Presentation on theme: "‘Optifood’ – A tool based on linear programming analysis to inform nutrition programme planning and policy decisions Elaine Ferguson London School of Hygiene."— Presentation transcript:
‘Optifood’ – A tool based on linear programming analysis to inform nutrition programme planning and policy decisions Elaine Ferguson London School of Hygiene & Tropical Medicine Improving health worldwide
Introduction Dietary survey data is important for describing food patterns, intakes of energy and nutrients and estimating the % at risk of inadequate nutrient intakes; however, there are important programme and policy uses of dietary data I will describe how dietary data together with a tool based on linear programming analyses (Optifood), can be used to inform decisions regarding the use of food-based strategies to improve nutrition of high risk target population I will present an illustrative example from SE Asia
Why a food-based intervention? Dietary approaches are more sustainable and will likely provide benefits across a wide range of age groups Avoids unintentional/unexpected adverse effects from providing high or unbalanced levels of nutrients However questions remain – is a food-based approach alone a cost- effective approach for ensuring dietary adequacy? → Culturally acceptable, affordable & nutritionally adequate What nutrient requirements are easy to meet using locally available foods and which are more difficult?
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 food sources of nutrients in this diet as well as the most expensive nutrient requirements to achieve
Types of issues it can address FOOD AVAILABILITY/ ACCESSIBILITY: Can locally available food provide all nutrients needed by a target population? → Policy & programme decisions and advocacy. 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? → Programme decisions and research
Optifood …. Tool based on linear programming analyses (LP) LP is mathematical optimisation which selects the best option from amongst all possible options given specified criteria In Optifood, its diet modeling, so its quickly selects the best diet from hundreds/thousands of modeled diets that are run in each analysis to inform decisions
Data Requirements Dietary Surveys – Quantitative (recalls, records) – Food frequency data Market surveys – Food cost per 100 g edible portion Food composition tables
Food Composition Table Energy Protein Water Fat Carbohydrate Vitamin A Vitamin C B1 B2 B3 Ca Fe Zn B6 B12 Folate Select Fe and Zn bioavailability
Optifood Analysis Structure Model Constraints Food list Min & max g/wk Food Patterns Min & max serves/wk Main food groups Staples & snacks Food sub-groups Energy content Maximum cost (optional) Food-based recommendations (FBRs) Nutrient content Module#1 Module#2 Module#3 Module#4 Module Outputs Check parameters Create food-based recommendations; ‘Problem nutrients’ Test & compare alternative FBRs Type of ‘problem nutrient’ Cost analysis: Lowest cost nutritionally best diet
Module III: models tails of the nutrient intake distribution to test FBRs BaselineFood-based recommendation >65% or 70% RNI=adequate Vitamin A intakes Test 11 micronutrients Test alternative sets of FBRs Define “problem nutrients” Upper tail < 100% RNI/AI
Formulate and Test Food-based Recommendations: What food-based recommendations are best to promote for this target group? Module 2 results are used = “best diet” → potential food-based recommendations –Best food and food sub-group sources of nutrients –Food group patterns
Food-based Recommendations Test and compare in Module 3 “lower tail of intake distributions” Dairy 14 serves / week Vegetables 21 serves / week Meat, fish or eggs 5 serves / week Legumes 7 serves/week Fruits 7 serves/week Liver 2 serves/week Green leafy vegetables 5 serves/week Vitamin C rich fruits 5 serves/week Potatoes 3 serves/week Tofu/tempeh 7 serves/week Anchovies 3 serves/week
Minimised nutrient content analysis from Module 3 Count number of “lower tails” >65% or 70% RNI and cost
Research in SE Asia
Countries and Target groups Up to 6 target groups representative at national or district level in each country – 6-8 month olds – 9-11 month olds – month olds – Pregnant women – Lactating women or adolescent girls – Non-pregnant, non-lactating women In all countries but Laos, dietary data were collected using a 24-hour recall at the national level; in Thailand FFQ in Laos, a 7-day qualitative 24-hour recall at a district level
Define “Problem nutrients” 1.Can a nutritionally adequate diet be promoted given local foods & food patterns?
Numbers of “Problem Nutrients” CambodiaIndonesiaLao PDRThailandVietnam Children: 6-8 m 9-11 m m Women: Pregnant Lactating NPNL Not analysed For children: Ca, Fe & Zn; sometimes folate, B1, B2 & B3 For women: Ca & Fe; often folate, B2, B6 & vitamin A
Food-based Recommendations 2.To what extent can food-based recommendations ensure dietary adequacy for these target groups?
