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Rice Fortification: An Emerging Opportunity to Contribute to

the Elimination of Vitamin and Mineral Deficiency Worldwide

Article  in  Food and Nutrition Bulletin · December 2012

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Rice fortification: An emerging opportunity to
contribute to the elimination of vitamin and mineral
deficiency worldwide
Sumithra Muthayya, Jessica Hall, Jack Bagriansky, Jonathan Sugimoto, Daniel Gundry,
Dipika Matthias, Shane Prigge, Peter Hindle, Regina Moench-Pfanner, and Glen Maberly
Abstract
Vitamin and mineral deficiencies are ranked among the
top causes of poor health and disability in the world.
These deficiencies damage developing brains, impair
learning ability, increase susceptibility to infections, and
reduce the work productivity of nations. Food fortifica-
tion is a sustainable, cost-effective approach to reducing
vitamin and mineral deficiency. As the staple food for an
estimated 3 billion people, rice has the potential to fill an
obvious gap in current fortification programs. In recent
years, new technologies have produced fortified rice ker-
nels that are efficacious in reducing vitamin and mineral
deficiency. There are opportunities to fortify a significant
share of rice that comes from large mills supplying cen-
tralized markets and national welfare programs in major
rice-growing countries. The rice export markets, which
handle 30 million MT of rice annually, also present a key
fortification opportunity. The cost of fortifying rice is only
1.5% to 3% of the current retail price of rice. Countries
that mandate rice fortification have the strongest evi-
dence for achieving wide coverage and impact. The Rice
Fortification Resource Group (RiFoRG), a global network
of public and private partners that offers technical and
Sumithra Muthayya, Jessica Hall, and Glen Maberly are
affiliated with the Centre for Health Innovation and Partner-
ship, NSW Health, North Parramatta, New South Wales, Aus-
tralia; Jack Bagriansky is affiliated with JBPHN Ltd, Decatur,
Georgia, USA; Jonathan Sugimoto is affiliated with the Fred
Hutchinson Cancer Research Center, Seattle, Washington,
USA; Daniel Gundry and Dipika Matthias are affiliated with
the Program for Appropriate Technology in Health, Seattle,
Washington, USA; Shane Prigge is affiliated with the World
Food Programme, Regional Bureau–Asia, Bangkok; Peter
Hindle is affiliated with P&J Communications, Morpeth,
Northumberland, UK; Regina Moench-Pfanner is affiliated
with the Global Alliance for Improved Nutrition, Geneva.
Please direct queries to the corresponding author: Sum-
ithra Muthayya, Centre for Health Innovation and Partner-
ship, NSW Health Bldg 52B, Cumberland Hospital, 5, Fleet
Street, North Parramatta, NSW 2151, Australia; e-mail: sumi.
muthayya@gmail.com; Sumithra.Muthayya@swahs.health.
nsw.gov.au.
296 Food and Nutrition Bulletin, vol. 33, no. 4 © 2012, The United Nations University.
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advocacy support for rice fortification, has a vision of
promoting rice fortification worldwide. It has a targeted
approach, engaging multisector partners in key countries
where the opportunities are greatest and there is recep-
tivity to early adoption of large-scale rice fortification.
The challenges are real, the imperative to address them
is powerful, and the opportunities to deliver the promise
of rice fortification are clear.
Key words: Rice fortification, rice fortification resource
group, undernutrition, vitamin and mineral deficiency
Introduction: The problem
The Food and Agriculture Organization (FAO) esti-
mates that close to 1 billion people are currently under-
nourished [1]. High and volatile food prices are further
forcing vulnerable populations deeper into poverty and
hunger [2]. There is evidence to suggest that poorer
households, those most affected by the food crisis, are
shifting away from food items such as meat, fish, and
dairy products as well as vegetables and fruits that are
richer in vitamins and minerals (also known as micro-
nutrients), while continuing to consume less nutritious,
staple foods that are less expensive and provide essen-
tial calorific input [3]. With current intakes of vitamins
and minerals already too low, this shift imposes an even
higher burden of deficiency on vulnerable populations.
Around the world, an estimated 2 billion people
(about 30% of the global population) are affected by
vitamin and mineral deficiency (VMD). The human
and economic costs of VMD are enormous, falling
hardest on low -income women and children. Accord-
ing to a 2009 global report, these deficiencies have seri-
ous adverse health consequences worldwide, including
1.1 million child deaths due to vitamin A and zinc
deficiencies, 136,000 maternal and child deaths due to
iron-deficiency anemia, 350,000 children becoming
blind due to vitamin A deficiency, 150,000 babies with
severe birth defects due to inadequate maternal folic
Rice fortification and vitamin and mineral deficiency
acid intake, 18 million babies born mentally impaired
because of maternal iodine deficiency, and 1.6 billion
adults with reduced productive capacity due to anemia
