(gelatinized cornmeal or wheat flour and wheat protein concentrate), defatted soy flour, and soybean oil; they are fortified with 6 essential minerals and 11 vitamins, including vitamin C. These foods are provided as ration supplements to refugees and internally displaced persons in camps and to recipients of development aid programs that are targeted largely towards mothers and children. The United States supplied 84 percent of the total fortified, blended foods used worldwide in 1996.

The current level of vitamin C fortification of CSB and WSB (40 mg/100 g) is based on the 1974 National Research Council (NRC) recommendations for children up to 11 years of age, by assuming an intake of 100 g of blended cereal per day. However, the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) recommend a minimal requirement of 20 mg of vitamin C per day for children up to 5 years of age and 30 mg for adults; the United Nations High Commissioner on Refugees (UNHCR) recommends 27 mg of vitamin C per day.

Beginning in fiscal year (FY) 1993, U.S. congressional appropriations committees urged USAID to increase the amount of vitamin C added to CSB and WSB from 40 mg/100 g of cereal blend to 90–100 mg/100g of cereal blend. The stated purpose of the increased vitamin C fortification of these blended foods was to improve the health of food aid recipients, particularly new mothers and infants, and to reduce the need for, and cost of, later medical interventions. An initial study commissioned by USAID on various options for appropriate micronutrient fortification recommended that vitamin C fortification not be increased until additional information was obtained on the stability of vitamin C during transport, storage, and preparation. The FY 1996 Senate Appropriations Committee directed USAID to initiate a pilot program to increase the vitamin C content of CSB and WSB to 90 mg/100 g and to report the results. In response, USAID initiated a cooperative agreement with the organization SUSTAIN (Sharing United States Technology to Aid in the Improvement of Nutrition) to devise and implement the pilot program. USAID also requested that the Institute of Medicine (IOM) address the cost-effectiveness and advisability of scaling up vitamin C fortification of these blended food aid commodities to improve recipients' diet, nutrition, and health. The Committee on International Nutrition—Vitamin C in Food Aid Commodities of the Food and Nutrition Board was constituted in response to this request.

The committee was charged with review of the proposed pilot program, examining it for soundness of scientific and technical design in relation to (1) monitoring the presence and stability of vitamin C in food aid commodities and (2) assessing the dietary intake of vitamin C, nutritional status, and health status of recipients. Based on this review, the committee prepared a brief report Vitamin C in Food Aid Commodities: Initial Review of a Pilot Program (IOM,