Affordability of nutritious foods for complementary feeding in Eastern and Southern Africa.

Low intake of diverse complementary foods causes critical nutrient gaps in the diets of young children. Inadequate nutrient intake in the first 2 years of life can lead to poor health, educational, and economic outcomes. In this study, the extent to which food affordability is a barrier to consumption of several nutrients critical for child growth and development was examined in Ethiopia, Mozambique, South Africa, Tanzania, Uganda, and Zambia. Drawing upon data from nutrient gap assessments, household surveys, and food composition tables, current consumption levels were assessed, the cost of purchasing key nutritious foods that could fill likely nutrient gaps was calculated, and these costs were compared with current household food expenditure. Vitamin A is affordable for most households (via dark leafy greens, orange-fleshed vegetables, and liver) but only a few foods (fish, legumes, dairy, dark leafy greens, liver) are affordable sources of iron, animal-source protein, or calcium, and only in some countries. Zinc is ubiquitously unaffordable. For unaffordable nutrients, approaches to reduce prices, enhance household production, or increase household resources for nutritious foods are needed.

Affordability of nutritious foods for complementary feeding in South Asia.

The high prevalence of stunting and micronutrient deficiencies among children in South Asia has lifelong health, educational, and economic consequences. For children aged 6-23 months, undernutrition is influenced by inadequate intake of complementary foods containing nutrients critical for growth and development. The affordability of nutrients lacking in young children's diets in Bangladesh, India, and Pakistan was assessed in this study. Using data from nutrient gap assessments and household surveys, household food expenditures were compared with the cost of purchasing foods that could fill nutrient gaps. In all 3 countries, there are multiple affordable sources of vitamin A (orange-fleshed vegetables, dark leafy greens, liver), vitamin B12 (liver, fish, milk), and folate (dark leafy greens, liver, legumes, okra); few affordable sources of iron and calcium (dark leafy greens); and no affordable sources of zinc. Affordability of animal-source protein varies, with several options in Pakistan (fish, chicken, eggs, beef) and India (fish, eggs, milk) but few in Bangladesh (eggs). Approaches to reduce prices, enhance household production, or increase incomes are needed to improve affordability.

Conditional cash transfer and/or lipid-based nutrient supplement targeting the first 1000 d of life increased attendance at preventive care services but did not improve linear growth in young children in rural Mali: results of a cluster-randomized controlled trial.

BACKGROUND: In 2014, the World Food Programme added to an ongoing health and nutrition program named "Santé Nutritionnelle à Assise Communautaire dans la région de Kayes" (SNACK), the distribution of cash to mothers and/or lipid-based nutrient supplement (LNS) to children aged 6-23 mo, conditional upon attendance at community health centers (CHCs) during the first 1000 d of life. OBJECTIVE: We evaluated the additional impact of the distribution of cash and/or LNS on mean height-for-age z scores (HAZ; primary outcome), stunting (HAZ < -2), and on intermediate outcomes along the program impact pathways. METHODS: In a cluster-randomized controlled trial using a 2 × 2 factorial design, 76 CHCs were randomly assigned to deliver either SNACK, SNACK + Cash, SNACK + LNS, or SNACK + Cash + LNS. Cross-sectional surveys among 12- to 42-mo-old children and their mothers were conducted at baseline (2013, n = 5046) and at endline (2016, n = 5098). RESULTS: Factorial analysis showed no interaction between cash and LNS treatments for HAZ, but found an antagonistic interaction for stunting (OR: 1.55; 95% CI: 1.05, 2.31; P = 0.03). There were no impacts of the cash, LNS, or cash + LNS treatments, compared with the SNACK alone, on either HAZ or stunting (treatment × time interaction). There were significant impacts of the LNS and cash + LNS treatments on attendance at ≥1 growth monitoring (GM) session (OR: 3.95; 95% CI: 1.69, 9.24; OR: 3.90; 95% CI: 1.73, 8.81, respectively) and half the expected sessions (OR: 4.72; 95% CI: 1.47, 15.17; OR: 5.25; 95% CI: 1.82, 15.11, respectively), mothers' knowledge on importance of GM (OR: 1.98; 95% CI: 1.16, 3.39; OR: 3.12; 95% CI: 1.60, 6.09, respectively), and, only for the LNS group, appropriate timing for complementary feeding (OR: 1.62; 95% CI: 1.09, 2.41). CONCLUSIONS: Implementation constraints and suboptimal participation in program activities may explain the lack of impact on child linear growth in this rural region of Mali.This trial was registered at www.isrctn.com as ISRCTN08435964.