[4]. These losses represent 7.3% of the global burden of
disease and US$180 billion annually [5, 6]. The imple-
mentation of sustainable, food-based interventions to
address VMD is essential to help nations make progress
toward the achievement of the Millennium Develop-
ment Goals by 2015.
Food fortification: A key intervention
The Lancet series on “Maternal and Child Undernutri-
tion” includes fortification of foods with micronutrients
among the key interventions with a history of dem-
onstrated impact in reducing VMD, undernutrition,
death, and disease [7]. The Copenhagen Consensus, an
expert panel of world-renowned economists, including
six Nobel Prize winners, ranked fortification of foods
with vitamins and minerals among the top three most
cost-effective international development priorities [8].
Food fortification is a supporting and complementary
strategy to other interventions, such as supplemen-
tation and dietary diversification, and can deliver
sustainable improvements in health to large segments
of the world’s population. Mass fortification of staple
foods does not require a change in dietary patterns
of the population. People consume their normal por-
tions but receive a significant added proportion of the
daily requirement for micronutrients [9]. However, the
experience of the past century demonstrates that it does
require a high level of political commitment to imple-
ment food fortification as a mandatory requirement.
The most successful fortification programs are those
in which governments have created a supportive policy
and legislative environment for both public and private
partners to work together; this includes a properly
regulated market environment with strong support-
ive food laws and implementing regulations that are
actively monitored and enforced. The rising concerns
about global and national food quality and safety
can be harnessed and extended to include protecting
populations from VMD. Based on public–private col-
laboration, the world has seen a dramatic reduction
in iodine deficiency through salt iodization over the
past two decades. Currently 125 countries have salt
iodization programs [10]. Flour fortification has also
been implemented successfully for more than 60 years,
starting with the United States. Since 2004, the number
of countries requiring fortification of flour with at least
iron or folic acid has increased from 30 to 74 [11].
However, there are major gaps in the elimination of
VMD, especially in large rice-consuming populations.
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297
Rice fortification: An underutilized
opportunity
As the major food staple for an estimated 3 billion
people, rice has the potential to fill an obvious gap
in current fortification programs, in particular in
low-income and food-deficit countries, where there is
widespread VMD. A large proportion of the population
in these countries, particularly infants and young chil-
dren, pregnant and lactating women, and the elderly,
suffer from high rates of VMD. Rice provides up to
60% of their daily energy requirement and a substantial
part of their protein intake, and is therefore crucial for
nutrition security [12, 13]. At the recent World Bank–
International Monetary Fund spring meetings held in
April 2011 before the G20 meetings, the head of the
World Bank urged the adoption of rice fortification
as a means to improve nutrition for millions of people
facing hunger [14]. To benefit those communities that
are not covered by current fortification vehicles, it is
time to catalyze action and introduce new fortified rice
technologies on a large scale.
New technologies to fortify rice using an improved
coating method and cold and hot extrusion techniques
have recently been shown to have the potential to
address VMD [15, 16]. The fortified rice kernels now
being produced have been shown to have improved
sensory characteristics (e.g., taste and appearance) as
well as improved vitamin and mineral retention during
distribution, washing, and cooking. Work is currently
under way to quantify the vitamin and mineral reten-
tion during the various rice fortification techniques.
There are emerging data to support the observation
that fortified rice is also acceptable to consumers.
Compared with the increases in rice prices of up to
50% over the last few years [17], the marginally higher
cost of fortified rice may be affordable even to poorer
populations for whom the health benefits are expected
to be substantial.
Loss of vitamins and minerals in rice
milling
The milling of paddy rice removes the outer hull, germ,
and bran layers to produce brown rice. Further milling
of brown rice to remove the bran layer yields white rice
[15]. On average, paddy rice produces 25% hulls, 10%
bran, and 65% white rice [18]. Rice milling results in
the loss of a significant proportion of B vitamins and
minerals such as iron and zinc that are found predomi-
nantly in the outer germ and bran layers (fig. 1) [15,
19]. Additionally, washing or rinsing rice prior to cook-
ing and certain cooking methods can result in further
losses of these nutrients [9]. It is worth noting that the
298 S. Muthayya et al.

