Use of lipid‐based nutrient supplements (LNS) to improve the nutrient adequacy of general food distribution rations for vulnerable sub‐groups in emergency settings
Authors: Chaparro Camila M. , Dewey Kathryn G. 
Published: December 2009

Table of Contents

Abstract
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 with lipid‐based nutrient supplements
66

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 grain
12

Table 2:
Energy requirements of each age/physiologic group
13

Table 3:
Hypothetical intake for each age/physiological group from the ‘typical’ GFD ration
14

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 group
21

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
24

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
25

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
26

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
27

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 diets
31

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
32

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
33

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
36

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
37

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
38

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
39

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
40

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 noted
42

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
43

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
44

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’ approach
46

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
47

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
48

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 formulation
52

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 ration
54

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
55

Table 41:
Possible chemical forms of nutrients included in products for infants and young children, and recommended chemical forms for inclusion in LNS
57

‘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 energy
Weight (g)
Energy (kcal)
Per cent of total energy

Grain (e.g. rice, cornmeal, wheat flour or sorghum)
400
1356–1476
70
425
1441–1568
74

Corn–soy blend
50
190
9
–
–
–

Pulse
50
173
8
75
345
12

Vegetable oil
25
221
10
25
221
11

Sugar
15
58
3
15
58
3

Salt
5
–
–
5
–
–

TOTAL
545
1997–2117
100
545
1978–2106
100

GFD, general food distribution; CSB, corn–soy blend.

Energy requirements of each age/physiologic group*

Age/physiologic group
‘Average’ intake from breast milk (kcal)
Energy requirement from food (kcal)
Total intake (kcal)

6–8 mo
413
202
615

9–11 mo
379
307
686

12–23 mo
346
548
894

24–35 mo
–
1024†
1024†

Pregnant
–
2588‡
2588‡

Lactating
–
2815§
2815§

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.

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 mo
9–11 mo
12–23 mo
24–35 mo
Pregnant
Lactating

Grain
70
141
215
384
717
1812
1971

Pulse
8
16
25
44
82
207
225

CSB
9
18
28
49
92
233
253

Veg oil
10
20
31
55
102
259
282

Sugar
3
6
9
16
31
78
85

Salt*
–
0
0
0
0
0
0

Hypothetical intake from ration (kcal)
202
307
548
1024
2588
2815

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.

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 mo
9–11 mo
12–23 mo
24–35 mo
Pregnant (1 dose LNS)
Pregnant (2 dose LNS)
Lactating (1 dose LNS)
Lactating (2 dose LNS)

Grain
74
62
140
319
672
1833
1745
2002
1913

Pulse
12
10
23
53
112
306
292
334
320

Veg. oil
11
9
20
46
96
262
249
286
273

Sugar
3
2
5
12
25
69
66
75
72

Salt*
–
0
0
0
0
0
0
0
0

Hypothetical intake from ration (kcal)
84
189
430
906
2470
2352
2697
2579

Intake from LNS (kcal)
118
118
118
118
118
236
118
236

Total energy intake from non‐breast milk sources (kcal)
202
307
548
1024
2588
2588
2815
2815

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.

Average nutrient concentrations in mature breast milk (World Health Organization 1998)

Nutrient
Amount (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

Adequate Intakes (AI) and Recommended Nutrient Intakes (RNIs) and Upper Levels (UL) for 7–11‐month‐old infants (IOM and WHO/FAO 2004)

Nutrient
IOM
WHO/FAO
Final values used for deficient/excess intake

AI
UL
RNI
UL
Recommended daily intake
UL

Carbohydrate (g/d)
95
–
–
–
95
–

Fat (g/d)
30
–
–
–
30
–

Linoleic acid (g/d)
4.6
–
–
–
4.6
–

α‐Linolenic acid (g/d)
0.5
–
–
–
0.5
–

Protein (g/d)
11
–
–
–
11
–

Calcium (mg/d)
270
ND
400
ND
400
ND

Copper (mg/d)
0.22
ND
–
–
0.22
ND

Folate (µg DFE/d)
80
ND
80
ND
80
ND

Iodine (µg/d)
130
ND
90
140 µg/kg/d*
90
1260

Iron (mg/d)†
1.1
40
0.93
ND
0.93
40

Magnesium (mg/d)
75
ND
54
ND
54
ND

Manganese (mg/d)
0.6
ND
–
–
0.6
ND

Niacin (mg/d)
4
ND
4
ND
4
ND

Pantothenic acid (mg/d)
1.7
ND
1.8
ND
1.8
ND

Phosphorous (mg/d)
275
ND
–
–
275
ND

Potassium (mg/d)
700
ND
–
–
700
ND

Riboflavin (mg/d)
0.4
ND
0.4
ND
0.4
ND

Selenium (µg/d)
20
60
10
ND
10
60

Thiamine (mg/d)
0.3
ND
0.3
ND
0.3
ND

Vitamin A (µg RAE /d)
500
600‡
400
ND
400
600

Vitamin B12 (µg/d)
0.5
ND
0.7
ND
0.7
ND

Vitamin B6 (mg/d)
0.3
ND
0.3
ND
0.3
ND

Vitamin C (mg/d)
50
ND
30
ND
30
ND

Vitamin D (IU/d)
200
1000
200
ND
200
1000

Vitamin E (mg/d)
5
ND
2.7
ND
2.7
ND

Vitamin K (µg/d)
2.5
ND
10
ND
10
ND

Zinc (mg/d)§
1.0
5
1.3
23–38
1.1¶
6¶

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.

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)

Nutrient
IOM
WHO/FAO
Final values used for deficient/excess intake

AI/RDA
UL
RNI
UL
Recommended daily intake
UL

Carbohydrate (g/d)
130
–
–
–
130
ND

Fat (g/d)
30–40 % E†
–
–
–
30–40 % E†
ND

Linoleic acid (g/d)
7*
–
–
–
7*
ND

α‐Linolenic acid (g/d)
0.7*
–
–
–
0.7*
ND

Protein (g/d)
13
–
–
–
13
ND

Calcium (mg/d)
500*
2500
500
2500
500*
2500

Copper (mg/d)
0.34
1
–
–
0.34
1

Folate (µg DFE/d)
150
300‡
150
300
150
300

Iodine (µg/d)
90
200
90
50 µg/kg/d§
90
600

Iron (mg/d)¶
1.26
40
0.58
40
0.58
40

Magnesium (mg/d)
80
65††
60
65
60
65

Manganese (mg/d)
1.2*
2
1.2
ND
1.2*
2

Niacin (mg/d)
6
10
6
ND
6
10

Pantothenic acid (mg/d)
2*
ND
2.0
ND
2*
ND

Phosphorous (mg/d)
460
3000
–
–
460
3000

Potassium (mg/d)
3000*
ND
–
–
3000*
ND

Riboflavin (mg/d)
0.5
ND
0.5
30
0.5
30

Selenium (µg/d)
20
90
17
–
17
90

Thiamine (mg/d)
0.5
ND
0.5
10
0.5
10

Vitamin A (µg RAE /d)
300
600‡‡
400
600
400
600

Vitamin B12 (µg/d)
0.9
ND
0.9
–
0.9
ND

Vitamin B6 (mg/d)
0.5
30
0.5
30
0.5
30

Vitamin C (mg/d)
15
400
30
400
30
400

Vitamin D (IU/d)
200*
2000
200
2000
200*
2000

Vitamin E (mg/d)
6
200
5
200
5
200

Vitamin K (µg/d)
30*
ND
15
–
15
ND

Zinc (mg/d)§§
0.9
7
1.2
23–28
0.7¶¶
8¶¶

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.

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)

Nutrient
IOM
WHO/FAO
Final values used for deficient/excess intake

AI/RDA
UL
RNI
UL
Recommended daily intake
UL

Carbohydrate (g/d)
175
–
–
–
175
ND

Fat (g/d)
20–35 %E†
–
–
–
20–35% E†
ND

Linoleic acid (g/d)
13*
–
–
–
13*
ND

α‐Linolenic acid (g/d)
1.4*
–
–
–
1.4*
ND

Protein (g/d)
71
–
–
–
71
ND

Calcium (mg/d)
1000*
2500
1200
3000
1200
3000

Copper (mg/d)
1
10
–
–
1
10

Folate (µg DFE /d)
600
1000‡
600
1000
600
1000

Iodine (µg/d)
220
1100
200
1100
200
1100

Iron (mg/d)§
4.6
45
–¶
45
4.6
45

Magnesium (mg/d)
350–360
350††
220
–
220
350

Manganese (mg/d)
2*
11
–
–
2*
11

Niacin (mg/d)
18
35
18
35
18
35

Pantothenic acid (mg/d)
6*
ND
6.0
–
6
ND

Phosphorous (mg/d)
700
3500
–
–
700
3500

Potassium (mg/d)
4700*
ND
–
–
4700*
ND

Riboflavin (mg/d)
1.4
ND
1.4
–
1.4
ND

Selenium (µg/d)
60
400
28, 30‡‡

29
400

Thiamine (mg/d)
1.2
ND
1.4
–
1.4
ND

Vitamin A (µg RAE /d)
770
3000§§
800
3000
800
3000

Vitamin B12 (µg/d)
2.6
ND
2.6
–
2.6
ND

Vitamin B6 (mg/d)
1.9
100
1.9
100
1.9
100

Vitamin C (mg/d)
85
2000
55
1000
55
1000

Vitamin D (IU/d)
200*
2000
200
2000
200*
2000

Vitamin E (mg/d)
15
1000
–
–
15
1000

Vitamin K (µg/d)
90*
ND
55
–
55
ND

Zinc (mg/d)¶¶
5.4
40
3.4
45
3.2†††
40

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.

