dr sesikeran

8/3/2019 Dr Sesikeran

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I

would

be

hard-

hearted

enough to

let the sick

die if youcan tell me

how to prevent

others

from

fallingsick

NIN-DFS


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EVOLUTION OF THE NINEVOLUTION OF THE NINDOUBLE FORTIFIED SALTDOUBLE FORTIFIED SALT

S. Ranganathan & B. Sesikeran

National Institute of Nutrition (ICMR)

Ministry ofHealth & Family Welfare (GOI)

Hyderabad 500 007

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OUT COMEOF 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 : Reducedphagocytic activity of WBC.

Children & Adults: Poor work capacity.

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In India, 75% of infants, 80%

of adolescent girls, and 85%

of pregnant & lactating

women suffer from anemia.


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Infancy & Childhood Adults

Still birth, abortions, Low

motor coordination, Low

scholastic performance

(lowered IQ), Juvenile

hypothyroidism, Goitre,

Retarded physical growth.

Hypothyroidism, Goitre,

Increased apathy, Impaired

mental function, Decreased

initiative, Decreased power

of decision making,

Reduced work output.

IODINE DEFICIENCY

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Iodine deficiency during pregnancy

causes about 6.6 million babies a yearto be born mentally impaired in India.

TGR is about 26% in the country.

IDD continue to be a public health

problem not only in Sub-Himalayanregion, but also in the peninsula. Callsfor immediate action.

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STRATEGIESSTRATEGIES

TOOVERCOME IRON DEFICIENCY:

Promotion of consumption offoods rich in iron ? Bioavailability

Sensitization/Awareness timeconsuming

Folifer tablets supplement torisk group.

Iron Fortified Salt for all.

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STRATEGIESSTRATEGIES

TOOVERCOME IODINE DEFICIENCY

NO SUITABLE FOOD RICH IN

IODINE

IODIZED SALT

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IMPORTANCE OF SALTIMPORTANCE 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

the ear. NIN-DFS


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IRON FORTIFIED SALT (IFS)1. FePO4 & NaHSO4: AJCN 1975;28: 1395 - 401.

2. FeSO4 & OPA: AJCN 1978; 31: 1112 - 14.

3. Multicentric Efficacy study: Hyderabad, Delhi, Madras,Calcutta. AJCN 1982; 35: 1442 - 51. (FNB).

4. FeSO4 & SHMP: Colourless IFS. Food Chemistry 1992;45: 263 - 67. Large-scale production: J Food SciTechnol 1993; 30: 166 - 68.

5. Successful Transfer of Technology to TNSC (1991).

200 - 300 MT/month.6. FGS alone: Food Chemistry 1996; 57: 311 - 15.

7. Ultra-structural differences of IS, IFS & DFS: SCANNING.Journal of Scanning Microscopies 1998; 20: 271 - 73.

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CHRONOLOGY OF DEVELOPMENTOF SALTCHRONOLOGY OF DEVELOPMENTOF SALTFORTIFICATION TECHNOLOGIES AT NINFORTIFICATION TECHNOLOGIES AT NIN


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IODIZED SALT (IS)Stable IS with KI or KIO3 using CO3 stabilizer

1. CaCO3: Dry mixing. Lab studies: Indian Food Industry

1986; 5: 12 2 - 24.

2. CaCO3, MgCO3: Factory. Long distance transport. AsiaPacific J Clin Nutr1997; 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 after15 months even at high humidity.

One more benefit of UIS is DFSOne more benefit of UIS is DFS

NIN-DFS

CHRONOLOGY OF DEVELOPMENTOF SALTCHRONOLOGY OF DEVELOPMENTOF SALTFORTIFICATION TECHNOLOGIES AT NINFORTIFICATION TECHNOLOGIES AT NIN (Contd..)(Contd..)


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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

DOUBLE FORTIFIED SALT (DFS)DOUBLE FORTIFIED SALT (DFS)


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DFSCOMMON SALT

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DFSDFS

Edible common salt [Mg:


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DFS @ 10g/dayDFS @ 10g/day

IRON

1/3 RDA

(10 mg)

IODINE

100% RDA

(150Qg)

PROPHYLACTICPROPHYLACTIC

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Lab studies

Factory studies

Safety evaluation

Acceptability studies

Impact & Efficacy studies

EXCELLENT RESULTS

DFSDFS

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STABILITY (6 STUDIES)STABILITY (6 STUDIES)

Study Year Quantity

(MT)

Mfr. (sample)

Period

(Year)

Sample

tested

(n)

Iodine(u 15

ppm)

Iron(1000

ppm)

(%)

Lab 1981-84,1997

0.1 (1 kg) 1 300 100 100

Factory 1984, 1996 20 (50 kg) 0.5 500 100 100

Tribal 1989-92 60 (1 kg) 2 1500 91-98 100

School 1997-98 9 (50 kg) 1 12100 (2)

50 (1)100

Multi

centric

stability

2001-03 6 (1 kg) 2 1440 76 100

2004 0.5 (0.5 kg) 1 1440 100 100

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STABILITYSTABILITY

NIN-DFS

0

5

10

15

20

25

30

35

40

45

1 2 3 4 5 6 12 15

MONTH

IODINE(ppm)

0

200

400

600

800

1000

1200

IRON(ppm)

Iodine Iron


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Chappati, Puri, Parotta, Lemon rice, Coconutrice, 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.

