Sufficiency in the Developing


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Original

Article Food and Nutrition Bulletin 1-

The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

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Organization

Zambia

an introduction

Statistical

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2015. 6. Fiedler JL, Lividini K, Zulu R, Kabaghe G,

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Survey( LCMS) consumption nutrient

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the

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Descriptive Agricultural

The

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Health Nutr. 2004; 7( 1A): 245- 250.

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Funding research,

of chronic diseases:

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on diet, nutri-

Interests

10.

The

Statistics

and Analysis for Zambia in Support of the USAID

joint WHO/ FAO expert consultation Declaration

gap-

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Food Nutr Bull. 2013; 34( 4):

population

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actual

the true

measured

errors result

Monitoring

the

underestimate

overestimate

deficiencies

measurement

tion

may

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impasse.

480- 500.

Conditions

Living

the

of

Living Condi-

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ing the food and nutrition

The

to methods

Food Nutr Bull. 2012;

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food-

Note 1.

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tions Monitoring Survey Report 2006 and 2010. Web site. http:// www. zamstats. gov. zm/ nada/

for

people

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M,

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availabil-

own

programs:

and their application.

policy

potential

ASF.

of

develop

to

balanced,

a

the

G, Razes

consumption to inform food fortification and other nutrition

the

and

E, Palma

4. Dary 0, Imhoff-Kunsch B. Measurement of food

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improvements

nutritional

vitamin with

whereas

Program

increasing

of

ity,

nutrients

appreciate

tages

iron,

3.

protein,

dramatically

meat

these

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micronutrient

Supplementation

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The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

5. Central

Organization

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an introduction

Statistical

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2015. 6. Fiedler JL, Lividini K, Zulu R, Kabaghe G,

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Article Food and Nutrition Bulletin 1-

The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

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The Importance

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Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

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Organization

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The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

5. Central

Organization

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Statistical

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IFPRI); 2001: 80.

T. Using reference

S214- S220.

controlled

intervention trial. Public Health Nutrition.

animal- source

RS, Cavalli- Sforza

cation planning in countries in the Western Pacific

morbidity in Kenyan

2013; 16( 9): 1593- 1604.

other

of

to identify likely micronutrient deficits for fortifi-

CG, Bwibo snacks

feeding

A Review

nutrient density goals with food balance sheet data

2014; 111( 5): 875- 886. 56.

A and Iron Deficiencies?

Recent Evidence. Washington, DC; International

intervention trial. Br J Nutr.

feeding

controlled

school

primary

schoolchildren

Vitamin

foods have

source

ofA Technical Consultation. Geneva, Switzerland: Animal

Quality for Washington,

ChilDC:

World Health Organization; 2003. 75.

Katona P, Katona- Apte J. The interaction between nutrition

and infection.

46( 10): 1582- 1588.

Clin Infect Dis. 2008;

Original

Article Food and Nutrition Bulletin 1-

The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

5. Central

Organization

Zambia

an introduction

Statistical

Office ( CSO).

2015. 6. Fiedler JL, Lividini K, Zulu R, Kabaghe G,

and nutri-

Tehinse J, Bermudez OI. Identifying Zambia' s industrial fortification options: toward overcom-

health.

induced results

Survey( LCMS) consumption nutrient

food

about

as

from

consumed

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sumed

food

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the

a

was

purchased

by

food

Descriptive Agricultural

The

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consumed

to,

Mission' s Feed the Future Strategic Review. 2011.

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8. World Health Organization.

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NLiS Country Profile:

Zambia. Web site. http:// apps. who. int/nutrition/ landscape/ report. aspx? iso= zmb. Accessed May

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Conflicting

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tion and the prevention

no potential conflicts of

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Health Nutr. 2004; 7( 1A): 245- 250.

article.

Funding research,

of chronic diseases:

cess, product and policy implications. Public Central Statistical Office MoH, International

Zambia Demographic 2014. s)

author(

on diet, nutri-

Interests

10.

The

Statistics

and Analysis for Zambia in Support of the USAID

joint WHO/ FAO expert consultation Declaration

gap-

7. Sitko N, Chapoto A, Kabwe S, et al. Technical Compendium:

lack

prior

information

Food Nutr Bull. 2013; 34( 4):

population

away from home. The

LCMS did include food that from home

actual

the true

measured

errors result

Monitoring

the

underestimate

overestimate

deficiencies

measurement

tion

may

and

impasse.

480- 500.

Conditions

Living

the

of

Living Condi-

on

ing the food and nutrition

The

to methods

Food Nutr Bull. 2012;

index. php/ catalog/ 59. Accessed September 18,

food-

Note 1.

of the

tions Monitoring Survey Report 2006 and 2010. Web site. http:// www. zamstats. gov. zm/ nada/

for

people

diversified,

M,

33( 3 suppl): S141- S145.

availabil-

own

programs:

and their application.

policy

potential

ASF.

of

develop

to

balanced,

a

the

G, Razes

consumption to inform food fortification and other nutrition

the

and

E, Palma

4. Dary 0, Imhoff-Kunsch B. Measurement of food

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by increasing

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tious

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nutritional

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Bader

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Siamusantu

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improves

reduces

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and

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marginally

countries,

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also

only

improvements

nutritional

vitamin with

whereas

Program

increasing

of

ity,

nutrients

appreciate

tages

iron,

3.

protein,

dramatically

meat

these

profile.

nutrient

including

available

of

based

micronutrient

Supplementation

D.

and

supply

plant-

zinc,

of milk

Multiple

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of

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for the

Central

and Health

Statistical

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Survey 2013–

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of

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The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

5. Central

Organization

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Statistical

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Article Food and Nutrition Bulletin 1-

The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

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food

actually

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This

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stor-

means

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level

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status

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It is

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Zhang

et

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I I

al

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the

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other

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The Importance

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Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

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Organization

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The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

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Organization

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Statistical

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Agriculture Organization; 2002.

59. Milton K. The

60.

S, Monteiro

70. Jacobs K, Sumner DA. The Food Balance Sheets

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Rev. 2013; 14( suppl 1): 135- 149.

