Grain of contention: Experts flag risks as govt expands supply of fortified rice

Grain of contention

on a pilot basis

The state government has expanded the supply of fortified rice, aimed at addressing malnutrition, to 31 districts of Karnataka without conducting any biomarker tests or studying the pros and cons.

In April 2022, the government, under its ‘Poushtika Karnataka’ (Nutrition Karnataka) programme, decided to provide fortified rice on a pilot basis. It involves grinding broken rice into powder and fortifying it with micronutrients such as iron, folic acid and vitamin B12, and then shaping it into rice-like kernels for beneficiaries in 14 districts. Based on the findings, the programme was to be implemented across the state.

From April 2023, over 4.44 crore people are receiving fortified rice under the centrally-sponsored programme.

Also Read | Cabinet approves Rs 1 lakh crore scheme to increase grain storage capacity in cooperative sector

However, multiple sources in Food & Civil Supplies and Women & Child Development departments confirmed to DH that they have not conducted any study to ascertain if fortified rice has addressed the intended purpose of minimising anaemia, malnutrition and others.

Scientists are divided over supplying iron-fortified rice under various schemes of the public distribution system including Antyodaya, priority household cards, Anganwadi, and mid-day meals.

While a section of experts fears that an irrational supply of iron — a ‘non-friendly chemical’ — could cause more harm, others argue that India is supplementing fortified rice as per the advice of the World Health Organisation and within the permissible limits.

Dr Anura Kurpad, member of NITI Aayog’s National Technical Board on Nutrition and Professor at St John’s Medical College, Bengaluru, says in principle, supplying fortified rice to a poor population is a great idea.

"But doing this in an imprecise way by supplying all through a mandatory system is not so great. This could provide excess iron supplement to a large proportion of beneficiaries, particularly men whose requirements are lower and whose diets do not need additional iron content, and this is is a worrying factor," he says.

He says several studies have shown that providing an excess of iron content, especially to men, can have a cascading effect (as they cannot easily excrete iron from body). His study of data from a national survey of children has also found that adolescent children with higher iron stores, as measured by serum ferritin levels, run a risk of higher blood sugar levels, which in the long run has been shown to increase the risk of diabetes, dyslipidemias, and high blood pressure. Giving an iron supplement through fortification to children will increase body iron stores over time, and there is need for caution and precision in giving iron only to those who need it. A mandatory blanket provision will not do this.

"Without screening or surveying patients, the government through PDS is providing fortified rice to two-thirds of its population. The amount of iron that will be delivered to a beneficiary will be 10 mg per day, from each iron-fortified food. Apart from this, it is also providing iron and folic acid tablets to women (60 mg per week) and children. Given that men and women need only 10-15 mg of iron per day, one serving of iron-fortified rice will supply the entire daily iron requirement for men, and most for women. Eating two fortified foods simultaneously — like fortified salt along with rice — will double the amount of ingested iron to 20 mg per day. To this, we must add the iron from iron tablets supplied to women and children, plus the natural iron in the usual foods that are eaten, like green leafy vegetables and millet. There is no defined time limit to the fortification programme, nor any plan to test when this should be rolled back. The prolonged consumption of fortified rice can result in high iron stores along with oxidative stress resulting in harm to the body. Without monitoring the consequences, we could be putting a large proportion of the population in harm's way," he warns.

Unlike other medications that are clinically provided under supervision (including consumption of iron tablets) where the dosage is for a specific period, the government has not mentioned a plan or indicators for tapering of fortified rice consumption, he adds.

The government, as recommended by the Food Safety and Standards Authority of India (FSSAI), has been mixing one kg of fortified rice in one quintal of normal rice.

Countering Dr Kurpad’s argument, Dr Prashanth Thankachan, an expert in micronutrients at St John's Research Institute, says the iron from fortified rice being provided in PDS is one-third (4.5 mg) of the total daily requirement. “In a country with a lack of diversity in food consumption, supplying iron-fortified rice is a low-cost, safe and effective means of addressing malnutrition,” he says. At least 14 countries including the United States of America, Canada and Bangladesh are supplying fortified rice since 2000. None of these countries have reported any adverse impact, he says.

"A person with no iron deficiency will not absorb additional iron into the body even if present in the food and, therefore, the risk of adverse events is nonexistent. The classic example is of salt fortified with iodine to tackle iodine deficiency in the country. Iodine deficiency has come down drastically in India," he says.

A couple of days ago, the World Health Organisation in its Switzerland assembly passed a resolution asking nations to increase supply of fortified food grains at the earliest to improve micronutrient levels among children and women.

Gyanendra Kumar Gangwar, Additional Director (Vigilance & Public Distribution) of the Food and Civil Supplies Department, says they are awaiting a study from Path Foundation regarding the benefits of fortified rice.

Path Foundation is funded by the Bill Gates and Melinda Foundation that is promoting the use of fortified rice in India.

"As of now, the state government does not have any report on the pros and cons of fortified rice. The centrally-sponsored scheme is being implemented based on several scientific studies conducted across the world. It has proved efficient in improving haemoglobin and nutrition levels in children and pregnant women,” he says.

Path Foundation office-bearer Satyabrat informed DH that they have not conducted biomarker tests but meta-analyses on beneficiaries.

Experts say there is no proof to suggest that the consumption of fortified rice improves malnutrition as the iron content in ‘chemically laced rice’ is low.

Kalaburagi Women and Child Welfare Department Deputy Director Naveen Kumar U says the department is not completely dependent on fortified rice. “We are trying to mitigate malnutrition and anaemia at multiple levels, including providing eggs, bananas and others. So, it is difficult to say if the changes witnessed in the district are due to fortified rice,” he says.

Kalaburagi was among the 14 districts selected on a pilot basis and received 1.33 lakh metric tonnes of fortified rice. It ranks among districts with high levels of malnutrition.

Dr Anura Kurpad said instead of supplying iron-fortified rice, the government should encourage the consumption of fruits and provide nutritious supplements based on screening.