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Research Protocol Summary: SUSTAIN Evaluation of the Bioavailability of Elemental Iron Powders used for Food Fortification (Initiated in 2001)
This document summarizes research methodologies that SUSTAIN is using to evaluate elemental iron powders used for food fortification. Iron deficiency anemia (IDA) is the most prevalent nutritional disorder in the world and has far-reaching consequences. IDA is so widespread, affecting literally millions of people, that public health resources alone cannot address the problem. Programs designed to fortify staple foods with iron are being introduced in many developing countries with elemental iron powders used as the most common iron fortificants; however little is known about the extent to which iron powders are absorbed by the body. To address these concerns, SUSTAIN has launched a comprehensive evaluation of each of the iron powder fortificants in use today. Initially, a series of screening tests will be run to indicate the most promising powders for subsequent evaluation in human trials in mildly iron deficient individuals. Results from the screening studies are expected in 2002; results from the human trials are expected the following year.

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Guidelines for Iron Fortification of Cereal Food Staples (May 2001)
The following are recommended guidelines for the type and levels of iron to add to cereal food staples. They have beebn written with the goal of optimizing bioavailability, cost-effectiveness, and consumer acceptance of the fortified product, and have been reviewed and endorsed by a panel of leading experts in the field. It is important to note that these guidelines should be considered interim and may change, as more information becomes available on the bioavailability of elemental iron powders.

------------------------------------------------------------------ Usage Report of "Guidelines for Iron Fortification of Cereal Food Staples"
In May 2001, SUSTAIN published a set of "Guidelines for Iron Fortification of Cereal Food Staples" to help program planners select and utilize iron fortificants in public health programs. A limited survey with respondents from public and private sectors working in North America, Europe, Central and Latin America, Africa and Asia indicates that the interim Iron Guidelines are being widely used and broadly disseminated. The following summarizes feedback from this survey.

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Summary of Monterrey Workshop: Evaluating the Usefulness of Elemental Iron Powders (September 2000)
Elemental iron powders are the most commonly used iron fortificants worldwide, but confusion exists over the extent to which these fortificants are absorbed by the body. Bioavailability studies on elemental iron powders over the last 45 years have yielded hightly variable results, from 5% to 145% relative bioavailability in compaison to the standard, ferrous sulfate. To help improve our understading of elemental iron's value as a fortificant, SUSTAIN convened a panel of world-renowned research scientists, physicians and industry specialists to review and evaluate past research. The meeting was held in Monterrey Mexico in September 2000 at the Monterrey Institute of Tehcnology and Higher Education (ITESM). The following document summarizes key findings and recommendations resulting from the Monterrey meeting.

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Micronutrient Compliance Review of Fortified PL 480 Commodities (October, 2001)
This report by SUSTAIN for USAID reviews compliance by cereal processing plants with the new micronutrient standards on fortified PL480 commodities that resulted from the Micronutrient Assessment Project (MAP study). SUSTAIN found that the industry had made great strides in implementing systems up-grades to comply with the new specifications. But the report also notes a number of areas that still need improvement, and suggests strengthening USDA's Total Quality Systems Audit (TQSA) program. Specific recommendations are made for systemizing assurances of product quality. For example, plant sampling procedures and laboratory measures used to test for compliance could be standardized, and fortificant suppliers regularly audited.

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Final Report of the Micronutrient Assessment Project (1999)
The Micronutrient Assessment Project (MAP), a three-year scientific study on three continents, was launched in 1996 to determine if adequate and uniform levels of micronutrients were reaching developing country recipients of U.S. P.L. 480 food aid commodities. The MAP investigated the stability (from U.S. manufacturer to overseas consumer) and uniformity in the manufacturing process of key micronutrients added to processed Title II food commodities. It was found that the amounts of vitamins A and C actually delivered to food aid recipients was well below expectations due to 1} serious shortcomings in the fortification and uniformity of some P.L. 480 processed and blended cereals at U.S. production facilities and 2} significant losses of vitamins during the cooking of the foods by recipients. Recommendations were made to strengthen minimum standards, improve monitoring and enforcement, and enhance the uniformity and quality of micronutrient fortified commodities. The study was conducted by SUSTAIN, with support from the U.S. Agency for International Development.

