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Kubuga CK, Baako M, Low JW. Potential Nutrient Contribution of Community-Based Insects in Children's Food in Northern Ghana. Curr Dev Nutr 2024; 8:104410. [PMID: 39157009 PMCID: PMC11327501 DOI: 10.1016/j.cdnut.2024.104410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/02/2024] [Accepted: 06/24/2024] [Indexed: 08/20/2024] Open
Abstract
Background Micronutrient deficiencies are a major problem among children in northern Ghana. Available local foods and existing plant-based dietary patterns among children are insufficient to meet children's nutrients requirements. Aside enhancing diets with animal source foods, most of which are expensive for rural households, entomophagy, which is culturally accepted, appears to be a great alternative. Objectives This study aimed to 1) document the types of insects commonly consumed and the reasons for or against entomophagy in the study area, 2) document the reasons for adding or not adding insects to household meals, and 3) determine the nutrient contribution of community-based insects in children's food. Methods Both qualitative and quantitative research methods were concurrently applied in this exploratory study (N = 392 individuals; 6 focus group discussions) in northern Ghana. Results Termites, crickets, grasshoppers, and caterpillars were recognized as the most prevalent edible insects in communities. These insects were largely consumed by children but presently only included in household meals by a few households. Individual, sociocultural, sensory characteristics of insects, climate, and economic aspects were cited as grounds for and against entomophagy. Existing community-based children's diets were unable to meet the acceptable recommended nutrient intake (RNI; within a given age and gender group, the RNI is the amount of a nutrient ingested daily that would meet the needs of almost all healthy individuals in that group) level of all nutrients under consideration, especially for zinc, vitamin B-12, folate, and fat. Inclusion of community-based edible insects increased the RNI levels for all 11 micronutrients considered and met children's zinc, vitamin B-12, folate, and fat requirements. Conclusions Community-based insects demonstrate a great potential for meeting micronutrients needs of children in the research setting. Future research is required to improve households' adoption of community-based insects as part of household meals and to make insects accessible to households.
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Affiliation(s)
| | - Majeed Baako
- Nutritional Sciences Department, University for Development Studies, Tamale, Ghana
| | - Jan W Low
- International Potato Center, Nairobi, Kenya
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Arimond M, Wiesmann D, Grummer‐Strawn LM, Ferguson EL. Food pattern modeling to inform global guidance on complementary feeding of infants. MATERNAL & CHILD NUTRITION 2024; 20:e13590. [PMID: 38124469 PMCID: PMC10981476 DOI: 10.1111/mcn.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/02/2023] [Accepted: 10/26/2023] [Indexed: 12/23/2023]
Abstract
Nutrient needs are difficult to meet during infancy due to high nutrient requirements and the small quantities of food consumed. Guidelines to support food choice decisions are critical to promoting optimal infant health, growth and development and food pattern modeling can be used to inform guideline development. We employed the Optifood modeling system to determine if unfortified complementary foods could meet 13 nutrient targets for breastfed infants (6-11 months), and to describe food patterns that met, or came as close as possible to meeting targets. We also examined the impacts of eliminating food groups, increasing starchy staple foods or adding sentinel unhealthy foods. We collated a global food list from dietary studies in 37 countries and used this list to develop nutrient values for a set of 35 food subgroups. We analyzed infant dietary intakes from studies in eight countries to inform maximum quantities and frequencies of consumption for these subgroups in weekly food patterns. We found that unfortified foods could meet targets for most infants for 12 nutrients, but not for iron. For the smallest and youngest infants, with the lowest energy intakes, there were additional deficits for minerals. Best-case food patterns that met targets or came as close as possible to meeting targets included ample amounts of diverse vegetables, diverse plant- and animal-source protein foods, small amounts of whole grain foods and dairy and no refined grains or added fats or sugar. There were nutrient deficits if animal-source foods or vegetables were eliminated or if unhealthy foods were included.
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Affiliation(s)
| | | | | | - Elaine L. Ferguson
- Department of Population Health, Faculty of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUnited Kingdom
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Tura DC, Belachew T, Tamiru D, Hassen Abate K. Energy, protein and iron densities of dabi teff-field pea-based optimised novel complementary flour and its contribution to daily energy and nutrients demand by 6-23-month-old children. Br J Nutr 2024; 131:1015-1030. [PMID: 37936348 PMCID: PMC10876449 DOI: 10.1017/s0007114523002581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/23/2023] [Accepted: 11/03/2023] [Indexed: 11/09/2023]
Abstract
Inadequate intake of age-specific energy and nutrients is among the prime immediate causes of child malnutrition. Thus, this study aimed to determine the energy, protein and Fe densities of pre-processed dabi teff-field pea-based optimised novel complementary flour and its contribution to daily energy and nutrients demand by 6-8, 9-11 and 12-23 month-old children. The optimal formula at overall optimisation was identified to be 34·66 % dabi teff, 25 % barley, 15 % oats, 15·34 % field pea, 5 % linseed and 5 % maize with response values of 15·74 % protein, 5·09 % fat, 2·26 % ash, 2·88 % fibre, 73·05 % carbohydrate, 1591·72 kJ/100 g (380·43 kcal/100 g) energy, 32·21 mg/100 g Fe, 77·51 mg/100 g Ca and 2·59 mg/100 g Zn. The energy density of the optimised novel complementary flour was 1·27 kcal/g which fulfilled the Pan American Health Organization/WHO recommendation (≥ 0·8 kcal/g), protein density was 4·14 g/100 kcal and the Fe density was 8·47 mg/100 kcal, which was 2·12 to 10·59 times higher than the recommended value where the optimal had demonstrated to contribute more than 100 % of the daily energy and protein demand and notably more than 200 % of daily Fe demand at moderate bioavailability (0·8-4 mg/100 kcal). These findings showed that the daily recommended dietary allowance for energy, protein and Fe could be attained by the developed dabi teff-field pea-based optimised novel complementary flour and its contribution to the children's daily energy and nutrients demand met the standard, where the product can be used as food-based nutrition intervention to manage protein-energy malnutrition and Fe deficiency anemia in children sustainably.
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Affiliation(s)
- Diriba Chewaka Tura
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
- Department of Human Nutrition, Wollega University, Nekemte, Ethiopia
| | - Tefera Belachew
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Dessalegn Tamiru
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Kalkidan Hassen Abate
- Department of Nutrition and Dietetics, Institute of Health, Jimma University, Jimma, Ethiopia
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Knight F, Ferguson EL, Rana ZH, Belizan J, Gomes F, Bourassa MW, Dickin KL, Weaver CM, Cormick G. Including calcium-fortified water or flour in modeled diets based on local foods could improve calcium intake for women, adolescent girls, and young children in Bangladesh, Uganda, and Guatemala. Ann N Y Acad Sci 2023; 1526:84-98. [PMID: 37391187 DOI: 10.1111/nyas.15032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Adequate calcium intake is essential for health, especially for infants, children, adolescents, and women, yet is difficult to achieve with local foods in many low- and middle-income countries. Previous analysis found it was not always possible to identify food-based recommendations (FBRs) that reached the calcium population recommended intake (PRI) for these groups in Bangladesh, Guatemala, and Uganda. We have modeled the potential contribution of calcium-fortified drinking water or wheat flour to FBR sets, to fill the remaining intake gaps. Optimized diets containing fortified products, with calcium-rich local foods, achieved the calcium PRI for all target groups. Combining fortified water or flour with FBRs met dietary intake targets for adolescent girls in all geographies and allowed a reduction from 3-4 to the more feasible 1-2 FBRs. Water with a calcium concentration of 100 mg/L with FBRs was sufficient to meet calcium targets in Uganda, but higher concentrations (400-500 mg/L) were mostly required in Guatemala and Bangladesh. Combining calcium-fortified wheat flour at 400 mg/100 g of flour and the FBR for small fish resulted in diets meeting the calcium PRI in Bangladesh. Calcium-fortified water or flour could improve calcium intake for vulnerable populations, especially when combined with FBRs based on locally available foods.
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Affiliation(s)
- Frances Knight
- London School of Hygiene and Tropical Medicine, London, UK
- Nutrition Division, United Nations World Food Programme, Rome, Italy
| | | | - Ziaul H Rana
- The New York Academy of Sciences, New York, New York, USA
| | - José Belizan
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-IECS). CONICET, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, Argentina
| | - Filomena Gomes
- The New York Academy of Sciences, New York, New York, USA
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | | | - Katherine L Dickin
- Department of Public and Ecosystem Health, Cornell University, Ithaca, New York, USA
| | | | - Gabriela Cormick
- Centro de Investigaciones en Epidemiología y Salud Pública (CIESP-IECS). CONICET, Ciudad de Buenos Aires, Argentina
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad de Buenos Aires, Argentina
- Departamento de Salud, Universidad Nacional de La Matanza (UNLAM), San Justo, Argentina
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Kubuga CK, Bantiu C, Low J. Suitability and Potential Nutrient Contribution of Underutilized Foods in Community-Based Infant Foods in Northern Ghana. Nutrients 2023; 15:nu15112593. [PMID: 37299556 DOI: 10.3390/nu15112593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023] Open
Abstract
In rural Ghana, infant feeding is largely home-based or community-based yet less is known about the kinds of community-based infant foods and the ability of families to create a range of recipes for baby feeding using context-specific ingredients particularly in northern Ghana which has a high prevalence of malnutrition. In this explorative study on mothers (15-49 years; n = 46), we investigated community-based infant foods' food group composition, enrichment, nutrient contribution, and acceptability. The identified community-based infant foods were mainly made of either corn or millet porridges in northern Ghana and had three nutrients with % RNI ≥ 70. We developed 38 recipes of enriched community-based infant foods adding underutilized foods (orange-fleshed sweet potato, pawpaw, cowpea, moringa, groundnut, Bambara beans, and soya beans) to increase the number of nutrients from three to at least five and at most nine nutrients with % RNI ≥ 70 based on the recipe combinations. The enriched community-based infant food recipes provided adequate caloric amounts and modest improvements in micronutrient content for infants (6-12 months). All recipes tested were deemed appropriate and acceptable for infants by mothers. Moringa and pawpaw emerged as the lowest-cost ingredients to add among the underutilized foods. Future research is necessary to assess the effectiveness of the new recipes at promoting linear growth and improving micronutrient status during the complementary feeding period.
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Affiliation(s)
- Clement Kubreziga Kubuga
- Nutritional Sciences Department, University for Development Studies, Tamale P.O. Box TL1350, Ghana
| | - Cabral Bantiu
- Nutritional Sciences Department, University for Development Studies, Tamale P.O. Box TL1350, Ghana
| | - Jan Low
- International Potato Center, Nairobi P.O. Box 25171, Kenya
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Greffeuille V, Dass M, Fanou‐Fogny N, Nyako J, Berger J, Wieringa FT. Micronutrient intake of children in Ghana and Benin: Estimated contribution of diet and nutrition programs. MATERNAL & CHILD NUTRITION 2023; 19:e13453. [PMID: 36394283 PMCID: PMC10019049 DOI: 10.1111/mcn.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/23/2022] [Accepted: 10/20/2022] [Indexed: 11/19/2022]
Abstract
We estimated how micronutrient needs of young children, aged 6-24 months were covered by the standard (traditional) diets in Ghana and Benin, and the contributions of partial breastfeeding and national nutrition programs aimed at improving micronutrient status to overall micronutrient intakes. Estimates of micronutrient intake from standard diets were based on previous surveys, using the food composition table of West Africa (INFOOD). Recommended micronutrient intakes were based on World Health Organization recommendations. Children were grouped in three age groups (6-8, 9-12, and 13-24 months) to capture the changing dynamics of the complementary feeding period. As expected, from 6 months of age onwards, breastmilk didn't cover the micronutrient needs. The standard diets contributed only minimal to micronutrient intakes of children ranging from 0% to 37% of recommended intakes for Ca, Fe, Zn, vitamin A, vitamin D and iodine depending on the micronutrient considered. The contribution of mass (bio)-fortification programs to the coverage of micronutrient needs varied widely, depending on the staple food considered and the country, but overall did not allow to fill the gap in micronutrient needs of children except for vitamin A in some contexts. In contrast, consumption of voluntary fortified complementary food, especially formulated for the needs in this age groups, contributed substantially to overall micronutrient intake and could fill the gap for several micronutrients. The development of young child-targeted programs including micronutrient-dense foods, associated with interventions to increase the diet diversity and meal frequency, could significantly improve micronutrients intakes of children in both Ghana and Benin.
