Food Composition Tables in Southeast Asia: The Contribution of the SMILING Project.

Objectives Food composition data are key for many nutrition related activities in research, planning and policy. Combatting micronutrient malnutrition among women and young children using sustainable food based approaches, as aimed at in the SMILING project, requires high quality food composition data. Methods In order to develop capacity and to align procedures for establishing, updating and assessing the quality of key nutrient data in the food composition tables in Southeast Asia, a detailed roadmap was developed to identify and propose steps for this. This included a training workshop to build capacity in the field of food composition data, and alignment of procedures for selecting foods and nutrients to be included for quality assessment, and update of country specific food composition tables. The SEA partners in the SMILING project finalised a country specific food composition table (FCT) with updated compositional data on selected foods and nutrients considered key for designing nutrient dense and optimal diets for the target groups. Results Between 140 and 175 foods were selected for inclusion in the country specific FCTs. Key-nutrients were: energy, protein, total fat, carbohydrates, iron, zinc, (pro-)-vitamin A, folate, calcium, vitamin D, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12 and vitamin C. A detailed quality assessment on 13 key-foods per nutrient was performed using international guidelines. Nutrient data for specific local food items were often unavailable and data on folate, vitamin B12 and vitamin B6 contents were mostly missing. For many foods, documentation was not available, thereby complicating an in-depth quality assessment. Despite these limitations, the SMILING project offered a unique opportunity to increase awareness of the importance of high quality well documented food composition data. Conclusion for Practise The self-reported data quality demonstrated that there is considerable room for improvement of the nutrient data quality in some countries. In addition, investment in sustainable capacity development and an urgent need to produce and document high quality data on the micronutrient composition of especially local foods is required.

Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia.

OBJECTIVE: To assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate. DESIGN: Pre-post evaluation between two surveys. SETTING: Twenty-four villages in West Java. SUBJECTS: Poor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baseline n 324/endline n 349), their infants aged 6-11 months (n 318/n 335) and children aged 12-59 months (n 469/477), and cohorts of children aged 5-9 years (n 186) and women aged 15-29 years (n 171), alongside food and oil consumption from dietary recall. RESULTS: Fortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12-23 months, 24-59 months, 5-9 years, lactating and non-lactating women, respectively. Serum retinol was 2-19 % higher at endline than baseline (P<0·001 in infants aged 6-11 months, children aged 5-9 years, lactating and non-lactating women; non-significant in children aged 12-23 months; P=0·057 in children aged 24-59 months). Retinol in breast milk averaged 20·5 µg/dl at baseline and 32·5 µg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 µg/dl) was 6·5-18 % across groups at baseline, and 0·6-6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6-59 months (P=0·003) and 5-9 years (P=0·03). CONCLUSIONS: Although this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.

Cost of the Diet (CoD) tool: first results from Indonesia and applications for policy discussion on food and nutrition security.

BACKGROUND: The Minimum Cost of a Nutritious Diet (MCNut) is the cost of a theoretical diet satisfying all nutrient requirements of a family at the lowest possible cost, based on availability, price, and nutrient content of local foods. A comparison with household expenditure shows the proportion of households that would be able to afford a nutritious diet. OBJECTIVE: To explore using the Cost of Diet (CoD) tool for policy dialogue on food and nutrition security in Indonesia. METHODS: From October 2011 to June 2012, market surveys collected data on food commodity availability and pricing in four provinces. Household composition and expenditure data were obtained from secondary data (SUSENAS 2010). Focus group discussions were conducted to better understand food consumption practices. Different types of fortified foods and distribution mechanisms were also modeled. RESULTS: Stark differences were found among the four areas: in Timor Tengah Selatan, only 25% of households could afford to meet the nutrient requirements, whereas in urban Surabaya, 80% could. The prevalence rates of underweight and stunting among children under 5 years of age in the four areas were inversely correlated with the proportion of households that could afford a nutritious diet. The highest reduction in the cost of the child's diet was achieved by modeling provision of fortified blended food through Social Safety Nets. Rice fortification, subsidized or at commercial price, can greatly improve nutrient affordability for households. CONCLUSIONS: The CoD analysis is a useful entry point for discussions on constraints on achieving adequate nutrition in different areas and on possible ways to improve nutrition, including the use of special foods and different distribution strategies.

