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Keywords:

  • Lipid-based nutrient supplements;
  • emergency;
  • fortified-blended foods;
  • micronutrients

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Table of Contents
Abstract5
1. Introduction6
 1.1 The current nutrition response to emergencies7
  1.1.1 General food distributions (GFD)7
  1.1.2 Supplementary feeding programs8
  1.1.3 Micronutrient interventions9
  1.1.4 LNS as supplements in an emergency nutrition response10
2. Objectives11
3. Methodological approach11
 3.1 Dietary intake in emergency nutrition settings and composition of rations for GFD11
 3.2 Hypothetical intake from example GFD rations12
 3.3 Nutrient composition and adequacy of hypothetical ration13
 3.4 Determination of the desired micronutrient composition of LNS16
 3.5 Accounting for bioavailability of nutrients from the GFD ration and LNS20
 3.6 Cost comparability estimates21
4. Results21
 4.1 Nutrient adequacy of ‘typical’ GFD ration21
  4.1.1 Hypothetical intake from and nutrient adequacy of ‘typical’ GFD ration for children 6–11 months of age21
  4.1.2 Hypothetical intake from and nutrient adequacy of ‘typical’ GFD ration for children 12–35 months of age23
  4.1.3 Hypothetical intake from and nutrient adequacy of ‘typical’ GFD ration for pregnant and lactating women (PLW)24
 4.2 Nutrient adequacy of ‘revised’ GFD ration with the addition of LNS27
  4.2.1 Age-physiological group specific approach for developing LNS formulation30
  4.2.2 ‘Age-specific’ LNS formulation for 6–35-month-old infants and children30
  4.2.3 Hypothetical intake from and nutrient adequacy of ‘revised’ GFD ration plus ‘age-specific’ LNS for 6–35-month-old children35
  4.2.4 ‘Age-specific’ LNS formulation for PLW35
  4.2.5 Hypothetical intake from and nutrient adequacy of ‘revised’ GFD ration plus ‘age-specific’ LNS for PLW38
 4.3 ‘One-size-fits-all’ approach for developing LNS formulation40
5. Appropriate use and toxicity concerns43
 5.1 Potential strategies to ensure appropriate use and to avoid inappropriate consumption50
6. Cost estimates of providing LNS with the ‘revised’ GFD ration52
7. Quality control, nutrient formulation, shelf-life and packaging55
 7.1 Quality control of LNS production56
 7.2 Nutrient formulation56
 7.3 Shelf-life and packaging56
8. Discussion57
Acknowledgements60
Conflicts of interest60
References60
Appendix 1: Planned general food distribution ration examples used for development of ‘typical’ general food distribution ration63
Appendix 2: Nutrient composition of principal food aid commodities used in this document65
Appendix 3: Protein adequacy of diets in emergency settings when supplemented with lipid-based nutrient supplements66
List of Tables
Table 1:‘Typical’ GFD ration with CSB, and a ‘revised’ GFD ration with CSB substituted with an equivalent amount of pulse and grain12
Table 2:Energy requirements of each age/physiologic group13
Table 3:Hypothetical intake for each age/physiological group from the ‘typical’ GFD ration14
Table 4:Hypothetical intake for each age/physiological group from the ‘revised’ GFD ration, adjusted for the quantity of LNS that will be added (118 kcal)14
Table 5:Average nutrient concentrations in mature breast milk (World Health Organization 1998)15
Table 6:Adequate Intakes (AI) and Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for 7–11-month-old infants (IOM and WHO/FAO 2004)17
Table 7:Adequate Intakes (AI), Recommended Dietary Allowances (RDAs) or Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for 1–3-year-old (12–35-month-old) children (IOM and WHO/FAO 2004)18
Table 8:Adequate Intakes (AI), Recommended Dietary Allowances (RDAs) or Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for pregnant women (19+ years of age) (IOM and WHO/FAO 2004)19
Table 9:Adequate Intakes (AI), Recommended Dietary Allowances (RDAs) or Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for lactating women (19+ years of age) (IOM and WHO/FAO 2004)20
Table 10:Hypothetical quantity consumed from each component of the ‘typical’ GFD ration for each age or physiologic group21
Table 11:Amount of nutrient provided by each ‘typical’ GFD ration (and ‘average’ breast milk intake) and per cent of the daily recommended intake provided for 6–8-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets24
Table 12:Amount of nutrient provided by each ‘typical’ GFD ration (and ‘average’ breast milk intake) and per cent of the daily recommended intake provided for 9–11-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets25
Table 13:Amount of nutrient provided by each ‘typical’ GFD ration (and ‘average’ breast milk intake) and per cent of the daily recommended intake provided for 12–23-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets26
Table 14:Amount of nutrient provided by each ‘typical’ GFD ration and per cent of the daily recommended intake provided for 24–35-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets27
Table 15:Nutrients that exceed the UL from the hypothetical intake from the ‘typical’ GFD ration. Presented by age/physiologic group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)29
Table 16:Amount of nutrient provided by each ‘typical’ GFD ration and per cent of the daily recommended intake provided for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets31
Table 17:Amount of nutrient provided by each ‘typical’ GFD ration and per cent of the daily recommended intake provided for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets32
Table 18:Composition (g) of hypothetical intakes from ‘revised’ GFD ration, taking into account energy content (118 kcal or 236 kcal) to be provided via LNS33
Table 19:LNS macro- and micro-nutrient content for 6–35-month-olds based on the higher of the two daily recommended intake values for 7–11 and 12–35 months (micronutrients only), except where noted36
Table 20:Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 6–8-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets37
Table 21:Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 9–11-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets38
Table 22:Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 12–23-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets39
Table 23:Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 24–35-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets40
Table 24:Nutrients that exceed the UL when the 6–35 mo formulation LNS is added to the hypothetical intake from the ‘revised’ GFD ration, and breast milk (when applicable). Presented by age group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)41
Table 25:LNS macro- and micro-nutrient content for pregnant and lactating women (PLW) based on the higher of the two RNI levels for pregnancy and lactation, except where noted42
Table 26:Amount of nutrient provided by each ‘revised’ GFD diet and LNS (PLW formulation) and per cent of the daily recommended intake provided for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets43
Table 27:Amount of nutrient provided by each ‘revised’ GFD diet and LNS (PLW formulation) and per cent of the daily recommended intake provided for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets44
Table 28:Nutrients that exceed the UL when the PLW LNS formulation is added to the hypothetical intake from the GFD ration. Presented by physiologic group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)45
Table 29:LNS micronutrient content for all groups, ‘one-size fits all’ approach46
Table 30:Amount of nutrient provided by each ‘revised’ GFD diet and LNS (‘one size’ formulation) and per cent of the daily recommended intake provided for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets47
Table 31:Amount of nutrient provided by each ‘revised’ GFD diet and LNS (‘one size’ formulation) and per cent of the daily recommended intake provided for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets48
Table 32:Nutrients that exceed the UL when the ‘one-size’ LNS formulation is added to the hypothetical intake from the GFD ration. Presented by age/physiologic group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)49
Table 33:Toxicity estimates for 6–35-month-old children consuming 2–7 times the recommended daily dose of the age-specific or one-size LNS formulation (alone)49
Table 34:Toxicity estimates for 6–35-month-old children consuming 2–7 times the recommended daily dose of the PLW LNS formulation (alone)50
Table 35:Toxicity estimates for PLW consuming 2–7 times the recommended daily dose of the PLW LNS formulation (alone)51
Table 36:Toxicity estimates for PLW consuming 2–7 times the recommended daily dose of LNS (alone), for the one-size formulation52
Table 37:Average commodity cost in US$ per metric ton (MT) of GFD commodities as provided by the Food for Peace commodity calculator for fiscal year 2009 (http://www.usaid.gov/our_work/humanitarian_assistance/ffp/comcalc_new.xls, accessed March 2009)53
Table 38:Cost estimate (in US$) for ‘typical’ full GFD ration and ‘revised’ full GFD ration (excluding sugar and salt)54
Table 39:Cost (in US$) of providing the hypothetical diet for each age/physiologic group from the ‘typical’ and ‘revised’ GFD rations, with and without addition of LNS, as well as the per cent change in cost from the current ‘typical’ GFD ration54
Table 40:Change in total commodity provided (g) for the ‘typical’ GFD diet vs. ‘revised’ GFD diet plus LNS for each age/physiologic group, plus a hypothetical mother–child dyad55
Table 41:Possible chemical forms of nutrients included in products for infants and young children, and recommended chemical forms for inclusion in LNS57
Table 1.  ‘Typical’ GFD ration with CSB, and a ‘revised’ GFD ration with CSB substituted with an equivalent amount of pulse and grain
Commodity‘Typical’ GFD ration with CSB‘Revised’ GFD ration without CSB
Weight (g)Energy (kcal)Per cent of total energyWeight (g)Energy (kcal)Per cent of total energy
  1. GFD, general food distribution; CSB, corn–soy blend.

Grain (e.g. rice, cornmeal, wheat flour or sorghum)4001356–1476704251441–156874
Corn–soy blend501909
Pulse5017387534512
Vegetable oil25221102522111
Sugar1558315583
Salt55
TOTAL5451997–21171005451978–2106100
Table 2.  Energy requirements of each age/physiologic group*
Age/physiologic group‘Average’ intake from breast milk (kcal)Energy requirement from food (kcal)Total intake (kcal)
  • *

    Sources: Food and Agriculture Organization/World Health Organization/United Nations University (UNU) (2001) Human Energy Requirements. FAO: Rome; and Dewey K.G. & Brown K.H. (2003) Update on technical issues concerning. complementary feeding of young children in developing countries and implications for intervention programs. Food and Nutrition Bulletin24, 5–28.

  • †Estimated energy requirement (EER) for 24-month-olds, males and females combined.

  • Average requirement over three trimesters for an 18–29-year-old woman. Based on a body weight of 55 kg, and a physical activity level of 1.75, and an additional energy allowance for pregnancy of 360 kcal in the second trimester and 475 kcal in the third.

  • §

    Average requirement over the first year postpartum for an 18–29-year-old woman Based on a body weight of 55 kg, and a physical activity level of 1.75, and an additional energy allowance for lactation of 505 kcal in the first 6 months postpartum.

6–8 mo413202615
9–11 mo379307686
12–23 mo346548894
24–35 mo10241024
Pregnant25882588
Lactating2815§2815§
Table 3.  Hypothetical intake for each age/physiological group from the ‘typical’ GFD ration
 Portion of energy in overall ration (%)Energy (kcal) needed from each ration component
6–8 mo9–11 mo12–23 mo24–35 moPregnantLactating
  1. GFD, general food distribution; CSB, corn–soy blend. *As salt did not contribute to the overall energy intake, the amount included in the diet is not presented. See Table 10 for quantity provided.

