How to tackle malnutrition and support immune health through large-scale fortification programs

• The link between good nutrition and optimal immune function is increasingly highlighted by public bodies.^1,2 However, vulnerable populations often cannot access or afford nutritious food, which means they are at higher risk of malnutrition. This could leave them with potentially weaker immune systems and therefore more prone to infections and illness.
  
• Fortification is one of the most effective, safe, and cost-efficient ways to tackle nutritional deficiencies, support immune health and positively influence economic development in low- and middle-income countries.
• In our latest Ask-the-Expert interview, dsm-firmenich’s Global Director Nutrition Improvement Yannick Foing and dsm-firmenich’s Lead Scientist Public Health Nutrition Dr. Maaike Bruins discuss the potential of large-scale food fortification programs for improving the nutritional status and immune health of all population groups, including the world’s most vulnerable.

Talking Nutrition Editor: Vulnerable populations already face a range of challenges such as high poverty and inequality rates; under-funded health systems; and limited financial reserves. Could you tell us why immune health is such an important consideration for these populations?

Maaike Bruins: In times of crisis, immune health is crucial to protect the body from infections and aid faster recovery during illness, with the link between nutrition and immune function increasingly highlighted by public bodies like the World Health Organization.³ Even before COVID-19, nearly one third of the global population suffered from disease and premature death linked to nutritional deficiencies. As the pandemic affects food supplies, there is no doubt that it is deepening all forms of malnutrition, from calorie to micronutrient deficiencies, particularly affecting the most vulnerable populations.⁴ This is likely to put these populations at even higher immediate risk of infectious diseases. Moreover, the profound impact of the COVID-19 pandemic on early life nutrition could have unprecedented life-long impacts on future education, chronic disease risks, and overall human capital formation.⁵

Yannick Foing: Malnutrition is a prevailing public health crisis and its effects on human health and socio-economic development are severe. Good nutrition plays a key role in supporting a healthy immune system⁶ and overall health. From decreased healthcare costs and sick day rates to improved work and school performance, delivering the right nutrition to those that need it the most can positively impact economic development and prosperity.

Ensuring that everyone receives both the calories and micronutrients they need can help build resilience to infections, aid faster recovery during illness and allow them to stay healthy and thrive. Micronutrients such as vitamins D and C and zinc are, for example, critical for a well-functioning immune system and play a vital role in promoting health and wellbeing.⁷ 

How have perceptions of immune health changed since the beginning of the COVID-19 pandemic?

Yannick Foing: A year into the COVID-19 pandemic, consumer concern over immunity has increased and awareness of the important role that nutrition plays in immune health is rising worldwide, across all socio-economic groups.⁸ This awareness also extends to both the private and public sectors - with policy makers now even more attuned to the critical impact of nutrition on public health and the return on investment of nutrition interventions.

Are certain population groups at higher risk of poor immune health?

Yannick Foing: People with lower incomes often cannot afford nutritious food and are at higher risk of malnutrition that can negatively impact immune health. This is a significant challenge for vulnerable groups such as school children, workers and pregnant women. Micronutrient deficiencies are, however, not only prevalent in low-income population groups, but across income brackets. The public and private sectors have a responsibility to come together and ensure that affordable and aspirational nutritional solutions are accessible by everyone, everywhere. 

Maaike Bruins: Women and children are particularly vulnerable to micronutrient deficiencies and poor immune health. Inadequate nutrition — especially during the first 1,000 days from the onset of pregnancy to the second year of life — can harm a baby’s growth and development, affecting their ability to do well in school and ability to earn a living later in life. In many societies, women are caregivers and make up a large proportion of front-line health care workers, meaning that they need a strong, healthy immune system in times of crisis. Addressing malnutrition in women and children must therefore be a central pillar in the global COVID-19 response strategy.

What solutions can help to improve access to nutritious foods that support immune health?