227- 243. 58.

2012; 33( 3

diet quality globally: a step- wise approach. Obes

of milk and

Food Nutr Bull. 2011; 32( 3):

countries.

Food Nutr Bull.

et al. Monitoring and benchmarking population

57. Dror DK, Allen LH. The importance

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IFPRI); 2001: 80.

T. Using reference

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animal- source

RS, Cavalli- Sforza

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morbidity in Kenyan

2013; 16( 9): 1593- 1604.

other

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feeding

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Recent Evidence. Washington, DC; International

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primary

schoolchildren

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Original

Article Food and Nutrition Bulletin 1-

The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

16. 10.

5

9

770 180

6

0

15. 10.

0

0

15.

8.

0

5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

5. Central

Organization

Zambia

an introduction

Statistical

Office ( CSO).

2015. 6. Fiedler JL, Lividini K, Zulu R, Kabaghe G,

and nutri-

Tehinse J, Bermudez OI. Identifying Zambia' s industrial fortification options: toward overcom-

health.

induced results

Survey( LCMS) consumption nutrient

food

about

as

from

consumed

during,

sumed

food

or

the

a

was

purchased

by

food

Descriptive Agricultural

The

intake. The

consumed

to,

Mission' s Feed the Future Strategic Review. 2011.

informa-

of

8. World Health Organization.

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but

NLiS Country Profile:

Zambia. Web site. http:// apps. who. int/nutrition/ landscape/ report. aspx? iso= zmb. Accessed May

con-

29, 2015. recall

period.

9. Nishida C, Uauy R, Kumanyika S, Shetty P. The

with

to the

respect

cation of

of

Conflicting

declared

author( s)

this

tion and the prevention

no potential conflicts of

research,

authorship,

interest

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and/ or publi-

Health Nutr. 2004; 7( 1A): 245- 250.

article.

Funding research,

of chronic diseases:

cess, product and policy implications. Public Central Statistical Office MoH, International

Zambia Demographic 2014. s)

author(

on diet, nutri-

Interests

10.

The

Statistics

and Analysis for Zambia in Support of the USAID

joint WHO/ FAO expert consultation Declaration

gap-

7. Sitko N, Chapoto A, Kabwe S, et al. Technical Compendium:

lack

prior

information

Food Nutr Bull. 2013; 34( 4):

population

away from home. The

LCMS did include food that from home

actual

the true

measured

errors result

Monitoring

the

underestimate

overestimate

deficiencies

measurement

tion

may

and

impasse.

480- 500.

Conditions

Living

the

of

Living Condi-

on

ing the food and nutrition

The

to methods

Food Nutr Bull. 2012;

index. php/ catalog/ 59. Accessed September 18,

food-

Note 1.

of the

tions Monitoring Survey Report 2006 and 2010. Web site. http:// www. zamstats. gov. zm/ nada/

for

people

diversified,

M,

33( 3 suppl): S141- S145.

availabil-

own

programs:

and their application.

policy

potential

ASF.

of

develop

to

balanced,

a

the

G, Razes

consumption to inform food fortification and other nutrition

the

and

E, Palma

4. Dary 0, Imhoff-Kunsch B. Measurement of food

advan-

in Zambia,

by increasing

guidelines

diet for better

tious

and

nutritional

utilization

need

changes

Bader

United Nations; 2009.

more

adding

WS,

files— Food and Agriculture

small

their

Siamusantu

Dop MC. Nutrition Country Profile for the Republic of Zambia. Rome, Italy: Country Pro-

A,

improves

reduces

planners the

ASF

and

and

marginally

countries,

accessibility,

also

only

improvements

nutritional

vitamin with

whereas

Program

increasing

of

ity,

nutrients

appreciate

tages

iron,

3.

protein,

dramatically

meat

these

profile.

nutrient

including

available

of

based

micronutrient

Supplementation

D.

and

supply

plant-

zinc,

of milk

Multiple

identified,

were

received

authorship,

no

financial

support

and/ or publication

of

this

for the

Central

and Health

Statistical

ICF.

Survey 2013–

Office,

Ministry

of

Health, and ICF International Report. Rockville,

article.

MD: Central Statistical Office, Ministry of Health, and ICF International; 2015.

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The Importance

Animal

of

Reprints and permission: sagepub. com/ journalsPermissions.

Source Foods for Nutrient

DOI:

I 0. 1 I 77/ 03795721

in the

Developing

nav

I 6647823

fnb. sagepub.

Sufficiency

14

The Author(5) 2016

com

SAGE

World: The Zambia Scenario

Zhiying Zhang,

PhD ( Cand)',

Peter

D. Goldsmith,

PhD2,

and Alex Winter- Nelson, PhD2

Abstract

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods( ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high- yielding and droughtresistant varieties that made cassava and oil crops more affordable and readily available. In this

research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods ( PSFs) or ASFs. The scenarios under study involve the addition of( I) I8 fl oz of whole cow' s milk;( 2) 60 g of beef, 30 g of chicken, and 5 g of beef liver;( 3) milk plus meat; or( 4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the" milk+ meat" group. The findings alert program planners and policy

makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant- based staples.

Keywords

animal source foods, plant source foods, food insecurity, hunger, low- income country, micronutrient malnutrition

Introduction Over the tion

of

past

I Department of Kinesiology and Community Health,

3 decades,

in Zambia

cassava

increased,

1 so

production

have

the

and

have

supply

University of Illinois at Urbana- Champaign, Champaign, IL, consump-

USA

dramatically

and

demand

for

2 Department of Agriculture and Consumer Economics, University of Illinois at Urbana- Champaign, Urbana, IL, USA

edible oils.2 On the other hand, concomitantly, the supply for human and

foods

marked

of animal

shift

of concern

consumption

in the

from

origin

of cereals,

has declined.

consumption

a nutritional

point

pattern

3

pulses,

Corresponding Author: Peter

Such

may be

of view.

D.

Goldsmith,

Department

of Agriculture

and

a

Consumer Economics, University of Illinois at UrbanaChampaign, Email:

Urbana, IL 61801,

pgoldsmi@illinois.

edu

USA.