Grain7014121538471718121971
Pulse816254482207225
CSB918284992233253
Veg oil10203155102259282
Sugar36916317885
Salt*000000
 Hypothetical intake from ration (kcal)202307548102425882815
Table 4.  Hypothetical intake for each age/physiological group from the ‘revised’ GFD ration, adjusted for the quantity of LNS that will be added (118 kcal)
 Portion of energy in overall ration (%)Energy (kcal) needed from each ration component
6–8 mo9–11 mo12–23 mo24–35 moPregnant (1 dose LNS)Pregnant (2 dose LNS)Lactating (1 dose LNS)Lactating (2 dose LNS)
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement. *As salt did not contribute to the overall energy intake, the amount included in the diet is not presented. See Table 18 for quantity provided.

Grain74621403196721833174520021913
Pulse12102353112306292334320
Veg. oil119204696262249286273
Sugar325122569667572
Salt*00000000
 Hypothetical intake from ration (kcal)841894309062470235226972579
 Intake from LNS (kcal)118118118118118236118236
 Total energy intake from non-breast milk sources (kcal)20230754810242588258828152815
Table 5.  Average nutrient concentrations in mature breast milk (World Health Organization 1998)
NutrientAmount (mean ± SD)
Lactose (g/L)72 ± 2.5
Protein (g/L)10.5 ± 2.0
Fat (g/L)39.0 ± 4.0
Calcium (mg/L)280 ± 26
Copper (mg/L)0.25 ± 0.03
Folate (µg/L)85 ± 37
Iodine (µg/L)110 ± 40
Iron (mg/L)0.30 ± 0.10
Magnesium (mg/L)35 ± 2
Manganese (µg/L)6 ± 2
Niacin (mg/L)1.50 ± 0.20
Pantothenic acid (mg/L)1.80 ± 0.20
Phosphorous (mg/L)140 ± 22
Potassium (mg/L)525 ± 35
Riboflavin (mg/L)0.35 ± 0.025
Selenium (µg/L)20 ± 5
Sodium (mg/L)180 ± 40
Thiamine (mg/L)0.21 ± 0.03
Vitamin A (µg RAE/L)500
Vitamin B12 (µg/L)0.97
Vitamin B6 (µg/L)93 ± 0.8
Vitamin C (mg/L)40 ± 10
Vitamin D (µg/L)0.55 ± 0.10
Vitamin E (mg/L)2.3 ± 1.0
Vitamin K (µg/L)2.1 ± 0.1
Zinc (mg/L)1.2 ± 0.2
Table 6.  Adequate Intakes (AI) and Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for 7–11-month-old infants (IOM and WHO/FAO 2004)
NutrientIOMWHO/FAOFinal values used for deficient/excess intake
AIULRNIULRecommended daily intakeUL
  1. IOM, Institute of Medicine; WHO, World Health Organization; FAO, Food and Agriculture Organization; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units; ND, not determined. *Assuming a reference weight for a 7–12 month-old infant of 9 kg, the UL for iodine would be approximately 1260 µg/d. This value was used for purposes of determining excessive iodine intake among 7–12 month-old children. Requirement for absorbed iron presented; the ULs are presented in terms of amount ingested. The amount needed in the diet will depend on estimated absorption level. The UL for vitamin A is for intake of preformed vitamin A. §Requirement for absorbed zinc presented; the ULs are presented in terms of amount ingested. The amount needed in the diet to meet the absorbed requirement will depend on estimated absorption level. Alternative recommendations made by the International Zinc Nutrition Consultative Group were used; daily requirement represents the ‘absorbed’ requirement, and the UL is based on the amount ingested.

Carbohydrate (g/d)9595
Fat (g/d)3030
 Linoleic acid (g/d)4.64.6
 α-Linolenic acid (g/d)0.50.5
Protein (g/d)1111
Calcium (mg/d)270ND400ND400ND
Copper (mg/d)0.22ND0.22ND
Folate (µg DFE/d)80ND80ND80ND
Iodine (µg/d)130ND90140 µg/kg/d*901260
Iron (mg/d)1.1400.93ND0.9340
Magnesium (mg/d)75ND54ND54ND
Manganese (mg/d)0.6ND0.6ND
Niacin (mg/d)4ND4ND4ND
Pantothenic acid (mg/d)1.7ND1.8ND1.8ND
Phosphorous (mg/d)275ND275ND
Potassium (mg/d)700ND700ND
Riboflavin (mg/d)0.4ND0.4ND0.4ND
Selenium (µg/d)206010ND1060
Thiamine (mg/d)0.3ND0.3ND0.3ND
Vitamin A (µg RAE /d)500600400ND400600
Vitamin B12 (µg/d)0.5ND0.7ND0.7ND
Vitamin B6 (mg/d)0.3ND0.3ND0.3ND
Vitamin C (mg/d)50ND30ND30ND
Vitamin D (IU/d)2001000200ND2001000
Vitamin E (mg/d)5ND2.7ND2.7ND
Vitamin K (µg/d)2.5ND10ND10ND
Zinc (mg/d)§1.051.323–381.16
Table 7.  Adequate Intakes (AI), Recommended Dietary Allowances (RDAs) or Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for 1–3-year-old (12–35-month-old) children (IOM and WHO/FAO 2004)
NutrientIOMWHO/FAOFinal values used for deficient/excess intake
AI/RDAULRNIULRecommended daily intakeUL
  1. IOM, Institute of Medicine; WHO, World Health Organization; FAO, Food and Agriculture Organization; RAE, retinol activity equivalents; IU, international units; ND, not determined. *AI. An AI/RDA is not provided for fat for this age group. The ‘acceptable macronutrient distribution range’ for fat intake is 30–40% of total energy intake. The UL for folate is for intake from fortified foods or supplements. §Assuming a reference weight for a 12–35-month-old child of 12 kg, the UL for iodine would be approximately 600 µg/day. This value was used as the UL for iodine at 12–35 months of age. Requirement for absorbed iron presented; the ULs are presented in terms of amount ingested. The amount needed in the diet will depend on estimated absorption level. ††The UL for magnesium is for intake from non-food sources. ‡‡The UL for vitamin A is for intake of preformed vitamin A. §§Requirement for absorbed zinc presented; the ULs are presented in terms of amount ingested. The amount needed in the diet to meet the absorbed requirement will depend on estimated absorption level. ¶¶Alternative recommendations for the ‘no-observed-adverse-effect-level’ made by the International Zinc Nutrition Consultative Group were used. The daily requirement represents the ‘absorbed’ requirement, and the UL is based on the amount ingested.

Carbohydrate (g/d)130130ND
Fat (g/d)30–40 % E30–40 % END
 Linoleic acid (g/d)7*7*ND
 α-Linolenic acid (g/d)0.7*0.7*ND
Protein (g/d)1313ND
Calcium (mg/d)500*25005002500500*2500
Copper (mg/d)0.3410.341
Folate (µg DFE/d)150300150300150300
Iodine (µg/d)902009050 µg/kg/d§90600
Iron (mg/d)1.26400.58400.5840
Magnesium (mg/d)8065††60656065
Manganese (mg/d)1.2*21.2ND1.2*2
Niacin (mg/d)6106ND610
Pantothenic acid (mg/d)2*ND2.0ND2*ND
Phosphorous (mg/d)46030004603000
Potassium (mg/d)3000*ND3000*ND
Riboflavin (mg/d)0.5ND0.5300.530
Selenium (µg/d)2090171790
Thiamine (mg/d)0.5ND0.5100.510
Vitamin A (µg RAE /d)300600‡‡400600400600
Vitamin B12 (µg/d)0.9ND0.90.9ND
Vitamin B6 (mg/d)0.5300.5300.530
Vitamin C (mg/d)154003040030400
Vitamin D (IU/d)200*20002002000200*2000
Vitamin E (mg/d)620052005200
Vitamin K (µg/d)30*ND1515ND
Zinc (mg/d)§§0.971.223–280.7¶¶8¶¶
Table 8.  Adequate Intakes (AI), Recommended Dietary Allowances (RDAs) or Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for pregnant women (19+ years of age) (IOM and WHO/FAO 2004)
NutrientIOMWHO/FAOFinal values used for deficient/excess intake
AI/RDAULRNIULRecommended daily intakeUL
  1. IOM, Institute of Medicine; WHO, World Health Organization; FAO, Food and Agriculture Organization; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units; ND, not determined. *AI. An AI/RDA is not provided for fat for this physiologic group. The ‘acceptable macronutrient distribution range’ for fat intake during pregnancy is 20–35% of energy intake. The UL for folate is for intake from fortified foods or supplements. §Requirement for absorbed iron is presented; the ULs are presented in terms of amount ingested. The amount needed in the diet will depend on estimated absorption level. Iron supplements (e.g. 100 mg of iron as ferrous sulphate) are recommended for all non-anaemic pregnant women during the second half of pregnancy. ††The UL for magnesium is for intake from supplements, not food or water. ‡‡Requirements for second and third trimester; first trimester not determined. §§The UL for vitamin A is for intake of preformed vitamin A. ¶¶Requirement for absorbed zinc presented and averaged over three trimesters; the ULs are presented in terms of amount ingested. The amount needed in the diet to meet the absorbed requirement will depend on estimated absorption level. †††Alternative recommendations made by the International Zinc Nutrition Consultative Group were used; daily requirement represents the ‘absorbed’ requirement, and the UL is based on the amount ingested.

