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Maternal and Child Health Journal

, Volume 23, Supplement 1, pp 55–66 | Cite as

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

  • Elaine L. FergusonEmail author
  • Louise Watson
  • Jacques Berger
  • Mary Chea
  • Uraiporn Chittchang
  • Umi Fahmida
  • Kuong Khov
  • Sengchanh Kounnavong
  • Bach Mai Le
  • Nipa Rojroongwasinkul
  • Otte Santika
  • Seyha Sok
  • Daream Sok
  • Tran Thanh Do
  • Lua Tran Thi
  • Manithong Vonglokham
  • Frank Wieringa
  • Emorn Wasantwisut
  • Pattanee Winichagoon
Article
  • 78 Downloads

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 ten 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 for practice 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.

Keywords

SE Asia Women Children Linear programming analyses Food-based recommendations 

Notes

Acknowledgements

The SMILING project was funded by the European Commission in the 7th Framework Programme for Research and Technological Development (GA 2896 16).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Allen, L. H. (2005). Multiple micronutrients in pregnancy and lactation: An overview. American Journal of Clinical Nutrition, 81(suppl), 1206–1212.CrossRefGoogle Scholar
  2. Allen, L. H. (2012). Adequacy of family foods for complementary feeding. American Journal of Clinical Nutrition, 95(4), 785–786.  https://doi.org/10.3945/ajcn.112.035675.CrossRefGoogle Scholar
  3. Allen, L. H., & Haskell, M. (2002). Extent of vitamin A deficiency among preschool children and women of reproductive age. Journal of Nutrition, 132, 2907S–2919S.CrossRefGoogle Scholar
  4. Anderson, V. P., Jack, S., Monchy, D., Hem, N., Hok, P., Bailey, K. B., et al. (2008). Co-existing micronutrient deficiencies among stunted Cambodian infants and toddlers. Asia Pacific Journal of Clinical Nutrition, 17(1), 72–79.  https://doi.org/10.6133/APJCN.2008.17.1.12.Google Scholar
  5. Arimond, M., Vitta, B. S., Martin-Prével, Y., Moursi, M., & Dewey, K. G. (2017). Local foods can meet micronutrient needs for women in urban Burkina Faso, but only if rarely consumed micronutrient-dense foods are included in daily diets: A linear programming exercise. Maternal and Child Nutrition.  https://doi.org/10.1111/mcn.12461.Google Scholar
  6. Barennes, H., Simmala, C., Odermatt, P., Thaybouavone, T., Vallee, J., Martinez-Ussel, B., et al. (2009). Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR. European Journal of Clinical Nutrition, 63(3), 323–331.  https://doi.org/10.1038/sj.ejcn.1602928.CrossRefGoogle Scholar
  7. Berger, J., Blanchard, G., Ponce, M. C., Chamnan, C., Chea, M., Dijkhuizen, M., et al. (2013). The SMILING project: A North-South-South collaborative action to prevent micronutrient deficiencies in women and young children in Southeast Asia. Food and Nutrition Bulletin, 34(2 Suppl), 133–139.  https://doi.org/10.1159/000354245.CrossRefGoogle Scholar
  8. Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., et al. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet, 382(9890), 427–451.  https://doi.org/10.1016/S0140-6736(13)60937-X.CrossRefGoogle Scholar
  9. Daelmans, B., Ferguson, E., Lutter, C. K., Singh, N., Pachón, H., Creed-Kanashiro, H., et al. (2013). Designing appropriate complementary feeding recommendations: Tools for programmatic action. Maternal and Child Nutrition, 9(Suppl 2), 116–130.  https://doi.org/10.1111/mcn.12083.CrossRefGoogle Scholar
  10. Deitchler, M., Mason, J., Mathys, E., Winichagoon, P., & Tuazon, M. A. (2004). Lessons from successful micronutrient programs. Part I: Program initiation. Food and Nutrition Bulletin, 25(1), 5–29.  https://doi.org/10.1177/156482650402500103.CrossRefGoogle Scholar
  11. De-Regil, L. M., Suchdev, P. S., Vist, G. E., Walleser, S., & Peña-Rosas, J. P. (2013). Home fortification of foods with multiple micronutrient powders for health and nutrition in children under two years of age (Review). Evidence-Based Child Health: A Cochrane Review Journal, 8(1), 112–201.  https://doi.org/10.1002/ebch.1895.CrossRefGoogle Scholar
  12. Fahmida, U., & Santika, O. (2016). Development of complementary feeding recommendations for 12–23-month-old children from low and middle socio-economic status in West Java, Indonesia: Contribution of fortified foods towards meeting the nutrient requirement. British Journal of Nutrition, 116(S1), S8–S15.  https://doi.org/10.1017/S0007114516002063.CrossRefGoogle Scholar
