies so that,starting
in 1923, in Switzerland, table salt was
iodized. This was followed in the United
Kingdom,in the UnitedStates (fortification
of milk with vitamin B) and in 1930 in
Denmarkwhenmargarinewas introduced
as a substitute for butter and was
Dr, C/;uan Kean Koh. "As societies become more
developed. the food industries playa more prominent
role in providing nutritious foods to the population".
standardized with vitamin Band
eventually with vitamin.A as well. So
in the early years, fortification started in
many of these countries where
micronutrient deficiencies were not
expected. Just before the second world
war, flour and bread, as well as com meal
were fortified with a series of B-vitamins
in the US.In 1974, startingin Latin America
sugar was fortified with vitamin A. This

t
started in Guatemala, followed by
Honduras and El Salvador. In Canada,
in 1943, flour was enriched with a series
of B-vitamins and iron and calcium, and
margarine was also fortified withvitamin
A. Whatwerethe resultsor thenutritional
impact of fortification? In 1944, some
clinical indicators of deficiencies'showed
an improvement, after the introduction
in 1943 and 1945 of the fortification of
flour and margarine. By 1948;percentage
.changes were seen as a result of vitamin
A supplementation as well. We can see,
anoverall improvement,basedon clinical
findings, after the population had been
given fortified foods. Thus, there is, in
a sense, a healthbenefitwhencertaintypes
of foods are fortified and this benefit can
be measured to ·show the contribution
of fortified foods to the h;aith of the
population. In America, prior to 1938,
before-the enrichment of bread and flour,
there was quite a high incidence of
pellagra, which is a deficiency of vitamin
B3, or niacin.
-..When fortification started in 1938,
,the,incidence due to pellagra dropped.
By 1943, enrichment wasmaridated in
particular states facing the problem and
there followed a drop in the' incidence
of pellagra. By 1948,22 states in America
decided to have mandatory enrichment
. of flours and bread with B-complex
A Report on Food Fortification 15
vitaminsand iron. In thePhilippines,way
back in 1947, there was an increased
prevalence of beriberi due to a deficiency'
of B1 because of the intake of polished
rice. You lose the nutrients here, because,
the nutrients are in the outer coating' of
the rice, so that there was quite a high
incidence of beriberi for some 100,000 of
the population. When rice was fortified,
'mortality due to beriberi dropped.
In 1992, in Rome, representatives
from manycountriesattended ajoinfFAD­
WHONutritiorialMeetingontheproblem
of Hidden Hunger.' From statistics on
vitaminAdeficiency alone, 70to 80million
children and women were afflicted and
mortalityamongchildrenwasin the region
of 300,000 per year. In the case of iron
deficiency, about 1 million children and
women were affected. Iron deficiency
increased the risk of premature birth and
maternal' death. Thus, in the meeting,
participants agreed that by the year 2000
deficiency in vitamin 'A and iron must
be eliminated. In the case of iodine, about
a billion people in the world suffer from
its -lack. In addition to these
micronutrients, the meeting stressed the
importance of B-complex vitamins,
calcium and zinc.
What are the health consequences
,of iron deficiencies? Anemia causes
lethargy, decreased' working capacity,
increased fetal-maternal deaths, impaired
,immuneresponse, arid, impairedlearning
ability. For iodine deficiency,
consequencesare hypothyroidism" goiter,

16
cretinism, irreversible brain damage,
mental retardation. Inthe case of vitamin
A deficiency, the main symptom is
nutritionalblindnessand anemia, because
basically, deficiency in vitaminAcan result
in iron deficiency as well. Vitamin A
deficiency can also cause an impaired
immune response as well as measles,
diarrheal diseases and high infant
mortality. These are based on quite recent
reports from many parts of the world.
Wha t about the health consequences
of B-vitamin complex deficiencies? Let's
start with the relative risk here: anemia.
We all know that the folate, B12 and B2
are essential. Vitamin C has also helped
in the absorption of iron if taken with
vitamin A.
On infectious diseases, B6 helps in
improving the immune function, in
addition to vitamins C and E. Folate or
folic acid plays an important role in
preventing the development of birth
defects among newborns, and cervical
cancer. Of course, there are some
correlations with some other nutrients,
such as vitamins C and E, and the
carotenoid.
Deficiencies in vitamin A and iron,
tend to affect particular groups of women
and children so that it becomes very
important that during pregnancy and
lactation, the adequacy of these critical
nutrients has to be' ensured.
A low level of iron will result in
A Report on Food Fortification
low birth weight, a higher risk of
premature child birth, and'increased risk
of maternal death.
It is also well documented that the
risk of having a child born with defects
is increased if there's an inadequate
amount of folic acid during pregnancy,
while the lack of calcium and magnesium
increases risk of cancer.
What would be the strategy then for
the prevention of the so-called
micronutrient deficiencies?·There are a
number of strategies, and it is possible
that we should try to emphasize all of
them. The first one is dietary
diversification and it is imperative that
the population in general should be
encouraged to eata widervariety offoods.
Anotherapproach wouldbe to encourage
dietary supplementation, in countries
which can afford it. The third strategy
would be food fortification. As societies
become more developed, the food
industries play a more prominent role
in providing nutritious foods to the
population in general because with more
peopleat work, industry assumes a bigger
responsibility over the household -,

