Presentation on theme: "Elaine Ferguson London School of Hygiene & Tropical Medicine"— Presentation transcript:
1 Elaine 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
2 IntroductionDietary 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
3 Why 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?
4 What 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
5 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
6 Optifood …. 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
7 Data Requirements Dietary Surveys Quantitative (recalls, records) Food frequency dataMarket surveysFood cost per 100 g edible portionFood composition tables
8 Select Fe and Zn bioavailability Food Composition TableEnergyProteinWaterFatCarbohydrateVitamin AVitamin CB1B2B3CaFeZnB6B12FolateSelect Fe and Zn bioavailability
9 Optifood 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
11 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 recommendationsBest food and food sub-group sources of nutrientsFood group patterns
12 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
13 Minimised nutrient content analysis from Module 3 Count number of “lower tails” >65% or 70% RNI and cost
15 Countries 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
16 Define “Problem nutrients” Can a nutritionally adequate diet be promoted given local foods & food patterns?
17 Numbers 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
18 Food-based Recommendations To what extent can food-based recommendations ensure dietary adequacy for these target groups?
19 Number 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
22 What 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
23 Daily 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
24 Will the proposed national sets of Complementary Feeding Recommendations ensure dietary adequacy?
25 CF 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
26 Did 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
27 Dietary 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
28 ConclusionsFood-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 )
29 The 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