Unmilled rice Milled rice

100

80

60

%
40

20

0
g)

g)

g)

g)

g)

g)

g)

g)

g)

g)

g)
g/

g/

g/

g/

g/

g/

g/

g/

g/

g/

g/
(µ

(µ

(µ

(µ

(µ

(µ

(m

(m

(m

m
(

(
id

in

nc

um

us

er
B

B
1

ac

ot

Iro

pp
in

in

in

in

or
Zi
Bi

lci
m

lic

ph

Co
Ca
ta

ta

ta

ta

Fo

os
Vi

Vi

Vi

Vi

Ph
FIG. 1. Percent rice milling losses of vitamins and minerals. Source: adapted from Dexter [15]
and Bauernfeind and DeRitter [19]

natural vitamins and minerals in rice grains are not all
readily bioavailable; however, fortification can ensure
that vitamins and minerals are restored to rice in a bio-
available form to provide intakes that will reduce VMD.
Innovations in rice fortification
Rice fortification technologies
Until a few years ago, technical challenges around
fortifying rice were still being resolved. Fortifying rice
by “dusting” it with a powdered mixture of vitamins
and minerals that adheres to the grains by electrostatic
forces resulted in high losses of micronutrients in
cooking, particularly when the rice was rinsed before
cooking or the excess cooking water was discarded,
which are common cooking processes [20]. A more
advanced and relatively inexpensive coating method
was developed that involved spraying several layers
of a liquid mix of vitamins and minerals onto rice
grains and covering them with an outer waxy layer to
produce fortified rice kernels that are later blended
with natural rice. The coating method is reported to
effectively prevent nutrient losses during washing [21].
Early reports estimated cooking losses of less than 1%
for added thiamine, pyridoxine, niacin, vitamin E, folic
acid, iron, calcium, and zinc from rice fortified by this
method [22]. Additional studies on vitamin and min-
eral losses during washing and cooking and the efficacy
and effectiveness of fortification of rice by the coating
technique are ongoing.
In recent years, new technologies with innovative
features have been developed to produce fortified
“faux” rice kernels using extrusion technology [15,
16]. In the extrusion method, dough made from rice
flour and a premix of vitamins and minerals is passed
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through an extruder to produce rice-shaped kernels.
These kernels are blended with natural rice during
milling (at a 1:200 to 1:50 ratio) to produce fortified
rice. The nutrients embedded in the extruded fortified
kernels are effectively protected during washing and
cooking. The process uses low-cost broken rice as raw
material, and kernels can be made to customers’ spe-
cific requirements of shape, color, and nutrient content
to match the rice with which the fortified kernels are
to be blended.
Research on extrusion technologies began in the
early 1990s. Since then, a number of studies have dem-
onstrated the stability, acceptability, and effectiveness
of extruded rice kernels [23, 24]. There are two general
types of extrusion technology—hot and cold extru-
sion—both of which have been studied and proven to
be effective. In the hot extrusion process, the dough
is passed through a single or twin screw extruder at
relatively high temperatures (70° to 110°C), which
results in a consistency and translucency that are very
similar to those of natural rice [16]. The cold extrusion
method uses a similar process at a lower temperature
(below 70°C), often using a pasta press to produce rice-
shaped fortified kernels that closely resemble natural
rice but are slightly more opaque [16]. There are also
hybrid extrusion methods in which the dough under-
goes some heat treatment prior to extrusion but is then
passed through an extruder at low temperature (below
70°C) to produce similar effects. An evaluation of the
retention of iron and vitamin B1 in rice fortified by both
hot- and cold-extruded rice kernels showed that both
products retained 100% of iron and between 83% and
63% of vitamin B1. Iron and vitamin B1 contents were
determined after rigorous preparation and cooking
methods, including rinsing several times, soaking in
water for 30 minutes, and even frying some samples
prior to cooking [25, 26]. Both hot- and cold-extruded
Rice fortification and vitamin and mineral deficiency
grains were also found acceptable in a study in which
50 consumers rated each product on a seven-point
hedonic scale [26]. Another study found both hot- and
cold-extruded rice products to be well accepted by
schoolchildren, their parents, and their teachers based
on their organoleptic properties.*
Biofortification
Biofortification of rice offers a unique opportunity
to grow rice varieties with a higher content of vita-
mins and minerals, either through selective breeding
of rice crops that are naturally high in micronutri-
ents or through transgenic techniques that modulate
gene expression in the rice crop to accumulate more
micronutrients in the kernel [27]. It is thought that
