Local Foods Can Increase Adequacy of Nutrients Other than Iron in Young Urban Egyptian Women: Results from Diet Modeling Analyses

Abstract

Background Nutrition transition and recent changes in lifestyle in Middle Eastern countries have resulted in the double burden of malnutrition. In Egypt, 88% of urban women are overweight or obese and 50% are iron deficient. Their energy, sugar, and sodium intakes are excessive, while intakes of iron, vitamin D, and folate are insufficient. Objective This study aimed to formulate dietary advice based on locally consumed and affordable foods and determine the need for fortified products to meet the nutrient requirements of urban Egyptian women. Methods Food intakes were assessed using a 4-d food diary collected from 130 urban Egyptian women aged 19–30 y. Food prices were collected from modern and traditional markets to calculate diet cost. Population-based linear and goal programming analyses (Optifood tool) were used to identify “limiting nutrients” and to assess whether locally consumed foods (i.e., consumed by >5% of women) could theoretically improve nutrient adequacy at an affordable cost (i.e., less than or equal to the mean diet cost), while meeting recommendations for SFAs, sugars, and sodium. The potential of hypothetical fortified foods for improving intakes of micronutrients was also assessed. Results Iron was the most limiting nutrient. Daily consumption of fruits, vegetables, milk or yogurt, meat/fish/eggs, and tahini (sesame paste) were likely to improve nutrient adequacy for 11 out of 12 micronutrients modeled. Among fortified foods tested, iron-fortified rice, milk, water, bread, or yogurt increased the minimized iron content of the modeled diet from 40% to >60% of the iron recommendation. Conclusions A set of dietary advice based on locally consumed foods, if put into practice, can theoretically meet requirements for most nutrients, except for iron for which adequacy is harder to achieve without fortified products. The acceptability of the dietary changes modeled needs evaluation before promoting them to young Egyptian women.

Including calcium‐fortified water or flour in modeled diets based on local foods could improve calcium intake for women, adolescent girls, and young children in Bangladesh, Uganda, and Guatemala

“…Fortification levels of 400 mg of elemental calcium per 100 g of flour were required for young adolescent girls' diets in Barisal to achieve the 100% Ca PRI, while lower levels of 200 or 156 mg/100 g were sufficient for younger children. Other Optifood analyses have concluded that it is harder to reach the Ca PRI of specific nutrients using local foods without the inclusion of fortified flour, rice, and other staple foods or complementary feeding products, specifically for iron among urban Egyptian women 50 ; for zinc and iron among infants and young children (IYC) across Northern Kenya 48 ; for calcium, zinc, and iron for IYC in Indonesia 51 and Cambodia 52 ; and for vitamins B1 and B3, folate, and iron for IYC in Colombia. 53 Fortified water was simulated in the diets of target groups, respectively, of Bangladesh, Guatemala, and Uganda to meet the Ca PRI.…”

“…This allows fortified products to be explored as part of whole diets and identify commonly consumed foods that could also be promoted to improve micronutrient intake. 50 However, the modeling in Optifood is a simulation based on overall observed dietary patterns and is unable to explore the percentage of the population at risk of inadequate intake or exceeding the UL of consumption. Other tools, such as the Intake Modeling, Assessment and Planning Program, would be able to provide more refined estimates of risk but would have distinct data requirements.…”

“…The LPA rapidly generates diets while simultaneously considering available and proposed foods, their nutrient composition, how these foods are eaten by the target group, and RNIs. This allows fortified products to be explored as part of whole diets and identify commonly consumed foods that could also be promoted to improve micronutrient intake 50 . However, the modeling in Optifood is a simulation based on overall observed dietary patterns and is unable to explore the percentage of the population at risk of inadequate intake or exceeding the UL of consumption.…”

Household‐level consumption data can be redistributed for individual‐level Optifood diet modeling: analysis from four countries

“…Modeling realistic diets using LP analysis in Optifood requires data on the current food consumption patterns of a specific population (defined by age, sex, and region), including food types, quantities consumed, and frequency of consumption 13 . Individual 24‐h recall (24HR) data are the most common source used to generate Optifood LP input parameters 1–3,5,14–17 . Unfortunately, the collection of quantitative individual‐level dietary intake data, through 7‐day observed‐weighed food records (the gold standard) or 24HRs, is complex and expensive in terms of time and resources 18–20 .…”

“…13 Individual 24-h recall (24HR) data are the most common source used to generate Optifood LP input parameters. [1][2][3]5,[14][15][16][17] Unfortunately, the collection of quantitative individual-level dietary intake data, through 7-day observed-weighed food records (the gold standard) or 24HRs, is complex and expensive in terms of time and resources. [18][19][20] These data constraints often make LP analyses unfeasible, 18,[21][22][23] which severely limits opportunities for evidencebased programmatic decision making using LP.…”