Fish-based products to

improve nutrition in the

first 1,000 days of life

By Anne-Louise Hother, Manika Saha, Jessica Bogard and

Shakuntala Haraksingh Thilsted

Outline

1. State of nutrition of women and children in Bangladesh

2. Why focus on the first 1,000 days of life?

3. Nutritional challenges in the 1,000 days

4. Why should fish consumption be increased in the 1,000

days?

5. Fish-based products for improved nutrition and health

• Fish-based CF product for infants and young children

• Fish chutney for pregnant and lactating women

• Fish powder to be added to family foods

State of nutrition in women in Bangladesh women of reproductive age (14-49 y)

• 1 out of 4 are underweight (BMI <18.5)

• 1 out of 10 are moderately of severely thin (BMI <17)

• >1 out of 10 have a short stature (height <145 cm)

• 4 out of 10 women are anaemic

• 1 out of 20 children are VERY small at birth

• 1 out of 10 children are SMALLER THAN AVERAGE at birth

Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

State of nutrition in children in Bangladesh Children 0-59 months

• 36% are underweight

• 17% are wasted (thin)

• 41% are stunted

Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

State of nutrition in children in Bangladesh Children 0-59 months

• 36% are underweight

• 17% are wasted (thin)

• 41% are stunted

26 months 52 months

Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

State of nutrition in children in Bangladesh Children 0-59 months

• 36% are underweight

• 17% are wasted (thin)

• 41% are stunted

26 months 52 months

The damages done early in life are irrevesible

BUT

can be prevented by eating a nutritious diet

rich in micronutrient rich foods

Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

0

10

20

30

40

50

60

-9 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59

% c

hil

dre

n

Age in months

stunting

severe stunting

wasting

severe wasting

Child malnutrition in Bangladesh 0–59 months

Source BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

0

10

20

30

40

50

60

-9 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59

% c

hil

dre

n

Age in months

stunting

severe stunting

wasting

severe wasting

Child malnutrition in Bangladesh 0–59 months

Window of

opportunity

Source BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

0

10

20

30

40

50

60

-9 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59

% c

hil

dre

n

Age in months

stunting

severe stunting

wasting

severe wasting

Child malnutrition in Bangladesh 0–59 months

Source BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

The period from the start of a woman’s pregnancy to the child’s 2nd birthday offers

a unique window of opportunity to shape healthier and more prosperous futures

Why focus on the first 1,000 days of life?

Pregnancy Breastfeeding Complementary feeding

1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24

Improve nutrition for mothers and young children during the critical 1,000 days

from pregnancy to the child’s second birthday, when better nutrition can have a

lifelong impact on a child’s future and help break the cycle of poverty.

Complementary feeding in 6-23 months old breastfed children

1. Exclusive breastfeeding from 0-6 months

>1 in 3 children are NOT exclusively breastfed

2. Meal frequency (2/day at 6-8 months, 3/day at 9-23 months)

>1 in 3 are NOT fed the minimum number of meals per day

3. Dietary diversity

>3 in 4 are NOT fed with appropriate dietary diversity

4. Adequate diet (Meal freq. AND dietary diversity)

Only 21% have an adequate diet

Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF

International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

Nutritional challenges in the first 1,000

days

• Predominantly plant based diet (>70% of energy from rice)

• Low in micronutrients

• High in antinutrients

• Limited food diversity (<6% of energy from animal-source foods)

• CFs rarely provide adequate energy and micronutrients

• Thin rice porrigde

• Suji – wheat porrigde

• Time

• Safe storage

• Inclusion of small amounts of animal-source foods in a

plant-based diet can substantially increase nutrient

adequacy. It is therefore recommended that infants and

young children and pregnant and lactating women are

fed animal-source foods every day

• Most commonly consumed animal-source food

• Small indigenous fish are particularly nutritious as they

are eaten whole, with head, bones and viscera, and

provide a rich source of animal protein, iron, zinc,

calcium and vitamin A

Why should fish consumption be

increased in the first 1,000 days?

• Inclusion of small amounts of animal-source foods in a

plant-based diet can substantially increase nutrient

adequacy. It is therefore recommended that infants and

young children and pregnant and lactating women are

fed animal-source foods every day.

• Most commonly consumed animal-source food

• Small indigenous fish are particularly nutritious as they

are eaten whole, with head, bones and viscera, and

provide a rich source of animal protein, iron, zinc,

calcium and vitamin A

BUT

• Amounts consumed by the poor are low

• Even if available in the household, fish are often

introduced to the child only after 9 months of age

Why should fish consumption be

increased in the first 1,000 days?

