Desirable Dietary Pattern for Bangladesh

Report
Desirable Dietary Pattern for Bangladesh
PI: Quamrun Nahar, PhD
Co-Investigators
Prof Subhagata Choudhury, BIRDEM
Dr M Omar Faruque, BIRDEM
Syeda Saliha Saliheen Sultana, HEC
Dr MA Siddiquee, BRRI
Introduction
Food production has tripled since 1971.
Rice production has increased from 9.77 mil
MT in 1971 to 33.5mil MT in 2010
Food consumption at individual levels has also
increased
However diets remain monotonous, imbalanced and
dominated by a high intake of cereals which is 70%
Disproportionate consumption of cereals and non
cereals foods is one of the factors leading to the
double burden of malnutrition
Current Nutrition situation in Bangladesh
Indicator
Prevalence (%)
LBW
Stunting (U5)
Wasting (U5)
Under weight (U5)
Zinc deficiency
Anaemia
*World Health Statistics; BDHS 2011
22*
41
16
36
44
33.1
Prevalence of selected micronutrient deficiencies
among non pregnant non lactating women
Indicators
Prevalence (%)
Anaemia
26
Zinc deficiency
57.3
Iodine deficiency
42.1
National Micronutrient Survey 2011-12
Current Prevalence* of NCD
Indicators
Prevalence (%)
DM
7.9a
BMI > 25
18
HTN >140/90
14.8
Central obesity
21.7
*National NCD survey 2010; aInternational Diabetes Federation (IDF)
Objectives
• Estimate energy requirements by age, gender and physical
activity levels namely sedentary, moderate and heavy work
in rural and urban areas in Bangladesh
• Compile nutrient requirements disaggregated by gender,
age and physiological status (pregnancy, lactation) and
physical activity levels
• Develop diet plans that identify the types and quantities of
foods required to provide energy and essential nutrients for a
balanced diet of population disaggregated by gender, age,
physiological status and physical activity levels in urban and
rural areas with due attention to local food habits, food
availability and biodiversity.
Calculation of energy requirement
Basal metabolic rate (BMR)
Physical activity level (PAL)
BMR (kcal/kg/d) in male and females adapted from
FAO/WHO, 2004
18-29.9 yrs
30-59.9 yrs
>60 yrs
Male
Female
Male
Female
Male
Female
BW BMR BW BMR BW BMR BW BMR BW BMR BW BMR
50
55
60
65
70
75
80
85
90
29
28
27
26
25
24
24
23
23
45
50
55
60
65
70
75
80
85
26
25
24
23
22
22
21
21
21
50
55
60
65
70
75
80
85
90
29
27
26
25
24
23
22
22
21
45
50
55
60
65
70
75
80
85
27
25
24
22
21
20
19
19
18
50
55
60
65
70
75
80
85
90
23
22
22
21
20
20
19
19
18
BW, Body weight in Kg; BMR, Basal metabolic rate, kcal/kg/day
45
50
55
60
65
70
75
80
85
24
22
21
20
19
18
18
17
17
PAL (Physical activity level) of selected occupations
Activity
PAL
Sleep
1
Brick breaking
4
Brick field worker
Cutting trees
3
4.8
Chopping wood
4.3
Clearing ground
3.8
Cooking
1.8
Physical activity levels of females
(sedentary occupation)
Example: PAL calculation of a female banker
Per day activity (hr/day)
hrs
8
PAL
1.3
Total PAL
10.4
7
1
7
1
2.3
2.3
3
1.7
5.1
2
1.95
3.9
Watching TV and chatting
3
1.4
4.2
Total time
Average PAL
24
Working
Sleeping
Personal care
Eating, Cooking and
Sitting
House hold working
32.9
1.37
Classification of lifestyles in relation to physical
activity, or PAL (FAO 2004)
Category
PAL value
Sedentary or light activity
1.40-1.69
Active or moderately active
1.70-1.99
Vigorous or vigorously active
>2.0
PAL of different occupations
Urban
Mild, PAL (1.5)
Occupation
Office worker
Private Driver
Doctor
Shopkeeper
Banker
PAL
1.41
1.59
1.44
1.36
1.37
Moderate PAL (1.85)
Occupation
Tailoring
Laundry worker
Shoe maker
PAL
1.88
1.85
1.78
Heavy, PAL(2.32)
Rickshaw puller
Day laboring
Brick field worker
Gardener
Electrical worker
2.84
2.65
2
