Dairy for Global Nutrition

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Whey proteins, stunting and international developmentVeronique Lagrange, US Dairy Export Council vlagrange@usdec.org www.dairyforglobalnutrition.org

• Definitions and world estimates• Impact and cost of stunting• Use of food supplements for the management of

moderate malnutrition• Current US and international recommendations• Evidence in support of whey proteins• Major studies in progress• Commercial opportunities and challenges• Next steps

Whey proteins, stunting and international development

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• Height-for-age Z (HAZ) score < 2SD

• Stunting affects 800 million people worldwide*

• 195 million children under 5 are stunted

• >40% in some countries

*Source: UNICEF, 2014

Image courtesy: Gates Foundation, 2014

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Definitions and world estimates

Impact of stunting

Malnutrition and stunting: relationships, outcomes

Stunting: impacts physical and mental development, overall economic development

Photos courtesy: ABC News, USA

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• Cognitive impairments early in life have long-term consequences on economic development

• Focus on the first 1,000 days: to include pregnant, lactating women

• Demonstrated economic rationale for investing in stunting reduction: Benefit-cost ratio average: 18*

*Hoddinott, J. Maternal & Child Nutrition, 2013 (9) Suppl. 2

Relationship with economic development

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Use of food supplements for the management of moderate malnutrition

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Customers: USAID, UNICEF, Doctors without Borders, Action against Hunger, other PVOs

Supplements contain sweet whey or WPC, milk powder (15-25%)

World Food ProgrammeSupplement contains 8% milk powder

Dairy represents 50% of the cost of the formula: Strong incentive to optimize formula, displace dairy

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Whey, dairy in recommendations for MAM

2010: 3% WPC80

WHO 2012: Milk powder as protein

source

Evidence for dairy

Food and Nutrition Bulletin, 2013, 35(2) 8

Product A vs. Product B

Role/function of nutrients

Outcome, costEffective dose of

nutrients(Delivered: in matrix,

featuring losses, synergies acceptability)

Most studies have been program-driven

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Most studies focused on this

relationship

Area of emerging interest: design products using new science

“Plumpy Sup” (whey, milk powder) vs, corn soy blend with milk powder, local food, local flour:

Recovery rate highest with whey/powder supplement

Acktia-Armah et al. 2012.

Most studies compare products, few systematically study whey (examples)

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Supplementary Plumpy (whey, milk powder) vs, corn soy blend with milk powder, local food, local flour:

Increases in weight, MUAC, highest with whey/milk powder supplement

McDonald et al, 2014

Most studies compare products, few systematically study whey (examples)

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• Soy/whey RUSF: superior rates of weight and MUAC gains compared to CSB++, superior rate of MUAC gain compared to soy RUSF

( Manary, 2012, USAID FANTA 2 Technical Report) Photo courtesy: wordpress

Most studies compare products, few systematically study whey (examples)

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Milk lipid-based supplement (25%), but not soy, promotes linear growth

( Mangani et al, 2013)

Photo courtesy: 1,000 Days foundation

Most studies compare products, systematically study whey (examples)

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• Faster recovery from moderate malnutrition

• Positive lean body mass accretion

• Moderate LAZ/HAZ… (30% of stunting occurs in utero)

• Immunity, infections benefits

Photo courtesy: Ekantipur

General trends in findings

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Whey Research Needs/Opportunities

• What is the optimal dose and mixture of whey protein in supplements for treatment and prevention of MAM? Prevention of stunting?‒ What is the optimal dose of milk protein to improve

growth in children with MAM?‒ Does DSM & MPC (intact dairy proteins) and whey

have similar effects on growth in MAM?, If so how?‒ Does dairy protein promote lean body gains, bone?‒ What is the effect on long term body composition?‒ Supplementation of the pregnant mother?

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Multiple Constraints

Dairy position not secure: need dose, mechanism of action

Narrow “dairy basket” available

Narrow supply chain to allow for in-country manufacture

Efficacy and mechanism of action research

Introduce full range of dairy ingredients

More suppliers, more supply lines

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• UNICEF: 30-40,000 mt LNS – supplied by Plumpy Field Network, Nutriset, PPB

• Doctors without Borders, PVOS: 30-40,000 mt LNS

• World Food Program: 235,000 mt “specialized nutrition” products

• USAID – emerging • Clinton Foundation (150,000 mt powder), PVOs

Demand – MAM

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Harmonization of research protocols, and filling in research gaps: need to fund more systematic research, clinical-style trials

Need for united efforts by the whey industry

Thank you! Veronique Lagrange

US Dairy Export Council vlagrange@usdec.org

Next steps

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• Questions?

DairyforGlobalNutrition.org

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