Use of lipid-based nutrient supplements (LNS) to improve the nutrient adequacy of general food distribution rations for vulnerable sub-groups in emergency settings

Table of Contents 5 1. Introduction 6 1.1 The current nutrition response to emergencies 7 1.1.1 General food distributions (GFD) 7 1.1.2 Supplementary feeding programs 8 1.1.3 Micronutrient interventions 9 1.1.4 LNS as supplements in an emergency nutrition response 10 2. Objectives 11 3. Methodological approach 11 3.1 Dietary intake in emergency nutrition settings and composition of rations for GFD 11 3.2 Hypothetical intake from example GFD rations 12 3.3 Nutrient composition and adequacy of hypothetical ration 13 3.4 Determination of the desired micronutrient composition of LNS 16 3.5 Accounting for bioavailability of nutrients from the GFD ration and LNS 20 3.6 Cost comparability estimates 21 4. Results 21 4.1 Nutrient adequacy of ‘typical’ GFD ration 21 4.1.1 Hypothetical intake from and nutrient adequacy of ‘typical’ GFD ration for children 6–11 months of age 21 4.1.2 Hypothetical intake from and nutrient adequacy of ‘typical’ GFD ration for children 12–35 months of age 23 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 LNS 27 4.2.1 Age‐physiological group specific approach for developing LNS formulation 30 4.2.2 ‘Age‐specific’ LNS formulation for 6–35‐month‐old infants and children 30 4.2.3 Hypothetical intake from and nutrient adequacy of ‘revised’ GFD ration plus ‘age‐specific’ LNS for 6–35‐month‐old children 35 4.2.4 ‘Age‐specific’ LNS formulation for PLW 35 4.2.5 Hypothetical intake from and nutrient adequacy of ‘revised’ GFD ration plus ‘age‐specific’ LNS for PLW 38 4.3 ‘One‐size‐fits‐all’ approach for developing LNS formulation 40 5. Appropriate use and toxicity concerns 43 5.1 Potential strategies to ensure appropriate use and to avoid inappropriate consumption 50 6. Cost estimates of providing LNS with the ‘revised’ GFD ration 52 7. Quality control, nutrient formulation, shelf‐life and packaging 55 7.1 Quality control of LNS production 56 7.2 Nutrient formulation 56 7.3 Shelf‐life and packaging 56 8. Discussion 57 Acknowledgements 60 Conflicts of interest 60 References 60 Appendix 1: Planned general food distribution ration examples used for development of ‘typical’ general food distribution ration 63 Appendix 2: Nutrient composition of principal food aid commodities used in this document 65 Appendix 3: Protein adequacy of diets in emergency settings when supplemented w