Industry now, takes on the obligation of
a housewife in the sense of delivering
a healthy diet for the .family.
What will be the nutritional impact
of food fortification? Early in 1974,sugar
was fortified in Guatemala, and the
percentageofpeople, diagnosed ashaving
vitamin A deficiency, dropped
.dramatically. Fortification of sugar has
now been established in many Latin
American countries.
Iri the case of vitamin A in MSG,
experiments, in Indonesia showed that
the incidence of Bitot'sspots dropped
dramatically for those groups given
intervention up to 12 months.:
Even . milk can be fortified . . with iron.
Chile, using the iron form ferrous sulfate,
in milk, reduced the prevalenceofanemia.
When a little amount of vitamin C was
A Report on Food Fortification 17
added, the absorption of the iron was
improved.
The cost-benefit ratio. The World
Bank has come up with a productivity
gain of the program in terms of dollars.
Vitamin A supplementationcost US$146,
whereas the fortification of vitamin A,
iron and iodine has become much more
affordable for the industry and more
effectiveto achieving productivitybecause
of the improved health of the population.
-We have over 50 years of proven
technology, globally, for a wide variety
of processed foods. Food fortification will
enhance micronutrient density and help
to achieve a balanced diet for all segments
of the population.

18
A Report on Food Fortification
IRON-FORTIFIED CHOCOLATE DRINK
Dr. HAILE MEHANSHO
Research Scientist, Procter & Gamble
Miami Valley Laboratory
Cincinnati, Ohio
Why iron deficiency anemia? Iron
isveryimportantfor the various functions
of our body. And iron deficiency is a
problem all over the world. It affects
the young, the old, the rich and the poor,
industrialized countries as well as the
developingcountries. The only difference
is in the magnitude. It is a serious health
and economic problem. People with
adequate ironstatus, are generally happy,
strong and are energetic. On the other
hand, people who are iron deficient, are
sad, tired and weak.
Industry delivers fortified products
in asustainable manner, because it has
a business goal, to meet consumer needs.
Micronutrient deficiency, is a consumer
need. The fortified product provides for
a very important need of the consumer.
Andserves as a direct link to the industrial
community in delivering the benefits of
the services of non-government
organizations and international agencies
and the development of policies of
government.
Procter & Gamble believes in
providing products to meet the
micronutrient needs of consumers. We
have developed an iron fortification
technology for a chocolate powder that
is primarily marketed in Mexico. By
workingclosely withthe NutritionCenter
of the Philippines and the Department
of Health we have also fortified Star
margarine with vitamin A and we have
products in Europe, United States and
the Arabian Peninsula which are fortified
with multiple vitamins.

On this occasion, I would like to talk
about our program on iron fortification
of chocolate powder. Clearly the objective
• of fortifying a chocolate powder or
chocolate. milk with iron is to provide
highlybioavailableironwithoutchanging
the color or flavor of the product. As
discussed with the folk leaders and -the
health department in Mexico, the concept
is for the chocolate powder to contribute
to the preventionofiron deficiencyanemia.
To accomplish this, the Procter &
Gamble developed a mini iron delivery
system called a nutri-iron. The approach
can be applied to any food' product
whether it is cereal or a beverageor spices.
The first step in iron fortification is
to identify'the product vehicle. The next
step is to develop a technology to put
iron into the food product to be fortified.
There are two critical points: one is the
vehicle has to be suitable, and has to be
consumed by the targetgroup. The second
one is: the iron to be added should be
compatible and at the same time
bioavailable. To be suitable means that,
the vehicle has to be consumed by the
target group, should be centrally
processed and served, and should not
affect the bioavailability of the nutrient
(iron) added.
Before we developed the iron
fortification technology, we did a habit
and practice study. About 50% of the
milk consumed in Mexico, is consumed
, A Report on Food Fortification 19
with a milk modifier, and only 16% of
the milk is consumed plain,so we thought
that chocomilk has a potential to' be a
vehicle for iron.. Mothers buy the milk
for two things: one is the flavor which
would make their children drink milk,
the second isthe nutrientdelivered. About
40% Of the consumers of the product are
children; about 30% are teenagers and
another 30% are women.
-_Let me explain a little bit more on
what bioavailability is and why it is
important. Basically, whenwe talk about
the iron contentoffood we'retalking about
quantity but quantity must have quality
to be of help, so bioavailability is that
fraction of the ingested iron that is
absorbed and the usefulness . of that iron
'
in various biological functions is the
quality of the, iron.
%ebioavailability of the iron varies
in different food groups, ironsources from
1% in rice to 20% from meat. We can
,classify' them into two groups: the iron
from plant foods are of poor quality
. whereas, the iron of animal foods are of
excellent quality. Of the iron compounds
commonly used for' fortification, the
United States Food ana Drug
Administration uses ferrous sulfate as
the standard because it is a good source

