Toward the Prevention of Childhood Undernutrition: Diet Diversity Strategies Using Locally Produced Food Can Overcome Gaps in Nutrient Supply

Abstract

Background

Chronic undernutrition is prevalent in Mozambique, where children suffer from stunting, vitamin A deficiency, anemia, and other nutrition-related disorders. Complete diet formulation products (CDFPs) are increasingly promoted to prevent chronic undernutrition.

Objective

Using linear programming, to investigate whether diet diversification using local foods should be prioritized in order to reduce the prevalence of chronic undernutrition.

Methods

Market prices of local foods were collected in Tete City, Mozambique. Linear programming was applied to calculate the cheapest possible fully nutritious food baskets (FNFB) by stepwise addition of micronutrient-dense local foods.

Results

Only the top quintile of Mozambican households, using average expenditure data, could afford the FNFB that was designed using linear programming from a spectrum of local standard foods. The addition of beef heart or liver, dried fish and fresh moringa leaves, before applying linear programming decreased the price by a factor of up to 2.6. As a result, the top three quintiles could afford the FNFB optimized using both diversification strategy and linear programming. CDFPs, when added to the baskets, were unable to overcome the micronutrient gaps without greatly exceeding recommended energy intakes, due to their high ratio of energy to micronutrient density.

Conclusions

Dietary diversification strategies using local, low-cost, nutrient-dense foods can meet all micronutrient recommendations and overcome all micronutrient gaps. The success of linear programming to identify a low-cost FNFB depends entirely on the investigators' ability to select appropriate micronutrient-dense foods. CDFPs added to food baskets are unable to overcome micronutrient gaps without greatly exceeding recommended energy intake.

Keywords

Linear programming complete diet formulation products food baskets ready-to-use therapeutic foods diet diversification nutrient gap

References

Demographic and Health Survey. Monitoring and evaluation to assess and use results of Demographic and Health Surveys (MEASURE DHS). Mozambique DHS, 2011—Final Report, 2013. Available at: http://www.measuredhs.com/pubs/pdf/FR266/FR266.pdf. Accessed 9 March 2014.

van Hees

Heines

de Pee

Acharya

Bloem

van den Briel

. Improving the nutritional quality of WFP's Food Basket—an overview of nutrition issues, commodity options and programming choices. Sight Life 2008;3:4–14.

Frega

Lanfranco

De Greve

Bernardini

Geniez

Grede

Bloem

de Pee

. What linear programming contributes: World Food Programme experience with the “cost of the diet” tool. Food Nutr Bull 2012;33 (3 suppl):S228–34.

Santini

Novellino

Armini

Ritieni

. State of the art of ready-to-use therapeutic food: a tool for nutraceuticals addition to foodstuff. Food Chem 2013;140:843–9.

Guimon

. How ready-to-use therapeutic food shapes a new technological regime to treat child malnutrition. Technologic Forecast Soc Change 2012;79:1319–27.

Briend

Ferguson

Darmon

. Local food price analysis by linear programming: a new approach to assess the economic value of fortified food supplements. Food Nutr Bull 2001;22:184–9.

International Baby Food Action Network (IBFAN). Statement on the promotion and use of commercial fortified foods as solutions for child malnutrition. Available at: http://ibfan.org/ips/IBFAN-Statement-RUTFs-english.pdf. Accessed 9 March 2014.

Briend

Darmon

Ferguson

Erhardt

. Linear programming: a mathematical tool for analyzing and optimizing children's diets during the complementary feeding period. J Pediatr Gastroenterol Nutr 2003;36:12–22.

Santika

Fahmida

Ferguson

. Development of food-based complementary feeding recommendations for 9- to 11-month-old peri-urban Indonesian infants using linear programming. J Nutr 2009;139:135–41.

10.

Dibari

Diop el

Collins

Seal

. Low-cost, ready-to-use therapeutic foods can be designed using locally available commodities with the aid of linear programming. J Nutr 2012;142:955–61.

11.

Save the Children UK. Cost of diet assessment Morrumbala Region, Mozambique 2010. 2012. Available at: http://www.heawebsite.org/countries/mozambique/reports/cod-report-morrumbala-mozambique-2010. Accessed 16 March 2014.

12.

Rose

Tschirley

. Predicting dietary intakes with simple food recall information: a case study from rural Mozambique. Eur J Clin Nutr 2003;57:1212–21.

13.

World Health Organization. Complementary feeding. 2000. Available at: http://whqlibdoc.who.int/hq/2000/WHO_NHD_00.1.pdf. Accessed 16 March 2014.

14.

Pinstrup-Andersen

. Nutrition-sensitive food systems: from rhetoric to action. Lancet 2013;382:375–6.

15.

Ahuja

Moshfegh

Holden

Harris

. USDA food and nutrient databases provide the infrastructure for food and nutrition research, policy, and practice. J Nutr 2013;143:241S–9S.

16.

US Department of Agriculture, Agricultural Research Service. USDA national nutrient database for standard reference, release 25. 2012. Nutrient Data Laboratory home page. Available at: http://www.ars.usda.gov/Services/docs.htm?docid=8964. Accessed 9 March 2014.