Reducing micronutrient deficiencies in Pakistani children: are subsidies on fortified complementary foods cost-effective?

OBJECTIVE: To estimate the cost-effectiveness of price subsidies on fortified packaged complementary foods (FPCF) in reducing iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in Pakistani children. DESIGN: The study proceeded in three steps: (i) we determined the current lifetime costs of the three micronutrient deficiencies with a health economic model; (ii) we assessed the price sensitivity of demand for FPCF with a market survey in two Pakistani districts; (iii) we combined the findings of the first two steps with the results of a systematic review on the effectiveness of FPCF in reducing micronutrient deficiencies. The cost-effectiveness was estimated by comparing the net social cost of price subsidies with the disability-adjusted life years (DALY) averted. SETTING: Districts of Faisalabad and Hyderabad in Pakistan. SUBJECTS: Households with 6-23-month-old children stratified by socio-economic strata. RESULTS: The lifetime social costs of iodine deficiency, iron-deficiency anaemia and vitamin A deficiency in 6-23-month-old children amounted to production losses of $US 209 million and 175 000 DALY. Poor households incurred the highest costs, yet even wealthier households suffered substantial losses. Wealthier households were more likely to buy FPCF. The net cost per DALY of the interventions ranged from a return per DALY averted of $US 783 to $US 65. Interventions targeted at poorer households were most cost-effective. CONCLUSIONS: Price subsidies on FPCF might be a cost-effective way to reduce the societal costs of micronutrient deficiencies in 6-23-month-old children in Pakistan. Interventions targeting poorer households are especially cost-effective.

Cost-effectiveness of prenatal food and micronutrient interventions on under-five mortality and stunting: Analysis of data from the MINIMat randomized trial, Bangladesh.

INTRODUCTION: Nutrition interventions may have favourable as well as unfavourable effects. The Maternal and Infant Nutrition Interventions in Matlab (MINIMat), with early prenatal food and micronutrient supplementation, reduced infant mortality and were reported to be very cost-effective. However, the multiple micronutrients (MMS) supplement was associated with an increased risk of stunted growth in infancy and early childhood. This unfavourable outcome was not included in the previous cost-effectiveness analysis. The aim of this study is to evaluate whether the MINIMat interventions remain cost-effective in view of both favourable (decreased under-five-years mortality) and unfavourable (increased stunting) outcomes. METHOD: Pregnant women in rural Bangladesh, where food insecurity still is prevalent, were randomized to early (E) or usual (U) invitation to be given food supplementation and daily doses of 30 mg, or 60 mg iron with 400 µg of folic acid, or MMS with 15 micronutrients including 30 mg iron and 400 µg of folic acid. E reduced stunting at 4.5 years compared with U, MMS increased stunting at 4.5 years compared with Fe60, while the combination EMMS reduced infant mortality compared with UFe60. The outcome measure used was disability adjusted life years (DALYs), a measure of overall disease burden that combines years of life lost due to premature mortality (under five-year mortality) and years lived with disability (stunting). Incremental cost effectiveness ratios were calculated using cost data from already published studies. RESULTS: By incrementing UFe60 (standard practice) to EMMS, one DALY could be averted at a cost of US$24. CONCLUSION: When both favourable and unfavourable outcomes were included in the analysis, early prenatal food and multiple micronutrient interventions remained highly cost effective and seem to be meaningful from a public health perspective.

Scaling-up interventions to improve infant and young child feeding in India: What will it take?

