High-Energy, Nutrient-Dense Emergency Relief Food Product

Subcommittee on Technical Specifications for a High-Energy Emergency Relief Ration

Committee on Military Nutrition Research

Food and Nutrition Board

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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High-Energy, Nutrient-Dense Emergency Relief Food Product High-Energy, Nutrient-Dense Emergency Relief Food Product Subcommittee on Technical Specifications for a High-Energy Emergency Relief Ration Committee on Military Nutrition Research Food and Nutrition Board INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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High-Energy, Nutrient-Dense Emergency Relief Food Product NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. Support for this project was provided by the U.S. Department of the Army, Army Medical Research and Materiel Command through grant No. DAMD17-99-1-9478. The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, MD 21702-5014, is the awarding and administering acquisition office. The views presented in this publication are those of the Subcommittee on Technical Specifications for a High-Energy Emergency Relief Ration and do not necessarily reflect the position or policy of the government, and no official endorsement should be inferred. International Standard Book Number: 0-309-08315-X Library of Congress Control Number: 2002101391 Additional copies of this report are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, D.C. 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP’s home page at www.nap.edu. The full text of this report is available at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2002 by the National Academy of Sciences. All rights reserved. Printed in the United States of America. The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Cover photo courtesy of Marjatta Tolvanen.

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High-Energy, Nutrient-Dense Emergency Relief Food Product “Knowing is not enough; we must apply. Willing is not enough; we must do.” —Goethe INSTITUTE OF MEDICINE Shaping the Future for Health

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High-Energy, Nutrient-Dense Emergency Relief Food Product THE NATIONAL ACADEMIES National Academy of Sciences National Academy of Engineering Institute of Medicine National Research Council The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Bruce M. Alberts is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Bruce M. Alberts and Dr. Wm. A. Wulf are chairman and vice chairman, respectively, of the National Research Council.

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High-Energy, Nutrient-Dense Emergency Relief Food Product SUBCOMMITTEE ON TECHNICAL SPECIFICATIONS FOR A HIGH-ENERGY EMERGENCY RELIEF RATION BARRY L. ZOUMAS (chair), Department of Agricultural Economics and Rural Sociology, The Pennsylvania State University, University Park LAWRENCE E. ARMSTRONG, Departments of Kinesiology, Nutritional Sciences, and Physiology and Neurobiology, University of Connecticut, Storrs JEFFREY R. BACKSTRAND, Program in Urban Systems, University of Medicine and Dentistry of New Jersey, Newark WANDA L. CHENOWETH, Department of Food Science and Human Nutrition, Michigan State University, East Lansing PAVINEE CHINACHOTI, Department of Food Science and Nutrition, University of Massachusetts, Amherst BARBARA P. KLEIN, Department of Food Science and Human Nutrition, University of Illinois, Urbana HELEN W. LANE, Advanced Human Support Technologies Program, NASA Johnson Space Center, Houston, Texas KENNETH S. MARSH, Kenneth S. Marsh & Associates, Ltd., Seneca, South Carolina MARJATTA TOLVANEN, Nutrition in Emergencies, UNICEF, New York, New York Staff RICARDO MOLINS, Study Director MARY I. POOS, Senior Program Officer LESLIE J. VOGELSANG, Research Assistant TAZIMA L. DAVIS, Senior Project Assistant

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High-Energy, Nutrient-Dense Emergency Relief Food Product COMMITTEE ON MILITARY NUTRITION RESEARCH JOHN E. VANDERVEEN (chair), San Antonio, Texas BRUCE R. BISTRIAN, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts JOHANNA T. DWYER, Agricultural Research Service, U.S. Department of Agriculture, Washington, D.C. JOHN W. ERDMAN, Jr., Division of Nutritional Science, University of Illinois at Urbana-Champaign HELEN W. LANE, Advanced Human Support Technologies Program, NASA Johnson Space Center, Houston, Texas MELINDA MANORE, Department of Nutrition and Food Management, Oregon State University, Corvallis WILLIAM P. MORGAN, Sport Psychology Laboratory, University of Wisconsin, Madison PATRICK M. O’NEIL, Weight Management Center, Medical University of South Carolina, Charleston ESTHER M. STERNBERG, Neuroendocrine Immunology and Behavior Section, National Institute of Mental Health, Bethesda, Maryland BEVERLY J. TEPPER, Department of Food Science, Rutgers University, New Brunswick, New Jersey U.S. Army Grant Representative LTC KARL E. FRIEDL, Military Operational Medicine Research Program, U.S. Army Medical Research and Materiel Command, Fort Detrick, Frederick, Maryland Staff MARY I. POOS, Study Director LESLIE J. VOGELSANG, Research Assistant TAZIMA A. DAVIS, Senior Project Assistant