17.

Food and Agriculture Organization (FAO/INFOODS). FAO/INFOODS Analytical food composition database version 1.0 (AnFooD1.0). 2012. Available at: http://www.fao.org/infoods/infoods/tables-and-databases/faoinfoods-databases/en/. Accessed 9 March 2014.

18.

Food and Agriculture Organization (FAO/INFOODS). FAO/INFOODS Food composition database for biodiversity — version 2.0 (BioFoodComp2.0). 2012. Available at: http://www.fao.org/infoods/infoods/tables-and-databases/faoinfoods-databases/en/. Accessed 9 March 2014.

19.

Korkalo

Hauta-alus

Mutanen

. Food composition tables for Mozambique, Version 2. 2011. Available at: http://www.helsinki.fi/food-and-environment/research/groups/Food_composition_tables_for_Mozambique.pdf. Accessed 9 March 2014.

20.

Anderson

Earle

. Diet planning in the third world by linear and goal programming. J Operat Res Soc 1983;34:9–16.

21.

US Department of Agriculture, Food and Nutrition Information Center: Dietary Reference Intake Tables, Institute of Medicine, National Academies, 2010 update. Available at: http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables. Accessed 9 March 2014.

22.

Michaelsen

Weaver

Brance

Robertson

. Feeding and nutrition of infants and young children. WHO Reg Publ Eur Ser 2003;87:101–25.

23.

Hunt

. Bioavailability of iron, zinc, and other trace minerals from vegetarian diets. Am J Clin Nutr 2003;78(3 suppl):633S–9S.

24.

Koethe

Chi

Megazzini

Heimburger

Stringer

. Macronutrient supplementation for malnourished HIV-infected adults: a review of the evidence in resource-adequate and resource-constrained settings. Clin Infect Dis 2009;49:787–98.

25.

World Health Organization. Guiding principles for feeding infants and young children during emergencies. Geneva: WHO, 2004. Available at: http://www.who.int/nutrition/publications/guiding_principles_feedchildren_emergencies.pdf. Accessed 9 March 2014.

26.

Institutio National de Estadisticas Mozambique. Household survey 2008/09. 2010. Available at: http://www.ine.gov.mz/en/ResourceCenter. Accessed 9 March 2014.

27.

Institutio National de Estadisticas Mozambique. Mozambique inflation rate. 2013. Available at: http://www.tradingeconomics.com/mozambique/inflation-cpi. Accessed 9 March 2014.

28.

Macauhub. Mozambican government approves new minimum wages. Available at: http://www.macauhub.com.mo/en/2013/04/17/mozambican-government-approves-new-minimum-wages/. Accessed 9 March 2014.

29.

UNICEF. Multiple Indicator Cluster Survey (MICS) 2008: summary. 2009. Available at: http://www.unicef.org/mozambique/5171.html. Accessed 9 March 2014.

30.

UNICEF. A supply chain analysis of ready-to-use therapeutic food for the horn of Africa. A study commissioned by the United Nations Children's Fund. UNICEF Press. 2009. Available at: http://www.unicef.org/supply/files/SUPPLY_CHAIN_ANALYSIS_OF_READY-TO-USE_THERAPEUTIC_FOODS_FOR_THE_HORN_OF_AFRICA.pdf. Accessed 9 March 2014.

31.

Uauy

Kain

Mericq

Rojas

Corvalán

. Nutrition, child growth, and chronic disease prevention. Ann Med 2008;40:11–20.

32.

Ali

Zachariah

Shams

Manzi

Akter

Alders

Allaouna

Delchevalerie

Harries

. Peanut-based ready-to-use therapeutic food: how acceptable and tolerated is it among malnourished pregnant and lactating women in Bangladesh? Matern Child Nutr 2013 May 6. doi: 10.1111/mcn.12050. [Epub ahead of print]

33.

Corvalán

Kain

Weisstaub

Uauy

. Impact of growth patterns and early diet on obesity and cardiovascular risk factors in young children from developing countries. Proc Nutr Soc 2009;68:327–37.

34.

The global game plan of Big Snack. World Nutrition February 2011;2:55–61.

35.

. Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev 2013;14:606–19.

36.

World Health Organization. Joint statement on the community-based management of severe acute malnutrition. 2007. Available at: http://www.who.int/maternal_child_adolescent/documents/a91065/en/. Accessed 9 March 2014.

37.

Briend

. Highly nutrient-dense spreads: a new approach to delivering multiple micronutrients to high-risk groups. Br J Nutr 2001;85(suppl 2):S175–9.

38.

Ferguson

Briend

Darmon

. Can optimal combinations of local foods achieve the nutrient density of the F100 catch-up diet for severe malnutrition? J Pediatr Gastroenterol Nutr 2008;46:447–52.

39.

Guimon

. Innovation to fight hunger: the case of Plumpy'Nut. UAM-accenture working papers. UAM, Autonomous University of Madrid, Madrid, Spain. 2009. pp. 1–23. ISSN: 2172–8143.