Carbohydrate (g/d)175175ND
Fat (g/d)20–35 %E20–35% END
 Linoleic acid (g/d)13*13*ND
 α-Linolenic acid (g/d)1.4*1.4*ND
Protein (g/d)7171ND
Calcium (mg/d)1000*25001200300012003000
Copper (mg/d)110110
Folate (µg DFE /d)600100060010006001000
Iodine (µg/d)220110020011002001100
Iron (mg/d)§4.645454.645
Magnesium (mg/d)350–360350††220220350
Manganese (mg/d)2*112*11
Niacin (mg/d)183518351835
Pantothenic acid (mg/d)6*ND6.06ND
Phosphorous (mg/d)70035007003500
Potassium (mg/d)4700*ND4700*ND
Riboflavin (mg/d)1.4ND1.41.4ND
Selenium (µg/d)6040028, 30‡‡ 29400
Thiamine (mg/d)1.2ND1.41.4ND
Vitamin A (µg RAE /d)7703000§§80030008003000
Vitamin B12 (µg/d)2.6ND2.62.6ND
Vitamin B6 (mg/d)1.91001.91001.9100
Vitamin C (mg/d)852000551000551000
Vitamin D (IU/d)200*20002002000200*2000
Vitamin E (mg/d)151000151000
Vitamin K (µg/d)90*ND5555ND
Zinc (mg/d)¶¶5.4403.4453.2†††40
Table 9.  Adequate Intakes (AI), Recommended Dietary Allowances (RDAs) or Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for lactating women (19+ years of age) (IOM and WHO/FAO 2004)
NutrientIOMWHO/FAOFinal values used for deficient/excess intake
AI/RDAULRNIULRecommended daily intakeUL
  1. IOM, Institute of Medicine; WHO, World Health Organization; FAO, Food and Agriculture Organization; DFE, dietary folate equivalents; RAE, retinol activity equivalents; ND, not determined. *AI. An AI/RDA is not provided for fat for this physiologic group. The ‘acceptable macronutrient distribution range’ for fat intake during lactation is 20–35% of energy intake. The UL for folate is for intake from fortified foods or supplements. §Requirement for absorbed iron presented; the ULs are presented in terms of amount ingested. The amount needed in the diet will depend on estimated absorption level. The UL for magnesium is for intake from supplements, not food or water. ††The UL for vitamin A is intake of preformed vitamin A. ‡‡Requirement for absorbed zinc is presented; the ULs are presented in terms of amount ingested. The amount needed in the diet to meet the absorbed requirement will depend on estimated absorption level. §§Alternative recommendations made by the International Zinc Nutrition Consultative Group were used; daily requirement represents the ‘absorbed’ requirement, and the UL is based on the amount ingested.

Carbohydrate (g/d)210ND210ND
Fat (g/d)20–35% END20–35% END
 Linoleic acid (g/d)13*ND13*ND
 α-Linolenic acid (g/d)1.3*ND1.3*ND
Protein (g/d)71ND71ND
Calcium (mg/d)1000*2500100030001000*3000
Copper (mg/d)1.3101.310
Folate (µg DFE/d)500100050010005001000
Iodine (µg/d)290110020011002001100
Iron (mg/d)§1.62451.5451.545
Magnesium (mg/d)310–320350270350270350
Manganese (mg/d)2.6*112.6112.6*11
Niacin (mg/d)173517351735
Pantothenic acid (mg/d)7*ND77*ND
Phosphorous (mg/d)70040007004000
Potassium (mg/d)5100ND5100ND
Riboflavin (mg/d)1.6ND1.61.6ND
Selenium (µg/d)704003540035400
Thiamine (mg/d)1.4ND1.51.5ND
Vitamin A (µg RAE /d)13003000††85030008503000
Vitamin B12 (µg/d)2.8ND2.82.8ND
Vitamin B6 (mg/d)210021002100
Vitamin C (mg/d)1202000701000701000
Vitamin D (µg/d)200*20002002000200*2000
Vitamin E (mg/d)191000191000
Vitamin K (µg/d)90*ND5555ND
Zinc (mg/d)‡‡5.3404.3453.6§§40§§
Table 10.  Hypothetical quantity consumed from each component of the ‘typical’ GFD ration for each age or physiologic group
FoodAmount in hypothetical intake from GFD diet (g)
6–8 months9–11 months12–23 months24–35 monthsPregnant womenLactating women
  1. GFD, general food distribution. *Because four different grains/grain products (rice, cornmeal, wheat flour and sorghum) were used, with slight variations in energy density, there were small differences in the quantity provided for each grain; for purposes of presentation in the table, the average quantity for all four grains is presented.

Grain*3960107199503547
Pulse5713235964
Corn-soy blend5713246167
Vegetable oil246122932
Sugar22482022
Salt111355
Total (g)5381144269679739
Table 11.  Amount of nutrient provided by each ‘typical’ GFD ration (and ‘average’ breast milk intake) and per cent of the daily recommended intake provided for 6–8-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units. *Adequacy based on absorbed iron requirement and based on calculated bioavailability of the diet. †Adequacy based on absorbed zinc requirement and based on calculated bioavailability of the diet.

Proteing10.99911.010012.211112.9117
Fatg26.78927.19026.88927.893
 Linoleic acidg1.4301.6351.5321.940
 α-Linolenic acidg0.2380.2380.2380.242
 n6 : n3 7.1 8.4 7.7 8.9 
Carbohydrateg82.28781.48680.78582.287
Calciummg218.655267.667261.765225.256
Coppermg0.31260.21070.31190.294
Folic acidµg DFE42.35350.863138.317339.349
Iodineµg99.511199.511199.511199.5111
Ironmg1.6173.3363.0323.133
 Absorbed iron*mg0.3280.5480.4440.443
Magnesiummg46.48649.09144.18235.666
Manganesemg0.5880.2290.4620.117
Niacinmg2.7683.9984.51123.792
Pantothenic acidmg1.81001.4791.5831.373
Phosphorousmg156.057154.756156.557234.285
Potassiummg433.362455.565438.863543.278
Riboflavinmg0.3660.4980.41000.376
Seleniumµg19.419417.917926.626613.5135
Sodiummg305.282307.083305.182306.883
Thiaminemg0.2730.51540.41470.397
Vitamin Aµg RAE378.395603.7151606.8152378.395
Vitamin B12µg0.7930.7930.7930.793
Vitamin B6mg0.2540.2580.1390.133
Vitamin Cmg26.38826.38826.38826.388
Vitamin DIU22.71122.71122.71122.711
Vitamin Emg1.9711.9711.9701.969
Vitamin Kµg6.0606.0606.1616.060
Zincmg1.5371.4331.4331.127
 Absorbed zincmg0.8720.6570.6580.546
Table 12.  Amount of nutrient provided by each ‘typical’ GFD ration (and ‘average’ breast milk intake) and per cent of the daily recommended intake provided for 9–11-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units. *Adequacy based on absorbed iron requirement and based on calculated bioavailability of the diet. †Adequacy based on absorbed zinc requirement and based on calculated bioavailability of the diet.

Proteing12.711512.911714.713415.8144
Fatg26.38827.09026.58828.093
 Linoleic acidg2.1452.4522.2482.861
 α-Linolenic acidg0.3580.3570.3580.363
 n6 : n3 7.1 8.4 7.7 8.9 
Carbohydrateg98.610497.410396.410198.6104
Calciummg229.957304.376295.374239.960
Coppermg0.31490.31210.31390.2101
Folic acidµg DFE63.78076.696209.726259.274
Iodineµg111.0123111.0123111.0123111.0123
Ironmg2.3255.0534.4474.649
 Absorbed iron*mg0.3370.6640.5580.556
Magnesiummg57.810761.711454.310141.376
Manganesemg0.81330.3440.6930.226
Niacinmg3.6905.51376.31583.383
Pantothenic acidmg2.11151.5841.6891.475
Phosphorousmg185.968184.067186.668304.7111
Potassiummg466.567500.271474.968633.691
Riboflavinmg0.3680.51170.51200.384
Seleniumµg22.222219.919933.233213.2132
Sodiummg397.5107400.2108397.3107399.9108
Thiaminemg0.3860.62080.61980.4122
Vitamin Aµg392.198734.6184739.3185392.198
Vitamin B12µg RAE0.6910.6910.6910.691
Vitamin B6mg0.2710.2770.1480.139
Vitamin Cmg25.48525.48525.48525.485
Vitamin DIU26.41326.41326.41326.413
Vitamin Emg2.1762.1772.0752.074
Vitamin Kµg8.4848.4848.5858.484
Zincmg1.9461.6401.6401.230
 Absorbed zincmg0.9800.7610.7630.546
Table 13.  Amount of nutrient provided by each ‘typical’ GFD ration (and ‘average’ breast milk intake) and per cent of the daily recommended intake provided for 12–23-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units. *Because there is not a recommended absolute amount of fat for the 12–35 month age group, the per cent of energy from fat is displayed in the ‘% daily intake column’. For this age group, the per cent of energy from fat is recommended to be between 30 and 40% of energy (Institute of Medicine). †Adequacy based on absorbed iron requirement and based on calculated bioavailability of the diet. ‡Adequacy based on absorbed zinc requirement and based on calculated bioavailability of the diet.

Proteing17.513417.913721.216323.1178
Fat*g27.92829.22928.32931.031
 Linoleic acidg3.7534.3624.0575.072
 α-Linolenic acidg0.5740.5730.5730.681
 n6 : n3 7.1 8.4 7.7 8.9 
Carbohydrateg141.1109138.9107137.0105141.1109
Calciummg274.255407.081391.178292.158
Coppermg0.51370.41040.41250.381
Folic acidµg DFE113.075136.191373.6249104.970
Iodineµg143.6160144.8161144.8161144.8161
Ironmg4.0688.71517.81348.1140
 Absorbed ironmg0.5880.91560.81430.8137
Magnesiummg86.114493.115579.913356.795
Manganesemg1.41180.5391.0830.323
Niacinmg5.7958.914910.41748.3138
Pantothenic acidmg2.81411.8922.01001.577
Phosphorousmg263.857260.357265.058475.9103
Potassiummg577.519637.821592.620875.829
Riboflavinmg0.3640.71320.71380.486
Seleniumµg29.817625.915249.529113.881
Sodiummg615.762628.263623.062627.763
Thiaminemg0.4711.02021.01920.6110
Vitamin Aµg RAE457.01141068.22671076.6269457.0114
Vitamin B12µg0.7740.7740.7740.774
Vitamin B6mg0.3670.4740.2420.233
Vitamin Cmg25.98625.98625.98625.986
Vitamin DIU36.51836.51836.51836.518
Vitamin Emg2.6432.6432.5422.441
Vitamin Kµg14.09313.99314.29513.993
Zincmg2.8682.3572.3571.639
 Absorbed zinc 1.11560.81150.81170.681
Table 14.  Amount of nutrient provided by each ‘typical’ GFD ration and per cent of the daily recommended intake provided for 24–35-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units. *Because there is not a recommended absolute amount of fat for the 12–35 month age group, the per cent of energy from fat is displayed in the ‘% daily intake’ column. For this age group, the per cent of energy from fat is recommended to be between 30 and 40% of energy (Institute of Medicine). †Adequacy based on absorbed iron requirement and based on calculated bioavailability of the diet. ‡Adequacy based on absorbed zinc requirement and based on calculated bioavailability of the diet.

