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ZAMBIA

Food-Based Dietary
Guidelines
Technical Recommendations
2021
With the technical assistance of

Co-funded by
REPUBLIC OF ZAMBIA the European Union
Zambia Food-Based
Dietary Guidelines
Technical Recommendations

By the
Ministry of Agriculture
2021

With the technical assistance of


the Food and Agriculture Organization of the
United Nations

Co-funded by
The European Union
© Zambia Ministry of Agriculture
Copy-editing and layout by Katarina Zeravica
Illustrations by Koji Soneka
Photos © Dr Mercy Chikoko | Shutterstock | Pixabay
Table of Contents
Foreword...........................................................................................................................................ii
Acknowledgements........................................................................................................................iii
Acronyms and Abbreviations������������������������������������������������������������������������������������������������������� vi

Executive Summary........................................................................................................................1

SECTION 1: About the Food-Based Dietary Guidelines for Zambia...........................................2


1. The Zambian food group graphic .............................................................................................3

2. The Zambia Food-Based Dietary Guidelines at a glance........................................................3

3.Background and context.............................................................................................................6


3.1Introduction...........................................................................................................................................6
3.2 Rationale and relevance for the Food-Based Dietary Guidelines ................................................6
3.3 About the Food-Based Dietary Guidelines (Technical Recommendations)..................................7
3.4 Guiding principles................................................................................................................................7

4. Methodology/process of developing FBDGs............................................................................9


4.1 The FBDGs development process steps...........................................................................................9
4.2 FBDG diet model cost of diet for a 2 100 Kcal diet per individual�����������������������������������������������13
4.3 FBDGs products���������������������������������������������������������������������������������������������������������������������������������13

SECTION 2: The Food-Based Dietary Guidelines for the general population in Zambia........15
5. Recommendation 1: Eat different types of food from each of the six food groups
every day to stay strong and healthy.������������������������������������������������������������������������������������ 17
5.1 Getting to know the six food groups�����������������������������������������������������������������������������������������������17
5.2 Why it is important to eat a variety of foods every day����������������������������������������������������������������18
5.3 The science behind the benefits of eating a variety of foods ������������������������������������������������������19
5.4 How the body benefits from eating a variety of foods daily��������������������������������������������������������19
5.5 Dietary diversity among Zambians �������������������������������������������������������������������������������������������������20
5.6 Rrecommendation and guidance on eating a variety of food�����������������������������������������������������21
5.7 The correct amount to eat from each of the six food groups������������������������������������������������������22
5.8 Consider the nutrient density of food ��������������������������������������������������������������������������������������������28
5.9 Tips on how to consume a variety of foods daily��������������������������������������������������������������������������28

6. Recommendation 2: Eat whole or milled whole grains (cereals), starchy roots and
tubers as part of meals every day for a healthy heart and weight.����������������������������������� 30
6.1 Getting to know whole grains, starchy roots and tubers��������������������������������������������������������������30
6.2 Why are whole grains, other cereals, starchy roots and tubers part of a healthy diet?�����������31
6.3 The relationship between whole grains intake and positive nutrition and health outcomes�31
6.4 Myth busters!�������������������������������������������������������������������������������������������������������������������������������������32
6.5 Zambia consumption patterns of cereals, starchy roots and tubers������������������������������������������32
6.6 Recommended amounts to eat daily����������������������������������������������������������������������������������������������33
6.7 Recommendations and guidance ���������������������������������������������������������������������������������������������������35
6.8 Tips on adding whole grains to a diet and eating the right amounts�����������������������������������������35
36
7. Recommendation 3: Eat plenty of different coloured vegetables every day to provide
vitamins, minerals and fibre to prevent diseases.������������������������������������������������������������������� 37
7.1 About vegetables�������������������������������������������������������������������������������������������������������������������������������37
7.2 Different coloured vegetables and their unique nutrients�����������������������������������������������������������37
7.3 Importance of vegetables in a diet��������������������������������������������������������������������������������������������������38
7.4 The scientific basis of the health and nutritional benefits of eating plenty of vegetables ������39
7.5 Recommendations and guidance on eating a variety of vegetables every day�������������������������40
7.6 How much vegetables should a person eat every day?���������������������������������������������������������������� 41
7.7 Tips on increasing consumption of vegetables������������������������������������������������������������������������������ 45
Eat two different coloured fruits every day to provide vitamins and minerals to prevent
8. Recommendation 4: Eat two different coloured fruits every day to provide vitamins
and minerals to prevent diseases.����������������������������������������������������������������������������������������� 47
8.1 Definition of a fruit���������������������������������������������������������������������������������������������������������������������������� 47
8.2 The unique types and colours of fruits and their unique nutrients and antioxidants for good
health�������������������������������������������������������������������������������������������������������������������������������������������������� 47
8.3 The scientific basis of the health and nutritional benefits of eating a lot of fruits�������������������� 48
8.4 Fruits are essential in preventing micronutrient deficiencies and promoting good health����� 48
8.5 Fruits are diet-related non-communicable disease protective���������������������������������������������������� 48
8.6 Fruits are a healthy option for weight loss and weight management���������������������������������������� 49
8.7 Fruits and vegetables as separate food groups����������������������������������������������������������������������������� 49
8.8 recommendations & guidance on eating a variety of fruits every day��������������������������������������� 50
8.9 Recommended amounts of fruits per day�������������������������������������������������������������������������������������� 50
8.10 Tips on eating at least two servings of fruit a day����������������������������������������������������������������������� 51
55
9. Recommendation 5: Eat pulses, beans, cowpeas, ground nuts or other nuts daily to
maintain good health. All these foods are rich sources of protein and a good substitute
for meat.������������������������������������������������������������������������������������������������������������������������������������� 56
9.1 Getting to know pulses, nuts and seeds����������������������������������������������������������������������������������������� 56
9.2 Healthy benefits of eating pulses, nuts and seeds������������������������������������������������������������������������ 57
9.3 Key functions of micronutrients of public health importance in Zambia���������������������������������� 57
9.4 Pulses, nuts and seeds and their relationship to health��������������������������������������������������������������� 57
9.5 Pulses are a healthier alternative to ASF and are NCD protective���������������������������������������������� 58
9.6 How nuts and seeds protect the body from NCDs.����������������������������������������������������������������������� 58
9.7 Pulses, nuts and seeds are a protein source for a healthier environment�������������������������������� 58
9.8 Recommendations and guidance on eating a variety of pulses, nuts and seeds���������������������� 59
9.9 How much legumes to eat per day�������������������������������������������������������������������������������������������������� 59
9.10 Tips on increasing intake of pulses, nuts and seeds ������������������������������������������������������������������ 61
62
10. Recommendation 6: Eat fish, insects or animal source foods daily��������������������������������� 63
10.1 A closer look: fish, eggs, insects and animal source foods��������������������������������������������������������� 63
10.2 Importance of eating fish, eggs and ASF��������������������������������������������������������������������������������������� 63
10.3 White meat is a healthier meat option than red meat �������������������������������������������������������������� 64
10.4 Limit the intake of red meat and processed meats to reduce the risk of diseases���������������� 64
10.5 The role of liver and kidney in addressing iron deficiency��������������������������������������������������������� 65
10.6 Fish, insects and white meat are healthier and sustainable options.��������������������������������������� 65
10.7 Recommendations and guidance on eating a variety of fish, insects or animal source
foods�������������������������������������������������������������������������������������������������������������������������������������������������� 67
10.8 Recommended amounts of fish, insects or animal source foods��������������������������������������������� 67
10.9 Tips on consuming fish, eggs, Insects and ASF���������������������������������������������������������������������������� 70

11. Recommendation 7: Take milk and dairy products for strong bones and teeth.����������� 72
11.1 A closer look: milk and dairy products������������������������������������������������������������������������������������������ 72
11.2 Importance of milk and milk products in a diet and for good health��������������������������������������� 73
11.3 Recommendations and guidance on eating a variety of milk and mill products every day�� 73
11.4 Take milk and milk products for healthy bones and teeth.�������������������������������������������������������� 74
11.5 Alternatives if one is not able to take milk and milk products �������������������������������������������������� 74
11.6 TIPs on taking milk and milk products������������������������������������������������������������������������������������������ 75
8
12. Recommendation 8: Limit eating ultra-processed foods and foods high in salt,
sugar, and fats and oils to prevent non-communicable diseases.����������������������������������� 79
12.1 About processed Foods������������������������������������������������������������������������������������������������������������������ 79
12.2 Substances only found in ultra-processed foods. ���������������������������������������������������������������������� 84
12.3 Identifying ultra-processed foods�������������������������������������������������������������������������������������������������� 85
12.4 Additives in processed and ultra-processed foods �������������������������������������������������������������������� 88
12.5 Recommendations and guidance for limiting the consumption of ultra-processed foods��� 89
12.6 Limit intake of salt��������������������������������������������������������������������������������������������������������������������������� 89
12.7 Recommendations and guidance on reducing salt intake to less than 5 g per day���������������� 90
12.8 Tips on reducing salt intake������������������������������������������������������������������������������������������������������������ 91
12.9 Limit intake of foods high in saturated fats �������������������������������������������������������������������������������� 91
12.10 The health risks of saturated fats and trans fats����������������������������������������������������������������������� 92
12.11 Recommendations and guidance on avoiding trans fats, limiting saturated fats and
replacing them with essential polyunsaturated fats����������������������������������������������������������������� 93
12.12 Tips on how to reduce intake of saturated fats ������������������������������������������������������������������������ 93
12.13 Limit intake of foods containing added sugar��������������������������������������������������������������������������� 93
12.14 Link between added sugars and diseases���������������������������������������������������������������������������������� 93
12.15 Recommendations and guidance on sugar intake�������������������������������������������������������������������� 95
12.16 Tips on reducing sugar intake������������������������������������������������������������������������������������������������������ 95
97
13. Recommendation 9: Handle, prepare and store food safely.�������������������������������������������� 98
13.1 Ways through which food gets contaminated ���������������������������������������������������������������������������� 98
13.2 Keeping food safe before and while cooking������������������������������������������������������������������������������� 99
13.3 Cooking and storing food safely ��������������������������������������������������������������������������������������������������� 99
13.4 Tips on handling, preparing and storing food���������������������������������������������������������������������������100
13.6 Keep food safe from aflatoxin contamination �������������������������������������������������������������������������101
13.7 Health concerns of aflatoxins������������������������������������������������������������������������������������������������������101
13.8 Recommendations and guidance on aflatoxins������������������������������������������������������������������������102
13.9 Helpful tips on decreasing exposure to aflatoxins��������������������������������������������������������������������102
103
14. Recommendation 10: Engage in physical activity at least 30 minutes every day.�������� 104
14.1 What is physical activity?���������������������������������������������������������������������������������������������������������������104
14.2 Physical activity among Zambians�����������������������������������������������������������������������������������������������104
14.3 Physical activity and its relationship to health��������������������������������������������������������������������������105
14.4 Current global recommendations on physical activity�������������������������������������������������������������105
14.5 Recommendations and guidance for physical activity��������������������������������������������������������������106
14.6 Tips for increased daily physical exercise�����������������������������������������������������������������������������������109