2.21
2.04
Calculated Energy Requirements for Bangladeshi Population
Energy Requirements = BMR X PAL X BW
Urban (18-29 yrs)
Rural (18-29 yrs)
Mild
Moderate
Heavy
Mild
Moderate Heavy
Male
2430
2997
3758
2430
3046
3985
Female
1980
2442
3062
1980
2482
3247
1st
2nd
3rd
trimester
trimester
trimester
Gender
Pregnancy
85
285
Lactation
+ 675
460
475
Energy requirement for adult Bangladeshi population
Distribution of Sedentary, moderate and heavy activity occupation in the Bangladeshi
population
Physical Activity level (PAL)
Sedentary
Moderate
Heavy
Male (%)
31
7
8
Female (%)
45
8
1
Average Energy Requirements= 2430 kcal
Recommended nutrient intakes of
micronutrients
11 vitamins
6 minerals
Vitamin C, Calcium and Iron (in mg) recommendations
Old(1992)
Current (FAO-2004)
Vitamin C
30
45
Calcium
450
1000
9
15%
12%
10%
9.1
11.4
13.7
5%
27.4
15%
12%
19.6
24.5
29.4
Male
Iron
Female
28
Bioavailability
19-50yrs
10%
5%
58.8
Analysis of Food Consumption, Household
Income Expenditure Survey, 2010
Average food consumption (g) per capita per day
450
416
400
350
300
250
200
150
100
50
0
131
70
50.3 45 40 40
36 32
20.4 15 14.7 11.5 9
7.3 5.72
Diversity of Fish intake in Bangladeshi population g/capita/d
11
10
9
8
7
6
5
Diversity of vegetable intake in Bangladeshi population
(g/capita/d)
40
36.1
35
30
25
21.1
20
15
10
12
11.4
10.9
10.3
Macro and Micronutrient
consumption
Per capita per day macronutrient intake of Bangladeshi
populations (weighted value), HIES, 2010
Energy (kcal)
Protein, g
CHO g
Fat, g
2190±521
57.2±15.6
413± 106
29.3±14
Requirement, 2430 kcal
Distribution of population nutrient intake
Macronutriments
Ranges of intake
Carbohydrate
<55%
55 – 75%
>75%
<10%
Protein
Fat
% Population
16.3
43.3
40.3
40
10 – 15%
>15%
<15%
50
10
53
15 – 30%
>30%
44
3
Current Intake and RNI of different Vitamins for adult
Bangladeshi Population (can you show as% of RNI??)
Vitamins
Intake
(HIES
2010)
Vitamin-A,
retinol
Eq 388±291
(µg/day)
Vitamin-C
84.8±64.2
mg/day
Thiamine
1.0±0.60
(mg/day)
Riboflavin
0.80±0.35
(mg/day)
Niacin(mg
17.8±10.2
NEq/day)
Folic
acid
197±81
(µ/day)
Calcium
439±227
(mg/day)
RNI
% of RNI,
Male
% of RNI,
Female
Male
Female
65
78
600
500
188
188
45
45
83
91
1.2
1.1
62
73
1.3
1.1
111
127
16
14
49
49
400
400
44
44
1000
1000
Zinc and Iron intake and RDA in adult Bangladeshi
population
Minerals
Zinc
(mg/day)
Intake
(HIES
2010)
% of
RNI,
Male
10.03
±2.62
71.6
Iron
(mg/day)
% of
BioRNI, availabili
Female
ty
102.3
10.96
±3.82
40.0
18.6
RDA
Male Female
High
4.2
3.0
Moderate
7.0
4.9
Low
14.0
9.8
15%
9.1
19.6
12%
11.4
24.5
10%
13.7
29.4
5%
27.4
58.8
Household dietary diversity score (HDDS) analysis
HDDS considered is a measures of access to food at the house
hold level
Dietary Diversity Score (DDS): 6.6±1.4 out of 12
food groups
6.8
6.75
6.7
6.65
6.6
6.55
6.5
6.45
6.4
6.77
6.65
6.65
6.61
D 1 D2
D3
D4
6.59
D5
6.63
6.61
6.57
D6
6.58
D7
6.57
D8
6.56
6.55
6.58
6.54
D9 d10 D11 d12 D13 D14
HDDS of 14 different days
Food Groups (FANTA/FAO, 2011)
Cereal, white tuber and roots , Vegetables, Fruits, Meat, Eggs, Fish, Legumes
and Nuts, Milk and milk products, Fats and oils, Sweets, Spices
<3 (0.2%)
3-5.99 (35%)
≥6 (64.8%)
Population distribution by HDDS
HDDS, out of 12 food groups
8
7.7 7.9
7.3
5
5
4.6
3.7
7
6
IDDS, out of 9 food groups
4
Dhaka
3
Khagrachari
Rangamati
2
4
1
3
0
Resident Students
Slum People
HDDS (Dhaka city, Khagrachari and Rangamati) and IDDS (Students and slum people)
Identification of key foods
Considering 75% cumulative % of total nutrient
contribution
30 Key foods identified from HIES 2010 using methodology of
Haytowitz et al., 2002
Food name
Food name