Proteing22.717523.418029.622833.2255
Fat*g15.11317.41515.91420.918
 Linoleic acidg6.9998.11157.41069.4135
 α-Linolenic acidg1.01391.01361.01371.1151
 n6 : n3 7.1 8.4 7.7 8.9 
Carbohydrateg195.1150191.1147187.6144195.1150
Calciummg246.249494.399464.693279.656
Coppermg0.61860.41240.61640.381
Folic acidµg DFE209.8140252.8169696.7464194.5130
Iodineµg163.6182166.0184166.0184166.0184
Ironmg7.112316.027614.224514.8256
 Absorbed ironmg0.61011.01811.01650.9158
Magnesiummg127.6213140.7234116.019372.7121
Manganesemg2.62200.9721.91540.543
Niacinmg9.315415.325418.130114.0234
Pantothenic acidmg3.61791.7862.01011.258
Phosphorousmg359.978353.377362.179756.2164
Potassiummg580.019692.623608.0201137.438
Riboflavinmg0.3520.91811.01910.593
Seleniumµg36.721629.317273.54326.840
Sodiummg977.8981002.2100992.6991001.3100
Thiaminemg0.5941.73381.63180.8166
Vitamin Aµg RAE378.5951520.73801536.4384378.595
Vitamin B12µg0.3350.3350.3350.335
Vitamin B6mg0.51070.61200.3610.243
Vitamin Cmg10.33410.33410.33410.334
Vitamin DIU47.32447.32447.32447.324
Vitamin Emg2.6432.7452.5412.439
Vitamin Kµg24.216124.016024.616424.0160
Zincmg4.1993.2793.2791.945
 Absorbed zincmg2.21870.91300.91330.680
Table 15.  Nutrients that exceed the UL from the hypothetical intake from the ‘typical’ GFD ration. Presented by age/physiologic group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)
Age/physiologic group (mo)RiceCornmealWheat flourSorghum
  1. UL, Upper Levels; GFD, general food distribution.

6–8 Vitamin AVitamin A 
9–11 Vitamin AVitamin A 
12–23MagnesiumMagnesium Vitamin ANiacin Magnesium Vitamin A Folic acidMagnesium
24–35Magnesium ManganeseMagnesium Vitamin A NiacinMagnesium Vitamin A Niacin Folic acidMagnesium Niacin
Pregnant Magnesium Niacin Vitamin AFolic acid Magnesium Niacin Vitamin ANiacin
LactatingMagnesiumMagnesium Niacin Vitamin AFolic acid Niacin Vitamin ANiacin
Table 16.  Amount of nutrient provided by each ‘typical’ GFD ration and per cent of the daily recommended intake provided for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; DFE, dietary folate equivalents; RAE, retinol activity equivalents; IU, international units. *Because there is not a recommended absolute amount of fat for pregnant or lactating women, the per cent of energy from fat is displayed in the ‘% daily intake’ column. For this physiological group, the per cent of energy from fat is recommended to be between 20 and 35% of energy (Institute of Medicine). †Amount of absorbed iron is based on an assumed 25% absorption for pregnant women (Institute of Medicine). Adequacy based on absorbed iron requirement. ‡Amount of absorbed zinc is based on calculated bioavailability of diet. Using standard equations for determining the bioavailability of zinc from the diet, the calculated zinc absorption from the ‘typical’ GFD ration is 19%. Adequacy based on absorbed zinc requirement.

Proteing57.38159.18374.910583.9118
Fat*g41.51347.81543.61457.518
 Linoleic acidg17.513520.315718.814423.8183
 α-Linolenic acidg2.51752.41722.41732.7190
 n6 : n3 7.1 8.4 7.7 8.9 
Carbohydrateg493.2282482.9276474.1271493.1282
Calciummg621.9521248.91041173.898706.359
Coppermg1.61601.11071.41410.769
Folic acidµg DFE530.188638.91061760.8293491.782
Iodineµg334.2167334.2167334.2167334.2167
Ironmg18.06740.515035.913337.5139
 Absorbed ironmg4.59810.12209.01959.4204
Magnesiummg322.6147355.5162293.2133183.784
Manganesemg6.73342.21094.72341.364
Niacinmg23.413038.621445.725445.7254
Pantothenic acidmg9.01514.3725.1852.949
Phosphorousmg909.5130893.0128915.01311911.2273
Potassiummg1465.7311750.2371536.5332874.461
Riboflavinmg0.7472.31632.41721.284
Seleniumµg92.832074.0255185.864117.159
Sodiummg1960.21311982.91321958.41311980.5132
Thiaminemg1.2854.33054.02872.1150
Vitamin Aµg RAE956.51203843.34803883.0485956.5120
Vitamin B12µg0.8310.8310.8310.831
Vitamin B6mg1.4711.5800.8400.529
Vitamin Cmg26.04726.04726.04726.047
Vitamin DIU119.560119.560119.560119.560
Vitamin Emg6.5446.8456.3426.040
Vitamin Kµg61.111160.611062.111360.6110
Zincmg10.31378.21098.21094.762
 Absorbed zincmg2.2681.5461.5480.929
Table 17.  Amount of nutrient provided by each ‘typical’ GFD ration and per cent of the daily recommended intake provided for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; DFE, dietary folate equivalents; IU, international units. *Because there is not a recommended absolute amount of fat for pregnant or lactating women, the recommended per cent of energy from fat is displayed in the ‘% daily intake’ column. For this physiological group, the per cent of energy from fat is recommended to be between 20 and 35% of energy (Institute of Medicine). Amount of absorbed iron presented based on calculated bioavailability of diet. For lactating women, using standard equations for determining the bioavailability of iron from the diet, the calculated iron absorption from the ‘typical’ GFD ration for lactating women is 7%. Adequacy based on absorbed iron requirement. Amount of absorbed zinc presented based on calculated bioavailability of diet. For lactating women, using standard equations for determining the bioavailability of zinc from the diet, the calculated zinc absorption from the ‘typical’ GFD ration is 21% (an increase of 10% above pregnancy). Adequacy based on absorbed zinc requirement.

Proteing62.48864.39181.511591.2128
Fat*g41.51347.835443.632357.5426
 Linoleic acidg19.014622.117020.415725.9199
 α-Linolenic acidg2.71912.61872.61892.9207
 n6 : n3 7.1 8.4 7.7 8.9 
Carbohydrateg536.4307525.2300515.7295536.4307
Calciummg676.4561358.41131276.7106768.264
Coppermg1.71741.21161.51530.875
Folic acidµg DFE576.696695.01161915.2319534.889
Iodineµg337.3169337.3169337.3169337.3169
Ironmg19.67344.116339.114540.8151
 Absorbed iron 1.71153.12092.91902.7183
Magnesiummg350.8159386.7176318.9145199.891
Manganesemg7.33632.41195.12551.470
Niacinmg25.414141.923349.727638.6214
Pantothenic acidmg9.81644.7785.6933.253
Phosphorousmg989.2141971.4139995.31422078.9297
Potassiummg1594.2341903.7411671.3363126.567
Riboflavinmg0.7512.51782.61871.392
Seleniumµg101.034880.5278202.169718.664
Sodiummg1962.11311986.81321960.21311984.3132
Thiaminemg1.3924.63324.43122.3163
Vitamin Aµg1040.41304180.45234223.65281040.4130
Vitamin B12µg0.9330.9330.9330.933
Vitamin B6mg1.5771.7870.8440.631
Vitamin Cmg28.35228.35228.35228.352
Vitamin DIU130.065130.065130.065130.065
Vitamin Emg7.1477.4496.8466.543
Vitamin Kµg66.412165.912067.512365.9120
Zincmg11.21498.91198.91185.168
 Absorbed zinc 3.494.32.467.62.568.81.540.9
Table 18.  Composition (g) of hypothetical intakes from ‘revised’ GFD ration, taking into account energy content (118 kcal or 236 kcal) to be provided via LNS
Food6–8 mo (84 kcal)9–11 mo (189 kcal)12–23 mo (430 kcal)24–35 mo (906 kcal)Pregnant (2470 kcal)Pregnant (2352 kcal)*Lactating (2697 kcal)Lactating (2579 kcal)*
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement. Because four different grains/grain products (rice, cornmeal, wheat flour and sorghum) were used, with slight variations in energy density, there were small differences in the quantity assumed for each grain; for purposes of presentation in the table, the average quantity for all four grains is presented. *Two ‘doses’ of LNS provided (236 kcal).

Grain (g)173989188512487559534
Pulses (g)37163389859793
Veg. oil (g)1251130283231
Salt (g)0.20.5126676
Sugar (g)0.613718171919
Total (g)2250114240654623714683
Table 19.  LNS macro- and micro-nutrient content for 6–35-month-olds based on the higher of the two daily recommended intake values for 7–11 and 12–35 months (micronutrients only), except where noted
NutrientUnitDaily recommended intake: 7–11 moDaily recommended intake: 12–35 moLNS 6–35 mo composition, per 20g ration
  1. LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Nutrients whose content in LNS is limited to less than 1 recommended nutrient intake due to technical/food science constraints. The daily recommended intake for iron and zinc provided is the absorbed need. The iron content in the LNS was based on an average of the calculated levels of iron absorption from the GFD diets for 7–11-month-olds of 21% and 16% for the 12–35-month-olds. The value was increased by 30–50% to account for uncertainty in the absorption from the base diet and LNS. §The average calculated zinc absorption from the GFD diets was 39% for the 7–11-month-olds and 29% for the 12–35-month-olds; however due to uncertainty in absorption from LNS, 5 mg was included.

Proteing11.0132.6
Fatg30.030–40% E9.6
 Linoleic acidg4.674.5
 α-linolenic acidg0.50.70.6
Carbohydrateg95.01305.3
EnergykcalNANA118
Calciummg400500280*
Coppermg0.220.340.34
Folic acidµg DFE80150150
Iodineµg909090
Ironmg0.930.586
Magnesiummg546060
Manganesemg0.61.21.2
Niacinmg466
Pantothenic acidmg1.822
Phosphorusmg275460190*
Potassiummg7003000200*
Riboflavinmg0.40.50.5
Seleniumµg101717
Thiamineµg0.30.50.5
Vitamin Aµg RAE400400400
Vitamin B12mg0.70.90.9
Vitamin B6mg0.30.50.5
Vitamin CIU303030
Vitamin Dmg200200200
Vitamin Eµg2.755
Vitamin Kmg101515
Zincmg1.10.75§
Table 20.  Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 6–8-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of daily requirement is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of daily requirement is calculated based on the amount of absorbed zinc.