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)

Nutrient
IOM
WHO/FAO
Final values used for deficient/excess intake

AI/RDA
UL
RNI
UL
Recommended daily intake
UL

Carbohydrate (g/d)
210
ND
–
–
210
ND

Fat (g/d)
20–35% E†
ND
–
–
20–35% E†
ND

Linoleic acid (g/d)
13*
ND
–
–
13*
ND

α‐Linolenic acid (g/d)
1.3*
ND
–
–
1.3*
ND

Protein (g/d)
71
ND
–
–
71
ND

Calcium (mg/d)
1000*
2500
1000
3000
1000*
3000

Copper (mg/d)
1.3
10
–
–
1.3
10

Folate (µg DFE/d)
500
1000‡
500
1000
500
1000

Iodine (µg/d)
290
1100
200
1100
200
1100

Iron (mg/d)§
1.62
45
1.5
45
1.5
45

Magnesium (mg/d)
310–320
350¶
270
350
270
350

Manganese (mg/d)
2.6*
11
2.6
11
2.6*
11

Niacin (mg/d)
17
35
17
35
17
35

Pantothenic acid (mg/d)
7*
ND
7
–
7*
ND

Phosphorous (mg/d)
700
4000
–
–
700
4000

Potassium (mg/d)
5100
ND
–
–
5100
ND

Riboflavin (mg/d)
1.6
ND
1.6
–
1.6
ND

Selenium (µg/d)
70
400
35
400
35
400

Thiamine (mg/d)
1.4
ND
1.5
–
1.5
ND

Vitamin A (µg RAE /d)
1300
3000††
850
3000
850
3000

Vitamin B12 (µg/d)
2.8
ND
2.8
–
2.8
ND

Vitamin B6 (mg/d)
2
100
2
100
2
100

Vitamin C (mg/d)
120
2000
70
1000
70
1000

Vitamin D (µg/d)
200*
2000
200
2000
200*
2000

Vitamin E (mg/d)
19
1000
–
–
19
1000

Vitamin K (µg/d)
90*
ND
55
–
55
ND

Zinc (mg/d)‡‡
5.3
40
4.3
45
3.6§§
40§§

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.

Hypothetical quantity consumed from each component of the ‘typical’ GFD ration for each age or physiologic group

Food
Amount in hypothetical intake from GFD diet (g)

6–8 months
9–11 months
12–23 months
24–35 months
Pregnant women
Lactating women

Grain*
39
60
107
199
503
547

Pulse
5
7
13
23
59
64

Corn‐soy blend
5
7
13
24
61
67

Vegetable oil
2
4
6
12
29
32

Sugar
2
2
4
8
20
22

Salt
1
1
1
3
5
5

Total (g)
53
81
144
269
679
739

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
10.9
99
11.0
100
12.2
111
12.9
117

Fat
g
26.7
89
27.1
90
26.8
89
27.8
93

Linoleic acid
g
1.4
30
1.6
35
1.5
32
1.9
40

α‐Linolenic acid
g
0.2
38
0.2
38
0.2
38
0.2
42

n6 : n3

7.1

8.4

7.7

8.9

Carbohydrate
g
82.2
87
81.4
86
80.7
85
82.2
87

Calcium
mg
218.6
55
267.6
67
261.7
65
225.2
56

Copper
mg
0.3
126
0.2
107
0.3
119
0.2
94

Folic acid
µg DFE
42.3
53
50.8
63
138.3
173
39.3
49

Iodine
µg
99.5
111
99.5
111
99.5
111
99.5
111

Iron
mg
1.6
17
3.3
36
3.0
32
3.1
33

Absorbed iron*
mg
0.3
28
0.5
48
0.4
44
0.4
43

Magnesium
mg
46.4
86
49.0
91
44.1
82
35.6
66

Manganese
mg
0.5
88
0.2
29
0.4
62
0.1
17

Niacin
mg
2.7
68
3.9
98
4.5
112
3.7
92

Pantothenic acid
mg
1.8
100
1.4
79
1.5
83
1.3
73

Phosphorous
mg
156.0
57
154.7
56
156.5
57
234.2
85

Potassium
mg
433.3
62
455.5
65
438.8
63
543.2
78

Riboflavin
mg
0.3
66
0.4
98
0.4
100
0.3
76

Selenium
µg
19.4
194
17.9
179
26.6
266
13.5
135

Sodium
mg
305.2
82
307.0
83
305.1
82
306.8
83

Thiamine
mg
0.2
73
0.5
154
0.4
147
0.3
97

Vitamin A
µg RAE
378.3
95
603.7
151
606.8
152
378.3
95

Vitamin B12
µg
0.7
93
0.7
93
0.7
93
0.7
93

Vitamin B6
mg
0.2
54
0.2
58
0.1
39
0.1
33

Vitamin C
mg
26.3
88
26.3
88
26.3
88
26.3
88

Vitamin D
IU
22.7
11
22.7
11
22.7
11
22.7
11

Vitamin E
mg
1.9
71
1.9
71
1.9
70
1.9
69

Vitamin K
µg
6.0
60
6.0
60
6.1
61
6.0
60

Zinc
mg
1.5
37
1.4
33
1.4
33
1.1
27

Absorbed zinc†
mg
0.8
72
0.6
57
0.6
58
0.5
46

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
12.7
115
12.9
117
14.7
134
15.8
144

Fat
g
26.3
88
27.0
90
26.5
88
28.0
93

Linoleic acid
g
2.1
45
2.4
52
2.2
48
2.8
61

α‐Linolenic acid
g
0.3
58
0.3
57
0.3
58
0.3
63

n6 : n3

7.1

8.4

7.7

8.9

Carbohydrate
g
98.6
104
97.4
103
96.4
101
98.6
104

Calcium
mg
229.9
57
304.3
76
295.3
74
239.9
60

Copper
mg
0.3
149
0.3
121
0.3
139
0.2
101

Folic acid
µg DFE
63.7
80
76.6
96
209.7
262
59.2
74

Iodine
µg
111.0
123
111.0
123
111.0
123
111.0
123

Iron
mg
2.3
25
5.0
53
4.4
47
4.6
49

Absorbed iron*
mg
0.3
37
0.6
64
0.5
58
0.5
56

Magnesium
mg
57.8
107
61.7
114
54.3
101
41.3
76

Manganese
mg
0.8
133
0.3
44
0.6
93
0.2
26

Niacin
mg
3.6
90
5.5
137
6.3
158
3.3
83

Pantothenic acid
mg
2.1
115
1.5
84
1.6
89
1.4
75

Phosphorous
mg
185.9
68
184.0
67
186.6
68
304.7
111

Potassium
mg
466.5
67
500.2
71
474.9
68
633.6
91

Riboflavin
mg
0.3
68
0.5
117
0.5
120
0.3
84

Selenium
µg
22.2
222
19.9
199
33.2
332
13.2
132

Sodium
mg
397.5
107
400.2
108
397.3
107
399.9
108

Thiamine
mg
0.3
86
0.6
208
0.6
198
0.4
122

Vitamin A
µg
392.1
98
734.6
184
739.3
185
392.1
98

Vitamin B12
µg RAE
0.6
91
0.6
91
0.6
91
0.6
91

Vitamin B6
mg
0.2
71
0.2
77
0.1
48
0.1
39

Vitamin C
mg
25.4
85
25.4
85
25.4
85
25.4
85

Vitamin D
IU
26.4
13
26.4
13
26.4
13
26.4
13

Vitamin E
mg
2.1
76
2.1
77
2.0
75
2.0
74

Vitamin K
µg
8.4
84
8.4
84
8.5
85
8.4
84

Zinc
mg
1.9
46
1.6
40
1.6
40
1.2
30

Absorbed zinc†
mg
0.9
80
0.7
61
0.7
63
0.5
46

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
17.5
134
17.9
137
21.2
163
23.1
178

