Nutrition Improvement Program for China

At the beginning of 2006, DSM Nutritional Products extended its Nutrition Improvement Program (NIP) to China with an aim to improve the nutritional status of the Chinese population through staple food fortification.

One of the most important prerequisites for starting a fortification program is political will. The Nutrition Improvement Program for China is therefore cooperating closely with government organizations in their efforts to encourage the country’s leaders to take the necessary steps. The team has also established formal partnerships with the State Grain Administration of China, the Public Nutrition and Development Center of China and UNICEF, and has formulated concrete plans and area-specific objectives for the establishment of successful and sustainable food fortification programs.

To ensure efficient communication of up-to-date knowledge and experience, the team has created a web site in Chinese, and regularly distributes printed materials, including a Chinese version of the newsletter Nutriview, to its partners. Sharing of capabilities and exploiting synergies will certainly accelerate progress towards the relief of micronutrient malnutrition (also called ‘hidden hunger’) among underprivileged populations in the country.

Good nutrition and health is the foundation for a population’s social and economic development. For the individual, malnutrition casts a long shadow of disability, and increases suffering as well as the risk of premature death. When micronutrient deficiencies affect a large proportion of the population, the disease burden can significantly slow down economic development of the whole nation.

Over the past ten years, rapid social and economic development in China has provided the foundation for eliminating malnutrition and improving the health of the Chinese people. On the other hand, it has resulted in changes in diet, lifestyle and disease patterns.

Although the nutritional quality of Chinese diets has improved significantly in recent years, and the prevalence of nutrient deficiencies has continuously decreased, China still faces the dual challenges of nutrient deficiency and nutrition imbalance. Deficiencies of micronutrients such as iron and vitamin A are still common, and pose a serious problem, especially among children in rural areas.

Nevertheless, the Chinese Ministry of Health was recently able to announce that the government’s massive drive to reduce damage caused by vitamin and mineral deficiencies, particularly to children, is paying rich dividends for China’s economy. Efforts to protect China’s 250 million inhabitants now suffering from hidden hunger are expected to boost GDP by $86 billion over the next ten years.

In spite of improvements in nutritional quality in the past ten years, many Chinese diets still do not provide the amounts of micronutrients essential for optimal health. Dietary supplementation can only be realized in specific target groups, because in China, as in most other countries, the health sector lacks the resources required to reach the populations who are most in need. Unlike dietary change and dietary supplementation, staple food fortification can deliver vital micronutrients to large segments of the population without requiring changes in food-consumption patterns and without having to rely on an overburdened health system.

A successful story of food fortification in China is salt iodization, which was started in 1993. By 1995, 54% of salt consumed was fortified with iodine. This level increased to 93.8% in 1999. Total goiter rate in children during this period fell from 20.4% to 8.8%.

Chinese specialists are currently investigating the best way to deliver the nutrients needed. The preferred solution is multimicronutrient fortification of wheat flour. Wheat flour is a popular staple food in China that is consumed in a wide range of forms such as steam bread and noodles. A micronutrient premix could be added easily and economically, so that even the poorest of families could afford to buy the fortified product.

In 2002, the State Grain Administration and the Ministry of Health issued the document ‘Notification on implementation of flour fortification in reforestation area’. Under the ‘reforestation policy’, farmers in Western China who allowed farmland to become forest were given free wheat flour as compensation. To test the effectiveness of fortified flour in this setting, UNICEF, DSM, the Chinese Center for Disease Control and the Public Nutrition and Development Center of China conducted an observation study with MOH permission.

The study was closely linked to a larger effort to introduce, promote and distribute fortified flour first in Western China and later throughout the country. The results were extremely encouraging: people who consumed fortified flour showed a significant improvement in nutritional status compared with those who consumed non- fortified flour.