We assessed India's readiness to deliver infant and young child feeding (IYCF) interventions by examining elements related to policy, implementation, financing, and evidence. We based our analysis on review of (a) nutrition policy guidance and program platforms, (b) published literature on interventions to improve IYCF in India, and (c) IYCF program models implemented between 2007 and 2012. We find that Indian policies are well aligned with global technical guidance on counselling interventions. However, guidelines for complementary food supplements (CFS) need to be reexamined. Two national programs with the operational infrastructure to deliver IYCF interventions offer great potential for scale, but more operational guidance, capacity, and monitoring are needed to actively support delivery of IYCF counselling at scale by available frontline workers. Many IYCF implementation efforts to date have experimented with approaches to improve breastfeeding and initiation of complementary feeding but not with improving diet diversity or the quality of food supplements. Financing is currently inadequate to deliver CFS at scale, and governance issues affect the quality and reach of CFS. Available evidence from Indian studies supports the use of counselling strategies to improve breastfeeding practices and initiation of complementary feeding, but limited evidence exists on improving full spectrum of IYCF practices and the impact and operational aspects of CFS in India. We conclude that India is well positioned to support the full spectrum of IYCF using existing policies and delivery platforms, but capacity, financing, and evidence gaps on critical areas of programming can limit impact at scale.

Cost of childhood diarrhoea in rural South Africa: exploring cost-effectiveness of universal zinc supplementation.

OBJECTIVE: To describe the cost of diarrhoeal illness in children aged 6-24 months in a rural South African community and to determine the threshold prevalence of stunting at which universal Zn plus vitamin A supplementation (VAZ) would be more cost-effective than vitamin A alone (VA) in preventing diarrhoea. DESIGN: We conducted a cost analysis using primary and secondary data sources. Using simulations we examined incremental costs of VAZ relative to VA while varying stunting prevalence. SETTING: Data on efficacy and societal costs were largely from a South African trial. Secondary data were from local and international published sources. SUBJECTS: The trial included children aged 6-24 months. The secondary data sources were a South African health economics survey and the WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. RESULTS: In the trial, stunted children supplemented with VAZ had 2·04 episodes (95 % CI 1·37, 3·05) of diarrhoea per child-year compared with 3·92 episodes (95 % CI 3·02, 5·09) in the VA arm. Average cost of illness was $Int 7·80 per episode (10th, 90th centile: $Int 0·28, $Int 15·63), assuming a minimum standard of care (oral rehydration and 14 d of therapeutic Zn). In simulation scenarios universal VAZ had low incremental costs or became cost-saving relative to VA when the prevalence of stunting was close to 20 %. Incremental cost-effectiveness ratios were sensitive to the cost of intervention and coverage levels. CONCLUSIONS: This simulation suggests that universal VAZ would be cost-effective at current levels of stunting in parts of South Africa. This requires further validation under actual programmatic conditions.

Papel de los cereales en la alimentación infantil / Role of the cereals in infant feeding

En el primer año de vida, la lactancia materna es el referente durante al menos los 6 primeros meses, pero hay una cierta dispersión de tendencias cuando se llega a la edad de introducir la alimentación complementaria. Tradicionalmente, los cereales han sido y son los primeros alimentos que se aconsejan como inicio de la alimentación complementaria. En los últimos tiempos se ha observado un descenso que posiblemente esté relacionado con algunos tópicos negativos, por lo que nos ha parecido oportuno actualizar su papel. Las características fisiológicas de los primeros años de vida son circunstancias que tienen gran importancia para conseguir una buena adaptación en la progresión de la alimentación atendiendo a las capacidades que el nuevo ser va adquiriendo en estos primeros años, preferentemente en sus funciones digestivas, renales y neuromusculares. Los cereales son una excelente fuente nutricional, pero no todos tienen las mismas propiedades, por lo que se repasa su composición para valorar los beneficios que representan en la salud del niño, tanto como aporte de la energía que va necesitando para cubrir sus necesidades, como para evitar deficiencias proteicas y de vitaminas y oligoelementos. No sólo es importante la cantidad, sino también la calidad y el contexto de una alimentación variada y equilibrada que ayude a compensar el resto de los aportes. Ya que los cereales son fundamentales en la alimentación de nuestros hijos, es bueno recordar algunas recomendaciones actualizadas sobre su uso en los diferentes periodos de la vida, ya sea en forma de papillas en los primeros meses o de cereales más complejos en etapas más avanzadas, así como resaltar la vigencia que conservan en la alimentación de los primeros años si se utilizan correctamente(AU)