SECTION 3: Special dietary requirements for under-five children, adolescent girls, and
pregnant and lactating women in Zambia������������������������������������������������������������������������������ 111
15. Recommendation A: Begin breastfeeding your baby within one hour of birth.����������� 112
15.1 Importance of early initiation of breastfeeding�������������������������������������������������������������������������112
15.2 Tips to ensure successful early initiation������������������������������������������������������������������������������������112

16. Recommendation B: Feed your baby breastmilk only for the first six months of life
and no water, herbs or porridge because mother’s milk contains all the food and
water your baby needs.������������������������������������������������������������������������������������������������������� 113
16.1Mother’s breastmilk������������������������������������������������������������������������������������������������������������������������113
16.2 Importance of exclusive breastfeeding for babies��������������������������������������������������������������������113
16.3 Breastfeeding benefits the country economy����������������������������������������������������������������������������114
16.4 Breastfeeding benefits for mothers��������������������������������������������������������������������������������������������114
16.5 Rates of exclusive breastfeeding in Zambia�������������������������������������������������������������������������������114
16.6 Recommendations and guidance for exclusive breastfeeding for children aged 0 to 6
months��������������������������������������������������������������������������������������������������������������������������������������������115
16.7 Tips for breastfeeding success�����������������������������������������������������������������������������������������������������115

17. Recommendation C: From six months, introduce a variety of foods from the six food
groups and continue to breastfeed up to two years and beyond.���������������������������������� 116
17.1 Why should children aged 6 to 23 months eat a variety of foods in addition to
breastfeeding?�������������������������������������������������������������������������������������������������������������������������������116
17.2 Dietary patterns and nutrition status for children aged 6 to 23 months in Zambia ������������119
17.3 Guiding principles for appropriate complementary feeding for children 6 to 23 months���119
17.4 The recommended intake for children aged 6 to 23 months��������������������������������������������������120
17.5 One serving size equivalents of different food groups�������������������������������������������������������������126
18. Recommendation D: Give a variety of foods from the six food groups to children
2 to 5 years to help them grow to their full potential. ��������������������������������������������������� 128
18.1 Importance of optimal nutrition for children 2 to 5 years of age �������������������������������������������128
18.2 Dietary patterns and nutrition status for children aged 24 to 59 months in Zambia�����������128
18.3 The recommended intake for children aged 2 to 5 years��������������������������������������������������������129
18.4 Tips on feeding children aged 6-59 months�������������������������������������������������������������������������������130

19. Recommendation E: Adolescents, especially girls, should eat a variety of foods


from the six food groups for healthy weight and growth.����������������������������������������������� 131
19.1 Nutritional needs for adolescents aged 10 to 19 years������������������������������������������������������������131
19.2 Diet and nutrition outcomes for adolescents in Zambia����������������������������������������������������������132

20. Recommendation F: When pregnant or breastfeeding, enjoy a variety of food


including animal source foods, pulses, fruits and vegetables with your meals for
your and your baby’s health.����������������������������������������������������������������������������������������������� 134
20.1 Nutritional needs for pregnant women��������������������������������������������������������������������������������������134
20.2 Special nutrient needs for a pregnant adolescent �������������������������������������������������������������������136
20.3 Recommendations and guidance for pregnant women�����������������������������������������������������������137
20.4 Nutrition for lactating women������������������������������������������������������������������������������������������������������139
20.5 Dietary practices and nutrition status for pregnant and lactating women in Zambia ���������139
20.6 Recommendations and guidance for lactating women������������������������������������������������������������140
20.7 Tips for lactating women��������������������������������������������������������������������������������������������������������������140

SECTION 4: Annexes and References.........................................................................................143


21. ANNEXES ����������������������������������������������������������������������������������������������������������������������������� 143
21.1 Annex 1: Diet model outputs�������������������������������������������������������������������������������������������������������143
21.2 Annex 2: List of TWG and attendance during the FBDG development process �������������������150

22. References����������������������������������������������������������������������������������������������������������������������������� 154


Zambia Food-Based Dietary Guidelines

Foreword

N
utrition is one of the main determinants of optimal health throughout the human lifecycle.
Promoting a well-nourished population free of all forms of malnutrition and capable of
contributing to economic growth and diversification is one of the aims of the Zambia National
Development Plan Agenda and the National Food and Nutrition Strategic Plan. The UN Sustainable
Development Goal number two (SDG 2) specifically stipulates ending hunger and malnutrition in all
its forms by 2030. Zambia faces a triple burden of malnutrition including chronic undernutrition,
micronutrient deficiencies as well as the emerging problem of overweight and obesity.

Diet has a profound influence on the nutrition, health and wellbeing of an individual. Healthy dietary
practices and regular physical activity are critical in attaining good health and reducing the risk of
developing diet-related Non-Communicable Diseases (NCDs). The Zambia Food-Based Dietary
Guidelines (FBDGs) provide scientifically proven recommendations on diet and a healthy lifestyle to
prevent and reduce the risk of NCDs while meeting nutrient and energy requirements. This FBDG
manual is primarily intended for technical experts who promote food consumption and diets for use
in designing, implementing and assessing nutrition programmes including the development of policies
and nutrition education materials.

The development of the FBDGs was multi-sectoral, therefore, implementing these guidelines ought
to also involve stakeholders from different sectors. The guidelines are grounded on the food systems
approach. Public policy makers, programme developers, civil society organizations, the private sector,
and the general population have a role in promoting and implementing the guidelines in order to
reduce the prevalence of malnutrition in Zambia.

The FBDGs are accompanied by the Healthy Eating Guides for the general population to enhance
healthy eating for all. The Healthy Eating Guides have been developed using simple language that can
be understood by non-technical people. These guides consider local consumption patterns, cultural
contexts and the food systems environment, and have the same aim as the FBDGs.

Hon. Reuben R. P Mtolo, MP


Minister of Agriculture

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Zambia Food-Based Dietary Guidelines

Acknowledgements

T
he FBDGs were developed under the Technical Cooperation Programme (TCP) agreement (TCP/
SFS/3604) between the Food and Agriculture Organization of the United Nations (FAO) and the
Ministry of Agriculture (MoA) in collaboration with the National Food and Nutrition Commission
(NFNC). The agreement entailed the provision of technical and financial support by FAO.

The Government of Zambia acknowledges the support of line ministries, academia and the non-
governmental sector. Sincere gratitude goes to Mrs Nancy Sakala Chella, Mr Mulele Sibeso and Ms
Rita Syafunko from the MoA for their role as National Project Coordinators for the development of the
FBDGs under the leadership of Mr Charles Sondashi, MoA Deputy Director – Advisory Services; and
to Mrs Karen Mukuka, MoA Chief Food and Nutrition, and Mr Musonda Mofu of the NFNC for their
time and devotion to making this work a success. We acknowledge the multi-sector Technical Working
Group (TWG) from 21 institutions (listed in Table A) that spearheaded the FBDGs development process
and provided advisory guidance.

The FBDGs were prepared under the stewardship and technical guidance of Dr Mercy Chikoko,
FAO’s Lead Technical Officer for the TCP under the FAO Sub-regional Office for Southern Africa. We
acknowledge the technical inputs and insights provided by Dr Ramani Wijesinha-Bettoni, Dr Yenory
Hernandez-Garbanzo and Dr Ana Islas from FAO headquarters. These efforts were jointly coordinated
by Ms Celestina Lwatula, who facilitated exchanges among FAO, MoA, NFNC and the TWG under the
guidance of Mr George Okech and Ms. Suze Filippini, the FAO Representative for Zambia.

Our gratitude equally goes to Dr Chiza Kumwenda, the FAO consultant who provided technical
input for the drafting of these FBDGs’ technical recommendations. We thank FAO consultants Lucie
Jouanneau and Pamela Munjoma, and Dr Mercy Chikoko and Josephine Ippe for their editorial and
technical inputs to the technical recommendations. We also acknowledge the contributions of Sokoine
University of Agriculture (SUA) of Tanzania for ensuring the quality of the evidence review document.
Our gratitude goes to Mango Tree Educational Enterprises of Uganda, the facilitators of the 27 Focus
Group Discussions (FGDs), the note takers and transcribers, and the pretesting coordination and
management team (listed in Table B) that played a key role in pretesting the FBDGs within communities
to assess their understanding of the messages and visual illustrations, barriers and motivations for
change, and cultural appropriateness. Gratitude goes out to all the people who made conducting 96
focus group discussions in 39 locations across Zambia possible. We are also thankful to PEP II and FAO
for the financial support they rendered during the pretesting.

