Ana Moltedo, Cristina Álvarez, Fernanda Grande, Anna Vincent, Nathalie Troubat, Carlo Cafiero, and Ruth Charrondiere

Transcription

1 Estimating the adequacy of apparent vitamin A consumption using Household Consumption and Expenditure Survey (HCES) data: effect of varying the unit of expression Ana Moltedo, Cristina Álvarez, Fernanda Grande, Anna Vincent, Nathalie Troubat, Carlo Cafiero, and Ruth Charrondiere 12th International Food Data Conference October, 11th 13th 2017

2 Background In 2015, FAO Statistics Division started the optimization of the ADePT-Food Security Module (FSM) for nutrient analysis within the framework of the International Dietary Data Expansion Project (INDDEX). ADePT-FSM software o Developed by the World Bank and FAO, with financial support from the European Union. o It produces food consumption statistics at national and subnational levels from Household Consumption and Expenditure surveys (HCES) data.

3 Background: Household Consumption and Expenditure Surveys (HCES) Multipurpose surveys not specifically designed for food security analyses. Conducted in a large number of countries (in 2011, there were 700 surveys for 116 countries). Conducted every 2-10 years. National, regional and urban-rural representative samples. Collect household food consumption and/or acquisition in quantity and monetary values. Capture apparent consumption not intake. o Division between individuals within the household is unknown o Do not account for within household losses, or changes to during cooking

4 Objective 1 Methods & Results Review of Food Composition Tables and Databases for type of Vitamin A information available

5 (1) Methods Searched for publicly available FCTs/FCDBs to determine how vitamin A was expressed. Reviewed 69: three are regional, the rest are national. Origin: Africa (n 14; 20%), Asia (n 16; 23%), Europe (n 17; 25%), Latin America & the Caribbean (n 16; 23%), Other (n 6; 9%). Year of publication After 2009 (56%) Between 2000 and 2009 (25%) Before 2000 (19%)

6 (1) Methods INFOODS TAGNAME <VITA> In 1967, the FAO and the WHO introduced the Retinol Equivalent () as a unit of measurement: μg = μg Retinol+μg Beta-carotene/6+μg Other-carotenes/12 INFOODS TAGNAME <VITA_RAE> Since 2001 the US Health and Medical Divison (HMD) recommends the use of a new system of equivalence, Retinol Activity Equivalents (RAE), to reflect a lower absorption of carotenoids: μg RAE = μg Retinol+μg Beta-carotene/12+μg Other- carotenes/24

7 INFOODS Tagname <TOL> + <CARTB> + <CARTA> + <CRYPXB> (1) Results Number of FCTs/FCDs that include information of vitamin A and its components μg and μg RAE Inconsistency <TOL> + between total <CARTBEQ> <VITA> <VITA_RAE> μg and μg RAE μg μg RAE vitamin A Tagname and description No total vitamin A or information to estimate it All regions 10 (14%) 13 (19%) 23 (33%) 22 (32%) 14 (20%) 11 (16%) Africa Asia Europe Latin America and the Caribbean Middle East North America Oceania

8 (1) Conclusions & Recommendations 42 (61%) of FCT/FCDBs provide information on total vitamin A (20 in, 19 in RAE, 3 in both); and 2 (3%) do not show total vitamin A but permit deriving it from retinol and provitamin-a carotenoid values. While an international consensus is achieved, FCTs/FCDBs should provide information on retinol and provitamin A carotenoids so that analysts can calculate total vitamin A in and/or RAE based on their needs.

9 Objective 2 Methods & Results Assessing the effect of the unit of expression of vitamin A on the adequacy ratio and on the percentage of individuals living in households with a consumption lower than the population EAR

10 (2) Methods Using 5 HCES datasets, we assessed: o Adequacy ratio = per capita average apparent consumption of the population / per capita estimated average requirement (EAR) of the population. o Percentage of individuals living in households (HH) with a per capita apparent consumption (i.e. HH consumption / number of HH members) lower than the EAR of the population. in both and RAE at national, urban-rural and income quintile levels; and compared differences in estimates.

11 (2) Methods Sources of the vitamin A requirements: EAR in RAE US Health and Medicine Division (HMD) (2001). Criterion used to set requirements: level of intake to assure adequate liver stores of the vitamin. EAR in WHO/FAO (2004). Criterion: level of intake to prevent xerophthalmia in the absence of clinical or sub-clinical infection. European Food Safety Authority (EFSA) (2015). Criterion: Level of intake for an adequate growth and other vitamin A dependent functions, and to maintain an acceptable total body pool of the vitamin.

12 (2) Methods Sources of the vitamin A requirements The average requirements of vitamin A, published by sex-age groups of individuals, depend on the criteria and the unit of expression. Example of requirements of adult males and females. Years WHO/FAO mcg EFSA mcg US HMD mcg RAE Male > Female Female >

13 (2) Methods Weighted population EARs were calculated (in or RAE) for each HCES dataset using values by sex-age group and considering the populations structure. Foods from the HCES food lists were matched with FCTs/FCDBs using INFOODS food matching guidelines. The food matching quality was high/medium in most cases and for all HCES datasets. o High quality: A: Single, perfect match, no modifications required A2: Exact match, but multiple selections o Medium quality: B: Similar, single match B2: Similar match, multiple selections

14 (2) Results: Adequacy ratio (%) Vitamin Source Income Quintile A unit EAR National Urban Rural Lowest Highest A B C D E RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA

15 (2) Results & Conclusions Average vitamin A apparent consumption is higher using. Lowest levels of inadequacy: using vitamin A expressed in and WHO/FAO requirements. Highest levels of inadequacy: using vitamin A expressed in RAE and US HMD requirements.

16 (2) Results: % of individuals living in households with a per capita vitamin A apparent consumption lower than the population EAR A B C D E Vitamin A unit Source EAR National Urban Rural Income Quintile Lowest Highest RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA RAE USA HMD WHO/FAO EFSA

17 (2) Results & Conclusions Among the five HCES, within-country differences in percentage points varied up to 65, 68, and 67, at national level, rural areas, and lowest quintile, respectively for estimates of % of individuals living in households with a per capita vitamin A apparent consumption lower than the population EAR. Estimates of vitamin A are highly affected by unit of expression and source of requirements.

18 (2) Recommendations 1. When reporting statistics on vitamin A and for monitoring of programs it is of utmost importance to mention: o o o the FCT/FCDBs used and the food matching quality; the unit of expression of vitamin A apparent consumption; and the source and criteria of vitamin A requirements. 2. Vitamin A indicators in monitoring programs should be based on the same unit of expression and requirements.

19 Funding disclaimer This research was done within the framework of the International Dietary Data Expansion Project (INDDEX) The INDDEX project is implemented by Tufts University s Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy with funding from the Bill & Melinda Gates Foundation.