Download THE FOOD WE NEED

THE FOOD WE NEED
REPORT
JULIE DAVIES
BSC (HONS) MSC RD
Copyright Can Cook
COMPARATIVE NUTRITIONAL
ANALYSIS OF A FOOD BANK BOX AND
A CUSTOM-BUILT FOOD WE NEED BOX.
ABSTRACT
In response to the agreed actions of the Can Cook Food Poverty
conferences, July & November 2013, and the Position Statement
produced by the Liverpool Food Poverty Working Party; a Food Aid+
package was designed under nutritional guidance as an alternative
to the current food bank offer. This paper describes the way the
alternative package – the Food We Need box, was planned, tried and
tested and discusses the implications and recommendations of the
findings comparing the nutritional analysis of both approaches.
2
‘Everyone has the right to a
standard of living adequate for the
health and well being of himself and
his family, including food...’
1.
BACKGROUND
1.1
The Universal Declaration of Human
Rights, Article 25, 1948
FOOD AID/SECURITY
The growth of food aid initiatives such as food
banks has raised the profile of household
food insecurity in the UK, proliferating
concern over the subsequent response
by charitable organisations. There is an
increasing commitment of bodies questioning
initiatives such as food banks, the experience
of household food insecurity and the
consequences of the receipt of food aid.
The factors driving people to seek food aid are
a consequence of financial adversity, such as a
sudden reduction in household income, benefit
sanctions and delays indebtedness, resulting in
an inability to purchase sufficient food to meet
household needs. 2 This purports an inability to
maintain food security.
“Food security exists when all people, at all
times, have physical and economic access to
sufficient, safe and nutritious food for a healthy
and active life” World Food Summit.3
‘[food security means] sustained access at
all times, in socially acceptable ways to food
adequate in quantity and quality to maintain a
healthy life. LSRO:4
Food insecurity is associated with a threefold
increase in anxiety when compared to those in
food secure homes.5 Physically, food insecurity
is associated with anaemia, chronic illness,
depression, obesity and poor overall health.6-8
The low income diet and nutrition survey of
2007 compared food intakes of those on
low income with blood markers of nutritional
status and found inadequate nutritional
status for levels of iron, folate and Vitamin C.9
Additionally, only 29% of the study population
were categorised as being in food insecure
households and the remaining 71% although
defined as being of low income, reported living
in food secure households. This suggests the
possibility that those living in food insecurity
may well be experiencing further nutritional
inadequacies. Commenting on food security, a
DEFRA report adds that ‘the composition, as
well as the overall volume of food available is
critical’.10
3
THE COST OF THE
CONTENTS OF A THRE
E
DAY FOOD BANK BOX
IS
APPROXIMATELY £3
0
1.2
FOOD BANKS
Food banks distribute food to clients who do
not have enough food to prevent themselves
being hungry. Clients are referred to food
banks by frontline staff such as health and
social care professionals, welfare advisers and
job centre plus staff. Food banks endeavour
to discourage dependency and emphasise
that they are an emergency food service only.
These charitable organisations are staffed by
volunteers who sort, pack and distribute the
1.3
THE FOOD BOX
The food boxes distributed by the main
food bank charity have been designed by
nutritionists to provide a minimum of three
days nutritionally balanced, non perishable
food. This is based on the total quantity of
food provided being consumed. The food
allocation of a food bank box for a family of
four to provide for three days is shown in table
1 to the right.
food boxes. Food is donated by individuals,
businesses, schools, churches and other
community organisations and is non perishable.
However, there is evidence to support that food
donor’s perceptions of the nutritional, cultural
and health needs of food aid recipients do not
match the actual client’s needs11. In part, the
Food We Need programme sets out to correct
this mismatch.
Table 1:
A typical 3 day food box for a family of four
ITEM
ALLOCATION
Cereal
1 Large
Soup (can/packet)
4 Standard
Beans or spaghetti in sauce
4 Standard
Tomatoes/pasta sauce
4 Standard
Vegetables
4 Standard
Meat
3 Standard
Or Vegetarian
2 Standard
Fish
4 Standard
Fruit
2 Standard
Rice Pudding or custard
2 Standard
Sponge Pudding
1 Standard
Biscuits
1 Lrg Pk
ITEM
ALLOCATION
Sugar
1kg
Snacks
1
Pasta or rice
1.5kg
Sauces
1
Instant Mash
1 pkt
Chocolate
1
Tea or Coffee
160 bags
Jam
1
Juice
1 Carton
Milk UHT/powder
2 Cart/1 pkt
Table 2: Extra Treats when available
4
(Jan 2014)
THE COST
OF THE CONTENTS
OF THE FOUR DAY
FOOD WE NEED BOX
IS
APPROXIMATELY £3
2
(M
arch 2014)
2.
