Greg S. Garrett, Alexi Ernstoff, Alison Cairns
Today in Geneva, the ground-breaking EAT-Lancet Report on Food, Planet and Health will be launched. This report highlights that the global food system is failing to meet global needs for healthy diets in an environmentally sustainable way. Solving this challenge is exacerbated in the face of rapid urbanisation and climate change which influences food provisioning as well as where and how crops grow.
Here we look at food fortification – the addition of vitamins and minerals to food supplies at the processing stage – and how it may be able to play a role in helping mitigate climate change.
The EAT-Lancet report argues strongly that we simply cannot continue to produce and consume foods in the same way and meet global health and environmental targets at the same time. The report further highlights needed attention on the environmental challenge of producing enough nutritious foods to satisfy a growing global population, building on years of previous studies. For example, a critical issue known for decades is that “hidden hunger” or micronutrient malnutrition – caused by insufficient levels of essential dietary vitamins and minerals – is adversely affecting the growth and development of around 2 billion individuals. Most of these individuals live in low- and middle-income countries (LMIC) where access to nutritious foods is often severely limited and unaffordable.
Alarmingly, climate change – and more specifically rising CO2levels – appears to be reducing the natural nutrient levels of many important staple foods consumed in LMIC. Important staples appear to now be gradually losing their nutritional value, with vitamin content and mineral levels dropping in correlation with rising CO2 levels. More research is required to quantify how climate change is influencing the micronutrient levels of staple crops. However, the apparent adverse nutritional outcomes of a carbon dioxide-rich atmosphere precautions to double down efforts to scale up the delivery of evidence-based, population-wide food system interventions which improve intakes of key micronutrients in LMIC. Furthermore, even the suggested diet recommended by the EAT-Lancet report will likely require supplementation or fortification of iodine, vitamin B12 and possibly riboflavin, which is relevant for people everywhere including in high-income countries where typical diets still lack these.
A variety of solutions are needed to combat micronutrient malnutrition in LMIC and to help address other deficiencies (e.g. protein) and ensure more sustainable and nutritious diets. Out of the potential solutions, one intervention with an abundance of evidence and which has been rolled out to counter micronutrient deficiencies in numerous populations, is large-scale food fortification (LSFF).
Global snapshot of food fortification
Food fortification has been around since the 1920s when Switzerland and the United States started adding iodine to table salt as an intervention to population-scale iodine deficiencies and associated health problems. With the success of this intervention historically, today over 100 countries implement national salt iodisation programmes[i]. In addition, 86 countries mandate at least one kind of cereal grain fortification, and over 30 mandate the fortification of edible oils, margarine and ghee as a response to large-scale micro-deficiency issues. Today, hundreds of millions of people around the world have benefited by fortified staple foods and condiments in their diets, both in developing and in developed countries where key nutrients may still be lacking in the average diet. Additionally, many billions more can still benefit from fortified foods in their diet, as laid out in this November 2018 food fortification policy brief.
Does the process of fortifying foods in any way further complicate the issue of climate change? Does fortification itself generate a significant environmental footprint?
Fortificants are manufactured and added to food stables using a variety of industrial processes which could impact the environment and food system. Yet for LSFF to be viable (i.e. reach a population with minimal external and ongoing investments), it must use existing food processing and delivery systems, which is why staple foods and condiments, such as cereals and salt, are selected as food vehicles. This means with LSFF there is no, or at least very minimal, demand for additional agricultural land or new infrastructure for staple crop production or distribution. Thus, by using existing food supply, it may generate only a negligible amount of greenhouse gases while improving intakes of essential vitamins and minerals.
In order to better understand the environmental impact of fortification, GAIN commissioned Quantis to screen LSFF’ impacts by calculating fortified foods’ carbon footprint in kilograms of CO2-equivalents. The purpose was to examine the potential impact of fortification and whether it could be a priority area for carbon footprint mitigation. The results are promising.
Quantis built on publicly available Life Cycle Assessment work done by DSM, a leading manufacturer of vitamin fortificants, as well as their internal life cycle inventory database in order to understand the relative impacts of fortification. As an example, producing a kilogram of iron sulfate has a carbon footprint of about 0.3 kilogram CO2-equivalent and iodine about 5 kilogram CO2-equivalent. To compare, staple foods such as maize and ghee butter generally have a carbon footprint between 0.6 and 2 kilogram CO2-equivalent per kilogram of food. Thus per kilogram the impacts of micronutrients can be similar or higher than the carbon footprints of staple foods.
However, fortificants are used in small amounts within foods for example in the range of 30 parts per million. Given the small quantity of vitamin or mineral added to the food, the carbon footprint of fortification is generally not more than 100 or 1000 times less impacting than the food itself. This suggests that when addressing key nutrient needs fortification is an interesting option to maintain environmental impacts of the food system without increasing food production. To put the environmental impacts of fortification at a large scale in perspective, we provide a provocative example: if per year 4 million women are pregnant in Indonesia with over 40% receiving 200 mg/day iron sulfate through fortification and supplementation to combat anaemia, this would result in only 30 tonnes of CO2-equivalent—roughly equal to only 15 transatlantic flights.
So, what does this mean for the future and food fortification?
Putting the environmental impacts of fortification into a systems perspective suggests that although it is important for vitamin and mineral fortificant producers to continuously improve the footprint of fortification processes, the overall impacts of producing the vitamin and mineral fortification is negligible to the carbon footprint of food systems. What’s more, the proliferation of innovation in new LSFF technologies and increase in renewable and low-carbon energy sources (e.g. solar) suggests society will have the ability to lessen the impact of fortification while simultaneously improving nutrient intakes among billions of people. Such innovations include new capacity being developed to fortify rice and tea, as well as create alternative protein sources.
With the EAT-Lancet and other scientific work suggesting a need for more sustainable protein consumption, fortification with alternative proteins, amino-acids and B vitamins will likely receive increasing attention. Protein and amino-acid fortification in particular can provide a compelling area of focus for future work as an intervention to prevent the greenhouse gases that would otherwise be generated through the production of animal source proteins. Currently, various lysine fortificants variably change the cost, colour and taste composition of foods so much more R&D is required to improve these organoleptic and cost issues, and further prove health impacts.
So, is food fortification the answer?
LSFF is no panacea for global nutrition security. But it is an important part of the solution to improve diets and micronutrient intakes, especially for iron and iodine for vulnerable low-income populations. It complements, rather than replaces, ongoing and often longer-term efforts to diversify diets and make nutritious foods more affordable and accessible, biofortify staples, and make crops more climate resilient. Given the global needs and food system impacts, fortification appears to be a climate friendly solution.
[i] Bhutta, Z. A., Das, J. K., Keats, E. C., Garrett, G. S., and Neufeld, L. (2019). Systematic evidence review and program analysis of large-scale fortification efforts for improving health outcomes in low and middle income countries. Accepted in AJCN May 2019.