The document introduces 'Optifood', a linear programming tool designed to enhance nutrition program planning and policy decisions in Southeast Asia, addressing under-nutrition. It outlines how Optifood can formulate food-based recommendations, assess nutrient adequacy, and analyze food affordability and availability to ensure dietary sufficiency for specific target groups. The tool aims to provide evidence for effective interventions and advocacy concerning nutritional needs in various populations.

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