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Abstract
Introduction
Micronutrient-deficiency problems in Thailand
Government-industry-academic partnership
Instant noodle market in Thailand
Feasibility study of triple fortification of instant noodles
Preparation stage before product distribution
Post-marketing activities
Conclusion
References
Visith Chavasit and Kraisid Tontisirin
The authors are affiliated with the Institute of Nutrition, Mahidol University at Salaya in Nakorn Pathom, Thailand. Mention of the names of firms and commercial products does not imply endorsement by the United Nations University.
Because Thailand was facing problems with deficiencies of iodine, iron, and vitamin A, in 1994 a committee of the Ministry of Public Health proposed a feasibility study of fortification of instant noodle seasoning powder. This project was undertaken by universities, government, and the private sector. Micronutrient dosages per serving were set at 5 mg for iron, 50 mg for iodine, and 267 mg for vitamin A, all of which represent one-third of the Thai recommended daily intake (RDI). The results showed that a premix containing potassium iodide, encapsulated reduced iron, and vitamin A remained stable under accelerated storage conditions, with no adverse effects on the sensory qualities of most products. Information concerning the fortified nutrients as well as the types and brands of the fortified product was publicized through the media with support from manufacturers of instant noodles and a ministerial committee. The products were marketed at the end of 1996.
Although protein-energy malnutrition in Thailand has lessened in severity over the past 10 years, deficiencies of certain micronutrients, such as iodine, iron, and vitamin A, are still significant. Among the many control and prevention strategies that have been implemented, fortification of industrially processed foods is now emerging as potentially important, since a growing reliance on such foods by the Thai people has arisen due to the country’s rapidly expanding industrialized and cash-based market economy [1]. One such food is the instant noodle, which is acceptable, available, and affordable in Thailand.
Micronutrient deficiency in a nation can take a heavy toll in lost productivity, vitality, and initiative. In Thailand iodine-deficiency disorders affect many people as a result of increasing deforestation and topsoil erosion. In 1995 about 6% of primary-school children were afflicted with goitre. The prevalence in the north was about 8%, the highest in the country, and reached as high as 28% in some provinces. The prevalence among primary-school children in other parts of the country was 2% to 7% [2]. To combat the problem in endemic areas, potassium iodate solution has been added to household, community, and school drinking water supplies for many years. Since 1994 table salt has been fortified with 50 ppm of potassium iodate or potassium iodide. However, community-produced salt, which is normally consumed by the target population, usually cannot be fortified to such a standard because of a lack of technology and low-quality salt. Despite these efforts, iodine-deficiency disorders persist as a significant public health problem.
Iron deficiency is found mostly in children and pregnant women. In the past, a high prevalence was correlated with hookworm infestation among people in southern Thailand. However, the problem is now widespread in all areas of the country. A 1991 survey indicated that the prevalence of anaemia in pre-school children ranged from 12% to 22%. In 1995 anaemia in primary-school children in all parts of the country ranged from 12% to 20%, while in pregnant mothers it ranged from 9% to 17% [3]. Currently, iron tablets are provided to pregnant women, although the impact of this supplementation is limited because of poor compliance and increased consumption of iron-rich foods by children.
The World Health Organization (WHO) does not classify Thailand as a country in which vitamin A deficiency is a public health problem. However, subclinical cases are sporadically found in many rural areas. In 1995 the prevalence of moderate subclinical vita- min A deficiency in pre-school children was estimated at about 20%, as demonstrated by inadequate liver stores of vitamin A and low serum retinol levels [4]. This situation has improved since 1992, when the prevalences of active xerophthalmia, inadequate liver stores of vitamin A, and low serum retinol in southern Thailand were as high as 43%, 56%, and 11%, respectively [5]. This improvement is the combined result of a vitamin A capsule supplementation programme, increased production and consumption of vitamin A-rich foods, and a 1994 government regulation requiring the fortification of sweetened condensed milk, which is sometimes used as a substitute for breastmilk or infant formula by the poor, with vitamin A (330 mg retinol/100 g milk).
Based on the 1992 World Declaration and Plan of Action for Nutrition developed at the International Conference on Nutrition (ICN) in Rome, Thailand’s Ministry of Public Health appointed an advisory working committee in 1993 to increase cooperation between government and the private sector in solving food and nutrition problems in the country. The committee was composed of representatives from the Ministry of Public Health, Ministry of Agriculture and Cooperatives, Federation of Thai Industries, and Institute of Nutrition of Mahidol University. The committee members agreed that cooperation among government, industry, and academia was necessary because it was impossible for the government sector alone to solve the nation’s nutritional problems It was also decided that the primary commitment of the committee should be solving micronutrient-deficiency problems, and that fortification of an industrially processed food with micronutrients should be pursued.