  13. Fahmida, U., Santika, O., Kolopaking, R., & Ferguson, E. (2014). Complementary feeding recommendations based on locally available foods in Indonesia. Food and Nutrition Bulletin, 35(4), S174–S179.CrossRefGoogle Scholar
  14. FAO, & World Health Organization. (2004). Vitamin and mineral requirements in human nutrition (2nd ed.). Geneva: World Health Organization.Google Scholar
  15. Ferguson, E., Chege, P., Kimiywe, J., Wiesmann, D., & Hotz, C. (2015). Zinc, iron and calcium are major limiting nutrients in the complementary diets of rural Kenyan children. Maternal and Child Nutrition, 11, 6–20.  https://doi.org/10.1111/mcn.12243.CrossRefGoogle Scholar
  16. Ferguson, E. L., Darmon, N., Fahmida, U., Fitriyanti, S., Harper, T. B., & Premachandra, I. M. (2006). Design of optimal food-based complementary feeding recommendations and identification of key “‘problem nutrients’” using goal programming. The Journal of Nutrition, 136(9), 2399–2404.CrossRefGoogle Scholar
  17. Food and Agricutural Organization. (2001). Human energy requirements: Report of a Joint FAO/WHO/UNU expert consultation. FAO food and nutrition technical report series.Google Scholar
  18. Gera, T., & Sachdev, H. P. S. (2002). Effect of iron supplementation on incidence of infectious illness in children: Systematic review. British Medical Journal, 325(7373), 1142.  https://doi.org/10.1136/bmj.325.7373.1142.CrossRefGoogle Scholar
  19. Gibson, R. S. (2005). Principles of nutritional assessment (2nd ed.). New York: Oxford University Press.Google Scholar
  20. Gibson, R. S., Yeudall, F., Drost, N., Mtitimuni, B. M., & Cullinan, T. R. (2003). Experiences of a community-based dietary intervention to enhance micronutrient adequacy of diets low in animal source foods and high in phytate: A case study in rural Malawian children. The Journal of Nutrition, 133(11 Suppl 2), 3992S–3999S.CrossRefGoogle Scholar
  21. Hlaing, L. M., Fahmida, U., Htet, M. K., Utomo, B., Firmansyah, A., & Ferguson, E. L. (2016). Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12–23-month-old Myanmar children. British Journal of Nutrition, 116(S1), S16–S26.  https://doi.org/10.1017/S000711451500481X.CrossRefGoogle Scholar
  22. Hoddinott, J., Alderman, H., Behrman, J. R., Haddad, L., & Horton, S. (2013). The economic rationale for investing in stunting reduction. Maternal and Child Nutrition, 9(S2), 69–82.  https://doi.org/10.1111/mcn.12080.CrossRefGoogle Scholar
  23. Kounnavong, S., Sunahara, T., Mascie-Taylor, C. G. N., Hashizume, M., Okumura, J., Moji, K., et al. (2011). Effect of daily versus weekly home fortification with multiple micronutrient powder on haemoglobin concentration of young children in a rural area, Lao People’s Democratic Republic: A randomised trial. Nutrition Journal, 10(1), 129.  https://doi.org/10.1186/1475-2891-10-129.CrossRefGoogle Scholar
  24. Krebs, N. F. (2007). Food choices to meet nutritional needs of breast-fed infants and toddlers on mixed diets. The Journal of Nutrition, 137, 511S–517S.CrossRefGoogle Scholar
  25. Krebs, N. F. (2014). Food based complementary feeding strategies for breastfed infants: What’s the evidence that it matters? Nutrition Today, 49(6), 271–277.  https://doi.org/10.1097/NT.0000000000000064.CrossRefGoogle Scholar
  26. Laillou, A., van Pham, T., Tran, N. T., Le, H. T., Wieringa, F., Rohner, F., et al. (2012). Micronutrient deficits are still public health issues among women and young children in Vietnam. PLoS ONE.  https://doi.org/10.1371/journal.pone.0034906.Google Scholar
  27. Ramakrishnan, U. (2002). Prevalence of micronutrient malnutrition worldwide. Nutrition Reviews, 60(5 Pt 2), S46–S52.CrossRefGoogle Scholar
  28. Raymond, J., Kassim, N., Rose, J. W., & Agaba, M. (2017). Optimal formulations of local foods to achieve nutritional adequacy for 6–23-month-old rural Tanzanian children. Food & Nutrition Research, 61(1), 1358035.  https://doi.org/10.1080/16546628.2017.1358035.CrossRefGoogle Scholar