In the first year, the breastfeeding is the gold standard for at least the first 6 months, but there is some dispersion of trends when it reaches the age of introducing complementary feeding. Traditionally, cereals are and have been the first foods that have been recommended as the start of complementary feeding. In recent times there has been a decline that is possibly related to some negative stereotypes so we thought it timely to update its role. The physiological characteristics of the first years of life are circumstances that are very important to get a good fit in the progression of food in response to the new capabilities will be acquired, in these early years, preferably in their digestive, renal and neuromuscular functions. Cereals are an excellent source of nutrition, but not everyone has the same properties, so it reviews the composition thereof, to assess the benefits that they have to the health of children, as well as the energy input is needed to cover their needs, and to avoid protected of deficits in vitamins and trace elements. Not only the quantity is important, it is undoubtedly the quality of them and place them in a context of varied and balanced diet that helps compensate the rest of the contributions. Being important cereals in the diet of our children, we should remember some updated recommendations in different periods of life will have on their use, either in the form of porridge in the early days, as more complex grain more advanced age and highlight the effect that conserve importance in the early years if used correctly(AU)

Alimentación complementaria dirigida por el bebé («baby-led weaning»). ¿Es una aproximación válida a la introducción de nuevos alimentos en el lactante? / Baby-led weaning, a valid approach to complementary feeding?

Tradicionalmente, la introducción de la alimentación complementaria pasa por un periodo de alimentación triturada, hasta que el lactante adquiere las habilidades para tomar comida en trocitos. En la práctica, el momento de la introducción de alimentos no triturados se ha ido retrasando, lo que ha llevado a una mayor frecuencia de problemas en la alimentación en esa edad. La alimentación complementaria guiada por el bebé (baby-led weaning) se basa en que sea el propio lactante quien se alimenta llevándose la comida a la boca, en vez de ser alimentado con una cuchara por un adulto. En esta práctica, el lactante se incorpora pronto a la comida familiar y comparte su menú, manteniendo la lactancia materna. Algunos estudios observacionales de pequeño tamaño sugieren que esta técnica favorece los patrones de alimentación, aunque no se ha podido demostrar si se plasma en efectos beneficiosos para la salud. Su difusión surge a raíz de la recomendación de la Organización Mundial de la Salud de retrasar la introducción de la alimentación complementaria hasta los 6 meses, en un momento en que el lactante ha alcanzado hitos importantes en su desarrollo, lo que haría posible que se alimentara por sí mismo. Algunos de los aspectos contenidos en esta filosofía serían válidos para la mayoría de los lactantes, aunque es difícil aceptarlo en su radicalidad (oposición a las comidas con cuchara). Las principales dudas que se plantean respecto a esta técnica son saber si el lactante recibe suficiente variedad de nutrientes y en una cuantía suficiente (p. ej., el hierro), si existe riesgo de atragantamiento y si la técnica es aplicable en todos los niños. A fecha de hoy, parece importante que los pediatras conozcamos en qué consiste esta técnica de alimentación y podamos responder a las preguntas de los padres sobre su eficacia y seguridad(AU)

Usually complementary feedings include, at least temporar­ily, pureed foods or spoon foods until infant is able to grasp food and feed herself. In daily practice time for chewable foods has delayed is this is a cause of eating problems in late infancy. Baby-led weaning (BLW) is an alternative approach for introducing complementary foods that emphasises infant self-feeding rather than adult spoon-feeding. In this way infants early joins family meals and share familial menu. Some small observacional studies suggest that this approach enhances eating patterns, although benefits for health are still to be probed. Its diffusion is according to the recommendations from the WHO to delay complementary feedings till 6 months of age. Many of the considerations of these phylosophy could be applied to most infants, although it is difficult to agree in some radical aspects (opposition to pureed foods). Main unanswered questions are: do infants following BLW obtain sufficient nutrients, including energy and iron? Are iron deficiency, choking and growth faltering real concerns for those following BLW approach? Is the technique suitable for all infants? Up to date, it seems important that pediatricians know about BLW approach, its benefits and risks(AU)

The potential role of small fish species in improving micronutrient deficiencies in developing countries: building evidence.

