Desirable Dietary Pattern for Bangladesh PI: Quamrun Nahar, PhD
Co-InvestigatorsProf Subhagata Choudhury, BIRDEMDr M Omar Faruque, BIRDEMSyeda Saliha Saliheen Sultana, HECDr 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
Indicator Prevalence (%)LBW 22*Stunting (U5) 41Wasting (U5) 16Under weight (U5) 36Zinc deficiency 44Anaemia 33.1
Current Nutrition situation in Bangladesh
*World Health Statistics; BDHS 2011
Indicators Prevalence (%)
Anaemia 26
Zinc deficiency 57.3
Iodine deficiency 42.1
Prevalence of selected micronutrient deficiencies among non pregnant non lactating women
National Micronutrient Survey 2011-12
Indicators Prevalence (%)
DM 7.9a
BMI > 25 18
HTN >140/90 14.8
Central obesity 21.7
Current Prevalence* of NCD
*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.
Basal metabolic rate (BMR)Physical activity level (PAL)
Calculation of energy requirement
18-29.9 yrs 30-59.9 yrs >60 yrsMale Female Male Female Male Female
BW BMR BW BMR BW BMR BW BMR BW BMR BW BMR
50 29 45 26 50 29 45 27 50 23 45 2455 28 50 25 55 27 50 25 55 22 50 2260 27 55 24 60 26 55 24 60 22 55 2165 26 60 23 65 25 60 22 65 21 60 2070 25 65 22 70 24 65 21 70 20 65 1975 24 70 22 75 23 70 20 75 20 70 1880 24 75 21 80 22 75 19 80 19 75 1885 23 80 21 85 22 80 19 85 19 80 1790 23 85 21 90 21 85 18 90 18 85 17
BMR (kcal/kg/d) in male and females adapted from FAO/WHO, 2004
BW, Body weight in Kg; BMR, Basal metabolic rate, kcal/kg/day
Activity PALSleep 1
Brick breaking 4Brick field worker 3Cutting trees 4.8Chopping wood 4.3Clearing ground 3.8Cooking 1.8
PAL (Physical activity level) of selected occupations
Physical activity levels of females (sedentary occupation)
Example: PAL calculation of a female banker
Per day activity (hr/day) hrs PAL Total PALWorking 8 1.3 10.4Sleeping 7 1 7Personal care 1 2.3 2.3
Eating, Cooking and Sitting 3 1.7 5.1
House hold working 2 1.95 3.9
Watching TV and chatting 3 1.4 4.2
Total time 24 32.9Average PAL 1.37
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
Classification of lifestyles in relation to physical activity, or PAL (FAO 2004)
UrbanMild, PAL (1.5)
Occupation PALOffice worker 1.41Private Driver 1.59Doctor 1.44Shopkeeper 1.36Banker 1.37
Moderate PAL (1.85)Occupation PALTailoring 1.88Laundry worker 1.85Shoe maker 1.78
Heavy, PAL(2.32)Rickshaw puller 2.84Day laboring 2.65Brick field worker 2Gardener 2.21Electrical worker 2.04
PAL of different occupations
Gender
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 trimester
2nd trimester
3rd trimester
Pregnancy 85 285 475
Lactation + 675 460
Calculated Energy Requirements for Bangladeshi Population
Energy Requirements = BMR X PAL X BW
Energy requirement for adult Bangladeshi populationDistribution 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 vitamins6 minerals
Vitamin C, Calcium and Iron (in mg) recommendations
19-50yrs Old(1992) Current (FAO-2004)
Vitamin C 30 45
Calcium 450 1000
Iron
Male 9
Bioavailability
15% 9.112% 11.410% 13.75% 27.4
Female 28
15% 19.612% 24.5
10% 29.4
5% 58.8
Analysis of Food Consumption, Household Income Expenditure Survey, 2010
Rice
Nn-leafy
vege
tables