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Affiliation(s)
- Valérie Greffeuille
- Institut de Recherche pour le Développement (IRD)MontpellierFrance
- QualiSud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La RéunionMontpellierFrance
| | - Mamta Dass
- Institut de Recherche pour le Développement (IRD)MontpellierFrance
- QualiSud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La RéunionMontpellierFrance
| | - Nadia Fanou‐Fogny
- Faculté des Sciences Agronomiques (FSA)Université d'Abomey‐Calavi (UAC)GodomeyBenin
| | - Jolene Nyako
- Nutrition Unit, Food Research Institute, Council for Scientific and Industrial Research (CSIR)AccraGhana
| | - Jacques Berger
- Institut de Recherche pour le Développement (IRD)MontpellierFrance
- QualiSud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La RéunionMontpellierFrance
| | - Frank T. Wieringa
- Institut de Recherche pour le Développement (IRD)MontpellierFrance
- QualiSud, Univ Montpellier, Avignon Université, CIRAD, Institut Agro, IRD, Université de La RéunionMontpellierFrance
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7
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The potential contribution of house crickets to the dietary zinc content and nutrient adequacy in young Kenyan children: a linear programming analysis using Optifood. Br J Nutr 2023; 129:478-490. [PMID: 35387693 PMCID: PMC9876809 DOI: 10.1017/s0007114522000915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Zn deficiency arising from inadequate dietary intake of bioavailable Zn is common in children in developing countries. Because house crickets are a rich source of Zn, their consumption could be an effective public health measure to combat Zn deficiency. This study used Optifood, a tool based on linear programming analysis, to develop food-based dietary recommendations (FBR) and predict whether dietary house crickets can improve both Zn and overall nutrient adequacy of children's diets. Two quantitative, multi-pass 24-h recalls from forty-seven children aged 2 and 3 years residing in rural Kenya were collected and used to derive model parameters, including a list of commonly consumed foods, median serving sizes and frequency of consumption. Two scenarios were modelled: (i) FBR based on local available foods and (ii) FBR based on local available foods with house crickets. Results revealed that Zn would cease to be a problem nutrient when including house crickets to children's diets (population reference intake coverage for Zn increased from 89 % to 121 % in the best-case scenario). FBR based on both scenarios could ensure nutrient adequacy for all nutrients except for fat, but energy percentage (E%) for fat was higher when house crickets were included in the diet (23 E% v. 19 E%). This manoeuvre, combined with realistic changes in dietary practices, could therefore improve dietary Zn content and ensure adequacy for twelve nutrients for Kenyan children. Further research is needed to render these theoretical recommendations, practical.
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8
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Fahmida U, Pramesthi IL, Kusuma S, Wurjandaru G, Izwardy D. Problem Nutrients and Food-Based Recommendations for Pregnant Women and Under-Five Children in High-Stunting Districts in Indonesia. Curr Dev Nutr 2022; 6:nzac028. [PMID: 35542385 PMCID: PMC9071569 DOI: 10.1093/cdn/nzac028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/14/2021] [Accepted: 02/21/2022] [Indexed: 11/12/2022] Open
Abstract
Background Stunting and anemia in pregnant women and under-five children remain a challenge in developing countries, including Indonesia. One of the significant contributors to these problems is inadequate nutrient intake. Objectives The aim of the study was to identify, using a linear programming (LP) approach, problem nutrients and optimized food-based recommendations for under-five children and pregnant women in 10 stunting-prioritized districts in Indonesia. Methods LP analysis was done using the Optifood tool on dietary data collected using single 24-h dietary recall in the National Monitoring of Nutrient Consumption (Pemantauan Konsumsi Gizi), conducted by the Ministry of Health from 10 stunting-prioritized districts in Indonesia. Problem nutrients and nutrient-dense foods were identified, and all alternative food-based recommendations or complementary feeding recommendations were compared to identify which recommendation will best contribute to fulfill dietary adequacy. Results The number of problem nutrients in each district ranged from 0 to 7 nutrients for under-five children and 1 to 6 nutrients for pregnant women. The top 3 problem nutrients were: iron, zinc, and folate (for children aged 6-11 mo); zinc, folate, and calcium (for 12-23-mo-olds and 24-35-mo-olds); folate, zinc, and vitamin C/riboflavin (for 36-59-mo-olds); and iron, folate, and calcium (for pregnant women). The findings showed that problem nutrients identified using LP were in line with nutritional problems in under-five children (stunting and anemia) and pregnant women (anemia). Food-based recommendations (FBRs)/complementary feeding recommendations were developed that best meet dietary adequacy for the nutrients. Conclusions Despite the similarity in stunting prevalence across the districts, there was variation in number and types of problem nutrients. The developed FBRs that promoted nutrient-dense foods suited to the problem nutrients in each area need to be promoted to improve nutrient intakes of under-five children and pregnant women in these areas with high stunting prevalence.
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Affiliation(s)
- Umi Fahmida
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Indriya Laras Pramesthi
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Sari Kusuma
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON)—Pusat Kajian Gizi Regional Universitas Indonesia, Jakarta, Indonesia
| | - Giri Wurjandaru
- Directorate of Public Health Nutrition, Indonesian Ministry of Health, Jakarta, Indonesia
| | - Doddy Izwardy
- Directorate of Public Health Nutrition, Indonesian Ministry of Health, Jakarta, Indonesia
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Windus JL, Duncanson K, Burrows TL, Collins CE, Rollo ME. Review of dietary assessment studies conducted among Khmer populations living in Cambodia. J Hum Nutr Diet 2022; 35:901-918. [PMID: 35377499 PMCID: PMC9545030 DOI: 10.1111/jhn.13011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 03/14/2022] [Indexed: 11/28/2022]
Abstract
Background Despite economic growth, Cambodia continues to have high rates of malnutrition, anaemia and nutrition‐related deficiencies. Government policies promote nutrition strategies, although dietary intake data is limited. A detailed synthesis of existing intake data is needed to inform nutrition policy and practice change. This review aims to characterise and assess quality of dietary assessment methods and outcomes from individual‐level ‘whole diet’ studies of Khmer people living in Cambodia. Methods Searches were conducted using PRISMA‐ScR guidelines. Included papers reported dietary intake at an individual level for ‘whole diet’. Studies using secondary data or lacking dietary assessment details were excluded. Extracted data included dietary assessment features, nutrient/food group intakes and database. Results Nineteen publications (15 studies) were included, with nine carried out among children under 5 years and six among women. Eleven studies reported intake by food groups and four by nutrients, prominently energy, protein, vitamin A, iron, calcium and zinc. Inconsistent intakes, food groupings and reporting of study characteristics limited data synthesis. All but one study used 24‐h recalls. Trained local fieldworkers used traditional interview‐administered data collection and varied portion estimation tools. Food composition databases for analysis were not tailored to the Cambodian diet. Overall quality was rated as ‘good’. Conclusions We recommend the development of a best‐practice protocol for conducting dietary assessment, a Cambodia‐specific food composition database and a competent trained workforce of nutrition professionals, with global support of expertise and funding for future dietary assessment studies conducted in Cambodia. Fifteen studies with highly variable intake data included in the review. The food composition databases used were not specific to Cambodian diet. Minimum reporting standards and best practice protocols recommended, including in‐country nutrition training. Lack of whole population dietary intake data indicates the need for a national survey.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences, University of Newcastle, Newcastle, Australia
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Knight F, Woldt M, Sethuraman K, Bergeron G, Ferguson E. Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries. Ann N Y Acad Sci 2021; 1509:145-160. [PMID: 34850396 PMCID: PMC9299870 DOI: 10.1111/nyas.14709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 12/05/2022]
Abstract
A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population‐specific food‐based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual‐level 24‐h recalls (24HRs). The 24HR data from 12‐ to 23‐month‐old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES‐ and 24HR‐defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food‐group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77–100% agreement), food sources of nutrients (71–100% agreement), and FBRs (80–100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12‐ to 23‐month‐old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.
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Affiliation(s)
- Frances Knight
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.,United Nations World Food Programme, Rome, Italy
| | - Monica Woldt
- Helen Keller International, Washington, District of Columbia.,Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,USAID Advancing Nutrition, Arlington, Virginia
| | - Kavita Sethuraman
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia
| | - Gilles Bergeron
- Formerly with the Food and Nutrition Technical Assistance Project (FANTA), Washington, District of Columbia.,New York Academy of Sciences, New York, New York
| | - Elaine Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
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11
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Sayed N, Schönfeldt HC. The use of linear programming to determine whether breastfed infants can achieve a nutritionally adequate complementary feeding diet: a case study of 6–11-month-old infants from KwaMashu, KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2021. [DOI: 10.1080/16070658.2021.1982499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Nazeeia Sayed
- Department of Animal Science, University of Pretoria, Hatfield, South Africa
| | - Hettie C Schönfeldt
- Department of Animal Science, University of Pretoria, Hatfield, South Africa
- ARUA Centre of Excellence in Food Systems, University of Pretoria, Hatfield, South Africa
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12
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Borgonjen-van den Berg KJ, de Vries JHM, Chopera P, Feskens EJM, Brouwer ID. Sensitivity of Food-Based Recommendations Developed Using Linear Programming to Model Input Data in Young Kenyan Children. Nutrients 2021; 13:3485. [PMID: 34684486 PMCID: PMC8541147 DOI: 10.3390/nu13103485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
Abstract
Food-based recommendations (FBR) developed using linear programming generally use dietary intake and energy and nutrient requirement data. It is still unknown to what extent the availability and selection of these data affect the developed FBR and identified problem nutrients. We used 24 h dietary recalls of 62 Kenyan children (4-6 years of age) to analyse the sensitivity of the FBR and problem nutrients to (1) dietary intake data, (2) selection criteria applied to these data and (3) energy and nutrient requirement data, using linear programming (Optifood©), by comparing a reference scenario with eight alternative scenarios. Replacing reported by estimated consumption frequencies increased the recommended frequencies in the FBR for most food groups while folate was no longer identified as a problem nutrient. Using the 10-90th instead of the 5-95th percentile of distribution to define minimum and maximum frequencies/week decreased the recommended frequencies in the FBR and doubled the number of problem nutrients. Other alternative scenarios negligibly affected the FBR and identified problem nutrients. Our study shows the importance of consumption frequencies for developing FBR and identifying problem nutrients by linear programming. We recommend that reported consumption frequencies and the 5-95th percentiles of distribution of reported frequencies be used to define the minimum and maximum frequencies.
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Affiliation(s)
- Karin J. Borgonjen-van den Berg
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (J.H.M.d.V.); (P.C.); (E.J.M.F.); (I.D.B.)
| | - Jeanne H. M. de Vries
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (J.H.M.d.V.); (P.C.); (E.J.M.F.); (I.D.B.)
| | - Prosper Chopera
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (J.H.M.d.V.); (P.C.); (E.J.M.F.); (I.D.B.)
- Department of Nutrition Dietetics and Food Science, Faculty of Science, University of Zimbabwe, Mt Pleasant, Harare P.O. Box MP 167, Zimbabwe
| | - Edith J. M. Feskens
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (J.H.M.d.V.); (P.C.); (E.J.M.F.); (I.D.B.)
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University, P.O. Box 17, 6700 AA Wageningen, The Netherlands; (J.H.M.d.V.); (P.C.); (E.J.M.F.); (I.D.B.)