2

Food and Nutrition Bulletin

Designing

an

requires

a good

file

nutrition

and

level

conducted

deficiencies

of

the Zambian

LCMS)

Note

cies (

iron,

especially

is

of

8 and

the

population

by FAO,

estimated of

energy from

of

the

is

still

the

statistics

national

the age

under

wasted,

been the

ditionally

the

at

from

resulting

been

children

with

A

since

the

vitamin

and

deficiency

are

intervention

intake

toward

the

iodized progress

of school

levels(<

72% in

of

100µg/

there

1993 to 4% den

study

sugar

and

1978

A

mothers

showed

been fortified

have

sup lementation

1998,

marked

started in reduction

to direct supplementation

mentation

reinforced,

program

also

due

respectively,

with

food-

1998. A

in

micronutrient

vita- Given

nutrient

children

and

of iron deficiency

15

LCMS

data.

87. 2%,

73. 1%,

hemoglobin from 65%

to

to 29%

in

39%

Data

on

anemia remains

the

intake

of other

average

intake

of vitamin

A,

Adjusting for bioavailability, 92. 8%

and

of the

Zambian'

s

fell below the estimated average requirements (

EARs).

A 2013 food consumption out to assess

survey was

the micronutrient

intake

of

vitamin A, iron, zinc, and vitamin B12 among women and children in 2 provinces in Zambia. 16 Results

food

elimination

percentage

low urinary iodine from

among

Significant the

for

strategies

Salt has been

1970s.

with

have tra-

preschool

in Zambia.

carried

deficiencies

micronutrient

in

of anemia(

intake of vitamin A, iron, and zinc, respectively,

chil-

Although

and

on

key

reported

reduced

2002. 3

supplementation

the

deficiency,

Zambian

with

underweight.

inadequate

since

of

women

iron, and zinc in Zambia is highly inadequate, according to the study using Zambia' s 2006

recom-

consistent

and

populations.

in Zambia

is

of pregnant

11. 0 g/ dL) decreased

able. The estimated

lower limit

WHO)

of iron/

micronutrients in Zambia are less readily avail-

share

10 are

3' 11

insecure

iodine

This

high

national

The

90%

over

the prevalence

prevalence

fulfilling

3

supplementation

nonpregnant women. 14 Despite this reduction, the

deficien-

5 are stunted and 6%

of

these

controlling

9

that 40%

15%

whereas

Biofortification

A

is

World Health Organization( 10%- 15%).

dren

energy

10%)

protein(

mendation (

children

53%

requirement

insufficient.

antenatal

concentration<

A in Zam-

though

13

for the country.

and 2003,

that

vitamin

The

persistent.

children

of childbearing

were supplemented with iron, although only 59% took them for more than 90 days. 10 Between 1998

women.

vitamin

women

in

folic acid has been provided by all health facili-

deficien-

anemia, and

subclinical

supply ( DES),

energy of

and

children

among

ties. In 2013 to 14,

deficien-

and

in 2003 among preschool 13%

In Zambia,

use

was

suggests

A,

vitamin

stunting,

and

high

still

75%

over

considerably

evidence

to

maize

several

to

22%

L) declined from 66%

µmol/

HarvestPlus announced the release of vitamin A

exten-

Monitoring

micronutrient

zinc,

among

iodine

dietary

has

past

54%

age. 3 The issue of vitamin A deficiency remains

3' 6' 7

of

bia

been

to

an important policy objective as just recently

micronutrient

micronutrient

multiple

and

Organi-

attempted

study

1997

of

survey

0. 70

centration (<

has been

survey

Conditions

Living

though the prevalence of low serum retinol con-

at

nationwide

for the

updated

Existing

have

The prevalence cies

no

population

a recent

data

in low-

collected

have

nor

measure

5' 6

iodine,

population.

nutrition

3

A deficiency remains a severe public health problem, especially among young children, even

pro-

to fill this gap, this survey

to

1).

Zambians of

and

dietary

Agricultural

and

general

2006

designed

B12,

the

Although

Survey (

national

Food

and sugar fortification. 12 But subclinical vitamin

program

consumption

seldom

nutrition

Zambia,

measured

sively

decades.

cies

the

by

FAO)

zation (

and

since

to 1971

1970

food

In Zambia,

countries.

consumption

the

of

the target

of

are 4

income

not

status

national

the individual

nutrition

understanding

Unfortunately,

food

effective

15%

that

showed

87%

and

of

children

under 5 were deficient in zinc and vitamin B, 2, For women, 95% were vitamin B12 respectively. deficient. These

studies

suggest

that

despite

efforts

in

mandatory biofortification and supplementation, has been limited success in reducing the bur-L) of vitamin A, B12, iron, and zinc deficiencies. in short- term

interventions such

and

fortification

food

still

as supple- Margarine need

to

be vitamin

the research in this article explores how whereas

based strategies might deficiencies that deficiencies

effectively combat

in

multiple rather are

than present,

for

Zambia. followsingle micro- min

food-

based

Zhang

et

diversification

dietary be

more

is

than

3

al

malnutrition 17' 18

insecurity.

communities

diversify

status, and

has been

animal

intake,

micronutrient

Livestock

production,

to

used

healthcare

as

well

37

Milk

ucts.

even

or

consumption

increases

producers,

dairy

through

the

results

cow

sale

dietary diversity

consumption,

39 nutritional mized

that direct ASF

show

only in

not

trials

controlled

and

experiments

quasi-

is

the risk of antagonistic

overload,

which

can be

improve the overall nutrition status populations

in Zambia

and other

In sum, because food- based dietary diversifi-

child

and

without

developing countries having multiple micronutrient malnutrition associated with food insecurity.

milk

from

supplementation

rando-

cation

approaches

multiple

may more

micronutrient

effectively

deficiencies,

address

and

there

exists evidence supporting the link between ASF

effective

quality40

diet

improving 44

score,

can

than single- nutrient supplements

of the vulnerable

where

Evidence

outcomes.

