OptiFood Improving Nutrition Programmes for the Future

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"OptiFood - Future Approach to Improve Nutrition Programme Planning and Policy Decisions in SE Asia" from the Regional Conference on Micronutrient Fortification of Foods 2013 (10 ~ 11 October 2013 in Bangkok, Thailand)

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OptiFood Improving Nutrition Programmes for the Future

  1. 1. ‘Optifood’ – Future Approach to Improve Nutrition Programme Planning and Policy Decisions in SE Asia Elaine Ferguson London School of Hygiene & Tropical Medicine Improving health worldwide www.lshtm.ac.uk
  2. 2. Introduction • Under-nutrition contributes to maternal and child morbidity, mortality and poor development outcomes. • In order to reduce negative functional impacts of undernutrition on human potential, effective programmes/policies are needed • Tools based on mathematical modelling can generate evidence to help inform nutrition programme planning and policy decisions or support advocacy efforts; providing rapid, objective and flexible methods for theoretically exploring alternative nutrition interventions or different scenarios
  3. 3. Aims of Presentation • Briefly describe a new tool– Optifood - which is based on linear programming analyses • To describe its potential for informing nutrition intervention programme planning and government policy decisions; using examples of its application in south-east Asia.
  4. 4. What is linear programming analyses? • Mathematical optimisation which selects the best option from amongst all possible options given specified criteria • In Optifood, its diet modeling
  5. 5. What Optifood can do.... Formulate food-based recommendations (FBR) for a specific target group Test & compare FBRs → cost & nutrient adequacy Identify nutrients whose requirements are difficult to achieve using local foods → “problem nutrients” Identify the lowest cost nutritionally best diet, and the most expensive nutrient requirements to meet & the most expensive food sources of nutrients
  6. 6. Types of issues it can address • FOOD AVAILABILITY/ ACCESSIBILITY: Can locally available food provide all nutrients needed by a target population? • FOOD AFFORDABILITY: How much will the nutritionally best diet cost ? → Cost transfer programme decisions. • BEHAVIOUR CHANGE: What food-based recommendations are best to promote for improving the nutritional status of the target population?
  7. 7. LINKAGES ..... • NUTRITION PROGRAMME DESIGN & POLICY: What food-based strategy should be promoted? Are there other foods available that could fill the nutrient gaps if they were accepted? Is a specific fortified food required to ensure a target population nutrient needs are met? What will it cost in relation to alternative strategies? • PREDICT PROGRAMME IMPACT: Is this food-based intervention/fortified food likely to improve the nutritional status of the target population? • ADVOCACY: Evidence that the food supply will not provide adequate intakes of nutrients x,y, z to selected target populations → the long term impacts on human health and capacity this implies
  8. 8. Data Requirements • Dietary Surveys – Quantitative intakes (recalls, records) – Food frequency data • Market surveys – Food cost per 100 g edible portion • Food composition tables
  9. 9. Optifood Analysis Structure Model Constraints Module Outputs Food list Check parameters Min & max g/wk Module#1 Food Patterns Min & max serves/wk Main food groups Staples & snacks Food sub-groups Module#2 Energy content Maximum cost Module#3 (optional) Food-based recommendations (FBRs) Nutrient content Module#4 Create food-based recommendations; ‘Problem nutrients’ Test & compare alternative FBRs Type of ‘problem nutrient’ Cost analysis: Lowest cost nutritionally best diet
  10. 10. Food Composition Table Energy Protein Water Fat Carbohydrate Vitamin Select Fe A and Zn bioavailability Vitamin C B1 B2 B3 Ca Fe Zn B6 B12 Folate
  11. 11. Define “Problem nutrients” 1. Can a nutritionally adequate diet be promoted given local foods & food patterns?
  12. 12. % RNI/AI & Cost in 2 Best Diets 140 ≥ 120 100 80 60 40 20 0 FP no-FP
  13. 13. Module #2 Question: • What food-based recommendations are best to promote for this target group?