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Windus JL, Burrows TL, Duncanson K, Collins CE, Rollo ME. Scoping review of nutrition intervention and dietary assessment studies in Khmer populations living in Cambodia. J Hum Nutr Diet 2021; 34:953-968. [PMID: 34231266 DOI: 10.1111/jhn.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This scoping review aims to describe the body of nutrition intervention and dietary assessment research undertaken with Khmer populations in Cambodia, as well as summarise the nutrition knowledge base and highlight priority areas for future research. METHODS Five databases and the grey literature were searched, following PRISMA-ScR guidelines. Studies involving dietary assessment or nutrition interventions published after 1992 were identified using specific search terms and extracted to a customised data extraction table for categorisation and analysis. Study participants were Khmer people of any age and gender, living in rural or urban Cambodia. RESULTS Of the 100 included studies, 58 were dietary assessment only studies, 24 were nutrition interventions only, and 18 studies involved both assessment of intake and an intervention. Sixty-eight percent of study populations were mothers and young children, of which 52 studies focused on children aged under 5 years. Nineteen interventions involved supplementation and six trialled fortification of rice or fish sauce. Anaemia was the most common nutrition condition studied (n = 17), followed by malnutrition (n = 15) and malnutrition risk factors (n = 11). General nutrition status was explored in 25 studies, and individual micronutrients that were studied included iron (n = 27), zinc (n = 6), vitamin A (n = 4) and thiamine (n = 3). CONCLUSIONS Diet-related research in Khmer populations in Cambodia has predominantly focused on dietary assessment or evaluation of interventions aimed at reducing malnutrition and resolving micronutrient deficiencies. Areas identified as emerging needs included non-communicable diseases, the ageing population and non-iron deficiency anaemia.
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Affiliation(s)
- Janelle L Windus
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Tracy L Burrows
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Kerith Duncanson
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
| | - Megan E Rollo
- Faculty of Health and Medicine, School of Health Sciences University of Newcastle, University Drive, Callaghan, NSW, Australia
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Nurhasan M, Prima RA, Olsen SB, Wieringa FT, Dijkhuizen MA, Chamnan C, Roos N. Caretakers' perceptions and willingness-to-pay for complementary food in urban and rural Cambodia. MATERNAL & CHILD NUTRITION 2021; 17:e13130. [PMID: 33403777 PMCID: PMC8189195 DOI: 10.1111/mcn.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 12/25/2022]
Abstract
Inadequate child nutrition during the first '1000 days' is widespread in Cambodia, resulting in a high prevalence of child malnutrition. Access to processed complementary food in packages (PCFP) may support caretakers in improving diet of young children. This study aimed to evaluate the caretakers' preferences and willingness-to-pay (WTP) for PCFP in Cambodia. The study was conducted in urban and rural settings, involving 520 caretakers with children aged 7-24 months in Phnom Penh (urban) and Prey Veng (rural). Four PCFPs were included: a commercial brand, a social-commercial brand, a worldwide distributed fortified complementary food aid product (CSB++) and an experimental fortified rice-and-fish-based PCFP developed in Cambodia (WF-L). Sensory analysis was conducted for all products, stated WTP was assessed for three products (excluding CSB++) and actual WTP experiment was conducted on WF-L only. Our results show that overall, WF-L was preferred by the rural participants over food aid CSB++. Further improvements in the organoleptic qualities of WF-L should focus on consistency and taste. The participants were, on average, willing to pay 1,667 Cambodian riel (KHR, $0.4) and 1,192 KHR ($0.3) in urban and rural settings, respectively, for 35 g of WF-L. We also found that despite being nutritionally inadequate, most participants considered homemade porridge to be healthier, more practical and preferred by the children. Therefore improving the quality of homemade foods merits urgent consideration. When applying PCFP in nutrition programmes as a supplementary option to homemade complementary foods, locally produced products could be a more viable supplementary option than global food aid.
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Affiliation(s)
- Mulia Nurhasan
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
- Center for International Forestry Research (CIFOR)BogorIndonesia
| | - Rizal Adi Prima
- School of Economics, Finance and MarketingRMIT UniversityMelbourneAustralia
| | - Søren Bøye Olsen
- Department of Food and Resource EconomicsUniversity of CopenhagenFrederiksbergDenmark
| | - Frank T. Wieringa
- UMR‐204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgroMontpellierFrance
| | | | - Chhoun Chamnan
- Department of Fisheries Post‐harvest Technologies and Quality ControlFisheries Administration, Ministry of Agriculture, Forestry and FisheriesPhnom PenhCambodia
| | - Nanna Roos
- Department of Nutrition, Exercise and SportsUniversity of CopenhagenCopenhagenDenmark
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15
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Mejos KK, Ignacio MS, Jayasuriya R, Arcot J. Use of Linear Programming to Develop Complementary Feeding Recommendations to Improve Nutrient Adequacy and Dietary Diversity Among Breastfed Children in the Rural Philippines. Food Nutr Bull 2021; 42:274-288. [PMID: 34002635 DOI: 10.1177/0379572121998125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lack of dietary diversity in complementary feeding contributes to nutrient gaps leading to undernutrition. Food-based strategies have been successfully used to enrich the complementary diets of infants and young children. However, context-specific recommendations based on an objective diet optimization are needed to formulate sound and practical nutritional guidelines. OBJECTIVES The present study aimed to identify problem nutrients in complementary diets and formulate complementary feeding recommendations (CFRs) using linear programming analysis for children aged 6 to 23 months in the rural Philippines. METHODS A cross-sectional survey was conducted in the municipality of Mercedes, Philippines. Dietary intakes of breastfed children 6 to 8, 9 to 11, and 12 to 23 months of age (n = 297) were assessed using a multipass 24-hour recall method with 7-day food consumption frequency. A linear programming tool was used to identify the recommended nutrient intakes that could not be met within the existing local food patterns and develop CFRs that would best fulfill nutrient adequacy for 11 modeled micronutrients. RESULTS Problem nutrients in the current diets were iron and calcium in any age-group, zinc for 6 to 8 and 9 to 11 months old, and thiamine and folate for 12 to 23 months old children. Adoption of CFRs with 4 to 5 food groups in the diet would ensure the adequacy of 7 to 8 nutrients, depending on the age-group. CONCLUSION Within the boundaries of local dietary patterns, adequacy for most nutrients could be achieved by promoting realistic servings of nutrient-dense foods and food groups. The linear programming results provide an evidence-based strategy in designing interventions to improve the quality of Filipino complementary diets.
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Affiliation(s)
- Karen Kay Mejos
- Food and Health, School of Chemical Engineering, 7800UNSW Sydney, Australia
| | - Maria Socorro Ignacio
- Department of Nutrition, College of Public Health, 54725University of the Philippines Manila, Manila, Philippines
| | | | - Jayashree Arcot
- Food and Health, School of Chemical Engineering, 7800UNSW Sydney, Australia
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Brouzes CMC, Darcel N, Tomé D, Bourdet-Sicard R, Youssef Shaaban S, Gamal El Gendy Y, Khalil H, Ferguson E, Lluch A. Local Foods Can Increase Adequacy of Nutrients Other than Iron in Young Urban Egyptian Women: Results from Diet Modeling Analyses. J Nutr 2021; 151:1581-1590. [PMID: 33693946 PMCID: PMC8169812 DOI: 10.1093/jn/nxab021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 01/21/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient. OBJECTIVE This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women. METHODS Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19-30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify "limiting nutrients" and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed. RESULTS Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation. CONCLUSIONS A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women.
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Affiliation(s)
- Chloé M C Brouzes
- Université Paris-Saclay, AgroParisTech, INR AE, UMR PNCA, 75005, Paris, France
| | - Nicolas Darcel
- Université Paris-Saclay, AgroParisTech, INR AE, UMR PNCA, 75005, Paris, France
| | - Daniel Tomé
- Université Paris-Saclay, AgroParisTech, INR AE, UMR PNCA, 75005, Paris, France
| | | | | | | | | | - Elaine Ferguson
- Faculty of Epidemiology and Population Health, Department of Population Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, United Kingdom
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17
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Dietary Sources and Nutrient Adequacy Potential of Local Foods among Children (6-23 Months) in Urban Slums of West Oromia (Ethiopia). J Nutr Metab 2021; 2020:1787065. [PMID: 33489360 PMCID: PMC7803176 DOI: 10.1155/2020/1787065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 11/18/2022] Open
Abstract
Background Identifying the combination of local foods that optimize nutrient intake is challenging. This study addressed how local foods could be rationally combined to provide basic nutritional needs, while limiting the use of commercial foods among children in Ethiopia. Methods A cross-sectional survey was carried out to estimate dietary intakes of 396 children (6-23 months of age) using 24-hour recall and WDR. Anthropometrics (weight and height) of the children was taken to calibrate energy and protein requirements to body sizes during ProPAN analysis. Model parameters were defined using dietary and market-survey data. ProPAN (2.0), SAS (9.2), and NutriSurvey for Windows were used for data analysis. Results Age-specific optimal combinations of local foods that achieve nutrient adequacy set by the WHO/FAO (≥70% RDA) for 9 nutrients were successfully generated. Overall, the percentage of children consuming ≥ EAR for most nutrients obtained from median servings was 54.3%, 89.9%, 61.8%, 12.9%, 85.6%, 79.7%, and 34.2% for energy, protein, iron, zinc, vitamin A, vitamin C, and calcium, respectively. The percentage of RDA was 46.3% for zinc, 56.7% for vitamin A, 24.3% for vitamin C, and 40% for calcium among infants (6-11 months), whereas the respective percentage of RDA was 78.1% for zinc, 100% for vitamin A, 43.3% for vitamin C, and 50% for calcium in older children (12-23 months of age). However, careful combination of local foods, slightly complimented by commercial foods, has shown substantial improvement in nutrient adequacy, ensuring ≥99% RDA for all target nutrients. Conclusions Careful combinations of local foods have the potential to achieve optimum dietary intakes of essential nutrients. However, minimal consideration of commercial foods has been inevitable, especially for infants aged 6-11 months.
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18
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Berra WG, Yang NH. Households Hunger: The Key Attribute to Anthropometric Failures of Children in West Oromia (Ethiopia). Curr Med Sci 2020; 40:580-585. [PMID: 32681263 DOI: 10.1007/s11596-020-2216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 07/02/2020] [Indexed: 10/23/2022]
Abstract
Poor nutrition is the underlying cause of child death. However, comprehensive data showing the relationships between dietary-practices, food security, and nutritional status are scant. The present study aimed to examine the association of inappropriate feeding practices and household-hunger with anthropometric measures in children aged 6-23 months. A cross-sectional survey was conducted on randomly selected 525-households. Semi-structured interviewer-administered questionnaires were used to gather data on socio-demographic, child health, dietary-practices and household-hunger. Weight and height/length of the children were measured and analyzed using the new World Health Organization (WHO) Growth Standards. The prevalence of stunting, wasting and underweight as well as composite index of anthropometric failure (CIFA) were used to indicate under-nutrition. The overall prevalence of inappropriate feeding practices was 22.9%, rate of moderate households-hunger was 12.4%, and the prevalence of stunting, underweight and wasting was 16.2%, 6.9% and 6.3%, respectively, while the CIAF was 21.3%. The prevalence was significantly higher in young children aged 12-23 months than in infants aged 6-11 months. Children from households experiencing moderate hunger had significantly higher risk of being stunting (OR: 10.20; 95%CI: 2.00-51.50), underweight (OR:3.89; 95%CI: 1.40-10.90), wasting (OR: 1.97; 95%CI: 0.99-3.90), and CIAF (OR: 1.90; 95%CI: 1.05-3.45), than those residing in households experiencing no or mild hunger. Multi-disciplinary approaches are required to improve household food-security and child dietary practices, thus the nutritional status among young children.