ASF

fore, increasing ASF intake has the potential to significantly

products.

increased

significantly

origin,

in alleviating poor micronutrient status. 67 There-

cow

among

in Rwanda

of plant

or nutrient

more effective

household

animal

found

were

raising

of

nutrients

interactions

38

incomes Similar

do

as

multiple

prod-

intake

meat

foods

An animal- based diet simultaneously provides

of

quality

dairy

among

producers and neighbors, and goat

better

with

in plant foods, such as nonheme iron and zinc. 66

also

variety

household

other

consumed

enhance the absorption of minerals and vitamins

Indir-

can

and beans,

and it is up to 10 times as absorbable.65 When

ani-

animal

sales

or

beef is more than twice that of maize

quality,

increase

wider

more

of

poor.

more

product

as

body. 61 Also, many minerals and vitamins, especially lipid-soluble vitamins, are provided primanly by foods of animal origin. Animal source foods are the almost exclusive dietary sources of 62 dietary vitamin B 12, highly bioavailable iron,63 and preformed vitamin A.64 The zinc content of

25- 31

the

of

32- 34

an

services

dietary

and

consumption.

animal

purchase

food,

nutritious

35

from

higher digestibility and thus are easier to absorb and be utilized by the

associ-

consumption

provides

for household

ectly, income be

which

tend to have 20% to 30%

nutrient

A positive

directly

can

alle-

food

sustainably

quality,

health

and

intervention

products

19- 24

foods ( ASFs)

source

and

between

observed

in of

in food- insecure

dietary

health.

products generally more closely match the amino acid requirements of humans than do PSFs and

suggests that

evidence

effectively

improve

overall

conditions

production

may

to

acceptable

fortification

or

Increasing

and

believed

are

culturally

under

livestock

promoting

mal

and

supplementation

viating

ation

approaches

sustainable

and micronutrient intake, the objectives of this

nutri-

and

status41-

tional

health

in promoting

also

study are to ( 1) track the dietary transition

various

26, 45- 5°

including

outcomes

growth,

assess

cogni-

27' 51' 52

function,

tive

but

53 physical

performance,

activity,

as well

as

reducing

57

food

consumption

and

pattern

in

life; ( 2) evaluate the macronutrient and micronu-

mor-

mortality56'

bidity

of children

and

in

trient profile of the current Zambian diet in order

developing

to identify the key nutrients likely to be Made-

countries.

Compared is

current

Zambia relative to recommendations fora healthy

and

54' 55 school

the

to

regarded

Animal

to

plant

have

source

58' 59

higher

foods

are

nutritional

not

a

only

quate in the diet of the Zambian population; and

ASF

foods ( PSFs),

source

value.

nutritionally

(

3) estimate the nutritional interventions

improvements

with moderate

amounts

through

of ASFs.

dense source of energy and readily digested protein

but

are

a compact

also

and

efficient

source

of

an array of bioavailable micronutrients that are difficult

include

formed

origin

iron, A),

vitamin

acid,

worldwide ated

in

obtain

of plant

trients

folic

to

adequate

with

which when

food

alone. zinc,

are

of

addressing

insecurity.

These

calcium,

vitamin

B12,

the

from

quantities

58' 60

foods

micronu-

retinol (

pre-

riboflavin,

and

greatest

malnutrition

Proteins

from

Methods To

accomplish

our

objectives,

we

adopt

an

approach based on nutrient density profiles derived from the FAO Food Balance Sheet( FBS) data because

nationwide

food

consumption

data

concern

at the individual level are not readily available. 68

associ-

We use scenario modeling analysis to explore the

animal

impact

of moderate

increases

in ASF

on

average

4

Food and Nutrition Bulletin

protein,

energy,

and

intake

micronutrient

in

The

FAO

with regular

FBS

contains

annually

estimates,

food supplies for

of national

updates,

95 food commodities across more than 170 tries

It has been widely

worldwide.

itoring

global,

consumption

long

status

69

comprehensive span

time

and

given

The data though

use

these data does involve the level

of

for a

valid

this

of

food

or "

for

available

Our study

Zambian

the Mediterranean

into meat

beans,

a

guideline.

of

for

3

2

of

The

71

This

cov-

based

was

was

China,

The baseline data

on

for

further

were

groups (

US

of

classified

grains,

fruits)

and

Guidelines.

Dietary

because Zambia food- based

food

available

then

referenced

has

oz

equivalent

3

ment

System

Dietary

program

were

bio- available protein

was

zinc ( phytate,

developed

calcium,

and animal

intake).

Food interactions within the same meal also

affect nutrient bioavailability.

But FBS data

reflect the aggregate national daily food supply, the analysis

meal data analysis.

reflected

all the foods

in this research

are consumed

Therefore,

assumes

in the same

that

meal.

Bioavailable iron at the level of preventing anemia, as measured by clinically detectable signs, was calculated

as well. For vitamin

zinc, 2 levels of availability

A and

were estimated:

for

persons with basal status, negligible stores but no functional impairment and for those with normastatus,

maintenance

of a reserve

adaptive

capacity.

For example, Zn-basal is the amount of zinc

needed to prevent clinically detectable signs of functional impairment. Zn- normative is the

not

yet

amount of zinc needed for the prevention of func-

dietary

amounts

meat

and and

for

using the

System,

nutrient

use

available

calculated

Assessment

bioavailable

content by taking into account protein bioavailability ( amino acid scores); dietary fiber intake; iron ( ascorbic acid); meat—fish— poultry protein intake; tannin- containing coffee or tea intake; and

impairment

version

primarily

for

and also for the generation

of a reserve

storage

of the

and

nutrient.

