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If fresh foods are unavailable, how can packaged foods be used to provide as diverse a diet as possible?

This question was posted the COVID-19 and nutrition programming forum area and has 1 replies.

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GTAM Wasting TWG

Emergency Nutrition Network

Frequent user

9 Sep 2020, 15:57

Question submitted to the prevention work stream of the wasting and risk TWG: If fresh foods are unavailable, how can packaged foods be used to provide as diverse a diet as possible?

GTAM Wasting TWG

Emergency Nutrition Network

Frequent user

9 Sep 2020, 16:01

From experience in early wave of COVID-19 pandemic countries there has been a tendency of people to bulk buy certain types of foods - especially packaged and dry long-life foods such as bean/legumes, nuts, dried/powdered milks. This is driven by consumer preference to stockpile or fear of scarcity, more than by unavailability of fresh foods. In food insecure settings we can anticipate variable and fluctuating levels of fresh foods from supply side, but also variable supply or possible market inflation of nutritious dried packaged or canned foods. Thus, it is important to undertake a good market analysis including data on prices, food availability and supply chains but also on government policies and access to markets, to identify immediate and longer-term policy and programme actions to ensure access to locally available, nutritious, safe, affordable and sustainable food.

Oftentimes, fresh foods are produced in one area and sold to other areas without being consumed by the people producing them. Disrupted market systems could lead to waste of those fresh foods in the locations where they are produced. COVID-19 might be an opportunity to increase consumption of fresh foods where they are produced.

Approaches to address the lack of fresh food must be adapted to the context and the nutritional requirements of various population categories. As a rule of thumb, the advice is to limit highly processed foods that are often of low nutritional value and high in saturated fat, free sugars and salt, and to avoid sugary drinks and follow-on milks. Inappropriate marketing and promotion of unhealthy commercial foods for infant and young children should be avoided as it can discourage caregivers from breastfeeding and feeding their children a home prepared and diverse diet while creating dependency on commercial products. Families should be informed on how to read the labels of packaged food (e.g. front of pack, nutrition declaration, the ingredients list, etc.) to identify the best available option for their situation. The nutritional value of the processed food may vary significantly according to the quality primary ingredients/agricultural inputs, processing technology and the storage.

Non-fresh sources (dried, canned or packaged) of protein-rich foods, with low sodium/sugar content will include whey powder, unsalted nuts and seeds, dried beans and peas – kidney beans, pinto beans, black beans, lima beans, black-eyed peas, garbanzo beans (chickpeas), split peas, and lentils. In some contexts, frozen packaged food could be an option. It is important to note that fresh food can be delivered through food voucher or cash for food programmes.

Canned vegetables that are low in sodium or have no salt added, low-sodium and sugar vegetable juices and canned or dried fruits with no added sugars can be consumed. Also, canned beans labelled “no salt added” or “low sodium” and dried egg powders. Dairy and non-dairy milk powders or long-life UHT milks can also be consumed. It is possible to replace refined flours with whole grains like brown or wild rice, millet, corn, quinoa, or barley, whole-wheat or whole-grain pasta and couscous, depending on preference and availability. Non-fresh food can also be a source of micronutrients (choose those with low sodium/no added sugar). By weight, dried fruit contains up to 3.5 times the fibre, vitamins and minerals of fresh fruit. One serving can provide a large percentage of the daily recommended intake of many vitamins and minerals, such as folate, but drying can reduce nutrient content (e.g. vitamin C).

Non-sweetened fruit juices, such as lemon juice can enrich diets and improve dietary iron uptake, similar to cooking food in iron pots. Dried beans, nuts and seed, lentils, vitamin enriched rice or sweet potato flours are also good options for micronutrients. Some of the issues related to antinutrients can be overcome by consuming dehulled pulses. A general recommendation from WHO on the issue of canned or dried vegetables and fruits is to choose varieties without added salt and sugar.

