1. Dairy for Global Nutrition 1 Whey proteins, stunting and international development Veronique Lagrange, US Dairy Export Council vlagrange@usdec.org www.dairyforglobalnutrition.orgvlagrange@usdec.orgwww.dairyforglobalnutrition.org

2. Definitions and world estimates Impact and cost of stunting Use of food supplements for the management of moderate malnutrition Current US and international recommendations Evidence in support of whey proteins Major studies in progress Commercial opportunities and challenges Next steps Whey proteins, stunting and international development 2

3. Height-for-age Z (HAZ) score < 2SD Stunting affects 800 million people worldwide* 195 million children under 5 are stunted >40% in some countries * Source: UNICEF, 2014 Image courtesy: Gates Foundation, 2014 3 Definitions and world estimates

4. Impact of stunting Malnutrition and stunting: relationships, outcomes Stunting: impacts physical and mental development, overall economic development Photos courtesy: ABC News, USA 4

5. Cognitive impairments early in life have long-term consequences on economic development Focus on the first 1,000 days: to include pregnant, lactating women Demonstrated economic rationale for investing in stunting reduction: Benefit-cost ratio average: 18* *Hoddinott, J. Maternal & Child Nutrition, 2013 (9) Suppl. 2 Relationship with economic development 5

6. Use of food supplements for the management of moderate malnutrition 6 Customers: USAID, UNICEF, Doctors without Borders, Action against Hunger, other PVOs Supplements contain sweet whey or WPC, milk powder (15-25%) World Food Programme Supplement contains 8% milk powder Dairy represents 50% of the cost of the formula: Strong incentive to optimize formula, displace dairy

7. 7 Whey, dairy in recommendations for MAM 2010: 3% WPC80 WHO 2012: Milk powder as protein source

8. Evidence for dairy Food and Nutrition Bulletin, 2013, 35(2) 8

9. Product A vs. Product B Role/function of nutrients Outcome, cost Effective dose of nutrients (Delivered: in matrix, featuring losses, synergies acceptability) Most studies have been program-driven 9 Most studies focused on this relationship Area of emerging interest: design products using new science

10. “Plumpy Sup” (whey, milk powder) vs, corn soy blend with milk powder, local food, local flour: Recovery rate highest with whey/powder supplement Acktia-Armah et al. 2012. Most studies compare products, few systematically study whey (examples) 10

11. Supplementary Plumpy (whey, milk powder) vs, corn soy blend with milk powder, local food, local flour: Increases in weight, MUAC, highest with whey/milk powder supplement McDonald et al, 2014 Most studies compare products, few systematically study whey (examples) 11

12. Soy/whey RUSF: superior rates of weight and MUAC gains compared to CSB++, superior rate of MUAC gain compared to soy RUSF ( Manary, 2012, USAID FANTA 2 Technical Report) Photo courtesy: wordpress Most studies compare products, few systematically study whey (examples) 12

13. Milk lipid-based supplement (25%), but not soy, promotes linear growth ( Mangani et al, 2013) Photo courtesy: 1,000 Days foundation Most studies compare products, systematically study whey (examples) 13

14. Faster recovery from moderate malnutrition Positive lean body mass accretion Moderate LAZ/HAZ… (30% of stunting occurs in utero) Immunity, infections benefits Photo courtesy: Ekantipur General trends in findings 14

15. Whey Research Needs/Opportunities What is the optimal dose and mixture of whey protein in supplements for treatment and prevention of MAM? Prevention of stunting? ‒ What is the optimal dose of milk protein to improve growth in children with MAM? ‒ Does DSM & MPC (intact dairy proteins) and whey have similar effects on growth in MAM?, If so how? ‒ Does dairy protein promote lean body gains, bone? ‒ What is the effect on long term body composition? ‒ Supplementation of the pregnant mother? 15

16. Multiple Constraints Dairy position not secure: need dose, mechanism of action Narrow “dairy basket” available Narrow supply chain to allow for in-country manufacture Efficacy and mechanism of action research Introduce full range of dairy ingredients More suppliers, more supply lines 16

17. UNICEF: 30-40,000 mt LNS – supplied by Plumpy Field Network, Nutriset, PPB Doctors without Borders, PVOS: 30-40,000 mt LNS World Food Program: 235,000 mt “specialized nutrition” products USAID – emerging Clinton Foundation (150,000 mt powder), PVOs Demand – MAM 17

18. Harmonization of research protocols, and filling in research gaps: need to fund more systematic research, clinical-style trials Need for united efforts by the whey industry Thank you! Veronique Lagrange US Dairy Export Council vlagrange@usdec.org Next steps 18

19. Questions? DairyforGlobalNutrition.org 19