Finally, sincere thanks and appreciation to all key individuals and organizations that, in one way or
another, contributed to the development of these dietary guidelines.

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Zambia Food-Based Dietary Guidelines

Acknowledgements
TABLE A
The Zambia Food-Based Dietary Guidelines Technical Working Group Members
Institutions Names of TWG members
National Food and Nutrition Belinda Tshinda Tembo; Patricia Sakala; Chisela Kauwile
Commission and Albertina Mweemba
Rose Silyato; Natasha Mhango; Rita Syafunko; the late Chris
Ministry of Agriculture
Kakunta; Mulele Sibeso and Nancy Sakala Chella

Ministry of Fisheries and Livestock Zyangani Chirambo and Dr. Venantious Musonda Mulenga

Agnes Aongola; Wila Zambezi; Yaled Sichvula; Davies Chutu


Ministry of Health
and Wilson Kapenda
Ministry of Community
Wilbroad Zimba and Precious Miti
Development and Social Services
MCDSS Luwindi Kabondo and Weka Banda

MOGE Tresphore Chanda

IAPRI Dr. Rhoda Mofya Mukuka

HIVOS William Chilufya

PEPII MOA/MFL Catherine Mkangama


Lukonde Mwelwa-Zgambo; Dr. Chiza Kumwenda and the
University of Zambia
late Dorothy Nthani
Lusaka Apex Medical University Dr. Luke Mugode

NRDC Brenda Sinonge

NISIR Dr. Hilda Nyambe Silavwe

CDH Wila Zambezi

Nutrition Association of Zambia Gloria Chola and Rose Musumali Lungu

Programme Against Malnutrition Mukombwe James and Maureen Chitundu

UNICEF Ruth Siyandi


USAID-SBH Rose Musumali
FAO Zambia Celestina Lwatula
CSO-SUN Nsungwe Mulende

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Acknowledgements
TABLE B
FBDGs Messages and Visual Illustration Field Testing Team
Focus group discussion facilitators Note takers and transcribers

Albertina Mweemba Charity Vuttah

Brenda Sinonge Chilufya Musendeka

Dr. Luke Mugode Jessica Mayenda

Dr. Venantious Musonda Mulenga Lemana Washingtone

Gloria Chola Lilian Mumba

Dr. Hilda Nyambe Silavwe Beene Mujala

Lungowe Simutanyi Yamba Chisombu Dyaunka

Lwindi Kabondo Dorothy Mulenga Kumwenda

Simasiku Purity Eunice Mbewe

Tresfold Chanda Judith Lembela Mupeta

Weka Banda Norman Tembo

Wila Zambezi Peggy Mukwakwa Kamelu

William Chilufya Songolo Akakandelwa

Pre-testing process organising and managing team:


Nancy Chella, Sibeso Mulele, Rita Syafunko and Celestina Lwatula

Designing pre-testing tools and instruments and training the pre-testing team:
Dr. Mercy Chikoko and Mango Tree Ltd.

Pre-test results analysis:


Dr Chiza Kumwenda, Dr Mercy Chikoko and Pamela Munjoma

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ZambiaFood-Based
Food-BasedDietary
DietaryGuidelines
Guidelines

Acronyms and Abbreviations


ASF Animal Source Foods NCDs Non Communicable Diseases

BMI Body Mass Index NFNC National Food and Nutrition Commission

National Institute For Scientific And Industri-


CDH Cancer Diseases Hospital NISIR
al Research

CHD Coronary Heart Disease NRDC Natural Resources Development College

Civil Society Organizations for Scaling Up


CSO-SUN NSP Non Starch Polysaccharides
Nutrition

CVD Cardiovascular Diseases PAL Physical Activity Levels

DOF Department of Fisheries PAM Programme Against Malnutrition

FAO Food and Agricultural Organisation PEP II Performance Enhancement Programme II

Protein Digestibility Corrected Amino Acid


FBDGs Food-Based Dietary Guidelines PDCAAS
Score

FCT Food Composition Table PUFAs Poly Unsaturated Fatty Acids

GBD Global Burden of Diseases SAER Situation Analysis and Evidence Review

Kcal Kilocalories SFAs Saturated Fatty acids

IAPRI Indaba Agricultural Policy Research Institute SUA Sokoine University of Agriculture

LDL Low Density Lipoprotein SUNLE Scaling Up Nutrition Learning and Evaluation

Ministry of Community Development and


MCDSS SUNTA Scaling Up Nutrition Technical Assistance
Social Services

MFL Ministry of Fisheries and Livestock TCP Technical Cooperation Programme

MoA Ministry of Agriculture TFA Trans Fatty Acids

MOGE Ministry of General Education TWG Technical Working Group

MoH Ministry of Health UNICEF United Nations Children’s Fund

NAIS National Agriculture Information Service UNZA University of Zambia

NAZ Nutrition Association of Zambia UPF Ultra Processed Foods

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Food-Based Dietary
Food-Based Guidelines
Dietary Guidelines

Executive Summary

U
ndernutrition, especially in children under the age of five,
has been declining at global level. However, sub-Saharan
Africa has one of the highest rates of undernutrition and
reduction is slow. Unfortunately, overweight and obesity are also on the
rise across the continent and micronutrient deficiencies still persist, creating
what has been dubbed the “triple burden” of malnutrition. The causes of
undernutrition are multifaceted and they operate in complex ways. Malnutrition
is linked to poor quality and quantity of dietary intake, among other factors.
A higher dietary diversity score is associated with better nutritional outcomes
among individuals. Additionally, regular physical activity plays a vital role
in preventing overweight, obesity and non-communicable diseases (NCDs).

In Zambia, undernutrition has remained one of the major public health


problems while the prevalence of overweight, obesity and diet-related
NCDs, such as diabetes, cancer and cardiovascular diseases, is on the
rise. The burden of malnutrition and diet-related NCDs is reflected in the
increased risk of morbidity and mortality among the Zambian population.
The Zambian FBDGs, grounded on current scientific evidence and principles,
have been designed to promote healthy dietary patterns, physical activity and
other healthy behaviours such as handwashing and discarding mouldy foods.

The FBDGs will help professionals working in the health, agricultural and
nutrition sectors to provide coherent and harmonised nutrition guidance
to the general Zambian population. Furthermore, policy makers from
both the public and private sectors will benefit from the FBDGs when
formulating policies which mainstream healthy dietary patterns and promote
physical activity and regular handwashing, particularly at critical times.

The Zambian FBDGs have twelve recommendations for the general


public and six recommendations for populations with special
nutrition needs. The guidelines have taken into consideration cultural
values, food diversity and food consumption patterns prevailing in the
country, hence making them very practical and applicable to everyone
in Zambian society, regardless of their cultural beliefs and location.

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Zambia Food-Based Dietary Guidelines

About the Food-

SECTION 1
Based Dietary
Guidelines for
Zambia

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Zambia Food-Based Dietary Guidelines

1. THE ZAMBIAN FOOD GROUP GRAPHIC


The Zambia FBDGs are based Figure 2: The six food groups
on the six food groups, namely;

1. CEREALS, STARCHY ROOTS and


TUBERS
2. VEGETABLES
3. FRUITS
4. FISH, INSECTS and ANIMAL
SOURCE FOODS
5. DAIRY
6. LEGUMES, PULSES and NUTS.

Guidance is provided regarding


the minimal use of fats and
oils in order to balance the
important role they play in the
diet and the risk of NCDs. The
food group graphic (Figure 2)
was produced through diet
optimization modelled on
commonly available foods in
each of the six food groups.
The food guide features locally
available foods, making it
flexible and adaptable to every
local community in the country.

2. THE ZAMBIA FOOD-BASED DIETARY


GUIDELINES AT A GLANCE
The Zambia FBDGs are a combination of nine evidence-based
dietary recommendations and three Healthy Practices Guides
for the general public.
The dietary recommendations combine healthy food choices from the six food groups and limit calorie
intake from other foods to promote healthy eating habits among Zambia’s general population. The
guidance also includes additional health-related behaviours such as handwashing, physical activity
and food safety practices like discarding mouldy food. Each recommendation also has several practical
examples of how to follow a healthy dietary pattern using locally available foods, including guidance
on portion sizes. The guidelines include scientific and context-based evidence underpinning each
recommendation. Furthermore, each recommendation is framed as a memorable key message,
following pilot testing with consumers. The FBDGs recommendations could be used in developing
consumer promotional materials and programmes.

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Zambia Food-Based Dietary Guidelines

EAT MORE
Whole or milled grains Vegetables of
Different coloured
Eat different types (cereals) and starchy different types and
fruits
of food from each roots/tubers colours
of the six food as part of your meals every day to provide every day to provide
groups every day every day for a healthy your body with your body with vitamins
to stay strong and heart and weight. vitamins, minerals and and minerals to prevent
roughage to prevent diseases.
healthy. diseases.