  29. Sandjaja, S., Budiman, B., Harahap, H., Ernawati, F., Soekatri, M., Widodo, Y., et al. (2013). Food consumption and nutritional and biochemical status of 0·5–12-year-old Indonesian children: The SEANUTS study. British Journal of Nutrition, 110(S3), S11–S20.  https://doi.org/10.1017/S0007114513002109.CrossRefGoogle Scholar
  30. Santika, O., Fahmida, U., & Ferguson, E. L. (2009). Development of food-based complementary feeding recommendations for 9 to 11 month old Peri-Urban Indonesian infants using linear programming. The Journal of Nutrition, 139, 135–141.  https://doi.org/10.3945/jn.108.092270.Indonesia.CrossRefGoogle Scholar
  31. Skau, J. K. H., Bunthang, T., Chamnan, C., Wieringa, F. T., Dijkhuizen, M. A., Roos, N., et al. (2014). The use of linear programming to determine whether a formulated complementary food product can ensure adequate nutrients for 6- to 11-month-old Cambodian infants. American Journal of Clinical Nutrition, 99(1), 130–138.  https://doi.org/10.3945/ajcn.113.073700.CrossRefGoogle Scholar
  32. Soofi, S., Cousens, S., Iqbal, S. P., Akhund, T., Khan, J., Ahmed, I., et al. (2013). Effect of provision of daily zinc and iron with several micronutrients on growth and morbidity among young children in Pakistan: A cluster-randomised trial. The Lancet, 382(9886), 29–40.  https://doi.org/10.1016/S0140-6736(13)60437-7.CrossRefGoogle Scholar
  33. Torheim, L. E., Ferguson, E. L., Penrose, K., & Arimond, M. (2010). Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. Journal of Nutrition, 140(11), 2051S–2058S.  https://doi.org/10.3945/jn.110.123463.CrossRefGoogle Scholar
  34. Vieux, F., Brouzes, C. M. C., Maillot, M., Briend, A., Hankard, R., Lluch, A., et al. (2016). Role of young child formulae and supplements to ensure nutritional adequacy in U.K. young children. Nutrients.  https://doi.org/10.3390/nu8090539.Google Scholar
  35. Whaley, S. E., Sigman, M., Neumann, C., Bwibo, N., Guthrie, D., Weiss, R. E., et al. (2003). Animal source foods to improve micronutrient nutrition and human function in developing countries. Journal of Nutrition, 133, 3965–3971.CrossRefGoogle Scholar
  36. WHO. (1998). Preparation and use of food-based dietary guidelines. World Health OrganizationTechnical Report Series.Google Scholar
  37. WHO/CDC. (2008). In B. de Benoist, E. McLean, I. Egli & M. Cogswell (Eds.), Worldwide prevalence of anaemia 1993–2005: WHO global database on anaemia. Geneva: World Health Organization.Google Scholar
  38. WHO/FAO/UNU Expert Consultation. (2007). Protein and amino acid requirements in human nutrition. World Health Organization Technical Report Series, 935, 1–265.Google Scholar
  39. Wieringa, F. T., Berger, J., Dijkhuizen, M. A., Hidayat, A., Ninh, N. X., Utomo, B., et al. (2007). Combined iron and zinc supplementation in infants improved iron and zinc status, but interactions reduced efficacy in a multicountry trial in southeast Asia. The Journal of Nutrition, 137(2), 466–471.CrossRefGoogle Scholar
  40. World Health Organization. (2017). World health statistics 2017: Monitoring health for SDGs, sustainable development goals. Geneva: World Health Organization.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Elaine L. Ferguson
    • 1
    Email author
  • Louise Watson
    • 1
  • Jacques Berger
    • 2
  • Mary Chea
    • 3
  • Uraiporn Chittchang
    • 4
  • Umi Fahmida
    • 5
  • Kuong Khov
    • 6
  • Sengchanh Kounnavong
    • 7
  • Bach Mai Le
    • 8
  • Nipa Rojroongwasinkul
    • 4
  • Otte Santika
    • 5
  • Seyha Sok
    • 6
  • Daream Sok
    • 6
  • Tran Thanh Do
    • 8
  • Lua Tran Thi
    • 8
  • Manithong Vonglokham
    • 7
  • Frank Wieringa
    • 2
  • Emorn Wasantwisut
    • 4
  • Pattanee Winichagoon
    • 4
  1. 1.Department of Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.Institute of Research for Development, UMR, NutripassMontpellierFrance
  3. 3.Ministry of HealthPhnom PenhCambodia
  4. 4.Institute of NutritionMahidol UniversityNakhon PathomThailand
  5. 5.Southeast Asian Ministries of Education (SEAMEO) Regional Centre for Nutrition and Nutrition (RECFON)University of IndonesiaJakartaIndonesia
  6. 6.Ministry of AgriculturePhnom PenhCambodia
  7. 7.Ministry of Health of Laos, National Institute of Public HealthVientianeLao People’s Democratic Republic
  8. 8.Ministry of Health of Vietnam, National Institute of NutritionHanoiVietnam

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