Desirable Dietary Pattern for Bangladesh

1. PI: Quamrun Nahar, PhD Desirable Dietary Pattern for Bangladesh Co-Investigators Prof SubhagataChoudhury, BIRDEM Dr M Omar Faruque, BIRDEM SyedaSalihaSaliheen Sultana, HEC Dr MA Siddiquee, BRRI

2. 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

3. Current Nutrition situation in Bangladesh *World Health Statistics; BDHS 2011

4. Prevalence of selected micronutrient deficiencies among non pregnant non lactating women National Micronutrient Survey 2011-12

5. Current Prevalence* of NCD *National NCD survey 2010; aInternational Diabetes Federation (IDF)

6. 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.

7. Calculation of energy requirement Basal metabolic rate (BMR) Physical activity level (PAL)

8. 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

9. PAL (Physical activity level) of selected occupations

10. Physical activity levels of females (sedentary occupation)

11. Classification of lifestyles in relation to physical activity, or PAL (FAO 2004)

12. PAL of different occupations

13. Calculated Energy Requirements for Bangladeshi Population Energy Requirements = BMR X PAL X BW

14. Energy requirement for adult Bangladeshi population Distribution of Sedentary, moderate and heavy activity occupation in the Bangladeshi population Average Energy Requirements= 2430 kcal

15. Recommended nutrient intakes of micronutrients 11 vitamins 6 minerals

16. Vitamin C, Calcium and Iron (in mg) recommendations

17. Analysis of Food Consumption, Household Income Expenditure Survey, 2010

18. Average food consumption (g) per capita per day

19. Diversity of Fish intake in Bangladeshi population g/capita/d

20. Diversity of vegetable intake in Bangladeshi population (g/capita/d)

21. Macro and Micronutrient consumption

22. Per capita per day macronutrient intake of Bangladeshi populations (weighted value), HIES, 2010 Requirement, 2430 kcal

23. Distribution of population nutrient intake

24. Current Intake and RNI of different Vitamins for adult Bangladeshi Population (can you show as% of RNI??)

25. Zinc and Iron intake and RDA in adult Bangladeshi population

26. Household dietary diversity score (HDDS) analysis HDDS considered is a measures of access to food at the house hold level

27. Dietary Diversity Score (DDS): 6.6±1.4 out of 12 food groups HDDS of 14 differentdays 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

28. Population distribution by HDDS

29. HDDS, out of 12 food groups IDDS, out of 9 food groups HDDS (Dhaka city, Khagrachari and Rangamati) and IDDS (Students and slum people)

30. Identification of key foodsConsidering 75% cumulative % of total nutrient contribution

31. 30 Key foods identified from HIES 2010 using methodology of Haytowitz et al., 2002

32. % of Total Protein Key foods for protein

33. % of Total Iron Key Foods for Iron

34. Desirable Dietary Pattern

35. Factors in Diet planning • 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)

36. Food cost per day, HIES, 2010

37. Balanced food basket providing 2430 Kcal 71 taka/day

38. Dietary guidelines

39. 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

40. 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

41. Eat a variety of seasonal fresh fruits and vegetables everyday • Eat everyday 2 seasonalfruits (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

42. Consume adequate amounts of milk and milk products • Take at least one cup • (130 ml) milk/ doifor good source of calcium throughout the life for healthy bones and teeth • 2. Eat curd or drink soya milk in case of lactose intolerance

43. 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

44. GUIDELINE 3: LIMIT SALT INTAKE AND CONDIMENTS AND USE ONLY IODIZED SALT Limit salt intake to half to one teaspoon (< 5g) a day. Use only iodized salt Reduce consumption of highly salted foods and condiments and avoid extra table salt with meals

45. GUIDELINE 4: TAKE LESS SUGAR, SWEETS OR SWEETENED DRINKS • 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.

46. GUIDELINE 5: DRINK PLENTY OF WATER DAILY • Drink 1.5 to 3.5 liter ( 6-14 glasses) clean and pure drinking water • Drink coconut water and fresh fruit juices instead of carbonated water

47. 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

48. 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) • Practiseminimum thirty minutes of daily aerobic physical activities - walking, running, jogging, cycling, household work

49. 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

50. 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)