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High-Energy, Nutrient-Dense Emergency Relief Food Product FOOD AND NUTRITION BOARD CUTBERTO GARZA (chair), Division of Nutritional Science, Cornell University, Ithaca, New York ALFRED H. MERRILL, JR. (vice chair), School of Biology, Georgia Institute of Technology, Atlanta ROBERT M. RUSSELL (vice chair), Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging, Tufts University, Boston, Massachusetts VIRGINIA A. STALLINGS (vice chair), Division of Gastroenterology and Nutrition, The Children’s Hospital of Philadelphia, Pennsylvania LARRY R. BEUCHAT, Center for Food Safety and Quality Enhancement, University of Georgia, Griffin BENJAMIN CABALLERO, Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland ROBERT J. COUSINS, Center for Nutritional Sciences, University of Florida, Gainesville SHIRIKI KUMANYIKA, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia LYNN PARKER, Child Nutrition Programs and Nutrition Policy, Food Research and Action Center, Washington, D.C. ROSS L. PRENTICE, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington A. CATHARINE ROSS, Department of Nutrition, The Pennsylvania State University, University Park BARBARA O. SCHNEEMAN, Department of Nutrition, University of California, Davis ROBERT E. SMITH, R.E. Smith Consulting, Inc., Newport, Vermont STEVE L. TAYLOR, Food Processing Center, University of Nebraska-Lincoln BARRY L. ZOUMAS, Department of Agricultural Economics and Rural Sociology, The Pennsylvania State University, University Park Staff ALLISON A. YATES, Director LINDA D. MEYERS, Deputy Director GAIL E. SPEARS, Administrative Assistant GEORGE YORK, Administrative Assistant GARY WALKER, Financial Associate

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High-Energy, Nutrient-Dense Emergency Relief Food Product Acknowledgments The Subcommittee on Technical Specifications for a High-Energy Emergency Relief Ration thanks all individuals and institutions that contributed information, time, and funds to this report. Special thanks are given to Samuel Kahn, Thomas Marchione, and other personnel of the U.S. Agency for International Development (USAID) and the U.S. Department of Defense, and to USAID consultants Michael Golden, Caroline Grobler-Tanner, and Mary Lung’aho, who contributed valuable written and verbal information to the subcommittee during its open discussions. Especially helpful were the information and experience shared with the subcommittee by the U.S. Department of Defense Combat Feeding Program, Performance Enhancement and Food Safety Team, during its first meeting, graciously hosted by the U.S. Army Soldier Systems Center, Natick, Massachusetts, with a special thanks to Major Maria Bovill, who so capably organized all the meeting logistics for the subcommittee at Natick, including suggesting hotels and restaurants and providing directions from Boston to the Center. This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain

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High-Energy, Nutrient-Dense Emergency Relief Food Product confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Lindsay H. Allen, Ph.D., R.D. E. Wayne Askew, Ph.D. Johanna Dwyer, D.Sc., R.D. Theodore Labuza, Ph.D. John H. Litchfield, Ph.D. Irwin H. Rosenberg, M.D. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Barbara Underwood, Ph.D., Scholar-in-Residence, Institute of Medicine. Appointed by the National Research Council and Institute of Medicine, she was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. The subcommittee presents its special appreciation to the Institute of Medicine staff who facilitated the work and the preparation of this report: Ricardo Molins, study director; Mary Poos, study director of the Committee on Military Nutrition Research; Gail Spears, who edited the report; Leslie Vogelsang, research assistant; Tazima Davis, senior project assistant; and Allison Yates, director of the Food and Nutrition Board. Barry Zoumas, Chair Subcommittee on Technical Specifications for a High-Energy Emergency Relief Ration

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High-Energy, Nutrient-Dense Emergency Relief Food Product Contents     EXECUTIVE SUMMARY   1     Background and Charge to the Committee,   2     Methods,   3     Report Organization,   3     Recommendations,   5     References,   8 1   INTRODUCTION   9     Project Description and Scope,   9     Origin of the Study,   10     The Need for and Uses of a High-Energy, Nutrient-Dense Emergency Relief Food Product,   11     References,   15 2   NUTRIENT CONTENT AND SPECIAL CONSIDERATIONS   17     Introduction,   18     Characteristics of Target Populations,   18     Characteristics of the Emergency Relief Food Product,   24     Nutrients Included in the Emergency Relief Food Product Specifications,   30     References,   77

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High-Energy, Nutrient-Dense Emergency Relief Food Product 3   PROCESSING AND PACKAGING OF THE EMERGENCY FOOD PRODUCT   97     Desirable Characteristics of an Emergency Relief Food Product,   97     Processing Considerations,   101     Microbiological Considerations,   106     Chemical Stability Considerations,   107     Acceptability Considerations,   111     Packaging Considerations,   113     Cost Considerations,   120     References,   120 4   PERFORMANCE SPECIFICATIONS   129     Item Description,   129     Performance Requirements,   130     Prohibitions,   136     Processing Requirements,   136     Packaging Requirements,   136     Miscellaneous Information,   138     APPENDIX — Biographical Sketches of Subcommittee Members   141