Potatoes
Fishes
Fruits
WheatSp
ices
Leafy
vege
tables
Milk OIls Salt
Pulses
Poultry
Suga
r/molas
sesMeat Eg
g0
50
100
150
200
250
300
350
400
450 416
131
7050.3 45 40 40 36 32 20.4 15 14.7 11.5 9 7.3 5.72
Average food consumption (g) per capita per day
Shoal/Gajar/T
aki
Rhui/Katla
/Mrig
el/Kalbaush
Pangash/B
oal/Air
Hilsa
Sea Fish
Puti/Big puti/T
elapia/Nilo
tica
Other F
ishes(S
pecify)
Shrimp
Driede Fi
sh
Baila/T
apashi
Mala/Dhela/C
hapila/B
atashi
Tangra/Eelfish Koi
Silver c
arp/G
rass ca
rp/ M
iror c
arp
Magur/Shinghi/K
halisha
56789
1011
Diversity of Fish intake in Bangladeshi population g/capita/d
Diversity of vegetable intake in Bangladeshi population (g/capita/d)
Leafy ve
getab
le
Brinjal
White go
urd/Pumpkin
Caulifl
ower/Cab
bage
Water g
ourd
Perbol(pata
l)
Bean/Lo
beyArum
Green banan
a/ pap
aya
Snake
gourd
/Ribbed go
urd
Tomato
Radish
Balsam
apple
Ladies' fi
nger
10
15
20
25
30
35
4036.1
21.1
12 11.4 10.9 10.3
Macro and Micronutrient consumption
Energy (kcal) Protein, g CHO g Fat, g
2190±521 57.2±15.6 413± 106 29.3±14
Per capita per day macronutrient intake of Bangladeshi populations (weighted value), HIES, 2010
Requirement, 2430 kcal
Macronutriments Ranges of intake % Population
Carbohydrate
<55% 16.355 – 75% 43.3>75% 40.3
Protein
<10% 4010 – 15% 50>15% 10
Fat
<15% 5315 – 30% 44>30% 3
Distribution of population nutrient intake
VitaminsIntake (HIES 2010)
% of RNI,Male
% of RNI, Female
RNI
Male Female
Vitamin-A, retinol Eq (µg/day)
388±291 65 78 600 500
Vitamin-C mg/day 84.8±64.2 188 188 45 45
Thiamine (mg/day) 1.0±0.60 83 91 1.2 1.1
Riboflavin (mg/day) 0.80±0.35 62 73 1.3 1.1
Niacin(mg NEq/day) 17.8±10.2 111 127 16 14
Folic acid (µ/day) 197±81 49 49 400 400
Calcium (mg/day) 439±227 44 44 1000 1000
Current Intake and RNI of different Vitamins for adult Bangladeshi Population (can you show as% of RNI??)
MineralsIntake (HIES 2010)
% of RNI,Male
% of RNI,
Female
Bio-availabili
ty
RDA
Male Female
Zinc (mg/day)
10.03±2.62
71.6 102.3
High 4.2 3.0
Moderate 7.0 4.9
Low 14.0 9.8
Iron (mg/day)
10.96±3.82
40.0 18.6
15% 9.1 19.6
12% 11.4 24.5
10% 13.7 29.4
5 % 27.4 58.8
Zinc and Iron intake and RDA in adult Bangladeshi population
Household dietary diversity score (HDDS) analysis
HDDS considered is a measures of access to food at the house hold level
D 1 D2 D3 D4 D5 D6 D7 D8 D9 d10 D11 d12 D13 D146.4
6.456.5
6.556.6
6.656.7
6.756.8 6.77
6.65 6.656.61 6.59
6.57 6.586.61
6.57 6.56 6.55 6.546.58
6.63
Dietary Diversity Score (DDS): 6.6±1.4 out of 12 food groups
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 IDDS, out of 9 food groups
HDDS (Dhaka city, Khagrachari and Rangamati) and IDDS (Students and slum people)
00.5
11.5
22.5
33.5
44.5
54.6
3.7
IDDS
33.5
44.5
55.5
66.5
77.5
8 7.37.7 7.9
HDDS
Identification of key foodsConsidering 75% cumulative % of total nutrient
contribution
Food name Food nameMedium rice Indian Spinach
Wheat (Atta) ChapilaPotato Ripe bananaCoarse rice BeanLiquid milk CauliflowerChicken CabbageRohu RadishGreen gram (boot) PumpkinJack fruit Perbol (patal)Brinjal Dried Fish (chapila)Puti HilsaPangash GuavaLentil(musur) TomatoBeef Bitter gourdMango Shrimp