ACCEPTABILITYACCEPTABILITY

DFS IS

AcceptabilityScore

4.1 5.0 4.0 4.9

No difference in colourorappearance or

texture orflavourortasteNIN-DFS


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BIOAVAILABILITYBIOAVAILABILITY

ANIMAL STUDY (RAT MODEL, n = 24)

GROUPHb (g/dl)

2 weeks 4 weeks 9 months

DFS 11.4 1.5 13.0 1.4 15.2 1.1

CONTROL 6.8 3.4 7.6 4.0 -

HUMAN STUDY (n = 8, Rice meal, 55Fe/59Fe)

GROUP Fe Absorption (%) UIE

DFS 6.1 1.29No difference

CONTROL 3.9 0.38

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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 for9months.

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.

100% compliance in all the studies.

SAFETYSAFETY

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IMPACT:IMPACT: Iodine statusIodine status

28

14

116

155

68

108

0

5

10

15

20

25

30

Before After

Go

itre

Prevalenc

e

(%)

0

2040

60

80

100

120

140

160

180

Media

n

U

rinaryIodine

(

g/L)

Goitre UIE (Rural) UIE (Urban)

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IMPACT:IMPACT: Iron status (anemic children)Iron status (anemic children)

83

57

42

30

0

10

20

30

40

50

60

70

80

90

Before After

Prevalence

(%)

Anaemia (%) (Rural)

Anaemia (%) (Urban)

IS:Urban: Before 54%;After 47%

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DFS: MEAN (95% CI) RISEIN Hb 0.72 (0.43, 1.01) g/dlIN COMPARISON TO IS

WELL WITHIN THE RANGE

OF GLOBAL EXPERIENCE

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NIN-DFS

0.5 TO 60 MT

(1) Hyderabad, AP (2) Chennai, TN

(3) Valinokkam, TN (4) Alathur, TN(5) Thirupporur, TN

(6) Mithapur, Gujarat

(7) Bhubaneswar, Orissa

(8) Gandhidham, Gujarat;

(9) Tiruchengode, TN

FACTORY PRODUCTIONFACTORY PRODUCTION


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COST (Rs.)OF 1 kgCOST (Rs.)OF 1 kg

5.85

6.85

IS DFS

6.85

5.85

=1.00

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NIN-DFS

AVERAGE COSTOF SALT IODIZATION & DOUBLE FORTIFICATION

Component Range per kg (Rs.)Average cost per kg

(Rs.)

IS DFS IS DFS

Salt 1.50 - 2.50 1.50 - 2.50 2.00 2.00

Chemicals 0.05 - 0.15 0.70 - 1.30 0.10 1.00

Processing 0.20 - 0.40 0.30 - 0.50 0.30 0.40

Packing material 0.70 - 1.30 0.70 - 1.30 1.00 1.00

Overheads 0.20 - 0.30 0.20 - 0.30 0.25 0.25

Amortization 0.10 - 0.30 0.10 - 0.30 0.20 0.20

Total: A 2.75 - 4.95 3.50 - 6.20 3.85 4.85

Profit margin:

Factory 0.30 - 0.50 0.30 - 0.50 0.40 0.40

Dealer 0.20 - 0.30 0.20 - 0.30 0.25 0.25

Whole Sale 0.15 - 0.25 0.15 - 0.25 0.20 0.20

Retail 0.10 - 0.20 0.10 - 0.20 0.15 0.15

Total: B 0.75 - 1.25 0.75 - 1.25 1.00 1.00

Transport: C 0.50 - 1.50 0.50 - 1.50 1.00 1.00

Total (A + B + C) 4.00 - 7.70 4.75 - 8.95 5.85 6.85


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With an averageconsumption of

10g salt per day,additional cost of

DFS over IS will beabout 1

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Elimination of IDA & IDD through DFS is a

worthwhile investment

In addition to health benefits, if benefitsrelated to education, increased

productivity of the population, humanresource development and increasedproductivity & yield of livestock (egg,milk, wool, etc) are included then, cost

benefit ratio is very high.

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MESSAGEMESSAGE

1. NIN-DFS is a low-cost technology.

2. All the ingredients are easily available.

3. Its stability, acceptability, bioavailability,safety, large-scale production in severalfactories & distribution to remote areas,impact and efficacy have been provedsuccessfully.

4. It is as effective as Iodized Salt incontrolling IDD & as effective as IronFortified Salt in controlling IDA.

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APPRAISALAPPRAISAL

DR. MK BHANCOMMITTEEREPORT,

2006: Approved only NIN-DFS

because of convincing

evidences.

Other DFS formulations were

lacking scientific evidence. NIN-DFS


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NIN wrote letters to the Secretaries ofWomen Development and Child WelfareDepartment and Department of Healthof all the States & UTs in the country(35 each) advocating the introductionof NIN-DFS in nutritional programmes

of the States & UTs.

PFA & BIS Standards

APPRAISALAPPRAISAL

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MoU: Free Technology

Transfer: No charges.

Dossier with Manual

for Factory

Production.DFS through PDS:

Minimum 20% to PDS.

WHAT IS NEW ?WHAT IS NEW ?

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DFS is the result of two decadesof untiring efforts of NIN Scientistswithout compromise on quality.

Dr. Bhan Committee, GOI clearedonly NIN-DFS.

Now the benefits should reach

the people with no further delay. With the NIN-DFS ARMOUR, the

country is geared up to combatthe double burden ofIDA & IDD.

NIN-DFS

CONCLUSIONCONCLUSION


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THANK YOUTHANK YOU

dr sesikeran

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