"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)

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. 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. 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. 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. 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. 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. 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. Data Requirements
• Dietary Surveys
– Quantitative intakes
(recalls, records)
– Food frequency data
• Market surveys
– Food cost per 100 g
edible portion
• Food composition tables

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. 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. Define “Problem nutrients”
1. Can a nutritionally adequate diet be promoted
given local foods & food patterns?

12. % RNI/AI & Cost in 2 Best Diets
140
≥ 120
100
80
60
40
20
0
FP
no-FP

13. Module #2 Question:
• What food-based recommendations are
best to promote for this target group?

14. Examine Food patterns – observed
median vs best diet
25
20
15
FP Goal
10
No FP Goal
5
0

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. 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. Module 3: test food-based recommendations (constraints)
using “worst-case scenario” level diets

18. Nutrient Intake Distribution
65% - 75% RNI (EAR )
Worst-case
Worst-case
Best-case
Best-case

20. 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

21. 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

22. 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

23. Module #3 Results:
Food-based recommendations
(FBRs)

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. Thank-you!

31. Compare intervention foods
example from Cambodia (6-8 months)
Foods
Winfood
Winfood-lite
CSB+
CSB++
J Kloppenborg-Heick, unpublished

32. 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