Complementaryfoodwithdriedsmallfish 130205220203-phpapp01

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Using nutrient-rich local ingredients in the development of a complementary foodJessica Bogardj.bogard@worldfishcenter.orgShakuntala Haraksingh ThilstedFISH FOR NUTRITIONEarlier today there has been mention and support for increasing dietary diversity as a food based stratgy for adressing undernutrition so I think this presentatino ties in nicely as an example of a novel idea that uses local ingredients to achieve that goal.

Generally, pre-prepared infant foods around the world tend to be cereal based, and often these cereal foods along with breastmilk make up the diets of many children in developing countries. At WorldFish we have been investigating including Fish in pre-prepared CFs for infants, which it quite a novel concept. We are in the preliminary stages so today Im introducing this concept and discussing our plans for future development.1Outline

Child malnutritionComplementary feedingRationale for product developmentIngredients selected for CFProduction processNutrient composition of CFPlans for the future

Give a snapshot on child malnutrition and CF practices in Bangladesh which leads on to our goals for developing a novel CF product. Then Ill talk about the ingredients we selected for inclusion and why, the nutrient composition of our proposed food and plans for its future development.2Window of opportunityChild Malnutrition in Bangladesh - 2011Moderate stuntingSevere stuntingSevere underweightModerate underweightFrom the most recent demographic and health survey 2011Under 5 mortality 53/1000 live births41% are moderately stunted (15% severely stunted)14% are wasted (4% severely wasted)36% are underweight (10% severely underweight)This graph tracks stunting and underweight from 6 months to 5 years and you can see particularly for stunting the dramatic increases after age 6 months This is the age where breastmilk is no longer sufficient to meet nutrient requirements of infants. This is the window of opportunity to try and improve complementary feeding practices and reverse this trend.

3Complementary feeding in Bangladesh - 2011(among breastfed infants)Exclusive breastfeeding from 0-6 months>1 in 3 children are NOT exclusively breastfed

Meal frequency (2/day at 6-8 months, 3/day at 9-24 months)> 1 in 3 are NOT fed the minimum number of meals per day

Dietary diversity>3 in 4 are NOT fed with appropriate dietary diversity

Meal frequency AND dietary diversityOnly 21%WHO has clearly defined indicators of appropriate IYCF practices.Exclusive breastfeeding: Minimum meal frequency of CFs: For breastfed children, at age 6-8months is 2 meals per day, for breastfed children at age 9-24 months is 3 meals per day of soft, semi solid or solid food.Minimum dietary diversity: proportion of children who receive foods from 4 or more different food groups.4. A composite measure of points 2 & 3. Only 21% of infants are meeting those minimum requirements.4Challenges for complementary feeding in BangladeshPredominantly plant-based dietLow in micronutrientsHigh in anti-nutrientsCFs rarely provide adequate energy and micronutrientsThin rice gruels/ sujiLow in iron, zinc and calciumTimeSafe storageGenerally, Bangladesh has a largely plant based diet less than 6% of energy intake on a national level comes from a combination of meat, fish, poultry, egg or dairy products. Plant based diets are also often at risk of being deficient in certain micronutrients. It is widely known that plant based diets are often high in antinutrients such as phytates which reduce the bioavailability of some nutrients.

Studies on CF in Bangladesh have shown that infants are rarely provided CFs containing adequate energy and micronutrients, AND this still occurs even when nutrient rich foods are available in the household. So we know that providing nutrient rich foods is not simply a matter of accessibility or availability. The result being that infants of often fed low nutrient foods like think rice gruels which are low in nutrients such as iron, zinc and calcium.

From several studies we know that time in preparing separate foods or modifying family foods to be suitable for CF for infants is a big constraint for mothers who are busy engaged in household or agricultural chores or who are away from the family home for work purposes throughout the day.

