Introduction: Children in developing countries often face multiple micronutrient deficiencies.
Introduction of zinc fortified water can increase zinc intake but additional recommendations are
required to address overall diet nutrient adequacy.
Objective: We developed and tested food based recommendations (FBRs) that included zinc
fortified water for children aged between 4 and 6 years from rural Kenya to achieve the best
possible nutrient adequacy.
Methods: Dietary intakes of 60 children aged 4-6 years, from Kisumu district, Western Kenya,
were assessed using a quantitative multi-pass 24-hour recall. Linear programming model
parameters were derived, including a list of foods consumed, median serving sizes and
distribution of frequency of consumption. By using the Optifood linear programming tool, food
based recommendations for diets including zinc fortified water were developed. Food subgroups
from nutrient dense foods were added to achieve an optimized nutritionally adequate diet. Food
based recommendations with nutrient levels achieving ≥70%RNI of the WHO/FAO
recommended nutrient intake (RNI) for most of the 12 considered nutrients were selected as the
final recommendations for the children.
Results: With no FBRs and no zinc fortified water percent RNI coverage range was between 40
and 76% for zinc, improving to 66-101% after introduction of zinc fortified water. The final set
of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25%RNI) and folate
(68%RNI).
Conclusions: Introduction of zinc fortified water combined with FBRs will likely improve the
nutrient adequacy of diets consumed by children in Kenya, but need to be complemented with
alternative interventions to ensure dietary adequacy. Optifood is a useful tool to assess the
extent to which introduction of a water fortification intervention plus additional FBRs can
contribute to nutrient adequacy of the diet.