“I
would
be
hardhearted
enough to
let the sick
die if you
can tell me
how to prevent
others
from
falling
sick”
NIN-DFS
EVOLUTION OF THE NIN
DOUBLE FORTIFIED SALT
S. Ranganathan & B. Sesikeran
National Institute of Nutrition (ICMR)
Ministry of Health & Family Welfare (GOI)
Hyderabad – 500 007
NIN-DFS
OUT COME OF IRON DEFICIENCY
Infant/Maternal: Increased mortality and
morbidity.
Poor reproductive outcome: Still birth, poor
fetal growth, prematurity, low birth weight,
intra uterine deaths, etc.
Immuno Competence : Reduced phagocytic
activity of WBC.
Children & Adults: Poor work capacity.
NIN-DFS
In India, 75% of infants, 80% of
adolescent girls, and 85% of
pregnant & lactating women
suffer from anemia.
IODINE DEFICIENCY
Infancy & Childhood
Adults
Still birth, abortions, Low Hypothyroidism,
motor
coordination,
scholastic
(lowered
Goitre,
Low Increased apathy, Impaired
performance mental function, Decreased
IQ),
hypothyroidism,
Juvenile initiative, Decreased power
Goitre, of
Retarded physical growth.
decision
making,
Reduced work output.
NIN-DFS
 Iodine
deficiency during pregnancy causes
about 6.6 million babies a year to be born
mentally impaired in India.
 TGR is about 26%
in the country.
 IDD
continue to be a public health problem
not only in Sub-Himalayan region, but also
in the peninsula. Calls for immediate
action.
NIN-DFS
STRATEGIES
TO OVERCOME IRON DEFICIENCY:

Promotion of consumption of
foods rich in iron ? Bioavailability

Sensitization/Awareness – time
consuming

Folifer tablets supplement to
‘risk’ group.

Iron Fortified Salt – for all.
NIN-DFS
STRATEGIES
TO OVERCOME IODINE DEFICIENCY


NO SUITABLE FOOD RICH IN IODINE
IODIZED SALT
NIN-DFS
NIN-DFS
NIN-DFS
IMPORTANCE OF SALT
 Salt is universally consumed
 Constant daily intake. Low potential for
excessive intake.
 Production of salt is limited to few centers.
 Ideal vehicle for Iodine/Iron fortification.
 Iodine & Iron introduced through salt will
be ingested by each individual at a
uniform dosage throughout the year.
NIN-DFS
CHRONOLOGY OF DEVELOPMENT OF SALT
FORTIFICATION TECHNOLOGIES AT NIN
IRON FORTIFIED SALT (IFS)
1.
2.
3.
4.
5.
6.
7.
FePO4 & NaHSO4: AJCN 1975;28: 1395 - 401.
FeSO4 & OPA: AJCN 1978; 31: 1112 - 14.
Multicentric Efficacy study: Hyderabad, Delhi, Madras,
Calcutta. AJCN 1982; 35: 1442 - 51. (FNB).
FeSO4 & SHMP: Colourless IFS. Food Chemistry 1992; 45: 263
- 67. Large-scale production: J Food Sci Technol 1993; 30:
166 - 68.
Successful Transfer of Technology to TNSC (1991).
200 - 300 MT/month.
FGS alone: Food Chemistry 1996; 57: 311 - 15.
Ultra-structural differences of IS, IFS & DFS: SCANNING.
Journal of Scanning Microscopies 1998; 20: 271 - 73.
NIN-DFS
CHRONOLOGY OF DEVELOPMENT OF SALT
FORTIFICATION TECHNOLOGIES AT NIN (Contd..)
IODIZED SALT (IS)
Stable „IS‟ with KI or KIO 3 using CO 3 stabilizer
1.
CaCO3: Dry mixing. Lab studies: Indian Food Industry 1986; 5:
122 - 24.
2.
CaCO3, MgCO3: Factory. Long distance transport. Asia Pacific J
Clin Nutr 1997; 6: 92 - 94.
3.
CO3 of Na: Spray mixing. Factory. Long distance transport.
Salt 2000 – 8th Salt Symposium, Vol 2, RM Geertman, 2000;
1051 - 56, Elsevier.
4.
IS stable after 15 months even at high humidity.
One more benefit of ‘UIS’ is DFS
NIN-DFS
DOUBLE FORTIFIED SALT (DFS)
 DFS is edible common salt to
which very small quantities
of iodine and iron are added.
 DFS is iron fortified iodized salt.
 DFS looks like iodized salt and
it is to be used in the same
way as iodized salt.
NIN-DFS
COMMON SALT
DFS
NIN-DFS
DFS
 Edible common salt [Mg: <0.1%; Moisture:
<1.5%; NaCl: >98.0%]
 Sodium Hexa Meta Phosphate (SHMP): 1%
 FeSO4.7H2O: 0.50% (Fe = 1000 ppm)
 KIO 3: 0.0067% (I = 40 ppm) [KI also can be used]
•Simple method of „dry mixing‟
•Does not involve elaborate and
expensive measures
NIN-DFS
DFS @ 10g/day
IRON
1/3 RDA
(10 mg)
IODINE
100% RDA
(150 g)
PROPHYLACTIC
NIN-DFS
DFS





