Earlier today there has been mention and support for increasing dietary diversity as a food based stratgy for adressingundernutrition so I think this presentatino ties in nicely as an example of a novel idea that uses local ingredients to achieve that goal.Generally, pre-prepared infant foods around the world tend to be cereal based, and often these cereal foods along with breastmilk make up the diets of many children in developing countries. At WorldFish we have been investigating including Fish in pre-prepared CFs for infants, which it quite a novel concept. We are in the preliminary stages so today I’m introducing this concept and discussing our plans for future development.
Give a snapshot on child malnutrition and CF practices in Bangladesh which leads on to our goals for developing a novel CF product. Then I’ll talk about the ingredients we selected for inclusion and why, the nutrient composition of our proposed food and plans for its future development.
From the most recent demographic and health survey 2011Under 5 mortality 53/1000 live births41% are moderately stunted (15% severely stunted)14% are wasted (4% severely wasted)36% are underweight (10% severely underweight)This graph tracks stunting and underweight from 6 months to 5 years and you can see particularly for stunting the dramatic increases after age 6 months This is the age where breastmilk is no longer sufficient to meet nutrient requirements of infants. This is the window of opportunity to try and improve complementary feeding practices and reverse this trend.
WHO has clearly defined indicators of appropriate IYCF practices.Exclusive breastfeeding: Minimum meal frequency of CFs: For breastfed children, at age 6-8months is 2 meals per day, for breastfed children at age 9-24 months is 3 meals per day of soft, semi solid or solid food.Minimum dietary diversity: proportion of children who receive foods from 4 or more different food groups.4. A composite measure of points 2 & 3. Only 21% of infants are meeting those minimum requirements.
Generally, Bangladesh has a largely plant based diet – less than 6% of energy intake on a national level comes from a combination of meat, fish, poultry, egg or dairy products. Plant based diets are also often at risk of being deficient in certain micronutrients. It is widely known that plant based diets are often high in antinutrients such as phytates which reduce the bioavailability of some nutrients. Studies on CF in Bangladesh have shown that infants are rarely provided CFs containing adequate energy and micronutrients, AND this still occurs even when nutrient rich foods are available in the household. So we know that providing nutrient rich foods is not simply a matter of accessibility or availability. The result being that infants of often fed low nutrient foods like think rice gruels which are low in nutrients such as iron, zinc and calcium.From several studies we know that time in preparing separate foods or modifying family foods to be suitable for CF for infants is a big constraint for mothers who are busy engaged in household or agricultural chores or who are away from the family home for work purposes throughout the day.Storage is also a big problem with very limited access to refrigeration, storage of cooked foods in hot and humid temperatures is high risk for microbial growth which can cause food poisoning and diarrhea.
With the things from previous slide in mind.We wanted to develop a product that would replace the low nutrient gruels commonly used, that would take an absolute minimum time to prepare for the caregiver.We wanted it to be:---And we wanted to use fish because although it might be encouraged in CF recipes in several countries, using it in a pre-prepared CF is quite a novel concept.
Rice is the obvious choice because its by far the most commonly consumed food item across the country. In comparison to other grain based complimentary foods it can be processed in a way to reduce the level of anti-nutrients.Including rice as a base plays an important role in ensuring that the food is culturally acceptable.
Fish is a very strong part of the Bangladeshi culture. “Mache bhate Bengali”It is the most commonly eaten animal source food across all income groups in BangladeshWe know from previous studies that many SIS found in abundance across the country are rich in micronutrientsThe other important reason we wanted to include fish was because we know what the presence of a small amount of animal source foods enhances the absorption of micronutrients from other ingredients: so it is a 2 fold effect, on one hand fish increase the nutrient density of the food and secondly, it increases the absorption of nutrients from the other ingredients.
Then the question was, which fish?With our goal in mind of maximising iron, zinc and calcium the obvious choice was Darkina fish. This is a common SIS found in beels, ditches, ponds and inundated fields and is abundant during the wet season.
Recognised globally for its contribution as a food based strategy to prevent vitamin A deficiency.Natural sweetener likely to improve the acceptability of the product.