conventional plant breeding approaches could provide
varieties of rice with 400% to 500% higher iron content
than the varieties commonly consumed in much of
Asia. Efforts are under way to resolve issues around
establishing a stable cultivar that will continue to pro-
duce good yields and also deliver substantial amounts
of vitamins and micronutrients that are bioavailable to
humans. These approaches could be complementary in
instances where some iron or zinc is already consumed
from these crops and fortification makes up the gap
in the amount or type of deficiency not corrected by
biofortification.
Considerations in the choice and level of
vitamins and minerals to add to rice
Since deficiencies of several micronutrients commonly
occur together in the same population, fortification of
rice with multiple vitamins and minerals, such as iron,
zinc, vitamin A, folic acid, vitamin B12, and other nutri-
ents, is recommended. However, the choice of vitamin
and mineral fortificants and the appropriate amounts to
add to rice should take into account a number of factors
[9]. These include the nutritional needs and deficiency
rates of the population, the estimated population cover-
age and per capita consumption of “fortifiable” rice, the
sensory and physical effects of the fortificant on rice
products, fortification of other food vehicles, dietary
intake and consumption of vitamin and mineral sup-
plements, cost, and feasibility. The suitability of the
fortificant (iron, for instance) to be added to rice must
be assessed due to significant differences in the bio-
availability of the various available compounds. The
fortification guidelines endorsed by the World Health
Organization (WHO) for wheat flour provide a good
indication of fortificant levels appropriate for rice.
Selection of appropriate fortificants and their levels
* Frank Wieringa. Acceptability of fortified rice in a WFP
school meal program in Cambodia, 2010 (unpublished).
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299
for rice fortification is currently under consideration
by a global expert group under the guidance of WHO.
Evidence of biological efficacy of fortified
rice
Several controlled research studies conducted among
children and young women have demonstrated that
regular consumption of rice fortified with adequate
levels of iron and other micronutrients significantly
improves anemia and micronutrient status. In 1948, a
large-scale pilot study in the province of Bataan in the
Philippines demonstrated the efficacy of of rice forti-
fied (coated) with thiamine, niacin, and iron in pre-
venting beri-beri [28]. After 1 year of implementation,
a significant reduction in mortality from beri-beri was
noted in the half of the province that received fortified
rice. By the second year, mortality from beri-beri was
virtually eliminated. In later years, Flores and col-
leagues reported acceptable bioavailability of vitamin A
in fortified rice in a study of 83 poor Brazilian children.
The relative dose response test was either positive or
negative in the children who were fed rice fortified
with vitamin A, in agreement with their serum retinol
levels [29]. More recently, several randomized, con-
trolled trials investigating the efficacy of rice fortified
with iron, with or without additional micronutrients,
have been successful in reducing the prevalence rates
of anemia, deficiencies of iron and other micronutri-
ents and improving micronutrient status in rice-eating
populations (table 1). In India, extruded rice fortified
with iron when fed to 6- to 13-year-old children, as
part of a school lunch meal, improved body iron stores
and decreased the prevalence of iron deficiency [30].
In another study, mean plasma ferritin concentration
and body iron stores were significantly higher while
transferrin receptor levels were lower in Mexican
women following a 6-month intervention with iron-
fortified rice [31]. A home-based effectiveness trial
among mildly anemic 6- to 24-month-old Brazilian
children reported that giving iron through extruded
fortified rice was more effective in decreasing anemia
and improving iron status than giving equal amounts
of iron through iron supplements [32]. Angeles-
Agdeppa and colleagues reported that rice fortified
with iron either as ferrous sulphate or micronized
dispersible ferric pyrophosphate was similarly effica-
cious in improving the hemoglobin concentrations
and reducing iron-deficiency anemia among school-
children when fed over a period of at least 6 months
[33]. Another Indian study providing a mid-day meal
of iron-fortified rice to schoolchildren over 8 months
showed a reduction in the prevalence of iron deficiency
from 33% to 14% and a significant improvement in iron
(serum ferritin) stores. However, the increase in hemo-
globin was similar between groups, suggesting that
300 S. Muthayya et al.

