Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations

Committee on International Nutrition

Food and Nutrition Board

Board on International Health

INSTITUTE OF MEDICINE

Lindsay H. Allen and Christopher P. Howson, Editors

NATIONAL ACADEMY PRESS
Washington, D.C.
1995



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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations Committee on International Nutrition Food and Nutrition Board Board on International Health INSTITUTE OF MEDICINE Lindsay H. Allen and Christopher P. Howson, Editors NATIONAL ACADEMY PRESS Washington, D.C. 1995

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations National Academy Press 2101 Constitution Avenue, N.W.Washington, DC20418 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 competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This study was supported by the U.S. Agency for International Development under the terms of Grant No. HRN-5110-G-00-3043-00. The opinions expressed herein do not necessarily reflect those of the U.S. Agency for International Development. Additional copies of this report are available in limited quantities from: Food and Nutrition Board Institute of Medicine 2101 Constitution Avenue, N.W. Washington, DC 20418 Copyright 1995 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 image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations COMMITTEE ON INTERNATIONAL NUTRITION LINDSAY H. ALLEN (Chair), Department of Nutrition, University of California, Davis, California KENNETH H. BROWN, Department of Nutrition, University of California, Davis, California JEAN-PIERRE HABICHT, Division of Nutritional Sciences, Cornell University, Ithaca, New York EILEEN T. KENNEDY, U.S. Department of Agriculture, Food and Consumer Services, Washington, D.C. JOANNE LESLIE, University of California-Los Angeles School of Public Health, and Pacific Institute for Women's Health, Los Angeles, California GILBERT A. LEVEILLE, Research and Technical Services, Nabisco Food Group, East Hanover, New Jersey Liaisons to the Committee ADELINE WYNANTE PATTERSON (Board on International Health), Caribbean Food and Nutrition Institute, Kingston, Jamaica ALFRED SOMMER (Food and Nutrition Board),* School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland Staff CHRISTOPHER P. HOWSON, Project Director SUSAN M. KNASIAK, Project Assistant JAMAINE L. TINKER, Financial Associate * Member, Institute of Medicine

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations FOOD AND NUTRITION BOARD JANET C. KING (Chair), Department of Nutritional Sciences, University of California, Berkeley, California EDWIN L. BIERMAN (Vice Chair),* University of Washington School of Medicine, Seattle, Washington JOHN W. ERDMAN, JR. (Vice Chair), Division of Nutritional Sciences, University of Illinois, Urbana, Illinois CUTBERTO GARZA (Vice Chair), Division of Nutritional Sciences, Cornell University, Ithaca, New York PERRY L. ADKISSON,† Department of Entomology, Texas A&M University, College Station, Texas LINDSAY H. ALLEN, Department of Nutrition, University of California, Davis, California DENNIS M. BIER, Children's Nutrition Research Center, Houston, Texas FERGUS M. CLYDESDALE, Department of Food Science and Nutrition, University of Massachusetts, Amherst, Massachusetts HECTOR F. DeLUCA,† Department of Biochemistry, University of Wisconsin, Madison, Wisconsin MICHAEL P. DOYLE, Department of Food Science and Technology, University of Georgia, Griffin, Georgia JOHANNA T. DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts SCOTT M. GRUNDY, University of Texas Southwestern Medical Center, Dallas, Texas K. MICHAEL HAMBIDGE, Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado LAURENCE N. KOLONEL, Cancer Center of Hawaii and University of Hawaii, Honolulu, Hawaii SANFORD A. MILLER, Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio, Texas ARTHUR H. RUBENSTEIN (Institute of Medicine Liaison),* Department of Medicine, The University of Chicago, Chicago, Illinois ALFRED SOMMER,* School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland STEVE L. TAYLOR (Ex Officio), Department of Food Sciences and Technology, University of Nebraska, Lincoln, Nebraska VERNON R. YOUNG,† School of Science, Massachusetts Institute of Technology, Cambridge, Massachusetts * Member, Institute of Medicine † Member, National Academy of Sciences

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations Staff ALLISON A. YATES, Director GAIL A. SPEARS, Administrative Assistant JAMAINE L. TINKER, Financial Associate

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations BOARD ON INTERNATIONAL HEALTH WILLIAM H. FOEGE (Chair),* Carter Center, Emory University, Atlanta, Georgia DEAN JAMISON (Co-chair), The World Bank, Washington, D.C. DAVID E. BELL, Harvard Center for Population and Development Studies, Cambridge, Massachusetts JAN E. G. BLANPAIN,* School of Public Health, Leuven University, Leuven, Belgium MARGARET CATLEY-CARLSON, Population Council, New York, New York RICHARD G. A. FEACHEM, London School of Hygiene and Tropical Medicine, London, England BERNARD N. FIELDS (Institute of Medicine Liaison),*† Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts JULIO FRENK,* National Institute of Public Health, Cuernavaca, Mexico DONALD A. B. LINDBERG (Acting Institute of Medicine Liaison), * National Library of Medicine, National Institutes of Health, Bethesda, Maryland ADETOKUNBO O. LUCAS,* Harvard School of Public Health, Boston, Massachusetts W. HENRY MOSLEY, Institute for International Programs, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland ADELINE WYNANTE PATTERSON, Caribbean Food and Nutrition Institute, Kingston, Jamaica DAVID P. RALL (Retired),* National Institute of Environmental Health Sciences, Washington, D.C. FREDERICK C. ROBBINS (Ex Officio),*† Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio TIMOTHY ROTHERMEL, Division for Global and Interregional Programmes, United Nations Development Programme, New York, New York NOEL S. WEISS,* Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington BARBARA L. WOLFE, Departments of Economics and Preventive Medicine, University of Wisconsin, Madison, Wisconsin * Member, Institute of Medicine † Member, National Academy of Sciences

