There is a new cookie on the market which is vitamin fortified: WhoNu? cookies. Three of these cookies (one serving) provide 10 to 25% of twenty different vitamins or minerals, including 20% of the daily value of vitamin A. Since the daily value is 5000 international units (250 RAE), one serving of cookies (3 cookies = 36 grams) provides 1000 IU, or 50 RAE. And so 15 cookies (5 servings x 20%) provides 100% of the daily value. Unfortunately, this daily value is less than the RDA for any age group (900 RAE for males, 700 for females, ages teen through adult). Still, the daily value is more than sufficient to prevent blindness due to Vitamin A deficiency.
Can this type of product be used in developing nations? The problem is that the children most at risk for Vitamin A deficiency are also least likely to be eating processed foods, like cookies, on a regular basis. We could say the same about vitamin fortified cereals and vitamin fortified milk. The children most in need of Vitamin A are least likely to eat these foods. I should point out, though, that cereals and milk typically only offer 10% of the daily value. These WhoNu? cookies have stepped it up a notch by offering 20% in 3 cookies. What child would consider 3 cookies to be sufficient? These cookies, or a similar fortified food, could be useful in getting a variety of vitamins and minerals to children.
But to reach those most in need, we would need to fortify some type of food that is commonly consumed by the poorest of the poor in the world, and especially by children. In Guatemala, they have had much success with a program to fortify sugar. This article, Fortification of Sugar with Vitamin A, details the program in Guatemala. The cost was minimal, and the effect on blood levels of Vitamin A in children was substantial. Sugar is of course a preferred food of children, and refined sugar is a common staple food, even among the poor.
This study The Costs and Effectiveness of Three Vitamin A Interventions in Guatemala compares (1) the sugar fortification program in Guatemala to (2) a Vitamin A capsule distribution program, and (3) a gardening and nutrition education program.
1. the fortified sugar program – reaches an estimated 90% of the population. However, the program is much less effective at reaching rural populations, who generally do not buy and use much refined sugar.
2. the capsule distribution program – reaches a much smaller percentage of the population, mainly in urban areas. The program has difficulty consistently dispensing capsules to the same children on a continuing basis. Again, the rural population is largely unaffected.
3. the gardening program – reaches mostly rural families. The program has limited usefulness in urban areas, where there is little space for gardening. Compliance and monitoring is problematic. Growing vegetables with Vitamin A does not guarantee that the children most in need will eat those vegetables.
All three approaches were helpful to thousands of children, but the sugar fortification program (which continues today) reaches the vast majority of the population. A gardening and nutrition education program could supplement sugar fortification especially in rural areas.
Other Possible Approaches
The rural poor in most nations will grow much of their food locally. The most common staple foods in these populations are grains (rice, wheat, barley, maize) and tubers. Introducing an adjunct staple food, such as sweet potato, would greatly increase the Vitamin A intake of the population. The difference between this approach and the ‘gardening and nutrition’ approach, is that staple foods are eaten by nearly all persons in a population, whereas vegetables from the garden might not be.
Changing the staple foods of a population is difficult. Cultural influences and personal preferences influence food choices. On the other hand, the poorer members of society tend to have fewer food choices. A new food offering might be more readily accepted, for the sake of variety if not nutrition. Sweet potatoes do not have a particularly strong taste; they are not so different in texture and flavor from other tubers. And so they are not so different from foods that are already well-accepted. Also, sweet potatoes are easy to prepare (boiling, baking) and easy to add to other foods (stews, soups) without changing the flavor to a great extent.
Sugar fortification is not effective among the rural poor, because they tend not to buy and use refined sugar on a regular basis. But the one processed food product that they do buy regularly is cooking oil. Even a rural family that grows their own food will usually not press their own oil. They buy cooking oil. The same is true of the poor in urban areas. Cooking oil is one of the most widely used and inexpensive staple foods.
Vitamin A fortification of cooking oil has not been attempted on a grand scale (to date, as far as I know). But it is interesting to note that the sugar fortification program in Guatemala uses oil as a carrier for the Vitamin A palmitate. Therefore, there is no technological obstacle to fortifying cooking oil with Vitamin A. The types of oil that have been tested and are considered adequate as a carrier for Vitamin A fortification are corn oil, palm oil, soybean oil, cottonseed oil, and sunflower oil. These are all commonly used food oils throughout the world.
A cooking oil Vitamin A fortification program could possibly reach that percentage of the population in rural areas who are not reached by sugar fortification and capsule distribution programs.