22
A Report on Food Fortification
THE STAR MARGARINE FORTIFICATION STORY
Dr. FLORENTINO S. SOLON
Executive Director, Nutrition Center of the Philippines
For several decades margarine has
beenconsumedby the Filipinopopulation.
According to a marketing survey, the
brand highly utilized (80%) was Star
Margarine produced by the Procter and
Gamble (P&G) Manila.Further, the survey
showed that about 37% of the margarine
users were children12years old and below,
most of whom were from the rural areas.
About 80%of the users of margarine used
it as spread on bread, approximately 20%
mixedit with hot·rice and 30% used it
for sauteing.
Star Margarine is about 80%
vegetable oil and the rest is water and
milk solid. It is shelf stable nonrefrigerated,
enriched with thiamine (B1)
and vitamin 03 (cholecalciferol). The
butter-like margarine uses beta carotene
ascolorant sothat some amountofVitamin
A is.present. The content of new Star
Margarine is similar to that of the old
Star Margarine except that the Vitamin
A content has been raised to a level of
431 ug RE per serving or 15 grams ( one
tablespoon). This amount of Vitamin A
is equivalent to 115% of the Filipino
recommended daily allowance.
The management of P&G Manila
upon the recommendation of Dr. Alfred
Sommer, Dean, School of Hygiene and
Public Health, Johns Hopkins University
(JHU), a foremost international vitamin
A expert, commissioned the Nutrition
Center of the Philippines (NCP) a nongovernment
organization (NGO) to
undertake a controlled field trial on
vitamin A-fortified Star Margarine. The
aim was to determine the effectiveness
of the fortified Star Margarine on the
vitamin Astatus of young children. The
study was endorsed by the Department
of Health (DOH).
-The double blind study was carried
out in six randomized barangays in the
municipalityofSilang,Cavite. Thesubjects
were 3-6 year old children. The specific
vitamin A status indicators e.g. serum
vitamin A, eye signs and dietary pattern
were taken before and after intervention.
The vitamin A fortified Star Margarine
(STAR + A)and a non-fortified margarine

FVRice: WHAT IS IT?
FVRice is ordinary rice tha t has beenfortified
with iron by adding a premix
containing enough iron to satisfy a large
requirement of individuals. FVRice-iron
contains 3 mg iron per 100 g raw rice.
An adult man, for example, taking the
usual amount of rice he eats in a day,
will satisfy more than 100% of his iron
requirement. An adult woman would.
satisfy about40%of her iron requirement,
while a school child would satisfy 2/3
of his/her requirement. These amounts
should be enough considering that
ordinarily, individuals are already taking
in about 2/3 of their iron allowance from
their diet.
To make FVRice-iron, the Premix is
first prepared by coating ordinary rice
with a coatingsolution containingferrous
sulfate, drying and then packaging the
product. To use the Premix, one part
of it is mixed either in the home or in
the mill with 199 parts of ordinary rice
to make iron enriched rice, which is then
ready for cookingandconsumption. When
mixed this way, one could hardly detect
.the premix grains in the mixture unless
the premix grains are colored, which is
precisely what some retailers want to be
able to distinguish enriched rice from
ordinary rice.
The resulting fortified rice does not
changein taste or odorevenaftercooking.
Ifthe premixiscolored (green), the cooked
A Report on Food Fortification 25
rice has a very faint greenish color, but
this has beer. found notto be disagreeable..
The addition of the premix of course
imparts additional cost to the consumer.
At current prices, it entails an additional
P 0.60- P 0.75per kilo ofrice - an addition
of about 5% to the cost of rice.
MANUFACTURE OF PREMIX
Basically,the process of manufacture
of the Premix is very simple. It consists
of preparing the coating solution
containing the required amount of iron
(ferrous sulfate), pouring or spraying this
on a measured amount of ordinary rice
while itisbeingmixed in a rotatingtumbler
or trombo( and then drying the coated
rice. The resulting premix is then packed
either in 5 gram polypropylene/
polyethylene sachets or bags. One can
do this manually over a hood, but in a
larger scale manufacture, we have come
out with a prototype spraying device that
safeguards the safety of the workers. The
prototype manufactured locally costs P
85,000.
Raw materials including fortificants
and packaging materials are locally
available (although imported).
SYSTEM OF USE OF PREMIX
There are two major schemes of using
the premix:
1) Mill enrichment where rmxmg of the
premix with ordinary rice is done at
the ricemill duringthe millingofpalay.