METHOD
It was decided that this report would establish
whether it was possible to use and hence
consume all items in a 3 day food bank box
and to determine which combination of foods/
meals could be used to formulate a meal plan.
This challenge was set to the Can Cook chef in
residence and to a number of professional chefs
in Liverpool.
The first step involved the Can Cook chef trying
various combinations of foods, for example,
draining the meat from a tinned meat product
and mixing with pasta or rice. It was found
unfeasible to produce any dish with enough
flavour, texture or mouthfeel to be palatable.
Additionally, professional restaurant chefs
were given the equivalent challenge - to create
recipes and meal suggestions using the same
food items. Again, it was found impossible to
create a dish or meal that was fit for purpose.
One of the qualified chefs commented:
‘Creating a meal with the Food Bank
ingredients was very, very difficult’.
The second step involved taking five store
cupboard items – oil, flour, stock cubes,
mixed herbs and lentils as well as a selection
of vegetables and adding these into the
equation. At the same time, after experimenting
with drained meatballs and realising that the
consistency of the item was not conducive to
‘cooking’ and was only suitable for reheating;
it was decided to create homemade meatballs
from fresh sausages. It was found that price for
price; sausages provided a better quality meat
source than the tinned meat products.
The third and final step involved creating meat
and meat free recipes and meal ideas from
the assembled selection of foods and testing
the foods on staff in-house and at food bank
training days. Minor adjustments were made
following feedback, and an alternative food bank
box containing four days worth of meal plans
plus additional left over ingredients which could
be used for future dishes, was created – the
Food We Need box.
In order to verify the nutritional improvement of
this box in comparison to the food bank box,
a nutritional analysis was carried out on both
the food bank box and the newly created Food
We Need box. Nutritional software based on
McCance and Widdowson’s The Composition of
Foods integrated dataset12 was used.
The total contents of a food bank box for a
family of four, omitting the sugar, tea and coffee,
was aggregated. This total was divided by three
to provide a daily intake and then by four to
provide estimates of the nutritional value per
person. For the purpose of this study, the daily
intake was equally divided by four allowing for
children’s nutritional needs within a family to
match those of an adult. For boys aged 15 –
18, there are some macro and micro nutrients
which are needed in greater quantities than
adult requirements and may not be met. For the
Food we Need box, all food items listed on the
meal plan were analysed and again the total was
divided by the number of days worth of food, in
this case, four, and further divided again by four
to provide a value per person.
Foods were analysed for energy, fat,
carbohydrate, protein, sodium and salt
equivalents, iron, calcium as well as folate,
B vitamins and Vitamin C content. This is
consistent with the macro and micronutrient
analyses of other institutional meal delivery
programmes.
5
3.
RESULTS
A summary table of the results is shown below. A full breakdown of the analysis can be supplied
on request.