Proteing10.99910.99911.510411.8107
Fatg34.411534.611534.511534.9116
 Linoleic acidg5.01085.11105.01095.2113
 α-linolenic acidg0.71320.71320.71320.7134
 n6 : n3 ratio 7.6 7.7 7.6 7.8 
Carbohydrateg65.26964.86864.56865.269
Calciummg454.9114476.4119473.9118457.8114
Coppermg0.52480.52400.52450.5234
Folic acidµg DFE164.3205168.0210206.6258163.0204
Iodineµg169.3188169.3188169.3188169.3188
Ironmg6.5897.31007.1977.298
 Absorbed iron*mg1.61711.61681.61681.5160
Magnesiummg90.216791.316989.116585.4158
Manganesemg1.42381.32121.42271.2207
Niacinmg7.61898.22058.32098.0200
Pantothenic acidmg3.41863.21773.21793.1175
Phosphorousmg305.6111305.1111305.8111340.1124
Potassiummg568.281578.083570.682616.688
Riboflavinmg0.71820.81960.81970.7186
Seleniumµg32.032031.331335.235229.4294
Sodiummg190.652191.452190.652191.352
Thiaminemg0.72210.82560.82530.7231
Vitamin Aµg RAE721.9180821.2205822.6206721.9180
Vitamin B12µg1.52131.52131.52131.5213
Vitamin B6mg0.61990.62000.61920.6189
Vitamin Cmg54.418154.418154.418154.4181
Vitamin DIU213.4107213.4107213.4107213.4107
Vitamin Emg6.52416.52416.52416.5240
Vitamin Kµg18.418418.418418.418418.4184
Zincmg6.02746.02716.02715.8265
 Absorbed zincmg2.62372.32122.42152.2200
Table 21.  Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 9–11-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing12.711612.811714.112814.8134
Fatg33.911334.411534.111435.0117
 Linoleic acidg5.71235.91285.81256.2134
 α-linolenic acidg0.81520.81510.81520.8155
 n6 : n3 ratio 7.5 7.8 7.6 7.9 
Carbohydrateg81.88681.08580.38581.886
Calciummg446.9112495.4124489.6122453.4113
Coppermg0.62730.62540.62660.5241
Folic acidµg DFE181.0226189.4237276.3345178.0223
Iodineµg180.9201180.9201180.9201180.9201
Ironmg6.9948.61188.31138.4115
 Absorbed iron*mg1.51581.61681.51651.5157
Magnesiummg99.5184102.118997.318088.8164
Manganesemg1.72851.42271.62591.3216
Niacinmg8.32089.523810.12519.3232
Pantothenic acidmg3.61993.21793.31823.1173
Phosphorousmg337.0123335.7122337.4123414.5151
Potassiummg603.886625.889609.387712.8102
Riboflavinmg0.71820.92140.92160.8192
Seleniumµg34.534533.133141.741728.6286
Sodiummg292.879294.680292.779294.480
Thiaminemg0.72320.93120.93050.8256
Vitamin Aµg RAE719.7180943.1236946.2237719.7180
Vitamin B12µg1.42061.42061.42061.4206
Vitamin B6mg0.62130.72180.61980.6193
Vitamin Cmg52.517552.517552.517552.5175
Vitamin DIU212.3106200.3100212.3106212.3106
Vitamin Emg6.52426.52426.52416.5240
Vitamin Kµg21.021020.920921.121120.9209
Zincmg6.32886.22816.22815.9269
 Absorbed zincmg2.52262.11922.21962.0178
Table 22.  Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 12–23-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Because there is not a recommended absolute amount of fat for the 12–35 month age group, the per cent of energy from fat is displayed in the ‘% daily intake’ column. For this age group, the per cent of energy from fat is recommended to be between 30 and 40% of energy (Institute of Medicine). The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing17.613617.913820.715922.3172
Fat*g35.33636.33735.63637.938
 Linoleic acidg7.21037.71107.51068.3119
 α-linolenic acidg1.01421.01411.01411.0147
 n6 : n3 ratio 7.3 7.9 7.5 8.1 
Carbohydrateg124.796122.995121.493124.796
Calciummg447.189557.6112544.4109462.092
Coppermg0.72180.61910.72090.6172
Folic acidµg DFE219.4146238.5159436.2291212.6142
Iodineµg211.9235211.9235211.9235211.9235
Ironmg7.812411.818710.917411.2178
 Absorbed ironmg1.42431.83031.72891.6275
Magnesiummg123.4206129.2215118.219798.9165
Manganesemg2.41971.61312.01671.4117
Niacinmg10.216912.821414.123512.3205
Pantothenic acidmg4.22123.41703.51773.2158
Phosphorousmg418.191415.290419.191594.5129
Potassiummg720.124770.226732.524968.232
Riboflavinmg0.81511.02081.12120.8169
Seleniumµg41.724538.422658.034128.3167
Sodiummg521.152525.153520.852524.752
Thiaminemg0.81581.32661.32580.9190
Vitamin Aµg RAE747.81871256.33141263.3316747.8187
Vitamin B12µg1.41551.41551.41551.4155
Vitamin B6mg0.71500.81550.61290.6121
Vitamin Cmg50.816950.816950.816950.8169
Vitamin DIU211.2106211.2106211.2106211.2106
Vitamin Emg6.71356.81356.71346.6133
Vitamin Kµg27.018026.918027.218126.9180
Zincmg7.13766.83576.83576.2324
 Absorbed zincmg2.43441.92772.02841.7246
Table 23.  Amount of nutrient provided by each ‘revised’ GFD ration, breast milk and LNS (6–35 mo formulation) and per cent of the daily recommended intake provided for 24–35-month-old children. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Because there is not a recommended absolute amount of fat for the 12–35 mo age group, the per cent of energy from fat is displayed in the ‘% daily intake’ column. For this age group, the per cent of energy from fat is recommended to be between 30 and 40% of energy (Institute of Medicine). The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of daily requirement is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing23.017723.718229.522732.9253
Fat*g21.91924.12122.72027.424
 Linoleic acidg10.314711.316210.815412.6180
 α-linolenic acidg1.42071.42051.42051.5218
 n6 : n3 ratio 7.1 7.9 7.5 8.3 
Carbohydrateg179.7138175.9135172.6133179.7138
Calciummg331.966564.6113536.7107363.273
Coppermg0.92710.72130.92500.6172
Folic acidµg DFE294.5196334.9223751.2501280.2187
Iodineµg222.7247222.7247222.7247222.7247
Ironmg9.515017.828316.125516.7265
 Absorbed ironmg1.11971.73001.62781.5267
Magnesiummg156.0260168.3280145.1242104.5174
Manganesemg3.63032.01642.92411.6136
Niacinmg13.222018.831321.435717.7294
Pantothenic acidmg4.82393.01523.31662.5126
Phosphorousmg520.4113514.3112522.4114892.2194
Potassiummg732.724838.328759.0251255.542
Riboflavinmg0.71321.32521.32620.9170
Seleniumµg47.528040.523882.048219.4114
Sodiummg865.287873.687864.586872.787
Thiaminemg0.91772.04061.93871.2244
Vitamin Aµg RAE596.81491668.24171682.9421596.8149
Vitamin B12µg0.91000.91000.91000.9100
Vitamin B6mg0.91841.01970.71410.6125
Vitamin Cmg31.010331.010331.010331.0103
Vitamin DIU200.0100200.0100200.0100200.0100
Vitamin Emg6.21246.31256.11226.0119
Vitamin Kµg38.125437.925338.525637.9253
Zincmg8.24347.53927.53926.2324
 Absorbed zincmg2.33341.82541.82601.5208
Table 24.  Nutrients that exceed the UL when the 6–35 mo formulation LNS is added to the hypothetical intake from the ‘revised’ GFD ration, and breast milk (when applicable). Presented by age group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)
Age group (mo)RiceCornmealWheat flourSorghum
  1. UL, Upper Levels; LNS, lipid-based nutrient supplement; GFD, general food distribution. *Nutrient quantity from the hypothetical intake of the ‘revised’ GFD ration already exceeds UL (before addition of LNS).

6–8Vitamin A ZincVitamin AVitamin AVitamin A
9–11Vitamin A ZincVitamin A ZincVitamin A ZincVitamin A
12–23Magnesium* Niacin Vitamin A ManganeseMagnesium* Niacin Vitamin A*Magnesium* Niacin Vitamin A* Folic acid ManganeseMagnesium Niacin Vitamin A
24–35Magnesium* Niacin Manganese* Folic acid ZincFolic acid Magnesium* Niacin* Vitamin A*Folic acid* Magnesium* Manganese Niacin* Vitamin A*Magnesium Niacin Folic acid
Table 25.  LNS macro- and micro-nutrient content for pregnant and lactating women (PLW) based on the higher of the two RNI levels for pregnancy and lactation, except where noted
NutrientUnitDaily recommended intake: PregnancyDaily recommended intake: LactationLNS PLW composition, per 20 g ration
  1. RNI, Recommended Nutrient Intake; DFE, dietary folate equivalents; RAE, retinol activity equivalents; LNS, lipid-based nutrient supplement; GFD, general food distribution. *Nutrients whose content in LNS is limited by technical/food science constraints. The daily recommended intake for iron and zinc provided is the ‘absorbed’ requirement. The iron content in the LNS was based on an average of the estimated levels of iron absorption from the GFD diets of 25% during pregnancy and 13% during lactation. The value was increased by 30–50% to account for uncertainty in the absorption from the base diet and LNS. §The zinc content in the LNS was based on an average of the calculated levels of zinc absorption from the GFD diets of 14% during pregnancy and 24% during lactation.