Yannick Foing: Fortification is one of the most effective, safe and cost-efficient ways to tackle deficiencies population-wide. It can enhance the nutritional value of staple foods such as rice, wheat flour and maize by adding or replacing essential vitamins and minerals that may have been lost during processing – without changing the taste, cooking requirements or consumer diets and preferences. Staple food fortification can also deliver significant social and economic benefits – with research suggesting that an annual investment of US$19 million in food fortification could yield US$570million in benefits in terms of improved health, lower mortality and increased income opportunities worth US$1 billion.⁹

A long-term investment with all stakeholders, large scale staple food fortification programs can help to combat malnutrition and improve the immune health of large population groups. These interventions can also be targeted at specific demographics via workforce nutrition or school feeding programs. Most catered meals for workers in low- and middle-income countries consist largely of staple foods that lack essential vitamins and minerals.¹⁰ Fortified foods centrally distributed throughout the workplace provide the opportunity for employers and governments alike to reach many workers, helping to ensure optimal immune health and improve quality of life, thereby boosting productivity and supply chain resilience. In fact, ensuring optimal nutrition and quality of life for today’s workforce creates a return on investment for employers of up to US$6 per US$1 invested in workforce nutrition.¹¹

Meanwhile, school feeding programs can supply fortified meals to children at school, and point-of-use fortification like micronutrient powders (MNPs) can also help combat malnutrition in children. These solutions, already widely used by governments and the World Food Program, are supplied in sachets for mixing directly into school meals and do not affect food attributes — such as taste and texture — in any way, which supports increased compliance to consumption. MNPs can also be distributed for home use for those unable to attend school due to closures or illness. Optimal school nutrition can support children’s cognitive function and immunity, providing an incentive for parents to send their children to school, allowing them to attend consistently and perform better both academically and professionally later in life.

Beyond school feeding and workforce nutrition interventions, the private sector also has a role to play in increasing consumer access to and availability of fortified products that support immune function. With 60% of consumers concerned about their immunity, there is clear demand for purpose-led, nutrient-rich solutions targeted at optimizing immune health.¹²

What is the role of nutritional solutions that support immune health and public health nutrition interventions in contributing to the UN's Sustainable Development Goals?

Maaike Bruins: The United Nations (UN) Sustainable Development Goal (SDG) 2 seeks to end world hunger and all forms of malnutrition, while the SDG 3 aspires to achieve good health and wellbeing for populations worldwide. Achieving these goals is a challenge that has become even more urgent in light of COVID-19, with public bodies increasingly highlighting the devastating impact the pandemic is having on both the global malnutrition crisis and public health. The pandemic is likely to generate new pockets of food insecurity and could increase world hunger by 12% to 20% (83-132 million people).¹³

Ensuring access to affordable nutritious food universally has become even more important as a result, requiring large-scale solutions. Nutrition interventions have the power to reach many people and improve their nutritional status, thereby accelerating progress towards achieving the UN SDGs 2 and 3.

How is dsm-firmenich supporting the food industry, governments and NGOs in providing cost-effective, safe and nutritious solutions to vulnerable groups?

Yannick Foing: We see a world without malnutrition creating brighter lives for all. But achieving this vision takes more than products. It takes a partner. Through public and private sector collaborations, dsm-firmenich creates affordable, aspirational and accessible nutritional solutions that can help keep the world’s growing population healthy. 

We work with governments, donors, non-governmental organizations (NGOs) and UN agencies to introduce effective public health nutrition interventions, including large-scale programs that utilize staple food fortification, public health supplementation or MNPs. dsm-firmenich also helps its partners roll out multiple micronutrient supplements (MMS) interventions to improve maternal nutrition in regions with a high prevalence of nutritional deficiencies or where food supply chains are significantly disrupted.14 And dsm-firmenich advocacy work focuses on raising awareness of the health and economic benefits of nutrition interventions to accelerate their implementation worldwide.