Television spots urging people to use iodised salt to avoid goiter - a swelling in the thyroid gland, which can lead to a swelling of the neck or larynx (voice box) - is something we've all grown up with watching. But if you ever wondered whether the extensive campaign was worth its salt, then the sharp fall in iodine-deficiency in India should settle your doubts for good.
Food fortification -adding essential vitamins and minerals to essential food items - is among the most cost-effective way of ensuring that those at risk receive the nutrients they need.
This week, Tata Chemicals Ltd - the makers of India's first packed iodised salt, in collaboration with National Institute of Nutrition (NIN), Hyderabad - launched salt fortified with iodine and iron to reduce anaemia, which affects two in three women in the country. "Using fortified salt will provide 50% of the daily recommended allowance of iron and improve the overall haemoglobin levels. Salt was chosen as it is consumed daily, but it took us 30 years to come out with a double fortified product," says Dr B Sesikeran, director, NIN.
Various state governments have also independently undertaken food fortification with the help of global support groups. Rajasthan is addressing micronutrient deficiencies by fortifying wheat flour with micronutrients such as iron, folic acid, and vitamin B-12, which is distributed among the target group through the public distribution system.
"Nearly 70% of India's population have iron-deficiency anaemia, which can be treated by simply adding vitamins and minerals to staple foods. Normally, one staple meal item of the target population is fortified with essential nutrients to ensure maximum benefit," says Jay Naidoo, chair of the partnership council of the Global Alliance for Improved Nutrition (GAIN), which is working with governments in Rajasthan, Madhya Pradesh and Rajasthan and Via Media to improve diets and raise awareness about healthy eating.
"In South Africa, we fortified maize meal, in China and Vietnam it was soy sauce and fish sauce respectively. In north India, we are looking at wheat flour fortification as it is a meal staple," said Naidoo. Plans are on to fortify oil with vitamin A and milk with other necessary micronutrients to encourage the masses to consume enriched products.
Deficiencies of iron, vitamin A, vitamin B, calcium and protein are still common among Indians, with children, adolescents and pregnant and lactating women being at most risk. The foetal stage and the initial 1,000 days after birth are nutritionally critical for the child to grow normally as this is when the body and the brain develops at a fast pace. "The origin of many lifestyle diseases in adults can be traced to bad nutrition in the foetal stage," said US-based paediatrician Prof Satish C Kalhan at Nestle' Nutrition India's workshop last month.
Studying the food pattern of a particular area and societies and modifying it according to the nutritional requirements is the best short-term solution for dealing with malnutrition. Long-term solutions is raising awareness to improve dietary habits, especially in women who remain the family meal providers.