Proteing71712.6
Fatg20–35 %E20–35 %E9.6
 Linoleic acidg13*13*4.5
 α-linolenic acidg1.4*1.3*0.6
Carbohydrateg1752105.3
EnergykcalNANA118
Calciummg12001000280*
Coppermg11.31.3
Folic acidµg DFE600500600
Iodineµg200200200
Ironmg4.61.520
Magnesiummg22027065*
Manganesemg22.62.6
Niacinmg181718
Pantothenic acidmg677
Phosphorusmg700700190*
Potassiummg47005100200*
Riboflavinmg1.41.61.6
Seleniumµg293535
Sodiummg150015000
Thiaminemg1.41.51.5
Vitamin Aµg RAE800850850
Vitamin B12µg2.62.82.8
Vitamin B6mg1.922
Vitamin Cmg557070
Vitamin DIU200200200
Vitamin Emg151919
Vitamin Kµg555555
Zincmg3.23.623§
Table 26.  Amount of nutrient provided by each ‘revised’ GFD diet and LNS (PLW formulation) and per cent of the daily recommended intake provided for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; PLW, pregnant and lactating women; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Because there is not a recommended absolute amount of fat for pregnant and lactating women, the per cent of energy from fat is displayed in the ‘% daily intake’ column. For this physiologic group, the per cent of energy from fat is recommended to be between 20 and 35% of energy (Institute of Medicine). The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of daily recommended intake is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing58.38260.08576.010785.1120
Fat*g43.21549.11745.21658.120
 Linoleic acidg20.315623.217921.616726.7206
 α-linolenic acidg2.92112.92072.92093.2226
 n6 : n3 ratio 6.9 8.0 7.4 8.5 
Carbohydrateg480.7275470.3269461.4264480.7275
Calciummg421.6351056.088980.082506.942
Coppermg2.92882.32342.72692.0197
Folic acidµg DFE993.91661104.01842239.1373954.9159
Iodineµg566.5283566.5283566.5283566.5283
Ironmg29.416352.229047.526449.1273
 Absorbed ironmg7.616513.830012.527213.0282
Magnesiummg326.7149360.1164297.0135186.385
Manganesemg9.24624.72347.23613.8189
Niacinmg37.520952.929460.133449.8277
Pantothenic acidmg14.62439.816410.61778.4140
Phosphorousmg1090.61561074.01531096.31572104.3301
Potassiummg1652.1351940.0411723.7373077.465
Riboflavinmg2.01453.72633.82722.6183
Seleniumµg118.240899.2342212.373241.6143
Sodiummg2388.81592411.81612387.11592409.4161
Thiaminemg2.51825.74055.43863.5248
Vitamin Aµg RAE1386.51734307.45384347.55431386.5173
Vitamin B12µg2.81082.81082.81082.8108
Vitamin B6mg3.21663.31752.61352.3123
Vitamin Cmg72.813272.813272.813272.8132
Vitamin DIU200.0100200.0100200.0100200.0100
Vitamin Emg22.214822.415022.014621.6144
Vitamin Kµg118.0214117.4214119.0216117.4214
Zincmg31.824529.722829.722826.2201
 Absorbed zincmg5.21633.91224.01263.392
Table 27.  Amount of nutrient provided by each ‘revised’ GFD diet and LNS (PLW formulation) and per cent of the daily recommended intake provided for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; PLW, pregnant and lactating women; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Because there is not a recommended absolute amount of fat for pregnant and lactating women, the per cent of energy from fat is displayed in the ‘% daily intake’ column. For this physiologic group, the per cent of energy from fat is recommended to be between 20 and 35% of energy (Institute of Medicine). The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of daily recommended intake is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing63.48965.39282.811792.7131
Fat*g46.31552.81748.41562.520
 Linoleic acidg21.816825.019223.217928.8221
 α-linolenic acidg3.22433.12403.12413.4261
 n6 : n3 ratio 6.9 8.0 7.4 8.5 
Carbohydrateg524.4250513.1244503.3240524.4250
Calciummg434.6431127.31131044.3104527.853
Coppermg3.02332.41882.82172.0156
Folic acidµg DFE1030.12061150.32302389.8478987.6198
Iodineµg602.4301602.4301602.4301602.4301
Ironmg30.320255.136850.033451.8345
 Absorbed ironmg4.53026.74446.24145.9396
Magnesiummg350.8130387.3143318.4118197.473
Manganesemg9.83794.91887.62943.9150
Niacinmg39.323156.133064.037652.7310
Pantothenic acidmg15.321810.114411.01578.5122
Phosphorousmg1173.51681155.31651179.61692280.3326
Potassiummg1785.7352100.1411864.0373342.166
Riboflavinmg2.11303.92424.02502.6165
Seleniumµg125.9360105.1300228.665342.2120
Sodiummg2622.71752647.81772620.81752645.2176
Thiaminemg2.61766.04035.83853.7243
Vitamin Aµg RAE1435.61694625.15444668.95491435.6169
Vitamin B12µg2.81002.81002.81002.8100
Vitamin B6mg3.31633.41722.61312.4118
Vitamin Cmg73.010473.010473.010473.0104
Vitamin DIU200.0100200.0100200.0100200.0100
Vitamin Emg22.511822.812022.211721.9115
Vitamin Kµg123.7225123.2224124.8227123.2224
Zincmg32.632630.330330.330326.5265
 Absorbed zincmg5.71594.31194.41223.6101
Table 28.  Nutrients that exceed the UL when the PLW LNS formulation is added to the hypothetical intake from the GFD ration. Presented by physiologic group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)
Age group (mo)RiceCornmealWheat flourSorghum
  1. UL, Upper Levels; PLW, pregnant and lactating women; LNS, lipid-based nutrient supplement; GFD, general food distribution. *Nutrient quantity from the hypothetical intake of the GFD ration (before addition of LNS) already exceeds the UL.

PregnantFolic acid NiacinMagnesium* Niacin* Vitamin A* Folic acid IronFolic acid* Niacin* Vitamin A* IronFolic acid Iron
LactatingFolic acid Niacin MagnesiumMagnesium* Vitamin A* Folic acid IronFolic acid* Niacin* Vitamin A* IronNiacin* Folic acid Iron
Table 29.  LNS micronutrient content for all groups, ‘one-size fits all’ approach
NutrientUnitLNS ‘one-size’ composition, per 20 g rationAmount in two rations (40 g)
  1. LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RDA, Recommended Dietary Allowance; RNI, Recommended Nutrient Intake. *Nutrients whose content in LNS is limited by technical/food science concerns. Content adjusted because intake <75% of RDA/RNI for some groups.

Proteing2.65.2
Fatg9.619.2
 Linoleic acidg4.58.92
 α-linolenic acidg0.61.16
Carbohydrateg5.310.6
Energykcal118236
Calciummg280*560
Coppermg0.340.68
Folic acidµg DFE150300
Iodineµg90180
Ironmg612
Magnesiummg60120
Manganesemg1.22.4
Niacin (total)mg612
Pantothenic acidmg24
Phosphorusmg190*380
Potassiummg200*400
Riboflavinmg0.51
Seleniumµg1734
Thiaminemg0.51
Vitamin Aµg400800
Vitamin B12µg1.42.8
Vitamin B6mg12
Vitamin Cmg3060
Vitamin DIU200400
Vitamin Emg612
Vitamin Kµg1530
Zincmg510
Table 30.  Amount of nutrient provided by each ‘revised’ GFD diet and LNS (‘one size’ formulation) and per cent of the daily recommended intake provided for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Because there is not a recommended absolute amount of fat for pregnant and lactating women, the per cent of energy from fat is displayed in the ‘% daily intake column’. For this physiologic group, the per cent of energy from fat is recommended to be between 20 and 35% of energy (Institute of Medicine). The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing60.98662.68878.611187.7124
Fat*g52.81858.72054.81967.724
 Linoleic acidg24.819127.721326.120131.2240
 α-linolenic acidg3.52523.52493.52503.7267
 n6 : n3 ratio 7.0 8.0 7.5 8.3 
Carbohydrateg486.0278475.6272466.7267486.0278
Calciummg701.6581336.01111260.0105786.966
Coppermg2.32261.71722.12071.3135
Folic acidµg DFE693.9116804.01341939.1323654.9109
Iodineµg546.5273546.5273546.5273546.5273
Ironmg21.411944.224539.521941.1229
 Absorbed ironmg5.612111.825610.522811.0238
Magnesiummg381.7174415.1189352.0160241.3110
Manganesemg9.04524.52247.03513.6179
Niacinmg31.517546.926154.130143.8243
Pantothenic acidmg11.61936.81147.61275.490
Phosphorousmg1280.61831264.01811286.31842294.3328
Potassiummg1852.1392140.0461923.7413277.470
Riboflavinmg1.41033.12203.22292.0140
Seleniumµg117.240498.2339211.372940.6140
Sodiummg2388.81592411.81612387.11592409.4161
Thiaminemg2.01465.23694.93513.0212
Vitamin Aµg RAE1336.51674257.45324297.55371336.5167
Vitamin B12µg2.81082.81082.81082.8108
Vitamin B6mg3.21663.31752.61352.3123
Vitamin Cmg62.811462.811462.811462.8114
Vitamin DIU400.0200400.0200400.0200400.0200
Vitamin Emg15.210115.410315.010014.698
Vitamin Kµg93.016992.416894.017192.4168
Zincmg18.814516.712816.712813.2101
 Absorbed zincmg3.51092.5792.6822.063
Table 31.  Amount of nutrient provided by each ‘revised’ GFD diet and LNS (‘one size’ formulation) and per cent of the daily recommended intake provided for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets
NutrientUnitRiceCornWheatSorghum
Amt.% daily intakeAmt.% daily intakeAmt.% daily intakeAmt.% daily intake
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents. *Because there is not a recommended absolute amount of fat for pregnant and lactating women, the per cent of energy from fat is displayed in the ‘% daily intake column’. For this physiologic group, the per cent of energy from fat is recommended to be between 20 and 35% of energy (Institute of Medicine). The total amount of iron in the diet is presented as well as the estimated amount of iron absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed iron. The total amount of zinc in the diet is presented as well as the estimated amount of zinc absorbed from the diet (based on the calculated bioavailability). The per cent of the daily recommended intake is calculated based on the amount of absorbed zinc.

Proteing66.09367.99685.412095.3134
Fat*g55.91862.42058.01972.123
 Linoleic acidg8.9698.9698.9698.969
 α-linolenic acidg1.2891.2891.2891.289
 n6 : n3 ratio 7.7 7.7 7.7 7.7 
Carbohydrateg529.7252518.4247508.6242529.7252
Calciummg714.6711407.31411324.3132807.881
Coppermg2.41851.81402.21691.4108
Folic acidµg DFE730.1146850.31702089.8418687.6138
Iodineµg582.4291582.4291582.4291582.4291
Ironmg22.314947.131442.028043.8292
 Absorbed ironmg3.02015.23454.73164.6304
Magnesiummg405.8150442.3164373.4138252.493
Manganesemg9.63714.71807.42863.7142
Niacinmg33.319650.129558.034146.7275
Pantothenic acidmg12.31757.11018.01145.579
Phosphorousmg1363.51951345.31921369.61962470.3353
Potassiummg1985.7392300.1452064.0403542.169
Riboflavinmg1.5923.32043.42132.0128
Seleniumµg124.9357104.1297227.665041.2118
Sodiummg2622.71752647.81772620.81752645.2176
Thiaminemg2.11435.53705.33513.2210
Vitamin Aµg RAE1385.61634575.15384618.95431385.6163
Vitamin B12µg2.81002.81002.81002.8100
Vitamin B6mg3.31633.41722.61312.4118
Vitamin Cmg63.09063.09063.09063.090
Vitamin DIU400.0200400.0200400.0200400.0200
Vitamin Emg15.58215.88315.28014.978
Vitamin Kµg98.718098.217999.818298.2179
Zincmg19.619617.317317.317313.5135
 Absorbed zincmg3.91082.8782.9802.261
Table 32.  Nutrients that exceed the UL when the ‘one-size’ LNS formulation is added to the hypothetical intake from the GFD ration. Presented by age/physiologic group and identified by the staple grain used in the GFD hypothetical intake (with all other components being equal between diets)
Age/physiologic groupRiceCornmealWheat flourSorghum
  1. UL, Upper Levels; LNS, lipid-based nutrient supplement; GFD, general food distribution. *Nutrient quantity from the hypothetical intake of the GFD ration (before addition of LNS) already exceeds UL.

