Balancing a sustained pursuit of nutrition, health, affordability and climate goals: exploring the case of Indonesia.

BACKGROUND: To guide the transformation of food systems to provide for healthy and sustainable diets, countries need to assess their current diet and food supply in comparison to nutrition, health, affordability, and environmental goals. OBJECTIVES: We sought to compare Indonesia's food utilization to diets optimized for nutritional value and cost and to diets that are increasingly plant-based in order to meet further health and environmental goals, including the EAT-Lancet planetary health diet, to explore whether multiple goals could be achieved simultaneously. METHODS: We compared 13 dietary scenarios (2 current, 7 optimized, 3 increasingly plant-based, 1 EAT-Lancet) for nutrient content, cost, greenhouse gas emissions (GHGe), and water footprints, using the FAO food balance sheet, Indonesia Household Income and Expenditure Survey household food expenditure, food composition, life cycle assessment, food losses, and trade data. RESULTS: The diversity of modeled scenarios was higher than that of current consumption, reflecting nutritional deficiencies underlying Indonesia's burden of different forms of malnutrition. Nutrient intake targets were met best by nutrient- and cost-optimized diets, followed by the EAT-Lancet diet. Those diets also had high GHGe, although less than 40% of a scenario in which Indonesia would adopt a typical high-income country's diet. Only the low food chain diet had a GHGe below the 2050 target set by the EAT-Lancet commission. Its nutrient content was comparable to that of a no-dairy diet, slightly above those of fish-and-poultry and current diets, and somewhat below those of the EAT-Lancet diets. To meet nutrient needs, some animal-source foods had to be included. Costs of all except the optimized diets were above the current national average food expenditure. No scenario met all goals simultaneously. CONCLUSIONS: Indonesia's consumption of rice and unhealthy foods should decrease; food production, trade, and processing should prioritize diversification, (bio)fortification, and limiting environmental impacts; and consumer and institutional demands for healthy, nutritious, and sustainable foods should be stimulated. More granular data and tools are required to develop and assess more detailed scenarios to achieve multiple goals simultaneously.

Cost of the Diet: a method and software to calculate the lowest cost of meeting recommended intakes of energy and nutrients from local foods.

BACKGROUND: When food is available, the main obstacle to access is usually economic: people may not be able to afford a nutritious diet, even if they know what foods to eat. The Cost of the Diet method and software was developed to apply linear programming to better understand the extent to which poverty may affect people's ability to meet their nutritional specifications. This paper describes the principles of the method; the mathematics underlying the linear programming; the parameters and assumptions on which the calculations are based; and then illustrates the output of the software using examples taken from assessments. RESULTS: The software contains five databases: the energy and nutrient content of foods; the energy and nutrient specifications of individuals; predefined groups of individuals in typical households; the portion sizes of foods; and currency conversion factors. Data are collected during a market survey to calculate the average cost of foods per 100 g while focus group discussions are used to assess local dietary habits and preferences. These data are presented to a linear programming solver within the software which selects the least expensive combination of local foods for four standard diets that meet specifications for: energy only; energy and macronutrients; energy, macronutrients and micronutrients; and energy, macronutrients and micronutrients but with constraints on the amounts per meal that are consistent with typical dietary habits. Most parameters in the software can be modified by users to examine the potential impact of a wide range of theoretical interventions. The output summarises for each diet the costs, quantity and proportion of energy and nutrient specifications provided by all the foods selected for a given individual or household by day, week, season and year. When the cost is expressed as a percentage of income, the affordability of the diet can be estimated. CONCLUSIONS: The Cost of the Diet method and software could be used to inform programme design and behaviour change communication in the fields of nutrition, food security, livelihoods and social protection as well as to influence policies and advocacy debates on the financial cost of meeting energy and nutrient specifications.

Assessing the potential of wild foods to reduce the cost of a nutritionally adequate diet: an example from eastern Baringo District, Kenya.

BACKGROUND: Wild foods and their actual and potential contributions to nutrition security have rarely been studied or considered in nutrition and conservation programs. OBJECTIVE: To study the role of wild food biodiversity in achieving a cost reduction of a nutritionally adequate diet for women and young children in Kenya using linear programming. METHODS: An ethnobiological inventory of available food biodiversity was carried out by means of focus group discussions, and five wild foods were selected for further modeling. A market survey assessed available food prices by season. Diets were modeled to minimize cost and maximize nutrient adequacy using the Cost of Diet linear programming tool. Modeling was done without and with wild foods. RESULTS: The modeled diets without wild species were deficient in iron for all age groups during the dry season, deficient in vitamin B6 and calcium for infants aged 6 to 8 months during the dry season, and deficient in iron and zinc for infants aged 6 to 8 months over the whole year. Adding wild foods, especially Berchemia discolor, to the modeled diets resulted in a lower-cost diet, while meeting recommended iron intakes for women and children between 12 and 23 months of age. Even after integrating wild foods into the model, targeted approaches are needed to meet micronutrient requirements for infants from 6 to 8 and from 9 to 11 months of age. CONCLUSIONS: An application of linear programming to screen available wild foods for meeting recommended nutrient intakes at a minimal cost was illustrated. This type of study helps to objectively assess the potential of biodiversity to contribute to diets and nutrition.