New research highlights how fortified foods and breastfeeding can curb malnutrition—but warns that success hinges on stronger policies, better monitoring, and global collaboration.
In a recent review in the journal Frontiers in Nutrition, researchers collated, screened, and reviewed more than 70 publications to investigate interventions that could achieve optimal nutritional outcomes, particularly during a child's first 1,000 days from conception. The review focused on India's recent and expanding practice of food fortification.
The review confirms the critical importance of adequate nutrition during early life stages (conception till a child's second birthday). It highlights the roles of breastfeeding and food fortification in ensuring optimal developmental health. Its findings suggest that education campaigns and food fortification programs can substantially curb India's micronutrient deficiencies while acknowledging the bioavailability challenges of plant-based diets but emphasize the need for persistent political support and public-private partnerships to achieve these ideals.
Background
The initial 1,000 days of a child's life represent its most vulnerable and critical developmental phase. Research suggests that brain development and overall growth during this phase are unmatched throughout the child's life, emphasizing the need for high-quality, bioavailable nutrition to ensure long-term health. Notably, this phase starts at the child's conception, highlighting optimal nutrition for the mother across pregnancy, post-partum, and breastfeeding months.
"By the age of 2 years, 80% of a child's brain is developed."
Unfortunately, today's world features rampant malnutrition, with only a handful of countries meeting the United Nations (UN) Statistics Division's Sustainable Development Goals (SDG Report 2024). An alarming number of children under the age of five years exhibit key malnutrition indicators, including low birth weight, stunted growth, overweight, and exclusive breastfeeding, exacerbated by growing obesity, anemia, and wasting in their mothers.
The report finds that 191 UN member countries are 'off-track' in meeting globally agreed-upon nutrition requirements, highlighting the need for urgent government and policy intervention to combat this silent pandemic. Africa and Asia are epicenters of these suboptimal trends, with 20.4% and 8.1% of their populations facing constant hunger, respectively.
Scientists have proposed several interventions to counter the global food crisis, including diversified diets, lipid-based supplements, micronutrient powders, and fortified foods. However, the study also highlights that food fortification alone is not a silver bullet and must be complemented with behavioral change initiatives and improvements in dietary diversity. Food fortification may provide the most significant benefit to growing infants because it incorporates the eight essential nutrients required for optimal development – carotenoids, choline, iodine, folate, omega-3 fatty acids, iron, and vitamin D.
About the Review
The present review explores the potential benefits of food fortification in enhancing nutrition for a mother and her child during the latter's first 1,000 days since conception. Review material was collated from several online scientific and organizational repositories, including PubMed, Scopus, Google Scholar, the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), and the United Nations Food and Agriculture Organization (FAO).
"Studies related to both global and Indian fortification programs, policy notes, and opinion articles were included in addition to randomized controlled trials (RCTs), cohort studies, systematic reviews, case-control studies, and programmatic evaluations that addressed food fortification interventions and their impact on maternal and child health outcomes."
All potential publications were subjected to a two-stage screening process (title/abstract and full text) before review inclusion. Generalized studies (those not focusing on mother and infant nutrition), disease evaluations, and government policy reports were excluded from the review.
Review Findings
The review highlights the positive influence of food fortification programs in achieving optimal nutrition goals, particularly during a child's first 1,000 days of life. Wheat flour and cooking oil fortified with iron and folic acid can meet a pregnant mother's nutritional requirements, with research suggesting a 34% decrease in anemia risk, a 41% decrease in neural tube defects, reductions in vitamin A deficiency (VAD), and improved hemoglobin concentrations.
Large-scale food fortification programs (LSFFs) may provide a long-term solution to per capita food intake deficiencies, particularly relevant in India, where per capita nutrition intake is among the world's lowest. However, the study notes that while fortification has been effective, it also faces challenges such as variations in food processing methods, stability of added nutrients, and potential changes in taste and texture that could impact consumer acceptance.
Parallel breastmilk fortification programs and the establishment of human milk banks may further improve long-term health outcomes, especially for premature and low birth weight (LBW) infants, for whom routine breastmilk alone may be insufficient.
"The ordinary Indian population predominantly relies on plant-based diets, which often lack essential nutrients. Micronutrient deficiency in the Indian diet poses a significant health challenge, impacting millions across the nation."
Complementary feeding education should be inculcated in first-time mothers, emphasizing the importance of good-quality, nutrient-dense foods (rich in iron, essential fats, and protein) alongside continued breastfeeding following 6 months of their infants' age.
The Indian Context
India has piloted several nutrition initiatives, a subset of which funds and supports rice, salt, wheat flour, edible oil, and milk fortification. Furthermore, India's Integrated Child Development Services (ICDS), comprising Poshan 2.0, Saksham Anganwadi, and the Anganwadi Services Scheme, provide supplementary nutrition, education, and health services, particularly in vulnerable, rural, and underdeveloped regions.
Unfortunately, while the benefits of these programs are undeniable, underweight prevalence continues to persist across the nation, underscoring the need for better monitoring systems, technological interventions, and consumer education to ensure the success of fortification initiatives.
India’s nutrition challenge.
Recommendations
The review proposes five main recommendations to support, enhance, and sustain India's nutritional ideals:
- Sustained implementation of nutritional interventions, emphasizing both fortification and dietary diversity.
- Enhanced delivery systems.
- Improved monitoring mechanisms to ensure the stability and efficacy of fortified foods.
- Building the capacity of local institutions, including leveraging digital tools for better data tracking and outreach.
- Facilitating knowledge exchange between developing nations through Global South cross-pollination initiatives.
The authors believe that public-private partnerships, improved and widespread education programs, and, most importantly, continued government involvement and support are essential in curbing malnutrition across the country, thereby fostering a healthier tomorrow.
Additionally, the review highlights the need to expand human milk banking infrastructure to provide fortified donor milk as a lifesaving alternative for premature and low-birth-weight infants.