FOOD BANK BOX
Estimated Average Requirement (EAR)
Energy (kcal)
Total (x)
Per person per day
(x ÷ 12)
EAR
% EAR
18 256
1 521
2306 (median male +
female 19-75)13
66%
Dietary Reference Value (DRV)
Total (x)
Per person per day
(x ÷ 12)
DRV % energy intake
Actual % of energy intake
Fat (g)
389
32
35
19.2%
Carbohydrate (g)
3197
266
50%
66%
Dietary fibre (NSP)
134
11.2
18
62%
Recommended Nutrient Intake(RNI)
6
Total (x)
Per person per day
(x ÷ 12)
RNI
% RNI
Protein (g)
692
57
15
15.2%
Sodium (g)
36.992
3.082
1.6
Salt (g)= sodium x2.5
92.48
7.7
6
128%
Calcium (mg)
5343
445.3
800
56%
Iron (mg)
160
13.3
Range 8.7 – 14.8
90-166%
Folate
4009
334
200
167%
Thiamine (mg)
22.6
1.8
0.9
200%
Riboflavin (mg)
20
1.66
1.3
128%
Niacin (mg)
322
26.8
18
149%
Vitamin B6 (mg)
28.8
2.4
1.4
171%
Vitamin B12 (µg)
43.1
3.6
1.5
240%
Vitamin C (mg)
989
82
40
205%
Food We Need Box
Estimated Average Requirement (EAR)
Energy (kcal)
Total (x)
Per person per day
(x ÷ 16)
EAR
% EAR
26479
1654
2306 (median male +
female 19-75)13
72%
Dietary Reference Value (DRV)
Total (x)
Per person per
day(x ÷ 16)
DRV % energy intake
Actual % of energy intake
Fat (g)
951
59
35
32.3%
Carbohydrate (g)
3775
235
50%
54.6%
Dietary fibre (NSP)
269
16.8
18
93%
Recommended Nutrient Intake(RNI)
Total (x)
Per person per day
(x ÷ 16)
RNI
% RNI
Protein (g)
946
59
14.3
15.2%
Sodium (g)
36.972
2.9
Salt (g)= sodium x2.5
92.4
5.8
6
96%
Calcium (mg)
12806
800
800
100%
Iron (mg)
202
12.6
Range 8.7 -14.8
85-144%
Thiamine (mg)
28.26
1.76
0.9
196%
Riboflavin (mg)
23
1.43
1.3
110%
Niacin (mg)
298
18.6
18
1035
Vitamin B6 (mg)
31.1
1.9
1.4
138%
Vitamin B12 (µg)
60
3.75
1.5
250%
Vitamin C (mg)
839
52.4
40
131%
Folate
7
ENERGY
DIETARY FIBRE
The estimated average requirement (EAR) for
energy is the average requirement for energy
- approximately 50% of a group of people will
require less, and 50% will require more. For a
group of people receiving adequate amounts,
the range of intakes will vary around the EAR.
The range of EAR for adults depends on age
and sex and is between 1840 – 2772 kcal
per day. The range for children again varies
depending on age and sex but shows more
variation because of different growth and
development stages throughout childhood.
The range for children of 4 to 18 years is 1291
– 3155 kcal per day. Both the food bank and
Food We Need boxes provide total energy per
person below the lower limit for an adult. The
reasons and implications for this are discussed
further in section 4.
The DRV for dietary fibre (Non Starch
Polysaccharide) is 18g a day. The food bank
box contained only 62% of the daily amount
compared to 93% from the Food We Need box.
Foods such as high fibre breakfast cereal, fruit,
vegetables and pulses contributed to the Food
We Need’s higher fibre content. As well as
providing more fibre, these higher fibre foods
also provide more B vitamins, folate and iron.
CARBOHYDRATE AND FAT
8
The dietary reference value (DRV) for
carbohydrate and fat is calculated as a
percentage of daily total energy intakes. The
percentage contribution of carbohydrate
as energy intake should be approximately
50%. The food bank box was above
recommendations (66%) and the Food We
Need box nearer to the recommended amount
(55%). The DRV for fat is approximately 35%
of daily energy intake. This was well below
recommendations in the food bank box (19.2%)
and met requirements in the Food We Need
box (32.3%). The low contribution of energy
from fat in the food bank box is compensated
by the high contribution of energy from
carbohydrate. The food bank box contained
very little fat, the main source being biscuits.
The Food We Need box contained more fat,
mainly from the sunflower oil and cheese.
Even though cheese has a moderate to high
fat content, it also provides essential vitamins
and minerals such as vitamins A and D and
calcium.
PROTEIN
The recommended nutrient intake for protein
can be calculated as grams per kilogram
of body weight or as a percentage energy
contribution. For the purpose of this report, it
has been calculated as the percentage of daily
energy contribution. The recommended amount
is approximately 15% of energy a day to be
derived from protein. For both boxes, this was
adequately provided for.
MINERALS
The minerals analysed in this report were
sodium and salt equivalents, calcium and iron.
Overall, the Food We Need box contained a
much better nutrient breakdown for minerals.
The food bank box was high in salt and low
in calcium. The Food We Need box provided
acceptable amounts of salt and adequate
amounts of both calcium and iron.
FOLATE, B VITAMINS AND VITAMIN C
Both the food bank and Food We Need boxes
provided adequate daily requirements for
folate, B vitamins and vitamin C.
4.