26 A Report on Food Fortification
The economics of manufacture of the Premix (Manual of Operations) are, as
follows:
Plant .Capacity _
Land/Building improvement .:..'
Equipment
_
Production -'- _
Office and Transportation _
Working Capital _
Others _
, , Production Cost _
Break-even selling price _-'- -r-r- _
Proposed selling price _
Return on investment _
Payback period _
2) Home' enrichment where mixing of
the premix, which may be obtained
in'S g sachets, is done at the household
level just after rinsing and before
cooking. A 5 g sachet is mixed by hand
per kilo of rice.
Mill enrichment requires a control
feeder for efficient mixing of the premix
with ordinary rice. A prototype of such
feeder hasbeendesigned and isnowbeing
constructed. A rough estimate of cost
is P 80,000 - P 100,000. The system is
for the rice miller to add the Premix to
the rice that goes through his mill, with
an additional cost to the trader, who then
sells the ricealreadyenrichedto'thegeneral
public, again at an additional cost. When
this was done with NFA in 1993, FVRice
250 kg/8 hr day
50,000
232,000
100,000
529,597
47,979
P 0,414/5 g pk
P 0.4425/5 g pk
P 0.60/5 g pk
151.5%
0.66 year
was sold retail at P 10.85, P 0.60
higher than the cost of unenriched NFA
nce.
Home enrichment of course entails
no additional cost for mixing. However,
there may be a slightly higher packaging
cost because of the use of the smaller
packs. At present, in Nueva Ecija,FVRiceiron
premix is being sold at P 0.75 per
gram sachet. The premix of FVRice may
also be sold and distributed in feeding
centers, hospitals, Army mess halls, school
canteens, etc. or to private companies
which distribute free rice to their
employees as part of employee benefits.
The major constraint in both home
andmill enrichmentsystems ispromotion

A Report on Food Fortification 27
and social marketing, as we have found
out in our experience in Nueva Ecija. The
major responsibility for promotion of
course lies on the-manufacturer of the
Premix, but in Nueva Ecija, the OOH­
Nutrition Service, the Provincial Health
Office, and FNRl have been collaborating
in social marketing to initiate the rice
I
enrichment habit in the population. But
as in any other commercial product, a
tremendous and sustained effort. in
promotion is required. Since this is
expensive, andsince the ultimate objective
isimprovementofhealthofthe population,
the government and NGOs must help
through an intensive social marketing
program to make the venture attractive
to private entrepreneurs, rice millers, and
traders.

28
A Report on Food Fortification
IODINE AND IRON FORTIFIED FISH SAUCE
AND OTHER CONDIMENTS
Mr. HECTOR MAGLALANG
Fortification Consultant, Nutrition 'Service-Department of Health
Condiments are food substances
added to basic foodstuff to enhance the
flavor of food. It is also called flavoring
agents, seasonings, or spices. Condiments
are widely consumed food products in
the Philippines. Studies by the University
of the Philippines have cited salt and
monosodium glutamate (MSG) as some
of the most fortifiable foods but for this
discussion, I would like to concentrate
on the fortification of fish sauce, salt and
soy saucewithbothiron and iodine. Other
condiments that can be considered are
ketchup and MSG.
.-
.First, the fortification of fish sauce.
This is a clean, lightbrownliquid prepared
by fermentation and extraction of marine
fish and used as a flavoring or salt
substitute. This is ideal for fortification
because the production of fish sauce is
concentrated in and around Malabon and
Navotas in Metro Manila, and this
concentration of production is one of the
requirements for a food product to be
considered for fortification.
Studies in iron fortification of soy
sauce were inititated in Thailand around
1974 because the Thais are also fond of
using fish sauce. From their experiments
they haveconcluded thatethelenediamine
tetraacctic acid sodium iron EDTA is the
most suitable fortificant for iron in fish
sauce than all the other iron sources,
because no precipitation was observed
in fish sauce. In other iron sources,
precipitation takes place aftertwoor more
hours but for the sodium iron EDTA no
precipitation was observed even for
mon!hs. After determining the most
suitable fortificant in terms of the
difference in the physical properties' of
the food, they tested it for taste using
a double blind technique. There was no
effect on the taste of variousfood products
where sodium iron EDTA fortified fish
sauce was used as the condiment.
On the bioavailability of iron, 7-8%
is absorbed in combination with other
foods On the average, which is usually