Consumption and sources of added sugar in Indonesia: a review.

BACKGROUND AND OBJECTIVES: The present report summarized the best available evidence regarding consumption level and sources of free or added sugars in Indonesia. METHODS AND STUDY DESIGN: Information was extracted from food balance sheets, household expenditure surveys, nutrition surveys, published studies, unpublished theses/ dissertations, and government reports. RESULTS: A total of 18 references were obtained, showing varying results. Indonesia's national surveys suggested intakes of sugar below 50 grams per day or below 10% of energy intake. Published studies suggested higher levels of intake. Studies used expenditure surveys or a single day of recall to determine dietary intake. None made use of biomarkers to determine the level of sugar intake. The 2014 Total Diet Study estimated that 11.8% of the population consumed >50 grams sugar per day. Common food sources were table sugar, wheat products, milk products, sweetened drinks, condiments, candies and chocolate products. CONCLUSIONS: Insufficient evidence exists regarding the levels and sources of added sugar intake of different population groups in Indonesia. A nationwide survey using multiple (at least two) 24-hour recalls to allow estimation of usual intake and to identify food sources, and the use of biomarkers to validate intake will provide more accurate information on which to base policy decisions.

Regional study of nutritional status of urban primary schoolchildren. 2. West Jakarta and Bogor, Indonesia.

The study provides information on the nutritional status of 8- to 10-year-old primary schoolchildren in urban areas of Jakarta and Bogor, Indonesia, based on anthropometric indicators. It compares the use of the anthropometric indicators weight-for-age Z score, height-for-age Z score, weight-for-height Z score, and body mass index (BMI) to assess thinness (underweight and wasted) and overweight in children. A total of 1,367 children were examined. The nutritional status of the 8- to 10-year urban schoolchildren was better than that of urban children under 5 years old. The prevalence of underweight among urban schoolchildren ranged from 7.4% (girls) to 12.95% (boys), while underweight among urban children under 5 years old in 1998 was 29.7%. Meanwhile, the prevalence of overweight (BMI > 85th percentile) ranged from 15.3% (girls) to 17.8% (boys). There were more overweight children in the private schools than in the public schools. On average, private schoolchildren, of all ages and both sexes, were heavier and taller than public schoolchildren. The BMI indicator for "thinness" and "wasting", using the NHANES reference, indicates a false positive result. For detecting overweight in children aged 8 to 10 years, BMI is comparable to the other indices, weight-for-age, height-for-age, and weight-for-height.

Developmental trajectories of poorly nourished toddlers that received a micronutrient supplement with and without energy.

Experimental and quasi-experimental studies on the effects of nutritional supplements on development in young children generally include snapshots of development. Developmental outcomes are better revealed when multiple assessments are made over time. We compared the effects of a micronutrient intervention with and without supplementary energy on the mental and motor growth curves of poorly nourished toddlers in West Java. Subjects (12-mo-old cohort, n = 33; 18-mo-old cohort, n = 42) were randomly assigned to receive energy + micronutrients (E + M) or micronutrients (M) daily for 12 mo. The cohort/treatment groups were then classified as either relatively short or tall. Within the 12-mo cohort, the baseline mean length Z-scores ranged from -2.53 to -1.29 and the baseline mean weight Z-scores ranged from -3.05 to -2.18. The same pretreatment anthropometrics for the older cohort ranged from -3.22 to -1.59 and from -3.42 to -2.26. Mental and motor development scores (Bayley) were obtained at baseline and every 2 mo for 12 mo. There was a Cohort x Length Category x Supplement interaction for mental slopes (P < 0.01). Slopes for tall-E + M (b = 5.35) and tall-M children (b = 5.39) in the 18-mo cohort were equivalent, but slopes for short-E + M (b = 6.13) and short-M (b = 4.67) children differed greatly (P = 0.03). On the basis of this finding and findings previously reported from this study, we concluded that the unfavorable developmental response to the M supplement that was restricted to the shortest children within an already disadvantaged group.