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‘Optifood’ – A tool based on linear
programming analysis to inform
nutrition programme planning and
policy decisions
Elaine Ferguson
London School of Hygiene & Tropical
Medicine
Improving health worldwide
www.lshtm.ac.uk
Introduction
• Dietary survey data is important for describing food patterns,
intakes of energy and nutrients and estimating the % at risk of
inadequate nutrient intakes; however, there are important
programme and policy uses of dietary data
• I will describe how dietary data together with a tool based on
linear programming analyses (Optifood), can be used to inform
decisions regarding the use of food-based strategies to
improve nutrition of high risk target population
• I will present an illustrative example from SE Asia
Why a food-based
intervention?
• Dietary approaches are more sustainable and will likely provide
benefits across a wide range of age groups
• Avoids unintentional/unexpected adverse effects from providing
high or unbalanced levels of nutrients
• However questions remain – is a food-based approach alone a costeffective approach for ensuring dietary adequacy?
• → Culturally acceptable, affordable & nutritionally adequate
• What nutrient requirements are easy to meet using locally available
foods and which are more difficult?
What Optifood can do....
 Formulate food-based recommendations (FBR) for a
specific target group
 Test & compare FBRs → cost & nutrient adequacy
 Identify nutrients whose requirements are difficult to
achieve using local foods → “problem nutrients”
 Identify the lowest cost nutritionally best diet, and the
most expensive food sources of nutrients in this diet as
well as the most expensive nutrient requirements to
achieve
Types of issues it can address
• FOOD AVAILABILITY/ ACCESSIBILITY: Can locally available food
provide all nutrients needed by a target population?
→ Policy & programme decisions and advocacy.
• FOOD AFFORDABILITY: How much will the nutritionally best
diet cost ? → Cost transfer programme decisions.
• BEHAVIOUR CHANGE: What food-based recommendations
are best to promote for improving the nutritional status of the
target population? → Programme decisions and research
Optifood ….
• Tool based on linear programming analyses (LP)
• LP is mathematical optimisation which selects the
best option from amongst all possible options given
specified criteria
• In Optifood, its diet modeling , so its quickly selects
the best diet from hundreds/thousands of modeled
diets that are run in each analysis to inform decisions
Data Requirements
• Dietary Surveys
– Quantitative (recalls,
records)
– Food frequency data
• Market surveys
– Food cost per 100 g
edible portion
• Food composition tables
Food Composition Table
Energy
Protein
Water
Fat
Carbohydrate
Vitamin A
Select
Fe and Zn bioavailability
Vitamin C
B1
B2
B3
Ca
Fe
Zn
B6
B12
Folate
Optifood Analysis Structure
Model Constraints
Module Outputs
Food list
Check parameters
Min & max g/wk
Module#1
Food Patterns
Min & max serves/wk
Main food groups
Staples & snacks
Food sub-groups
Module#2
Energy content
Maximum cost
Module#3
(optional)
Food-based
recommendations (FBRs)
Nutrient content
Module#4
Create food-based
recommendations;
‘Problem nutrients’
Test & compare
alternative FBRs
Type of ‘problem
nutrient’
Cost analysis:
Lowest cost
nutritionally best diet
Module III: models tails of the
nutrient intake distribution to test
FBRs
• Test 11 micronutrients
• Test alternative sets of FBRs
>65% or 70% RNI=adequate
Define “problem nutrients”
Upper tail < 100% RNI/AI
Baseline Food-based recommendation
Vitamin A intakes
Formulate and Test Food-based
Recommendations:
• What food-based recommendations are best to promote
for this target group?