The six food groups are Aim for 4 servings per Aim for 3 servings per Aim for 2 servings of
day of whole cereals day of raw vegetables fruit per day
• Cereals , starchy and starchy roots/ (about 230 g or 1.5 (about 300 g or two
roots and tubers tubers (about 560 g) cups cooked or 3 cups medium size fruits like
• Vegetables uncooked) bananas or oranges or
• Fruits two cups of cut fruit)
• Fish, insects and
animal source foods
• Dairy
• Legumes, pulses and
nuts
Milk and milk * If milk is not available,
Beans, cowpeas, Chicken and other
products (like yogurt, eat calcium-rich foods
groundnuts, or other poultry, fish, eggs,
sour milk, cheese) such as moringa,
nuts insects or caterpillars
amaranthus, cowpeas
daily to maintain good every day to build and every day for strong leaves, cassava leaves,
health. All these foods repair your body. bones. baobab fruit or leaves,
are rich sources of tamarind leaves,
protein and a good kapenta and small fish
substitute for meat. eaten with bones.

Aim for 2 servings of Aim for 1 serving per Aim for 1 serving per
nuts and seeds per day (about 50 to 115 g day (about 245 g)
day (about 180g [1 cup] depending on the food
cooked pulses or 60 g selected from the food
[6 tablespoons] nuts exchange list).
and seeds or a mix of
90 g [9 tablespoons]
of pulses and 30 g [3
tablespoons] nuts and
seeds).

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Zambia Food-Based Dietary Guidelines

EAT LESS
Ultra-processed foods (UPFs) and foods high in
HEALTHY
PRACTICES
salt, sugar, and fats and oils

Throw away grains


Prevent diseases like high blood pressure, sugar
1 and legumes that
disease (diabetes) and cancer. are mouldy because
they are away
Throw not safe for
people
grainsand
andanimals
Salt: less than 5 g (just under 1 teaspoon) per day
Limit intake
tolegumes
eat. They canare
that
cause
mouldycancer and
Saturated fats: (such as animal fats and vegetable affect child growth.
oil hard at room temperature like margarine):
Limit intake
Wash your hands
Trans fats (such as oils used to fry foods in fast-food 2 with soap and
restaurants and ultra-processed foods:
Not recommended clean, safe water
before handling
Utra Processed foods (processed meats like bacon, food, and wash food
sausage, and hot dogs; packages snacks like crisps,
biscuits, Sugary drinks like soft drink and fruit before preparation
flavoured juices, ice cream, etc.: or eating to prevent
Not recommended
diseases such as
diarrhoea and worm
infestation.

Engage in physical
3 activities at least 30
minutes every day.
Cooking oil and animal fat Choose activities that
Use less when preparing food and choose meals with
you enjoy and can
less fat and oils to avoid becoming overweight. do regularly at home
and at work, such as
Limit added oils to 1 tablespoon (14 g) per day. Use walking, carrying out
vegetables oils.
household activities
or playing to avoid
being overweight
and to maintain a
healthy heart.

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Zambia Food-Based Dietary Guidelines

3. BACKGROUND AND CONTEXT


3.1 INTRODUCTION et al., 2020). Conflicting and inconsistent nutrition
Malnutrition is a public health problem in Zambia. information significantly contributes to poor
The country is experiencing a triple burden of dietary habits among individuals (Spiteri Cornish
malnutrition with high rates of undernutrition, and Moraes, 2015).
increasing rates of overweight and obesity, and
persisting micronutrient deficiencies, despite At the same time, Zambia is endowed with a wide
making progress on some nutritional outcomes variety of foods, making it possible to consume
such as wasting among children. Thirty-five percent healthy and diverse diets which are essential for
of children under the age of five are stunted (MOH, the prevention of malnutrition and diet-related
2019) and underweight is also prevalent among NCDs.
the women of reproductive age (WRA) group (CSO,
2014). Furthermore, micronutrient deficiencies 3.2 RATIONALE AND RELEVANCE FOR THE
are also high, largely owing to the consumption of FOOD-BASED DIETARY GUIDELINES
less diverse diets (Kaliwile et al., 2019; Grech et al., Zambia is facing multiple burdens of malnutrition.
2018). About 55 percent of WRA are zinc deficient At the same time, the country is undergoing
and 18.6 percent have iron deficiency anaemia, a nutritional transition with a shift from
while 3.2 percent are at risk of vitamin A deficiency predominantly unprocessed traditional foods such
(Alaofè et al., 2014). as wild and locally produced fruit and vegetables,
roots and tubers, to a diet consisting mainly of
Furthermore, the prevalence of diet-related NCDs ultra-processed food and drink products. The
is also on the rise and is contributing significantly nutrition situation – coupled with a complex,
to high mortality rates in the country. Unhealthy crowded, confusing and rapidly evolving nutrition
diets are one of the four major risk factors for information environment – makes it difficult for
NCDs in Zambia. The most common diet-related consumers to know what a healthy diet really
NCDs include some cancers, type 2 diabetes, means.
hypertension and oral diseases. Other than health
problems, the economic cost of malnutrition With the increased focus on the need for healthy
to individuals, households and the country at diets and lifestyles, as well as the need to respond
large are likely to be quite high (Global panel, to public health and nutrition priorities, and
2016). Additionally, both undernutrition and over food production and consumption patterns, the
nutrition contribute significantly to morbidity, Government of Zambia recognised the importance
disability and mortality among Zambians. of developing and implementing, for the first time
ever, the Zambia National Food-Based Dietary
Poor dietary patterns among Zambians remain Guidelines.
quite prevalent. Up to nine in ten Zambians do not
consume the recommended amounts of fruits and FAO and the World Health Organization (WHO)
vegetables in a day (Pengpid and Peltzer, 2020). define national FBDGs as evidence-based
Overall, consumption of nutrient dense plant and recommendations which are aimed at promoting
animal source foods is quite low among Zambians. healthy diets and lifestyles in a particular country.
This partly explains the persistently high levels of FAO further defines FBDGs as a package of outputs
both malnutrition and micronutrient deficiencies for governments to outline what constitutes a
in the country (Harris et al., 2019). Adults in Zambia healthy diet at a national level. The FBDGs are
consume high amounts of salt, which is a risk developed through an evidence-based, context-
factor for elevated blood pressure. There is also specific multi-sectoral process and a food system
evidence of a rapid increase in the consumption approach to serve as a reference for aligning food-
of saturated fats among Zambian adults (Micha related policies and programmes, and supporting
et al., 2014). While the factors associated with social and behaviour change communication for a
suboptimal dietary practices are multifaceted, population to adopt healthier, more sustainable
poor nutritional knowledge is one of the main dietary patterns and practices.
reasons for poor dietary intake. As a modifiable
risk factor, poor dietary habits or behaviours can FBDGs define what a healthy diet means to
be improved through nutrition education (Bundala a country by providing harmonised food and

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Zambia Food-Based Dietary Guidelines

nutrition guidance that can inform and orient nutrition education, promotion of diverse
food-system policies and programmes that go crops and livestock production, the regulation
beyond the health sector. The FBDGs provide of food industries, and school-based nutrition
advice on foods, food groups and dietary patterns programmes. However, the guidelines do not
that would provide the required nutrients to the cover requirements during emergency situations
general public to promote overall health and such as droughts, floods, etc.
prevent chronic diseases while achieving the
broader vision of the Zambia National Food and These guidelines aim to steer the Zambian
Nutrition Security Policy. population towards attaining a nutritionally
adequate and healthy diet. While the FBDGs
Unlike nutrient recommendations, which are Technical Recommendations are written for
not country specific, the development of FBDGs professionals and educators, it is accompanied
is driven by an individual country’s need to by a FBDGs Eat Well Guide for the general public
address its public health and nutrition priorities. that translates the FBDGs’ recommendations into
Furthermore, FBDGs are not meant to be used as messages and visual illustrations tailor-made for
clinical guidelines for disease treatment, but rather all consumers, including those with low literacy
aim to promote health and prevent malnutrition levels.
and diseases. However, individuals with clinical
conditions are encouraged to follow the FBDGs The dissemination of the FBDGs includes the
to optimise their nutritional and health status. development of other simpler communication
The process of developing FBDGs also considers materials, including booklets and posters, and
a number of food systems dimensions including mobile apps, translated into three local Zambian
national food production, food composition data, languages. Through traditional media and new
consumption patterns, sociocultural influences technologies, the consumer materials will ensure
and accessibility. accessibility and ease of use by all. These materials
will be made available as electronic and printed
FBDGs are also used to provide policy and copies, and distributed for implementation in
programme guidance on food- and nutrition- schools, health and agriculture extension centres,
related matters. The Government of Zambia, in hospitals, markets and other food environments.
collaboration with FAO, has developed FBDGs for
Zambians to promote healthy eating. It is expected 3.3.2 Target population group of the FBDGs
that the guidelines will ultimately contribute The FBDGs have been developed for the healthy
towards the national nutrition response, hence general public between the ages of 0 and 65 years,
contributing towards achieving the Government’s who do not have significant medical conditions
vision of having a well-nourished population that may warrant specific diet modifications.
free of all forms of malnutrition and capable In addition to the guidelines for the general
of contributing to economic growth and population provided in Section 2, Section 3
diversification. provides added guidance for children under five
years of age, adolescent girls, and pregnant and
3.3 ABOUT THE FOOD-BASED DIETARY lactating women, given their special nutrition
GUIDELINES (TECHNICAL RECOMMENDATIONS) requirements. The FBDGs are meant to promote
3.3.1 Target users for the FBDGs Technical healthy eating and thus the improvement of the
Recommendations health and wellbeing of the general population.

