Position of Dietary Diversity on Public Health Nutrition and Potential Interventions Omar Dary, USAID/GH/HIDN/NUT

Food Security: macroµ

Health Status

Complementary delivering strategies

Safe water & foods, healthy environments

Health services, immunization

Self-esteem & motivation Motherchild interaction

Family and community interactions

Production and income generation Institutional Support National policies and economic structure National resources, international agreements

“Nutrition” sensitive strategies

Nutrient intakes

“Nutrition” specific strategies

Causal determinants for physical, mental and emotional development

Modified from: UNICEF, Strategies for improving nutrition in developing countries, 1990; and Ruel, 2008. Multi-Sectoral Nutrition Global Learning and Evidence Exchange Washington, DC

2

Immediate determinants for “good nutrition” Food Macronutrients:

Micronutrients:

Energy Protein Ess.fatty acids Ca, Mg P, K, Na

Vitamins Minerals

Health Hygienic environments

Treatment when sick

Safe water

Medicines

Immunization

Control of contaminants

Care Stimulation Love Selfconfidence Physical activity

Interaction with mother, siblings, family, community

Protecting: fiber, antioxidants, nondigestible oligosaccharides, others

Concept taken from UNICEF, Strategies for improving nutrition in developing countries, 1990.

Although nutrients (foods) are insufficient to assure “good nutrition”, they are still essential.

Multi-Sectoral Nutrition Global Learning and Evidence Exchange Washington, DC

3

Study design PM2A (IFPRI/FANTA/USAID-FFP) in Guatemala: Research questions Question 2a: Family ration?

Question 2b: Individual ration?

Full CSB A. Full family ration (PROCOMIDA)

LNS

D. FFR+LNS

MNP

E. MNP

Reduced B. Reduced family ration

W/ou

No C. No family ration

F. Control

Source: Olney, Leroy, Bliznashka & Ruel. Presentation in the Experimental Biology Meeting, San Diego, CA. April, 2016.

Multi-Sectoral Nutrition Global Learning and Evidence Exchange Washington, DC

4

Child stunting (LAZ < -2) 70 Prevalence of stunting

60

Source: Olney, Leroy, Bliznashka & Ruel. Presentation in the Experimental Biology Meeting, San Diego, CA. April, 2016.

50 * **

40 * *

30 **

20

10

Note: All estimates adjusted for clustering, maternal age and height, and child sex. * p