Medium rice
Indian Spinach
Wheat (Atta)
Potato
Coarse rice
Liquid milk
Chicken
Rohu
Green gram (boot)
Jack fruit
Brinjal
Puti
Pangash
Lentil(musur)
Beef
Mango
Chapila
Ripe banana
Bean
Cauliflower
Cabbage
Radish
Pumpkin
Perbol (patal)
Dried Fish (chapila)
Hilsa
Guava
Tomato
Bitter gourd
Shrimp
% of Total Protein
60
50
48
40
30
20
10
5
4
3
3
2
2
0
Key foods for protein
2
2
2
1
30
26
% of Total Iron
25
20
15
10
5
11
8
7
4
3
3
3
2
0
Key Foods for Iron
2
2
2
1
1
1
Desirable (g/P/D) &%
Energy (2310 Kcal),
Yusuf et al, 1996
Food
Current
intake
% Energy
Desirable intake (g/P/D) & %
of energy (2430 kcal)
(DDP 2012)
Cereal
372
55
375
55
Rice
312
46.6
350
51
Wheat & other cereals
Pulses
60
66
8.4
10
25
60
4
8.8
Desirable
intake
400
350
50
50
Animal Foods
126
5
180
5.46
260
10.5
Fish
Poultry & Meat
Egg
Milk & milk products
Fruits
50
22
7
47
57
2.5
55
35
15
75
100
2.1
1.4
0.58
2.9
4.2
60
40
30
130
100
3
2
2
3.5
3
100
2
3.6
200
2
4
Vegetables
Desirable Dietary Pattern
Desirable
% Energy
intake
Desirable intake
(g/P/D) & % of energy
(2350 kcal)
(suggested by the
Expert Committee on
07.08.2007)
GLV
Non leafy
Vegetables
Potato
Cooking oil
Sugar/ Gur/ Molasses
Spices
Food taken outside
Miscellaneous
Total (g)
% Energy
56
49
7
6.5
200
132
2.5
130
38
28
10
5
15
5
60
40
18
20
2.47
15.3
3.66
0.42
100
30
20
20
11
3
2
959
100
1053
100
1280
100
Factors in Diet planning
•
•
•
•
Physical activity level (PAL)
Gender
Average food price, DAM, 2010
Per capita money spent on food by
household
• Serving size
• RNI of Micro nutrients
• Dietary Diversity Score (DDS)
Food cost per day, HIES, 2010
Food cost / month
range (Taka)
4259-5304
% HH
65
Food cost (Taka)
/person/day
35
5927-8247
34
52
>11014
1
82
Balanced food basket providing 2430 Kcal
71 taka/day
Food groups
Cereal
Rice parboiled
(milled)
Amount (g)
Portion
size
Energy
(kcal)
% of total
Energy
8 cup
844
33
240
Rice (flattened)
Wheat flour
(coarse)
60
2 cup
213
5
200
9
60
Pulse
60
4 small
piece
2/3 cup
201
8
1 big piece
meat, 1 egg
185
3 cup
1.25 cup
114
57
Meat-fishpoultry
Vegetable
Green leafy
vegetables
Oil
Fruit
Milk
Sugar
Total
120
320
130
30
300
130
10
1460
3 sp
3 cup
1 cup
270
234
82
40
2440
8
5
2
11
10
3
2
100
Taka
8
3
2
4
17
2
5
5
16
8
1
71
Dietary guidelines
GUIDELINE 1: EAT A WELL-BALANCED DIET WITH A
VARIETY OF FOODS AT EACH MEAL
• Key messages
• Eat rice or wheat or a combination of cereals around 300-420 g
which is equivalent to 10-14 servings daily.
• Eat rice or roti with lentils or beans or fish / poultry/ egg every
day for better nutritional quality
• Do not discard water from cooked rice as they contain water
soluble vitamins
• Try and consume unpolished/brown rice and whole wheat
brown atta for dietary fiber
Consume required amounts of fish, meat, poultry, egg, legumes daily
• Eat 1-4 piece fish, meat, poultry or 1-2 bati pulses and
legumes daily
• Combine cereals with legumes in the ratio of 3:1 to
improve protein quality
Eat a variety of seasonal fresh fruits and vegetables everyday
• Eat everyday 2 seasonal fruits (100g), one from
citrus another from vitamin A sources
• Eat a citrus fruit after a meal to enhance iron
absorption
• Eat at least 100g leafy , 200g non leafy
vegetables daily
Consume adequate amounts of milk and milk products
1. Take at least one cup
(130 ml) milk/ doi for
good source of calcium
throughout the life for
healthy bones and teeth
2. Eat curd or drink soya
milk in case of lactose
intolerance
GUIDELINE 2: CONSUME MODERATE AMOUNTS OF OILS AND FATS
• Vegetable oil like mustard oil and soybean oil, should be used in
moderation daily instead of ghee, butter, butter oil and palm oil.