30
level but iodine is in the microgram level.
The cost of the fortificant would be 0.1
centavo per bottle and the preparation
of the iodine solution and the addition
to the fish sauce would be probablyaround
10 to 25 centavos per bottle. Thus, the
additional cost for the fortification would
only amount to 10 to 25 centavos per
bottle. In the manufacturing of fish
sauce the first extract of fish sauce can
also be diluted. The brine solution can
be usedwith iodizedsaltspecially fortified
at the level of 150 ug iodine per gram
or 150 ppm. The iodized salt producers
can do this fortification withan additional
chargeof probablyP 50.00persack, which
will amount to an additional cost for
fortification of only about 3 centavos per
bottle at 1:1 dilution usinghighly fortified
iodized saltfor the brinesolution. Diluting
the first extract of the fish sauce will only
add 3 centavos to the production cost.
Even if the food manufacturer puts in
an additional 5 centavos the consumer
can easily afford that.
On saltfortification, there are already
17 iodization plants in the Philippines.
Next week this will be 18. Salt iodization
is an easy process whereby .the salt is
sprayed with iodine at a certain level (we.
are recommending 100 ppm potassium
iodate or 60 ppm iodine).
A Report on Food Fortification
Double fortification of salt with iron'
and iodine, as well as fortification of salt
with iron has been done in India. The
fortified products may already be in the
market. Fortification of salt with iron
uses ferrous sulfate stabilized with
monosodium dihydrogen phosphate and
sodium acid sulfate. Mix the first two
compoundsbefore addingthe sodiumacid
sulfate and then use the machine in
fortifying with iodine, spraying the
fortificant mixture on the salt, and you
have an iron fortified salt. A technical
problem encountered in double
fortification of salt with iron and iodine
was in the acidic natureof ironfortifica tion
as well as in sodium acid sulfate. The
wocesswill oxidize the iodideof or iodate
to free iodine which will vaporize.
Potassium iodateisalso an oxidizingagent,
actually the fortificant used most in India
as well as in the Philippines, which will
cause oxidation of ferrous to ferric with
a corresponding, decrease in
bioavailability. Using other iron
compounds develops a color formation
and the hygroscopic nature of salt tends
to oxidizeferrous to ferric sulfateshowing
a high concentration of the iron fortificant
as against the fortificant required for the
iodine. In solving this technical problem,
experiments showed that salt required
for double fortification should almost he
pure salt: 99% sodium chloride content,
minimum magnesium, insoluble residue
and moisture content. These are the salt
specifications for double fortification. For
the iron fortificant, ferrous fumarate

34 A Report. on Food Fortification
advocacy, formulating quality standards
and enforcing them, and providing for
tax breaks and other health-oriented
incentives. The NGOs and international
agencies can playa strong support role
through advocacy to promote a positive
attitudetowards fortification attheglobal,
national and community levels.
Organizations like the WHO and FAO
can help much through endorsement of
standardsand promotionof products that
meet such standards. Helen Keller, for
instance, placed its seal on Star Margarine
and supported training for health
education.
The real doers, however, are those
in the industry, since you are the ones
who will handle technical production,
bring in local ingredients and put quality
control .in .place. You also have the
marketing and distribution skills. You
can find effective ways of reaching target
groups, conduct post-marketing
surveillance, undertake product
development as an investment for the
future, and get involved in local nutrition
education programs.
What is important is that you have.
a product that can be fortified and that
its fortification will have a significant
impact. This requires the establishment
and maintenance of quality assurance
program, backed up by international
product control, especially on packaging,
labeling, and distribution. Government
must have supportive laws, regulations
and standards, put in place an inspection
and surveillance system, and follow
through with enforcement. The
community needs to be informed of the
nature and extent of the problem in order
to be able to accept and demand products
of fortification.
The partnership also requires us to
understand differences in language. The
language of industry often revolves
around the consumer and the market.
Government often talks of taxpayers and
voters and the will and welfare of the
people, while the language of service
agencies is full of terms of children and
families at risk and population in need.
But micronutrient malnutrition affects
the same people, not just those in remote
villages but also those in urban centers
like Manila where 20% of newborns were
reported sufferingfrom iodinedeficiency.
We need to understand one another.
A major barrier to .our effort ·is that
the concept of micronutrient deficiency
is relatively new and the people are just
getting aware of it. Except for the health
and scme other cabinet ministries, some
developmentagencies and a few industries
which champion the cause of nutrition,
very few know about the nature and
magnitude of the problem or are
committedto its elimination. To overcome
this difficulty on a global scale, a project
is now underway to conduct a survey
covering more than 15 countries, which
will be the potential key actors in the
campaign, to bringoutissues, or obstacles,
andpossiblesolutions andwaysofrnoving

A Report-on Food Fortification 35
Establishing a working partnership involves a network of players from industry,government
, and deoelopment agencies at national level, and this relationship :must be carried on in
everyday work.' -' ,
ahead. At the end of this conference,
you will each receive a survey form to
draw feedback from you on what you
think are the key barriers. This feedback
can be included for discussion in global
forums. '
, .One forum will be a meeting in
Septemberof this year in Ottawa to bridge
the-knowledge gap, to develop further
dialogue, and to establish better thrusts
andplaris fornational action. Its einphasis
will be on, national action, and the
Philippines will be represented in this
dialogue by a strong team. Establishing
a workingpartnership involvesanetwork
ofplayers from industry,governmentand
development agencies at n,ational level,
as is happening here now, and this
relationship must be carried on' in
everyday work.
Also being discussed now is a
marketing communication idea on what
is called the "supernutrient edge". It is
actually an advocacy, linking athletic '
performance with adequate essential
micronutrients or supernutrients. It will
have the 1996 Olympics in Atlanta as a
launching pad, reaching a climax in the
2000 Olympics in Sydney. The vehicles
may vary. It could be basketball in the
Philippines, or .a whole lot of- sporting
events.
A lesson plan on micronutrients is
also being drawn up for integration in
the school' curriculum and non-forrrial
educational systems like the boy scouts.
Another idea is to use the potential of
mothers and prominentwomenin various
countries, like the Princess'of Thailand
or an eminent lady in the Philippines,
to head a coalition of women in support
ofmicronutrient advocacy. This would
, be later expanded to create a global
network pushing for the elimination of
micronutrientdeficiency. For thatmatter,
the partnership can be expandedbetween
industries, between governments, and
betweenagencies in orderto create a global
movement on micronutrients similar to,
the GreenMovementor the Anti-Smoking
Movement. Many countries have
comntitted themselves to the elimination
of micronutrient deficiencies by the year
2000. This cannotbe achieved unless there
is a major movement in industry. I am
very confident this is coming.

