It is called hidden hunger. Unlike the growling, aching kind of hunger, no one seems to pay attention to it. Unknowingly, more than 2 billion people are affected by micronutrient deficiencies around the world.
Defined as “the lack of one or more of the essential vitamins and minerals required for healthy growth, development and functioning,” micronutrient deficiencies affect all ages and socioeconomic groups.
“The consequences of hidden hunger are particularly damaging for women of reproductive age and their children,” noted a joint publication published by the UN World Food Program and Sight and Life.
Hidden hunger contributes to killing an estimated 40,000 people each day. “We’re still losing one generation after another to malnutrition and this just shouldn’t be happening anymore,” deplored Dr. Howard Bouis, a senior research fellow at the Washington-based International Food Policy Research Institute.
Micronutrient deficiencies occur when a diverse and nutrient-rich diet (that is, one that includes animal-source foods such as meat, eggs, fish, dairy, as well as legumes, cereals, fruits and vegetables) is neither consistently available nor consumed in sufficient quantities.
In Asia, where nearly all the world’s rice is grown and eaten, food means rice. “Precious things are not pearls and jade but the five grains, of which rice is the finest,” a Chinese proverb reminds.
In the Philippines, people consume about four to five cups of cooked rice per day. “If we did not have rice, our deepest comfort food, we would probably feel less Filipino,” said the late food epicure Doreen Fernandez.
Although rice is basically a complex carbohydrate, its protein contains all eight of the essential amino acids found in many other foods. Low in sodium and fat, with no cholesterol or gluten, it is a boon to weight worriers and those allergic in other grains. It is also low in fiber and easily digested. Eating one-half cup of cooked rice can furnish 82 calories of energy—enough to give person energy to walk 26 minutes.
Since rice is consumed in great amounts, the cereal is a good vehicle for fortification. According to the Food and Nutrition Research Institute (FNRI), food fortification is “the addition of one or more essential nutrients to a food, whether or not it is normally contained in the food, for the purpose of preventing or correcting a demonstrated deficiency in one or more nutrients in the population of specific population groups in which a risk of nutrient deficiency has been identified.”
Rice fortification is highly recommended by the World Health Organization (WHO). “Today, affordable technology exists to produce fortified rice kernels that look and taste the same as nonfortified rice,” notes the publication, Scaling up Rice Fortification in Asia.
“While milled rice is a good source of energy, it is a poor source of micronutrients,” the publication pointed out. “Therefore, in countries with widespread micronutrient deficiencies and large per-capita consumption, making rice more nutritious through fortification can effectively increase micronutrient intake.”
One of the nutrients identified as lacking in Filipino diet is iron. “Iron is a mineral that is responsible in the production of hemoglobin, the red coloring of the blood,” FNRI, an attached agency of the Department of Science and Technology (DOST), explained. “Hemoglobin is the carrier of oxygen from the lungs to be distributed to the different parts of the body.”
A person who does not get enough iron from his diet will have a lower hemoglobin level. “If this condition is prolonged, one will be suffering from iron deficiency anemia, or IDA,” FNRI warned.
IDA develops when body stores of iron drop too low to support normal red blood cell production. “In the Philippines, IDA is very serious across population groups,” FNRI says, adding that it is most common among new born babies (from 6 to 11 months old) and pregnant women.
Among children, the consequences of IDA include poor scholastic performance due to poor cognition, low attention span and frequent attacks of illness due to lowered immune response.
Low and poor productivity due to easy fatigability are what adults experience when they have IDA. Pregnant women with IDA, on the other hand, may suffer from stillbirths, miscarriages and hemorrhage, or worst, death of the baby.
In a recent National Nutrition Survey, it was found that the Philippines has national iron-deficiency prevalence rate of 11 percent. Another nutritional survey suggested that about 50 percent of the iron intake, even among high-income households, comes from the cereals, particularly rice and corn.
Balancing cereal-based diets with vegetables and animal products is one approach used in some developing countries to address malnutrition problems. But results were frustrating. Vegetables and animal products are expensive, and seasonal, subject to spoilage because of limited storage and transport facilities.
This is where fortification comes in. It can be done via rice fortification or biofortification. In either way, both make rice more nutritious. “They can safely coexist as part of a strategy to improve micronutrient health,” said the publication cited earlier. “The difficulties likes in when and how micronutrients are added, and the type, number and level of micronutrients that can be incorporated.”
The publication explains the difference of the two approaches: “In rice fortification, micronutrients are added after the rice has been harvested. For instance, folic acid, niacin, vitamins B1 (thiamin), B6 (pyridoxine), B12 (cobalamin), A (retinol), D (cholecalciferol), E (tocopherol), iron, zinc and selenium can be added without changing the appearance of rice.
“Biofortification increases the micronutrient content through breeding or genetic modification. Therefore, it occurs before harvesting the crop. An example of biofortification is golden rice…. Genetically modified golden rice containing provitamin A has not been released on the market.”
In 2000 the government signed the Food Fortification law, or Republic Act 8976. It stipulates mandatory fortification of staples like rice with iron and voluntary fortification of processed foods with iron, vitamin A and/or iodine.
In 2004 the National Food Authority [NFA] fortified rice with iron. “NFA led the implementation of the law and has imported iron premix rice [IPR] fortified with ferrous sulfate using coating technology from the United States as no locally produced IPR was available at that time,” said a briefing paper on iron-fortified rice [IFR].
The IFR was distributed to already “identified nutritionally-at-risk areas” through Food for Schools Program. Unfortunately, the NFA fortified rice was less accepted by consumers due to the dark yellow-colored iron premix in rice and the darkening color of cooked rice. In 2010, NFA stopped the importation of IPR and is now committed to utilizing locally-produced IPR.
For its part, FNRI developed IPR made from rice flour blended with iron—with micronized dispersible ferric pyrophosphate as fortificant—using extrusion technology, which proved to be stable for one-year storage with iron content still retained.
The National Center for Biotechnology Information said ferric pyrophosphate is “a water-insoluble iron [Fe] compound used to fortify infant cereals and chocolate drink powders.”
In a study conducted among school children in a public school in Pasig, it was found that there was “a very significant decline in anemia prevalence from 100 percent to 33 percent.” The IFR was rated as “liked moderately” to “liked very much.”
Another study, done in the town of Orion, Bataan, and the province of Zambales showed that IFR could be marketed under normal conditions by licensed grain dealers.
“The proven nutritional benefits of fortifying rice merits to be downloaded to the private mills making IFR available, affordable and accessible for consumption of all Filipinos to achieve food and nutrition security for higher productivity,” FNRI said in a statement.
The ancient Indian name for rice, dhanya, meaning “sustainer of the human race,” indicates its age-old importance. In Java, where it is the gift of the goddess Dewi Siri, people believe that rice has a soul and may be spoken to as a relative.
An old Chinese relief for aching bones, stomach upsets and colds was toasted brown rice and minced ginger root simmered in wine, tied in cloth and rubbed on the joints, stomach or chest.
“Grain upon grain, fresh and delightful as frost, a dazzling jewel, to what can I compare this treasure,” wrote Chinese poet Yang Ji.