OBJECTIVE: To build a comprehensive overview of the potential role of fish in improving nutrition with respect to certain micronutrient deficiencies in developing countries. DESIGN: A comprehensive literature review was completed. For this the electronic library databases ASFA, CABD and Scopus were systematically searched and relevant references cited in these sources were carefully analysed. The search terms used were 'fish', 'small fish species', 'micronutrients', 'food-based strategies', 'fish consumption' and 'developing countries'. The quality of data on nutritional analyses was carefully reviewed and data that lacked proper information on methods, units and samples were excluded. RESULTS: The evidence collected confirmed the high levels of vitamin A, Fe and Zn in some of the small fish species in developing countries. These small fish are reported to be more affordable and accessible than the larger fish and other usual animal-source foods and vegetables. Evidence suggests that these locally available small fish have considerable potential as cost-effective food-based strategies to enhance micronutrient intakes or as a complementary food for undernourished children. However, the present review shows that only a few studies have been able to rigorously assess the impact of fish consumption on improved nutritional status in developing countries. CONCLUSIONS: Further research is required in areas such as determination of fish consumption patterns of poor households, the nutritional value of local fish and other aquatic animals and the impact of fish intake on improved nutritional status in developing countries where undernutrition is a major public health problem.

Alimentación complementaria / Supplementary feeding

La alimentación complementaria, se define como el proceso que se inicia con la introduccióngradual y paulatina de alimentos que sean diferentes a la leche materna o en su defecto a la fórmula infantil. La AAP, la ESPGHAN, la UNICEF y la OMS, recomiendan la lactancia materna exclusiva entre los 4 y 6 meses edad. Existe un mayor riesgo de alergia alimentaria en el niño menor. La evaluación de la alimentación del niño debe incluir, entre otros, conocer el tipo de alimentación láctea que recibió el niño; y que: los alimentos sean preparados de forma higiénica; los utensilios sean adecuados; hay adiversidad, variación y combinación de alimentos; el aporte energético sea el adecuado; la textura y consistencia de los alimentos vaya progresando y sea adecuado para su desarrollo neurológico; no haya ninguna intolerancia o reacción adversa respecto a la alimentación, y el crecimiento pondoestatural sea adecuado, entre otros.

Complementary feeding is defined as the process begins with the gradual and progressive introduction of foods that are different from breast milk or failing to infant formula. The AAP, theESPGHAN, UNICEF and WHO recommend exclusive breastfeeding between 4 and 6 monthsof age. There is an increased risk of food allergy in the minor child. The evaluation of the child's diet should include, among others, know the type of milk feeding the child received and that: the food is hygienically prepared, the tools are adequate, there is diversity, variation and combination offoods, the energy intake is adequate, the texture and consistency of food progresses and is suitablefor their neurological development, there is no intolerance or adverse reaction with respect tofood, and appropriate physical growth, among others.

Rede e apoio social e práticas alimentares de crianças no quarto mês de vida / Social network, social support and feeding practices of infants in their fourth month

Cerca de 97 por cento das crianças brasileiras iniciam a amamentação ao peito nas primeiras horas de vida. No entanto, o início do desmame é precoce, ocorrendo nas primeiras semanas ou meses de vida, com a introdução de água, chás, sucos, outros leites e alimentos. Fatores sociais, culturais, psicológicos e econômicos, ligados à mãe e ao bebê, podem estar relacionados a variações das práticas alimentares de crianças nos primeiros meses de vida. OBJETIVO: Investigar a associação entre rede e apoio social e as práticas alimentares de lactentes no quarto mês de vida. MÉTODOS: Estudo seccional inserido em uma coorte prospectiva, tendo como população fonte recém-nascidos acolhidos em Unidades Básicas de Saúde da Secretaria Municipal de Saúde do Rio de Janeiro. Para avaliar as práticas alimentares foi aplicado às mães (n=313) um recordatório 24h adaptado e foram construídos dois indicadores considerando o consumo de alimentos sólidos e da alimentação láctea. Para medir rede social foram feitas perguntas relacionadas ao número de parentes e amigos com quem a mulher pode contar e à participação em atividades sociais em grupo. Para aferir apoio social foi utilizada uma escala utilizada no Medical Outcomes Study (MOS) e adaptada para uso no Brasil. A análise dos dados se baseou em modelos de regressão logística multinomial, estimando-se razões de chance e respectivos intervalos de 95 por cento de confiança para as associações entre as variáveis...