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Affiliation(s)
- Wondu Garoma Berra
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.,Nutrition Unit, Wollega University, Nekemte, Ethiopia
| | - Nian-Hong Yang
- Department of Nutrition & Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, MOE Key Laboratory of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
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19
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Chileshe J, Talsma EF, Schoustra SE, Borgonjen-van den Berg KJ, Handema R, Zwaan BJ, Brouwer ID. Potential contribution of cereal and milk based fermented foods to dietary nutrient intake of 1-5 years old children in Central province in Zambia. PLoS One 2020; 15:e0232824. [PMID: 32384114 PMCID: PMC7209124 DOI: 10.1371/journal.pone.0232824] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
Zambia is still facing undernutrition and micronutrient deficiencies despite fortification and supplementation programmes stressing the need for additional solutions. Fermented foods have the potential to improve nutrient intake and, therefore, could have an important role in food based recommendations (FBRs) to ensure adequate intake of nutrients for optimal health of populations. Secondary dietary intake data was used in Optifood, a linear programming software to develop FBRs, for children aged 1-3 and 4-5 years in Mkushi district of Zambia. Three scenarios per age group were modeled to determine FBRs based on: (1) FBRs based on local available foods (2) FBR and Mabisi, a fermented milk beverage, and (3) FBR with Munkoyo, a cereal fermented beverage. The scenarios were compared to assess whether addition of Mabisi or Munkoyo achieved a better nutrient intake. FBRs based on only locally available non-fermented foods did not meet ≥70% of recommended nutrient intake (RNI) for calcium, fat, iron and zinc, so-called problem nutrients. The addition of Munkoyo to the FBRs did not reduce the number of problem nutrients, but after adding Mabisi to the FBR's only iron (67% of RNI) in the 1-3 year age group and only zinc (67% of RNI) in the 4-5 year age group remained problem nutrients. Mabisi, a fermented milk product in combination with the local food pattern is a good additional source of nutrients for these age groups. However, additional nutrition sensitive and cost-effective measures would still be needed to improve nutrient intake, especially that of iron and zinc.
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Affiliation(s)
- Justin Chileshe
- Laboratory of Genetics, Plant Sciences Group, Wageningen University and Research, The Netherlands
- Division of Human Nutrition and Health, Wageningen University and Research, The Netherlands
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Elise F Talsma
- Division of Human Nutrition and Health, Wageningen University and Research, The Netherlands
| | - Sijmen E Schoustra
- Laboratory of Genetics, Plant Sciences Group, Wageningen University and Research, The Netherlands
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Zambia, Zambia
| | | | - Ray Handema
- Tropical Diseases Research Centre, Ndola, Zambia
| | - Bas J Zwaan
- Laboratory of Genetics, Plant Sciences Group, Wageningen University and Research, The Netherlands
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, The Netherlands
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20
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Soe LT, Fahmida U, Seniati ANL, Firmansyah A. Nutrients Essential for Cognitive Function Are Typical Problem Nutrients in the Diets of Myanmar Primary School Children: Findings of a Linear Programming Analysis. Food Nutr Bull 2020; 41:211-223. [PMID: 32013580 DOI: 10.1177/0379572119878070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Good cognitive function is important for school-age children. Although essential fatty acids play a main role in cognitive functions, their intakes are assumed as inadequate among developing countries including Myanmar. However, there is still lack of evidence to show whether they are problem nutrients. OBJECTIVE This study aimed to determine the problem nutrients in the diets of Myanmar primary schoolchildren and to formulate food-based recommendations (FBR) to optimize the intake of these micronutrients. METHODS A cross-sectional study was conducted at 3 primary schools in Nyaungdon Township of Myanmar. A 1-week dietary intake assessment was done on 7- to 9-year-old (n = 100) primary schoolchildren. A linear programming approach using the World Health Organization Optifood software was used to assess the nutrient intake and develop FBRs. RESULTS The prevalence of stunted growth, wasting, and being underweight in the students were 28%, 18%, and 28%, respectively. The intake of calcium, vitamin B1, folate, iron, omega-3 fatty acids, eicosapentaenoic acid, and docosahexaenoic acid was insufficient. Locally available nutrient-dense foods that include water spinach, carp fish, duck egg, garden pea, and shrimp were selected to develop FBR to increase the intake of problem nutrients. CONCLUSION The linear programming analysis showed that the primary schoolchildren have difficulty meeting nutrient recommendations given locally available foods, especially iron and essential fatty acids which are important for cognitive performance of schoolchildren.
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Affiliation(s)
- Le Thandar Soe
- Department of Nutrition, Faculty of Medicine, Universitas Indonesia-Dr. CiptoMangunkusumo General Hospital, Jakarta, Indonesia.,South East Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO-RECFON) - Pusat Kajian Gizi Regional (PKGR), Universitas Indonesia, Jakarta, Indonesia.,Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | - Umi Fahmida
- South East Asian Ministers of Education Organization Regional Centre for Food and Nutrition (SEAMEO-RECFON) - Pusat Kajian Gizi Regional (PKGR), Universitas Indonesia, Jakarta, Indonesia
| | | | - Agus Firmansyah
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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21
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Whole-blood PUFA and associations with markers of nutritional and health status in acutely malnourished children in Cambodia. Public Health Nutr 2020; 23:974-986. [PMID: 31973779 DOI: 10.1017/s1368980019003744] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To measure fatty acid composition, particularly whole-blood PUFA content, in acutely malnourished children and identify associations with markers of nutritional and health status. DESIGN PUFA were assessed in dried blood spots obtained from a cross-sectional study. Nutritional and health status were assessed by anthropometry, haemoglobinopathies, inflammation and blood counts. SETTING Cambodia. PARTICIPANTS The study was conducted with 174 children aged 0·5-18 years with acute malnutrition. RESULTS Among total fatty acids (FA), the relative percentage of total PUFA was 20 % FA, with 14 % of the children having very low PUFA (mead acid (MA):arachidonic acid (AA) >0·02, n-6 docosapentaenoic acid:DHA >0·2 and total n-6:n-3 PUFA >10·5). Wasting was not associated with any PUFA. Stunting and low height were consistently positively associated with total PUFA and positively with n-6 PUFA. Height was positively associated with n-3 long-chain PUFA (LCPUFA). The presence of haemoglobinopathies or inflammation was positively associated with MA:AA, but not total PUFA. Elevated blood platelet counts were positively correlated with linoleic acid and appeared to be influenced by anaemia (P = 0·010) and inflammation (P = 0·002). Monocyte counts were high during inflammation (P = 0·052) and correlated positively with n-6 LCPUFA and n-3 LCPUFA. CONCLUSIONS Children with acute malnutrition or stunting had low PUFA, while elevated platelets and monocytes were associated with high PUFA. In acutely malnourished children, inflammation could lead to elevated blood cell counts resulting in increased whole-blood PUFA which does not reflect dietary intake or nutritional status.
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Borg B, Sok D, Mihrshahi S, Griffin M, Chamnan C, Berger J, Laillou A, Roos N, Wieringa FT. Effectiveness of a locally produced ready-to-use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial. MATERNAL & CHILD NUTRITION 2020; 16:e12896. [PMID: 31885221 PMCID: PMC7038903 DOI: 10.1111/mcn.12896] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 09/01/2019] [Accepted: 09/09/2019] [Indexed: 12/11/2022]
Abstract
This cluster randomised controlled trial tested the effectiveness of a locally produced, fish-based, ready-to-use supplementary food (RUSF) to prevent growth faltering (decline in z-scores). Cambodian infants (n= 485), aged 6 to 11 months, were randomised by site to receive the RUSF, Corn-Soy Blend++ (CSB++), micronutrient powders (MNP), or no supplement (control). The intervention was for 6 months. In unadjusted analysis, the control group had statistically significantly decreased weight-for-age z-scores (WAZ; -0.02, 95%CI = -0.03 - -0.01, P= 0.001) and height-for-age z-scores (HAZ; -0.07, 95%CI = -0.09 - -0.05, P < 0.001), and increased mid-upper arm-circumference (MUAC; 0.02cm, 95%CI = 0.01 - 0.04, P = 0.010), but no statistically significant change in weight-for-height z-scores (WHZ). The RUSF group did not differ significantly from the control for WAZ, HAZ or WHZ (in other words, WAZ and HAZ decreased and WHZ did not change), but had increased MUAC in comparison to the control (0.04cm, 95%CI = 0.01 - 0.06, P = 0.008). There were no statistically significant differences between the RUSF group and the CSB++ or MNP groups with respect to WAZ, HAZ, WHZ or MUAC. Interestingly, in adjusted analysis, low consumers of RUSF had increased WAZ, WHZ and MUAC (0.03, 95%CI = 0.01-0.06, P = 0.006; 0.04, 95%CI = 0.01-0.08, P = 0.026; and 0.05cm, 95%CI = 0.02-0.09, P = 0.004, respectively) compared with the control. The novel RUSF, particularly in small quantities, protected against ponderal growth faltering, but the improvements were of limited clinical significance.
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Affiliation(s)
- Bindi Borg
- School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
| | - Daream Sok
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenCopenhagenDenmark
- Department of Fisheries Post‐Harvest Technologies and Quality Control, Fisheries AdministrationMinistry of Agriculture, Forestry and FisheriesPhnom PenhCambodia
| | - Seema Mihrshahi
- School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
| | - Mark Griffin
- School of Public Health, Faculty of MedicineUniversity of SydneySydneyAustralia
- School of Public HealthUniversity of QueenslandBrisbaneAustralia
| | - Chhoun Chamnan
- Department of Fisheries Post‐Harvest Technologies and Quality Control, Fisheries AdministrationMinistry of Agriculture, Forestry and FisheriesPhnom PenhCambodia
| | - Jacques Berger
- UMR‐204 NutripassInstitut de Recherche pour le Développement, IRD/UM/SupAgroMontpellierFrance
| | - Arnaud Laillou
- Child Survival and Development SectionUNICEFPhnom PenhCambodia
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, Faculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Frank T. Wieringa
- UMR‐204 NutripassInstitut de Recherche pour le Développement, IRD/UM/SupAgroMontpellierFrance
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HENDRIYANI H, SUDARGO T, FAHMIDA U, HELMYATI S, SUSETYOWATI, HUMAYRAH W. Deficient Nutrient Intake from Complementary Foods among Infants Aged 6–11 Months in Rural Areas of Yogyakarta. J Nutr Sci Vitaminol (Tokyo) 2020; 66:S87-S93. [DOI: 10.3177/jnsv.66.s87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Heni HENDRIYANI
- Doctoral Program Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
- Nutrition Department, Health Polytechnic of Semarang
| | - Toto SUDARGO
- Nutrition and Health Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
| | - Umi FAHMIDA
- Southeast Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO-RECFON) - Pusat Kajian Gizi Regional (PKGR) Universitas Indonesia
| | - Siti HELMYATI
- Nutrition and Health Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
| | - SUSETYOWATI
- Nutrition and Health Program, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada
| | - Wardina HUMAYRAH
- Nutrition Study Program, Faculty of Food Technology and Health, Sahid University
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Hotz C, Abdelrahman L. Simple methods to obtain food listing and portion size distribution estimates for use in semi-quantitative dietary assessment methods. PLoS One 2019; 14:e0217379. [PMID: 31626670 PMCID: PMC6799923 DOI: 10.1371/journal.pone.0217379] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022] Open
Abstract
Semi-quantitative dietary assessment methods are frequently used in low income countries, and the use of photographic series for portion size estimation is gaining popularity. However, when adequate data on commonly consumed foods and portion sizes are not available to design these tools, alternative data sources are needed. This study aimed to develop and test methods to: (i) identify foods likely to be consumed in a study population in rural Uganda, and; (ii) to derive distributions of portion sizes for common foods and dishes. A process was designed to derive detailed food and recipe lists using guided group interviews with women from the survey population, including a score for the likelihood of foods being consumed. A rapid recall method for portion size distribution estimation (PSDE) using direct weight by a representative sample of the survey population was designed and implemented. Results were compared to data from a 24 hour dietary recall (24HR). Of the 82 food items reported in the 24HR survey, 87% were among those scored with a high or medium likelihood of being consumed and accounted for 95% of kilocalories. Of the most frequently reported foods in the 24HR, portion sizes for many (15/25), but not all foods did not differ significantly (p<0.05) from those in the portion size estimation method. The percent of portion sizes reported in the 24 hour recall falling between the 5th and 95th percentiles as determined by the PSDE method ranged from 18% up to 100%. In conclusion, a simple food listing and scoring method effectively identified foods most likely to occur in a dietary survey. A novel PSDE method produced similar estimates as for the 24HR, while the approach for others should be further considered and validated. These methods are an improvement on those in current use.