The target users of this document are the technical 3.4 GUIDING PRINCIPLES
experts who promote healthy food consumption 3.4.1 Evidence based
and healthy diets. The guidelines are also designed The FBDGs are based on the prevailing nutrition
for policy makers to ensure a conducive policy landscape in Zambia and current scientific evidence
environment that enables consumers to follow on the relationship between diets or dietary
the recommendations towards healthier diets. patterns and nutritional or healthy outcomes.
Prior to developing the FBDGs’ recommendations,
The FBDGs are a resource for creating evidence- evidence was synthesized and consolidated into
based interventions to form the basis of nutrition one of the FBDGs’ process outputs called the
communication to the public including, but not Zambia Evidence Review Document.
limited to, mass and social media messages,

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Zambia Food-Based Dietary Guidelines

3.4.2 Addresses Zambian nutrition priorities Zambia FBDGs emphasise healthy diet principles,
The guidelines aim at promoting healthy dietary which include making whole grains, legumes, nuts
patterns to contribute towards addressing the and a variety of fruits and vegetables a major part
high levels of undernutrition and the emerging of the diet.
problem of overweight and diet-related NCDs,
which were identified and prioritised by the There is increasing evidence of the health benefits
FBDG Technical Working Group (TWG) based on of plants (grains, legumes, nuts and a variety of
the Zambia Evidence Review conducted for the fruits and vegetables) on human health (Micha,
FBDGs. The guidelines target the following priority 2014; MOH, 2019). Eating a diet predominantly
problems identified at the population level: based on whole grains, legumes, fruits and
vegetables, fish and insects is not only good for
1. Undernutrition and micronutrient our health, but it is good for planetary health
deficiencies too. Growing whole grains, legumes, fruit and
2. Overweight, obesity and diet-related NCDs vegetables, and producing fish and insects does
(e.g. diabetes, hypertension, cardiovascular not produce as much greenhouse gas as raising
diseases, (CVDs) and cancers) cattle or large livestock. Raising livestock produces
3. Poor diet in terms of quality and/or quantity 14.5 percent of all greenhouse gas emissions, with
4. Poor infant and young child feeding practices cattle (raised for both beef and milk, as well as for
5. Poor hygiene and environments inedible outputs like manure and draft power)
6. Physical inactivity contributing 65 percent of the livestock sector’s
emissions (FAO, 2021a).
3.4.3 Based on globally recommended FBDGs
development process Whole grains, pulses, fruits and vegetables,
The guidelines are based on a scientific process insects and fish also help reduce waste and lower
of developing FBDGs in order to enhance the pollution. Such a dietary pattern also reduces water
credibility of the recommendations for public use. and land use, slows deforestation and reduces the
These processes included national, multi-sector destruction of topsoil, among other benefits.
FBDGs TWG engagement in eight of the ten steps Further, the FBDGs also encourage the
of the FBDGs process as, shown in Figure 2, as per consumption of fresh, unprocessed or minimally
FAO and WHO (1998) guidance. processed foods as a critical part of sustainable
healthy diets.
3.4.4 Considers the cultural diversity of Zambia
The guidelines reflect the cultural diversity of the Reducing the intake of red meats and processed
country. The recommendations apply across the meats like bacon, ham, sausages and burgers,
cultural divide and therefore represent optimal and replacing these with healthier plant-based
dietary practices attainable by all Zambians. The food options, insects and fish helps to reduce the
pretesting of the FBDG recommendations and risk of obesity and associated NCDs such as heart
visual illustration included a discussion on the disease, diabetes and cancer. A smaller portion
cultural acceptability of the guidance. of the meals may include healthier animal source
foods like fish, chicken, insects, eggs and low-fat
3.4.5 Founded on healthy diets from sustainable dairy products.
food systems
The FBDGs are grounded on the sustainable food 3.4.6 Uses consumer-driven language
systems approach driven by the understanding The guidelines for the general population (Eat
that adoption of the guidelines is, to a larger Well Guides) use simplified terms that are easy to
extent, dependent on a nutrition-sensitive and understand among the target audience. The use
sustainable food system. of scientific words is minimal and those that are
used are likely to be familiar and understood by
Healthy diets from sustainable food systems are the primary targets.
dietary patterns that promote all dimensions
of individuals’ health and wellbeing; have 3.4.7 Practical
low environmental pressure and impact; are The recommendations contained in the FBDGs
accessible, affordable, safe and equitable; and are are for everyday practical use by all Zambians
culturally acceptable (FAO and WHO, 2019). The regardless of their location and economic status.

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Zambia Food-Based Dietary Guidelines

The foods and dietary behaviours promoted are sensitive to the prevailing conditions among Zambians.
The guidelines also include tips to empower consumers to make healthy choices.

4. METHODOLOGY/PROCESS OF
DEVELOPING FBDGS
The development of the Zambia FBDGs was possible and to address the prevailing national
necessitated by the need to define what a diet-related public health and nutritional needs.
healthy diet means in the Zambian context, The development process comprised the
and to harmonise the national nutrition following eight of the ten key steps (Figure 2).
recommendations, guidance and messaging in Once the guidelines are endorsed, it is expected
a systematic, evidence-informed and scientific that various stakeholders will disseminate and
way. To that effect, the Government of the implement the FBDGs and thereby be able
Republic of Zambia followed the process for to monitor the impact of the FBDGs on the
developing the guidelines based on the FAO Zambian population.
and WHO, 1998 recommended steps, to ensure
that the developed guidelines are as credible as

Figure 2: The 9 steps for developing FBDGs

4.1 THE FBDGS DEVELOPMENT PROCESS Union (EU), through the PEP II programme, also
STEPS supported the process via the MoA. Thus, the
4.1.1 Planning development of the Zambian FBDGs began with
Realising that Zambia had inadequate national planning meetings between FAO, the MoA and
harmonised and scientifically generated the NFNC.
recommendations that promote healthy dietary
patterns, the Ministry of Agriculture (MoA) and 4.1.2 Technical Working Group formation
the National Food and Nutrition Commission The MoA facilitated the formation of the national
(NFNC) initiated the development of the FBDGs TWG. The TWG is composed of members from
in Zambia with a request for technical and both the public and private sectors, comprising
financial support from FAO through a Technical 21 stakeholder organizations. In addition to the
Cooperation Programme (TCP). The European MoA, the members of the TWG included the

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Zambia Food-Based Dietary Guidelines

Ministries of Health, General Education, Fisheries During the evidence validation process, additional
and Livestock, Community Development and members from academia and civil society were
Social Welfare and the NFNC. Members from the invited to strengthen the feedback on the evidence.
private sector and civil society organizations were Thus, 15 stakeholder organizations represented
from: Civil Society Organizations for Scaling up by 33 participants attended the workshop. The
Nutrition (CSO-SUN), Hivos-Zambia, Programme validated evidence facilitated the development of
Against Malnutrition and Nutrition Association of key technical recommendations around which the
Zambia; and Indaba Agricultural Policy Research FBDGs are based.
Institute. Members from academia and research
institutes were from: University of Zambia, 4.1.4 Drafting the FBDGs Technical
Lusaka Apex Medical University, and National Recommendations
Institute for Scientific and Industrial Research and 4.1.4.1 Ranking priority problems and setting dietary
Development. Members from partners agencies goals
were from: WHO, United Nations World Food Based on the draft evidence review and situation
Programme (WFP), UNICEF, FAO, the EU and United analysis, 24 TWG members identified over 35
States Agency for International Development nutrition, diet-related and behavioural problems
(USAID). Each of the TWG members signed a during a workshop held in May 2018. The TWG
form indicating no conflict of interest. The TWG consolidated similar problems and compiled a list
was further grouped into areas of specialty to of 22 problems which they ranked to identify 10
help with evidence gathering and validation. The priority problems to be addressed by the FBDGs.
MoA, together with the TWG, NFNC and FAO, then
agreed on the road map and resources required During the ranking of the nutrition problems, each
for the development of the FBDGs. member of the TWG used a ‘decision matrix”. The
matrix ranked problems in terms of magnitude,
4.1.3 Scientific evidence review and situation feasibility, and impact and spillover effect on a
analysis scale of zero to five. Once the points were assigned
The gathering and review of evidence for the to each problem, the scores were consolidated
development of the Zambia FBDGs was done and the problems with the highest scores were
by the FBDGs TWG, a national consultant and selected.
consultants from the Sokoine University of
Agriculture in Tanzania. FAO trained the TWG The TWG then set dietary and lifestyle goals to
and the national consultant on gathering and address the priority problems. They defined
reviewing of evidence. The review process was critical nutrients and critical foods and food
based on agreed upon guiding questions which groups to address the nutrition problems. The
focused on the following main themes in the FBDG TWG decided and agreed on six food
Zambian context: Risk factors and problems groups for the FBDGs and established food
associated with diet; food consumption patterns; intake recommendations for each food group
review of policies; review of programmes related and subgroups, by adopting and adapting one or
to food and nutrition; review of behaviours
and food-related habits (knowledge, attitudes,
practices); review of other related behaviours; food
DECISION MATRIX
environment and settings; the media; and food • Magnitude of the problem
sustainability. The review also looked at global • Feasibility to solve the problem through
evidence on the relationship between diet and FBDGs implementation interventions
lifestyle with nutrition and health outcomes. The including determining how easy or likely
review adopted a systematic search of both peer- it is to change the behaviour.
reviewed journal articles in electronic databases • Likely impact if the behaviour were to
as well as policy documents and various other
be changed.
government publications.
• The spillover score was based on the
The main output from this stage was the Situation centrality of the behaviour in the
Analysis and Evidence Review (SAER) Report, which system of behaviours and the positive
was technically validated during a week-long spillover effect if that behaviour were to
workshop from 20 October to 2 November, 2018. be changed.

