By Anne-Louise Hother, Manika Saha, Jessica Bogard and Shakuntala Haraksingh Thilsted.

1. Fish-based products to
improve nutrition in the
first 1,000 days of life
By Anne-Louise Hother, Manika Saha, Jessica Bogard and
Shakuntala Haraksingh Thilsted

2. Outline
1. State of nutrition of women and children in Bangladesh
2. Why focus on the first 1,000 days of life?
3. Nutritional challenges in the 1,000 days
4. Why should fish consumption be increased in the 1,000
days?
5. Fish-based products for improved nutrition and health
• Fish-based CF product for infants and young children
• Fish chutney for pregnant and lactating women
• Fish powder to be added to family foods

3. State of nutrition in women in Bangladesh
women of reproductive age (14-49 y)
• 1 out of 4 are underweight (BMI <18.5)
• 1 out of 10 are moderately of severely thin (BMI <17)
• >1 out of 10 have a short stature (height <145 cm)
• 4 out of 10 women are anaemic
• 1 out of 20 children are VERY small at birth
• 1 out of 10 children are SMALLER THAN AVERAGE at birth
Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

4. State of nutrition in children in Bangladesh
Children 0-59 months
• 36% are underweight
• 17% are wasted (thin)
• 41% are stunted
Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

5. State of nutrition in children in Bangladesh
Children 0-59 months
• 36% are underweight
• 17% are wasted (thin)
• 41% are stunted
26 months 52 months
Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

6. State of nutrition in children in Bangladesh
Children 0-59 months
• 36% are underweight
• 17% are wasted (thin)
• 41% are stunted
26 months 52 months
The damages done early in life are irrevesible
BUT
can be prevented by eating a nutritious diet
rich in micronutrient rich foods
Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

7. 0
10
20
30
40
50
60
-9 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59
%children
Age in months
stunting
severe stunting
wasting
severe wasting
Child malnutrition in Bangladesh
0–59 months
Source BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

8. 0
10
20
30
40
50
60
-9 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59
%children
Age in months
stunting
severe stunting
wasting
severe wasting
Child malnutrition in Bangladesh
0–59 months
Window of
opportunity
Source BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

9. 0
10
20
30
40
50
60
-9 <6 6-8 9-11 12-17 18-23 24-35 36-47 48-59
%children
Age in months
stunting
severe stunting
wasting
severe wasting
Child malnutrition in Bangladesh
0–59 months
Source BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.
The period from the start of a woman’s pregnancy to the child’s 2nd birthday offers
a unique window of opportunity to shape healthier and more prosperous futures

10. Why focus on the first 1,000 days of life?
Pregnancy Breastfeeding Complementary feeding
1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Improve nutrition for mothers and young children during the critical 1,000 days
from pregnancy to the child’s second birthday, when better nutrition can have a
lifelong impact on a child’s future and help break the cycle of poverty.

11. Complementary feeding
in 6-23 months old breastfed children
1. Exclusive breastfeeding from 0-6 months
>1 in 3 children are NOT exclusively breastfed
2. Meal frequency (2/day at 6-8 months, 3/day at 9-23 months)
>1 in 3 are NOT fed the minimum number of meals per day
3. Dietary diversity
>3 in 4 are NOT fed with appropriate dietary diversity
4. Adequate diet (Meal freq. AND dietary diversity)
Only 21% have an adequate diet
Source: BDHS 2011 - National Institute of Population, Research and Training (NIPORT), Mitra and Associates, ICF
International. Bangladesh Demographic and Health Survey 2011. Dhaka, Bangladesh and Calverton, Maryland, USA; 2011.

12. Nutritional challenges in the first 1,000
days
• Predominantly plant based diet (>70% of energy from rice)
• Low in micronutrients
• High in antinutrients
• Limited food diversity (<6% of energy from animal-source foods)
• CFs rarely provide adequate energy and micronutrients
• Thin rice porrigde
• Suji – wheat porrigde
• Time
• Safe storage

13. • Inclusion of small amounts of animal-source foods in a
plant-based diet can substantially increase nutrient
adequacy. It is therefore recommended that infants and
young children and pregnant and lactating women are
fed animal-source foods every day
• Most commonly consumed animal-source food
• Small indigenous fish are particularly nutritious as they
are eaten whole, with head, bones and viscera, and
provide a rich source of animal protein, iron, zinc,
calcium and vitamin A
Why should fish consumption be
increased in the first 1,000 days?

14. • Inclusion of small amounts of animal-source foods in a
plant-based diet can substantially increase nutrient
adequacy. It is therefore recommended that infants and
young children and pregnant and lactating women are
fed animal-source foods every day.
• Most commonly consumed animal-source food
• Small indigenous fish are particularly nutritious as they
are eaten whole, with head, bones and viscera, and
provide a rich source of animal protein, iron, zinc,
calcium and vitamin A
BUT
• Amounts consumed by the poor are low
• Even if available in the household, fish are often
introduced to the child only after 9 months of age
Why should fish consumption be
increased in the first 1,000 days?