PregnantMagnesium*Magnesium Niacin* Vitamin A*Folic acid* Magnesium Niacin* Vitamin A* 
LactatingMagnesiumMagnesium* Niacin Vitamin A* IronFolic acid* Magnesium Niacin* Vitamin A*Niacin*
Table 33.  Toxicity estimates for 6–35-month-old children consuming 2–7 times the recommended daily dose of the age-specific or one-size LNS formulation (alone)
NutrientUnitUL 7–11 moUL 12–35 moLNS age-specific or one-size composition (6–35 mo)×2×3×4×5×6×7
  1. LNS, lipid-based nutrient supplement; UL, Upper Levels; DFE, dietary folate equivalents; ND, not determined; RAE, retinol activity equivalents. *Note that for these nutrients there are slight differences between the age-specific and one-size composition: in the one-size composition, these values are slightly higher (1.4 µg for vitamin B12, 1.0 µg for vitamin B6, and 6 mg for vitamin E). However, these differences do not change the toxicity estimates presented here. Values in bold exceed the UL for either or both age groups of children (6–11 or 12–35-month-olds).

Energykcal118236354472590708826
CalciummgND25002805608401120140016801960
CoppermgND10.340.681.021.361.72.042.38
Folic acidµg DFEND3001503004506007509001050
Iodineµg126060090180270360450540630
Ironmg40406121824303642
MagnesiummgND6560120180240300360420
ManganesemgND21.22.43.64.86.07.28.4
NiacinmgND106121824303642
Pantothenic acidmgNDND2468101214
PhosphorusmgND300019038057076095011401330
PotassiummgNDND200400600800100012001400
RiboflavinmgND300.511.522.533.5
Seleniumµg60901734516885102119
SodiummgND15000000000
ThiaminemgND100.511.522.533.5
Vitamin Aµg RAE60060040080012001600200024002800
Vitamin B12µgNDND0.9*1.82.73.64.55.46.3
Vitamin B6mgND300.5*11.522.533.5
Vitamin CmgND400306090120150180210
Vitamin DIU10002000200400600800100012001400
Vitamin EmgND2005*101520253035
Vitamin KµgNDND153045607590105
Zincmg685101520253035
Table 34.  Toxicity estimates for 6–35-month-old children consuming 2–7 times the recommended daily dose of the PLW LNS formulation (alone)
NutrientUnitUL 7–11 moUL 12–35 moLNS PLW composition×2×3×4×5×6×7
  1. PLW, pregnant and lactating women; LNS, lipid-based nutrient supplement; UL, Upper Levels; DFE, dietary folate equivalents; ND, not determined; RAE, retinol activity equivalents. Values in bold exceed the UL for either or both age groups of children (6–11 or 12–35-month-olds).

Energykcal118236354472590708826
CalciummgND25002805608401120140016801960
CoppermgND11.32.63.95.26.57.89.1
Folic acidµg DFEND300600120018002400300036004200
Iodineµg1260600200400600800100012001400
Ironmg404020406080100120140
MagnesiummgND6565130195260325390455
ManganesemgND22.65.27.810.41315.618.2
NiacinmgND101836547290108126
Pantothenic acidmgNDND7142128354249
PhosphorusmgND300019038057076095011401330
PotassiummgNDND200400600800100012001400
RiboflavinmgND301.63.24.86.489.611.2
Seleniumµg60903570105140175210245
SodiummgND15000000000
ThiaminemgND101.534.567.5910.5
Vitamin Aµg RAE600600850170025503400425051005950
Vitamin B12µgNDND2.85.68.411.21416.819.6
Vitamin B6mgND302468101214
Vitamin CmgND40070140210280350420490
Vitamin DIU10002000200400600800100012001400
Vitamin EmgND2001938577695114133
Vitamin KµgNDND55110165220275330385
Zincmg6823466992115138161
Table 35.  Toxicity estimates for PLW consuming 2–7 times the recommended daily dose of the PLW LNS formulation (alone)
NutrientUnitUL pregnantUL lactatingLNS PLW composition×2×3×4×5×6×7
  1. PLW, pregnant and lactating women; LNS, lipid-based nutrient supplement; UL, Upper Levels; DFE, dietary folate equivalents; ND, not determined; RAE, retinol activity equivalents. Values in bold exceed the UL for either or both groups of pregnant and lactating women.

Energykcal118236354472590708826
Calciummg300030002805608401120140016801960
Coppermg10101.32.63.95.26.57.89.1
Folic acidµg DFE10001000600120018002400300036004200
Iodineµg11001100200400600800100012001400
Ironmg454520406080100120140
Magnesiummg35035065130195260325390455
Manganesemg11112.65.27.810.41315.618.2
Niacinmg35351836547290108126
Pantothenic acidmgNDND7142128354249
Phosphorusmg3500400019038057076095011401330
PotassiummgNDND200400600800100012001400
RiboflavinmgNDND1.63.24.86.489.611.2
Seleniumµg4004003570105140175210245
Sodiummg230023000000000
ThiaminemgNDND1.534.567.5910.5
Vitamin Aµg RAE30003000850170025503400425051005950
Vitamin B12µgNDND2.85.68.411.21416.819.6
Vitamin B6mg1001002468101214
Vitamin Cmg1000100070140210280350420490
Vitamin DIU20002000200400600800100012001400
Vitamin Emg100010001938577695114133
Vitamin KµgNDND55110165220275330385
Zinc mgmg404023466992115138161
Table 36.  Toxicity estimates for PLW consuming 2–7 times the recommended daily dose of LNS (alone), for the one-size formulation
NutrientUnitUL pregnantUL lactatingLNS one-size composition×2×3×4×5x6×7
  1. PLW, pregnant and lactating women; LNS, lipid-based nutrient supplement; DFE, dietary folate equivalents; RAE, retinol activity equivalents; UL, Upper Levels; ND, not determined. Values in bold exceed the UL for either or both groups of pregnant and lactating women.

Energykcal118236354472590708826
Calciummg300030002805608401120140016801960
Coppermg10100.340.681.021.361.72.042.38
Folic acidµg DFE100010001503004506007509001050
Iodineµg1100110090180270360450540630
Ironmg45456121824303642
Magnesiummg35035060120180240300360420
Manganesemg11111.22.43.64.86.07.28.4
Niacinmg35356121824303642
Pantothenic acidmgNDND2468101214
Phosphorusmg3500400019038057076095011401330
PotassiummgNDND200400600800100012001400
RiboflavinmgNDND0.511.522.533.5
Seleniumµg4004001734516885102119
Sodiummg230023000000000
ThiaminemgNDND0.511.522.533.5
Vitamin Aµg RAE3000300040080012001600200024002800
Vitamin B12µgNDND1.42.84.25.678.49.8
Vitamin B6mg1001001234567
Vitamin Cmg10001000306090120150180210
Vitamin DIU20002000200400600800100012001400
Vitamin Emg100010006121824303642
Vitamin KµgNDND153045607590105
Zinc mgmg40405101520253035
Table 37.  Average commodity cost in US$ per metric ton (MT) of GFD commodities as provided by the Food for Peace commodity calculator for fiscal year 2009 (http://www.usaid.gov/our_work/humanitarian_assistance/ffp/comcalc_new.xls, accessed March 2009)
CommodityCommodity Price (US$/MT)
  1. GFD, general food distribution. When more than one form of a commodity was provided (for example, bagged rice vs. bulk rice with bags) an average was calculated.

Rice (average)655
Cornmeal (average)385
Wheat flour, all-purpose400
Sorghum (average)158
Pulses (average)808
CSB – Corn–Soy Blend475
Vegetable (soy) oil690
Table 38.  Cost estimate (in US$) for ‘typical’ full GFD ration and ‘revised’ full GFD ration (excluding sugar and salt)
‘Typical’ GFD ration
 RiceCornmealWheatSorghumAverage
Grain0.260.150.160.060.16
Corn-soy blend0.020.020.020.020.02
Pulse0.040.040.040.040.04
Vegetable oil0.020.020.020.020.02
Total cost (1 full ration)0.340.240.240.140.24
‘Revised’ GFD ration
 RiceCornmealWheatSorghumAverage
  1. GFD, general food distribution. Cost estimate includes commodity cost only, as provided by the Food For Peace commodity calculator for fiscal year 2009 (http://www.usaid.gov/our_work/humanitarian_assistance/ffp/comcalc_new.xls, accessed March 2009).

Grain0.280.160.170.070.17
Pulse0.060.060.060.060.06
Vegetable oil0.020.020.020.020.02
Total cost (1 full ration)0.360.240.250.150.25
Table 39.  Cost (in US$) of providing the hypothetical diet for each age/physiologic group from the ‘typical’ and ‘revised’ GFD rations, with and without addition of LNS, as well as the per cent change in cost from the current ‘typical’ GFD ration
 Average cost ‘typical’ GFD ration (with CSB)Average cost ‘revised’ GFD ration (no CSB)Average cost ‘revised’ GFD ration (no CSB) + LNS (1 dose)Average cost ‘revised’ GFD ration (no CSB) + LNS (2 doses)Per cent change in cost from ‘typical’ GFD ration (1 dose LNS)Per cent change in cost from ‘typical’ GFD ration (2 dose LNS)
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; CSB, corn-soy blend.

Total cost (6–8 month-olds)0.020.010.08236
Total cost (9–11 month-olds)0.040.020.09160
Total cost (12–23 month-olds)0.060.050.1290
Total cost (24–35 month-olds)0.120.110.1851
Total cost (pregnant women)0.300.300.370.422341
Total cost (lactating women)0.320.320.390.452138
Total cost (avg. pregnant/lactating woman + avg. child <3)0.370.360.500.563452
Table 40.  Change in total commodity provided (g) for the ‘typical’ GFD diet vs. ‘revised’ GFD diet plus LNS for each age/physiologic group, plus a hypothetical mother–child dyad
 6–8 months9–11 months12–23 months24–35 monthsPregnant womenLactating womenPregnant women (2 doses LNS)Lactating women (2 doses LNS)Mother–child dyad*
  1. GFD, general food distribution; LNS, lipid-based nutrient supplement; PLW, pregnant and lactating women. *Calculated as the sum of the average of the child rations plus the average of the PLW rations.