Fat*
g
27.9
28
29.2
29
28.3
29
31.0
31

Linoleic acid
g
3.7
53
4.3
62
4.0
57
5.0
72

α‐Linolenic acid
g
0.5
74
0.5
73
0.5
73
0.6
81

n6 : n3

7.1

8.4

7.7

8.9

Carbohydrate
g
141.1
109
138.9
107
137.0
105
141.1
109

Calcium
mg
274.2
55
407.0
81
391.1
78
292.1
58

Copper
mg
0.5
137
0.4
104
0.4
125
0.3
81

Folic acid
µg DFE
113.0
75
136.1
91
373.6
249
104.9
70

Iodine
µg
143.6
160
144.8
161
144.8
161
144.8
161

Iron
mg
4.0
68
8.7
151
7.8
134
8.1
140

Absorbed iron†
mg
0.5
88
0.9
156
0.8
143
0.8
137

Magnesium
mg
86.1
144
93.1
155
79.9
133
56.7
95

Manganese
mg
1.4
118
0.5
39
1.0
83
0.3
23

Niacin
mg
5.7
95
8.9
149
10.4
174
8.3
138

Pantothenic acid
mg
2.8
141
1.8
92
2.0
100
1.5
77

Phosphorous
mg
263.8
57
260.3
57
265.0
58
475.9
103

Potassium
mg
577.5
19
637.8
21
592.6
20
875.8
29

Riboflavin
mg
0.3
64
0.7
132
0.7
138
0.4
86

Selenium
µg
29.8
176
25.9
152
49.5
291
13.8
81

Sodium
mg
615.7
62
628.2
63
623.0
62
627.7
63

Thiamine
mg
0.4
71
1.0
202
1.0
192
0.6
110

Vitamin A
µg RAE
457.0
114
1068.2
267
1076.6
269
457.0
114

Vitamin B12
µg
0.7
74
0.7
74
0.7
74
0.7
74

Vitamin B6
mg
0.3
67
0.4
74
0.2
42
0.2
33

Vitamin C
mg
25.9
86
25.9
86
25.9
86
25.9
86

Vitamin D
IU
36.5
18
36.5
18
36.5
18
36.5
18

Vitamin E
mg
2.6
43
2.6
43
2.5
42
2.4
41

Vitamin K
µg
14.0
93
13.9
93
14.2
95
13.9
93

Zinc
mg
2.8
68
2.3
57
2.3
57
1.6
39

Absorbed zinc‡

1.1
156
0.8
115
0.8
117
0.6
81

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
22.7
175
23.4
180
29.6
228
33.2
255

Fat*
g
15.1
13
17.4
15
15.9
14
20.9
18

Linoleic acid
g
6.9
99
8.1
115
7.4
106
9.4
135

α‐Linolenic acid
g
1.0
139
1.0
136
1.0
137
1.1
151

n6 : n3

7.1

8.4

7.7

8.9

Carbohydrate
g
195.1
150
191.1
147
187.6
144
195.1
150

Calcium
mg
246.2
49
494.3
99
464.6
93
279.6
56

Copper
mg
0.6
186
0.4
124
0.6
164
0.3
81

Folic acid
µg DFE
209.8
140
252.8
169
696.7
464
194.5
130

Iodine
µg
163.6
182
166.0
184
166.0
184
166.0
184

Iron†
mg
7.1
123
16.0
276
14.2
245
14.8
256

Absorbed iron†
mg
0.6
101
1.0
181
1.0
165
0.9
158

Magnesium
mg
127.6
213
140.7
234
116.0
193
72.7
121

Manganese
mg
2.6
220
0.9
72
1.9
154
0.5
43

Niacin
mg
9.3
154
15.3
254
18.1
301
14.0
234

Pantothenic acid
mg
3.6
179
1.7
86
2.0
101
1.2
58

Phosphorous
mg
359.9
78
353.3
77
362.1
79
756.2
164

Potassium
mg
580.0
19
692.6
23
608.0
20
1137.4
38

Riboflavin
mg
0.3
52
0.9
181
1.0
191
0.5
93

Selenium
µg
36.7
216
29.3
172
73.5
432
6.8
40

Sodium
mg
977.8
98
1002.2
100
992.6
99
1001.3
100

Thiamine
mg
0.5
94
1.7
338
1.6
318
0.8
166

Vitamin A
µg RAE
378.5
95
1520.7
380
1536.4
384
378.5
95

Vitamin B12
µg
0.3
35
0.3
35
0.3
35
0.3
35

Vitamin B6
mg
0.5
107
0.6
120
0.3
61
0.2
43

Vitamin C
mg
10.3
34
10.3
34
10.3
34
10.3
34

Vitamin D
IU
47.3
24
47.3
24
47.3
24
47.3
24

Vitamin E
mg
2.6
43
2.7
45
2.5
41
2.4
39

Vitamin K
µg
24.2
161
24.0
160
24.6
164
24.0
160

Zinc
mg
4.1
99
3.2
79
3.2
79
1.9
45

Absorbed zinc‡
mg
2.2
187
0.9
130
0.9
133
0.6
80

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.

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)
Rice
Cornmeal
Wheat flour
Sorghum

6–8

Vitamin A
Vitamin A

9–11

Vitamin A
Vitamin A

12–23
Magnesium
Magnesium Vitamin A
Niacin Magnesium Vitamin A Folic acid
Magnesium

24–35
Magnesium Manganese
Magnesium Vitamin A Niacin
Magnesium Vitamin A Niacin Folic acid
Magnesium Niacin

Pregnant

Magnesium Niacin Vitamin A
Folic acid Magnesium Niacin Vitamin A
Niacin

Lactating
Magnesium
Magnesium Niacin Vitamin A
Folic acid Niacin Vitamin A
Niacin

UL, Upper Levels; GFD, general food distribution.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
57.3
81
59.1
83
74.9
105
83.9
118

Fat*
g
41.5
13
47.8
15
43.6
14
57.5
18

Linoleic acid
g
17.5
135
20.3
157
18.8
144
23.8
183

α‐Linolenic acid
g
2.5
175
2.4
172
2.4
173
2.7
190

n6 : n3

7.1

8.4

7.7

8.9

Carbohydrate
g
493.2
282
482.9
276
474.1
271
493.1
282

Calcium
mg
621.9
52
1248.9
104
1173.8
98
706.3
59

Copper
mg
1.6
160
1.1
107
1.4
141
0.7
69

Folic acid
µg DFE
530.1
88
638.9
106
1760.8
293
491.7
82

Iodine
µg
334.2
167
334.2
167
334.2
167
334.2
167

Iron
mg
18.0
67
40.5
150
35.9
133
37.5
139

Absorbed iron†
mg
4.5
98
10.1
220
9.0
195
9.4
204

Magnesium
mg
322.6
147
355.5
162
293.2
133
183.7
84

Manganese
mg
6.7
334
2.2
109
4.7
234
1.3
64

Niacin
mg
23.4
130
38.6
214
45.7
254
45.7
254

Pantothenic acid
mg
9.0
151
4.3
72
5.1
85
2.9
49

Phosphorous
mg
909.5
130
893.0
128
915.0
131
1911.2
273

Potassium
mg
1465.7
31
1750.2
37
1536.5
33
2874.4
61

Riboflavin
mg
0.7
47
2.3
163
2.4
172
1.2
84

Selenium
µg
92.8
320
74.0
255
185.8
641
17.1
59

Sodium
mg
1960.2
131
1982.9
132
1958.4
131
1980.5
132

Thiamine
mg
1.2
85
4.3
305
4.0
287
2.1
150

Vitamin A
µg RAE
956.5
120
3843.3
480
3883.0
485
956.5
120

Vitamin B12
µg
0.8
31
0.8
31
0.8
31
0.8
31

Vitamin B6
mg
1.4
71
1.5
80
0.8
40
0.5
29

Vitamin C
mg
26.0
47
26.0
47
26.0
47
26.0
47

Vitamin D
IU
119.5
60
119.5
60
119.5
60
119.5
60

Vitamin E
mg
6.5
44
6.8
45
6.3
42
6.0
40

Vitamin K
µg
61.1
111
60.6
110
62.1
113
60.6
110

Zinc
mg
10.3
137
8.2
109
8.2
109
4.7
62

Absorbed zinc‡
mg
2.2
68
1.5
46
1.5
48
0.9
29

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
62.4
88
64.3
91
81.5
115
91.2
128