The concept of zinc for basal and normative sta-

tus is still accepted according to the most recent update by the FAO/ WHO/International Atomic Energy Agency ( IAEA) committee ( 2004). The International IZiNCG),

consumption

also estimates

We

of vegetables,

for the foods

as

fol-

fruit. profiles

approach,

lean

equivalent

lean

of

cups

oz

of the nutrient

for dietary comparisons. Additionally, the WorldFood Dietary Assess-

tional

daily

distribution

probabilistic

mended intake levels, is regarded to be superior

maintenance

8

are

The

opposed to statements as to discrete recom-

capita

food

group

on the estimated

requirements.

guide-

each

of milk,

al' s probability of deficiency for each nutrient based

dietary to the

2 African

of the software is the calculation of an individu-

for

per

including

countries, Kenya and Senegal. A unique feature

tive

recommended

cups

WorldFood 2.

States,

for

daily

capita

consumption

milk, vegetables,

was

nutrient

Zambian

Per

The

6. 5

grains,

beans, cups

2013.

food

main

national

Quantity

consumption

needed

aver-

available

countries.

items

guidelines

developed line.

the 5

the 2005

US

the

of

and

lowing

to

pattern

food

single

one

as

2005 to 2007.

years

All

read

estimated

items

Zambian

and

consumption

con-

reported from 6 countries,

thus limits separate

the

on

to those for United

compared

food

be

should

are

In the

food

using the FAO FBS

also

the

but

as ours.

such

food

1961 for

ASF

of

supply

data

various

period

the

consumption."

consumption

the

ering

of

not

that

quality tradeoffs in

intake"

compiles

amount

per

and

recognize

the terms "

article,

the

aggregate

aggregation

study

of

these

all

70

sumption"

age

we

data

of

nutritional

remainder

food

Thus,

cross-

and

on

for human

availability consumption.

data

analyses

based

food

of

series

represent

sta-

country for

allow

consumption

diet

a

actual

terms

food

universally

capita

of

specific

accepted

for human

available

mon-

of nutrition

historical

comparisons

nutrient

foods.

and

country-

coun-

for

used

trends

methods,

and

country

and

and

patterns

collection

foods

regional,

formal

tus. The

panel,

dietary research projects in developing countries. The database contains a list of over 1800 foods

Zambia.

Zinc Nutrition Consultative

in their first technical

document,

Group corn-

pares the estimated physiologic requirements for

absorbed/ available committees: and

Nutrition

zinc developed

by 3 expert

the FAO/ WHO/ IAEA, the US Food Board/ Institute

of

Medicine ( FNB/

Zhang

et

5

al

IOM),

Assessment

System

uses

the FAO/ WHO/ IAEA

corn-

estimated

to

the

relatively

program.

Similarly,

dietary

allowance (

IZiNCG

is higher than that recommended

RDA)

US FNB/ IOM. Thus, the

most

the

physiologic

For

detailed

zinc

by

FAO/ WHO/ IAEA

the

conservative

total

estimates

requirements

information

among

of

available

(

Milk plus meat.

4)

A baseline

the

estimated

of 2479 kcal.

diet plus extra plant- based

staples ( 123 g of cassava, 83 g of maize

flour, 7 g of wheat, 1 g of sweet potato,

by

1. 2 g of sugar, 5 g of palm oil, 0. 5 g of

sunflower seed oil, and 0. 5 g of cotton-

are

seed oil). These

additions

reflect a mix of

locally available PSF that when com-

of

bined

zinc.

the definition

on

meets

the

3

the

of meat, when combined

milk,

3)

recommended

for

the

energy requirement (

WorldFood

the

revised

with

physiologic

are

zinc

compared

and diversity

Dietary

research

available

IZiNCG

by

WorldFood in this

use

The

for

requirements

higher

73

1996).

mittee (

The

we

by

of zinc

estimates

72

IZiNCG.

and

with

the baseline

are isocaloric

to

the milk plus meat diet.

and

calculation of usable protein and all the bioavailable minerals, readers can refer to the user' s guide

for the WorldFood 2 Dietary Assessment System 73 program.

Following Zambian

Intake

EAR for

the

weighing

activity. level of

healthy

individuals,

the

meet

We

level

will

parsimony,

we

were

they We 50

years sex

ments

receive

of age,

as a

category,

the

rec-

For

nutrition.

on

the

of

results,

EAR males

because

as

results.

19

other

to age

have higher require-

generally

Therefore,

deficiencies gender

and

4

A

moderate

per

of

identifies

analysis

are

with

to

applicable

addition

the

amount

cow

milk).

to the levels

capita

Meat( 60 g g

that

in

scenarios,

return

our

other

groups.

intervening

whole

2)

to

people.

for nutrients to be considered potentially

age

1)

the

RDA

to the

analysis

nutrient

The

only

our

inadequate.

involve

adequate

comparable

groupings

of

percentage

the

RDA

the

sufficient

study because

focus

also

and

quite

97. 5%

a greater

report

intake

the needs

whereas

nutrient

of

assures

population

a

in this

the RDA

use

of

requirements

ommendation

cereals and starch roots as staples, followed by

to satisfy

of

the

grams available for Zambian consumption are

daily dietary

expected

found of

to the baseline,

following:

level

of milk

in Zambia

beef, 30 g

beef liver). The

18 fl

of milk (

This

The main food groups in terms of quantity in

both the RDA

healthy male 19 to 50 years of 79 kg, with moderate physical

nutrient

considers

use

Results

Dietary

a

a

of

50%

We

reports.

with

nutrient

the IOM' s

by

EAR is the

The

we compare

individual

each

recommended

Reference

age,

for

intake

the intakes

and

standard practice,

oz

of

reflects

a

animal

beverages, products (

fruits Table

and 1).

vegetables,

Although

the

and per

capita supply of cereals has declined steadily since the 1978 to 1983 period, the supply of starchy roots, which is comprised mainly of cassava,

has been increasing. Concomitantly, the availability of pulses and ASF has dropped since the 1970s and remains at a relatively low level. On the other hand, the per capita supply of vegetable oils and oil crops has increased dramatically in recent

years.