Total ‘typical’ GFD ration weight (g)5381144269679739679739846
Total ‘revised’ GFD ration weight + LNS (g)4270134260674734663723830
Absolute change (g)111110955161616
Per cent change in weight from ‘typical’ GFD ration (%)20147311222
Table 41.  Possible chemical forms of nutrients included in products for infants and young children, and recommended chemical forms for inclusion in LNS
NutrientPossible chemical formsRecommended chemical forms for LNS
  1. LNS, lipid-based nutrient supplement; EDTA, ethylene-diamine-tetra-acetic acid. Adapted from ‘Formulation Subgroup, 2009’.

Vitamin ARetinyl acetate or retinyl palmitate or beta-caroteneRetinyl acetate
Vitamin Dergocalciferol (D2) or cholecalciferol (D3)Cholecalciferol (D3)
Vitamin EAcetates of d or dl-alpha-tocopheroldl-alpha-tocopherol acetate
Vitamin KPhylloquinone 5%
Vitamin Cl-ascorbic acidl-ascorbic acid
Thiamine (vitamin B1)Thiamine mononitrate (preferred for dry products) or Thiamine hydrochlorideThiamine hydrochloride
Riboflavin (vitamin B2)RiboflavinRiboflavin
Niacin (vitamin B3)NiacinamideNiacinamide
Vitamin B6Pyridoxine hydrochloridePyridoxine hydrochloride
Vitamin B12Cyanocobalamin (diluted form (0.1% or 1%) with 100% active particles, spray dried formCyanocobalamin (0.1%)
Folic acidPteroyl monoglutamic acidPteroyl monoglutamic acid
IronNa Fe EDTA (subject to Codex limits), encapsulated ferrous sulfate, encapsulated ferrous fumarate and micronized ferric pyrophosphate could also be used but costs need to be consideredEncapsulated ferrous sulfate
ZincZinc sulfate, zinc gluconate, zinc oxideZinc sulfate
CopperCopper sulfate or Copper gluconateEncapsulated copper sulfate
SeleniumSodium selenate, Sodium seleniteSodium selenite 1.5%
CalciumSeveral forms available some with higher contents of Ca, such as Ca phosphate and Ca carbonate; Soluble organic Ca salts such as Ca citrate5; Calcium salts containing well absorbed anions (such as chloride) should be avoided as they may induce acidosis5Tricalcium phosphate
PhosphorousTricalcium phosphate Dipotassium phosphate
PotassiumDipotassium phosphate, potassium chloride
MagnesiumSoluble organic magnesium salts such as Mg citrate. Magnesium salts containing well absorbed anions (such as chloride) should be avoided as they may induce acidosisMagnesium citrate
ManganeseMangasese sulphate
IodinePotassium iodatePotassium iodate
List of Figures
Figure 1:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 6–8-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets22
Figure 2:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 9–11-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets23
Figure 3:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 12–23-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets28
Figure 4:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 24–35-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets28
Figure 5:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets29
Figure 6:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets30
Figure 7:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for a 4-year-old child. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets33
Figure 8:Per cent of the daily recommended intake provided by the ‘revised’ general food distribution ration for selected nutrients for a 4-year-old child. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets34
Figure 9:Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for an adult male. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets34
Figure 10:Per cent of the daily recommended intake provided by the ‘revised’ general food distribution ration for selected nutrients for an adult male. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets35
image

Figure 1. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 6–8-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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image

Figure 2. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 9–11-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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image

Figure 3. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 12–23-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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image

Figure 4. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration (and ‘average’ breast milk intake) for selected nutrients for 24–35-month-old infants. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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Figure 5. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for pregnant women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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Figure 6. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for lactating women. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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image

Figure 7. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for a 4-year-old child. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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Figure 8. Per cent of the daily recommended intake provided by the ‘revised’ general food distribution ration for selected nutrients for a 4-year-old child. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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image

Figure 9. Per cent of the daily recommended intake provided by the ‘typical’ general food distribution ration for selected nutrients for an adult male. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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Figure 10. Per cent of the daily recommended intake provided by the ‘revised’ general food distribution ration for selected nutrients for an adult male. Diets are identified by the type of grain or grain product provided, with all other components equivalent between diets.

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List of Acronyms
AIAdequate intake
AMDRAcceptable macronutrient distribution range
CSBCorn-soy blend
CVCoefficient of variation
EAREstimated average requirement
EFAEssential fatty acid
EMOPEmergency operation
FAOFood and Agriculture Organization
FBFFortified blended food
GFDGeneral food distribution
IDPInternally displaced person
IOMInstitute of Medicine
IZiNCGInternational Zinc Nutrition Consultative Group
LNSLipid-based nutrient supplement
MAMModerate acute malnutrition
MNPMicronutrient powder
NOAELNo observed adverse effect level
PLWPregnant and lactating women
RDARecommended dietary allowance
RNIRecommended nutrient intake
RUTFReady-to-use therapeutic food
SAMSevere acute malnutrition
SFPSupplementary (selective) feeding program
ULUpper Level
USDAUnited States Department of Agriculture
USAIDUnited States Agency for International Development
WFPWorld Food Program
WHOWorld Health Organization

Abstract

The term ‘lipid-based nutrient supplements’ (LNS) refers generically to a range of fortified, lipid-based products, including products like Ready-to-Use Therapeutic Foods (RUTF) (a large daily ration with relatively low micronutrient concentration) as well as highly concentrated supplements (1–4 teaspoons/day, providing <100 kcal/day) to be used for ‘point-of-use’ fortification. RUTF have been successfully used for the management of severe acute malnutrition (SAM) among children in emergency settings. Recent research on smaller doses of LNS for prevention of malnutrition has created interest in their potential use in emergency settings to ensure a more nutritionally adequate ration for the most vulnerable groups [e.g. infants and children between 6 and 24 months of age, and pregnant and lactating women (PLW)]. Currently, the main food and nutrition interventions in emergency settings include general food distribution (GFD) rations, which are provided to the affected population as a whole, and selective (or supplementary) feeding programs (SFP), which are to be provided to nutritionally vulnerable or malnourished individuals. In addition to logistical and operational challenges that may limit the intended effect of these programs, the nutritional quality of the food commodities provided may be insufficient to meet the needs of infants and young children and PLW. Because these subgroups have particularly high nutrient needs for growth and development, meeting these needs is challenging in settings where the ration is limited to a few food commodities, with little access to a diverse diet and bioavailable sources of micronutrients. In recent years, there has been increased attention to adding micronutrient interventions, on top of the other food-based interventions (such as GFDs and SFPs), to fill micronutrient gaps in diets in emergency settings.

The focus of this document is the potential role of LNS in meeting the nutritional needs of these vulnerable subgroups, with the goal of preventing malnutrition in emergency-affected populations. The document addresses the desired nutritional formulation of LNS for these target groups, taking into account the expected bioavailability of relevant nutrients and toxicity concerns. It also discusses the recommended chemical forms of the fortificants in LNS; stability and shelf-life considerations; production, packaging and distribution of LNS in the context of emergencies; and cost implications of the addition of LNS to current GFD rations for vulnerable groups.

To develop the desired nutritional formulation of LNS for these purposes, we calculated the current nutrient content of commonly provided GFD rations and determined the nutritional ‘gaps’ (of both micro- and macronutrients) of these rations for each of the target groups (i.e. children 6–35 months of age and PLW). For fat and protein, both quantity and quality were evaluated. Through an iterative process, we determined the formulation of a small dose of LNS that would best meet the recommended nutrient intakes for each group in combination with other foods in the GFD ration [composed of a grain, pulse, oil, sugar and salt, but excluding a fortified blended food (FBF)], as well as breast milk for children 6–24 months of age, while avoiding excess levels of any one nutrient to the extent possible. The composition of the LNS used for these calculations is based on an existing LNS product (Nutributter®, Malaunay, France, Nutriset), but with less sugar and more oil. Two different approaches were used: (1) developing two different formulations of LNS, one to be used for infants and children 6–35 months of age and a separate one for PLW; and (2) developing a single formulation that could be used for all of these subgroups. We used commodity cost data to estimate the cost of adding an LNS product to the GFD ration.

The results indicate that the typical GFD ration currently provided in emergency settings – based on cereals, pulse, an FBF such as corn–soy blend (CSB), oil, salt and sugar – does not meet the nutritional needs of infants and young children and PLW. The hypothetical intake from a ration composed of food aid commodities (based on the current USAID/USDA specifications for exported food aid commodities used in emergency settings), and including breast milk for children 6–24 months of age, provided less than 75% of the recommended intake for several micronutrients for certain age/physiologic groups, including calcium, iron, zinc, B vitamins such as riboflavin, B6 and B12, and fat-soluble vitamins such as D, E and K. It also generally contained lower than recommended levels of fat and essential fatty acids.

The initial LNS formulation for each target group was designed to provide 100% of the recommended amount (RDA or RNI) for most micronutrients per daily dose (20 g, ∼118 kcal) of LNS. This would ensure consumption of the recommended levels of each nutrient even if the ‘base’ diet changed. However, because such a formulation could provide excess amounts of certain nutrients when consumed in combination with the ‘base’ diet (especially when the ‘base’ diet contains fortified foods), we made adjustments in the LNS formulation when there was a risk of greatly exceeding the Upper Level for certain subgroups and there were relevant concerns about adverse effects from chronic consumption of such amounts. For most nutrients, consumption of toxic amounts is highly unlikely with the proposed LNS formulations.

The ‘one-size’ LNS formulation was designed so that one ‘dose’ (20 g) would be provided to infants and young children and two ‘doses’ (i.e. 40 g/day) would be provided to PLW. This ‘one-size’ formulation was based on the LNS formulation developed for children 6–35 months of age. Although the resulting formulation is not a perfect match for the unique nutritional needs of each subgroup, there are several practical advantages to using such an approach.

As anticipated, addition of LNS to the GFD ration, even after eliminating the FBF (e.g. CSB), increases the cost. The ‘revised’ ration without CSB but with LNS would cost 34–52% more (food only) than the ‘typical’ GFD diet for a hypothetical mother–infant pair, depending on how many LNS ‘doses’ were provided to the mother. However, depending on the contribution of food costs to overall program costs, the overall increase in costs may be significantly less. Although cost is an important consideration, options to improve the nutritional quality of foods provided in emergency settings should also be assessed with regard to effectiveness in maintaining and improving nutritional outcomes. Another consideration is whether a specialized product like LNS is more easily targeted to the individuals for whom it is intended, thus reducing inter- and intra-household sharing, a common concern with other fortified products such as CSB. This could have substantial cost implications because programs usually compensate for sharing by inflating the amount of FBF provided.

This document is intended to be a starting point for considering the incorporation of LNS in the food packages provided in emergency settings. Our goal was to examine the potential nutritional benefits but also the challenges of adopting such a strategy. There are many different options for emergency nutrition programs, and there are also many considerations governing which option to choose. This document is intended to encourage further evaluation of all of these options.