Análise econômica da suplementação protéico-energética de novilhos durante o período de transição entre água-seca / Economic analysis of protein and energy supplementation of steers during the transition period between the rainy and dry seasons

Avaliou-se economicamente o efeito da suplementação protéico-energética em dois níveis de ingestão diária, 0,17 por cento e 0,37 por cento do peso vivo, sobre o desempenho de novilhos, em pastagens de Brachiaria brizantha cv. Marandu utilizando-se 14 animais por tratamento. Os tratamentos foram: SM - suplementação mineral (controle), SUP1 - suplementação protéico-energética com média de ingestão diária de 0,17 por cento do peso vivo e SUP2 - suplementação protéico-energética com média de ingestão diária de 0,37 por cento do peso vivo. Novilhos que receberam a suplementação protéico-energética SUP1 e SUP2 apresentaram maiores ganhos de peso, 0,655 e 0,746kg/animal/dia, respectivamente em relação aos que receberam apenas suplementação mineral, 0,535kg/animal/dia. Os maiores lucros operacionais, observados para os animais dos tratamentos SUP1 e SUP2. 67,12 e 72,08 R$/animal/período, respectivamente, em relação aos do tratamento controle, 66,67 R$/animal/período; os resíduos para remuneração foram de R$59,92, R$55,10 e R$54,85/animal/período, para novilhos que receberam SUP2, SUP1 e SM, respectivamente e sugerem que a suplementação protéico-energética possibilitou maior retorno econômico.

The effects of protein and energy supplements at two levels of daily intake - 0.17 percent and 0.37 percent of live weight (LW) - on the performance of steers under Brachiaria brizantha cv. Marandu pasture were economically evaluated using 14 steers per treatment. Treatments were: MS - mineral supplementation (control), SUP1 - protein and energy supplementation with an average daily intake of 0.17 percent of live weight, and SUP2 - protein and energy supplementation with an average daily intake of 0.37 percent of live weight. Steers of treatments SUP1 and SUP2 showed higher weight gains, 0.655 and 0.746kg/animal/day, respectively, in relation to those in the control group, 0.535kg/animal/dia. Higher operational profits were observed, R$67.12/animal/period and R$72.08/animal/period, for steers from SUP1 and SUP2 treatments, respectively; in comparison to the R$66.67/animal/period for MS treatment. The residual remunerations of R$59.92, R$55.10, and R$54.85/animal/period, for steers from SUP2, SUP1, and SM, respectively, strongly suggest that energy-protein supplementation allow higher economic profit.

Programas de suplementación alimentaria y de fortificación de alimentos con micronutrientes en Chile / Programs of nutritional supplementation and micronutrient enrichment of foods in Chile

Los programas de suplementación alimentaria y de fortificación de alimentos en Chile datan de principios de siglo pasado. Estos programas han sufrido adecuaciones permanentes en el tiempo, adaptándose a los cambios epidemiológicos de nuestra población. Los programas vigentes hoy involucran a la población infantil, a las embarazadas, a los adultos mayores y a algunos grupos específicos de alto riesgo. El objetivo principal de todos los programas continúa siendo mantener óptimo el estado nutricional de nuestra población. Entre los logros más importantes se cuenta la disminución de grandes problemas de salud pública como lo son la desnutrición infantil, la anemia del lactante, la desnutrición de la embarazada, el bocio endémico y otros logros más recientes como la disminución de la prevalencia de las enfermedades del tubo neural y mejoría del estado nutricional y de la funcionalidad del adulto mayor. Como desafíos futuros se plantea continuar optimizando estos programas en cuanto a cobertura poblacional, calidad de productos según nuevas necesidades y según requerimientos especiales, y contribuir a la reducción de la obesidad y de la prevalencia de las enfermedades crónicas no transmisibles del adulto.