DISCUSSION
The results are encouraging that for both
boxes, the levels of iron, folate and vitamin C
are adequate, particularly as mentioned earlier,
people living in food insecurity are prone to a
higher incidence of anaemia and lower levels of
folate and Vitamin C.
In its entirety, the Food We Need box provides
a better nutritional package than the food bank
box. In addition to this, the Food We Need
analysis was based on a meal plan of recipes
and meals that had been tried and tested. The
food bank analysis was based on a list of foods
that are known to be very difficult to create a
meal plan from and there is evidence to cite
an abundance of food wastage from the food
bank box. This supports the probability that
the nutrient content of foods consumed from
the food bank box is a lot less than the results
describe.
It is of concern that both boxes failed to
meet a person’s daily energy needs. This is
however a limitation imposed by the financial
constraints of a £30 - £32 budget per family
box. The strength of the Food We Need box is
that the surplus foods can be used to create
an additional day’s food or to supplement
the energy intake of the 4 day meal plan by
increasing rice, pasta, potato, pulse and
flatbread quantities. This option is not available
as part of the food bank box.
9
5.
RECOMMENDATIONS
In order to ensure adequate quantity and
quality of food aid provision, it is recommended
that;
1. A targeted approach to developing food
aid packages is adopted, promoting and
including foods that can be used within a 3
or 4 day meal plan based on tried and tested
recipes.
2. Food donors are educated to donate
foods which have an evidenced nutritional
superiority to those donated at present and
to ensure that food is not wasted at the
point of use.The irregular nature of food
donation and subsequent distribution by the
food banks makes it challenging to meet
recipients’ nutritional needs and can at times
provide little other than respite from severe
hunger.
3. Ideally, every food aid package should
provide enough energy for a person’s daily
need and that is the next stage target
for the Food We Need Programme. As
well as ensuring adequate energy intake,
encouraging the use of nutrient dense foods
(foods that have a lot of nutrients relative
to the number of calories) will enhance the
nutritional composition of the package.
Nutrient dense foods are;
10
ITEM
Eggs
Mushrooms
Dark green vegetables
Pulses
Avocados
Almonds, cashews
Dried fruit
Barley, oats, brown rice
Salmon, tuna, sardines, mackerel
Lean beef, lamb
Chicken, turkey
So far, the programme has been restricted by
trying to overcome important barriers such as
meal planning, fresh food in each food box,
donor education and avoiding food waste
whilst staying within a target budget – which
was set at £35 for a family box. The next stage
development will be to address whether there
is a need for a budget and identifying additional
options for improving the food box still further.
6.
REFERENCES
1. Universal Declaration of Human Rights. United Nations Office of the High Commissioner for
Human rights. 1948 Available from: http://www.un.org/en/documents/udhr/
2. Lambie-Mumford, H et al (2014) Household food security in the UK: a review of food aid - final
report. UK: Defra.
3. FAO. Rome Declaration on World Food Security and World Food Summit Plan of Action.
World Food Summit 13-17. November 1996, Rome
4. Galal, O. Scoping workshop on future activities of ICSU on food security. Paris. 2002.
Available at http://www.iuns.org/scoping-workshop-on-future-activities-of-icsu-on-foodsecuri
5. Ledrou I, Gervais J. Food insecurity. Health Reports 2005; 16(3): 47-51. Statistics Canada
6. Che J, Chen J. Food insecurity in Canadian households. Health Reports 2001; 12(4): 11-21.
Statistics Canada
7. Dietitians of Canada. Individual and household food insecurity in Canada. Position of
Dietitians of Canada, 2005.
8. Skalicky A, Meyers AF, Adams WG, Yang Z, Cook JT, Frank DA. Child food insecurity and
iron deficiency anaemia in low income infants and toddlers in the United States. Matern Child
Health J 2005;9:1-9
9. Food Standards Agency (2007) Low income diet and nutrition survey: summary of key
findings. London: The Stationery Office.
10. Food security and the UK – An evidence and analysis paper. The Food Chain Analysis Group.
DEFRA, 2006
11. Attitudes and Behaviours of Food Donors and Perceived Needs and Wants of Food Shelf
Clients. Journal of Education and Behaviour
12. McCance and Widdowson’s (eds.) The Composition of Foods (6th edn.; MW6)2002
13. Dietary Reference Values for Energy (2011) Scientific Advisory Committee on Nutrition.
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