• Limit intake of fat rich food, fast food, fat rich baked foods and processed
meat that may add to undesirable trans-fats
GUIDELINE 3: LIMIT SALT INTAKE AND CONDIMENTS AND
USE ONLY IODIZED SALT
Limit salt intake to half to one teaspoon (< 5g) a day.
Use only iodized salt
Reduce consumption of highly salted foods and condiments
and avoid extra table salt with meals
GUIDELINE 4: TAKE LESS SUGAR, SWEETS OR
SWEETENED DRINKS
• Refine sugar is known as a dietary disaster and it is
advisable to reduce the intake sugar based food
especially sweetmeats and rich desserts.
• Encourage the intake of natural sugars from a variety of
seasonal fruits.
GUIDELINE 5: DRINK PLENTY OF WATER DAILY
Drink 1.5 to 3.5 liter ( 6-14 glasses) clean and pure drinking
water
Drink coconut water and fresh fruit juices instead of
carbonated water
GUIDELINE 6: CONSUME SAFE AND CLEAN
FOODS AND BEVERAGES
• Choose fresh, safe and clean foods and beverages.
• Eat vegetables and fruits after thorough washing to avoid
microbes and bacteria
• Avoid open street foods
GUIDELINE 7: MAINTAIN DESIRED BODY WEIGHT THROUGH A
BALANCED FOOD INTAKE AND REGULAR PHYSICAL ACTIVITY
Key messages
• Maintain normal BMI (18.5-23.0, kg/m2) along with Waist
circumference (male: 90 cm, female: 80 cm and waist hip
ratio (male : > 0.9; female 0.8)
• Practise minimum thirty minutes of daily aerobic physical
activities - walking, running, jogging, cycling, household
work
GUIDELINE 8: PRACTISE HEALTHY LIFE STYLE
WITH RIGHT COOKING AND HEALTHY EATING
•
•
•
•
•
Key messages
Eat food timely and avoid overeating
Avoid reuse of fried oil
Avoid faulty food beliefs, fads and fallacies
Avoid sleeping immediately after major meals
Avoid smoking, alcohol consumption and betel nut
chewing
GUIDELINE 9: EAT ADDITIONAL FOOD DURING PREGNANCY
AND LACTATION
Key messages
• Eat beef, mutton or poultry or germinated pulses
throughout pregnancy for getting dietary iron
source
• Eat seasonal fruits throughout pregnancy
especially after meals
• Maintain proper weight gain during pregnancy
12kg during pregnancy)
GUIDELINE 10: PRACTISE EXCLUSIVE BREAST FEEDING FOR SIX MONTHS
AND START APPROPRIATE COMPLEMENTARY FOODS IN TIME
Key messages
• Exclusively breast feed for six months for adequate
growth of the child
• Introduce appropriate complementary foods after
completion of 6 months and continue complementary
feeding along with breast feeding up to 2 years
Conclusions
 The study provides an update on energy, macro and
micronutrients requirement for all ages considering
gender, PAL and physiological conditions adapted to
FAO/WHO recommendations.
 Average energy requirement is 2430 kcal, current intake
is deficient by 240 kcal. More than 50% dietary protein
and iron sources are from plant sources.
 Micronutrient intake especially vitamin A, calcium, iron,
zinc, folic acid are inadequate.
 The diet plans and menu options have been formulated
considering dietary adequacy and nutrient gaps in
Bangladeshi diets.
Recommendations
• The diets proposed can be adapted for use by both poor and non poor
households in urban and rural areas. A variety of foods and food groups has
been used in planning the diets so as to achieve a desirable dietary pattern
with adequate dietary diversity scores.
• The study findings can be considered for agriculture, food and diet planning
where in updates on energy and nutrient requirements are needed.
• The key nutrition messages can be considered for use in policy, programmes
and field interventions across food, agriculture and health sectors.
Acknowledgements
Technical Assistance Team
Dr Lalita Bhattacharjee, FAO
Dr Md Abdul Mannan, FAO
Prof Nazmun Nahar
Director General, BIRDEM
Jillan Waid, HKI
Prof Nazma Shaheen, INFS
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