Alcoholic

beverages

available

for

Zambian consumption have dramatically declined from 314 g/per capita/ day in 1961 to 1965 to 79 g/ per capita/ day in 2008 to 2013 but still reflect a large component

of Zambian

national food availability. The total protein supply fell from 67 g/ capita/ day in 1977 to 45 g/ capita/ day in 2007, whereas fat supply has grown steadily from 29 g/ capita/ day in 1991 to 42 g/capita/ day in 2013. In fast developing countries such as China, per capita supply of ASF has been dramatically increasing, approaching the level for Mediterranean countries ( 778 kcal/ capita/ day) and the United States ( 995 kcal/ capita/ day; 1). The per capita supply of total animal

consumption

Figure

in the 1970s.

products in Zambia though has declined after the

of chicken,

addition

alcoholic

of

this

and

5

level

mid- 1970s, from an already very low level ( 164 capita/ day).

kcal/

6

Food and Nutrition Bulletin

Table

I. Trends in Per Capita Supply of Major Food Groups for Zambian

Consumption (

g/ capita/ day).

1961-

1966-

1972-

1978-

1984-

1990-

1996-

2002-

2008-

Major Food Groups

1965

1971

1977

1983

1986

1995

2001

2007

2013

Cereals (

491

479

507

506

470

433

409

366

355

134

145

136

157

173

231

240

253

255

90

90

88

88

86

79

67

67

71

34

34

31

32

33

30

29

29

28

7

2

3

5

4

7

5

46

40

34

41

40

40

39

Starchy

beer)

excl.

roots

Vegetables Fruits ( excl.

wine)

Pulses Meat

8 and

Fish,

offals

seafood

Milk(

butter)

excl.

45

48

32

42

34

25

25

24

20

19

18

36

51

55

37

26

29

22

21

23

3

6

12

11

7

8

10

9

9

1

1

2

1

1

1

1

1

Eggs fats

Animal

Oil

19

21

10

5

5

6

10

30

3

7

8

9

8

7

9

13

13

1

1

1

0

0

1

1

2

3

314

312

281

150

97

106

100

74

79

33

42

47

47

44

36

31

28

oils

Stimulants

1

14

crops

Vegetable

11

and

spices

Alcoholic beverages Sugar

17

and

sweeteners

Abbreviation: Excl., excluding.

1200

1000

a

4..-- s`•`•-°.. a-••• . . • •

a 800 600 -

y u) T,

QY 400 200 -

Year USA }

Mediterranean

China

Zambia

Figure I. Changes in annual supply of animal source foods ( ASF), 1961 to 2011 ( kcal/ capita/ day). Note: The Mediterranean

supply is based on the average of Italy, Portugal,

A baseline able

is

period,

based, of

8

diet, based

for Zambian found

exceeding oz

includes

grains

to the

by

little ASF

vegetables.

Only

on

all

consumption

be

100% (

avail-

2007

to

daily

recommended

and

foods

predominantly

over

3%,

the

in 2005

Figure

cereal

intake 2).

very few fresh fruits

22%,

5%,

and

40%

of

It and

the

Spain, Morocco,

recommended

Greece, Cyprus, and Croatia.

daily intake level of 3 cups of

milk, 6. 5 oz of meat and beans,

and 3 cups of vegetables The

DES

in the

baseline

2 cups of fruits,

are met, respectively. diet

was

about

1892

kcal/ per capita/ day, which was insufficient to meet the population' s average dietary energy requirement( ADER) of 2099 kcal/ per capita/ day

Zhang

et

7

al

300 Baseline

Mick

Meat

65Milk+ Meat

oBaseiine+

250 •

200 e

0

150 •

r 100 h0 •

Meat& Beans

Grains

Milk

Vegetables

Fruits

Food Groups

Figure 2. Distribution of food groups in the food supply of Zambia.

FAO

by

estimated

48. 1 g meets 86% low quality

found and

lysine.

supply

all

forms

The

By meet

67%

milk

Figure

in

of

2).

the

for

milk-

based

70%

of

1

up from

relatively such

products

as

amount

together

was

available vitamin

97%),

and

to the

level

still

yogurt,

All

the

population'

EER ( Table

s 2).

of recommendation. Dietary quality by 173%, 36%, and 66% in terms of

45%,

26%,

and

3%,

respectively. Adding

18 fl oz of whole cow milk lowers the probability of inadequacy for all of these nutrients to below 30%,

except

for

available

iron

and

zinc,

which

75%(

Figure 3). Therefore, adding milk alone is not sufficient for reducing the inadequacy of these 2 key micronutrients. Similarly, adding 60 g of beef, 30 g of chicken, and 5 g of beef liver to the baseline diet in scenario 2 increases the supply of" meat and beans"

remain

at

group to 56%

of the consumption recommenda-

18 fl

kcal) becomes sufficient for the population' s

other avail-

less than

when

increase

tion ( Figure 2). The dietary caloric intake ( 2140

consumed

reach

even

of the

3%

of

of milk(

or

to

of milk

There are few

consumption.

recommendation,

Figure

available

quantity

cheese

of

65%)

consumers

a current

small.

115%

risk

s milk

cow'

allows

recommended

Zambian

the

of whole

We regard this

products,

able

oz

scenario

products,

added as

dairy

18 fl

diet

for

90%

Protein supply becomes adequate, satisfying improves

81%).

anemia (

sufficient

fulfills

and

zinc,

inadequacy by

becomes

respectively. The supply of calcium and vitamin B12 increases more than 3- fold and vitamin A and B2 almost double. Vitamin D, zinc, and iron

minerals (

B12 (

ADER

consum-

iron ( 99%),

vitamin

prevent

of

animal protein, utilizable protein and lysine,

high

and

kcal)

the

intake (

followed

available

98%),

(

adding

baseline

oz)

100%)

Fe to

available

and

diet.

Under scenario 1, the dietary caloric supply( 2230

of

and

cow' s milk to the baseline

the RDA,

People

relatively

18 fl oz of whole

were

Although

protein

nutrient

99%),

calcium,

exceeds

of

100%),

protein

micronutrients

calcium (

normative (

A- normative

a

utilizable

of vitamins

for

Zn- basal (

and

diet have

probability

highest Zn-

of animal

Multiple

it is bioavailable.

ing the baseline inadequacy for

day

supply

the RDA level, but it is

iron ( 15 mg)

of

energy

capita/

protein

including B2, B12, and D.