Number of nutrients –lower tails of their intake distributions >70% RNI when FBRs were tested (11 micronutrients)
% target groups where nutrient adequacy was not ensured
Testing Alternative Interventions - children
What is the minimum of sachets/w of multiple micronutrient powders that would ensure dietary adequacy? 6-8 months9-11 months12-23 months AloneWith FBR AloneWith FBR AloneWith FBR Cambodia5*4* 3 Indonesia5*3*5*3*4* Lao PDR5*4*5*4*5*3* Vietnam5*3 34*3 *Ca adequacy not ensured FBR – food-based recommendations
Choose an iron-folate or a multi- micronutrient supplement for pregnant Cambodian women? Daily Fe – folate SupplementDaily Multiple Micronutrient Supplement Number per week Only supplement #Nutrients ≥70% RNI Supplement + FBR #Nutrients ≥70% RNI Number per week Only supplement #Nutrients ≥70% RNI Supplement + FBR #Nutrients ≥70% RNI 1 day 2 days 3 days 4 days 5 days 6 days 7 days 1 2 3* # 1 day 2 days 3 days 4 days 5 days 6 days 7 days ** ** *Achieved only Fe, folate & niacin #Did not achieve Ca, riboflavin & vitamin A **Did not achieve Ca
Will the proposed national sets of Complementary Feeding Recommendations ensure dietary adequacy?
CF Recommendations for 6-8 m olds in Thailand OriginalTested#1Tested#2Tested#3Tested#4Optifood Rice -14 MFE – 14 Egg – 7 Veg – 14 Fruit-14 Oil-7 “ Fruit -7 “ No oil “ Fruit-7 Oil-3 “ F- rice-14 Not feasible 4 low nutrients* 4 low nutrients 2 low nutrients Problem nutrients Ca Fe Zn B3 Ca Fe Zn B3 Fe B3 Ca Fe Zn *low nutrients defined as worst-case scenarios <65% RNI
Did intervention foods ensure dietary adequacy? from Cambodia (6-8 months) Foods Winfood Winfood-lite CSB+ CSB++ Skau et al, AJCN 99:130-8, 2014
Conclusions Food-based approaches can improve the micronutrient content of diets in SE Asian countries but they may not ensure dietary adequacy for all nutrients especially – Ca, Fe, and Zn for children; and perhaps also folate, thiamin, riboflavin & niacin – Ca, Fe and folate for women; and perhaps also thiamin, riboflavin, niacin, B 6, VA Alternative strategies are needed to ensure dietary adequacy in these SE Asian populations (advocacy) Food-based recommendations plus an alternative strategy, such as multiple micronutrient powders/supplements or tailored fortified foods, can ensure dietary adequacy for most micronutrients if successfully adopted (programmes/policy – need evaluations )
The SMILLING Team Lao – National Institute of Public Health – Dr Sengchanh Kownnavong – Dr Manithong Vonglokham – Dr Daovieng Douangvichith Thailand – Mahidol University – Dr Uraiporn Chittchang – Dr Nipa Rojroongwasiukul – Dr Pattanee Winnichagoon Indonesia – SEAMEO TROPMED RCCN – Dr Umi Fahmida – Mr Otte Santika Cambodia – Ministry of Health; Ministry of Agriculture, Forestry & Fisheries – Dr Mary Chea – Mr Seyha Sok – Ms Daream Sok – Mr Kuong Khov – Dr Jutta Skau Vietnam – National Institute of Nutrition – Prof Le Bach Mai – Dr Tran Thaan Do – Dr Tran Lua-NIN
Nutrients not adequate (<70% RNI) CambodiaIndonesiaLao PDRThailandVietnam 6-8 mCa, Fe, Zn, folate Fe, Zn, B 3 Ca, Fe, Zn, B 1, B 3 Ca, Fe, Zn 9-11 mCa, Fe, Zn, folate Ca, Fe, Zn, B 3 Ca, Fe, Zn, B 1, B 3 Ca, Fe, ZnFe mFe, folateCa, B 2, B 3 Fe, Zn, B 1, B 3, folate Fe, B 3, folate Ca, Fe, B 1 PregnantCa, Fe, folate, B 2, VA Ca, Fe, B 1, B 3, B 6, folate Ca, Fe, folate, B 2, B 3, B 6 LactatingCa, Fe, folate, B 2, VA Ca, Fe, B 1, B 3, B 6, folate Ca, folate, B 2 NPNLCa, Fe, folate, B 2, VA Ca, Fe, B 1, folate Ca, Fe, B 2, B 3