Combining food‐based dietary recommendations using Optifood with zinc‐fortified water potentially improves nutrient adequacy among 4‐ to 6‐year‐old children in Kisumu West district, Kenya

Abstract

Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc-fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food-based recommendations (FBRs) that included zinc-fortified water for children aged between 4 and 6 years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4-6 years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24-hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc-fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc-fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66-101% after introduction of zinc-fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc-fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy.

Mathematical Optimization to Explore Tomorrow's Sustainable Diets: A Narrative Review

“…In the context of severe malnutrition, it was shown that no combination of local foods was able to achieve a nutrient density as high as diets promoted by the WHO, thus showing the need for fortified foods in this specific health condition ( 70 ). Several others studies have found that nutritional adequacy was only attainable via the inclusion of fortified products ( 47 , 48 , 69 ). For example, in Kenya, with no zinc-fortified water, only 76% of the zinc RVs could be covered in the nutritionally best diet for young children, which was improved to 101% with the fortified product ( 48 ).…”

“…Optifood's modules are further detailed in Supplemental Method s 2 . The Optifood software program has been extensively used for developing FBRs for children aged <2 y [e.g., in Kenya ( 42 , 43 ), Guatemala ( 44 ), Indonesia ( 30 , 45 ), Cambodia ( 46 ), and in 5 Southeast Asian countries ( 47 )], for older children [in specific regions of Malawi ( 39 ) or Kenya ( 48 )], and for women in Guatemala ( 44 ). Diet optimization also contributed to the development of a food guide in Benin for several adult age and sex subpopulations ( 49 ).…”

“…For example, this approach integrated in the Optifood software program (Supplemental Methods 2) helped to highlight iron as a “problem nutrient” because the nutritionally best diets only reached 21–66% of the iron RV depending on age-district subgroup in Bogota (Colombia) ( 42 ). Iron, zinc, and calcium were common problem nutrients in children aged 6–23 mo living in Indonesia ( 68 ), in 5 Southeast Asian countries ( 47 ), and in Kenya ( 42 , 43 ), whereas vitamin A and zinc were problematic for Kenyan children aged 4–6 y ( 48 ). Thiamin was identified as the only “problem nutrient” for a population of children from Bogota (Colombia) aged 12 mo ( 69 ).…”

Food and nutrient gaps in rural Northern Ghana: Does production of smallholder farming households support adoption of food-based dietary guidelines?

“…Second, Optifood linear programming software (version 4.0.9, e-Optifood) was used to generate diets that best cover the nutrient needs of the target population. Nutrient intakes above 70% of RNI were classified as adequate, for most nutrients this represents at least the EAR, and it allows for comparison with other studies [ 8 , 9 , 22 ].…”

“…FBDGs that provide sufficient nutrients required by LMIC populations have recently been developed using linear programming [ 8 , 9 ]. These studies based their analysis on actual dietary patterns and their costs–in doing so they implicitly assumed that the developed FBDGs are available, affordable and acceptable for the population under study [ 10 ].…”