• Module 2 results are used = “best diet” → potential
food-based recommendations
– Best food and food sub-group sources of nutrients
– Food group patterns
Food-based Recommendations
Test and compare in Module 3
“lower tail of intake distributions”
Dairy
Vegetables
Meat, fish or eggs
Legumes
Fruits
Liver
Green leafy vegetables
Vitamin C rich fruits
Potatoes
Tofu/tempeh
Anchovies
14 serves / week
21 serves / week
5 serves / week
7 serves/week
7 serves/week
2 serves/week
5 serves/week
5 serves/week
3 serves/week
7 serves/week
3 serves/week
Minimised nutrient content analysis from Module 3
Count number of “lower tails” >65% or 70% RNI and cost
Research in SE Asia
Countries and Target groups
• Up to 6 target groups representative at
national or district level in each country
– 6-8 month olds
– 9-11 month olds
– 12-23 month olds
– Pregnant women
– Lactating women or adolescent girls
– Non-pregnant, non-lactating women
• In all countries but Laos, dietary data were
collected using a 24-hour recall at the
national level; in Thailand FFQ
• in Laos, a 7-day qualitative 24-hour recall
at a district level
Define “Problem nutrients”
1. Can a nutritionally adequate diet be promoted
given local foods & food patterns?
Numbers of “Problem Nutrients”
Cambodia Indonesia Lao PDR Thailand Vietnam
Children:
6-8 m
9-11 m
12-23 m
Women:
Pregnant
Lactating
NPNL
6
6
4
4
2
0
3
3
0
3
3
0
2
1
0
7
5
4
Not
analysed
3
2
1
Not
analysed
4
4
2
For children: Ca, Fe & Zn; sometimes folate, B1, B2 & B3
For women: Ca & Fe; often folate, B2, B6 & vitamin A
Food-based Recommendations
2. To what extent can food-based
recommendations ensure dietary
adequacy for these target groups?
Number of nutrients –lower tails
of their intake distributions >70%
RNI when FBRs were tested
(11 micronutrients)
% target groups where nutrient
adequacy was not ensured
Testing Alternative Interventions children
What is the minimum of sachets/w of
multiple micronutrient powders that
would ensure dietary adequacy?
Cambodia
Indonesia
Lao PDR
Vietnam
6-8 months
Alone With
FBR
5*
4*
5*
3*
5*
4*
5*
3
9-11 months
Alone With
FBR
4*
4*
5*
3*
5*
4*
5*
3
*Ca adequacy not ensured
FBR – food-based recommendations
12-23 months
Alone With
FBR
4*
3
4*
4*
5*
3*
4*
3
Choose an iron-folate or a multimicronutrient supplement for pregnant
Cambodian women?
Daily Fe – folate Supplement
Daily Multiple Micronutrient Supplement
Number per
week
Only
supplement
#Nutrients
≥70% RNI
Supplement
+ FBR
#Nutrients
≥70% RNI
Number per
week
Only
supplement
#Nutrients
≥70% RNI
Supplement
+ FBR
#Nutrients
≥70% RNI
1 day
2 days
3 days
4 days
5 days
6 days
7 days
1
1
2
2
2
2
3*
6
6
7
7
7
8
8#
1 day
2 days
3 days
4 days
5 days
6 days
7 days
2
3
4
6
9
9
10**
6
6
7
8
9
10
10**
*Achieved only Fe, folate & niacin
#Did not achieve Ca, riboflavin & vitamin A
**Did not achieve Ca
Will the proposed national sets of
Complementary Feeding
Recommendations ensure dietary
adequacy?
CF Recommendations for 6-8 m
olds in Thailand
Original
Rice -14
MFE – 14
Egg – 7
Veg – 14
Fruit-14
Oil-7
Tested#1
“
“
“
“
Fruit -7
“
Not feasible Not feasible
Tested#2
Tested#3
“
“
“
“
“
No oil
“
“
“
“
Fruit-7
Oil-3
“
“
“
“
“
“
F- rice-14
4 low
nutrients*
4 low
nutrients
2 low
nutrients
Problem
nutrients
Fe
B3
Ca
Fe
Zn
Ca
Ca
Fe
Fe
Zn
Zn
B3
B3
*low nutrients defined as worst-case scenarios <65% RNI
Tested#4
Optifood
Did intervention foods ensure
dietary adequacy?
