I would be hardhearted enough to let the sick die if you can tell me how to prevent others from falling

sick

NIN-DFS

EVOLUTION OF THE NIN DOUBLE FORTIFIED SALT

S. Ranganathan & B. Sesikeran National Institute of Nutrition (ICMR) Ministry of Health & Family Welfare (GOI) Hyderabad 500 007
NIN-DFS

OUT COME OF IRON DEFICIENCY Infant/Maternal: Increased mortality and morbidity. Poor reproductive outcome: Still birth, poor fetal growth, prematurity, low birth weight, intra uterine deaths, etc. Immuno Competence : Reduced phagocytic activity of WBC. Children & Adults: Poor work capacity.
NIN-DFS

In India, 75% of infants, 80% of adolescent girls, and 85% of pregnant & lactating women suffer from anemia.

IODINE DEFICIENCY
Infancy & Childhood Adults
Goitre,

Still birth, abortions, Low Hypothyroidism, motor coordination,

Low Increased apathy, Impaired

scholastic (lowered

performance mental function, Decreased IQ), Juvenile initiative, Decreased power Goitre, of decision making,

hypothyroidism,

Retarded physical growth.

Reduced work output. NIN-DFS

 Iodine

deficiency during pregnancy causes about 6.6 million babies a year to be born mentally impaired in India. is about 26% in the country.

 TGR  IDD

continue to be a public health problem not only in Sub-Himalayan region, but also in the peninsula. Calls for immediate action.
NIN-DFS

STRATEGIES
TO OVERCOME IRON DEFICIENCY:  Promotion of consumption of foods rich in iron ? Bioavailability  Sensitization/Awareness time consuming  Folifer tablets supplement to risk group.  Iron Fortified Salt for all.
NIN-DFS

STRATEGIES
TO OVERCOME IODINE DEFICIENCY
 

NO SUITABLE FOOD RICH IN IODINE IODIZED SALT

NIN-DFS

NIN-DFS

NIN-DFS

IMPORTANCE OF SALT
 Salt is universally consumed  Constant daily intake. Low potential for excessive intake.  Production of salt is limited to few centers.  Ideal vehicle for Iodine/Iron fortification.  Iodine & Iron introduced through salt will be ingested by each individual at a uniform dosage throughout NIN-DFS the year.

CHRONOLOGY OF DEVELOPMENT OF SALT FORTIFICATION TECHNOLOGIES AT NIN IRON FORTIFIED SALT (IFS)
1. 2. 3. 4.

5. 6. 7.

FePO4 & NaHSO4: AJCN 1975;28: 1395 - 401. FeSO4 & OPA: AJCN 1978; 31: 1112 - 14. Multicentric Efficacy study: Hyderabad, Delhi, Madras, Calcutta. AJCN 1982; 35: 1442 - 51. (FNB). FeSO4 & SHMP: Colourless IFS. Food Chemistry 1992; 45: 263 - 67. Large-scale production: J Food Sci Technol 1993; 30: 166 - 68. Successful Transfer of Technology to TNSC (1991). 200 - 300 MT/month. FGS alone: Food Chemistry 1996; 57: 311 - 15. Ultra-structural differences of IS, IFS & DFS: SCANNING. Journal of Scanning Microscopies 1998; 20: 271 - 73.
NIN-DFS

CHRONOLOGY OF DEVELOPMENT OF SALT FORTIFICATION TECHNOLOGIES AT NIN (Contd..) IODIZED SALT (IS)
Stable IS with KI or KIO3 using CO3 stabilizer CaCO3: Dry mixing. Lab studies: Indian Food Industry 1. 1986; 5: 122 - 24. 2. CaCO3, MgCO3: Factory. Long distance transport. Asia Pacific J Clin Nutr 1997; 6: 92 - 94. 3. CO3 of Na: Spray mixing. Factory. Long distance transport. Salt 2000 8th Salt Symposium, Vol 2, RM Geertman, 2000; 1051 - 56, Elsevier. 4. IS stable after 15 months even at high humidity.

