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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. 11