TABLE 1. Evidence of efficacy of fortified rice in improving the prevalence of anemia and deficiencies of iron and other
micronutrients in different settings
Study site, duration, Change in anemia Change in iron defi-
and design Daily dose Subjects prevalence ciency prevalence Ref.
India, 7 mo, rand- 20 mg iron (MFPP) Schoolchildren; From 30% to 15% in From 78% to 28% in 31
omized, double- 6–13 yr; n = 184 the iron-fortified the iron-fortified
blind, controlled group group
trial From 28% to 27% in From 78% to 49% in
the control group the control group
Mexico, 6 mo, ran- 13 mg iron (MFPP) NPNL women; From 21% to 4% in From 33% to 23% in 32
domized, placebo- 18–49 yr; n = 201 the iron-fortified the iron-fortified
controlled trial group group
From 20% to 13% in From 27% to 28% in
the control group the control group
Brazil, 5 mo, rand- 23 mg iron (MFPP) Infants and young From 100% to 69% From 69% to 25% in 33
omized, double- children; 0.5–2 yr; in the iron-forti- the iron-fortified
blind, home-based n = 175 fied group group
trial From 100% to 86% From 77% to 53% in
in the control the control group
group
Philippines, 6 mo, 13 mg iron (FeSO4 Schoolchildren; 6–9 From 100% to 38% — 34
randomized, or MFPP) yr; n = 180 in the FeSO4-forti-
double-blind, con- fied group;
trolled trial From 100% to 33%
in the FePP-forti-
fied group
From 100% to 63%
in the control
group
India, 7 mo, double- 19 mg iron (MFPP) Schoolchildren; From 40% to 14% in From 33% to 14% in 35
blind, placebo- 5–11 yr; n = 140 the iron- fortified the iron-fortified
controlled trial group group
From 38% to 16% in From 33% to 37% in
the control group the control group
India, 6 mo, rand- 12.5 mg or 6.25 mg Schoolchildren; From 59% to 62% in From 5% to 7% in 36
omized, double- iron (MFPP) 6–12 yr; n = 258 the iron-fortified the iron-fortified
blind trial 0.5 mg vitamin A (12.5 mg) group (12.5 mg) group
0.38 mg thiamine From 61% to 39% in From 9% to 14% in
5 mg niacin the iron-fortified the iron-fortified
0.38 mg vitamin B6 (6.25 mg) group (6.25 mg) group
0.75 µg vitamin B12
75 µg folic acid From 62% to 54% in From 7% to 12% in
3 mg zinc the control group the control group
FeSO4, ferrous sulfate; MFPP, micronized ferric pyrophosphate; NPNL, nonpregnant, nonlactating