Instant noodles sold in ready-to-prepare packages are a popular industrially processed food in Thailand. Six million packages are produced each day, 80% of which are made by only three companies. Most are consumed domestically, although they are also exported. In 1993 instant noodle consumption in Thailand was 30 packs per capita [6]. Over 90% of these instant noodles are of the deep-fried type, which are sometimes classified by academics as “junk food” due to their high salt, fat, and carbohydrate content and low-quality protein. Therefore, the label on the package suggests adding meat or egg and vegetables, which is the traditional mode of eating noodles in Thailand. However, because of inconvenience, this suggestion is seldom practised by consumers. Both males and females aged 15 to 49 years from all socio-economic strata in Thailand consume instant noodles. The consumption of the products according to the country’s regions and zones is shown in table 1. Forty-one percent of the products are consumed in Bangkok, at the same percentages as in up-country rural areas.
The cost of a 55-g package of instant noodles is only 3.50 to 4.00 baht (US$0.14-0.16), whereas one serving of Thai fast food costs at least 10-15 baht (US$ 0.50-0.60). This price increased in October 1996 after remaining at about 3.00 baht (US$0.12) for almost 16 years. The price was previously fixed because of high market competition. Instant noodles are a low-profit-margin product, but they can be distributed to consumers all over the country. In addition to its low price, the product has acceptable sensory characteristics and good shelf stability. Instant noodles of various flavours are available in both original Chinese and traditional Thai styles. The shelf life of instant noodles is at least six months at room temperature. The product is widely accepted throughout the country and has become of interest as a vehicle for nutrient fortification.
In late 1994 the ministerial committee agreed that a study of the feasibility of triple fortification of instant noodles should be undertaken. The committee and the manufacturers of instant noodles agreed to fortify the seasoning packet, because the seasoning powder does not need much additional cooking before consumption and is well protected in a separate bag within the package. To attract public interest in the project, the committee planned to include the fortification programme as part of the celebration of the golden jubilee of King Bhumipol’s accession to the throne.
TABLE 1. Regional and zonal percent distributions of instant noodles
|
Location |
Percentage |
|
|
Regions |
||
|
Bangkok |
41 |
|
|
Central |
17 |
|
|
North 18 |
|
|
|
North-East |
18 |
|
|
South 7 |
|
|
|
Zones |
||
|
Bangkok |
41 |
|
|
Rest of country |
|
|
|
|
Urban |
18 |
|
|
Rural |
41 |
However, this would have set the deadline for launching the product at December 1996. The fortification dosages for iodine, iron, and vitamin A were 50 mg, 5 mg, and 267mg, respectively, which represent one-third of the Thai recommended dietary intake (RDI) for these nutrients. This project has been conducted on a voluntary basis, and representatives from the manufacturers are working jointly with the committee members. For the feasibility study, information about the fortified products, such as the fortificant to be used, sensory acceptability, cost, and shelf stability, was evaluated.
Selection of the fortificants
A premix of potassium iodide, ferrous fumarate, and vitamin A palmitate was initially tested in several flavours of instant noodles. The manufacturers found that some seasoning ingredients containing Chinese five-spice powder, especially nutmeg, reacted adversely with ferrous fumarate, resulting in an unacceptably black-coloured soup. Iron EDTA was also tested, with the same result. Finally, encapsulated iron, which is a reduced iron encapsulated with partially hydrogenated oil as the coating material, did not react with those spices or with any other seasoning powders. Therefore, the premix used for fortification contained potassium iodide, encapsulated iron, and vitamin A palmitate. The premix was used at 20 mg per package of instant noodles.
Sensory acceptability
After the premix was selected, a sensory discrimination test was conducted using pork-flavoured instant noodles. Because this product has the mildest flavour of all the noodles, any off flavour caused by the fortificant could be easily detected. Results from the triangle test showed no significant difference in sensory qualities (p>.05) between the original and fortified products. For colour changes due to the reaction between certain seasoning powders and the iron fortificant, a study was performed by observing colour changes in cooked Pa-Lo duck-flavoured instant noodles that contain Chinese five-spice powder. Observations of both normal and fortified noodles were made every 5 minutes for 30 minutes using a Munsell colour chart (Macbeth Division, Kollmongen Instruments, Baltimore, Md, USA). This period is long enough for the average consumer to eat a bowl of noodles.
Cost
The premix increases the cost of the product. However, until 1999 the cost of the premix per serving of instant noodles will remain below 0.02 baht (US$0.08). This cost has actually been lowered due to the special taxation rate for the premix, which was reduced from 45% to 10% at the request of the Ministry of Public Health and a nutrient importer. Although the cost of fortifying instant noodles is not high, most manufacturers hesitated to join the programme at the beginning because of the low profit margin. Since October 1996, however, the manufacturers have raised their prices by 15% to 20%, which has eased the cost problem for many manufacturers. After encouragement from the Federation of Thai Industries, seven manufacturers of instant noodles agreed to join the project.