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Zambia Food-Based Dietary Guidelines

a combination of both locally or internationally energy requirements. During diet modelling, the
recognised standard references from Table 1. following factors were considered:

4.1.4.2 Drafting and review of the technical 1. The energy levels to be covered by the
recommendations specific food pattern and specific population
TWG members from ten stakeholder organizations needs. The general population energy level
represented by 18 participants reviewed the for the diet model was set at 2 100 Kcal per
FBDGs technical recommendations during a day based on the average calculations using
workshop that commenced on 22 to 26 July, 2019. the FAO, WHO and United Nations University
The FBDGs writing team then drafted the FBDG (UNU) 2004 human energy requirements.
Technical Recommendations and the FBDGs Eat The calculations ensured that the energy
Well Guide. The process of drafting the technical needs for women of reproductive age (19 to
recommendations was informed by the evidence 50 years) are met. The calculations also took
review, nutrition-related problems and dietary into consideration the rural versus urban
and lifestyle goals. population proportions and their physical
activity levels (PAL); noting that PAL values
4.1.5 Diet modelling and food group graphic are the same between men and women who
Diet modelling is mathematical (linear) have the same activity levels (FAO, 2004).
programming that translates the nutrient Birth rate and body weight/body mass
requirement for each population group into index (BMI) for age were also factored into
food group amounts by simultaneously solving population energy calculation. Diet models
several equations with numerous variables and for other populations with special needs like
considerations (constraints), such as consumption under-five children, adolescent girls, and
patterns, energy and nutrient goals, the cost pregnant and lactating women are provided
of the diet, and the environmental impact of in Section 3 of these FBDGs.
the recommendations. The linear programme 2. The nutrients of key public health importance,
optimisation selects the best solution for a especially those micronutrients of concern
combination of foods (types and quantities) which such as iron, vitamin A, calcium and zinc.
will meet the set of goals (constraints). This was based on micronutrient needs for
WRA from WHO and FAO and WHO (2004)
Some of the products of diet modelling include vitamin and mineral requirements in human
a breakdown of the contribution of each food nutrition.
group to the total energy and nutrients in several 3. The six food groups that represent a
formats, including pie charts. Other products diversified diet for Zambia, and their
include the total and proportion contribution in nutrient profiles. Drawing from food
food weight amounts, servings and serving sizes composition tables, the diet model
for each food group. The pie chart is the basis for
optimization ensures that when
the FBDGs food group graphic.
combined in various amounts, the
The Zambia Food Group Guide provides a graphic six food groups meet the energy and
representation of the six food groups, with nutrients requirements for the target
the aim of visually communicating a desirable population.
eating pattern for each food group through the 4. The serving size Kcal or gram (g) outputs
proportions suggested in the graphic per day. should be as close as possible to usual
The amount contribution of each food group was portion sizes and easily estimated using
calculated through diet modelling and using linear common household measures.
programming to meet the 2 100 kilocalories (Kcal) 5. Zambia food consumption patterns and
and essential nutrient requirements per day. local foods that are widely accessible and
The FBDGs food group guide graphic is based on culturally acceptable.
general population requirements. 6. The minimum cost of the proposed
recommendations in the food group
Furthermore, diet was modelled based on amounts that meet the energy and essential
consumption patterns of foods by the general nutrient targets.
population and the recommended nutrient and

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Zambia Food-Based Dietary Guidelines

After these decisions were made, the most group guide format, which was then used as the
commonly consumed foods and their nutrient visual illustration in diet modelling. The co-creation
profiles were entered into the programme. The and pilot testing was facilitated by Mango-Tree
proportion contribution of each food to the food Enterprises from Uganda from 23 to 26 July, 2019.
group was weighted appropriately using Zambia’s
food consumption data or expert opinions when
data was not available.. The recommended
intake for each food group was calculated by the
programme using minimum and maximum food
quantities that were compatible with current
eating habits, while striving to optimise the
pattern to meet nutrient requirements, especially
those of interest to the target population. The
recommended amounts of each food group
were determined when food consumption data
was available and the existing diet was also well
considered, with attempts made to deviate as little Training of pretest facilitators
as possible from the current diet when the optimal
diet was calculated. After the dietary pattern was
optimised, a graphic representation of the model 4.1.7 Field pretesting of messages, food group
was created to depict the food groups and their guide and visuals, and validation of FBDGs
proper proportions to be consumed (suggesting The Zambian FBDGs were extensively pretested
each food group’s recommended proportion of to achieve four specific objectives, namely; to
the total diet). ensure that the developed guidelines (in the form
of messages, a food group guide and associated
The Zambia diet modelling was completed visuals) are understood by an average Zambian with
with assistance from FAO headquarters and very basic or little knowledge of nutrition concepts
the Sub-Regional Office of Southern Africa by and terms. The exercise was carried out to ensure
utilizing existing food consumption data and acceptability and cultural appropriateness; to
expert opinions. Although the South Africa Food ensure applicability of the guidelines to the general
Composition Table (FCT) is close to Zambia’s food public, including an assessment of barriers such as
composition, the models used the publicly available affordability and availability, and motivation for
West African and United States Department of change; as well as to ensure message and image
Agriculture (USDA) FCTs for nutrient analysis. effectiveness. The pretest sought to establish
Data was processed through an Excel programme promotional channels that would enhance the
written by MS-Nutrition (Marseille, France). The adoption of the FBDGs messages and visuals.
diet modelling was preceded by a regional training The developed messages, food group guide and
in Tanzania, including five TWG members from visuals were pretested three times across different
Zambia. One of the outputs from the training was sites and times of the year in the English, Nyanja
for each country TWG to come up with diet models and Bemba languages. For the English messages,
for their respective countries. the pretesting also ensured that the messages

4.1.6 FBDGs’ message and food group guide co-


creation and pilot testing
The team that prepared the key messages
and associated visuals from the FBDGs
recommendations comprised a group of 25
members of the general population, agriculture
extension officers and health workers drawn from
communities around Kafue District in Lusaka
Province. These co-created messages and the food
group guide were first pilot tested among diverse
groups drawn from the public, representing
TWG facilitating a pretesting session with
various social backgrounds in Lusaka. Pilot test
community members
participants selected the most favoured food

12
Zambia Food-Based Dietary Guidelines

are understood by an average Zambian with a 4.2 FBDG DIET MODEL COST OF DIET FOR
basic education of eight to ten years of schooling. A 2 100 KCAL DIET PER INDIVIDUAL
Due to financial constraints, the messages were The diet model used for the six food group
pretested in Nyanja and Bemba languages only. quantities costs ZMW 15.9/per person/day. The
price used in the diet model was sourced from
In November 2019, pilot pretesting was conducted the WFP and is reflective of what was prevailing in
in 21 locations within Chongwe, Lusaka, Samfya the second quarter of 2021. The following foods
and Luangwa districts, with two Focus Group contributed to the model in various weightings (see
Discussions per site and a total of 459 community Annex 1): Cereals, roots and tubers (cooked nshima,
members participating, some in English and brown rice, boiled cassava root, white bread/rolls,
others in Nyanja and Bemba. The images and boiled deep yellow sweet potato); fruits: papaya,
English messages were revised and pretested banana, mango, orange and avocado; vegetables
again in September 2020. A total of 433 women (boiled pumpkin, cassava, amaranth, spinach,
participated in 54 Focus Group Discussions at 18 moringa [drumstick] and sweet potato leaves, and
locations in Chongwe, Nchelenge, Nyimba, Lusaka tomato); pulses, nuts and seeds (boiled cowpeas,
districts. beans, and groundnuts), animal sourced foods
(ASF) and insects (cooked mopane worms, tilapia,
The FBDGs, including the diet models, messages kapenta/anchovy, chicken, chicken eggs, chicken
and visuals, were validated in multiple steps. In liver and cow, pig, goat and sheep meat). This
May 2021, a total of 16 TWG members from ten model was based on the weightings of common
institutions reviewed the draft FBDGs technical portion sizes and frequency of consumption,
manual and provided inputs. A two-day validation dairy products (cow’s milk), vegetable oil and
workshop was then held in August, 2021, where discretionary foods (sugar).
56 participants from 21 institutions validated the
FBDGs technical document. These institutions Another model with a reduced cost of ZMW 12/
included different line ministries, research per person/day was also formulated. This model
and academia, the Nutrition Association, food is based on the same foods as above but with
processing companies, UN agencies and other reduced weightings of individual (more costly)
cooperating partners (see Annex 2 for details). foods to the respective food group, while increasing
the weightings of cheaper foods (so that the cost
4.1.8 Preparation of the FBDGs Implementation of the food group goes down proportionately). For
Strategy and Plan further details, refer to Annex 1.
Mango Tree Enterprises, together with the TWG,
held discussions on how the FBDGs are to be 4.3 FBDGs PRODUCTS
disseminated and used. The key output achieved 4.3.1 Situation Analysis and Evidence Review
was an implementation strategy supported by a (SAER) Report
multi-sectoral action plan on capacity development, The SEAR Report provides detailed evidence of
communication and promotion activities. the diet and health relationships, risk factors and
proven healthy eating patterns that reduce risks
4.1.9 Dissemination and implementation and promote healthy outcomes. The SEAR analysed
There are four main outputs of the FBDGs the nutrition and health situation that guided the
process that have policy and programme priority problems to be addressed by the FBDGs
implementation applications: the FBDGs Technical and informed decisions on the recommendations.
Recommendations for professionals; the FBDGs Thus, the SAER ensured that the dietary guidance
Eat Well Guide for the general public; the Food remained scientifically sound and relevant.
Group Guide; and the Situation Analysis and
Evidence Review document. The dissemination 4.3.2 The Zambian Food-Based Dietary
method depends on the type of the document and Guidelines (Technical Recommendations)
the target audience for each product. The Zambian FBDGs Technical Recommendations
document is primarily intended for use by
4.1.10 Monitor, evaluate and revise professionals in the nutrition, health, agriculture,
During implementation, monitoring the use and food systems, education and social protection
application of the FBDGs and their impacts will be sectors. This technical manual was developed to
critical to ensuring that the intended objectives of provide more detailed information on the amounts
the FBDGs are realised. and types of foods to be consumed for optimal

13
Zambia Food-Based Dietary Guidelines

health and wellbeing, reducing malnutrition as well determined the serving sizes based on Kcal outputs
as minimizing the risk of diet-related NCDs. The linked to food list exchanges in weight and which
manual provides detailed evidence and explains aligned with common household measures.
the science behind the recommendations. The
document can be used as a basis to develop 4.3.4 The Zambia FBDGs: Eat Well Guide for the
advisory and education materials for counselling, general public
classroom teaching, community education, health The Zambia FBDG Eat Well Guide translates the
promotion, and menu development or evaluation. healthy diets concepts into easy-to-understand
practical steps in order to ensure that the ultimate
4.3.3 Zambia diet models and serving sizes beneficiaries of the guidelines, the Zambian general
The linear programming used provided various public, use and practice the recommendations. As
diet models. The Zambia FBDGs model met the part of the FBDGs implementation plan, various
2 100 Kcal target for recommended key nutrients sectors will develop additional educational
intake, which was closest to Zambia’s portion sizes materials for numerous target groups to ensure
and was one of the lower cost models. The models wide coverage across the entire Zambian society.