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations Staff CHRISTOPHER P. HOWSON, Director DEE SUTTON, Project Assistant JAMAINE L. TINKER, Financial Associate

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations Preface ◆ ◆ ◆ ◆ ◆ Over the past 2 years, there has been growing awareness of the potential value for the U.S. Agency for International Development (USAID) to have a standing capability in the Institute of Medicine (IOM) for a more flexible, less costly response to agency needs for advice in the areas of nutrition, food, and health science policy. With support from USAID, the IOM responded in October 1993 by establishing the Committee on International Nutrition (CIN) under the aegis of the Food and Nutrition Board (FNB) and the Board on International Health (BIH). The CIN's mandate is to answer questions of interest and concern, evaluate current nutrition activities undertaken by the agency, and make recommendations for future activities based on this review. Topics are chosen through systematic consultation with the Office of Nutrition in USAID's Bureau for Research and Development. Representing the areas of human nutrition, maternal and child health, epidemiology, economics, and program design and evaluation, the committee's six members will convene three times to produce brief reports that review specific programs, research projects, or project designs. With an initial project life of 18 months, the CIN is designed to be flexible (e.g., capable of responding to specific nutrition concerns that arise abruptly) and to provide quick turnaround, with the time from meeting date to document availability being 2 months. This report is the result of the second meeting of the CIN, which was held on 6–7 October 1994. The report topic was requested by USAID 's Bureau for Humanitarian Response (BHR).

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations CHARGE TO THE COMMITTEE The charge to the committee by USAID was as follows: “Based on the scientific and technical knowledge of individual members and the background information [provided by USAID], the Committee is requested to make a recommendation as to a mean per capita daily energy requirement for emergency situations (citing and defining the scientific and technical information which supports this mean value).” (For further background information and details on USAID 's request to the CIN, see the memoranda to the committee from Samuel Kahn, USAID Office of Health and Nutrition, and Thomas Marchione, Nutrition Advisor, USAID BHR, in the Appendix). During the 2-day meeting, the CIN reviewed the following background information provided it by USAID: a description of the United Nations High Commissioner Emergency Training Program-Nutrition; a draft copy of the “Supplement on Emergency Rations” to be added to the Commodities Reference Guide published by USAID's Office of Food for Peace; and background correspondence among agencies relevant to the topic under study. The committee gathered the following additional information for consideration at the meeting: the 1992 CDC report entitled Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues (CDC, 1992); a 1992 letter to the journal Lancet on “Misconceptions on Nutrition of Refugees” (Mason et al., 1992); the 1985 report of the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements; “Methodological Basis for Estimating the Mean per Capita Daily Energy Requirements for a Typical Refugee Camp Population” (Clugston, 1993); a paper commissioned by the United Nations' Administrative Committee on Coordination/Subcommittee on Nutrition on “Evaluating the Energy Adequacy of Rations Presented to Refugees and Displaced Persons” (Schofield, 1994); and miscellaneous personal correspondence among agencies. USAID representatives were invited to attend the first day of the meeting to answer questions related to the committee's charge and to provide additional background as needed. The following USAID representatives attended: Eunyong Chung and Samuel G. Kahn, Office of Nutrition and Maternal Health, and Rita Hudson, Office of Food for Peace. The CIN thanks these individuals for their important contributions to its review. On the second day of the meeting, the CIN met in executive session to review the previous day's discussions and to begin drafting the report. ORGANIZATION OF THE REPORT The report contains three chapters and one appendix. Chapter 1 describes the project scope and its rationale. Chapter 2 provides a historical view of energy recommendations for refugee populations and describes the methods of estimating energy requirements of individuals and of populations of refugees and dis

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations placed persons. The committee describes the calculation of an estimated mean per capita energy requirement for use in planning the food energy needs of populations of refugees and displaced persons, and the assumptions underlying the estimate. The effects of varying the population distribution and of assuming different body sizes, physical activity levels, and proportions of breastfed infants are presented. The impact on the estimate of considering the energy requirements for catch-up growth and for cold environmental conditions is also reviewed. Chapter 3 provides a brief summary of the report and presents the committee 's recommendations. The Appendix contains the two USAID memoranda outlining the specific charge for this second CIN meeting. ACKNOWLEDGMENTS The committee gives special thanks to the USAID staff who graciously made themselves available for questions during the open session on 6 October. The committee would also like to express its appreciation to the IOM staff who facilitated the work of the CIN: Christopher P. Howson, study director; Susan M. Wyatt, financial associate; Michael Edington, managing editor; Claudia Carl, administrative associate; and Gail Spears, administrative assistant. The committee especially thanks Susan M. Knasiak, project assistant, for her help in conducting the second meeting and for her valuable editorial advice in preparing the report draft. Finally, the committee thanks Richard G. Seifman, formerly at USAID; Polly Harrison, IOM; and Catherine Woteki, formerly of the FNB, for their vision and hard work in realizing this project and Allison A. Yates, FNB, for her useful editorial advice and support of the CIN's activities. Lindsay H. Allen, Chair Committee on International Nutrition

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Estimated Mean per Capita Energy Requirements for Planning Emergency Food Aid Rations Contents ◆ ◆ ◆ ◆ ◆  1   Background   1      Project Description and Scope,   1      Motivation for the Scope Chosen,   2  2   Estimating Energy Requirements of Refugee and Other Populations Requiring Food Aid   5      Historical View of Energy Recommendations,   5      Estimating Energy Requirements of Individuals,   6      Estimating Energy Requirements of Populations,   12  3   Summary and Recommendations   23     References   27     Appendix: USAID's Request to the Committee        Memorandum from Samuel G. Kahn Dated 7 September 1994,   29      Memorandum from Tom Marchione Dated 7 September 1994,   30

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