Fortified Rice: A Key to Combating Micronutrient Deficiency in India

Union Cabinet's recent decision to extend the distribution of fortified rice through all government schemes, including the Pradhan Mantri Garib Kalyan Anna Yojana (PMGKAY), until December 2028, is aimed at tackling micronutrient deficiencies in India. Fortified rice has been identified as an effective tool in addressing iron deficiency and related health issues in the country, and the government’s move aims to expand its distribution while addressing concerns surrounding its safety, particularly for individuals with certain medical conditions like Thalassemia and Sickle Cell Anaemia.

What is Fortified Rice?

Fortified rice is rice that has been enriched with essential nutrients, particularly iron, to improve the nutritional intake of populations that rely heavily on rice as a staple food. In India, where nearly 65% of the population consumes rice daily, rice fortification plays a crucial role in addressing micronutrient deficiencies, particularly iron deficiency anemia, which is prevalent across the country.

Scientific evidence supports the safety of fortified rice consumption for all individuals, including those with Thalassemia and Sickle Cell Anaemia. Initially, the Food Safety and Standards (Fortification of Foods) Regulations, 2018, mandated a health advisory for people with these conditions. This advisory was challenged by experts, leading the Department of Food and Public Distribution (DFPD) to form a working group in 2023 to reassess the need for such warnings.

Scientific Review and Findings

The working group, consisting of haematologists, nutritionists, and public health experts, conducted a thorough review of existing literature and data on the safety of iron-fortified rice. The review revealed that individuals with Thalassemia and Sickle Cell Anaemia are not at increased risk from consuming iron-fortified rice. For Thalassemia patients, the iron absorbed from fortified rice is negligible compared to the iron intake from blood transfusions. Furthermore, these patients receive treatment to manage iron overload through chelation therapy.

In the case of individuals with Sickle Cell Anaemia, the hormone hepcidin, which regulates iron absorption in the body, prevents excessive iron accumulation. As a result, these individuals are unlikely to experience harm from consuming fortified rice. This conclusion was further supported by a community study conducted in India, which involved over 8,000 participants from tribal areas. The study found that nearly two-thirds of those with Sickle Cell Disease experienced iron deficiency, reinforcing the need for iron fortification rather than posing a risk.

Global Standards and India's Fortification Program

• Globally, rice fortification is recognized as a best practice in combating malnutrition, particularly in regions where rice is a staple food. Organizations like the World Health Organization (WHO) and the U.S. Food and Drug Administration (FDA) do not require advisory labels for individuals with Thalassemia or Sickle Cell Anaemia, and no other country mandates such labels on fortified rice packaging.

• India’s rice fortification program began in 2019 as a pilot project and has since been expanded in three phases. The program aligns with WHO guidelines, which recommend rice fortification with iron in countries where rice is a staple. Under PMGKAY, the government plans to procure 520 Lakh Metric Tons (LMT) of fortified rice annually, a substantial amount aimed at improving nutritional intake across the country.

• The infrastructure supporting rice fortification in India has grown significantly. More than 21,000 of the country’s 30,000 operational rice mills are now equipped with blending machines, capable of producing 223 LMT of fortified rice per month. In addition, 1,023 manufacturers of fortified rice kernels (FRK) and 232 premix suppliers ensure a steady supply to meet the needs of the fortification program. Quality control is maintained through rigorous testing by NABL-accredited laboratories.

A Safe and Effective Solution

The review conducted by the committee, chaired by the Director General of the Indian Council of Medical Research (ICMR), found no evidence that iron-fortified rice poses health risks to individuals with Thalassemia or Sickle Cell Anaemia. In states like Jharkhand and Maharashtra, where large-scale distribution of fortified rice has already taken place, no adverse health effects related to iron overload have been reported among the more than 264,000 beneficiaries in each state. This further solidifies the safety and efficacy of the program.

In July 2024, following the findings of the scientific review and the recommendations of the committee, the Food Safety and Standards Authority of India (FSSAI) officially removed the advisory label requirement for fortified rice packaging. This decision aligns with global standards and ensures that the distribution of fortified rice can continue without unnecessary concerns regarding its safety.

With a robust infrastructure in place and scientific evidence supporting the safety of fortified rice, particularly for vulnerable populations, this initiative is set to make a significant impact on public health. As India strengthens its rice fortification efforts, it joins a global movement aimed at improving nutrition and combating malnutrition.