One more benefit of UIS is DFS

NIN-DFS

DOUBLE FORTIFIED SALT (DFS)

 DFS is edible common salt to which very small quantities of iodine and iron are added.  DFS is iron fortified iodized salt.  DFS looks like iodized salt and it is to be used in the same way as iodized salt.

NIN-DFS

COMMON SALT

DFS

NIN-DFS

DFS
 Edible

common salt [Mg: <0.1%; Moisture: <1.5%; NaCl: >98.0%]  Sodium Hexa Meta Phosphate (SHMP): 1%  FeSO4.7H2O: 0.50% (Fe = 1000 ppm)  KIO3: 0.0067% (I = 40 ppm) [KI also can be
used]

Simple method of dry mixing Does not involve elaborate and expensive measures
NIN-DFS

DFS @ 10g/day
IRON 1/3 RDA (10 mg) IODINE 100% RDA (150 Qg)

PROPHYLACTIC
NIN-DFS

DFS
     Lab studies Factory studies Safety evaluation Acceptability studies Impact & Efficacy studies EXCELLENT RESULTS
NIN-DFS

NIN-DFS

STABILITY (6 STUDIES)
Period Sampl e tested Mfr. (sample) (Year) (n) Quantity (MT) 0.1 (1 kg) 20 (50 kg) 60 (1 kg) 9 (50 kg) 6 (1 kg) 0.5 (0.5 kg) 1 0.5 2 1 2 1 300 500 1500 12 1440 1440 Iodine (u 15 ppm)

NIN-DFS

Study

Year

Iron (1000 ppm)

(%) Lab Factory Tribal School Multi centric stability 1981-84, 1997 1984, 1996 1989-92 1997-98 2001-03 2004 100 100 91-98 100 (2) 50 (1) 76 100 100 100 100 100 100 100

STABILITY
Iodine 45 40 IODINE (ppm) 35 30 25 20 15 10 5 0 1 2 3 4 5 6 12 15 MONTH Iron 1200 1000 800 600 400 200 0 IRON (ppm)

NIN-DFS

ACCEPTABILITY
Chappati, Puri, Parotta, Lemon rice, Coconut rice, Dal, Chutney, Potato curry, Mixed vegetables curry, Idli, Dosa, Upma, Pongal, Vada, Pakodi, Bajji, Samosa, Vegetable Salad, Lemon/Orange juices, Butter milk, Fruits slices, Pickles, Sambar, Rasam, Egg omelet, Fish/Prawn, Chicken/Mutton. DFS IS
Acceptability Score 4.1 5.0 4.0 4.9

No difference in colour or appearance or texture or flavour or taste

NIN-DFS

BIOAVAILABILITY
ANIMAL STUDY (RAT MODEL, n = 24) GROUP 2 weeks DFS CONTROL 6.8 3.4 Hb (g/dl) 4 weeks 7.6 4.0 UIE No difference
NIN-DFS

9 months 55Fe/59Fe)

11.4 1.5 13.0 1.4 15.2 1.1

HUMAN STUDY (n = 8, Rice meal, GROUP DFS CONTROL Fe Absorption (%) 6.1 1.29 3.9 0.38

SAFETY
P intake about 30mg/day.  No change in bone integrity and histopathology of tissues; no impairment in Ca & P balance in rats fed with DFS for 9 months.  No change in Ca & P homeostasis of children who consumed DFS for 2 years.  No undesirable effect, allergy or toxicity over 2 years of consumption of DFS in the tribal study and residential school study. NIN-DFS 100% compliance in all the studies.