from Cambodia (6-8 months)
Foods
Winfood
Winfood-lite
CSB+
CSB++
Skau et al, AJCN 99:130-8, 2014
Dietary Adequacy not ensured:
“worst-case scenario” <65% RNI
Baseline
Winfood
Winfood-lite
CSB+
CSB++
6-8m
6-8m
6-8m
6-8m
6-8m
B1*
B2
B3*
B6*
B9*
B12*
Ca*
Fe*
Zn*
B1*
B2
B9*
Fe*
B1*
B9
Fe*
B1*
B9
Ca
Fe*
B1*
B9
Fe*
*worst-case scenario <50% RNI
Skau at al, AJCN 99:130-8, 2014
Conclusions
• Food-based approaches can improve the micronutrient content of
diets in SE Asian countries but they may not ensure dietary adequacy
for all nutrients especially
– Ca, Fe, and Zn for children;
and perhaps also folate, thiamin, riboflavin & niacin
– Ca, Fe and folate for women;
and perhaps also thiamin, riboflavin, niacin, B6, VA
• Alternative strategies are needed to ensure dietary adequacy in
these SE Asian populations (advocacy)
• Food-based recommendations plus an alternative strategy, such as
multiple micronutrient powders/supplements or tailored fortified
foods, can ensure dietary adequacy for most micronutrients if
successfully adopted (programmes/policy – need evaluations )
The SMILLING Team
Lao – National Institute of
Public Health
Cambodia – Ministry of Health;
Ministry of Agriculture,
Forestry & Fisheries
– Dr Sengchanh Kownnavong
– Dr Manithong Vonglokham
– Dr Daovieng Douangvichith
Thailand – Mahidol University
– Dr Uraiporn Chittchang
– Dr Nipa Rojroongwasiukul
– Dr Pattanee Winnichagoon
Indonesia – SEAMEO TROPMED
RCCN
– Dr Umi Fahmida
– Mr Otte Santika
–
–
–
–
–
Dr Mary Chea
Mr Seyha Sok
Ms Daream Sok
Mr Kuong Khov
Dr Jutta Skau
Vietnam – National Institute of
Nutrition
– Prof Le Bach Mai
– Dr Tran Thaan Do
– Dr Tran Lua-NIN
Thank-you!
FBRs – number servings/w
Children- breastfeed
Women
C
I*
L
T
V
C
L
V
MFE
Pork
Liver
Eggs
21
7
7
14
14, 21
14, 21
21
1, 3
3
21
7
3
21
7
1
7
Dairy (12-23 m)
7
14
14
Legumes
7
7
7
Fruits
7
7
7
7, 14
Vegetables
GLV
7
7
4
7
2
14
Fortified
Products
3
7
14
7
*Indonesia – day-based servings not meal-based
MFE – meat, fish, eggs
7
14
7
7
21
49
14
35
Nutrients not adequate
(<70% RNI)
Cambodia
Indonesia
Lao PDR
Thailand
Vietnam
6-8 m
Ca, Fe, Zn,
folate
Fe, Zn, B3
Ca, Fe, Zn,
B1, B3
Ca, Fe, Zn
Ca, Fe, Zn
9-11 m
Ca, Fe, Zn,
folate
Ca, Fe, Zn,
B3
Ca, Fe, Zn,
B1, B3
Ca, Fe, Zn
Fe
12-23 m
Fe, folate
Ca, B2, B3
Fe, Zn, B1,
B3, folate
Fe, B3,
folate
Ca, Fe, B1
Pregnant
Ca, Fe,
folate, B2,
VA
Ca, Fe, B1,
B3, B6,
folate
Ca, Fe,
folate, B2,
B3, B6
Lactating
Ca, Fe,
folate, B2,
VA
Ca, Fe, B1,
B3, B6,
folate
Ca, folate,
B2
NPNL
Ca, Fe,
folate, B2,
VA
Ca, Fe, B1,
folate
Ca, Fe, B2,
B3