other factors beyond additional iron intake had a large Cost of fortified rice
influence on hemoglobin concentration [34]. A recent
trial of extruded rice grains fortified with multiple The processes involved in fortification add extra costs
micronutrients reported significant improvements in to rice that are minimal when compared with the health
vitamin B12 status and physical performance in Indian and economic costs associated with populations expe-
schoolchildren [35]. These studies demonstrate that riencing high levels of VMD. The initial capital invest-
rice can now be fortified effectively for real-life situ- ments to be made for centralized facilities to produce
ations. Additional studies confirming the efficacy of fortified rice kernels (for later addition to normal rice)
fortified rice in improving population zinc, folic acid, using the coating, cold extrusion, and hot extrusion
and vitamin B12 status are needed. methods are approximately US$0.30 million, US$0.75
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Rice fortification and vitamin and mineral deficiency 301

TABLE 2. Cost of fortified rice produced from different rice fortification technologies
Estimated cost Estimated cost
Retail rice price of rice premix of rice fortifica- Retail price
Country (US$/kg) Technology (US$/kg) tion (US$/MT) increase (%)
China 0.50 Hot extrusion 2.00 15.0 2–4
Philippines 0.55 Coating 2.00 10.0 1.8
Costa Rica 0.63 Cold extrusion 2.11 10.5 1.7
India 0.52 Cold extrusion 1.50 14.7 1.5–2.5
Source: adapted from A2Z Project [16].

million, and US$4.0 million, respectively. These capital
costs will vary widely depending on the location and
capacity of the rice fortification facility. The cost of
production of fortified rice kernels is expected to be
reduced considerably if countries go to scale with rice
fortification and if the processing equipment is pro-
duced locally or regionally.
Ideally, rice millers would be responsible for the
relatively minor capital investment in machinery, staff
training, and establishing quality assurance systems to
incorporate such kernels, thus producing fortified rice
that conforms to government standards. The govern-
ment would be responsible for overall food control,
monitoring, and evaluation. Ultimately, a part of the
cost of fortification will be borne by the consumer,
either directly through the market price of rice or
indirectly through any government subsidies [16]. The
incremental increase in cost to fortify 1 kg of rice has
been calculated to be around 1.5% to 3% of the current
retail price of rice. To provide further perspective, the
cost to fortify 1 MT of rice is only approximately US$6
to US$20, and the cost of providing a child a school
lunch meal of fortified rice daily for an entire year
would be around US$0.40 (40 cents). However, the
total costs incurred by governments to subsidize large
school meal programs supplying fortified rice, such
as that in India, could be substantial. This investment
will pay off several fold with improved health, lower
healthcare costs, and improved productivity. The esti-
mated additional costs of fortifying rice with vitamins
and minerals using the various technologies in selected
rice-eating countries are shown in table 2. It is probable
that economies of scale and competitive markets will
lower these costs considerably, as more countries take
up rice fortification.
Global opportunities for rice fortification
Major producing and consuming nations
Rice is a globally produced, milled, and traded staple
food with an annual production worldwide of about
450 million MT. Fifteen countries account for 92%
of the world’s rice harvest, and approximately 90% of
the world’s rice is grown in Asia, as shown in figure 2

Proportion of global
rice production (%)
1.0–1.9
2.0–4.9
Rice fortification
5.0–9.9
None
Planned 10.0–19.9
Medium or small scale
≥20.0
National requirement or large scale