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Affiliation(s)
- Christine Hotz
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
- * E-mail:
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Samuel A, Osendarp SJM, Ferguson E, Borgonjen K, Alvarado BM, Neufeld LM, Adish A, Kebede A, Brouwer ID. Identifying Dietary Strategies to Improve Nutrient Adequacy among Ethiopian Infants and Young Children Using Linear Modelling. Nutrients 2019; 11:E1416. [PMID: 31238506 PMCID: PMC6627485 DOI: 10.3390/nu11061416] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022] Open
Abstract
Nutrient adequacy of young children's diet and best possible strategies to improve nutrient adequacy were assessed. Data from the Ethiopian National Food Consumption Survey were analysed using Optifood (software for linear programming) to identify nutrient gaps in diets for children (6-8, 9-11 and 12-23 months), and to formulate feasible Food-Based Dietary Recommendations (FBDRs) in four regions which differ in culture and food practices. Alternative interventions including a local complementary food, micronutrient powders (MNPs), Small quantity Lipid-based Nutrient Supplement (Sq-LNS) and combinations of these were modelled in combination with the formulated FBDRs to compare their relative contributions. Risk of inadequate and excess nutrient intakes was simulated using the Estimated Average Requirement cut-point method and the full probability approach. Optimized local diets did not provide adequate zinc in all regions and age groups, iron for infants <12 months of age in all regions, and calcium, niacin, thiamine, folate, vitamin B12 and B6 in some regions and age-groups. The set of regional FBDRs, considerably different for four regions, increased nutrient adequacy but some nutrients remained sub-optimal. Combination of regional FBDRs with daily MNP supplementation for 6-12 months of age and every other day for 12-23 months of age, closed the identified nutrient gaps without leading to a substantial increase in the risk of excess intakes.
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Affiliation(s)
- Aregash Samuel
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Saskia J M Osendarp
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
- Nutrition International (NI), Ottawa, ON K2P2K3, Canada.
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine (LSHTM), London WC1E 7HT, UK.
| | - Karin Borgonjen
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Brenda M Alvarado
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
| | - Lynnette M Neufeld
- Global Alliance for Improved Nutrition (GAIN), 1202 Geneva, Switzerland.
| | - Abdulaziz Adish
- Nutrition International (NI), Nifas Silk Lafto Sub City, Kebele 04, Addis Ababa, Ethiopia.
| | - Amha Kebede
- Ethiopian Public Health Institute (EPHI), Gulele Sub City, Addis Ababa, Ethiopia.
| | - Inge D Brouwer
- Division of Human Nutrition and Health, Wageningen University and Research, 6700 AA Wageningen, The Netherlands.
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Park HW, Park JW, Yoon WB. Developing a Linearization Method to Determine Optimum Blending for Surimi with Varied Moisture Contents Using Linear Programming. INTERNATIONAL JOURNAL OF FOOD ENGINEERING 2019. [DOI: 10.1515/ijfe-2018-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractNovel algorithm to determine the least cost formulation of a surimi blend was developed using linear programming (LP). Texture properties and the unit cost of surimi blend at the target moisture content were used as constraint functions and the objective function, respectively. The mathematical models to describe the moisture content dependence of the ring tensile properties were developed using critical moisture content, and the model parameters were used for the least cost LP (LCLP) model. The LCLP model successfully predicted the quality of surimi blend. Sensitivity analysis was used to obtain an additional information when the perturbations of design variables are provided. A standard procedure to determine the least cost formulation for blending surimi with varied moisture contents was systematically developed.
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Affiliation(s)
- Hyeon W. Park
- Department of Food Science and Biotechnology, College of Agriculture and Life Science, Kangwon National University, Chuncheon, Gangwon24341, Republic of Korea
| | - Jae W. Park
- 2001 Marine Drive, OSU Seafood Research and Education Center, Oregon State University, Astoria, OR97103, USA
| | - Won B. Yoon
- Department of Food Science and Biotechnology, College of Agriculture and Life Science, Kangwon National University, Chuncheon, Gangwon24341, Republic of Korea
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Bekele H, Turyashemererwa F. Feasibility and acceptability of food-based complementary feeding recommendations using Trials of Improved Practices among poor families in rural Eastern and Western Uganda. Food Sci Nutr 2019; 7:1311-1327. [PMID: 31024704 PMCID: PMC6475803 DOI: 10.1002/fsn3.964] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 11/09/2022] Open
Abstract
Inadequate complementary feeding practices are a major contributor to stunting among children in Uganda. The WHO recommends the promotion of local food-based complementary feeding recommendations (FBCFRs) to address nutrient gaps during complementary feeding. This study tested the feasibility and acceptability of FBCFRs, using trials of improved practices (TIPs). Qualitative and quantitative methods were used in a cross-sectional survey over three household visits. At first household visit, information on socio-demographic factors and food frequency was collected and FBCFRs introduced. The second household visit assessed the use and barriers related to the FBCFRs, while the third household visit assessed the continued use of the FBCFRs. Focus group discussions and key informant interviews provided the insights into community norms on the FBCFRs. Most FBCFRs were feasible and acceptable. However, caretakers found it difficult to implement a full set of FBCFRs together with the recommended frequencies. Caretakers were more likely to try and continue using FBCFRs that had familiar methods of preparation and commonly used ingredients. Seasonality and cost were major barriers to use. Through TIPs, mothers demonstrated that they are open to try new ways of improving their children's nutrition.
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Blaney S, Menasria L, Main B, Chhorvann C, Vong L, Chiasson L, Hun V, Raminashvili D. Determinants of Undernutrition among Young Children Living in Soth Nikum District, Siem Reap, Cambodia. Nutrients 2019; 11:E685. [PMID: 30909463 PMCID: PMC6471553 DOI: 10.3390/nu11030685] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 03/17/2019] [Accepted: 03/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Child undernutrition is of public concern in Cambodia. An understanding of factors influencing child nutritional status is essential to design programs that will reduce undernutrition. Using the UNICEF conceptual framework of causes of malnutrition, our research investigates the relationship between nutritional status of children aged 6⁻23 months and its immediate and underlying determinants. METHODS Baseline data from a cluster-randomized controlled trial aiming to assess the impact of the promotion of optimal feeding practices combined or not with the provision of local foods among 360 children 6⁻23 months of age were used. Anthropometry and biochemical measurements were performed at baseline. Data on each determinant of undernutrition were collected through interviews and direct observations. RESULTS Our results show that the degree of satisfaction of proteins and zinc requirements as well as the access to improved water sources and sanitation were positively associated with length-for-age, while having a better health status and a higher degree of satisfaction of energy, protein, zinc, and iron requirements were associated to an improved weight-for-length. Only child health status was associated to ferritin. CONCLUSION Our results reiterate the importance of improving child diet and health status, but also the access to a healthy environment to ensure an optimal nutritional status.
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Affiliation(s)
- Sonia Blaney
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada.
| | - Lylia Menasria
- École des sciences des aliments, de nutrition et d'étude familiale, Université de Moncton, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada.
| | - Barbara Main
- Public Health Specialist, Guelph, ON N1E 6Y8, Canada.
| | - Chhea Chhorvann
- National Institute of Public Health, Phnom Penh 12203, Cambodia.
| | - Lenin Vong
- Independent consultant, Phnom Penh 12203, Cambodia.
| | - Lucie Chiasson
- Direction du mieux-être, Ministère du développement social, 1780 rue Water, Miramichi, NB E1N 1B6, Canada.
| | - Vannary Hun
- World Vision Cambodia, #20 Street 71 Tonle Bassac, Chamkar Morn, Phnom Penh 12203, Cambodia.
| | - David Raminashvili
- World Vision Cambodia, #20 Street 71 Tonle Bassac, Chamkar Morn, Phnom Penh 12203, Cambodia.
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Bose I, Baldi G, Kiess L, de Pee S. The "Fill the Nutrient Gap" analysis: An approach to strengthen nutrition situation analysis and decision making towards multisectoral policies and systems change. MATERNAL AND CHILD NUTRITION 2019; 15:e12793. [PMID: 30698364 PMCID: PMC6767452 DOI: 10.1111/mcn.12793] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
Improved nutrition situation analysis can increase the understanding of the likely magnitude and main causes of the nutrient gap among a particular target group, for example, children under 2 or pregnant and lactating women, in a particular context. The World Food Programme, with input from University of California Davis, International Food Policy Research Institute, Epicentre, Harvard University, Mahidol University, Save the Children, and UNICEF, has developed a framework for strengthened nutrition situation analysis and decision making called the "Fill the Nutrient Gap" (FNG), which aims to support identification of strategies to increase availability, access, and choice of nutritious foods, to ultimately improve nutrient intake. The FNG engages stakeholders from different sectors throughout the analytical process to provide input and discuss findings to collectively identify and prioritize context-specific strategies. The FNG analysis contributes to better understanding the nutrition situation because it (a) focuses on the dietary intake side of the malnutrition framework and analyses in-depth the nutrient intake of different target groups; (b) linear programming is used in combination with review of secondary data to characterize barriers to nutrient intake, in particular to understand the availability, cost and affordability of nutritious diets for households and target groups with higher nutritional needs, and model potential interventions to improve them; (c) it links the nutrition situation analysis to decision making by providing an evidence base for decision makers to inform their strategies; (d) it facilitates multisectoral discussion on barriers to nutrient intake and enables a prioritization of context-specific strategies (both nutrition specific and sensitive) to improve the nutrition situation across food, health, and social protection systems.
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Affiliation(s)
- Indira Bose
- Nutrition Division, World Food Programme, Rome, Italy
| | - Giulia Baldi
- Nutrition Division, World Food Programme, Rome, Italy
| | - Lynnda Kiess
- Nutrition Division, World Food Programme, Rome, Italy
| | - Saskia de Pee
- Nutrition Division, World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Human Nutrition, Wageningen University, Wageningen, The Netherlands
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de Jager I, Borgonjen-van den Berg KJ, Giller KE, Brouwer ID. Current and potential role of grain legumes on protein and micronutrient adequacy of the diet of rural Ghanaian infants and young children: using linear programming. Nutr J 2019; 18:12. [PMID: 30791898 PMCID: PMC6385461 DOI: 10.1186/s12937-019-0435-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 02/12/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Grain legumes are appreciated for their contribution to dietary protein and micronutrient intake in addition to their benefits in providing income and replenishing soil fertility. They offer potential benefits in developing countries where future food demand is increasing and both undernutrition and overweight co-exist. We studied the current and potential role of grain legumes on protein, both quantity and quality, and micronutrient adequacy in the diet of rural Ghanaian infants and young children. METHODS Energy and nutrient (including amino acids) intakes of breastfed children of 6-8 months (n=97), 9-11 months (n=97), 12-23 months (n=114), and non-breastfed children of 12-23 months (n=29) from Karaga district in Northern Ghana were assessed using a repeated quantitative multi-pass 24-hour recall method. Food-based dietary guidelines that cover nutrient adequacy within the constraints of local current dietary patterns were designed using the linear programming software Optifood (version 4.0.9, Optifood©). Optifood was also used to evaluate whether additional legumes would further improve nutrient adequacy. RESULTS We found that 60% of the children currently consumed legumes with an average portion size of 20 g per day (cooked) contributing more than 10% of their total protein, folate, iron and niacin intake. The final sets of food-based recommendations included legumes and provided adequate protein and essential amino acids but insufficient calcium, iron, niacin and/or zinc among breastfed children and insufficient calcium, vitamin C, vitamin B12 and vitamin A among non-breastfed children. The sets of food-based recommendations combined with extra legumes on top of the current dietary pattern improved adequacy of calcium, iron, niacin and zinc but only reached sufficient amounts for calcium among breastfed children of 6-8 months old. CONCLUSIONS Although legumes are often said to be the 'meat of the poor' and current grain legume consumption among rural children contribute to protein intake, the main nutritional benefit of increased legume consumption is improvement of micronutrient adequacy. Besides food-based recommendations, other interventions are needed such as food-based approaches and/or fortification or supplementation strategies to improve micronutrient adequacy of infants and young children in rural Ghana. TRIAL REGISTRATION Noguchi Memorial Institute for Medical Research Institutional Review Board (NMIMR-IRB CPN 087/13-14).