36 . A Report on Food Fortification
THE SANGKAP PINOY SEAL
Ms. ADEllSA c. RAMOS
Director, Nutrition Service - Department of Health
The Sangkap PinoySeal Program is
a strategy to encourage the food
manufacturers to fortify food products
with the essential nutrients approved by
the Department of Health. The concept
here is toauthorizethe food manufacturers
to use the seal ofacceptance forthe fortified
food products. The objectives of this
program are to:
.Thiswouldbe partofourpartnership
wherein the DOH and the other members
ofthe NNewill help promotethe purchase
of food products that have the Sangkap
Pinoy seal. . The targets are all food
manufacturers producing food products
fortified with vitamin A; iron and iodine.
For approval of an application, the
fortified products and their labels must
conform to the DOH guidelines on
Micronutrient Fortification of Processed
Foods. The required documents to be
. submitted by the applicant include the
. .
application form (this is to be completely
accomplished), the license to operate
(approved by the Bureau of Food and
Drugs), the results of laboratory analysis
(also approved by BFAD). There are also
Mrs. Adelisa Ramos, "The Sangkap Pinoy seal will
be the initial step in strengthening our food fortification
program in the country".

· A Report on Food Fortification
WHY SHOULD MANUFACTURERS BE INVOLVED?
The growing number of processed food available in
the market today as well as the increasing public acceptance
of these type of foods make them more and more a part
of the Filipino consumers food habits. The food industry,
particularly the food manufacturers can make a big difference
by makingavailab Ieto the general populationfood products
that are fortified with the essential nutrients as a means
of preventing nutritional deficiency.
WHAT ARE THE QUALIFICATION REQUIREMENTS?
WHERE TO APPLY?
HOW TO SECURE SANGKAP PINOY SEAL?
39
1. The applicant-firm mustsubmit/meet
all the requirements set by the DOH.
2. The fortified food product and its
labelling must conform to the DOH
Guidelines on Micronutrient
Fortification of Processed Foods.
3, The applicant-firm must have the
capability to assure the quality of its
fortified product as determined by the
SPS Program Technical Board.
All applications shall be forwarded to the:
NutritionService-Department of Health Bldg. No. 16
San Lazaro Compound, Rizal Avenue
Sta. Cruz, Manila
Tel. Nos. 711-61-35 or 711-61-20
The following are the steps in securing the Sangkap Pinoy Seal:
STEPS
1
2
ACTIVITIES
Applicant-firm accomplishes application form for specific food product.
Submits accomplished application form to Nutrition Service-Secretariat and
the following documentary requirements:

44
costs of fortified products.citingthis factor
as a-critical area in nutrition education.
She said there would be a need to lower
productcosts to ensure public acceptance.
Ms. Alma Ocampo of Century Canning
Corporation also asked how the
governmentandotheragencies couldhelp
the food industry to reach the poor
consumer in volume, considering the cost
of fortification would significantly affect
the already thin or minimal margins of
profit of certain products. Mr. Maglalang
answered that in the case of sardines, for
example, which is a product of the poor,
the cost of fortification would not raise
the product cost higher than the highest
price of the product in the market. He
said that the government marketing
program, if combined with the,marketing
or promotionplanofthe food maufacturer,
.-
1EETING WITH FOOD
'D FORTIFKATION
'pl P,lU'>U,Lnu
;'1. [nnit'a. ,,,htl,!; 1:} Jure
Mrs. Zeny Yao, Salt Producer, JY International
. A Report on Food Fortification
•
should ensure market reach. Dr.
Mehansho added that since the
micronutrients to be added are in very
small amounts, there is no needto increase
prices, asIn the fortification of Star
Margarine with vitamin A. He said the
government could help by. reducing
importtaxes on ingredientsbutotherwise,
the real additional cost of fortification is
very minimal. Inthis regard,Ms. Mendoza
mentioned a food producer, Swift, which
fortified a meat product without raising
its price.
Availability of Iodized Salt.
. Ms. Angie Maglaya of the Philippine
Institute of Pure and Applied Chemistry
asked about the availability of iodized
salt in the market. Ms. Jonjie Guballa
of Guballa Corporation in San Jose,
OccidentalMindorosaid that hercompany
is still studying the prospect of selling
in Metro Manila ifthe demand for iodized
salt makes it worthwhile. She expressed
hope that, with the help of the food
manufacturers, her sales volume would
allow her company to concentrate on salt
iodization. Ms. Zeny Yao of JY
International informed the audience that
her company can supply iodized salt,
especially in volume. She urged the food
manufacturers to use iodized salt which,
she said, would not add too much cost
on their production. Mr. Johnny Khong
Hun also "advertised" theavailability of
iodized salt, among 30 kinds of salt, in