FIG. 2. Global map of rice production and rice fortification activities

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302
[36–38]. For these rice-growing countries, which are
as varied as China, India, Indonesia, Bangladesh,
Vietnam, Brazil, Pakistan, and Egypt, there may be
opportunities to fortify a reasonably significant share
of consumed rice that comes from large mills. Rice con-
sumption is also among the highest in Asian countries,
with Brunei Darussalam, Vietnam, Laos, Bangladesh,
Myanmar, and Cambodia reporting intakes of over 400
g of rice per capita per day (fig. 3). Other countries in
the Pacific Islands region, West Africa, and South and
Central America consume rice as their staple food in
significant quantities.
Rice can be fortified on a large scale in large rice
mills, commercial retail distribution centers, or large
supermarkets. However, in most rice-growing coun-
tries, milling takes place in thousands of small and
medium-sized mills and fewer large industrial facilities.
This is likely to change over time, as there are indica-
tions that the rice industry is consolidating to include
more medium and large mills in many rice-growing
countries. Small-scale fortification using simple blend-
ers is being tested in small rural mills, where most of
the rice is locally grown and consumed and where the
classic fortification technology is difficult to apply.
However, past experience with small-scale operations
has raised concerns about their sustainability in the
long term.
Exporting and importing nations
Approximately 30 million MT of rice (8% of global
rice production) is internationally traded annually,
enough to supply about 800 million people with 100
g daily throughout the year [36–38]. The importing
Proportion of global
milled rice (%)
Imports Exports
0.5–0.9
1.0–2.9 1.0–2.9
3.0–4.9 3.0–4.9
≥ 5.0 5.0–9.9
10.0–19.9
≥20.0
FIG. 3. Global map of rice consumption, imports, and exports
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S. Muthayya et al.
and exporting of rice is a large-scale enterprise that is
concentrated in 12 countries, which account for more
than 90% of this global rice trade (fig. 3). About half
of this international trade is supplied from Thailand
and Vietnam. While there appears to be a lack of
information on a full industry analysis of rice forti-
fication feasibility, the supply chain that runs from
producer to mill to distribution warehouse to loading
container ships may have a number of critical points
where fortification can be applied. The opportunities
to fortify internationally traded rice are concentrated
among only a few countries and need to be further
researched, identified, and developed. Many countries
import significant quantities of rice to meet national
food security needs, and these tend to be among the
world’s least developed countries (fig. 3). Although
rice represents less than 10% of all cereal imports on
a global basis, it accounts for 25% to 33% of cereal
imports to the least developed countries, according
to the FAO. Some regions are particularly dependent
on imports and may offer short-term opportunities to
develop rice fortification [36, 37].
Humanitarian food aid: Showcasing the United
Nations World Food Programme
Over the past decade, between 0.5 and 1.5 million
MT of rice has been provided annually in the form of
international food assistance. The largest global pro-
vider of food assistance, the World Food Programme
(WFP), is one of the key organizations exploring
the potential of fortified rice. WFP’s commitment to
determining the feasibility of using fortified rice in
its own programs could bring immediate benefit to a
Per capita rice
consumption (g/day)
No data
<50
50–99
100–199
200–299
≥300
Rice fortification and vitamin and mineral deficiency
significant proportion of the poorest rice-consuming
populations in some of the most remote places in the
developing world. WFP is conducting operational trials
to determine how fortified rice could be provided in
its programs. Yet, WFP recognizes that there is even
greater potential beyond its own operations and sees
an opportunity to advocate for and encourage invest-
ments in national safety net programs by supporting
rice fortification technology. WFP’s broader vision is
to see fortified rice on commercial markets at prices
within reach of the poor. A commitment by donors and
organizations operating food assistance programs to
utilize fortified rice can begin to build the experience,
systems, and supply chain needed for large-scale com-
mercial rice fortification programs. As this happens, a
broader advocacy with governments of rice-consuming
nations is needed to galvanize support for its usage.
West Africa: Opportunities to import fortified rice
According to the US Department of Agriculture For-
eign Agriculture Service, “The largest rice-importing
region in the world is Sub-Saharan Africa,” which is
supplied mainly from southeast Asian countries [37].
The structure of rice consumption and trade in West
Africa may offer some significant opportunities for
rice fortification. With a population of 270 million
and widespread micronutrient deficiencies, this region
relies on a basket of five staple cereals: maize, millet,
sorghum, wheat flour, and rice. The average per capita
rice consumption is 31.3 kg per year or about 22% of
total cereal intake. In some countries, such as Guinea,
Sierra Leone, Guinea-Bissau, Senegal, Liberia, Côte
d’Ivoire, and Gambia, rice consumption is on a par
with that in Asian populations [36]. About 60% of rice
is imported by the large-scale rice trade, and an addi-
tional unknown share is produced by large domestic
processors. Therefore, it may be possible to fortify a
large proportion of the rice consumed in this region,
as part of a comprehensive program that supports the
fortification of oil with vitamin A and flour with vita-
mins and minerals. Blending a premix of fortified rice
grains could be done at source by exporting mills, or
potentially in large blending facilities in warehousing
facilities prior to distribution.
Pacific Island countries: Illustrative of the niche that
rice fortification could play
Most of the rice consumed in the Pacific Island coun-
tries is imported, with the trade being managed by
a handful of importing companies. The average per
capita rice consumption is more than 100 g per day in
several of these countries. At the Pacific Food Summit
in 2010, representatives from all of the 22 Pacific Island
countries included rice fortification as a food security
goal, which was further endorsed by the heads of state
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303
at the Pacific Island Forum in 2010. Since then, the gov-
ernments of several Pacific Island countries have been
exploring the next steps in implementing rice fortifica-
tion. The approaches being considered are intended to
maintain a level playing field in that all traders of rice
will all have to comply with the requirement of fortified
rice in the Pacific Island countries.
Illustrative global potential for rice
fortification: Progress in countries
The most obvious opportunity to scale up rice fortifi-
cation is the 30 million MT of internationally traded
rice that reaches the rice-importing and vitamin- and
mineral-deficient countries in Asia, West Africa, and
the Pacific island region. Countries with high rice pro-
duction, high per capita rice consumption, and VMD
are also an obvious target for this intervention. Before
the countries are ready to adopt a nationally required
fortification program, it may be possible to consider a
more targeted approach. Examples of this under early
consideration are the public distribution system (PDS)
in India and the RASKIN program in Indonesia. There
is also great potential for the use of fortified rice in sup-
plementary feeding programs, food stamp programs
(targeting children and women), and food for work
programs, which target those most in need. In the
medium short term, there are opportunities to fortify
rice in the large-production countries of the Mekong
Basin region. This could all add up to a reasonable goal
of seeing 30% of the world’s industrially milled rice
being fortified by 2030.
Competition on price is especially intense for staple
foods such as rice, and even a small incremental cost
can tilt the market in favor of producers or traders who
choose not to fortify. Therefore, to reach all rice con-
sumers, a national requirement for rice fortification is
a key policy requirement. Nearly two decades of experi-
ence with global salt iodization and flour fortification
programs indicate that only when such an approach is
adopted by countries can a level playing field be main-
tained that enables companies to invest in fortification.
However, when considering such an approach, policy
makers will need to implement changes in require-
ments in a way that will not be seen as a barrier to
international and regional trade obligations. Several
countries around the world are making significant
progress advancing rice fortification initiatives (fig. 2
and table 3).
National requirement for rice fortification
» The United States has been fortifying rice since
the 1970s with a nonuniform requirement for rice
fortification; rice fortification is mandatory in only
six states in the United States.
304 S. Muthayya et al.