Lab studies
Factory studies
Safety evaluation
Acceptability studies
Impact & Efficacy studies
“EXCELLENT RESULTS”
NIN-DFS
NIN-DFS
NIN-DFS
STABILITY (6 STUDIES)
Study
Year
Quantity
(MT)
Mfr. (sample)
Period Sample
tested
(Year)
(n)
Iodine
( 15
ppm)
Iron
(1000
ppm)
(%)
Lab
1981-84,
1997
0.1 (1 kg)
1
300
100
100
Factory
1984, 1996
20 (50 kg)
0.5
500
100
100
Tribal
1989-92
60 (1 kg)
2
1500
91-98
100
100
School
1997-98
9 (50 kg)
1
12
100 (2)
50 (1)
Multi
centric
stability
2001-03
6 (1 kg)
2
1440
76
100
2004
0.5 (0.5 kg)
1
1440
100
100
STABILITY
Iodine
Iron
45
1200
1000
35
30
800
25
600
20
15
400
10
IRON (ppm)
IODINE (ppm)
40
200
5
0
0
1
2
3
4
5
6
12
15
MONTH
NIN-DFS
ACCEPTABILITY
Chappati, Puri, Parotta, Lemon rice, Coconut rice,
Dal, Chutney, Potato curry, Mixed vegetables curry,
Idli, Dosa, Upma, Pongal, Vada, Pakodi, Bajji,
Samosa, Vegetable Salad, Lemon/Orange juices,
Butter milk, Fruits‟ slices, Pickles, Sambar, Rasam,
Egg omelet, Fish/Prawn, Chicken/Mutton.
Acceptability
Score
DFS
IS
4.1 – 5.0
4.0 – 4.9
No difference in colour or appearance or
texture or flavour or taste
NIN-DFS
BIOAVAILABILITY
ANIMAL STUDY (RAT MODEL, n = 24)
GROUP
DFS
CONTROL
Hb (g/dl)
2 weeks
4 weeks
9 months
11.4 ± 1.5 13.0 ± 1.4 15.2 ± 1.1
6.8 ± 3.4
7.6 ± 4.0
-
HUMAN STUDY (n = 8, Rice meal, 55 Fe/59Fe)
GROUP
Fe Absorption (%)
DFS
6.1 ± 1.29
CONTROL
3.9 ± 0.38
UIE
No difference
NIN-DFS
SAFETY
P intake about 30mg/day.
 No change in bone integrity and histopathology
of tissues; no impairment in Ca & P balance in
rats fed with DFS for 9 months.
 No change in Ca & P homeostasis of children
who consumed DFS for 2 years.
 No undesirable effect, allergy or toxicity over 2
years of consumption of DFS in the tribal study
and residential school study. 100% compliance
in all the studies.