Avaliaçäo ex-post de três programas de intervençäo nutricional: gente da gente I, gente da gente II e prodea / Evaluation of three nutritional interventions implemented in the Northeast of Brazil between 90/November and 94/December

O objetivo da pesquisa foi avaliar três intervençöes nutricionais implementadas, no Nordeste do Brasil, entre nov/90 e dez/94: (Gente da Gente)GG-I, GG-II e Programa Emergencial de Alimentos (PRODEA). Com diferentes desenhos e mecanismos operacionais, visavam distribuir, gratuito e mensalmente, alimentos às famílias vitimadas pela seca, tendo em comum, o uso de gêneros, em vias de deterioraçäo, dos Estoques Governamentais de Alimentos (EGA). O aporte nutricional do GG-I, GG-II e PRODEA foi, respectivamente: energia 22,01 por cento; 21,63 por cento; e 16,31 por cento. Proteína: 22,98 por cento; 22,64 por cento; e 19,24 por cento. Fe: 22,09 por cento; 28,22 por cento; e 24,05 por cento. Vitamina A: 1,05 por cento; 0,72 por cento e 0,47 por cento. Os gastos por nutriente, em dólar, foi, respectivamente: Kcal (x1000) 0,24; 0,07; e 0,11. Proteína (gx1000): 11,66; 3,12; e 4,53. Fe (mg x1000): 46,26; 9,57; e 14,15. Vitamina A (ug RE x1000): 14,28; 5,47; e 10,51. Fez-se uso de documentos acadêmicos e governamentais e entrevistas. Determinou-se o aporte com base na Recommended Dietary Allowances (RDA) de 1989. As famílias foram caracterizadas a partir das PNADs 1990 e 1993. Determinou-se a composiçäo dos alimentos a partir da Tabela do IBGE de 1996 e os gastos foram convertidos em dólar americano e corrigidos para dezembro de 1994. Os resultados apontaram o GG-II como o melhor Programa, com menor custo operacional e maior aporte. Constatou-se, ainda, nas três Intervençöes, recorrência em açöes intermitentes e descontinuadas em algumas regiöes, e ausência de metas ou expressäo nutricionais, apesar do notório quadro carencial

Análise nutricional e complementaçäo alimentar de cesta básica derivada do consumo / Nutritional analysis and complementation of a food basket derived of the consumption

A "cesta básica DIEESE e PROCON", originada de uma Pesquisa de Padräo de Vida e Emprego no Município de Säo Paulo, tem sido empregada como parâmetro para o acompanhamento de preços. Seria desejável que um instrumento econômico, utilizado com esta finalidade, correspondesse também a uma nutriçäo efetivamente saudável. Assim, foram analisados os níveis de adequaçäo dos itens alimentares da cesta básica em relaçäo às necessidades nutricionais de uma família-referência paulistana, e propostas técnicas de complementaçäo dietética para sanar possíveis deficiências ou desbalanceamento. Utilizou-se o Censo Demográfico do IBGE, de 1991, para se determinar a família-referência; adotaram-se dois terços das "Recommended Dietary Allowances" como parâmetro de necessidades nutricionais; e utilizou-se das tabelas de composiçäo centesimal para verificaçäo do aporte de nutrientes da cesta básica. Efetuou-se a complementaçäo alimentar por meio de três diferentes métodos: Ad Hoc (proposta direta e fixa), Programaçäo Linear (proposta via computador e sazonal, com ênfase na minimizaçäo de custos), Híbrido (uma combinaçäo dos dois anteriores). Foram encontrados valores insuficientes para as vitaminas A, C, B2 e B6 e para os minerais Ca, Mg, Fe, Zn, I e Se; o percentual de lipídios no total calórico mostrou-se elevado. Entre as técnicas de complementaçäo, o método Híbrido pareceu assimilar, mais eficientemente, os baixos custos e os hábitos dietéticos. Inferiu-se uma eventual correspondência entre os problemas nutricionais detectados na relaçäo de itens da cesta básica e a chamada transiçäo alimentar que se processa nos países em desenvolvimento. Näo parece aconselhável que os riscos epidemiológicos associados a essa alteraçäo nos padröes dietéticos sejam incorporados num instrumento econômico que tenha por finalidade mensurar os preços de uma alimentaçäo equilibrada