Fat*
g
41.5
13
47.8
354
43.6
323
57.5
426

Linoleic acid
g
19.0
146
22.1
170
20.4
157
25.9
199

α‐Linolenic acid
g
2.7
191
2.6
187
2.6
189
2.9
207

n6 : n3

7.1

8.4

7.7

8.9

Carbohydrate
g
536.4
307
525.2
300
515.7
295
536.4
307

Calcium
mg
676.4
56
1358.4
113
1276.7
106
768.2
64

Copper
mg
1.7
174
1.2
116
1.5
153
0.8
75

Folic acid
µg DFE
576.6
96
695.0
116
1915.2
319
534.8
89

Iodine
µg
337.3
169
337.3
169
337.3
169
337.3
169

Iron
mg
19.6
73
44.1
163
39.1
145
40.8
151

Absorbed iron†

1.7
115
3.1
209
2.9
190
2.7
183

Magnesium
mg
350.8
159
386.7
176
318.9
145
199.8
91

Manganese
mg
7.3
363
2.4
119
5.1
255
1.4
70

Niacin
mg
25.4
141
41.9
233
49.7
276
38.6
214

Pantothenic acid
mg
9.8
164
4.7
78
5.6
93
3.2
53

Phosphorous
mg
989.2
141
971.4
139
995.3
142
2078.9
297

Potassium
mg
1594.2
34
1903.7
41
1671.3
36
3126.5
67

Riboflavin
mg
0.7
51
2.5
178
2.6
187
1.3
92

Selenium
µg
101.0
348
80.5
278
202.1
697
18.6
64

Sodium
mg
1962.1
131
1986.8
132
1960.2
131
1984.3
132

Thiamine
mg
1.3
92
4.6
332
4.4
312
2.3
163

Vitamin A
µg
1040.4
130
4180.4
523
4223.6
528
1040.4
130

Vitamin B12
µg
0.9
33
0.9
33
0.9
33
0.9
33

Vitamin B6
mg
1.5
77
1.7
87
0.8
44
0.6
31

Vitamin C
mg
28.3
52
28.3
52
28.3
52
28.3
52

Vitamin D
IU
130.0
65
130.0
65
130.0
65
130.0
65

Vitamin E
mg
7.1
47
7.4
49
6.8
46
6.5
43

Vitamin K
µg
66.4
121
65.9
120
67.5
123
65.9
120

Zinc
mg
11.2
149
8.9
119
8.9
118
5.1
68

Absorbed zinc‡

3.4
94.3
2.4
67.6
2.5
68.8
1.5
40.9

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.

Composition (g) of hypothetical intakes from ‘revised’ GFD ration, taking into account energy content (118 kcal or 236 kcal) to be provided via LNS

Food
6–8 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)*

Grain (g)†
17
39
89
188
512
487
559
534

Pulses (g)
3
7
16
33
89
85
97
93

Veg. oil (g)
1
2
5
11
30
28
32
31

Salt (g)
0.2
0.5
1
2
6
6
7
6

Sugar (g)
0.6
1
3
7
18
17
19
19

Total (g)
22
50
114
240
654
623
714
683

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).

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

Nutrient
Unit
Daily recommended intake: 7–11 mo
Daily recommended intake: 12–35 mo
LNS 6–35 mo composition, per 20g ration

Protein
g
11.0
13
2.6

Fat
g
30.0
30–40% E
9.6

Linoleic acid
g
4.6
7
4.5

α‐linolenic acid
g
0.5
0.7
0.6

Carbohydrate
g
95.0
130
5.3

Energy
kcal
NA
NA
118

Calcium
mg
400
500
280*

Copper
mg
0.22
0.34
0.34

Folic acid
µg DFE
80
150
150

Iodine
µg
90
90
90

Iron†
mg
0.93
0.58
6‡

Magnesium
mg
54
60
60

Manganese
mg
0.6
1.2
1.2

Niacin
mg
4
6
6

Pantothenic acid
mg
1.8
2
2

Phosphorus
mg
275
460
190*

Potassium
mg
700
3000
200*

Riboflavin
mg
0.4
0.5
0.5

Selenium
µg
10
17
17

Thiamine
µg
0.3
0.5
0.5

Vitamin A
µg RAE
400
400
400

Vitamin B12
mg
0.7
0.9
0.9

Vitamin B6
mg
0.3
0.5
0.5

Vitamin C
IU
30
30
30

Vitamin D
mg
200
200
200

Vitamin E
µg
2.7
5
5

Vitamin K
mg
10
15
15

Zinc†
mg
1.1
0.7
5§

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
10.9
99
10.9
99
11.5
104
11.8
107

Fat
g
34.4
115
34.6
115
34.5
115
34.9
116

Linoleic acid
g
5.0
108
5.1
110
5.0
109
5.2
113

α‐linolenic acid
g
0.7
132
0.7
132
0.7
132
0.7
134

n6 : n3 ratio

7.6

7.7

7.6

7.8

Carbohydrate
g
65.2
69
64.8
68
64.5
68
65.2
69

Calcium
mg
454.9
114
476.4
119
473.9
118
457.8
114

Copper
mg
0.5
248
0.5
240
0.5
245
0.5
234

Folic acid
µg DFE
164.3
205
168.0
210
206.6
258
163.0
204

Iodine
µg
169.3
188
169.3
188
169.3
188
169.3
188

Iron
mg
6.5
89
7.3
100
7.1
97
7.2
98

Absorbed iron*
mg
1.6
171
1.6
168
1.6
168
1.5
160

Magnesium
mg
90.2
167
91.3
169
89.1
165
85.4
158

Manganese
mg
1.4
238
1.3
212
1.4
227
1.2
207

Niacin
mg
7.6
189
8.2
205
8.3
209
8.0
200

Pantothenic acid
mg
3.4
186
3.2
177
3.2
179
3.1
175

Phosphorous
mg
305.6
111
305.1
111
305.8
111
340.1
124

Potassium
mg
568.2
81
578.0
83
570.6
82
616.6
88

Riboflavin
mg
0.7
182
0.8
196
0.8
197
0.7
186

Selenium
µg
32.0
320
31.3
313
35.2
352
29.4
294

Sodium
mg
190.6
52
191.4
52
190.6
52
191.3
52

Thiamine
mg
0.7
221
0.8
256
0.8
253
0.7
231

Vitamin A
µg RAE
721.9
180
821.2
205
822.6
206
721.9
180

Vitamin B12
µg
1.5
213
1.5
213
1.5
213
1.5
213

Vitamin B6
mg
0.6
199
0.6
200
0.6
192
0.6
189

Vitamin C
mg
54.4
181
54.4
181
54.4
181
54.4
181

Vitamin D
IU
213.4
107
213.4
107
213.4
107
213.4
107

Vitamin E
mg
6.5
241
6.5
241
6.5
241
6.5
240

Vitamin K
µg
18.4
184
18.4
184
18.4
184
18.4
184

Zinc
mg
6.0
274
6.0
271
6.0
271
5.8
265

Absorbed zinc†
mg
2.6
237
2.3
212
2.4
215
2.2
200

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
12.7
116
12.8
117
14.1
128
14.8
134

Fat
g
33.9
113
34.4
115
34.1
114
35.0
117

Linoleic acid
g
5.7
123
5.9
128
5.8
125
6.2
134

α‐linolenic acid
g
0.8
152
0.8
151
0.8
152
0.8
155

n6 : n3 ratio

7.5

7.8

7.6

7.9

Carbohydrate
g
81.8
86
81.0
85
80.3
85
81.8
86

Calcium
mg
446.9
112
495.4
124
489.6
122
453.4
113

Copper
mg
0.6
273
0.6
254
0.6
266
0.5
241

Folic acid
µg DFE
181.0
226
189.4
237
276.3
345
178.0
223

Iodine
µg
180.9
201
180.9
201
180.9
201
180.9
201

Iron
mg
6.9
94
8.6
118
8.3
113
8.4
115

Absorbed iron*
mg
1.5
158
1.6
168
1.5
165
1.5
157

Magnesium
mg
99.5
184
102.1
189
97.3
180
88.8
164

Manganese
mg
1.7
285
1.4
227
1.6
259
1.3
216

Niacin
mg
8.3
208
9.5
238
10.1
251
9.3
232

Pantothenic acid
mg
3.6
199
3.2
179
3.3
182
3.1
173

Phosphorous
mg
337.0
123
335.7
122
337.4
123
414.5
151

Potassium
mg
603.8
86
625.8
89
609.3
87
712.8
102

Riboflavin
mg
0.7
182
0.9
214
0.9
216
0.8
192

Selenium
µg
34.5
345
33.1
331
41.7
417
28.6
286

Sodium
mg
292.8
79
294.6
80
292.7
79
294.4
80

Thiamine
mg
0.7
232
0.9
312
0.9
305
0.8
256

Vitamin A
µg RAE
719.7
180
943.1
236
946.2
237
719.7
180

Vitamin B12
µg
1.4
206
1.4
206
1.4
206
1.4
206

Vitamin B6
mg
0.6
213
0.7
218
0.6
198
0.6
193

Vitamin C
mg
52.5
175
52.5
175
52.5
175
52.5
175

Vitamin D
IU
212.3
106
200.3
100
212.3
106
212.3
106

Vitamin E
mg
6.5
242
6.5
242
6.5
241
6.5
240

Vitamin K
µg
21.0
210
20.9
209
21.1
211
20.9
209

Zinc
mg
6.3
288
6.2
281
6.2
281
5.9
269

Absorbed zinc†
mg
2.5
226
2.1
192
2.2
196
2.0
178

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
17.6
136
17.9
138
20.7
159
22.3
172

