The purpose of the present paper is to review the evidence in favour of food-based strategies to meet the challenges of micronutrient malnutrition in the developing world. Increasing dietary diversification is the most important factor in providing a wide range of micronutrients, and to achieve this objective in a development context requires an adequate supply, access and consumption of a variety of foods. Diets in developing countries generally lack many nutrients, including energy (inadequate amounts of food), so that strategies need to also emphasize an increase in total food intake, in addition to a greater variety. Agricultural and food policies tend to be oriented to primary agricultural productions, but they could also be formulated to promote and support home gardens and small livestock production for the explicit purpose of increasing the household consumption of micronutrient-rich foods. The adoption of 'desirable' dietary patterns for nutrition improvement, e.g. appropriately formulated to meet micronutrient needs, could be used in the formulation of agricultural policies and programmes. This process could be achieved through support for integrated farming systems oriented to assuring household food security, but also based on a variety of foods that will meet total dietary (including micronutrient) needs. Thus, availability of energy-rich staples, animal and/or fish as major sources of protein, and vitamin-, mineral-and phytonutrient-rich fruit and vegetables could constitute the types of production envisaged. The cultivation of edible indigenous plants as additional sources of micronutrients could also be added. The low bioavailability of some key micronutrients from foods, such as Fe, are substantially enhanced with the right food combinations and with appropriate food processing and preparation techniques. Simple appropriate technology for the preservation of micronutrientrich foods would need further development and promotion for their year-round availability. Linking community development policies to national programmes for the alleviation of hunger and malnutrition, with an emphasis on increasing the variety of foods consumed, is probably the best strategy for improving micronutrient malnutrition sustainably.
Background: There are no internationally agreed recommendations on compositional requirements of follow-up formula for young children (FUF-YC) aged 1-3 years. Aim: The aim of the study is to propose international compositional recommendations for FUF-YC. Methods: Compositional recommendations for FUF-YC were devised by expert consensus based on a detailed literature review of nutrient intakes and unmet needs in children aged 12-36 months. Results and Conclusions: Problematic nutrients with often inadequate intakes are the vitamins A, D, B12, C and folate, calcium, iron, iodine and zinc. If used, FUF-YC should be fed along with an age-appropriate mixed diet, usually contributing 1-2 cups (200-400 ml) of FUF-YC daily (approximately 15% of total energy intake). Protein from cow's milk-based formula should provide 1.6-2.7 g/100 kcal. Fat content should be 4.4-6.0 g/100 kcal. Carbohydrate should contribute 9-14 g/100 kcal with >50% from lactose. If other sugars are added, they should not exceed 10% of total carbohydrates. Calcium should provide 200 mg/100 kcal. Other micronutrient contents/100 kcal should reach 15% of the World Health Organization/Food and Agriculture Organization recommended nutrient intake values. A guidance upper level that was 3-5 times of the minimum level was established. Countries may adapt compositional requirements, considering recommended nutrient intakes, habitual diets, nutritional status and existence of micronutrient programs to ensure adequacy while preventing excessive intakes.
To improve maternal nutritional status and to ameliorate protein-energy malnutrition in pregnant women and infants, supplementary foods for rural pregnant women were formulated and evaluated. Six formulas with protein and energy contents of 16-22 g and 350-500 kcal/100 g food, respectively, were developed from locally available raw materials. A field evaluation of formulas I and V was conducted at the regional MCH Center at Rajchaburi, about 120 km from Bangkok. Formulas providing 13 g protein and 350 kcal per day were given to two groups of mothers in the first or second pregnancy, starting at 28 +/- 2 wk of gestation. A third group, unsupplemented, served as controls. Maternal weight gain and left mid-arm circumference were measured every 2 wk. Birth weight, length, head and chest circumferences of newborns, and placental weight were significantly higher in both supplemented groups. These findings suggest that among undernourished mothers, supplementation of as little as 13 g protein and 350 kcal daily during the last trimester can significantly improve maternal weight gain and birth weight of newborns.
OBJECTIVE:To describe the prevalence of childhood obesity in a moderately industrialized province in Thailand and examine the in¯uence of socioeconomic status (SES) on childhood obesity. DESIGN: Cross-sectional study. SUBJECTS: One thousand one hundred and ®fty seven children in the second or third grade of kindergartens in Saraburi Province, Thailand. MEASUREMENTS: Height and weight were measured and the weight-for-height index with the Thai national standard was used for assessing nutritional status. A questionnaire was used for measuring parents' socioeconomic status. RESULTS: The prevalence of childhood obesity over 97th percentile for weight-for-height (bp 97 ) was 22.7% in urban and 7.4% in rural areas. There were marked relationships between childhood obesity and parents' educational level and household income. CONCLUSION: Childhood obesity is an emerging health problem in developing countries, especially in urban areas. This study demonstrates a marked correlation between SES and prevalence of childhood obesity in an Asian developing country.
SummaryUnder-nutrition in Thailand has been successfully controlled for over two decades. However, Thailand is now facing a double-burden malnutrition problem where under-and over-nutrition coexist. Overweight, obesity, and related diseases are the main nutritional challenges, leading to high costs for curative care. Thailand foresees that nutrition can be an effective strategy for preventing diet-related non-communicable chronic diseases, and the country aims to reduce costs for secondary and tertiary health care. Various organizations have conducted national programmes, focusing especially on nutrition education and public campaigns, which have been sustainable and not sustainable. Only milk and certain foods for children are mandated for nutrition labeling. Guideline daily amounts is now the nutrient profile mandated for snack foods in Thailand. To increase efficiency, Thailand's National Food Committee has been established to link food, nutrition and health via a multi-sectoral approach.
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