In rural settings, where fresh food is produced and usually available, promoting proximity trade and supporting local food markets should be considered. A medium- and long-term option is the production of bio-fortified crops (e.g. orange fleshed sweet potato, iron-rich beans, etc.) and the promotion of small-holders farming and home/community vegetable gardens (when access to land is possible) to insure people autonomy to better cope with market’s dynamics (e.g. rooftop garden in Bangladesh camps, in camps schools and health facilities, etc.). 

In urban settings, the access rather than availability to fresh food might be compromised amongst poorer populations. The access to packaged food is likely to be even lower considering their higher price. Humanitarian cash and voucher assistance (CVA) is likely to be an adapted option.

If none of the above are available in markets, it is possible that food assistance is in place. For instance, point-of-use fortification with micronutrient powders is advised where the micronutrient requirements of children 6-23 months old are not met by the diet. High Energy Biscuits and Fortified Biscuits are packaged food, distributed to older children, often through school feeding. This type of packaged food can be also distributed in an emergency prior to the organisation of humanitarian relief. They require safe water as they are quite dry biscuits. 

In humanitarian situations, such as the COVID-19 pandemic, large-scale interventions prioritise packaged food (e.g. General Food Assistance), including fortified items (e.g. vitamin A fortified oil, iodine fortified salt or fortified blended foods) based on caloric requirements of 2100 kcal. This support can be seasonal or ad hoc to cope with lack of availability or inaccessibility to fresh food. In settings where movement is restricted and/or markets closed, extending the coverage and the duration of usual food aid might help to sustain minimum dietary requirements.

It is always important to assess and respond to the specific nutritional needs of the population. Children and pregnant and lactating women (PLW) require special attention as they have increased nutritional needs. Multiple micronutrient powders (MMP) that respect WHO recommendations, can be added to households and individual rations. Programmes addressing micronutrients deficiencies (e.g. MNP, vitamin A campaigns, iron-folate supplementation to PLW via antenatal care, etc.) might also be relevant in context consuming monotonous diets. Linkages with other programmes (e.g. deworming campaigns, WASH, etc.) should also be promoted.

Please bear in mind that protecting, promoting and supporting exclusive breastfeeding for the first six months of life is a critical intervention in all types of food support. Interventions to prevent micronutrient deficiencies also include complementary feeding from 6 months while continuing breastfeeding up to 2 years and beyond, fortification of staples and complementary foods and provision of lipid-based supplementary food. Appropriate maternal nutrition during pregnancy is important to support foetal development and stores of important nutrients such us iron.

Agencies should adhere to the International Code of Marketing of Breast-milk Substitutes (BMS) and its subsequent related WHA resolutions ensuring that untargeted distributions of BMS (which include milk, milk powder and infant formula) are always prevented.

For infants and young children, parents should be provided with guidance on age appropriate and safe complementary foods and optimal feeding practices. Young children should consume enough fruits and vegetables, wholegrains and protein sources. These types of food can be cooked from dried, tinned or frozen when fresh foods are not available. Practical and context specific information and examples on healthy food options to replace fresh products when those are unavailable should be provided to caregivers and families. Such information will need to be adapted to address specific barriers of each context.

Country-specific databases of the nutritional value of fresh, packaged or local recipes are available in FAO website: http://www.fao.org/nutrition/food-composition/en/

Finally, products specifically designed to treat acutely malnourished children and PLW should be reserved for these populations.

These recommendations should be adapted to the context and national policies.

https://www.who.int/nutrition/topics/5keys_healthydiet/en/

https://www.who.int/news-room/fact-sheets/detail/healthy-diet

https://pubmed.ncbi.nlm.nih.gov/21229417/

https://www.farmstew.org/about-us/theory-for-change

https://www.who.int/topics/nutrition/publications/emergencies/Tsunami%20May%2005.pdf?ua=1

https://www.ennonline.net/attachments/3445/UNICEF-GTAM-GNC-Maternal-Nutrition-Programming-COVID19-V3_22-April-2020.pdf

https://drive.google.com/file/d/1hfG8u3pPyzrXVMUl81QvB3eBcduQ3FYg/view

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