Fat*
g
35.3
36
36.3
37
35.6
36
37.9
38

Linoleic acid
g
7.2
103
7.7
110
7.5
106
8.3
119

α‐linolenic acid
g
1.0
142
1.0
141
1.0
141
1.0
147

n6 : n3 ratio

7.3

7.9

7.5

8.1

Carbohydrate
g
124.7
96
122.9
95
121.4
93
124.7
96

Calcium
mg
447.1
89
557.6
112
544.4
109
462.0
92

Copper
mg
0.7
218
0.6
191
0.7
209
0.6
172

Folic acid
µg DFE
219.4
146
238.5
159
436.2
291
212.6
142

Iodine
µg
211.9
235
211.9
235
211.9
235
211.9
235

Iron
mg
7.8
124
11.8
187
10.9
174
11.2
178

Absorbed iron†
mg
1.4
243
1.8
303
1.7
289
1.6
275

Magnesium
mg
123.4
206
129.2
215
118.2
197
98.9
165

Manganese
mg
2.4
197
1.6
131
2.0
167
1.4
117

Niacin
mg
10.2
169
12.8
214
14.1
235
12.3
205

Pantothenic acid
mg
4.2
212
3.4
170
3.5
177
3.2
158

Phosphorous
mg
418.1
91
415.2
90
419.1
91
594.5
129

Potassium
mg
720.1
24
770.2
26
732.5
24
968.2
32

Riboflavin
mg
0.8
151
1.0
208
1.1
212
0.8
169

Selenium
µg
41.7
245
38.4
226
58.0
341
28.3
167

Sodium
mg
521.1
52
525.1
53
520.8
52
524.7
52

Thiamine
mg
0.8
158
1.3
266
1.3
258
0.9
190

Vitamin A
µg RAE
747.8
187
1256.3
314
1263.3
316
747.8
187

Vitamin B12
µg
1.4
155
1.4
155
1.4
155
1.4
155

Vitamin B6
mg
0.7
150
0.8
155
0.6
129
0.6
121

Vitamin C
mg
50.8
169
50.8
169
50.8
169
50.8
169

Vitamin D
IU
211.2
106
211.2
106
211.2
106
211.2
106

Vitamin E
mg
6.7
135
6.8
135
6.7
134
6.6
133

Vitamin K
µg
27.0
180
26.9
180
27.2
181
26.9
180

Zinc
mg
7.1
376
6.8
357
6.8
357
6.2
324

Absorbed zinc‡
mg
2.4
344
1.9
277
2.0
284
1.7
246

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
23.0
177
23.7
182
29.5
227
32.9
253

Fat*
g
21.9
19
24.1
21
22.7
20
27.4
24

Linoleic acid
g
10.3
147
11.3
162
10.8
154
12.6
180

α‐linolenic acid
g
1.4
207
1.4
205
1.4
205
1.5
218

n6 : n3 ratio

7.1

7.9

7.5

8.3

Carbohydrate
g
179.7
138
175.9
135
172.6
133
179.7
138

Calcium
mg
331.9
66
564.6
113
536.7
107
363.2
73

Copper
mg
0.9
271
0.7
213
0.9
250
0.6
172

Folic acid
µg DFE
294.5
196
334.9
223
751.2
501
280.2
187

Iodine
µg
222.7
247
222.7
247
222.7
247
222.7
247

Iron
mg
9.5
150
17.8
283
16.1
255
16.7
265

Absorbed iron†
mg
1.1
197
1.7
300
1.6
278
1.5
267

Magnesium
mg
156.0
260
168.3
280
145.1
242
104.5
174

Manganese
mg
3.6
303
2.0
164
2.9
241
1.6
136

Niacin
mg
13.2
220
18.8
313
21.4
357
17.7
294

Pantothenic acid
mg
4.8
239
3.0
152
3.3
166
2.5
126

Phosphorous
mg
520.4
113
514.3
112
522.4
114
892.2
194

Potassium
mg
732.7
24
838.3
28
759.0
25
1255.5
42

Riboflavin
mg
0.7
132
1.3
252
1.3
262
0.9
170

Selenium
µg
47.5
280
40.5
238
82.0
482
19.4
114

Sodium
mg
865.2
87
873.6
87
864.5
86
872.7
87

Thiamine
mg
0.9
177
2.0
406
1.9
387
1.2
244

Vitamin A
µg RAE
596.8
149
1668.2
417
1682.9
421
596.8
149

Vitamin B12
µg
0.9
100
0.9
100
0.9
100
0.9
100

Vitamin B6
mg
0.9
184
1.0
197
0.7
141
0.6
125

Vitamin C
mg
31.0
103
31.0
103
31.0
103
31.0
103

Vitamin D
IU
200.0
100
200.0
100
200.0
100
200.0
100

Vitamin E
mg
6.2
124
6.3
125
6.1
122
6.0
119

Vitamin K
µg
38.1
254
37.9
253
38.5
256
37.9
253

Zinc
mg
8.2
434
7.5
392
7.5
392
6.2
324

Absorbed zinc‡
mg
2.3
334
1.8
254
1.8
260
1.5
208

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.

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)
Rice
Cornmeal
Wheat flour
Sorghum

6–8
Vitamin A Zinc
Vitamin A
Vitamin A
Vitamin A

9–11
Vitamin A Zinc
Vitamin A Zinc
Vitamin A Zinc
Vitamin A

12–23
Magnesium* Niacin Vitamin A Manganese
Magnesium* Niacin Vitamin A*
Magnesium* Niacin Vitamin A* Folic acid Manganese
Magnesium Niacin Vitamin A

24–35
Magnesium* Niacin Manganese* Folic acid Zinc
Folic acid Magnesium* Niacin* Vitamin A*
Folic acid* Magnesium* Manganese Niacin* Vitamin A*
Magnesium Niacin Folic acid

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).

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

Nutrient
Unit
Daily recommended intake: Pregnancy
Daily recommended intake: Lactation
LNS PLW composition, per 20 g ration

Protein
g
71
71
2.6

Fat
g
20–35 %E
20–35 %E
9.6

Linoleic acid
g
13*
13*
4.5

α‐linolenic acid
g
1.4*
1.3*
0.6

Carbohydrate
g
175
210
5.3

Energy
kcal
NA
NA
118

Calcium
mg
1200
1000
280*

Copper
mg
1
1.3
1.3

Folic acid
µg DFE
600
500
600

Iodine
µg
200
200
200

Iron†
mg
4.6
1.5
20‡

Magnesium
mg
220
270
65*

Manganese
mg
2
2.6
2.6

Niacin
mg
18
17
18

Pantothenic acid
mg
6
7
7

Phosphorus
mg
700
700
190*

Potassium
mg
4700
5100
200*

Riboflavin
mg
1.4
1.6
1.6

Selenium
µg
29
35
35

Sodium
mg
1500
1500
0

Thiamine
mg
1.4
1.5
1.5

Vitamin A
µg RAE
800
850
850

Vitamin B12
µg
2.6
2.8
2.8

Vitamin B6
mg
1.9
2
2

Vitamin C
mg
55
70
70

Vitamin D
IU
200
200
200

Vitamin E
mg
15
19
19

Vitamin K
µg
55
55
55

Zinc†
mg
3.2
3.6
23§

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
58.3
82
60.0
85
76.0
107
85.1
120