Storage is also a big problem with very limited access to refrigeration, storage of cooked foods in hot and humid temperatures is high risk for microbial growth which can cause food poisoning and diarrhea. 5Rationale for Product DevelopmentRich in nutrients (iron, zinc, vitamin A, calcium)Made from local ingredientsCulturally acceptableLow in anti-nutrientsHygienic and safeWith the things from previous slide in mind.We wanted to develop a product that would replace the low nutrient gruels commonly used, that would take an absolute minimum time to prepare for the caregiver.We wanted it to be:---And we wanted to use fish because although it might be encouraged in CF recipes in several countries, using it in a pre-prepared CF is quite a novel concept.6Selection of ingredients - RiceRice is the obvious choice because its by far the most commonly consumed food item across the country. In comparison to other grain based complimentary foods it can be processed in a way to reduce the level of anti-nutrients.Including rice as a base plays an important role in ensuring that the food is culturally acceptable.7Selection of ingredients - FishMache bhate Bengali Fish and rice make a BengaliFish most commonly eaten animal-source food across all income groups

Small indigenous fish are highly nutritiousAnimal-source foods enhance bioavailability of mineralsFish is a very strong part of the Bangladeshi culture. Mache bhate BengaliIt is the most commonly eaten animal source food across all income groups in BangladeshWe know from previous studies that many SIS found in abundance across the country are rich in micronutrients

The other important reason we wanted to include fish was because we know what the presence of a small amount of animal source foods enhances the absorption of micronutrients from other ingredients: so it is a 2 fold effect, on one hand fish increase the nutrient density of the food and secondly, it increases the absorption of nutrients from the other ingredients.

8Selection of ingredients - FishThen the question was, which fish?With our goal in mind of maximising iron, zinc and calcium the obvious choice was Darkina fish. This is a common SIS found in beels, ditches, ponds and inundated fields and is abundant during the wet season.9Selection of ingredients - Orange Flesh Sweet PotatoVitamin AFructose (natural sweetener)Low in anti-nutrientsRecognised globally for its contribution as a food based strategy to prevent vitamin A deficiency.Natural sweetener likely to improve the acceptability of the product.10Homestead production of sweet potato

Sweet potato not widely available in Bangladesh but it has received a lot of attention and is now a large part of homestead food production projects in BangladeshAvailability will continue to increase.Any other projects11RiceFishSweet potatoSoybean oilSoakingWashingWashingParboilingBoilingPeeling/trimmingMillingGrindingDryingDryingGrindingGrindingMixing in correct proportions with added water15% fish, 45% rice, 30% sweet potato, 10% oilCookingDrying/ PowderingPackaging

Nutrient composition (100g dry product)15% dried Darkina fish, 30% sweet potato flour, 10% soybean oil, 45% rice flour

Energy ProteinFatIronZincCalciumVit A435kcal17g13g14mg6mg657mg348g

Contribution to RDIs (%)EnergyIronZincCalciumVitamin A1 serve per day6-8 mo21444549269-11mo194445392612-23 mo15704539262 serves per day6-8 mo42889199529-11mo388891795212-23 mo291419179781 serve = 30g dry powder mixed with warm water15Comparison to other productsOur productSuper Cereal Plus*Pushti Packet*Energy434.8410394.7Protein16.9163.75Fat12.793.23Vitamin A348.3499394.5Calcium657.1130300Iron13.62.52.1Zinc6.254.4* Fortified with micronutrientsSupercereal Plus is the current Fortified Blended Food provided by the WFP program in Bangladesh, provided to children from 6-23 months as a complement to breastmilk. It is made from wheat, soybeans, dried skim milk, sugar and soybean oil.

Pushti packet was the supplementary food provided in the National Nutrition Program in different quantities depending on whether it was for prevention or treatment of malnutrition. Main ingredients were rice powder and pulses.

Worth noting that both of these products are fortified products, where ours is produced from local ingredients and yet is still a better source of iron, zinc and calcium and a comparable source of energy and vitamin A.16Where to from hereImmediate plans:Acceptability trialNutrient and shelf life analysis

Future plansEfficacy trialInvestigating options for distributionSubsidized product through existing maternal and child health programs, safety net programsMarket-based approach

Where to from hereImprove the nutrient quality of ingredients:High zinc riceSweet potato variety (higher vitamin A)Different fish species

Modified as a supplement for pregnant and lactating women

Modified to treat moderate and severe malnutrition

Modified for use in school feeding programsToday I wanted to share the concept of using fish as an ingredient in pre-prepared foodsTheres also lots of potential for modifying this product and adapting it for different target groups. For example, HarvestPlus are working in Bangladesh to develop a high zinc rice. CIP are working on improving the production of SP varieties that are higher in vitamin A than what is currently available in Bangladesh.

At the moment, weve designed the product for use in prevention of malnutriton but it also could be modified for TREATMENTHarvestPlus