15. Fish-based products developed by
WorldFish
1. Fish-based CF product for infants and young children
2. Fish chutney for pregnant and lactating women
3. Fish powder to be added to family foods

16. Fish-based complementary food product
• Made from local
ingredients
• High content of MN (iron,
zinc, vit A, calcium)
• High energy density
• Low content of anti-
nutrients
• Include animal-source
food
• Culturally acceptable
• Acceptable taste, texture
and colour
• Easy to prepare
• Hygenically safe

17. Selection of ingredients - Rice

18. Selection of ingredients - Fish
“Mache bhate Bengali” Fish and rice make a Bengali
Fish most commonly eaten animal-source food across all income
groups
Small indigenous fish are highly nutritious

19. Selection of ingredients - Fish
0
2
4
6
8
10
12
14
Chanda Chapila Chikra Darkina Kaski Mola Puti Taki
Fe (mg/100g)
Zn (mg/100g)
Calcium (g/100g)

20. Selection of ingredients - Orange Sweet
Potato
Vitamin A
Fructose (natural sweetener)
Low in anti-nutrients

21. Homestead
production of
sweet potato

22. Parboil
Sun-dry
Oven-dry
Blanch
Oven-dry
Slice into chips
Mill
Polish
GrindGrind Grind
Darkina fish Rice paddyOSP roots Soybean oil
Wash Wash Wash
SoakPeel and trim

23. Mix in specified proportions
Oven-dry
Grind
Package
15% Fish 45% Rice flour30% OSP flour 10% Soybean oil

24. Nutrient composition of the fish-based
CF compared to other CFs in Bangladesh
Fish-based
CF
SUPER
CEREAL plus
Pushti Packet
Energy (kcal) 423 410 395
Protein (g) 12 16 NA
Iron (mg) 15 6.5 2.1
Zinc (mg) 4.5 5 4.4
Calcium (mg) 895 130 300
Vitamin A (RAE) 418 499 197
Daily recommended ration:
6-11 months: 1 serve (30 g)
12-23 months: 2 serves (60 g)

25. Contribution to nutrient needs from CFs
[1] Desired nutrient needs from CFs are calculated from desired nutrient densities of CFs,
assuming energy required from complementary foods is 202, 307 and 548 kcal/day for
infants and young children, aged 6-8, 9-11 and 12-23 months, respectively as per US
longitudinal data.
% contribution of the daily ration of fish-based CF
to desired nutrient needs from CFs
6-8 months 9-11 months 12-23 months
(1 serve/day) (1 serve/day) (2 serves/day)
Energy (kcal) 63 41 46
Protein (g) 179 118 147
Iron (mg) 50 49 164
Zinc (mg) 42 40 82
Calcium (mg) 127 118 156
Vitamin A (RAE) 401 272 398

26. Fish chutney for pregnant and lactating
women
• Rich in
micronutrients
(especially iron)
• Animal protein
• Essential fats
• Energy

27. Ingredients: 37% dried small fish, 15% oil, 37% onion,
7% garlic and 4% red chili
Fish chutney for pregnant and lactating
women
Protein, Fe, Zn, Ca
Energy density, EFA
Texture and flavour
Taste enhancer

28. Increased consumption of fish
= 60 g of raw fish

29. Nutrient composition of fish chutney
A supplement to the diet
Content
per 100 g*
Content per
serve (30 g)*
% Contribution to RNI for
pregnant women from 1 serve
% Contribution to RNI for
lactating women from 1 serve
1st
trimester
2nd
trimester
3rd
trimester
0-2
months
3-6
months
7-12
months
Energy (kcal)^ 432.8 129.8 153 46 27 19 19 26
Protein (g)^ 38.5 11.5 1150 128 37 61 61 92
Iron (mg)#
9 2.7 - - - 18 18 18
Zinc (mg) 7.8 2.4 71 57 40 41 45 56
Calcium (mg) 1879.4 563.8 75 75 70 75 75 75
* Content is estimated based on analysed nutrient composition values for individual ingredients
^ Recommended additional energy and protein requirements during pregnancy and lactation Joint FAO/WHO/UNU 2004; WHO/FAO/UNU,
2007). Base energy requirements dependant on body weight and physical activity level
# It is recommended that iron supplements be given to all pregnant women because of difficulties in correctly assessing iron status in
pregnancy. Using RNI for iron assuming a dietary iron bioavailability of 10%
Source mineral requirements: WHO, 2004 (assuming 10% availability of iron; high availability of zinc)

30. Acceptability of fish chutney

31. Fish powder to be added to family foods

32. Preparation of fish powder
Nutrient composition per 100 g of fish powder
Energy Protein Fat Iron Zinc Calcium
317 kcal 19 g 22 g 22 g 4.5 mg 1669 mg
Fish powder added to different types of family foods

33. Acceptability trial
• Well-liked by mothers and
children in Sunamganj
• Regular introduction of fish
powder to the child will
help familiarise the child
with the new product
• Mothers expressed interest
in including the fish powder
in their own meal

34. Future plans for fish-based products
• Food distribution programmes
• Community business plan
• Commercial sale including rural sales programmes
• Emergency response food rations
• School feeding programmes
• Moderate and severe acute malnutrition
• A business model to determine the feasibility of distribution of
the fish-based products through the various channels and
production scalability

35. Thank you

36. Draw attention to that you can taste the
products at the table by the door
1. Fish-based CF product for infants and young children
2. Fish chutney for pregnant and lactating women
3. Fish powder to be added to family foods