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Affiliation(s)
- Ilse de Jager
- Division of Human Nutrition and Plant Production Systems group, Wageningen University, Wageningen, The Netherlands
| | | | - Ken E. Giller
- Plant Production Systems group, Wageningen University, Wageningen, The Netherlands
| | - Inge D. Brouwer
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
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Wessells KR, Young RR, Ferguson EL, Ouédraogo CT, Faye MT, Hess SY. Assessment of Dietary Intake and Nutrient Gaps, and Development of Food-Based Recommendations, among Pregnant and Lactating Women in Zinder, Niger: An Optifood Linear Programming Analysis. Nutrients 2019; 11:E72. [PMID: 30609695 PMCID: PMC6357040 DOI: 10.3390/nu11010072] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 12/18/2018] [Accepted: 12/20/2018] [Indexed: 12/14/2022] Open
Abstract
Pregnant and lactating women in rural Niger are at high risk for inadequate intakes of multiple micronutrients. Thus, 24 h dietary recalls were conducted and analyzed for dietary intakes in this population (n = 202). Using linear programming analyses, micronutrient gaps in women's diets were identified, food-based recommendations (FBR) to improve dietary micronutrient adequacy were developed, and various supplementation strategies were modelled. Energy intakes were below estimated requirements, and, for most micronutrients, >50% of women were at risk of inadequate intakes. Linear programming analyses indicated it would be difficult to select a diet that achieved recommended dietary allowances for all but three (vitamin B₆, iron and zinc) of 11 modeled micronutrients. Consumption of one additional meal per day, and adherence to the selected FBR (daily consumption of dark green leafy vegetables, fermented milk, millet, pulses, and vitamin A fortified oil), would result in a low percentage of women at risk of inadequate intakes for eight modeled micronutrients (vitamin A, riboflavin, thiamin, B6, folate, iron, zinc, and calcium). Because the promotion of realistic FBRs likely will not ensure that a low percentage of women are at risk of inadequate intakes for all modeled micronutrients, multiple micronutrient supplementation or provision of nutrient-dense foods should be prioritized.
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Affiliation(s)
- K Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Rebecca R Young
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
| | - Elaine L Ferguson
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
| | - Césaire T Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
| | | | - Sonja Y Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA 95616, USA.
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Ferguson EL, Watson L, Berger J, Chea M, Chittchang U, Fahmida U, Khov K, Kounnavong S, Le BM, Rojroongwasinkul N, Santika O, Sok S, Sok D, Do TT, Thi LT, Vonglokham M, Wieringa F, Wasantwisut E, Winichagoon P. Realistic Food-Based Approaches Alone May Not Ensure Dietary Adequacy for Women and Young Children in South-East Asia. Matern Child Health J 2018; 23:55-66. [DOI: 10.1007/s10995-018-2638-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gazan R, Brouzes CMC, Vieux F, Maillot M, Lluch A, Darmon N. Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review. Adv Nutr 2018; 9:602-616. [PMID: 30239584 PMCID: PMC6140431 DOI: 10.1093/advances/nmy049] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/14/2018] [Indexed: 12/22/2022] Open
Abstract
A sustainable diet is, by definition, nutritionally adequate, economically affordable, culturally acceptable, and environmentally respectful. Designing such a diet has to integrate different dimensions of diet sustainability that may not be compatible with each other. Among multicriteria assessment methods, diet optimization is a whole-diet approach that simultaneously combines several metrics for dimensions of diet sustainability. This narrative review based on 67 published studies shows how mathematical diet optimization can help with understanding the relations between the different dimensions of diet sustainability and how it can be properly used to identify sustainable diets. Diet optimization aims to find the optimal combination of foods for a population, a subpopulation, or an individual that fulfills a set of constraints while minimizing or maximizing an objective function. In the studies reviewed, diet optimization was used to examine the links between dimensions of diet sustainability, identify the minimum cost or environmental impact of a nutritionally adequate diet, or identify food combinations able to combine ≥2 sustainability dimensions. If some constraints prove difficult to fulfill, this signals an incompatibility between nutrient recommendations, over-monotonous food-consumption patterns, an inadequate supply of nutrient-rich foods, or an incompatibility with other dimensions. If diet optimization proves successful, it can serve to design nutritionally adequate, culturally acceptable, economically affordable, and environmentally friendly diets. Diet optimization results can help define dietary recommendations, tackle food security issues, and promote sustainable dietary patterns. This review emphasizes the importance of carefully choosing the model parameters (variables, objective function, constraints) and input data and the need for appropriate expertise to correctly interpret and communicate the results. Future research should make improvements in the choice of metrics used to assess each aspect of a sustainable diet, especially the cultural dimension, to improve the practicability of the results.
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Affiliation(s)
- Rozenn Gazan
- MS-Nutrition, Marseille, France
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Chloé M C Brouzes
- UMR PNCA, AgroParisTech, INRA, Université Paris-Saclay, Paris, France
| | | | | | - Anne Lluch
- Danone Nutricia Research, Centre Daniel Carasso, Palaiseau, France
| | - Nicole Darmon
- MOISA, INRA, CIHEAM-IAMM, CIRAD, Montpellier SupAgro, University of Montpellier, Montpellier, France
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Nurhasan M, Roos N, Skau JK, Wieringa FT, Friis H, Michaelsen KF, Dijkhuizen MA, Stark KD, Ritz C, Chhoun C, Lauritzen L. Effect of complementary food with small amounts of freshwater fish on whole blood n-3 fatty acids in Cambodian infants age 6-15 months. Prostaglandins Leukot Essent Fatty Acids 2018; 135:92-101. [PMID: 30103938 DOI: 10.1016/j.plefa.2018.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 07/06/2018] [Indexed: 11/20/2022]
Abstract
The impact of freshwater fish consumption on the status of long-chain n-3 fatty acids (n-3 LCPUFA) in infants in landlocked, low-income populations is unknown. We used secondary data from a randomized, single-blinded, controlled trial to evaluate the impact of daily consumption of complementary food products with small amounts of freshwater fish on whole blood n-3 LCPUFA in Cambodian infants. Infants (n = 419), received daily, one of four food products for 9 months. Two products contained freshwater fish: WinFood (10% fish by dry weight) and WinFood-L (12% fish by dry weight), while two products were non-fish-based: corn-soy blends (CSB+ and CSB++). Whole blood fatty acids and breastfeeding status were assessed at baseline and endline of the intervention. The WinFood products contributed to an estimated maximum intake of 86.5 mg/day n-3 LCPUFA. There was no difference in whole blood n-3 LCPUFA among the four intervention groups or between the fish-based and the non-fish-based groups (p ≥ 0.142). At endline, 71% of the children were still breastfed. Interaction analyses indicated a lower ratio of n-6/n-3 PUFA in non-breastfed infants in the WinFood groups compared to the CSB groups (pinteraction = 0.026). Thus, a high intake of n-3 LCPUFA from breastmilk may have blurred a potential impact of small amounts of freshwater fish effect on n-3 LCPUFA status in Cambodian infants.
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Affiliation(s)
- Mulia Nurhasan
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark; Center for Regulation, Policy and Governance, Universitas Ibn Khaldun Bogor, Indonesia
| | - Nanna Roos
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - Jutta Kh Skau
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Frank T Wieringa
- UMR-204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
| | - Henrik Friis
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Kim F Michaelsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | | | - Ken D Stark
- Department of Kinesiology, University of Waterloo, Canada
| | - Christian Ritz
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark
| | - Chamnan Chhoun
- Department of Fisheries Post-harvest Technologies and Quality Control, Fishery Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh
| | - Lotte Lauritzen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
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Kujinga P, Borgonjen‐van den Berg KJ, Superchi C, ten Hove HJ, Onyango EO, Andang'o P, Galetti V, Zimmerman MB, Moretti D, Brouwer ID. Combining food-based dietary recommendations using Optifood with zinc-fortified water potentially improves nutrient adequacy among 4- to 6-year-old children in Kisumu West district, Kenya. MATERNAL & CHILD NUTRITION 2018; 14:e12515. [PMID: 28925036 PMCID: PMC6866207 DOI: 10.1111/mcn.12515] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 07/09/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
Abstract
Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between 4 and 6 years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4-6 years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24-hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc-fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc-fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66-101% after introduction of zinc-fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc-fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy.
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Affiliation(s)
- Prosper Kujinga
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | | | - Cecilia Superchi
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
| | | | | | | | - Valeria Galetti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and HealthETH ZurichZurichSwitzerland
| | - Michael B. Zimmerman
- Laboratory of Human Nutrition, Institute of Food, Nutrition and HealthETH ZurichZurichSwitzerland
| | - Diego Moretti
- Laboratory of Human Nutrition, Institute of Food, Nutrition and HealthETH ZurichZurichSwitzerland
| | - Inge D. Brouwer
- Division of Human NutritionWageningen UniversityWageningenThe Netherlands
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Borg B, Mihrshahi S, Griffin M, Sok D, Chhoun C, Laillou A, Berger J, Wieringa FT. Randomised controlled trial to test the effectiveness of a locally-produced ready-to-use supplementary food (RUSF) in preventing growth faltering and improving micronutrient status for children under two years in Cambodia: a study protocol. Nutr J 2018; 17:39. [PMID: 29548287 PMCID: PMC5857085 DOI: 10.1186/s12937-018-0346-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Existing ready-to-use supplementary and therapeutic foods (RUSFs and RUTFs) have had limited acceptance and effectiveness in Cambodia. This has hampered the treatment and prevention of child malnutrition. An innovative, locally produced, multiple micronutrient fortified lipid-based nutrient supplement (LNS) has been developed for use as an RUSF. Unlike most RUSFs, which contain milk, this product contains fish as the animal protein. Few RUSFs have been formulated using non-milk animal-source foods and they have not been widely tested. An acceptability trial that was conducted on this novel RUSF in June 2015 demonstrated that children will eat the RUSF and that caregivers will feed it to their children. The current trial aims to evaluate the effectiveness of the RUSF in preventing growth faltering and improving micronutrient status in Cambodian children. METHODS AND ANALYSIS This trial is a six-month, prospective, cluster randomised, non-blinded controlled trial among infants in peri-urban Phnom Penh. The trial aims to establish the superiority of the novel RUSF, compared to three alternatives (Corn-Soy Blend Plus Plus (CSB++) and Sprinkles micronutrient powders as active comparators, and the unimproved diet as a control). The allocation ratio is 1:1. Healthy children (N = 540) aged six to eleven months will be recruited. Data will be collected at baseline, and monthly thereafter for a period of six months. Participants will be provided with a monthly supply of the food to which their village has been allocated. DISCUSSION There is an urgent need to develop locally produced and culturally acceptable RUSFs, and to compare these with existing options in terms of their potential for preventing malnutrition, in Cambodia and elsewhere. This trial will contribute much-needed data on the effectiveness of supplementary foods with an animal-source food other than milk, by comparing a novel RUSF based on fish to one that uses milk (CSB++). Moreover, it will deepen the understanding of the impact of multiple micronutrients provided with or without macronutrients, by comparing the novel RUSF and CSB++, which combine macronutrients with multiple micronutrients, to Sprinkles, which contains no macronutrients. In addition, it will augment the body of evidence from Asia. TRIAL REGISTRATION ClinicalTrials.gov, Identifier: LNS-CAMB-INFANTS-EFF; NCT02257762 .