A,

total

of

only 0. 6 mg

3).

per

to be inadequate,

vitamins

and

of

The

only 9. 5 g

with

insufficient

2).

estimated

kcal

2479

of

the IOM ( Table

by

the

and

EER)

requirement (

adding

ADER and fulfills ply becomes

86%

sufficient,

of the EER. Protein supsatisfying

122%

of the

recommendation. Dietary quality also improves, as

there is

animal

a

210%,

protein,

44%,

utilizable

and

80%

protein,

increase and

in

lysine,

PSF

Baselin + Meat

Recomndati of

Milk+

0

6

100.

101. 60. 80. 22.

Milk

0

9

3

9

13.

20.

4

8

237.

89. 76.

ne ds;

2

NA NA NA NA NA NA

0

9

0

9

8

1

6

8

1

1

100. 150. 178. 156. 373. 20. 77. 212. 115. 167. NA NA NA NA NA NA 7

0

3

1

6

4

5

5

96.

122. NA NA NA NA NA NA

0

2

7

3

0

3

0

4

tocpherl;

90.

115. 63. 132. 108.

19.

77.

194.

91.

112. NA NA NA NA NA NA

AT,

9

3

9

4

Baselin

187.

72. 67.

Ad ing

Compared

PSF

ASF

Baselin +

a-

Consumpti

Suplemntaio Availbe for

by

Sup lies Nutrient Key of

Change

Meat

co

9

0

9

NA NA NA NA NA NA

56

900

3

4

15

1.

2.

8

1000

11

30 2 NA NA NA NA NA NA

2478 56. 548

0

6

0

1.

0.

2.

209

0

9

19.

9.

0

2 8 53.

5

8

2

0

0

9.

0.

1. 1. 1.

acording estimad

RAE,

food; food; level,

2478 84. 1602

0

0

0

2.

9.

3.

0

776

7

17. 12.

5015

4

9

2

8

5

5

2. 2.

1. 1.

81.

45.

Meat 2140 68. 1320 5

2 30 64. 573 1

1892

48.

2

1.

6.

2.

6

1.

2. 2.

6

0. 0.

5

1

7

9

291

9

186

0 2.

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9

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0

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0

0

15.

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5

3678 65. 29. 3 75

4

61.

0

2038 45.

1

7

6

6

1. 1. 1. 1.

9

7

0

1. 1. 1.

25.

0.

5

5

5

animal PSF,

moderat

ASF,

6

0

8

1.

0.

8 0.

also we

aprotein; vilbe; with authors, 79

not

weightd requst age

anemia;

prevnt equivalnts;

iron

of

on

years

avilbe

50 to 19

folate males

dietary

for

Zn,

ne ds;

and

purose,

is

avilbe DFE, Zinc. RDAs)

AFeiron;

the

from

animal NA,

PA,

9. 0.

the

source source activ y used

to

Baselin

averg

to

Fe,

1

Milk

retinol

Apro, Iron; 5

estimae

to

requimnts

kg

Milk+

compartive

result. EER). simlar

normative usable Alowances( IOM). genratd reeqnuimrngt(y protein;

For

avilbe zinc Upro, Dietary Medicne( whic AFe, avilbe alownce; Instiue estimad for

Unit kcal

2.

Table

4

the

activ y Dtiheteary

plant

9

as

Nutrient

3

76. 85. 32. 65. 22. 13. 18.

RDAa 2479b

to

With

3

Intake(

equivalnts; Refrnce

146. 90. 288. 3

DRI)

avilbe B,

86. 121.

3

recomnd

RDA,

14. 18.

206.

repots percntag

zinc

AZn6

PSF.

More

basal for

3

Meat

9

Nutriens

g

RAE

mg

A

B2

µg

µg

mg mg mg mg

g

g

mg mg mg mg

of

B12 D PA

B

N

Energy Protein Vitamin Vitamin Vitamin Vitamin Calcium Iron Zinc Lysine UPro APro AFe AFe- AZn- AZn-

R e c o m n d Abreviatons: dietary recomndati, bBased

on

N,

AZn- aThe

the

by

Zhang

et

9

al

Baseline •

Mik •

Meat

6IviiIk{ Meat

a Baseline+

100 90 80 fe

70 -

Q

60 -R

50 40 -

k

30 -

2

10 -

a n

d,

0 to

$

ti

$

a

titi

e

P

Figure 3. The probability of micronutrient inadequacy under 4 nutrition scenarios. AFe indicates available iron; AFe- PA, available

iron to prevent anemia; AZn- B, available

zinc for basal needs; AZn- N, available

zinc for nor-

mative needs; Ca, calcium; Upro indicates utilizable protein; VA- B, vitamin A for basal needs; VA- N, vitamin A for

normative

needs; VB2, vitamin B2; VB I2, vitamin B12.

The

respectively.

increases

B12

min

B2

vitamin

iron,

and

3%,

increases

zinc

D, and

vitamin

3. 5- fold

than

more

A

of vitamin

supply

and

this

of

Total

33%.

over

increase

calcium

vita-

that

and

10%,

6%,

Adding of inadequacy for available zinc for normative needs and avail30% by able iron by 60%. Adding small amounts of meat eliminates the risk of inadequacy for all other and

respectively.

of meat

the

reduces

nutrients

for

except

in

effective

amount

risk

Therefore,

change.

small

calcium,

adding

the

reducing

which

meat

does

not

was

not

alone

risk

of

calcium

deficiency. The

3 meets 67%

contrast

baseline

of

and

both 56%,

mendation

4

scenario

diet

meet

for the

and

milk

meat

Figure

where

PSF

in scenario of

respectively,

recommendation (

to

2).

the

con-

This is in to the

additions

255%

and

57%

2).

kcal)

The

grains

and

vegetables

and

protein

are

only

levels 54%

intervention(

and

for calcium

and vitamin

D

20% of the recommendations,

respectively. Note that the RDA value for vitamin D is based on minimal sun exposure. and

meat

combination

inadequacy an

iron

risk

except

deficiency(

eliminates

for

a

35%

Figure 3). The"

all

The milk nutrient

probability

baseline+

of

PSF"

intervention( 4) diet maintains all micronutrient levels below RDA levels, except for vitamin A.

