RESUMEN
Several types of interventions can be used to improve nutrient intake adequacy in infant and young child (IYC) diets, including fortified foods, home fortification, nutrition education and behaviour change communication (BCC) in addition to agricultural and market-based strategies. However, the appropriate selection of interventions depends on the social, cultural, physical and economic context of the population. Derived from two rural Kenyan populations, this analysis combined information from: (1) a quantitative analysis to derive a set of food-based recommendations (FBRs) to fill nutrient intake gaps in IYC diets and identify 'problem nutrients' for which intake gaps require solutions beyond currently available foods and dietary patterns, and (2) an ethnographic qualitative analysis to identify contextual factors posing opportunities or constraints to implementing the FBRs, including perceptions of cost, convenience, accessibility and appropriateness of the recommended foods for IYC diets and other social or physical factors that determine accessibility of those foods. Opportunities identified included BCC to increase the acceptability and utilisation of green leafy vegetables (GLV) and small fish and agronomic interventions to increase the productivity of GLV and millet. Value chains for millet, beans, GLV, milk and small fish should be studied for opportunities to increase their accessibility in local markets. Processor-level interventions, such as partially cooked fortified dry porridge mixes or unfortified cereal mixes incorporating millet and beans, may increase the accessibility of foods that provide increased amounts of the problem nutrients. Multi-sectoral actors and community stakeholders should be engaged to assess the feasibility of implementing these locally appropriate strategies.
Asunto(s)
Agricultura/métodos , Alimentos , Fenómenos Fisiológicos Nutricionales del Lactante , Valor Nutritivo , Población Rural , Adulto , Animales , Antropología Cultural , Costos y Análisis de Costo , Dieta , Encuestas sobre Dietas , Grano Comestible , Fabaceae , Peces , Alimentos/economía , Alimentos Fortificados , Educación en Salud , Humanos , Lactante , Alimentos Infantiles , Kenia , Leche , Mijos , Política Nutricional , Necesidades Nutricionales , VerdurasRESUMEN
Simultaneous dietary achievement of a comprehensive set of nutrient recommendations is difficult. Our objective was to assess the feasibility of achieving a set of 30 nutrient recommendations at the individual level and characterize factors associated with feasibility. Seven-day food records collected from adults participating in the French national food consumption survey (n = 1171) were modified using an individualized diet optimization approach. For each individual, departure from his/her recorded diet was minimized, using only foods reported in his/her weekly diet record to fulfill a set of nutritional constraints. These constraints aimed to achieve or exceed the French Estimated Average Requirements and varied depending on the individual's gender, age, and observed nutrient intake levels. Acceptability constraints ensured realistic food portion sizes and food patterns. Model feasibility (i.e. percentage of feasible optimized diets) was calculated for all diets and by tertiles of dietary variety (i.e. the number of foods in the weekly food repertoire). Among the 1171 modeled diets, only 22% were mathematically feasible, showing that 78% of French adults would need to expand their weekly food repertoire to fulfill nutrient recommendations. Model feasibility increased from 6.6 to 50.3% and from 2.7 to 42.9% in tertiles 1 and 3 of dietary variety for men and women, respectively. The vitamin D constraint was the most difficult to fulfill (feasibility doubled after its removal), followed by sodium (maximum), magnesium (minimum), and SFA (maximum). The new approach developed in this study provides a method for identifying nutrient levels to carefully evaluate when establishing recommendations.