Use of Linear Programming to Develop Complementary Feeding Recommendations to Improve Nutrient Adequacy and Dietary Diversity Among Breastfed Children in the Rural Philippines

Background: Lack of dietary diversity in complementary feeding contributes to nutrient gaps leading to undernutrition. Food-based strategies have been successfully used to enrich the complementary diets of infants and young children. However, context-specific recommendations based on an objective diet optimization is needed to formulate sound and practical nutritional guidelines. Objectives: The present study aimed to identify problem nutrients in complementary diets and formulate complementary feeding recommendations (CFRs) using linear programming analysis for children aged 6 to 23 months in the rural Philippines. Methods: A cross-sectional survey was conducted in the municipality of Mercedes, Philippines. Dietary intakes of breastfed children 6 to 8, 9 to 11, and 12 to 23 months of age (n = 297) were assessed using a multipass 24-hour recall method with 7-day food consumption frequency. A linear programming tool was used to identify the recommended nutrient intakes that could not be met within the existing local food patterns and develop CFRs that would best fulfil nutrient adequacy for 11 modelled micronutrients. Results: Problem nutrients in the current diets were iron and calcium in any age-group, zinc for 6 to 8 and 9 to 11 months old, and thiamine and folate for 12 to 23 months old children. Adoption of CFRs with 4 to 5 food groups in the diet would ensure the adequacy of 7 to 8 nutrients, depending on the age-group. Conclusion: Within the boundaries of local dietary patterns, adequacy for most nutrients could be achieved by promoting realistic servings of nutrient-dense foods and food groups. The linear programming results provide an evidence-based strategy in designing interventions to improve the quality of Filipino complementary diets.