30 Key foods identified from HIES 2010 using methodology of Haytowitz et al., 2002
% o
f Tot
al P
rote
in
Key foods for protein
Rice
Wheat flour
Chicken
Lentils
PutiBeef
Black F
ish/B
aho
Aire Fi
sh
Silve
r curp
Skim
-milk
(Liquid)
Indian sp
inach0
10
20
30
40
50
6048
5 4 3 3 2 2 2 2 2 1
% o
f Tot
al Ir
on
Key Foods for Iron
Rice
Wheat flour
Turm
eric
Indian sp
inach
Cumin seed
PotatoLe
ntils
Bengal g
ram
Puti fish
Indian riv
er shad
,raw
Onion
Prawal/
potol
Coriander s
eedBeef
Chili(gre
en)0
5
10
15
20
25
3026
11
8 74 3 3 3 2 2 2 2 1 1 1
FoodDesirable (g/P/D) &% Energy (2310 Kcal),
Yusuf et al, 1996
Desirable intake (g/P/D) & % of energy
(2350 kcal) (suggested by the
Expert Committee on 07.08.2007)
Desirable intake (g/P/D) & % of energy (2430 kcal)
(DDP 2012)
Desirable intake % Energy Current
intake % Energy Desirable intake % Energy
Cereal 372 55 375 55 400 56Rice 312 46.6 350 51 350 49
Wheat & other cereals 60 8.4 25 4 50 7Pulses 66 10 60 8.8 50 6.5
Animal Foods 126 5 180 5.46 260 10.5Fish 50 55 2.1 60 3
Poultry & Meat 22 35 1.4 40 2Egg 7 15 0.58 30 2
Milk & milk products 47 75 2.9 130 3.5Fruits 57 2.5 100 4.2 100 3
VegetablesGLV
200100 2
Non leafy Vegetables 132 2.5 3.6 200 2
Potato 130 5 60 2.47 100 4Cooking oil 38 15 40 15.3 30 11
Sugar/ Gur/ Molasses 28 5 18 3.66 20 3Spices 10 20 0.42 20 2
Food taken outside Miscellaneous
Total (g) 959 100 1053 100 1280 100
Des
irab
le D
ieta
ry P
atte
rn
• 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)
Factors in Diet planning
Food cost per day, HIES, 2010Food cost / monthrange (Taka)
% HH Food cost (Taka)/person/day
4259-5304 65 35
5927-8247 34 52
>11014 1 82
Balanced food basket providing 2430 Kcal 71 taka/day
Food groups Amount (g)Portion
sizeEnergy (kcal)
% of total Energy Taka
Cereal
Rice parboiled (milled) 240
8 cup 844 338
Rice (flattened) 60 2 cup 213 5 3
Wheat flour (coarse) 60
4 small piece
200 92
Pulse 60 2/3 cup 201 8 4
Meat-fish-poultry 120
1 big piece meat, 1 egg
185
817
Vegetable 320 3 cup 114 5 2
Green leafy vegetables 130
1.25 cup 572
5
Oil 30 3 sp 270 11 5Fruit 300 3 cup 234 10 16Milk 130 1 cup 82 3 8Sugar 10 40 2 1
Total 1460 2440 100 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
Limit salt intake to half to one teaspoon (< 5g) a day.Use only iodized saltReduce consumption of highly salted foods and condiments and avoid extra table salt with meals
GUIDELINE 3: LIMIT SALT INTAKE AND CONDIMENTS AND USE ONLY IODIZED SALT
• 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 4: TAKE LESS SUGAR, SWEETS OR SWEETENED DRINKS
Drink 1.5 to 3.5 liter ( 6-14 glasses) clean and pure drinking waterDrink coconut water and fresh fruit juices instead of carbonated water
GUIDELINE 5: DRINK PLENTY OF WATER DAILY
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.
• 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.
Recommendations
Acknowledgements
Technical Assistance Team Dr Lalita Bhattacharjee, FAO
Dr Md Abdul Mannan, FAO
Supported by
Prof Nazmun NaharDirector General, BIRDEMJillan Waid, HKIProf Nazma Shaheen, INFS
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