Fortified Milk in India | Milk Fortification

What is fortification?

As per FSSAI, fortification means deliberately increasing the content of essential micronutrients in a food so as to improve the nutritional quality of food and to provide public health benefits with minimal risk to health. In general, fortification is the process of the intentional addition of essential micronutrients such as vitamins and minerals to the food to encounter related deficiencies.

What is milk fortification?

The process of addition of vitamins and minerals in milk externally that are not found in milk in sufficient amounts is called milk fortification. In India, milk is fortified with vitamins A & D as they can improve health and immunity. Vitamin A is associated with normal vision processes, whereas vitamin D is required for strong bones and calcium absorption.

Why is milk fortification required?

In India, the majority of the population of all ages are suffering from serious micronutrient deficiencies. According to the National Family Health Survey (NFHS-5) from 2019-2021, 67% of children aged 6-59 months, 57% among childbearing age women and 52% of pregnant women are suffering from anaemia. There is an urgent need to tackle such alarming situations to increase the intake of essential nutrients within available resources as individuals from low-resource areas find it difficult to have access to a variety of foods.

As per the report published by Tata 1mg Labs (2022), 76% of the Indian population is suffering from Vitamin D deficiency. This study was conducted across 27 cities in India and data from tests of more than 2.7 lakh people was collected. As per the report, 3 out of 4 Indians are suffering from vitamin D deficiency in India.

Fig. Vitamins A & D deficiency in India

           Source: Tata 1mg Labs (March- August 2022)

Fig. City-wise incidence of vitamin-D deficiency in India

Micronutrient deficiency in the Indian population (2021)

The meta-analysis conducted by Venkatesh et al., 2021, highlights the micronutrient deficiency in the Indian population. These micro-nutrients are essential for the normal functioning of the human body and their deficiencies can lead to malnutrition and serious health concerns. To avoid such deficiency and malnutrition, FSSAI introduced the Food Safety and Standards (Fortification of Foods) Regulations, 2016 in October 2016, as food fortification is a scientifically proven and cost-effective way to help nutrition around the world.

This act focuses on fortification of wheat flour & rice (with Iron, Vitamin B12 and Folic Acid), Milk and Edible Oil (with Vitamins A and D) and Double Fortified Salt (with Iodine and Iron) as these foods are consumed nationwide on day to day basis by everyone and fortification of such foods with given nutrients can tackle the micronutrients deficiencies at higher rate.

Milk is an almost complete food, it is a rich source of proteins, calcium and fat-soluble vitamins. Food Fortification Resource Centre of FSSAI, states that when milk fat is removed from milk during processing, vitamins A & D are lost in milk fat as these are fat-soluble vitamins. This is why it is essential to fortify milk with these vitamins to ensure that the milk contains the desired number of vitamins that are necessary for normal functioning of  our body.

Source: Micronutrient deficiency in India: Meta-analysis (2021)

Fig. Logo of fortified food, commodities and deficiency related to such nutrients

What is fortified milk?

As per FSSAI, any milk whether it is full cream milk, toned milk, double toned milk, skimmed milk or standardized milk, when fortified with nutrients at a level given by FSSAI, wherein the milk is to undergo a process of pasteurization, sterilization, UHT or boiling is a fortified milk. Vitamin A palmitate and vitamin D3 are the most absorptive and active forms of these vitamins and hence added to milk.

The vitamins used in milk fortification are available in powder and liquid form, have great solubility in milk and do not affect the taste, smell or texture. These vitamins are heat resistant and hence added to milk before pasteurization to ensure that the final product is free from any microbial hazard. This fortified milk can be consumed in a similar way as unfortified milk. In India over 193 lakh litres of milk is fortified per day, which is consumed by 121 million people.

Table: Guidelines for milk fortification

Fig. Process of milk fortification

What is the difference between fortified & unfortified milk?

Let’s understand it by an example given. The table given compares the nutrient contents of 240 ml of fortified and unfortified milk.

The comparison between fortified and unfortified milk gives us an understanding of their nutritional content. Fortified milk provides 15% of the daily value of vitamins A and D each, indicating that it is a good source of these vitamins. The rest of the components of both the milks are similar. This makes fortified milk a better option for those seeking additional vitamins, particularly Vitamin A & D, which support the eye vision process and bone health respectively.

Is milk fortification mandatory in India?

Yes, milk fortification is mandatory in India. FSSAI introduced the Food Safety and Standards (Fortification of Foods) Regulations on August 21, 2018. These regulations established mandatory fortification of vitamins A & D in milk. The regulation states that milk must be fortified with these vitamins if intended to be marketed and sold in India. Along with this, it is mandatory to provide the fortification logo ‘+F’ with dimensions and color codes provided by regulation on the package of fortified milk.

Despite all these mandatory regulations, India faces many challenges in milk fortification. Most of the milk in India is sold by the unorganized sector, with only 35-40% of milk being sold through organized channels such as dairy companies, unions, etc. Hence such fortified milk does not reach normal populations as well as vulnerable populations. At the same time, lactose intolerance is prevailing in India, which restricts the consumption of milk by such individuals.

References:

• Venkatesh U, Sharma A, Ananthan VA, Subbiah P, Durga R; CSIR Summer Research training team. Micronutrient deficiency in India: a systematic review and meta-analysis. J Nutr Sci. 2021 Dec 21;10:e110. doi: 10.1017/jns.2021.102. PMID: 35059191; PMCID: PMC8727714.
• Food Safety and Standards (Fortification of Foods) Regulations, 2018.
• National Family Health Survey (NFHS-5)
• FSSAI News Milk Healthline