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Zambia Food-Based Dietary Guidelines

The Food

SECTION 2
Based Dietary
Guidelines for
the general
population
in Zambia

This section details the FBDGs. Each recommendation is described in detail:


what it is about, its importance – specifically the importance of consuming the
food group in the right amount, and the expected health outcomes, including
the scientific reasoning for the recommendation. The section also details the
current consumption patterns and the gaps identified as the basis for why
the guidelines were developed. Recommended amounts of consumption,
including visuals of the correct amounts, proportions and serving sizes
required per day are provided. Each guideline also includes tips for small
changes individuals can make in order to follow the recommendation.

15
Overview of the Export
Zambia Food-Based DietaryMarkets
Guidelines

Recommendation 1
Eat different types of
food from each of the
six food groups every
day to stay strong and
healthy

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Zambia Food-Based Dietary Guidelines

5. RECOMMENDATION 1: Eat different


types of food from each of the six food
groups every day to stay strong and
healthy.

5.1 GETTING TO KNOW THE SIX FOOD In the Zambian FBDGs, fruits and vegetables are
GROUPS presented as separate groups. This was done in
Foods are divided into macronutrients (nutrients order to encourage the consumption of fruits.
required by the body in larger amounts) and The FBDGs TWG also decided to separate milk
micronutrients (nutrients required by the body and milk products from animal source foods, like
in smaller amounts). Most foods are mixtures many other FBDGs do, for three main reasons:
of nutrients. Most of them have a few essential (1) To emphasise this important food and
nutrients, with some nutrients in large amounts encourage consumption given the low intake of
and others in small amounts or none at all. milk in Zambia; (2) Milk and milk products are
Food groups are grouped according to the key an important source of calcium, among other
and similar nutrients that they contain in large nutrients, for all age groups (Willet et al., 2019;
amounts. Each of the six food groups has a GBD, 2017; FAO, 2013a); (3) When consumed at
unique and important role to play in the body. an appropriate age (from one year of age), cow’s
The six Zambian food groups are: (1) cereals milk is associated with increased linear growth
and starchy roots and tubers; (2) vegetables; (3) and can help prevent stunting, especially during
fruits; (4) pulses, legumes and nuts; (5) animal the first two years of life. This is because in
source foods such as insects, poultry, fish and children with a poor nutritional status, milk is
meats; and (6) dairy. likely to supply nutrients that are important for

17
Zambia Food-Based Dietary Guidelines

growth but which are deficient in the diet, while energy, vitamins and minerals. In addition,
in well-nourished children, the effect of milk on legumes play a key role in reducing some NCDs,
linear growth is likely through the stimulation of while red meats increase the risk factors of
insulin-like growth factor 1 (IGF-1) (FAO, 2013a). NCDs. Globally, the new food grouping system
Previously, foods in Zambia were grouped into currently puts foods with similar nutrients
three broad categories based on their function together. The current grouping system uses
in the body. The three categories were body food groups like fruits, vegetables, cereals, roots
building foods, protective foods and energy and tubers, pulses, nuts and seeds etc. rather
giving foods. For example, legumes and meats than grouping foods based on the main nutrient
were grouped only as body building foods. provided.
However, legumes are also good sources of

Figure 3: How the old three food groups link to the new six food groups

5.2 WHY IT IS IMPORTANT TO EAT A nutritional status depends on the overall balance
VARIETY OF FOODS EVERY DAY of foods eaten on a daily basis, as well as on the
needs of the individual. Thus, a diet with limited
Figure 4: The six food groups variety and which does not include all food
groups is more likely to be deficient in one or
multiple nutrients, placing the individual at risk
of malnutrition. In addition, a meal containing a
variety of foods is also more appealing, enjoyable
and satisfying.

Although foods are grouped together into


six food groups because they provide similar
key nutrients and similar key functions in the
body, different foods within that food group
provide varied amounts and combinations of
nutrients and other beneficial substances such
as phytochemicals and fibre. For example:

Apart from breast milk consumed during the first 1. Vegetables are good sources of vitamins
six months of life, there is no other food or food (antioxidants), minerals and fibre. Although
group which supplies all the daily energy and vegetables are a great source of vitamin C,
nutrient requirements. The human body needs only dark green leaf and orange-coloured
more than 50 different essential nutrients to vegetables contain significantly more
stay nourished and function properly. A person’s vitamin A than other vegetables.
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Zambia Food-Based Dietary Guidelines

2. Fruits are good sources of vitamins seeds daily. A diversified diet includes small
(antioxidants), minerals and fibre. However, amounts of fish, poultry eggs, insects or white
orange fruits like mango and papaya are meat eaten daily. Red meat should only be eaten
high in carotenoids such as beta-carotene occasionally or avoided where possible. Milk
(pro-vitamin A) while blue and purple fruits and milk products should also be included in
contain anthocyanins, another powerful diets. Where dairy products are not available,
antioxidant. Some fruits like oranges, additional servings of small fish eaten with
lemons and baobab (chibuyu) are high bones, moringa or pulses should be consumed
in vitamin C, while bananas are high in to get the benefits of calcium and protein that
potassium. Avocados are a good source dairy products provide.
of healthy fats. Thus, eating different
coloured fruits and vegetables ensures that 5.3 THE SCIENCE BEHIND THE BENEFITS OF
individuals get all the nutrients necessary EATING A VARIETY OF FOODS
for good health. The consumption of a variety of foods across and
3. Beans, pulses, legumes and nuts are within food groups is associated with improved
good and affordable sources of protein, dietary quality and diet micronutrient adequacy,
vitamins, minerals and fibre. Nuts are also hence increasing the likelihood of both adults
a good source of healthy oils. and children meeting their daily nutrient
4. Poultry, fish, insects, mice and meats requirements (FAO and FHI, 2016; Martin-Prevel
are rich sources of protein, vitamins and et al., 2017; Hatløy, Torheim and Oshaug, 1998;
minerals such as iron, zinc and calcium. Oldewage-Theron and Kruger, 2008; Steyn et al.,
While all fish provide the body with protein, 2006). Dietary diversity thus prevents various
small fish like kapenta are a great source of forms of malnutrition, such as stunting, wasting
calcium when eaten with the bones. Livers and micronutrient deficiencies.
are the richest source of iron.
5. Cereals and starchy roots and tubers Basing diets on a variety of foods also reduces
provide carbohydrates which are a primary the risk of developing several NCDs such as
source of energy for the body. Whole cancers, and other diseases and even death
grain cereals are also a rich source of (Wirt and Collins, 2009). For example, individuals
fibre. Cereals also supply small amounts consuming a variety of nutritious foods from
of protein, vitamins and minerals while different food groups and within a food group are
orange-fleshed sweet potato and maize significantly less likely to die from cardiovascular
are rich in vitamin A and also contain diseases (CVDs) such as heart diseases and
some vitamin C, vitamin B6, potassium and stroke (Yu, Malik and Hu, 2018; WHO, 2017a).
manganese.
6. Milk and milk products: Although milk 5.4 HOW THE BODY BENEFITS FROM
contains sufficient amounts of calcium and EATING A VARIETY OF FOODS DAILY
protein, it is comparatively deficient in iron A diet based on a variety of healthy foods provides
and vitamin C, whereas fruits like oranges adequate nutrients and energy. Foods from plants
are relatively rich in vitamin C but deficient also contain bioactive non-nutrient compounds.
in protein. The most common biologically active non-
nutrient components are called phytochemicals
Since each food has only a few essential nutrients (Zhang, 2015). While phytochemicals are known
and not all the nutrients the body needs, eating a to be independently associated with improved
variety of food from each of the six food groups health and nutritional status, their effect is much
and a diverse combination of foods from within more pronounced when consumed in the form
the food group will help the body meet all the of whole plant-based foods than when isolated
essential nutrient requirements and prevent as single phytochemical compounds (Heneman
diseases, including NCDs. There are plenty of and Zidenberg-Cherr, 2008; Xi and Liu, 2016). The
options to choose from within each of the food proposed mechanisms for their beneficial health
groups. effects include their role in protecting body cells
from toxins found in the body, lipid and blood
Over three quarters of the foods should include sugar lowering effects, as well as strengthening
a variety of plant-based foods such as fruits, the body’s immune system (Yu, Malik and Hu,
vegetables, grains, tubers, pulses, nuts and 2018; Kris-Etherton et al., 2002).