Fat*
g
43.2
15
49.1
17
45.2
16
58.1
20

Linoleic acid
g
20.3
156
23.2
179
21.6
167
26.7
206

α‐linolenic acid
g
2.9
211
2.9
207
2.9
209
3.2
226

n6 : n3 ratio

6.9

8.0

7.4

8.5

Carbohydrate
g
480.7
275
470.3
269
461.4
264
480.7
275

Calcium
mg
421.6
35
1056.0
88
980.0
82
506.9
42

Copper
mg
2.9
288
2.3
234
2.7
269
2.0
197

Folic acid
µg DFE
993.9
166
1104.0
184
2239.1
373
954.9
159

Iodine
µg
566.5
283
566.5
283
566.5
283
566.5
283

Iron
mg
29.4
163
52.2
290
47.5
264
49.1
273

Absorbed iron†
mg
7.6
165
13.8
300
12.5
272
13.0
282

Magnesium
mg
326.7
149
360.1
164
297.0
135
186.3
85

Manganese
mg
9.2
462
4.7
234
7.2
361
3.8
189

Niacin
mg
37.5
209
52.9
294
60.1
334
49.8
277

Pantothenic acid
mg
14.6
243
9.8
164
10.6
177
8.4
140

Phosphorous
mg
1090.6
156
1074.0
153
1096.3
157
2104.3
301

Potassium
mg
1652.1
35
1940.0
41
1723.7
37
3077.4
65

Riboflavin
mg
2.0
145
3.7
263
3.8
272
2.6
183

Selenium
µg
118.2
408
99.2
342
212.3
732
41.6
143

Sodium
mg
2388.8
159
2411.8
161
2387.1
159
2409.4
161

Thiamine
mg
2.5
182
5.7
405
5.4
386
3.5
248

Vitamin A
µg RAE
1386.5
173
4307.4
538
4347.5
543
1386.5
173

Vitamin B12
µg
2.8
108
2.8
108
2.8
108
2.8
108

Vitamin B6
mg
3.2
166
3.3
175
2.6
135
2.3
123

Vitamin C
mg
72.8
132
72.8
132
72.8
132
72.8
132

Vitamin D
IU
200.0
100
200.0
100
200.0
100
200.0
100

Vitamin E
mg
22.2
148
22.4
150
22.0
146
21.6
144

Vitamin K
µg
118.0
214
117.4
214
119.0
216
117.4
214

Zinc
mg
31.8
245
29.7
228
29.7
228
26.2
201

Absorbed zinc‡
mg
5.2
163
3.9
122
4.0
126
3.3
92

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
63.4
89
65.3
92
82.8
117
92.7
131

Fat*
g
46.3
15
52.8
17
48.4
15
62.5
20

Linoleic acid
g
21.8
168
25.0
192
23.2
179
28.8
221

α‐linolenic acid
g
3.2
243
3.1
240
3.1
241
3.4
261

n6 : n3 ratio

6.9

8.0

7.4

8.5

Carbohydrate
g
524.4
250
513.1
244
503.3
240
524.4
250

Calcium
mg
434.6
43
1127.3
113
1044.3
104
527.8
53

Copper
mg
3.0
233
2.4
188
2.8
217
2.0
156

Folic acid
µg DFE
1030.1
206
1150.3
230
2389.8
478
987.6
198

Iodine
µg
602.4
301
602.4
301
602.4
301
602.4
301

Iron
mg
30.3
202
55.1
368
50.0
334
51.8
345

Absorbed iron†
mg
4.5
302
6.7
444
6.2
414
5.9
396

Magnesium
mg
350.8
130
387.3
143
318.4
118
197.4
73

Manganese
mg
9.8
379
4.9
188
7.6
294
3.9
150

Niacin
mg
39.3
231
56.1
330
64.0
376
52.7
310

Pantothenic acid
mg
15.3
218
10.1
144
11.0
157
8.5
122

Phosphorous
mg
1173.5
168
1155.3
165
1179.6
169
2280.3
326

Potassium
mg
1785.7
35
2100.1
41
1864.0
37
3342.1
66

Riboflavin
mg
2.1
130
3.9
242
4.0
250
2.6
165

Selenium
µg
125.9
360
105.1
300
228.6
653
42.2
120

Sodium
mg
2622.7
175
2647.8
177
2620.8
175
2645.2
176

Thiamine
mg
2.6
176
6.0
403
5.8
385
3.7
243

Vitamin A
µg RAE
1435.6
169
4625.1
544
4668.9
549
1435.6
169

Vitamin B12
µg
2.8
100
2.8
100
2.8
100
2.8
100

Vitamin B6
mg
3.3
163
3.4
172
2.6
131
2.4
118

Vitamin C
mg
73.0
104
73.0
104
73.0
104
73.0
104

Vitamin D
IU
200.0
100
200.0
100
200.0
100
200.0
100

Vitamin E
mg
22.5
118
22.8
120
22.2
117
21.9
115

Vitamin K
µg
123.7
225
123.2
224
124.8
227
123.2
224

Zinc
mg
32.6
326
30.3
303
30.3
303
26.5
265

Absorbed zinc‡
mg
5.7
159
4.3
119
4.4
122
3.6
101

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.

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)
Rice
Cornmeal
Wheat flour
Sorghum

Pregnant
Folic acid Niacin
Magnesium* Niacin* Vitamin A* Folic acid Iron
Folic acid* Niacin* Vitamin A* Iron
Folic acid Iron

Lactating
Folic acid Niacin Magnesium
Magnesium* Vitamin A* Folic acid Iron
Folic acid* Niacin* Vitamin A* Iron
Niacin* Folic acid Iron

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.

LNS micronutrient content for all groups, ‘one‐size fits all’ approach

Nutrient
Unit
LNS ‘one‐size’ composition, per 20 g ration
Amount in two rations (40 g)

Protein
g
2.6
5.2

Fat
g
9.6
19.2

Linoleic acid
g
4.5
8.92

α‐linolenic acid
g
0.6
1.16

Carbohydrate
g
5.3
10.6

Energy
kcal
118
236

Calcium
mg
280*
560

Copper
mg
0.34
0.68

Folic acid
µg DFE
150
300

Iodine
µg
90
180

Iron
mg
6
12

Magnesium
mg
60
120

Manganese
mg
1.2
2.4

Niacin (total)
mg
6
12

Pantothenic acid
mg
2
4

Phosphorus
mg
190*
380

Potassium
mg
200*
400

Riboflavin
mg
0.5
1

Selenium
µg
17
34

Thiamine
mg
0.5
1

Vitamin A
µg
400
800

Vitamin B12
µg
1.4†
2.8

Vitamin B6
mg
1†
2

Vitamin C
mg
30
60

Vitamin D
IU
200
400

Vitamin E
mg
6†
12

Vitamin K
µg
15
30

Zinc
mg
5
10

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
60.9
86
62.6
88
78.6
111
87.7
124

Fat*
g
52.8
18
58.7
20
54.8
19
67.7
24

Linoleic acid
g
24.8
191
27.7
213
26.1
201
31.2
240

α‐linolenic acid
g
3.5
252
3.5
249
3.5
250
3.7
267

n6 : n3 ratio

7.0

8.0

7.5

8.3

Carbohydrate
g
486.0
278
475.6
272
466.7
267
486.0
278

Calcium
mg
701.6
58
1336.0
111
1260.0
105
786.9
66

Copper
mg
2.3
226
1.7
172
2.1
207
1.3
135

Folic acid
µg DFE
693.9
116
804.0
134
1939.1
323
654.9
109

Iodine
µg
546.5
273
546.5
273
546.5
273
546.5
273

Iron
mg
21.4
119
44.2
245
39.5
219
41.1
229

Absorbed iron†
mg
5.6
121
11.8
256
10.5
228
11.0
238

Magnesium
mg
381.7
174
415.1
189
352.0
160
241.3
110

Manganese
mg
9.0
452
4.5
224
7.0
351
3.6
179

Niacin
mg
31.5
175
46.9
261
54.1
301
43.8
243

Pantothenic acid
mg
11.6
193
6.8
114
7.6
127
5.4
90

Phosphorous
mg
1280.6
183
1264.0
181
1286.3
184
2294.3
328

Potassium
mg
1852.1
39
2140.0
46
1923.7
41
3277.4
70

Riboflavin
mg
1.4
103
3.1
220
3.2
229
2.0
140

Selenium
µg
117.2
404
98.2
339
211.3
729
40.6
140

Sodium
mg
2388.8
159
2411.8
161
2387.1
159
2409.4
161

Thiamine
mg
2.0
146
5.2
369
4.9
351
3.0
212

Vitamin A
µg RAE
1336.5
167
4257.4
532
4297.5
537
1336.5
167

Vitamin B12
µg
2.8
108
2.8
108
2.8
108
2.8
108

Vitamin B6
mg
3.2
166
3.3
175
2.6
135
2.3
123

Vitamin C
mg
62.8
114
62.8
114
62.8
114
62.8
114

Vitamin D
IU
400.0
200
400.0
200
400.0
200
400.0
200

Vitamin E
mg
15.2
101
15.4
103
15.0
100
14.6
98

Vitamin K
µg
93.0
169
92.4
168
94.0
171
92.4
168

Zinc
mg
18.8
145
16.7
128
16.7
128
13.2
101

Absorbed zinc‡
mg
3.5
109
2.5
79
2.6
82
2.0
63

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.

