Estimating the Micronutrient Adequacy of the Food Supply Using Food Balance Sheets for Targeted Nutrition-sensitive Agricultural Approaches: Example of Bangladesh.

Objectives: To estimate the micronutrient availability and adequacy of the food supply of Bangladesh and estimate the additional agricultural output needed to achieve nutrient adequacy. Methods: We estimated micronutrient availability of the food supply using an average of 5 years of Food and Agricultural Organization (FAO) food balance sheet data. We estimated nutrients for non-specific food commodities (e.g., other vegetables) using FAO production data supplemented with known consumption information from a dietary survey. We estimated the probability of adequacy of the food supply using a method similar to the cut-point method of estimating nutrient intake adequacy. Then, we estimated the target level of nutrient needed in the food supply to achieve 80% adequacy and amounts of micronutrient-rich foods and land needed to meet the nutrient shortfall. Results: The current food supply in Bangladesh provides very low amounts (0-1% adequacy) of calcium and vitamins A, C, and folate; and low-moderate amounts of several other micronutrients. Using vitamin A as an example, the food supply would need to provide an additional 570 mcg RAE/capita/d to achieve 80% adequacy. This could be accomplished by adding ~67g/capita/d of carrots or ~73g/capita/d of orange-flesh sweet potatoes, requiring ~4 and 6% of the country's total agricultural land, respectively. Conclusions: National food balance sheets can be used to guide agricultural policies to ensure nutrient adequacy of the food supply, recognizing the need to consider other factors like climate, season, economics, and behavior change to drive food production decisions.

An Economic Model for Optimizing Effective Coverage of MN interventions: A Case Study of Cameroon.

Objectives: Micronutrient (MN) interventions are generally undertaken at national scale. New spatially disaggregated data on MN deficiencies in Cameroon suggest that subnational strategies may be more efficient, but methods to choose among alternative interventions are needed. We developed a tool to plan and manage sub-national MN interventions for Cameroon. Methods: Data from a nationally representative multi-stage cluster survey were used to determine the spatial distribution of MN deficiencies among population sub-groups at greatest risk. Macroregion-specific data (North, South, Douala/Yaoundé) on food intake were used to predict the effects of alternative MN intervention strategies on the prevalence of inadequate MN intake and absorption. MN supplements, fortified and biofortified foods, deworming and behavioral change communication to promote breastfeeding are among the interventions examined. Costs of alternative interventions were prepared. The costs and nutritional benefits of alternative interventions are included in an economic optimization model that chooses the best combination of MN interventions to ensure adequate MN intake, at regional level, over a ten-year planning horizon, given funding and other constraints. Results: Preliminary results indicate large spatial differences in MN deficiencies, e.g., estimated prevalence of vitamin A deficiency varied from ~62% (North region) to ~22% (Northwest region). Consumption of VA-rich foods and fortifiable foods also varies spatially. Hence, program efficiency may be enhanced by adopting targeted sub-national MN intervention strategies. Conclusions: Given spatial patterns in MN deficiencies, diet-driven effectiveness of alternative MN interventions, and costs of these interventions, sub-national MN interventions may offer efficiency gains that exceed the costs of planning and implementing them.

Short-term, Daily Supplementation with Vitamin A, But Not Beta-carotene, Increases Plasma and Breast Milk Retinol Concentration in Lactating Filipino Women.

Objective: To assess the usefulness of breast milk vitamin A (BMVA) for evaluating the impact of food-based vitamin A (VA) interventions. Methods: We assessed the effect of daily supplementation with 600 ug VA activity as either retinyl palmitate or β-carotene (BC) or 0 ug VA activity as corn oil (CO) on BMVA and BC concentrations in lactating women (n=83) who were randomly assigned to receive one of the three treatments, 6 d/wk for 3 wk. Treatments were administered as capsules (containing either 300 ug or 0 ug VA ), 2 times/d, with morning and noon meals consisting of low VA foods. Plasma and milk concentrations of VA and BC were measured before and after the intervention. Results: Initial mean plasma retinol concentration was 1.29±0.41 umol/L, and the mean change in plasma retinol was greater in the VA group than in the BC and CO groups (0.13, 0.03, -0.04 umol/L, respectively, P<0.01). Initial mean BMVA was 28.0±14.6 nmol/g fat, and the mean change in BMVA was greater in the VA group than in the BC and CO groups (4.6, 0.5, -3.6 nmol/g fat, respectively, P<0.001). Initial plasma BC concentration was 0.33±0.22 umol/L, and the mean change in plasma BC was greater in the BC group than in the VA and CO groups (0.74, 0.02, 0.07 umol/L, respectively, P<0.0001). Conclusions: Both BMVA and plasma retinol concentrations increased in response to supplementation with retinyl palmitate, but bioconversion of BC to VA is limited in this population.

Addition of Zinc to Soaking Water during Parboiling Increases the Zinc Content of Bangladeshi Rice.

Objectives: In Bangladesh, zinc deficiency affects 45% of preschool children and 57% of women. As zinc deficiency is linked to child growth stunting, diarrheal disease, pneumonia, and increased risk of child mortality, large-scale programs for its prevention are required. Most rice produced in Bangladesh is parboiled and this presents a technical opportunity to increase rice zinc content by adding zinc during soaking. The objective of this study was to evaluate the increase in zinc content achievable by this strategy in milled Bangladeshi rice using local parboiling conditions, and its potential effect on adequacy of zinc intakes. Methods: A major local rice variety (BR29) and zinc sulfate were used. Paddy was steamed for 2 minutes, soaked in distilled, deionized water for 9 hours with addition of 0, 100, 150, 200, or 300 mg zinc/kg paddy. Drained paddy was steamed in a pressurized autoclave before drying and milling. Zinc content was determined by X-Ray Fluorescence. Results: Rice zinc content was 12.3, 16.0, 16.7, 21.6, and 23.6 mg/kg dry weight, respectively, where the highest level represents a 92% increase over the control. Using existing dietary intake data from two districts, we estimated that if parboil-fortified rice with 300 mg/kg zinc were consumed by 70% of the population, the prevalence of inadequate intakes would decrease from 34 to 16% among preschool children and 98 to 43% among women. Conclusions: This strategy has potential to substantially decrease the prevalence of dietary zinc deficiency in Bangladesh, although the technical feasibility of implementing in large-scale mills requires further study.