Presentation on theme: "Elaine Ferguson London School of Hygiene & Tropical Medicine"— Presentation transcript:
1Elaine Ferguson London School of Hygiene & Tropical Medicine ‘Optifood’ – A tool based on linear programming analysis to inform nutrition programme planning and policy decisionsElaine Ferguson London School of Hygiene & Tropical MedicineImproving health worldwide
2IntroductionDietary 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 dataI 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 populationI will present an illustrative example from SE Asia
3Why a food-based intervention? Dietary approaches are more sustainable and will likely provide benefits across a wide range of age groupsAvoids unintentional/unexpected adverse effects from providing high or unbalanced levels of nutrientsHowever questions remain – is a food-based approach alone a cost-effective approach for ensuring dietary adequacy?→ Culturally acceptable, affordable & nutritionally adequateWhat nutrient requirements are easy to meet using locally available foods and which are more difficult?
4What Optifood can do....Formulate food-based recommendations (FBR) for a specific target groupTest & compare FBRs → cost & nutrient adequacyIdentify 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
5Types 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
6Optifood …. Tool based on linear programming analyses (LP) LP is mathematical optimisation which selects the best option from amongst all possible options given specified criteriaIn 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
7Data Requirements Dietary Surveys Quantitative (recalls, records) Food frequency dataMarket surveysFood cost per 100 g edible portionFood composition tables
8Select Fe and Zn bioavailability Food Composition TableEnergyProteinWaterFatCarbohydrateVitamin AVitamin CB1B2B3CaFeZnB6B12FolateSelect Fe and Zn bioavailability
9Optifood Analysis Structure Module OutputsCheck parametersCreate food-based recommendations; ‘Problem nutrients’Test & compare alternative FBRsType of ‘problem nutrient’Cost analysis:Lowest cost nutritionally best dietModel ConstraintsFood listMin & max g/wkFood PatternsMin & max serves/wkMain food groupsStaples & snacksFood sub-groupsEnergy contentMaximum cost(optional)Food-based recommendations (FBRs)Nutrient contentModule#1Module#2Module#3Module#4
10>65% or 70% RNI=adequate Module III: models tails of the nutrient intake distribution to test FBRsTest 11 micronutrientsTest alternative sets of FBRs>65% or 70% RNI=adequateDefine “problem nutrients”Upper tail < 100% RNI/AIBaselineFood-based recommendationVitamin A intakes
11Formulate 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 recommendationsBest food and food sub-group sources of nutrientsFood group patterns
12Food-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
13Minimised nutrient content analysis from Module 3 Count number of “lower tails” >65% or 70% RNI and cost
15Countries and Target groups Up to 6 target groups representative at national or district level in each country6-8 month olds9-11 month olds12-23 month oldsPregnant womenLactating women or adolescent girlsNon-pregnant, non-lactating womenIn all countries but Laos, dietary data were collected using a 24-hour recall at the national level; in Thailand FFQin Laos, a 7-day qualitative 24-hour recall at a district level
16Define “Problem nutrients” Can a nutritionally adequate diet be promoted given local foods & food patterns?
17Numbers of “Problem Nutrients” CambodiaIndonesiaLao PDRThailandVietnamChildren:6-8 m9-11 m12-23 m64231Women:PregnantLactatingNPNL75Not analysedFor children: Ca, Fe & Zn; sometimes folate, B1, B2 & B3For women: Ca & Fe; often folate, B2, B6 & vitamin A
18Food-based Recommendations To what extent can food-based recommendations ensure dietary adequacy for these target groups?
19Number of nutrients –lower tails of their intake distributions >70% RNI when FBRs were tested (11 micronutrients)
20% target groups where nutrient adequacy was not ensured
22What is the minimum of sachets/w of multiple micronutrient powders that would ensure dietary adequacy?6-8 months9-11 months12-23 monthsAloneWith FBRCambodia5*4*3Indonesia3*Lao PDRVietnam*Ca adequacy not ensuredFBR – food-based recommendations
23Daily Fe – folate Supplement Choose an iron-folate or a multi-micronutrient supplement for pregnant Cambodian women?Daily Fe – folate SupplementDaily Multiple Micronutrient SupplementNumber per weekOnly supplement#Nutrients≥70% RNISupplement + FBR1 day2 days3 days4 days5 days6 days7 days123*6788#34910**10*Achieved only Fe, folate & niacin#Did not achieve Ca, riboflavin & vitamin A**Did not achieve Ca
24Will the proposed national sets of Complementary Feeding Recommendations ensure dietary adequacy?
25CF Recommendations for 6-8 m olds in Thailand OriginalTested#1Tested#2Tested#3Tested#4OptifoodRice -14MFE – 14Egg – 7Veg – 14Fruit-14Oil-7“Fruit -7No oilFruit-7Oil-3F- rice-14Not feasible4 low nutrients*4 low nutrients2 low nutrientsProblem nutrientsCaFeZnB3Fe increased from 18 or 19% RNI to 57% RNI; B3 – 61 & 62% RNI; but with fortified rice = 39% RNI*low nutrients defined as worst-case scenarios <65% RNI
26Did intervention foods ensure dietary adequacy Did intervention foods ensure dietary adequacy? from Cambodia (6-8 months)FoodsWinfoodWinfood-liteCSB+CSB++Skau et al, AJCN 99:130-8, 2014
27Dietary Adequacy not ensured: “worst-case scenario” <65% RNI BaselineWinfoodWinfood-liteCSB+CSB++6-8mB1*B2B3*B6*B9*B12*Ca*Fe*Zn*B9Ca8 PN*worst-case scenario <50% RNISkau at al, AJCN 99:130-8, 2014
28ConclusionsFood-based approaches can improve the micronutrient content of diets in SE Asian countries but they may not ensure dietary adequacy for all nutrients especiallyCa, Fe, and Zn for children;and perhaps also folate, thiamin, riboflavin & niacinCa, Fe and folate for women;and perhaps also thiamin, riboflavin, niacin, B6, VAAlternative 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 )
29The SMILLING Team Lao – National Institute of Public Health Dr Sengchanh KownnavongDr Manithong VonglokhamDr Daovieng DouangvichithThailand – Mahidol UniversityDr Uraiporn ChittchangDr Nipa RojroongwasiukulDr Pattanee WinnichagoonIndonesia – SEAMEO TROPMED RCCNDr Umi FahmidaMr Otte SantikaCambodia – Ministry of Health; Ministry of Agriculture, Forestry & FisheriesDr Mary CheaMr Seyha SokMs Daream SokMr Kuong KhovDr Jutta SkauVietnam – National Institute of NutritionProf Le Bach MaiDr Tran Thaan DoDr Tran Lua-NIN