Sweet potato not widely available in Bangladesh but it has received a lot of attention and is now a large part of homestead food production projects in BangladeshAvailability will continue to increase.Any other projects
Supercereal Plus is the current Fortified Blended Food provided by the WFP program in Bangladesh, provided to children from 6-23 months as a complement to breastmilk. It is made from wheat, soybeans, dried skim milk, sugar and soybean oil.Pushti packet was the supplementary food provided in the National Nutrition Program in different quantities depending on whether it was for prevention or treatment of malnutrition. Main ingredients were rice powder and pulses.Worth noting that both of these products are fortified products, where ours is produced from local ingredients and yet is still a better source of iron, zinc and calcium and a comparable source of energy and vitamin A.
Today I wanted to share the concept of using fish as an ingredient in pre-prepared foodsThere’s also lots of potential for modifying this product and adapting it for different target groups. For example, HarvestPlus are working in Bangladesh to develop a high zinc rice. CIP are working on improving the production of SP varieties that are higher in vitamin A than what is currently available in Bangladesh.At the moment, we’ve designed the product for use in prevention of malnutriton but it also could be modified for TREATMENTHarvestPlus and CIP
Using nutrient-rich localingredients in the developmentof a complementary foodJessica Bogardj.firstname.lastname@example.orgShakuntala Haraksingh Thilsted
Outline• Child malnutrition• Complementary feeding• Rationale for product development• Ingredients selected for CF• Production process• Nutrient composition of CF• Plans for the future
60 Child Malnutrition in Bangladesh - 2011 50 Moderate stunting 40 Moderate underweight% children 30 Window of opportunity 20 Severe stunting 10 Severe underweight 0 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59 Age (months)
Complementary feeding in Bangladesh - 2011(among breastfed infants)1. Exclusive breastfeeding from 0-6 months – >1 in 3 children are NOT exclusively breastfed2. Meal frequency (2/day at 6-8 months, 3/day at 9-24 months) – > 1 in 3 are NOT fed the minimum number of meals per day3. Dietary diversity – >3 in 4 are NOT fed with appropriate dietary diversity4. Meal frequency AND dietary diversity – Only 21%
Challenges for complementary feeding inBangladesh• Predominantly plant-based diet – Low in micronutrients – High in anti-nutrients• CFs rarely provide adequate energy and micronutrients – Thin rice gruels/ suji – Low in iron, zinc and calcium• Time• Safe storage
Rationale for Product Development • Rich in nutrients (iron, zinc, vitamin A, calcium) • Made from local ingredients • Culturally acceptable • Low in anti-nutrients • Hygienic and safe
Selection of ingredients - Fish• “Mache bhate Bengali” Fish and rice make a Bengali• Fish most commonly eaten animal-source food across all income groups• Small indigenous fish are highly nutritious• Animal-source foods enhance bioavailability of minerals
14 Fe (mg/100g) Zn (mg/100g)12 Selection of ingredients - Fish Calcium (g/100g)1086420 Chanda Chapila Chikra Darkina Kaski Mola Puti Taki
Selection of ingredients - Orange FleshSweet Potato• Vitamin A• Fructose (natural sweetener)• Low in anti-nutrients
Contribution to RDIs (%) 1 serve = 30g dry powder mixed with warm water Energy Iron Zinc Calcium Vitamin A 6-8 mo 21 44 45 49 261 serve per 9-11mo 19 44 45 39 26 day 12-23 mo 15 70 45 39 26 6-8 mo 42 88 91 99 522 serves per 9-11mo 38 88 91 79 52 day 12-23 mo 29 141 91 79 78
Comparison to other products Super Cereal Pushti Our product Plus* Packet* Energy 434.8 410 394.7 Protein 16.9 16 3.75 Fat 12.7 9 3.23Vitamin A 348.3 499 394.5 Calcium 657.1 130 300 Iron 13.6 2.5 2.1 Zinc 6.2 5 4.4 * Fortified with micronutrients
Where to from here…• Immediate plans: – Acceptability trial – Nutrient and shelf life analysis• Future plans – Efficacy trial – Investigating options for distribution Subsidized product through existing maternal and child health programs, safety net programs Market-based approach
Where to from here…• Improve the nutrient quality of ingredients: – High zinc rice – Sweet potato variety (higher vitamin A) – Different fish species• Modified as a supplement for pregnant and lactating women• Modified to treat moderate and severe malnutrition• Modified for use in school feeding programs