TABLE 3. Rice fortification activities around the world

Vitamins
Date Fortification and minerals Scale and distribution
Country commenced technology added channels Population targeted
Brazil 2008 Extrusion Iron–FePP Large-scale General public
Zinc Distributed through com- Schoolchildren
Vitamin B1 mercial retail market, Low-income consumers
Vitamin B3 public sector programs
Vitamin B9
Vitamin B12
Vitamin A
Burundi 2011 Extrusion Iron–FePP Small-scale Schoolchildren
(imported) Zinc Distributed through food Food aid recipients
Vitamin B1 aid programs
Vitamin B9
China 2007 Extrusion Vitamin B1 Small-scale High-end market
Vitamin B3 Distributed through com- consumers
Vitamin B9 mercial retail market
Iron–FePP
Zinc
India 2008 Extrusion Iron–FePP Medium-scale Schoolchildren
Distributed through public Low-income consumers
sector programs, govern-
ment-subsidized shops
Indonesia 2011 Extrusion Iron–FePP Large-scale All age groups
Zinc Distributed through com- Low-income consumers
Vitamin B1 mercial retail market,
Vitamin B3 public sector programs
Vitamin B9
Vitamin B12
Colombia 2002 Extrusion, Iron–FePP National requirement General public
coating Zinc Distributed through com- Schoolchildren
Vitamin B1 mercial retail market,
Vitamin B9 public sector programs
Costa Rica 2001 Extrusion, Vitamin B1 National requirement General public
coating Vitamin B3 Distributed through com-
Vitamin B9 mercial retail market
Vitamin B12
Vitamin E
Selenium
Zinc
Dominican 2011 Extrusion Not yet Large-scale General public
Republic determined Distributed through com-
mercial retail market
Panama 2009 N/A Vitamin B1 National requirement General public
Vitamin B3 Distributed through com-
Vitamin B6 mercial retail market
Vitamin B9
Vitamin B12
Iron–FePP
Zinc
Papua New 2007 Coating Vitamin B1 National requirement General public
Guinea Vitamin B3 Distributed through com-
Iron–FePP mercial retail market
Philippines 2000 Coating, Iron–FePP National requirement General public
extrusion Iron–FeSO4 Distributed through gov- All population groups
ernment sector programs
and the open market
USA 1958 Coating Vitamin B1 Large-scale (70% of rice General public
Vitamin B3 available is fortified) All population groups
Vitamin B9 Rice fortification is required
Iron–FePO
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Rice fortification and vitamin and mineral deficiency
» All rice in Papua New Guinea has been required
by law to be fortified since 2007.
» In 2009, Nicaragua issued a Ministerial Resolution
that it was the responsibility of the rice producers
and traders to make sure that rice was fortified.
» In Costa Rica, mandatory regulations on rice for-
tification were issued in 2001.
» In 2009, Panama passed a food bill that requires
all rice to be fortified
» Since 2000, the Philippines has mandated the
fortification of rice with iron. Most of the fortified
rice is handled by the National Food Authority, a
quasi-governmental institution.
Large-scale rice fortification
» In Brazil, there are several fortified, rice-blended
products using kernels from either extrusion or coat-
ing technologies that are both sold in commercial
retail markets and distributed through public sector
food programs.
» In Colombia, several companies are currently selling
fortified rice brands through retail channels and the
government.
Medium- and small-scale rice fortification
» In India, multiple programs to fortify rice delivered
through the Government of India’s Mid-Day Meal
program have been implemented since 2008, reach-
ing nearly 200,000 beneficiaries.
» In China, a draft standard for rice fortification has
been prepared.
» Indonesia is building capacity at six rice mills to
produce 24,000 MT of iron-fortified rice to be deliv-
ered to approximately 800,000 people via Indonesia’s
public rice distribution program for the poor, the
RASKIN program.
Advocacy associations,
civil organizations
Civic
sector
RiFoRG
Private Public
sector sector
Millers, equipment UN agencies,
and rice-product companies, government agencies,
rice traders NGOs, academia
FIG. 4. Rice Fortification Resource Group (RiFoRG)
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305
Countries planning rice fortification
Countries such as Bangladesh, Cambodia, Burundi,
and Egypt are planning the introduction of fortified
rice into their national markets in the near future. Sev-
eral of the Pacific Island countries are considering the
introduction of fortified rice as an immediate solution
for micronutrient malnutrition and are indicating a
willingness to move forward as soon as possible.
Rice Fortification Resource Group: A global
partnership
The successful delivery of large-scale interventions,
including the fortification of rice globally, requires
broad-based multisectoral partnerships. In response to
the opportunity to advance rice fortification, a group
of global partners met in December 2009 in Sydney,
Australia. The group represented senior staff from the
United Nations, not-for-profit development organi-
zations, government health organizations, research
institutions, rice trading and producing companies,
mill manufacturers, and rice fortification technology
companies. The group discussed ways to promote the
uptake and implementation of rice fortification, over-
come barriers, and encourage nations and markets to
adopt rice fortification. This multisectoral group sup-
ported the creation of the Rice Fortification Resource
Group (RiFoRG) (fig. 4) to undertake activities in five
key areas:
» Widen the network of organizations by effectively
engaging rice millers and other industry groups to
be involved in this partnership;
» Support the development of national rice fortifica-
tion programs;
» Provide technical support for the development of
international guidelines on rice fortification by
WHO;
» Be a resource in technical, advocacy, and regulatory
matters relating to the fortification of rice;
» Build a website and effectively communicate useful
technical information and progress in rice fortifica-
tion efforts [39].
The RiFoRG secretariat, currently jointly managed
by the Center for Health Innovation and Partnership,
Sydney, and the Global Alliance for Improved Nutri-
tion, Geneva, helps stimulate and coordinate activi-
ties of the group and provides linkages to key global
partners actively working on rice fortification. Tasks
related to the building of the RiFoRG partnership,
collation of data relating to rice production and con-
sumption, and the feasibility of fortification are under
way in South and East Asia, Central America, and the
Pacific Islands (details at http://www.gainhealth.org/
riforg). RiFoRG partners are currently engaged with
the various channels and organizations involved with
306
the supply and consumption of rice in key rice-eating
countries.
Conclusions
Innovative and appropriate technologies for rice for-
tification are now available; however, the real benefit
of large-scale rice fortification has yet to be realized. If
this can be harnessed by countries over the next decade,
global-scale rice fortification could be among the main
contributing interventions that will ensure substantial
and sustained reduction of the global burden of dis-
ease attributable to VMD. Developing a successful rice
fortification global initiative faces many of the same
opportunities and challenges experienced with salt
iodization, as well as wheat and maize flour fortifica-
tion. Establishing a global rice fortification initiative is
an essential foundation for meeting the United Nations
Millennium Development Goals. Rice fortification is
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