Fish-based products developed by

WorldFish

1. Fish-based CF product for infants and young children

2. Fish chutney for pregnant and lactating women

3. Fish powder to be added to family foods

Fish-based complementary food product

• Made from local

ingredients

• High content of MN (iron,

zinc, vit A, calcium)

• High energy density

• Low content of anti-

nutrients

• Include animal-source

food

• Culturally acceptable

• Acceptable taste, texture

and colour

• Easy to prepare

• Hygenically safe

Selection of ingredients - Rice

Selection of ingredients - Fish

“Mache bhate Bengali” Fish and rice make a Bengali

Fish most commonly eaten animal-source food across all income

groups

Small indigenous fish are highly nutritious

Selection of ingredients - Fish

0

2

4

6

8

10

12

14

Chanda Chapila Chikra Darkina Kaski Mola Puti Taki

Fe (mg/100g)

Zn (mg/100g)

Calcium (g/100g)

Selection of ingredients - Orange Sweet

Potato

Vitamin A

Fructose (natural sweetener)

Low in anti-nutrients

Homestead

production of

sweet potato

Parboil

Sun-dry

Oven-dry

Blanch

Oven-dry

Slice into chips

Mill

Polish

Grind Grind Grind

Darkina fish Rice paddy OSP roots Soybean oil

Wash Wash Wash

Soak Peel and trim

Mix in specified proportions

Oven-dry

Grind

Package

15% Fish 45% Rice flour 30% OSP flour 10% Soybean oil

Nutrient composition of the fish-based

CF compared to other CFs in Bangladesh

Fish-based

CF

SUPER

CEREAL plus Pushti Packet

Energy (kcal) 423 410 395

Protein (g) 12 16 NA

Iron (mg) 15 6.5 2.1

Zinc (mg) 4.5 5 4.4

Calcium (mg) 895 130 300

Vitamin A (RAE) 418 499 197

Daily recommended ration:

6-11 months: 1 serve (30 g)

12-23 months: 2 serves (60 g)

Contribution to nutrient needs from CFs

[1] Desired nutrient needs from CFs are calculated from desired nutrient densities of CFs, assuming energy required from complementary foods is 202, 307 and 548 kcal/day for infants and young children, aged 6-8, 9-11 and 12-23 months, respectively as per US longitudinal data.

% contribution of the daily ration of fish-based CF

to desired nutrient needs from CFs

6-8 months 9-11 months 12-23 months

(1 serve/day) (1 serve/day) (2 serves/day)

Energy (kcal) 63 41 46

Protein (g) 179 118 147

Iron (mg) 50 49 164

Zinc (mg) 42 40 82

Calcium (mg) 127 118 156

Vitamin A (RAE) 401 272 398

Fish chutney for pregnant and lactating

women

• Rich in

micronutrients

(especially iron)

• Animal protein

• Essential fats

• Energy

Ingredients: 37% dried small fish, 15% oil, 37% onion,

7% garlic and 4% red chili

Fish chutney for pregnant and lactating

women

Protein, Fe, Zn, Ca

Energy density, EFA

Texture and flavour

Taste enhancer

Increased consumption of fish

= 60 g of raw fish

Nutrient composition of fish chutney A supplement to the diet

Content

per 100 g*

Content per

serve (30 g)*

% Contribution to RNI for

pregnant women from 1 serve

% Contribution to RNI for

lactating women from 1 serve

1st

trimester

2nd

trimester

3rd

trimester

0-2

months

3-6

months

7-12

months

Energy (kcal)^ 432.8 129.8 153 46 27 19 19 26

Protein (g)^ 38.5 11.5 1150 128 37 61 61 92

Iron (mg)# 9 2.7 - - - 18 18 18

Zinc (mg) 7.8 2.4 71 57 40 41 45 56

Calcium (mg) 1879.4 563.8 75 75 70 75 75 75

* Content is estimated based on analysed nutrient composition values for individual ingredients

^ Recommended additional energy and protein requirements during pregnancy and lactation Joint FAO/WHO/UNU 2004; WHO/FAO/UNU,

2007). Base energy requirements dependant on body weight and physical activity level

# It is recommended that iron supplements be given to all pregnant women because of difficulties in correctly assessing iron status in

pregnancy. Using RNI for iron assuming a dietary iron bioavailability of 10%

Source mineral requirements: WHO, 2004 (assuming 10% availability of iron; high availability of zinc)

Acceptability of fish chutney

Fish powder to be added to family foods

Preparation of fish powder

Nutrient composition per 100 g of fish powder

Energy Protein Fat Iron Zinc Calcium

317 kcal 19 g 22 g 22 g 4.5 mg 1669 mg

Fish powder added to different types of family foods

Acceptability trial

• Well-liked by mothers and

children in Sunamganj

• Regular introduction of fish

powder to the child will

help familiarise the child

with the new product

• Mothers expressed interest

in including the fish powder

in their own meal

Future plans for fish-based products

• Food distribution programmes

• Community business plan

• Commercial sale including rural sales programmes

• Emergency response food rations

• School feeding programmes

• Moderate and severe acute malnutrition

• A business model to determine the feasibility of distribution of

the fish-based products through the various channels and

production scalability

Thank you

Draw attention to that you can taste the

products at the table by the door

1. Fish-based CF product for infants and young children

2. Fish chutney for pregnant and lactating women

3. Fish powder to be added to family foods