Opinion | An innovative method for boosting nutrition

Iron deficiency and anemia are well-recognized and persistent problems in India, exacting a toll that goes much beyond measurable health problems. Most Indian government initiatives targeting anemia so far have had limited success in achieving large-scale impact.

Solving these problems require an innovative approach that can reach the most affected segment of the population—one that combines ease of access, affordability and scalability within the socio-cultural context. Biofortified nutrient-rich crops, such as iron-rich bajra (pearl millet), paired with an effective adoption and delivery strategy, is a promising approach to fight hidden hunger.

Adolescence is a period of rapid growth, poor dietary habits and, in females, marks the onset of menstruation. Together, these factors lead to a high anemia prevalence in this age group. A 2016 survey of around 8,000 adolescents, conducted by the Population Council in two Indian states of Bihar and Uttar Pradesh, found that 55% of younger girls (10-14 years), 65% of older girls (15-19 years), 34% of younger boys, and 29% of older boys were anemic. Iron deficiency is thought to be the most common cause of anemia globally, accounting for between 25 and 50% of anemia cases.

To reduce the prevalence and incidence of anemia in adolescents, the Union ministry of health and family welfare launched the Weekly Iron and Folic Acid Supplementation (WIFS) programme in 2013 as part of its National Health Mission. Under this scheme, adolescents are provided weekly iron-folic acid tablets and biannual deworming tablets through schools and health centres.

While well-intentioned, WIFS has fallen short for at least two main reasons. In addition to low programme coverage, studies have shown that half of the students who receive the tablets discontinue due to side effects such as gastrointestinal disturbances. The end result is that, even when the tablets reach the target user, the problem is often not corrected.

Iron, over four decades of research has concluded, is a key nutrient required for numerous brain processes, and iron folic acid tablets are an important component in the national strategy but will not solve the anemia problem alone. Other strategies with lower potential for side effects and wider reach to the rural poor are needed. NextMAds

Our study, published in the Journal of Nutrition, provides insights in shaping policies targeting iron deficiency and anemia. We investigated whether nutritional status and cognitive ability of adolescents belonging to disadvantaged households can be improved by consuming food rather than pills.

With colleagues from Harvest Plus, Pennsylvania State University, Cornell University, the University of Oklahoma, and SNDT Women’s University, we compared the effects of consuming biofortified bajra to conventional bajra among adolescents between 12 to 16 years old, belonging to poor households in Maharashtra. The biofortified bajra was developed by plant breeders using conventional, non-genetically-modified methods. Biofortification using this traditional method involves crossing varieties over successive generations to eventually yield a plant with high nutrient content along with other favourable traits such as high yield and drought tolerance. Although it is a slower process than genetic modification, there are large cultural barriers around genetically modified foods in India. In the current climate, non-genetically-modified crops are more likely to be accepted by the target population.thirdMAds

To measure the cognitive skills of the adolescents in the study, we administered computer-based tasks before and after six months of consuming biofortified bajra, in the form of locally consumed foods, bhakri and shev. We found that consumption of biofortified bajra significantly improved both iron status and computer-based tests of attention and memory. We also found that improving iron status was related to improvements in cognition.

We now know that biofortified crops rich in iron have the potential to improve iron status and cognition. In students attending school, this may mean they are able to learn better and perform better in the classroom, setting them up for a more secure future. Other work is ongoing to assess the efficacy and effectiveness of biofortified crops in different settings.

Biofortification fills an important gap as it provides a food-based, sustainable and low-dose alternative to iron supplementation. It does not require behaviour change, can reach the poorest sections of the society, and supports local farmers. In the context of a growing population and a rapidly shifting food system, nutrient density in staple food crops is increasingly important.fourthMAds

As the Indian government continues to make investments to reduce anemia, improve education and ensure optimal quality of life for all people, the integration of biofortified crops—not just iron-rich bajra but a combined food basket of crops rich in iron, vitamin A and zinc—into the existing policy may be a worthwhile strategy.

The Midday Meal Scheme alone reaches 100 million school-aged children. The Integrated Child Development Scheme delivers food to more women and children that any other childcare program globally. These schemes, with their wide coverage, and existing delivery structures, provide a ready platform to integrate and deliver nutrient-rich biofortified staple foods in the battle against hidden hunger.

Samuel Scott is an associate research fellow at the International Food Policy Research Institute (IFPRI).