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- 


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 


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 

------------- 

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 

.?

10. 

o 


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 


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.

• 


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 


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 


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 


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 


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 


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 


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


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 


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). 


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 


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. 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. 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 

. I11I11111111111111111111111111 

D057 

H50,48 P94f 1995 f Proceedings second consultative meeting wit

ON FOOD fORTI - DOH Central Library - Department of Health

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