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

Nutrient
Unit
Rice
Corn
Wheat
Sorghum

Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake
Amt.
% daily intake

Protein
g
66.0
93
67.9
96
85.4
120
95.3
134

Fat*
g
55.9
18
62.4
20
58.0
19
72.1
23

Linoleic acid
g
8.9
69
8.9
69
8.9
69
8.9
69

α‐linolenic acid
g
1.2
89
1.2
89
1.2
89
1.2
89

n6 : n3 ratio

7.7

7.7

7.7

7.7

Carbohydrate
g
529.7
252
518.4
247
508.6
242
529.7
252

Calcium
mg
714.6
71
1407.3
141
1324.3
132
807.8
81

Copper
mg
2.4
185
1.8
140
2.2
169
1.4
108

Folic acid
µg DFE
730.1
146
850.3
170
2089.8
418
687.6
138

Iodine
µg
582.4
291
582.4
291
582.4
291
582.4
291

Iron
mg
22.3
149
47.1
314
42.0
280
43.8
292

Absorbed iron†
mg
3.0
201
5.2
345
4.7
316
4.6
304

Magnesium
mg
405.8
150
442.3
164
373.4
138
252.4
93

Manganese
mg
9.6
371
4.7
180
7.4
286
3.7
142

Niacin
mg
33.3
196
50.1
295
58.0
341
46.7
275

Pantothenic acid
mg
12.3
175
7.1
101
8.0
114
5.5
79

Phosphorous
mg
1363.5
195
1345.3
192
1369.6
196
2470.3
353

Potassium
mg
1985.7
39
2300.1
45
2064.0
40
3542.1
69

Riboflavin
mg
1.5
92
3.3
204
3.4
213
2.0
128

Selenium
µg
124.9
357
104.1
297
227.6
650
41.2
118

Sodium
mg
2622.7
175
2647.8
177
2620.8
175
2645.2
176

Thiamine
mg
2.1
143
5.5
370
5.3
351
3.2
210

Vitamin A
µg RAE
1385.6
163
4575.1
538
4618.9
543
1385.6
163

Vitamin B12
µg
2.8
100
2.8
100
2.8
100
2.8
100

Vitamin B6
mg
3.3
163
3.4
172
2.6
131
2.4
118

Vitamin C
mg
63.0
90
63.0
90
63.0
90
63.0
90

Vitamin D
IU
400.0
200
400.0
200
400.0
200
400.0
200

Vitamin E
mg
15.5
82
15.8
83
15.2
80
14.9
78

Vitamin K
µg
98.7
180
98.2
179
99.8
182
98.2
179

Zinc
mg
19.6
196
17.3
173
17.3
173
13.5
135

Absorbed zinc‡
mg
3.9
108
2.8
78
2.9
80
2.2
61

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.

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 group
Rice
Cornmeal
Wheat flour
Sorghum

Pregnant
Magnesium*
Magnesium Niacin* Vitamin A*
Folic acid* Magnesium Niacin* Vitamin A*

Lactating
Magnesium
Magnesium* Niacin Vitamin A* Iron
Folic acid* Magnesium Niacin* Vitamin A*
Niacin*

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.

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)

Nutrient
Unit
UL 7–11 mo
UL 12–35 mo
LNS age‐specific or one‐size composition (6–35 mo)
×2
×3
×4
×5
×6
×7

Energy
kcal
–
–
118
236
354
472
590
708
826

Calcium
mg
ND
2500
280
560
840
1120
1400
1680
1960

Copper
mg
ND
1
0.34
0.68
1.02
1.36
1.7
2.04
2.38

Folic acid
µg DFE
ND
300
150
300
450
600
750
900
1050

Iodine
µg
1260
600
90
180
270
360
450
540
630

Iron
mg
40
40
6
12
18
24
30
36
42

Magnesium
mg
ND
65
60
120
180
240
300
360
420

Manganese
mg
ND
2
1.2
2.4
3.6
4.8
6.0
7.2
8.4

Niacin
mg
ND
10
6
12
18
24
30
36
42

Pantothenic acid
mg
ND
ND
2
4
6
8
10
12
14

Phosphorus
mg
ND
3000
190
380
570
760
950
1140
1330

Potassium
mg
ND
ND
200
400
600
800
1000
1200
1400

Riboflavin
mg
ND
30
0.5
1
1.5
2
2.5
3
3.5

Selenium
µg
60
90
17
34
51
68
85
102
119

Sodium
mg
ND
1500
0
0
0
0
0
0
0

Thiamine
mg
ND
10
0.5
1
1.5
2
2.5
3
3.5

Vitamin A
µg RAE
600
600
400
800
1200
1600
2000
2400
2800

Vitamin B12
µg
ND
ND
0.9*
1.8
2.7
3.6
4.5
5.4
6.3

Vitamin B6
mg
ND
30
0.5*
1
1.5
2
2.5
3
3.5

Vitamin C
mg
ND
400
30
60
90
120
150
180
210

Vitamin D
IU
1000
2000
200
400
600
800
1000
1200
1400

Vitamin E
mg
ND
200
5*
10
15
20
25
30
35

Vitamin K
µg
ND
ND
15
30
45
60
75
90
105

Zinc
mg
6
8
5
10
15
20
25
30
35

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).

Toxicity estimates for 6–35‐month‐old children consuming 2–7 times the recommended daily dose of the PLW LNS formulation (alone)

Nutrient
Unit
UL 7–11 mo
UL 12–35 mo
LNS PLW composition
×2
×3
×4
×5
×6
×7

Energy
kcal
–
–
118
236
354
472
590
708
826

Calcium
mg
ND
2500
280
560
840
1120
1400
1680
1960

Copper
mg
ND
1
1.3
2.6
3.9
5.2
6.5
7.8
9.1

Folic acid
µg DFE
ND
300
600
1200
1800
2400
3000
3600
4200

Iodine
µg
1260
600
200
400
600
800
1000
1200
1400

Iron
mg
40
40
20
40
60
80
100
120
140

Magnesium
mg
ND
65
65
130
195
260
325
390
455

Manganese
mg
ND
2
2.6
5.2
7.8
10.4
13
15.6
18.2

Niacin
mg
ND
10
18
36
54
72
90
108
126

Pantothenic acid
mg
ND
ND
7
14
21
28
35
42
49

Phosphorus
mg
ND
3000
190
380
570
760
950
1140
1330

Potassium
mg
ND
ND
200
400
600
800
1000
1200
1400

Riboflavin
mg
ND
30
1.6
3.2
4.8
6.4
8
9.6
11.2

Selenium
µg
60
90
35
70
105
140
175
210
245

Sodium
mg
ND
1500
0
0
0
0
0
0
0

Thiamine
mg
ND
10
1.5
3
4.5
6
7.5
9
10.5

Vitamin A
µg RAE
600
600
850
1700
2550
3400
4250
5100
5950

Vitamin B12
µg
ND
ND
2.8
5.6
8.4
11.2
14
16.8
19.6

Vitamin B6
mg
ND
30
2
4
6
8
10
12
14

Vitamin C
mg
ND
400
70
140
210
280
350
420
490

Vitamin D
IU
1000
2000
200
400
600
800
1000
1200
1400

Vitamin E
mg
ND
200
19
38
57
76
95
114
133

Vitamin K
µg
ND
ND
55
110
165
220
275
330
385

Zinc
mg
6
8
23
46
69
92
115
138
161

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).

Toxicity estimates for PLW consuming 2–7 times the recommended daily dose of the PLW LNS formulation (alone)

Nutrient
Unit
UL pregnant
UL lactating
LNS PLW composition
×2
×3
×4
×5
×6
×7

Energy
kcal
–
–
118
236
354
472
590
708
826

Calcium
mg
3000
3000
280
560
840
1120
1400
1680
1960

Copper
mg
10
10
1.3
2.6
3.9
5.2
6.5
7.8
9.1

Folic acid
µg DFE
1000
1000
600
1200
1800
2400
3000
3600
4200

Iodine
µg
1100
1100
200
400
600
800
1000
1200
1400

Iron
mg
45
45
20
40
60
80
100
120
140

Magnesium
mg
350
350
65
130
195
260
325
390
455

Manganese
mg
11
11
2.6
5.2
7.8
10.4
13
15.6
18.2

Niacin
mg
35
35
18
36
54
72
90
108
126

Pantothenic acid
mg
ND
ND
7
14
21
28
35
42
49

Phosphorus
mg
3500
4000
190
380
570
760
950
1140
1330

Potassium
mg
ND
ND
200
400
600
800
1000
1200
1400

Riboflavin
mg
ND
ND
1.6
3.2
4.8
6.4
8
9.6
11.2

Selenium
µg
400
400
35
70
105
140
175
210
245

Sodium
mg
2300
2300
0
0
0
0
0
0
0

Thiamine
mg
ND
ND
1.5
3
4.5
6
7.5
9
10.5

Vitamin A
µg RAE
3000
3000
850
1700
2550
3400
4250
5100
5950

Vitamin B12
µg
ND
ND
2.8
5.6
8.4
11.2
14
16.8
19.6

Vitamin B6
mg
100
100
2
4
6
8
10
12
14

Vitamin C
mg
1000
1000
70
140
210
280
350
420
490

Vitamin D
IU
2000
2000
200
400
600
800
1000
1200
1400

Vitamin E
mg
1000
1000
19
38
57
76
95
114
133

Vitamin K
µg
ND
ND
55
110
165
220
275
330
385

Zinc mg
mg
40
40
23
46
69
92
115
138
161

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.