his company which distributes through
Finetex Enterprises. In this regard, Ms.
Chorie Ignacio said that the DOH will
soon come up with the generic campaign
ads or commercials to promote iodized
salt, but that this will only be supportive
to the individual marketing efforts of-salt
producers and traders.
Focus on affected areas.
Another reaction from a guest
.inquired on where micronutrient
deficiencies are concentrated so that the
health campaign can focus onthese areas.
He asked how the governmentcan market
the program in far-flung areas, since most
products reach only places like Metro
Manila. Dr. Florentino said that these
deficiencies .- are found in both rural and
urban areas, especially where poverty is
prevalent. •
Sangkap Pinoy Seal: Information and
Promotion.
Mr. FlorendoofNestle asked formore .
information on the Sangkap Pinoy seal,
especially on where to get the DOH
guidelinesandwheretoapply. Ms.Ramos
directed him to the Nutrition Service ­
DOH for- the application forms and to
the Bureau of Food and Drugs for product
analysis andothertechnicalrequirements.
Ms. Aguinaldo, forum moderator, added
that the guidelines requested were
included in the kits distributed to the
. A. Report on Food Fortification 45
participants. On promotions, Ms. Susie
Marina ofCFC (Consolidated Foods
Corporation) wanted to know the
marketing program for the Seal. Ms.
Chorie Ignacio gave a-brief summary of
the social marketing program on
fortification, which she said would
similarly be done on the Seal. Thiswould .
include use of mass media (print, radio,
TV,MTV,cinemaplugs, etc.),mobilization
of front-line health workersfor promotion
at the grass roots, one-on-one client
(mother) calls, with tie-up with the
Phllippine Information Agency on
information production and
dissemination.
Fee for the Seal.
Ms. Aguinaldo read a question of
a participant who asked why an ordinary
businessman would need the Seal when
he could fortify his products without
paying the P 500 application feeand the
P 40,000 contract fee for fortifying with
three micronutrients. Ms. Ramos replied
that the seal is a means of not only giving
credentials to a product but also of
regulating the fortification so as to avoid
lack or excess of fortificant and provide
protection to the consumer. Dr. Mehansho
.added that it is a way of giving credibility
to' the claims of industries which adopt
fortification, as againstunfounded claims
in the market.
Dr. Esqueta of Coca-Cola Export
Corporation raised the issue of a seeming

•
said that a'lot of foods could be fortified
with nutrients and some food items could
eVen be fortified with "multi" nutrients.
.And, finally, as emphasized by Dr..
Maberly, that for fortification to be a
success. a close collaboration and
cooperation between the government,
non-government organizations, private
agencies andindustrieswouldbe required.
The success of fortification would depend
on a sharing of expertise, technological
A· Report on Food Fortification 49 \
'know-how, resources, and.intensive and
aggressive advocacy by the different
sectors. Strong advertising andmarketing
strategies for example, are key elements
in generating awareness and demand of
fortified food products.
Lastly, the Sangkap Pinoy seal
program of the DOH presents both an
incentive and a challenge to the food
industry to help in the struggle against
micronutrient deficiency .

A Report on Food. Fortification 51
We wouldlike to acknowledge the invaluablesupportofdonorandotherinternational
agencies, such as the UNICEF, who have-been with us as far back as we can remember.
Surely with concerted efforts from all sectors, we canbeat this monster that is
depriving us and our children of their health and productivity.
•
.MRS. ADELISAC. RAMOS
Director, Nutrition Service-Department
of Health, and Chairman, Steering Committee­
Second Consultative Meeting with
Food Manufacturers on Food Fortification

