UpdateonAnalyticalMethodsandResearchGaps intheUseofHouseholdConsumptionand ExpenditureSurveyDatatoInformtheDesignof Food-FortificationPrograms

Abstract

The lack of nationally representative, individual-level dietary intake data has led researchers to increasingly turn to household-level data on food acquisitionsand/orconsumptiontoinformthedesignoffood-fortificationprogramsinlow-andmiddle-incomecountries(LMICs).Thesenationally representative, household-level data comefromhousehold consumptionand expenditure surveys (HCESs), which are collected regularly in many LMICs and are often made publicly available. Our objectives were to examine the utility of HCES data to inform the design of food-fortification programsandtoidentifybest-practicemethodsforanalyzingHCESdataforthispurpose.Tothisend,wesummarizedinformationneededtodesign fortification programs and assessed the extent to which HCES data can provide corresponding indicators. We concluded that HCES data are well suitedtoguidetheselectionofappropriatefoodvehicles,butbecauseindividual-levelestimatesofapparentnutrientintakesrelyonassumptions abouttheintrahouseholddistributionoffood,morecautionisadvisedwhenusingHCESdatatoselectthetargetmicronutrientcontentoffortified foods. We also developed a checklist to guide analysts throughthe use of HCES data and, where possible, identified research-based, best-practice analyticalmethodsforanalyzingHCESdata,includingselectingthenumberofdaysofrecalldatatoincludeintheanalysisandconvertingreported unitstostandardunits.Moreresearchisneededonhowbesttodealwithcompositefoods,foodsconsumedawayfromhome,andextremevalues, as well as the best methods for assessing the adequacy of apparent intakes. Ultimately, we recommend sensitivity analyses around key model parameters,andthecontinualtriangulationofHCES-basedresultswithothernationalandsubnationaldataonfoodavailability,dietaryintake,and nutritionalstatuswhendesigningfood-fortificationprograms