Affordability of nutritious foods for complementary feeding in South Asia

Abstract

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.

Priority micronutrient density in foods

“…In addition to DGLVs, both eggs and dairy foods are excellent sources of priority micronutrients for lacto-ovo vegetarians and should be prioritized for regular consumption. Fortunately, eggs and dairy foods are among the more affordable animal-source foods per unit priority nutrient density, although not as affordable as organs and small fish, and they are still often inaccessible or unaffordable for people with limited resources 30,33 . Importantly, DGLVs and pulses are accessible and affordable sources of several priority micronutrients in most populations 30,33 .…”

“…Fortunately, eggs and dairy foods are among the more affordable animal-source foods per unit priority nutrient density, although not as affordable as organs and small fish, and they are still often inaccessible or unaffordable for people with limited resources 30,33 . Importantly, DGLVs and pulses are accessible and affordable sources of several priority micronutrients in most populations 30,33 . Further, traditional grains, including teff, quinoa, fonio, and millet, are at least moderately dense in iron, zinc, and folate and can also make significant contributions to nutrient adequacy.…”

“…Similarly, recommended intakes are based on dietary reference values that are appropriate for global populations, including LMICs, and were calculated for the general adult population as well as groups with increased needs. Our ratings prioritize foods that are optimal sources of micronutrients known to be commonly lacking and causing significant health burdens in LMICs, in alignment with the recommendation to focus nutrient profiling models for LMICs on nutrient density of beneficial nutrients, rather than nutrients to limit 33 . Lastly, the results are organized in clear and simple visualizations which are easily interpretable by non-technical audiences, including decision makers.…”

“…Researchers could build on this work by incorporating additional foods and food groups, including wild or indigenous vegetables, nuts, seeds, pulses, and insects 47 , many of which contain very high nutrient densities 48 . Moreover, these ratings could be paired with broader diet quality metrics 46 and included as an additional way to assess food affordability, for example, by expanding on existing approaches 30,33 , as has been done for other nutrient profiling systems 49 . Finally, these ratings could also be used for environmental impact assessments.…”

Nutrient shortfalls in young children’s diets and the role of affordability

“…An additional contribution of this work was to develop an approach to do so, using data on household consumption and expenditure, food prices, and food composition data. This method was applied to assess the affordability of the key nutrients commonly lacking in young children's diets (4,5). Foods were assessed in terms of their affordability for meeting needs for several micronutrients in combination.…”