Toxicity estimates for PLW consuming 2–7 times the recommended daily dose of LNS (alone), for the one‐size formulation

Nutrient
Unit
UL pregnant
UL lactating
LNS one‐size composition
×2
×3
×4
×5
x6
×7

Energy
kcal
–
–
118
236
354
472
590
708
826

Calcium
mg
3000
3000
280
560
840
1120
1400
1680
1960

Copper
mg
10
10
0.34
0.68
1.02
1.36
1.7
2.04
2.38

Folic acid
µg DFE
1000
1000
150
300
450
600
750
900
1050

Iodine
µg
1100
1100
90
180
270
360
450
540
630

Iron
mg
45
45
6
12
18
24
30
36
42

Magnesium
mg
350
350
60
120
180
240
300
360
420

Manganese
mg
11
11
1.2
2.4
3.6
4.8
6.0
7.2
8.4

Niacin
mg
35
35
6
12
18
24
30
36
42

Pantothenic acid
mg
ND
ND
2
4
6
8
10
12
14

Phosphorus
mg
3500
4000
190
380
570
760
950
1140
1330

Potassium
mg
ND
ND
200
400
600
800
1000
1200
1400

Riboflavin
mg
ND
ND
0.5
1
1.5
2
2.5
3
3.5

Selenium
µg
400
400
17
34
51
68
85
102
119

Sodium
mg
2300
2300
0
0
0
0
0
0
0

Thiamine
mg
ND
ND
0.5
1
1.5
2
2.5
3
3.5

Vitamin A
µg RAE
3000
3000
400
800
1200
1600
2000
2400
2800

Vitamin B12
µg
ND
ND
1.4
2.8
4.2
5.6
7
8.4
9.8

Vitamin B6
mg
100
100
1
2
3
4
5
6
7

Vitamin C
mg
1000
1000
30
60
90
120
150
180
210

Vitamin D
IU
2000
2000
200
400
600
800
1000
1200
1400

Vitamin E
mg
1000
1000
6
12
18
24
30
36
42

Vitamin K
µg
ND
ND
15
30
45
60
75
90
105

Zinc mg
mg
40
40
5
10
15
20
25
30
35

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.

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)

Commodity
Commodity Price (US$/MT)

Rice (average)
655

Cornmeal (average)
385

Wheat flour, all‐purpose
400

Sorghum (average)
158

Pulses (average)
808

CSB – Corn–Soy Blend
475

Vegetable (soy) oil
690

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.

Cost estimate (in US$) for ‘typical’ full GFD ration and ‘revised’ full GFD ration (excluding sugar and salt)

‘Typical’ GFD ration

Rice
Cornmeal
Wheat
Sorghum
Average

Grain
0.26
0.15
0.16
0.06
0.16

Corn‐soy blend
0.02
0.02
0.02
0.02
0.02

Pulse
0.04
0.04
0.04
0.04
0.04

Vegetable oil
0.02
0.02
0.02
0.02
0.02

Total cost (1 full ration)
0.34
0.24
0.24
0.14
0.24

‘Revised’ GFD ration

Rice
Cornmeal
Wheat
Sorghum
Average

Grain
0.28
0.16
0.17
0.07
0.17

Pulse
0.06
0.06
0.06
0.06
0.06

Vegetable oil
0.02
0.02
0.02
0.02
0.02

Total cost (1 full ration)
0.36
0.24
0.25
0.15
0.25

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).

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)

Total cost (6–8 month‐olds)
0.02
0.01
0.08
–
236
–

Total cost (9–11 month‐olds)
0.04
0.02
0.09
–
160
–

Total cost (12–23 month‐olds)
0.06
0.05
0.12
–
90
–

Total cost (24–35 month‐olds)
0.12
0.11
0.18
–
51
–

Total cost (pregnant women)
0.30
0.30
0.37
0.42
23
41

Total cost (lactating women)
0.32
0.32
0.39
0.45
21
38

Total cost (avg. pregnant/lactating woman + avg. child <3)
0.37
0.36
0.50
0.56
34
52

GFD, general food distribution; LNS, lipid‐based nutrient supplement; CSB, corn‐soy blend.

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 months
9–11 months
12–23 months
24–35 months
Pregnant women
Lactating women
Pregnant women (2 doses LNS)
Lactating women (2 doses LNS)
Mother–child dyad*

Total ‘typical’ GFD ration weight (g)
53
81
144
269
679
739
679
739
846

Total ‘revised’ GFD ration weight + LNS (g)
42
70
134
260
674
734
663
723
830

Absolute change (g)
11
11
10
9
5
5
16
16
16

Per cent change in weight from ‘typical’ GFD ration (%)
20
14
7
3
1
1
2
2
2

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.

Possible chemical forms of nutrients included in products for infants and young children, and recommended chemical forms for inclusion in LNS

Nutrient
Possible chemical forms
Recommended chemical forms for LNS

Vitamin A
Retinyl acetate or retinyl palmitate or beta‐carotene
Retinyl acetate

Vitamin D
ergocalciferol (D2) or cholecalciferol (D3)
Cholecalciferol (D3)

Vitamin E
Acetates of d or dl‐alpha‐tocopherol
dl‐alpha‐tocopherol acetate

Vitamin K
–
Phylloquinone 5%

Vitamin C
l‐ascorbic acid
l‐ascorbic acid

Thiamine (vitamin B1)
Thiamine mononitrate (preferred for dry products) or Thiamine hydrochloride
Thiamine hydrochloride

Riboflavin (vitamin B2)
Riboflavin
Riboflavin

Niacin (vitamin B3)
Niacinamide
Niacinamide

Vitamin B6
Pyridoxine hydrochloride
Pyridoxine hydrochloride

Vitamin B12
Cyanocobalamin (diluted form (0.1% or 1%) with 100% active particles, spray dried form
Cyanocobalamin (0.1%)

Folic acid
Pteroyl monoglutamic acid
Pteroyl monoglutamic acid

Iron
Na 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 considered
Encapsulated ferrous sulfate

Zinc
Zinc sulfate, zinc gluconate, zinc oxide
Zinc sulfate

Copper
Copper sulfate or Copper gluconate
Encapsulated copper sulfate

Selenium
Sodium selenate, Sodium selenite
Sodium selenite 1.5%

Calcium
Several 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 acidosis5
Tricalcium phosphate

Phosphorous
–
Tricalcium phosphate Dipotassium phosphate

Potassium
–
Dipotassium phosphate, potassium chloride

Magnesium
Soluble organic magnesium salts such as Mg citrate. Magnesium salts containing well absorbed anions (such as chloride) should be avoided as they may induce acidosis
Magnesium citrate

Manganese
–
Mangasese sulphate

Iodine
Potassium iodate
Potassium iodate

LNS, lipid‐based nutrient supplement; EDTA, ethylene‐diamine‐tetra‐acetic acid. Adapted from ‘Formulation Subgroup, 2009’.

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 diets
22

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
23

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
28

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
28

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
29

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
30

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
33

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
34

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
34

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
35

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.imagePer 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.imagePer 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.imagePer 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.imagePer 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.imagePer 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.imagePer 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.imagePer 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.imagePer 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.imagePer 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.image

List of Acronyms

AI
Adequate intake

AMDR
Acceptable macronutrient distribution range

CSB
Corn‐soy blend

CV
Coefficient of variation

EAR
Estimated average requirement

EFA
Essential fatty acid

EMOP
Emergency operation

FAO
Food and Agriculture Organization

FBF
Fortified blended food

GFD
General food distribution

IDP
Internally displaced person

IOM
Institute of Medicine

IZiNCG
International Zinc Nutrition Consultative Group

LNS
Lipid‐based nutrient supplement

MAM
Moderate acute malnutrition

MNP
Micronutrient powder

NOAEL
No observed adverse effect level

PLW
Pregnant and lactating women

RDA
Recommended dietary allowance

RNI
Recommended nutrient intake

RUTF
Ready‐to‐use therapeutic food

SAM
Severe acute malnutrition

SFP
Supplementary (selective) feeding program

UL
Upper Level

USDA
United States Department of Agriculture

USAID
United States Agency for International Development

WFP
World Food Program

WHO
World Health Organization

AbstractThe 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.