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Affiliation(s)
- Bindi Borg
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, Australia. .,c/o Pascal Marino, European Union Delegation in Cameroon, BP, 847, Yaoundé, Cameroon.
| | - Seema Mihrshahi
- School of Public Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Mark Griffin
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Daream Sok
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | - Chamnan Chhoun
- Department of Fisheries Post-Harvest Technologies and Quality Control, Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | - Arnaud Laillou
- Child Survival and Development Section, UNICEF, Phnom Penh, Cambodia
| | - Jacques Berger
- UMR Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
| | - Frank T Wieringa
- UMR Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
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Brixi G. Innovative optimization of ready to use food for treatment of acute malnutrition. MATERNAL AND CHILD NUTRITION 2018. [PMID: 29536665 DOI: 10.1111/mcn.12599] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treatment of acute malnutrition typically requires the provision of ready-to-use food (RUF). Common RUF is effective but expensive, being manufactured from costly ingredients, and shipped worldwide from few global suppliers. I developed a linear programming tool to create RUF optimized for low cost using locally grown crops while maintaining necessary nutritional goals and other constraints. My tool utilizes a database of the nutritional value, price, and water efficiency of suitable ingredients and allows adjustment of constraints, including nutrients, flavour, and crop water efficiency. It is designed to (a) address nutrient requirements conforming to current standards and practice; (b) optimize RUF formulae for low cost using a wide range of ingredients for nutritional value and acceptability improvement; (c) ensure protein quality through protein digestibility corrected amino acid score; and (d) adjust RUF formulae according to locally grown crop selection, local prices, and crop water footprint. The tool creates formulae free of expensive dairy ingredients, ensuring desired protein digestibility corrected amino acid score by automatically balancing proteins with complementary quantities of essential amino acids. Using publicly available data with an application to Nigeria, my tool created RUF formulae suitable for local production using local crops to meet all nutrient requirements at a fraction of the ingredient cost and water footprint of current formulae, demonstrating the tool's effectiveness. Optimization of RUF for low cost using locally grown crops will facilitate local production and reduce ingredient as well as transport costs, so more patients can receive lifesaving treatment.
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Affiliation(s)
- Garyk Brixi
- Winston Churchill High School, Potomac, MD, USA
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Arimond M, Vitta BS, Martin‐Prével Y, Moursi M, Dewey KG. Local foods can meet micronutrient needs for women in urban Burkina Faso, but only if rarely consumed micronutrient-dense foods are included in daily diets: A linear programming exercise. MATERNAL & CHILD NUTRITION 2018; 14:e12461. [PMID: 28464499 PMCID: PMC6866244 DOI: 10.1111/mcn.12461] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/19/2022]
Abstract
Women of reproductive age are at nutritional risk due to their need for nutrient-dense diets. Risk is further elevated in resource-poor environments. In one such environment, we evaluated feasibility of meeting micronutrient needs of women of reproductive age using local foods alone or using local foods and supplements, while minimizing cost. Based on dietary recall data from Ouagadougou, we used linear programming to identify the lowest cost options for meeting 10 micronutrient intake recommendations, while also meeting energy needs and following an acceptable macronutrient intake pattern. We modeled scenarios with maximum intake per food item constrained at the 75th percentile of reported intake and also with more liberal maxima based on recommended portions per day, with and without the addition of supplements. Some scenarios allowed only commonly consumed foods (reported on at least 10% of recall days). We modeled separately for pregnant, lactating, and nonpregnant, nonlactating women. With maxima constrained to the 75th percentile, all micronutrient needs could be met with local foods but only when several nutrient-dense but rarely consumed items were included in daily diets. When only commonly consumed foods were allowed, micronutrient needs could not be met without supplements. When larger amounts of common animal-source foods were allowed, all needs could be met for nonpregnant, nonlactating women but not for pregnant or lactating women, without supplements. We conclude that locally available foods could meet micronutrient needs but that to achieve this, strategies would be needed to increase consistent availability in markets, consistent economic access, and demand.
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Affiliation(s)
- Mary Arimond
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Bineti S. Vitta
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
| | - Yves Martin‐Prével
- Nutripass Research UnitFrench National Research Institute for Sustainable DevelopmentMontpellierFrance
| | - Mourad Moursi
- HarvestPlus/International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Kathryn G. Dewey
- Department of NutritionUniversity of California DavisDavisCaliforniaUSA
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The potential contribution of yellow cassava to dietary nutrient adequacy of primary-school children in Eastern Kenya; the use of linear programming. Public Health Nutr 2017; 21:365-376. [PMID: 28965533 DOI: 10.1017/s1368980017002506] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Introduction of biofortified cassava as school lunch can increase vitamin A intake, but may increase risk of other deficiencies due to poor nutrient profile of cassava. We assessed the potential effect of introducing a yellow cassava-based school lunch combined with additional food-based recommendations (FBR) on vitamin A and overall nutrient adequacy using Optifood (linear programming tool). DESIGN Cross-sectional study to assess dietary intakes (24 h recall) and derive model parameters (list of foods consumed, median serving sizes, food and food (sub)group frequency distributions, food cost). Three scenarios were modelled, namely daily diet including: (i) no school lunch; (ii) standard 5d school lunch with maize/beans; and (iii) 5d school lunch with yellow cassava. Each scenario and scenario 3 with additional FBR were assessed on overall nutrient adequacy using recommended nutrient intakes (RNI). SETTING Eastern Kenya. SUBJECTS Primary-school children (n 150) aged 7-9 years. RESULTS Best food pattern of yellow cassava-based lunch scenario achieved 100 % RNI for six nutrients compared with no lunch (three nutrients) or standard lunch (five nutrients) scenario. FBR with yellow cassava and including small dried fish improved nutrient adequacy, but could not ensure adequate intake of fat (52 % of average requirement), riboflavin (50 % RNI), folate (59 % RNI) and vitamin A (49 % RNI). CONCLUSIONS Introduction of yellow cassava-based school lunch complemented with FBR potentially improved vitamin A adequacy, but alternative interventions are needed to ensure dietary adequacy. Optifood is useful to assess potential contribution of a biofortified crop to nutrient adequacy and to develop additional FBR to address remaining nutrient gaps.
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Masters WA, Nene MD, Bell W. Nutrient composition of premixed and packaged complementary foods for sale in low- and middle-income countries: Lack of standards threatens infant growth. MATERNAL & CHILD NUTRITION 2017; 13:e12421. [PMID: 28008727 PMCID: PMC6865969 DOI: 10.1111/mcn.12421] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 10/22/2016] [Accepted: 11/18/2016] [Indexed: 01/17/2023]
Abstract
Premixed flours for infant porridge are increasingly produced and sold in developing countries to complement continued breastfeeding. Such complementary food (CF) products have known efficacy against malnutrition in children from 6 to 24 months of age, but ingredient ratios and production processes may vary. This study provides the first systematic measurement of their actual nutrient composition. We purchased samples of 108 premixed CF products in 22 low- and middle-income countries, and commissioned blind laboratory measurement of each product's macronutrients and micronutrients. We compared measured contents to nutrient claims on their packaging and to CF standards from the Codex Alimentarius, the Super Cereal Plus product used in nutrition assistance programs, and the Lutter and Dewey (2003) recommendations, as well as our own modeled nutrient requirements for a healthy breastfed child. Actual densities are significantly different from nutrient claims for protein (p = .013) and fat (p = .000). Only 15% of samples met two of the three benchmarks for fat, 32% met the most stringent protein standard, while only 22% met them for iron, and 21% for zinc. The median healthy child consuming breast milk plus enough of these solid foods to meet energy needs would experience deficits of zinc at 6 months, iron at 6 and 9 months, and dietary fat from 12 months of age. In summary, premixed CF products can provide adequate nutrient density but usually do not, revealing the need and opportunity for independent monitoring and quality assurance to help grain millers making premixed foods maintain uniform ingredient ratios and production practices.
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Affiliation(s)
- William A. Masters
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Marc D. Nene
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
| | - Winnie Bell
- Friedman School of Nutrition Science and PolicyTufts UniversityBostonMassachusettsUSA
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Borg B, Mihrshahi S, Griffin M, Chamnan C, Laillou A, Wieringa FT. Crossover trial to test the acceptability of a locally produced lipid-based nutrient supplement (LNS) for children under 2 years in Cambodia: a study protocol. BMJ Open 2017; 7:e015958. [PMID: 28882910 PMCID: PMC5588973 DOI: 10.1136/bmjopen-2017-015958] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The acceptability and efficacy of existing ready-to-use supplementary and therapeutic foods has been low in Cambodia, thus limiting success in preventing and treating malnutrition among Cambodian children. In that context, UNICEF and IRD have developed a locally produced, multiple micronutrient fortified lipid-based nutrient supplement. This food is innovative, in that it uses fish instead of milk as the animal source food. Very few supplementary foods have non-milk animal source foods, and in addition they have not been widely tested. This trial will assess the novel food's acceptability to children and caregivers. METHODS AND ANALYSIS This is a cluster-randomised, incomplete block, 4×4 crossover design with no blinding. It will take place in four sites in a community setting in periurban Phnom Penh. Healthy children aged 9-23 months (n=100) will eat each of four foods for 3 days at a time. The amount they consume will be measured, and at the end of each 3-day set, caregivers will assess how well their child liked the food. After 12 days, caregivers themselves will do a sensory test of the 4 foods and will rank them in terms of preference. ETHICS AND DISSEMINATION Ethical clearance was received from the University of Queensland Medical Research Ethics Committee (2014001070) and from Cambodia's National Ethics Committee for Health Research (03/8 NECHR). REGISTRATION ClinicalTrials.gov, identifier: LNS-CAMB-INFANTS; NCT02257437. Pre-results.
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Affiliation(s)
- Bindi Borg
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Seema Mihrshahi
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Griffin
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Chhoun Chamnan
- DFPTQ, Fisheries Administration, Ministry of Agriculture, Forestry and Fisheries, Phnom Penh, Cambodia
| | | | - Frank T Wieringa
- UMR-204 Nutripass, Institut de Recherche pour le Développement, IRD/UM/SupAgro, Montpellier, France
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Raymond J, Kassim N, Rose JW, Agaba M. Optimal formulations of local foods to achieve nutritional adequacy for 6-23-month-old rural Tanzanian children. Food Nutr Res 2017; 61:1358035. [PMID: 28814951 PMCID: PMC5553099 DOI: 10.1080/16546628.2017.1358035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 07/14/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Achieving nutritional goals of infants and young children while maintaining the intake of local and culture-specific foods can be a daunting task. Diet optimisation using linear goal programming (LP) can effectively generate optimal formulations incorporating local and culturally acceptable foods. Objective: The primary objective of this study was to determine whether a realistic and affordable diet that achieves dietary recommended intakes (DRIs) for 22 selected nutrients can be formulated for rural 6–23-month-old children in Tanzania. Design: Dietary intakes of 400 children aged 6–23 months were assessed using a weighed dietary record (WDR), 24-hour dietary recalls and a 7-days food record. A market survey was also carried out to estimate the cost per 100 g of edible portion of foods that are commonly consumed in the study area. Dietary and market survey data were then used to define LP model parameters for diet optimisation. All LP analyses were done using linear program solver (LiPS) version 1.9.4 to generate optimal food formulations. Results: Optimal formulations that achieved DRIs for 20 nutrients for children aged 6–11 months and all selected nutrients for children aged 12–23 months were successfully developed at a twofold cost of the observed food purchase across age groups. Optimal formulations contained a mixture of ingredients such as wholegrain cereals, Irish potatoes, pulses and seeds, fish and poultry meat as well as fruits and vegetables that can be sourced locally. Conclusions: Our findings revealed that given the available food choices, it is possible to develop optimal formulations that can improve dietary adequacy for rural 6–23-month-old children if food budget for the child’s diets is doubled. These findings suggest the need for setting alternative interventions which can help households increase access to nutrient-dense foods that can fill the identified nutrient gaps.