Shelf stability
A study of the fortified product’s shelf stability was performed jointly by the manufacturers and the Institute of Nutrition at Mahidol University. The manufacturers prepared and packed fortified seasoning powders in their laboratories and incubated them along with unfortified seasonings under their own acceleration conditions. The results showed that most fortified seasoning powders had a shelf life of about three months, mainly on the basis of appearance criteria (as decided by each manufacturer). Some manufacturers found that the fortificants, especially iron, caused changes in the colour of dried onions and in the flavour of some of their products during incubation. Although this shelf life is acceptable to many manufacturers, it has caused uncertainty among some whose products need to be on the market for more than three months. The incubated seasoning powder from each period was later analysed for its content of fortified micronutrients at the Institute of Nutrition. The results showed that the fortified micronutrients were stable under the accelerated incubation conditions. However, a non-homogeneity problem was found in some sample sets, since they were prepared on a small scale without using a standard mixing machine. From this study, the committee suggested to the Food and Drug Administration that the standard for the fortification dosage might need an allowance of 20% for overage.
A strategy for launching the product was carefully designed to assure fairness in terms of marketing and convenience in terms of regulations for all participating manufacturers. However, consumers must receive correct information and have access to high-quality fortified products at an affordable price. The following processes were performed in order to prepare for distribution.
Registration and labelling
The Thai Food and Drug Administration eased the registration process for new fortified products for manufacturers of instant noodles. The manufacturers were allowed to use the results of the feasibility study from the Institute of Nutrition instead of analysing each product. The Thai Food and Drug Administration and the committee also established standard terms to be used on the labels of fortified products: “Fortified with iodine, iron, and vitamin A” on the front panel and “contains iodine, iron, and vitamin A in amounts that fulfil 1/3 of the Thai RDI” in the ingredient list. The manufacturer was allowed to use these terminologies without having to apply for a new label.
Public relations, advertising, and marketing
The committee organized three press conferences to release information about the project through newspapers, radio, and television. Conferences were held about the agreement with the manufacturers before and after introducing the product. Based on their market shares, the manufacturers also proportionally provided funds for advertising the project and the fortified brands. Advertising posters were also sent to sub-district health centres and even lower levels by the Ministry of Public Health. In addition, the Ministry of Public Health provided another marketing channel for the manufacturers by allowing them to send the fortified products through the health service system at the village level.
After the fortified products are introduced on the market, the fortification dosage of the products from each factory and the stability of each fortificant under real distribution conditions will be closely monitored. If necessary, academic advice, further research, or even law enforcement may be implemented. The percentage allowance of the fortification dosage also must be reconsidered. A short-term metabolic study or field efficacy trial of the bioavailability of these fortificants in the target population should be conducted in order to confirm their benefits. Studies of long-term community effectiveness should be performed to evaluate the cost-effectiveness of this programme.
Successful cooperation among the government, academia, and the industrial sectors can result in a “win-win situation,” in which every party can benefit. The fortification of instant noodles is only an example of such cooperation. It is to be expected that difficulties will arise during operation of the programme, especially when the project is performed on a voluntary basis. However, once it is sustainable, the consumers will benefit the most.
1. Chavasit V, Tontisirin K. Status of food industry in Thailand and its role in upliftment of nutritional status of the people. In: Report of the regional expert consultation of the Asia-Pacific network for food and nutrition on the importance of the food industry in increasing safe food supplies. Bangkok: Food and Agriculture Organization, Regional Office for Asia and the Pacific Region, 1995:84-6.
2. Nutrition Division, Ministry of Public Health. Report on the prevalence of iodine deficiency disorder (IDD) in Thailand in 1995,1996. Bangkok: Ministry of Public Health, 1996.
3. Nutrition Division, Ministry of Public Health. Report on the prevalence of iron deficiency anaemia in Thailand in 1995,1996. Bangkok: Ministry of Public Health, 1996.
4. Nutrition Division, Ministry of Public Health. Vitamin A deficiency among pre-school children in five southernmost provinces of Thailand. Bangkok: Ministry of Public Health, 1995:23-4.
5. World Health Organization. Prevalence of vitamin A deficiency: South-East Asia region, April 1995. In: Global prevalence of vitamin A deficiency. Micronutrient Deficiency Information System (MDIS) Working Paper No. 2, Geneva: WHO, 1995:43.
6. Anonymous. Reaching the masses. Asia Pacific Food Industry 1996;8:38-45.