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Storage, Sensory and Bioavailability Evaluation of Iron Fortified Corn Masa Flour: SUSTAIN Final Report (August, 2000)
The recent development of industrially produced corn masa flour (CMF) and its increasing popularity in Mexico and Central America has created the opportunity to improve the nutritional status of millions of people vulnerable to iron deficiency anemia (IDA) by using CMF as a fortification vehicle. Overall success of Fe fortification programs depends on several factors, including fortificant bioavailability and product acceptability by consumers. In 1998 SUSTAIN commissioned a three-part study to help identify a viable iron fortificant for use in fortifying corn masa flour, one that does not adversely affect the product, and that is readily absorbed by the body. This report presents the research findings. Ferrous fumarate, though it is not optimal in all respects, emerges as the most promising iron compound for CMF fortification based on the combined results of storage, sensory and bioavailability tests.

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Fortification of Corn Masa Flour with Iron and/or Other Nutrients: A Literature and Industry Experience Review (December, 1997)
Tortillas are a major food staple in Central American countries, particularly in rural populations. Corn masa flour (CMF), a timesaving alternative to the labor-intensive process of making tortilla dough from raw ingredients, provides a convenient and newly available vehicle for enrichment. This document provides a thorough review of literature and industry experience with CMF fortification, revealing that our current knowledge and technology for this is very limited. Recommended are quality and bioavailability studies of CMF tortillas and other CMF products fortified with selected iron compounds.

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SUSTAIN Forum on Iron Fortification, Forum Proceedings (June, 1998)
Held in Atlanta (1998) during the IFT Annual Meeting, SUSTAIN' Forum on Iron Fortification presented the current state of our understanding of iron fortification as a means to reduce IDA in developing countries. The forum also served as an opportunity to discuss encouraging scientific advancements in the field, risk factors, and relevant regulatory issues.

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Vitamin A Fortification of P.L. 480 Vegetable Oil Report (Fall, 1998)
Fortification of P.L. 480 vegetable oil, which reaches approximately 20 million recipients in over 40 developing countries, would be an effective way to deliver vitamin A to deficient populations. This paper provides information on the technical and biological aspects of fortifying vegetable oil with vitamin A and recommends the appropriate form and level of fortification. Based on this report, and at the request of USAID/FFP, the Kansas City Commodity Office amended Announcement VO-6 to require vitamin A fortification (in the recommended form of retinol palmitate) of vegetable oil purchased for foreign food assistance programs.


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Results report on the Vitamin C Pilot Program (September, 1997)
The Vitamin C Pilot Program, initiated in March 1996, was designed to explore the advisability and cost-effectiveness of scaling up vitamin C fortification of food
aid commodities. Findings indicated that problems exist with the uniformity of fortification in corn soy blend; however, the amount of vitamin C in blended foods was found to be generally stable during shipping, transport and storage. Financial analyses indicate that scaling up vitamin C fortification while maintaining present costs would significantly reduce the numbers currently benefiting from food aid. The report includes information requested by the Committee on International Nutrition on: the worldwide prevalence of scurvy; and on vitamin C and iron uptakes in refugee camps and in targeted beneficiary households in Title II development programs.

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Food Technology and Enterprise Project (FY 92-00)
This final report describes short- and long-term activities undertaken by the Food Technology and Enterprise - SUSTAIN Project under Cooperative Agreement DAN-A-00-91-00066-00 during the fiscal years of 1992-2000. It also suggests what steps USAID might take to build on Project SUSTAIN's work to improve the quality and micronutrient content of PL 480 Food Aid Commodities and of local food products worldwide.

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