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Affiliation(s)
- Jofrey Raymond
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Neema Kassim
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
| | - Jerman W Rose
- SolBridge International School of Business, Woosong University, Daejeon, Republic of Korea
| | - Morris Agaba
- School of Life Science and Bioengineering, Nelson Mandela African Institution of Science and Technology (NM-AIST), Arusha, Tanzania
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Analysis of nutritional adequacy of local foods for meeting dietary requirements of children aged 6-23 months in rural central Tanzania. ACTA ACUST UNITED AC 2017; 75:60. [PMID: 28824803 PMCID: PMC5559821 DOI: 10.1186/s13690-017-0226-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 07/19/2017] [Indexed: 11/16/2022]
Abstract
Background Under nutrition remains a serious problem among children in Sub-Saharan Africa. Analysing how diets composed of local foods could achieve nutritional goals for infants and young children in low-income settings is essential. The objective of this study was to analyse how local foods can be used rationally and to what extent these foods can be supplemented to achieve nutrient requirements for children aged 6 – 23 months in resource-poor settings. Methods A cross-sectional study was carried out to estimate dietary intakes of 400 children aged 6-23 months using a 12-h weighed dietary record, 24-h dietary recalls, and 7-days food records. Anthropometric measurements on each subject were also taken. Analyses were done to establish the level of nutrient intake, and nutritional status of the study population using Microsoft Excel 2013 and ProPAN software version 2.0. Results The results showed that the prevalence of stunting, wasting and underweight for children aged 6–23 months was 30–41%, 1.5–3% and 4–9%, respectively. In addition, the results showed that diets that were consumed by the subjects comprised of local foods met vitamin A, vitamin C, protein and energy requirements for children aged 6–23 months. However, the extent of deficit in iron, zinc and calcium in baseline diets was large and difficult to meet under the existing feeding practices. Conclusions The study shows that local foods in the study area have a potential to achieve recommended dietary intakes of some essential nutrients, and that interventions are needed to meet the required amount of iron, zinc and calcium for children aged 6–23 months. The interventions we propose here may encourage changes in traditional feeding habits and practices of the target population. Possible intervention options are (1) supplementation of local foods with nutrient-dense foods that are not normally consumed in the locality (2) providing new avenues for increasing the production and wide consumption of local nutrient-dense foods, or optimizing the way local diets are constituted so as to achieve nutrient recommendations for infants and young children.
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Deptford A, Allieri T, Childs R, Damu C, Ferguson E, Hilton J, Parham P, Perry A, Rees A, Seddon J, Hall A. Cost of the Diet: a method and software to calculate the lowest cost of meeting recommended intakes of energy and nutrients from local foods. BMC Nutr 2017; 3:26. [PMID: 32153808 PMCID: PMC7050783 DOI: 10.1186/s40795-017-0136-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/11/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND When food is available, the main obstacle to access is usually economic: people may not be able to afford a nutritious diet, even if they know what foods to eat. The Cost of the Diet method and software was developed to apply linear programming to better understand the extent to which poverty may affect people's ability to meet their nutritional specifications. This paper describes the principles of the method; the mathematics underlying the linear programming; the parameters and assumptions on which the calculations are based; and then illustrates the output of the software using examples taken from assessments. RESULTS The software contains five databases: the energy and nutrient content of foods; the energy and nutrient specifications of individuals; predefined groups of individuals in typical households; the portion sizes of foods; and currency conversion factors. Data are collected during a market survey to calculate the average cost of foods per 100 g while focus group discussions are used to assess local dietary habits and preferences. These data are presented to a linear programming solver within the software which selects the least expensive combination of local foods for four standard diets that meet specifications for: energy only; energy and macronutrients; energy, macronutrients and micronutrients; and energy, macronutrients and micronutrients but with constraints on the amounts per meal that are consistent with typical dietary habits. Most parameters in the software can be modified by users to examine the potential impact of a wide range of theoretical interventions. The output summarises for each diet the costs, quantity and proportion of energy and nutrient specifications provided by all the foods selected for a given individual or household by day, week, season and year. When the cost is expressed as a percentage of income, the affordability of the diet can be estimated. CONCLUSIONS The Cost of the Diet method and software could be used to inform programme design and behaviour change communication in the fields of nutrition, food security, livelihoods and social protection as well as to influence policies and advocacy debates on the financial cost of meeting energy and nutrient specifications.
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Affiliation(s)
- Amy Deptford
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Tommy Allieri
- Imperial College, School of Public Health, Norfolk Place, London, W2 1PG UK
| | - Rachel Childs
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Claudia Damu
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Elaine Ferguson
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK
| | - Jennie Hilton
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Paul Parham
- Department of Public Health and Policy, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, L69 3GL UK
| | - Abigail Perry
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - Alex Rees
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
| | - James Seddon
- Stainton House, 101 Church Street, Staines, Middlesex, TW18 4XS UK
| | - Andrew Hall
- Programme Policy and Quality, Save the Children, 1 St John’s Lane, London, EC1M 4 AR UK
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Westmark CJ. Soy-Based Therapeutic Baby Formulas: Testable Hypotheses Regarding the Pros and Cons. Front Nutr 2017; 3:59. [PMID: 28149839 PMCID: PMC5241282 DOI: 10.3389/fnut.2016.00059] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 12/23/2016] [Indexed: 12/18/2022] Open
Abstract
Soy-based infant formulas have been consumed in the United States since 1909, and currently constitute a significant portion of the infant formula market. There are efforts underway to generate genetically modified soybeans that produce therapeutic agents of interest with the intent to deliver those agents in a soy-based infant formula platform. The threefold purpose of this review article is to first discuss the pros and cons of soy-based infant formulas, then present testable hypotheses to discern the suitability of a soy platform for drug delivery in babies, and finally start a discussion to inform public policy on this important area of infant nutrition.
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Affiliation(s)
- Cara J Westmark
- Department of Neurology, University of Wisconsin , Madison, WI , USA
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Context-specific complementary feeding recommendations developed using Optifood could improve the diets of breast-fed infants and young children from diverse livelihood groups in northern Kenya. Public Health Nutr 2016; 20:971-983. [PMID: 27917743 DOI: 10.1017/s1368980016003116] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To formulate age- and context-specific complementary feeding recommendations (CFR) for infants and young children (IYC) and to compare the potential of filling population-level nutrient gaps using common sets of CFR across age groups. DESIGN Linear programming was used to develop CFR using locally available and acceptable foods based on livelihood- and age-group-specific dietary patterns observed through 24 h dietary recalls. Within each livelihood group, the nutrient potential of age-group-specific v. consolidated CFR across the three age groups was tested. SETTING Three food-insecure counties in northern Kenya; namely, settled communities from Isiolo (n 300), pastoralist communities from Marsabit (n 283) and agro-pastoralist communities from Turkana (n 299). SUBJECTS Breast-fed IYC aged 6-23 months (n 882). RESULTS Age-specific CFR could achieve adequacy for seven to nine of eleven modelled micronutrients, except among 12-23-month-old children in agro-pastoralist communities. Contribution of Fe, Zn and niacin remained low for most groups, and thiamin, vitamin B6 and folate for some groups. Age-group-consolidated CFR could not reach the same level of nutrient adequacy as age-specific sets among the settled and pastoralist communities. CONCLUSIONS Context- and age-specific CFR could ensure adequate levels of more modelled nutrients among settled and pastoralist IYC than among agro-pastoralist communities where use of nutrient-dense foods was limited. Adequacy of all eleven modelled micronutrients was not achievable and additional approaches to ensure adequate diets are required. Consolidated messages should be easier to implement as part of a behaviour change strategy; however, they would likely not achieve the same improvements in population-level dietary adequacy as age-specific CFR.
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de Pee S. Special nutritious solutions to enhance complementary feeding. MATERNAL AND CHILD NUTRITION 2016; 11 Suppl 4:i-viii. [PMID: 26751986 DOI: 10.1111/mcn.12265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Saskia de Pee
- Nutrition Division, World Food Programme, Rome, Italy. .,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
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Tumilowicz A, McClafferty B, Neufeld LM, Hotz C, Pelto GH. Using implementation research for evidence-based programme development: a case study from Kenya. MATERNAL AND CHILD NUTRITION 2016; 11 Suppl 3:1-5. [PMID: 26778798 PMCID: PMC5066633 DOI: 10.1111/mcn.12242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 01/22/2023]
Abstract
The few available studies of programme effectiveness in nutrition find that programmes are less effective than would be predicted from the efficacy trials that are the basis for evidence‐based programming. Some of these are due to gaps in utilisation within households. To a greater extent, these gaps can be attributed to problems in programme design and implementation. ‘Implementation research in nutrition’ is an emerging area of study aimed at addressing this problem, by building an evidence base and a sound theory to design and implement programmes that will effectively deliver nutrition interventions. The purpose of this supplement to Maternal & Child Nutrition is to contribute to this growing area of implementation research. The series of papers presented and the reflections for policymaking and programmes, combined with the reflections on the application of ethnography to this area of inquiry, illustrate the value of systematic research undertaken for the purpose of supporting the design of nutrition interventions that are appropriate for the specific populations in which they are undertaken. © 2015 Blackwell Publishing Ltd
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Affiliation(s)
| | | | | | - Christine Hotz
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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Osendarp SJM, Broersen B, van Liere MJ, De-Regil LM, Bahirathan L, Klassen E, Neufeld LM. Complementary Feeding Diets Made of Local Foods Can Be Optimized, but Additional Interventions Will Be Needed to Meet Iron and Zinc Requirements in 6- to 23-Month-Old Children in Low- and Middle-Income Countries. Food Nutr Bull 2016; 37:544-570. [DOI: 10.1177/0379572116655239] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The question whether diets composed of local foods can meet recommended nutrient intakes in children aged 6 to 23 months living in low- and middle-income countries is contested. Objective: To review evidence of studies evaluating whether (1) macro- and micronutrient requirements of children aged 6 to 23 months from low- and middle-income countries are met by the consumption of locally available foods (“observed intake”) and (2) nutrient requirements can be met when the use of local foods is optimized, using modeling techniques (“modeled intake”). Methods: Twenty-three articles were included after conducting a systematic literature search. To allow for comparisons between studies, findings of 15 observed intake studies were compared against their contribution to a standardized recommended nutrient intake from complementary foods. For studies with data on intake distribution, %< estimated average requirements were calculated. Results: Data from the observed intake studies indicate that children aged 6 to 23 months meet requirements of protein, while diets are inadequate in calcium, iron, and zinc. Also for energy, vitamin A, thiamin, riboflavin, niacin, folate, and vitamin C, children did not always fulfill their requirements. Very few studies reported on vitamin B6, B12, and magnesium, and no conclusions can be drawn for these nutrients. When diets are optimized using modeling techniques, most of these nutrient requirements can be met, with the exception of iron and zinc and in some settings calcium, folate, and B vitamins. Conclusion: Our findings suggest that optimizing the use of local foods in diets of children aged 6 to 23 months can improve nutrient intakes; however, additional cost-effective strategies are needed to ensure adequate intakes of iron and zinc.
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Affiliation(s)
- Saskia J. M. Osendarp
- The Micronutrient Initiative, Ottawa, Ontario, Canada
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | - Britt Broersen
- The Micronutrient Initiative, Ottawa, Ontario, Canada
- Global Alliance for Improved Nutrition (GAIN), Geneva, Switzerland
| | | | | | | | - Eva Klassen
- The Micronutrient Initiative, Ottawa, Ontario, Canada
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Development of complementary feeding recommendations for 12–23-month-old children from low and middle socio-economic status in West Java, Indonesia: contribution of fortified foods towards meeting the nutrient requirement. Br J Nutr 2016; 116 Suppl 1:S8-S15. [DOI: 10.1017/s0007114516002063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AbstractInadequate nutrient intake as part of a complementary feeding diet is attributable to poor feeding practices and poor access to nutritious foods. Household socio-economic situation (SES) has an influence on food expenditure and access to locally available, nutrient-dense foods and fortified foods. This study aimed to develop and compare complementary feeding recommendations (CFR) for 12–23-month-old children in different SES and evaluate the contribution of fortified foods in meeting nutrient requirements. A cross-sectional survey was conducted in low and medium SES households (n 114/group) in urban Bandung district, West Java province, Indonesia. Food pattern, portion size and affordability were assessed, and CFR were developed for the low SES (LSES) and middle SES (MSES) using a linear programming (LP) approach; two models – with and without fortified foods – were run using LP, and the contribution of fortified foods in the final CFR was identified. Milk products, fortified biscuits and manufactured infant cereals were the most locally available and consumed fortified foods in the market. With the inclusion of fortified foods, problem nutrients were thiamin in LSES and folate and thiamin in MSES groups. Without fortified foods, more problem nutrients were identified in LSES, that is, Ca, Fe, Zn, niacin and thiamin. As MSES consumed more fortified foods, removing fortified foods was not possible, because most of the micronutrient-dense foods were removed from their food basket. There were comparable nutrient adequacy and problem nutrients between LSES and MSES when fortified foods were included. Exclusion of fortified foods in LSES was associated with more problem nutrients in the complementary feeding diet.
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