NIN-DFS
IMPACT: Iodine status
NIN-DFS
IMPACT: Iron status (anemic children)
90
83
80
Prevalence (%)
70
57
60
50
Anaemia (%) (Rural)
42
40
30
Anaemia (%) (Urban)
30
20
IS:Urban: Before 54%;
After 47%
10
0
Before
After
NIN-DFS
 DFS: MEAN (95% CI) RISE IN
Hb 0.72 (0.43, 1.01) g/dl
IN COMPARISON TO „IS‟
 WELL WITHIN THE RANGE OF
GLOBAL EXPERIENCE
NIN-DFS
FACTORY PRODUCTION
0.5 TO 60 MT
(1)
(3)
(5)
(6)
(7)
(8)
(9)
Hyderabad, AP (2) Chennai, TN
Valinokkam, TN (4) Alathur, TN
Thirupporur, TN
Mithapur, Gujarat
Bhubaneswar, Orissa
Gandhidham, Gujarat;
Tiruchengode, TN
NIN-DFS
NIN-DFS
NIN-DFS
NIN-DFS
NIN-DFS
NIN-DFS
NIN-DFS
NIN-DFS
NIN-DFS
COST (Rs.) OF 1 kg
6.85
5.85
6.85
– 5.85
= 1.00
IS
DFS
NIN-DFS
AVERAGE COST OF SALT IODIZATION & DOUBLE FORTIFICATION
Average cost per kg
Component
Range per kg (Rs.)
(Rs.)
IS
DFS
IS
DFS
Salt
Chemicals
7 -13
10
Processing
Packing material
Overheads
Amortization
Total: A
5 -62
8
Profit margin:
Factory
-
-
Dealer
Whole Sale
Retail
Total: B
Transport: C
Total (A + B + C)
-
7 -
9
8
NIN-DFS
With an average
consumption of
10g salt per day,
additional cost of
DFS over IS will be
about 1 Paise/head/day
NIN-DFS

Elimination of IDA & IDD through DFS is a
worthwhile investment

In addition to health benefits, if benefits
related
to
education,
increased
productivity of the population, human
resource development and increased
productivity & yield of livestock (egg,
milk, wool, etc) are included then, cost
benefit ratio is very high.
NIN-DFS
MESSAGE
1.
2.
3.
4.
NIN-DFS is a low-cost technology.
All the ingredients are easily available.
Its stability, acceptability, bioavailability,
safety, large-scale production in several
factories & distribution to remote areas,
impact and efficacy have been proved
successfully.
It is as effective as Iodized Salt in
controlling IDD & as effective as Iron
Fortified Salt in controlling IDA.
NIN-DFS
APPRAISAL
DR. MK BHAN COMMITTEE
REPORT, 2006:
 Approved only NIN-DFS because
of convincing evidences.
 Other DFS formulations
lacking scientific evidence.
were
NIN-DFS
APPRAISAL
 NIN wrote letters to the Secretaries of
Women Development and Child Welfare
Department and Department of Health
of all the States & UTs in the country
(35 each) advocating the introduction
of NIN-DFS in nutritional programmes
of the States & UTs.
 PFA & BIS Standards
NIN-DFS
WHAT IS NEW ?
 MoU: Free Technology
Transfer: No charges.
 Dossier with Manual for
Factory Production.
 DFS through PDS:
Minimum 20% to PDS.
NIN-DFS
CONCLUSION




DFS is the result of two decades
of untiring efforts of NIN Scientists
without compromise on quality.
Dr. Bhan Committee, GOI cleared
only NIN-DFS.
Now the benefits should reach
the people with no further delay.
With the ‘NIN-DFS ARMOUR’, the
country is geared up to combat
the double burden of IDA & IDD.
NIN-DFS
THANK YOU