IMPACT: Iodine status

Goitre 30 G o itre P re va le n ce (%) 25 UIE (Rural) UIE (Urban) M e d ia n Urin a ry Io d in e ( g/ L )

28 116

155 108 14

180 160 140 120 100 80 60 40 20 0

20 15 10 5 0 Before

68

After

NIN-DFS

IMPACT: Iron status (anemic children)

90 80 70 P re va le n ce (%) 60 50 40 30 20 10 0 Before After

83

57 42 30
Anaemia (%) (Rural) Anaemia (%) (Urban)

IS:Urban: Before 54%; After 47%

NIN-DFS

 DFS: MEAN (95% CI) RISE IN Hb 0.72 (0.43, 1.01) g/dl IN COMPARISON TO IS  WELL WITHIN THE RANGE OF GLOBAL EXPERIENCE

NIN-DFS

FACTORY PRODUCTION
0.5 TO 60 MT
(1) (3) (5) (6) (7) (8) (9) Hyderabad, AP (2) Chennai, TN Valinokkam, TN (4) Alathur, TN Thirupporur, TN Mithapur, Gujarat Bhubaneswar, Orissa Gandhidham, Gujarat; Tiruchengode, TN
NIN-DFS

NIN-DFS

NIN-DFS

NIN-DFS

NIN-DFS

NIN-DFS

NIN-DFS

NIN-DFS

NIN-DFS

COST (Rs.) OF 1 kg
6.85 5.85

6.85 5.85 = 1.00

IS

DFS
NIN-DFS

AVERAGE COST OF SALT IODIZATION & DOUBLE FORTIFICATION Average cost per kg Component Range per kg (Rs.) (Rs.) IS DFS IS DFS 1.50 - 2.50 1.50 - 2.50 2.00 2.00 Salt Chemicals 0.05 - 0.15 0.70 - 1.30 0.10 1.00 0.20 - 0.40 0.30 - 0.50 0.30 0.40 Processing 0.70 - 1.30 0.70 - 1.30 1.00 1.00 Packing material Overheads 0.20 - 0.30 0.20 - 0.30 0.25 0.25 0.10 - 0.30 0.10 - 0.30 0.20 0.20 Amortization Total: A 2.75 - 4.95 3.50 - 6.20 3.85 4.85 Profit margin: Factory Dealer Whole Sale Retail Total: B Transport: C Total (A + B + C) 0.30 - 0.50 0.20 - 0.30 0.15 - 0.25 0.10 - 0.20 0.75 - 1.25 0.50 - 1.50 4.00 - 7.70 0.30 - 0.50 0.20 - 0.30 0.15 - 0.25 0.10 - 0.20 0.75 - 1.25 0.50 - 1.50 4.75 - 8.95 0.40 0.25 0.20 0.15 1.00 1.00 5.85 0.40 0.25 0.20 0.15 1.00 1.00 6.85

NIN-DFS

With an average consumption of 10g salt per day, additional cost of DFS over IS will be about 1 Paise/head/day

NIN-DFS

Elimination of IDA & IDD through DFS is a worthwhile investment In addition to health benefits, if benefits related to education, increased productivity of the population, human resource development and increased productivity & yield of livestock (egg, milk, wool, etc) are included then, cost benefit ratio is very high.

NIN-DFS

MESSAGE
1. 2. 3.

4.

NIN-DFS is a low-cost technology. All the ingredients are easily available. Its stability, acceptability, bioavailability, safety, large-scale production in several factories & distribution to remote areas, impact and efficacy have been proved successfully. It is as effective as Iodized Salt in controlling IDD & as effective as Iron Fortified Salt in controlling IDA.
NIN-DFS

APPRAISAL DR. MK BHAN COMMITTEE REPORT, 2006:

 Approved because evidences. only of NIN-DFS convincing

 Other DFS formulations were lacking scientific evidence. NIN-DFS

APPRAISAL
 NIN wrote letters to the Secretaries of Women Development and Child Welfare Department and Department of Health of all the States & UTs in the country (35 each) advocating the introduction of NIN-DFS in nutritional programmes of the States & UTs.  PFA & BIS Standards
NIN-DFS

WHAT IS NEW ?
 MoU: Free Technology Transfer: No charges.  Dossier with Manual for Factory Production.  DFS through PDS: Minimum 20% to PDS. NIN-DFS

CONCLUSION


  

DFS is the result of two decades of untiring efforts of NIN Scientists without compromise on quality. Dr. Bhan Committee, GOI cleared only NIN-DFS. Now the benefits should reach the people with no further delay. With the NIN-DFS ARMOUR, the country is geared up to combat the double burden of IDA & IDD.
NIN-DFS

THANK YOU