The PSF- enhanced diet only eliminates the risk

of vitamin A inadequacy in basal form and leaves

all

other

nutrients

at

some

risk

for

supplies

by

are

both

lysine

is elevated to 119% for 3)

scenario raises

all

and

Table

sufficient.

The

utilizable

pro-

in scenario 3

4. The " essential

more plant- based staples to the baseline diet

will not be as effective in improving the level of micronutrient sufficiency in the diet as with the

addition

of ASF.

groups,

for the EER(

adequate

diet quality reflected tein

except

78%

of the recom-

respectively. Both scenario 3 and scenario 4 intervention diets have the same dietary caloric intake 2478

levels,

meet

inadequacy. These results suggest that adding

addition

sumption

RDA that

milk + nutrients

and

meat"

to the

Discussion

Our analysis of the trend in food supply in Zambia since

1961

highlights

a notable

decline

in the

availability of ASF and pulses for Zambian consumption and a significant increase in supply of cassava and vegetable oils. It is consistent with

the observed falling supply of total protein since 1977

and

the

steady increase

in the supply

of

fat

10

Food and Nutrition Bulletin

in the diet

includes

often

fruits and food

protein,

and

to

human

maintain

to balance

needs

supplies

vating

ing by

the

of

Improving

promoting

utilization

tural,

nutrition,

diversity

food

of

ele-

such

health

through

policy

interventions

There

ging

present

tion

study on

our

enabled

of

Results

of

provide

a

the

remove

Zambian

present

of

risk

tion of the true nutrition

to

to

changes

be

than

communities

where

disease

incidence

are recommended

to be elevated over that needed by healthy indi-

to

viduals

of

treatment efficacy.

in order to improve

disease

resistance

and

74' 75 This is especially impor-

tant for a country like Zambia with relatively high

similar

infection levels of HIV/ AIDS, malaria, tubercu-

nutrition,

losis, and other diseases. Therefore, the nutrient

in

inform

makers

policy

used

because

For example, children and

is high, dietary requirements

micronutrient

and countries can

insecure

population.

can

status in Zambia

nutritional needs to maintain health. In food-

in

nutri-

development

control

as

improved

achieve

there

to be

need

the

amount

consumption

preparation,

what

is

of at

the

due to

micronutrient

are

a number

First,

recognized.

overestimate

age,

and intake

to

deficiencies identified in the present article may

alter-

also be applicable

nutrition

to other age and gender

groups

in Zambia.

consumed

true

intake

pregnant or lactating women often have higher

these

and

current

general

future

to

agricultural

Nevertheless,

measure

in micronutrient

this age and gender group generally has lower

of

of nutrition

the

the

analyses

for

programs

approaches

human

uses,

physical activity. This may lead to an overestima-

even

outcomes.

that

study

ommendation level for a healthy male 19 to 50 years of age, weighing 79 kg, with moderate

micro-

Encoura-

the FAO FBS data,

in Zambia

and

multiple

a method

The analysis also

situations.

native

average

only present results comparing to the dietary rec-

greater

consumption,

patterns and

the

the

deficiencies

health,

are great variations

nutrient requirements.

adapts

reference

intervention

a

in Zambia.

meat

understanding

consumption status

and

have

the

potentially

based

assessment

food

our

assumption that nutrient availability are unevenly distributed.

prove

inadequacy.

nutrient

The

ASF

present

milk

could

marginally,

data

modeling

PSF to tackle

than

additional

most

which

the

across regions, 6 which is consistent with the

and

shows that

analysis

involving

deficiencies

nutrient

accessibility,

that

Third, it is important to bear in mind that we

scenario

potential

of income,

of the population having extreme deficiencies.

as

beneficial. Our

should be regarded as " not

well.

distribution

nutrient

agricul-

may

as

reflects the median or modal levels, nor the state

quality

accessibility,

results

hidden. It is unlikely, as is the case with the uneven

expand-

diet

our

graphic, ethnic, and socioeconomic strata remain

policy

foods, and

in Zambia

and

food is

required

with

dense

availability,

ASF

of

vitamin

benefits

staples

starchy

deficient,

of

affect

Second, the estimated per capita food supply is applicable only at the aggregate national level, and therefore, important differences among geo-

micronutri-

variety

and

nutrient-

the

adequate"

Future

costs

diet

actual consumption

animal

iron,

not

is insufficient for the nutrient needs, then the

in

quality

nutrients

many

would

dietary

available

health.

of

the supply

ASF.

the

provide

this

on all the foods available for human consumption

fresh

few

highly a

However,

because if FBS data show that even a diet based

protein,

Multiple

to be

zinc,

and

with

in

poor

D. However,

and

con-

only insufficient

not

is low.

calcium,

B2, B12,

to

lysine

identified

including

cereal

of utilizable

supply

were

needed

It is

food based

Zambian

ASF,

no

or

but also

quantity the

A,

little

vegetables.

because

ents

the 1990s.

since

is predominantly

sumption

all

the

foods

national

quantities

wastage

and

and

of

estimated

FBS

the

data for

available

stantial increase in the supply of cassava and (

more recently)

vegetable

oils and a correspond-

and

tend

ing decrease in that of ASF, pulses, and cereals

food

actually

during the past several decades. A diet based on all the foods currently available for Zambian consumption is predominantly cereal based and

This

during

stor-

means

in Zambia may be in

In conclusion, Zambia has experienced a sub-

limitations

level

losses

cooking.

status

of

the

present

the

worse

study.

includes very little ASF and few fresh fruits and vegetables.

It is

unbalanced,

poor

in quality,

and

Zhang

et

lacks

of

I I

al

dietary diversity.

deficiencies lysine,

calcium,

B2, B12, amount

the

probability

and

makers

of

inadequacy,

foods

should

other

low- income

is

in

based

urgent

dietary

how to

intake

secure

and

its

to

its

educate

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Organization

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