title: Local food-based complementary feeding recommendations developed by the linear programming approach to improve the intake of problem nutrients among 12-23-month-old Myanmar children.
abstract: Poor feeding practices result in inadequate nutrient intakes in young children in developing countries. To improve practices, local food-based complementary feeding recommendations (CFR) are needed. This cross-sectional survey aimed to describe current food consumption patterns of 12-23-month-old Myanmar children (n 106) from Ayeyarwady region in order to identify nutrient requirements that are difficult to achieve using local foods and to formulate affordable and realistic CFR to improve dietary adequacy. Weekly food consumption patterns were assessed using a 12-h weighed dietary record, single 24-h recall and a 5-d food record. Food costs were estimated by market surveys. CFR were formulated by linear programming analysis using WHO Optifood software and evaluated among mothers (n 20) using trial of improved practices (TIP). Findings showed that Ca, Zn, niacin, folate and Fe were 'problem nutrients': nutrients that did not achieve 100 % recommended nutrient intake even when the diet was optimised. Chicken liver, anchovy and roselle leaves were locally available nutrient-dense foods that would fill these nutrient gaps. The final set of six CFR would ensure dietary adequacy for five of twelve nutrients at a minimal cost of 271 kyats/d (based on the exchange rate of 900 kyats/USD at the time of data collection: 3rd quarter of 2012), but inadequacies remained for niacin, folate, thiamin, Fe, Zn, Ca and vitamin B6. TIP showed that mothers believed liver and vegetables would cause worms and diarrhoea, but these beliefs could be overcome to successfully promote liver consumption. Therefore, an acceptable set of CFR were developed to improve the dietary practices of 12-23-month-old Myanmar children using locally available foods. Alternative interventions such as fortification, however, are still needed to ensure dietary adequacy of all nutrients.
authors.affiliation: 1Department of Public Health,National Nutrition Center,Ministry of Health,Nay Pyi Taw 100604,Myanmar.
authors.forename: Lwin Mar
authors.initials: LM
authors.lastname: Hlaing
authors.affiliation: 2South East Asian Ministers of Education Organization Regional Center for Food and Nutrition (SEAMEO RECFON),University of Indonesia,Jakarta 10430,Indonesia.
authors.forename: Umi
authors.initials: U
authors.lastname: Fahmida
authors.affiliation: 3The Center of Community Health and Population Studies,The Research Institute,Trisakti University,Jakarta 11440,Indonesia.
authors.forename: Min Kyaw
authors.initials: MK
authors.lastname: Htet
authors.affiliation: 4Department of Population and Biostatistics, Faculty of Public Health,University of Indonesia,Jakarta 10430,Indonesia.
authors.forename: Budi
authors.initials: B
authors.lastname: Utomo
authors.affiliation: 5Department of Child Health,Gasterohepatology Division, Faculty of Medicine,University of Indonesia,Jakarta 10430,Indonesia.
authors.forename: Agus
authors.initials: A
authors.lastname: Firmansyah
authors.affiliation: 6London School of Hygiene and Tropical Medicine, The Faculty of Epidemiology and Population Health,London WC1E 7HT,UK.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Ferguson
mesh_terms: D001942:Breast Feeding; D003430:Cross-Sectional Studies; D004032:Diet; D005247:Feeding Behavior; D005260:Female; D005502:Food / Q000145:classification*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000517:prevention & control*; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D002052:Myanmar
keywords: CFR complementary feeding recommendations; Complementary feeding recommendations; FBR food-based recommendations; Linear programming; MFE meat; Myanmar children; Optifood; Problem nutrients; RNI recommended nutrient intakes; TIP trial of improved practices; WDR weighed dietary record; fish; poultry and eggs