  14. 14. Examine Food patterns – observed median vs best diet 25 20 15 FP Goal 10 No FP Goal 5 0
  15. 15. Best Food Sources of Nutrients in Best Diet Ca % Anchovy 13 Spinach 10 Fe Liver Tofu % 28 22 Zn % Liver 20 Rice 18 % of nutrient provided by each food B-1 % Anchovy 18 Banana 14
  16. 16. Food-based Recommendations Tested and compared Dairy 21 serves / week Vegetables 21 serves / week Meat, fish or eggs 5 serves / week Legumes 7 serves/week
  17. 17. Module 3: test food-based recommendations (constraints) using “worst-case scenario” level diets
  18. 18. Nutrient Intake Distribution 65% - 75% RNI (EAR ) Worst-case Worst-case Best-case Best-case
  19. 19. Preliminary Results: • Laos – 15 villages in Salavan district; women & 6-23 month old children; 7day qualitative 24-hour recall • Thailand – national nutrition survey; 6-23 month old children; 24-hour recall and food frequency questionnaire • Vietnam – national food consumption survey; women & 6-23 month old children; 24-hour recall
  20. 20. What are the ‘problem nutrients’? i.e., RNI cannot be met with local foods 6 – 8 months # ‘problem nutrients’ 3 3 1 Ca, Fe, Zn Ca 3 3 0 Ca, Fe, Zn Vietnam # ‘problem nutrients’ Ca, Fe, Zn Thailand 12 – 23 months # ‘problem nutrients’ Lao PDR 9 – 11 months Ca, Fe, Zn 3 1 Ca, Fe, Zn Fe 0
  21. 21. Number of ‘problem nutrients’ for women ... Pregnant # ‘problem nutrients’ # ‘problem nutrients’ 3 2 0 Ca, Fe, folate Ca, Fe 4 4 2 Ca, Fe, B2, Ca, B2, B6, Ca, Fe folate Vietnam NPNL # ‘problem nutrients’ Lao PDR Lactating folate NPNL – non-pregnant & non-lactating
  22. 22. Module #3 Results: Food-based recommendations (FBRs)
  23. 23. Number of nutrients for which the best set of FBRs could ensure >65% RNI(of 11 micronutrients) 12 10 8 Lao 6 Vietnam Thailand 4 2 0 6-8 mth 9-11 mth 12-23 mth Pregnant Lactating NPNL
  24. 24. Number of countries & nutrients for which FBRs could not ensure adequacy for population 6-8 m 9-11 m 12-23 m Pregnant Lactating NPNL Ca 2 2 2 2 2 2 Fe 3 3 2 2 1 2 Zn 3 3 1 B1 1 1 2 1 1 1 B2 1 1 1 B3 1 1 2 2 2 B6 1 1 1 2 Folate 3 2 2 1
  25. 25. Multiple Micronutrient Powders - Laos 6-8 months # nuts >65% RNI 9-11 months # nuts >65% RNI 12-23 months # nuts >65% RNI FBR 6 5 5 MNP 1 2 3 4 5 6 8 8 10 10 6 8 8 10 10 1 4 5 7 10 1 + FBR 2 + FBR 3 + FBR 4+ FBR 5 + FBR 8 8 9 10 10 8 8 9 10 10 8 10 11
  26. 26. Food-based recommendations 9-11 month olds 12-23 month olds (not BF) • Breastfeed on demand • Feed meat, fish or eggs at least twice per day • Feed liver at least three times per week • Feed fruit every day • Feed dairy products twice a day • Feed meat, fish or eggs at least twice per day • Feed liver at least 3 times per week • Feed fruit every day • Feed green leafy vegetables twice per day • Introduce vegetables into your child’s diet as often as you can • Feed other vegetables as often as you can
  27. 27. Conclusions • food-based approaches can improve the micronutrient content of diets but they may not ensure dietary adequacy for all nutrients especially – Ca, Fe, and Zn for children; and perhaps also thiamin, niacin & B6 – Ca, Fe, folate, B2 and B6 for women; and perhaps also thiamin & niacin • Diet modelling so the results are dependent on model parameters especially – RNIs used – Food composition tables values – Dietary data accuracy → database of foods servings and food patterns
  28. 28. Acknowledgements Lao – Ministry of Health – Dr Sengchanh Kownnavong – Dr Manithong Vonglokham Thailand – Mahidol University – Dr Nipa Rojroongwasiukul – Dr Uraiporn Chittchang – Dr Pattanee Winnichagoon Vietnam – National Institute of Nutrition – Dr Tran Thaan Do – Dr Tran Lua-NIN – Dr Le Bach Mai • Funding: European Union
  29. 29. Thank-you!
  30. 30. Compare intervention foods example from Cambodia (6-8 months) Foods Winfood Winfood-lite CSB+ CSB++ J Kloppenborg-Heick, unpublished
  31. 31. Problem Nutrients: <100% RNI in “best-case scenario” Baseline Winfood Winfood-lite CSB+ CSB++ PN=8 PN=6 PN=5 PN=6 PN=5 Zn Fe Ca B1 B2 B3 B-12 Folate Zn Fe B1 B2 B3 Folate Zn Fe B1 B3 Folate Zn Fe Ca B1 B3 Folate Fe Ca B1 B3 Folate PN = problem nutrient J Kloppenborg-Heick, unpublished

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