acquainted with the methodologies you
will work them out and be driven by
the' knowledge that these are very
important. factors in the growth of our
nation and that you must do your part.
Let us find the niches where we can
fit in. For instance, in processing different
foods we may find certain places where
we can promote vitamin' A., There may
be, other products in which it is easier
to promoteiodine, andstillotherproducts
in which we can promote iron. Let us
get these niches and work outwith the
authoritieswherewe feelare the particular
niches for our particular products. And
in the end, 'I believe that we can work
it out.
As much of our attention has been
placed I'm salt. 1would like to challenge
our food manufacturers who use salt ­
practically all of us use salt - asking them
to consider that in striving for excellence,
competitivenessandquality, we mustlook
forward to trying to use at all times the
best quality available ill the ingredients
that we use. Ifwe can convince ourselves
on this we will come to the conclusion
that the best way to start achieving high
quality is to use high quality salts. And
fortunately, we have enough
manufacturers of salt in the Philippines
who are world competitive. Let us start
A Report on Food, Fortification 53
. '. .
quality improvement through better salt,
and 1 hope that we can find our way
to using not only bettersalt hutalsoiodized
salt. ' Let us start with quality sugar or
quality salt which may give us a chance
to promote iodine.
The other niche that 1 can see in
probably all of the elements that we are
promoting is in the sauces. The Filipino
diet is quite dependent on sauces, red,
salty' or any other kind.' 'So let us see'
if.we can get some of.these elements in
our' sauces. For one thing the unit cost
of a sauce is usually higher than the unit
cost of, say,sardines so. maybe we can
afford it. It may be against our health
. policies but 1don't think we can get away
from "patis", although people say "patis"
is not good for those with high blood'
pressure. What 1 am saying is let us
find the proper niches for our foods and
see if we can incorporate our campaign
against these deficiencies,
Let me end this meeting by saying
thank..you for coming and participating
in this activity. Your attendance to this
meeting speaks for itself. Thanks too to
the organizersofthis activity. Restassured
, we will support the goal of eradicating
micronutrientmalnutritionin the country.
As the theme says, indeed, the food"
industryisyour"Katulongsa Pagsulong".

IODIZED SALT PRODUCERS
California Manufacturing Co." Inc.
Remedios Laguindanum
JY International
Zeny Yao .
Pacific Farms Inc. (PFI)
Domingo Daiz
Johnny Khong Hun
Ricnar
Januario Basco .
RM Guballa Corporation
[onjie Guballa
MARGARINE
Meadow "Brands
Jun de Asis
Philippine Dairy Products Corp. (PDPC)
Grace Marquez
Cita Velasco
MEAT .- & FISH PROCESSING.
Century Canning Corporation'
Alma Ocampo
Inglenook
Napoleon Bente
Philips Foods Corporation
Erlinda de Limban
Purefoods Corporation
Maribeth Espana
REM Corporation
Susan Atienza
Chit Fernandez
Edwin Sena
Swifts Foods, Inc.
Evelyn Bandian
NOODLE MANUFACTURER
Liwayway Marketing Corporation
·Rinna Mateo
Rodrigo Monzon
.A Report'on Food Fortification
SNACK FOODS
Leslie
A. .Fernandez
Medin Sapon
Stateline
Ledovina Romero
SUGAR MILLERS
Philippine Sugar Millers Association and
Retailers Institute
Vicente'Castro
Oscar Cortes
Cesar Ramos
DRUG COMPANY
Roche (Philippines),' Inc.
Luisa Asprec
'Corazon Garaide
Vitacolor .Industries
Gilbert Garcia
LABORATORIES
BUREAU OF PLANT INDUSTRY (BPI) .:
Lydia Zara
57
DEPARTMENT OF SCIENCE & TECHNOLOGY
- ITDI (VOST - ITDI)
Aida Balagot
FOOD&DEVELOPMENTCENTER-NATIONAL
FOOD AUTIfORITY (FDC-NFA)
Alberto Cariso
INSTITUTE OF CHEMISTRY,UPDiliman
. Marte ViIlena
PIDLIPPINE COCONUT AUTIfORITY (PCA)
Nelly Valencia
PIDLIPPINEINSTITUTE OFPURE & APPLIED
CHEMISTRY (PPAC) .
Angie Maglaya
SGS PIDLIPPINES
Jocelyn Babaan.

58
A Report on Food Fortification
CONSULTATIVE MEETING WITH FOOD MANUFACTURERS
ON FOOD. FORTIFICATION
STEERING COMMITTEE
Chairman:
Members:
EXECUTIVE COMMITTEE
Chairman:
Members:
TECHNICAL COMMITTEE
Chairman: .
Members:
WORKING COMMllTEES
Ms. Adelisa C. Ramos, NS-DOH
Ms. Ellen E. Villate, HKI
Dr. Florentino S. Solon, NCP
Ms. Azucena B. Limbo, NFP
Ms. Elsa M. Bayani, NNC
Dr. Demetria C. Bongga, UNICEF
Dr. Alex dela Cuadra, NS:-DOH
Ms. Azucena B. Limbo, NFP
Ms. Daylin B. Sandrino, HKI
Dr. Demetria C. Bongga, UNICEF - Nutrition
Ms. Maria Lourdes A. Vega, NNC
Dr. Teresa C. Nano., NCP
Dr. Carmina Parce, BFAD
Dr. Aida Aguinaldo, FNRI
Mr. Hector C. Maglalang, NS:-DOH
Ms. Maria-Bemardita T. Flores, NNC
Mr. Albert Cariso,FDC-NFA
PROGRAM COMMITTEE
Chairman: .Ms. baylin B. Sandrino,HKI
Ms. Azucena B. Limbo, NFP
Ms. Ma. Socorro E. Ignacio, NS-OOH .
Ms. Sylvia Fulgencio, UNICEF - Nutrition
Dr. Teresa c. Nano, NCP
Ms. Maria Lourdes A" Vega,. NNC

• Department of Health
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H50,48 P94f 1995 f Proceedings second consultative meeting wit