Fortification of Milk with Vitamins A & D

“ Milk processors in India have begun fortifying milk with Vitamin A and D after the FSSAI have laid down new guidelines to combat common deficiency diseases. National level consultations were organized to make the industry aware of the desirability of fortification for public good. Tata Trusts have supported the initiative of fortification in Jharkhand and Assam to start the fortification of their milk variants. Mother Dairy sells about 25 lakh litres of fortified milk on daily basis. A couple of private dairies and cooperative plants have also started fortifying milk. The plan is to fortify about 50% of country’s milk by 2019 and 80% by 2021.

The public health significance of the potential benefits of food fortification is primarily determined by the problem of prevailing Vitamin deficiency symptoms. Fortification programmes lay emphasis on controlling those nutrient deficiencies that are most common in the identified population causing greatest adverse effects on health and body functions at the country or regional levels. Whereas ‘restoration’ involves addition of essential nutrients to foods lost during processing, the term ‘fortification’ addresses the addition of essential nutrients to meet public health needs. Foods that are widely consumed by the general population are subjected to mass fortification with one or more micro-nutrients on voluntary basis and governed by statutory regulations on the basis of average daily intakes. Market driven fortification plays a positive role in public health by meeting nutrient requirement. In some countries, mandatory fortification of foods ensures a high level of certainty of supplying micronutrients to public in an effective manner. Iodization of salt is most widely adopted form of mandatory mass fortification destined for human consumption.

It is important that governments exercise an appropriate degree of control over voluntary fortification through food laws or use of industry codes of practice. The potential benefits should be demonstrable and the consumers are not misled or deceived.

The micronutrient deficiency or “hidden hunger” has remained a serious issue in both developing and developed countries. Billions of people are iron-deficient and 200 million women are affected by osteoporosis worldwide due to Vitamin D deficiency or insufficiency. Milk is a suitable vehicle for fortification as it is consumed regularly by a major population, and used soon after production and distribution.

The Vitamin D deficiency (VDD) is defined as a low serum total 25 (OH) D concentration and associated with increased risks of various diseases like cardiovascular problems, malignancies, infectious diseases, diabetes, autoimmune disorders and kidney ailments. The probable reasons for the high prevalence of hypovitaminosis D are the reduced synthesis of Vitamin D because of a low exposure of skin to sunlight or its decreased daily consumption. Low exposure to sunlight is a risk factor among those who live in the more northerly or southerly latitudes where UV radiation levels are lower during the winter months, and among women who, for cultural reasons, spend a large proportion of their time indoors or covered with clothing. Indian epidemiologic studies have reported higher than 70% prevalence of VDD in all age groups including school children, pregnant women, young adults, adolescent girls and adult men and women. Genetic and epigenetic variants in genes involved in Vitamin D metabolism play fundamental role in person specific differences.

In these situations, vitamin D fortification of milk has been found to be useful strategy for increasing its intake up to 200 IU/day.

Vitamin D promotes absorption of calcium. It regulates proper bone mineralization and growth and modulates the immune function. Dietary sources of Vitamin D are limited, so synthetic Vitamin D is used. Some people argue that synthetic vitamins have poor assimilation in the human body and overdozing of milk especially with Vitamin D₃ may lead to toxicity. Studies on Indian school children fed on vitaminised milk have shown significant improvement in Vitamin D status due to consumption of Vitamin D fortified milk. The fortification levels are set by considering the potential toxicity. For instance, suggested daily requirement of Vitamin D is 400-800 IU/day and the level of fortification is set at 550 IU per litre of milk. Thus, consumption of 500 ml of milk every day will provide 50% of Vitamin D requirement, which is not anticipated to have any adverse health problem. Many dairy plants in India have been supplying fortified milk for the last several years and no reports on adverse effects are published.

The researchers in Latvia studied the bio-availability of Vitamin D in fortified milk and concluded that higher protein concentration in milk increases Vitamin D3 bio-availability. It may be advisable to fortify toned, double toned, skimmed milk and standardized milk within 5 ug to 7.5 ug per lit using cholecalciferol or ergocalciferol from plant source only (1 IU is equivalent to 0.025 ug or 1 ug is equal to 40 IU).

Vitamin A is yet another essential nutrient needed for the normal functioning of the visual/ optical activities, maintenance of cell function for growth, epithelial cellular health, immune function and reproduction. Vitamin A deficiency (VAD) causes night blindness and xerophthalmia symptoms. VAD is an important determinant of child survival rate and safe motherhood. WHO estimates that 254 million preschool aged children in the world have low serum retinol levels considered subclinical or clinical VAD. The best sources of vitamin A are animal products, particularly dairy products, green leafy vegetables, fruits and eggs. Studies indicate that improvement of Vitamin A status by supplementation or fortification decrease all-cause mortality in children aged between six months and five years by about 23%. Vitamin A deficiency also increases vulnerability to other disorders, such as iron deficiency.

The recommended level of fortification with Vitamin A is 270 to 450 ug as Retinyl acetate or palmitate. The fortificants should be drawn from plant source only.

Milk suppliers in India have begun fortifying milk with Vitamin A and D after the FSSAI have laid down new guidelines to combat common deficiency diseases. National level consultations were organized to make the industry aware of the desirability of fortification for public good. Tata Trusts have supported the initiative of fortification in Jharkhand and Assam to start the fortification of their milk variants. Mother Dairy sells about 25 lakh litres of fortified milk on daily basis. A couple of private dairies and cooperative plants have started fortifying milk. The plan is to fortify about 50% of country’s milk by 2019 and 80% by 2021. The cost of fortification is about two paise per litre.

Fortification is a complementary strategy to build a healthy nation and provide nutritional security to the population of the country. Make sure that milk you buy is pasteurized and fortified with Vitamins A & D.