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Dairy for Global Nutrition
Whey proteins, stunting and internationaldevelopmentVeronique Lagrange, US Dairy Export Council [email protected] www.dairyforglobalnutrition.org
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• Definitions and world estimates• Impact and cost of stunting• Use of food supplements for the management of
moderate malnutrition• Current US and international recommendations• Evidence in support of whey proteins• Major studies in progress• Commercial opportunities and challenges• Next steps
Whey proteins, stunting and international development
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• Height-for-age Z (HAZ) score < 2SD
• Stunting affects 800 million people worldwide*
• 195 million children under 5 are stunted
• >40% in some countries
*Source: UNICEF, 2014Image courtesy: Gates Foundation, 2014
Definitions and world estimates
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Impact of stunting
Malnutrition and stunting: relationships, outcomes
Stunting: impacts physical and mental development, overall economic development
Photos courtesy: ABC News, USA
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• Cognitive impairments early in life have long-term consequences on economic development
• Focus on the first 1,000 days: to include pregnant, lactating women
• Demonstrated economic rationale for investing in stunting reduction: Benefit-cost ratio average: 18*
*Hoddinott, J. Maternal & Child Nutrition, 2013 (9) Suppl. 2
Relationship with economic development
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Use of food supplements for the management of moderate malnutrition
Customers: USAID, UNICEF, Doctors without Borders, Action against Hunger, other PVOs
Supplements contain sweet whey or WPC, milk powder (15-25%)
World Food ProgrammeSupplement contains 8%milk powder
Dairy represents 50% of the cost of the formula:Strong incentive to optimize formula, displace dairy
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Whey, dairy in recommendations for MAM
2010: 3% WPC80
WHO 2012: Milk powder as protein
source
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Evidence for dairy
Food and Nutrition Bulletin, 2013, 35(2) 8
Product A vs. Product B
Role/function of nutrients
Outcome, costEffective dose of
nutrients(Delivered: in matrix,
featuring losses, synergies acceptability)
Most studies have been program-driven
Most studies focused on this
relationship
Area of emerging interest: design products using
new science
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“Plumpy Sup” (whey, milk powder) vs, corn soy blend with milk powder, local food, local flour:
Recovery rate highest with whey/powder supplement
Acktia-Armah et al. 2012.
Most studies compare products, few systematically study whey (examples)
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Supplementary Plumpy (whey, milk powder) vs, corn soy blend with milk powder, local food, local flour:
Increases in weight, MUAC, highest with whey/milk powder supplement
McDonald et al, 2014
Most studies compare products, few systematically study whey (examples)
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• Soy/whey RUSF: superior rates of weight and MUAC gains compared to CSB++, superior rate of MUACgain compared to soy RUSF
( Manary, 2012, USAID FANTA 2 Technical Report) Photo courtesy: wordpress
Most studies compare products, few systematically study whey (examples)
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Milk lipid-based supplement (25%), but not soy, promotes linear growth
( Mangani et al, 2013)Photo courtesy: 1,000 Days foundation
Most studies compare products, systematically study whey (examples)
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• Faster recovery from moderate malnutrition
• Positive lean body mass accretion
• Moderate LAZ/HAZ… (30% of stunting occurs in utero)
• Immunity, infections benefits
Photo courtesy: Ekantipur
General trends in findings
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Whey Research Needs/Opportunities
• What is the optimal dose and mixture of whey protein in supplements for treatment and prevention of MAM? Prevention of stunting?‒ What is the optimal dose of milk protein to improve
growth in children with MAM?‒ Does DSM & MPC (intact dairy proteins) and whey
have similar effects on growth in MAM?, If so how?‒ Does dairy protein promote lean body gains, bone?‒ What is the effect on long term body composition?‒ Supplementation of the pregnant mother?
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Multiple Constraints
Dairy position not secure: need dose, mechanism of action
Narrow “dairy basket” available
Narrow supply chain to allow for in-country manufacture
Efficacy and mechanism of action research
Introduce full range of dairy ingredients
More suppliers, more supply lines
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• UNICEF: 30-40,000 mt LNS – supplied by Plumpy Field Network, Nutriset, PPB
• Doctors without Borders, PVOS: 30-40,000 mt LNS
• World Food Program: 235,000 mt “specialized nutrition” products
• USAID – emerging • Clinton Foundation (150,000 mt powder), PVOs
Demand – MAM
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Harmonization of research protocols, and filling in research gaps: need to fund more systematic research, clinical-style trials
Need for united efforts by the whey industry
Thank you! Veronique Lagrange US Dairy Export Council [email protected]
Next steps
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• Questions?
DairyforGlobalNutrition.org
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