Realistic Food-Based Approaches Alone May Not Ensure Dietary Adequacy for Women and Young Children in South-East Asia

Abstract

Objectives Micronutrient deficiencies, in southeast Asia (SE Asia), remain a public health challenge. We evaluated whether promoting the consumption of locally available nutritious foods, which is a low-risk micronutrient intervention, alone can ensure dietary adequacy, for women of reproductive age and 6-23 m old children. Methods Representative dietary data from Cambodia, Indonesia, Lao PDR, Thailand and Vietnam were analysed using linear programming analysis to identify nutrients that are likely low in personal food environments (problem nutrients), and to formulate food-based recommendations (FBRs) for three to six target populations per country. Results The number of problem nutrients ranged from zero for 12-23 m olds in Indonesia, Thailand and Vietnam to six for pregnant women in Cambodia. The FBRs selected for each target population, if adopted, would ensure a low percentage of the population was at risk of inadequate intakes for five to 10 micronutrients, depending on the country and target population. Of the 11 micronutrients modelled, requirements for iron, calcium and folate were most difficult to meet (≥10 of the 24 target populations), using FBRs alone. The number of individual FBRs selected per set, for each target population, ranged from three to eight; and often included meat, fish or eggs, liver/organ meats, vegetables and fruits. Conclusions Intervention strategies need to increase access to nutritious foods, including products fortified with micronutrients, in SE Asia, when aiming to ensure dietary adequacy for most individuals in the population.

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 ).…”

Effectiveness of a locally produced ready‐to‐use supplementary food in preventing growth faltering for children under 2 years in Cambodia: a cluster randomised controlled trial

“…The majority of growth faltering, indicated by a decline in z‐scores (Victora, de Onis, Hallal, Blössner, & Shrimpton, ) in Cambodia occurs from 6 to 20 months (Dewey & Huffman, ; NIS et al, ). Poor complementary feeding practices are often implicated in the growth faltering observed in low‐ and middle‐income countries (Ferguson et al, ). Borbor (white rice porridge , the traditional weaning food in Cambodia) has inadequate energy and micronutrient nutrient density to sustain adequate growth velocity in the first 2 years of life (Black et al, ; Ferguson et al, ).…”

“…Poor complementary feeding practices are often implicated in the growth faltering observed in low‐ and middle‐income countries (Ferguson et al, ). Borbor (white rice porridge , the traditional weaning food in Cambodia) has inadequate energy and micronutrient nutrient density to sustain adequate growth velocity in the first 2 years of life (Black et al, ; Ferguson et al, ). Nutrition‐specific interventions aimed at improving complementary feeding seem warranted (Black et al, ; Pham et al, ).…”