19
Zambia Food-Based Dietary Guidelines

Eating a variety of foods also contributes to accompanied by poorly cooked vegetables


preventing both deficiencies or excesses of which have lost their nutrients. Consumption of
single nutrients (Smiciklas-Wright, Krebs-Smith, protein-rich foods, such as legumes, pulses, nuts
H., and Krebs-Smith, J., 1986) as well as reducing and animal sourced foods, which are also rich
the risk of exposure to contaminants in any in essential nutrients, is also quite low among
single food item, since toxicity increases with an Zambians.
increase in the amount of contaminated foods
consumed (Hodgson, Hsu Hage and Wahlqvist, However, Zambia is endowed with a wide
1994). variety of nutritious foods available throughout
the different seasons, including traditional and
5.5 DIETARY DIVERSITY AMONG ZAMBIANS underutilised foods on which individuals can
Evidence suggests most Zambians do not base their healthy diets (Mukuka, Simwanza and
base their diets on diverse foods (Mukuka, Tembo, 2009). Both individuals and communities
Simwanza and Tembo, 2009). The diet of most should take advantage of the diverse food
Zambians is monotonous, mostly dominated sources available, and choose a variety of locally
by maize-based foods such as nshima, which available foods that are relatively affordable
makes up most of the dietary calories for most (Baldermann et al., 2016). Dietary diversity
Zambian diets. Furthermore, most Zambians based on locally available foods contributes to
prefer highly processed maize flour (breakfast sustainable diets.
meal), which is low in nutrient density as it just
provides carbohydrates. The nshima is mostly

Figure 5: Examples of food commonly found in Zambia

20
Zambia Food-Based Dietary Guidelines

5.6 RECOMMENDATION & GUIDANCE


ON EATING A
VARIETY OF FOOD

1. Eat different types of food from each of the six food groups every day to stay strong
and healthy.
2. Make whole grain cereals, vegetables, fruits and beans and legumes a major part
of your meals daily.
3. Eat nutrient dense foods to get most of the nutrients your body needs with less
calories.
4. Eat whole or milled whole grains (cereals), starchy roots and tubers as part of your
meals every day for a healthy heart and weight
5. Eat plenty of different coloured vegetables every day to provide vitamins, minerals
and roughage to prevent diseases.
6. Eat different coloured fruits every day to provide vitamins and minerals to prevent
diseases.
7. Eat chicken and other poultry, fish, eggs, insects or caterpillars daily to build and
repair your body.
8. Eat beans, cowpeas, ground nuts, or nuts daily to maintain good health. All these
foods are rich sources of protein and a good substitute for meat.
9. Take milk and milk products or foods rich in calcium every day for healthy bones
and teeth.

21
Zambia Food-Based Dietary Guidelines

5.7 THE CORRECT AMOUNT TO EAT FROM the guidelines do not distinguish the serving
EACH OF THE SIX FOOD GROUPS size by individual needs. However, everyone
Eating a variety of foods from all the six food consuming the recommended amounts will be
groups daily and in the right amounts is part of a able to meet the minimum dietary requirements
healthy diet. Eating less than the recommended for optimal health and nutrition status, prevent
amounts from the food group can lead to overweight and obesity and reduce the risk of
malnutrition, such as underweight, stunting, and NCDs. Details of diet model intakes for other age
micronutrient deficiencies caused by a dietary groups and Kcal diets are found in Annex 1.
deficiency of certain vitamins and/or minerals.
Eating too much or less than the recommended 5.7.1 Global nutrient and food intake
amounts is also associated with diet-related recommendations
NCDs such as type 2 diabetes, some types of For each food group, recommended amounts
cancers and heart diseases. Thus, eating the to eat per day in order to get the nutrients
right amounts of each food increases a person’s that the body requires and to maintain good
chance of living a longer and healthier life. health are provided. The scientific basis for the
recommended amounts per day are based on
The amount of nutrients and food required global guidance on energy contributions from
varies according to an individual’s specific needs, macronutrients and the recommended amounts
mostly determined by the person’s gender, of different food groups summarised in Table 1,
age, height, weight, physical activity level and as well as the Zambia diet modelling taking into
physiological state. Since this is a guideline for account the Zambian context.
a healthy population based on a 2 100 Kcal diet,

Table 1: Summary of recommended global daily nutrient and food intake amounts

Summary of recommended global daily nutrient and food intake amounts


WCRF and
EAT-Lancet* GBD study FAO and WHO
Food groups and nutrients AICR
Grams (g) and/or percentage of total energy (%)

Carbohydrates <60% - - -

232 g
Whole grains >125 g 55-75% -
0-60%

Starchy vegetables:
50 (0-100) g - - -
potato and cassava

Dietary fibre - - >25 g >30 g

400-500 g >400 g
Vegetables (total) 300 (200-600) g 360 g (fruits and vege- (fruits and
tables) vegetables)
Dark Vegetables 100 g - - -
Red and Orange Vegetables 100 g - - -
Others Vegetables 100 g - - -

Fruits 200 (100-300) g 250 g - -

Milk (or equivalent) 250 (0-500) g >435 g - -

22
Zambia Food-Based Dietary Guidelines

Summary of recommended global daily nutrient and food intake amounts


WCRF and
EAT-Lancet* GBD study FAO and WHO
Food groups and nutrients AICR
Grams (g) and/or percentage of total energy (%)
8-12%
Adults: 0.83 kg
Protein 10% - -
per kg body
weight

Animal meat and animal


- - - -
products

300-500 g/
Beef, lamb (red meat) 7 (0-14) g <22.5 g - wk (cooked
weight)
<2 g
Pork 7 (0-14) g - -
(processed)
Chicken and other poultry 29 (0-58) g - - -
Eggs 13 (0-25) g - - -
>250 mg
Fish 28 (0-100) g 1-2 servings/wk -
(Omega-3)

Legumes, nuts and seeds Included in fruits


125 g - -
(total) and vegetables

>60 g
Pulses 50 (0-100) g - -
(legumes)
Soya products 25 (0-50) g - - -
>20.5 g
Peanuts 25 (0-75) g (nuts and - -
seeds)
Tree nuts 25 g - - -
15-30%
Fats - - -
(total energy)
Palm oil 6.8 (0.6.8) g - - -

Unsaturated fats 40 (20-80) g >11% (PUFA)** 6-10% -

Lard or tallow 5 (0-5) g <7% (SFA)** <10% (SFA)** -

<2.5g per day <10%


Sweeteners (all) 31 (0-31) g from 226.8 g <5% for added
of SSB benefits
<3 g/day 2 g/day (sodium)
Sodium - 24-hour uri- 5 g/day (sodium
nary sodium chloride)
*Based on 2 500 kcal g/d
**Polyunsaturated fatty acid (PUFA); saturated fatty acid (SFA); sugar-sweetened beverage (SSB)
References: FAO, 1998; WHO and FAO, 2002; WHO, 2020a; WHO, FAO and UNU, 2007; Willet et al., 2019; EAT-Lan-
cet, 2019; World Cancer Research Foundation (WCRF) and American Institute for Cancer Research (AICR), 2018;
Global Burden of Disease Study (GBD), 2017.

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Zambia Food-Based Dietary Guidelines

5.7.2 Zambia-specific nutrient and food intake There are no global harmonised standards for
recommendations what constitutes a serving size or recommended
To contextualise this global guidance on numbers of servings per day for most food
nutrient and food intakes for Zambia, a diet groups (FAO and FHI, 2016). Given this, the
model optimised a diet for the country by serving sizes for the Zambian FBDGs are based
taking into consideration consumption patterns on the serving sizes form other countries like
and commonly consumed foods among other the United States of America and Australia for
factors. The diet model provided Zambia-specific similar foods with Zambia. The serving sizes for
recommendations on total amounts of food to Zambia were further adapted to accommodate
eat per day for each food group, given in food commonly consumed local foods in Zambia.
weight, which were then divided into serving
sizes as outlined in Table 2. A serving size is a Each food group serving size has a Kcal range
standardised recommended amount of food to which, through diet modelling, estimates the
be eaten daily from each of the food groups. amounts in grams of common foods as per
Table 2. Determining the serving sizes also
5.7.3 Determinants of Zambian food group took into account the ease of converting these
serving sizes and amounts serving sizes into everyday household measures
The number of recommended servings depends and common portion sizes for the Zambian
on the physiological needs and physical activity population.
levels of the various population groups among
other factors. In Zambia, the majority of adults In these guidelines, a serving size is expressed
living in rural areas are physically active as they in Kcal and grams. The serving sizes will also
engage in farming and other manual labour be communicated to the public in everyday
activities, and rural women spend hours in household measures such as cups or hand
fetching water, firewood and other household measures to help with estimating the amount to
chores. In contrast, urban population would be be eaten per day.
considered less active given their white-collar
jobs. 5.7.4 Portion size versus serving size
A portion size is the amount of food individuals
A serving size for each food group is based on eat for a meal, snack or other eating occasions.
a standardised Kcal value set for that group. Depending on the amount of food a person eats
Through diet modelling, the linear program per meal, a portion can be bigger or smaller than a
optimised various combinations of food items, serving size. For example, a country can set half a
their foods weights and nutrient and energy cup of cooked rice as the serving size for starches.
density within the six foods groups to come However, a person can eat three-quarters of a
up with a proportion contribution of each cup of rice per meal which is their portion size.
food group to the total Kcal a day (2 100 Kcal Regardless of the portion size, individuals must
for the general population). The optimisation meet the daily serving size recommendations for
process determined the number of serving optimal health and to avoid eating too much or
sizes for each of the six food groups. The diet too little. General guidance and serving sizes for
modelling also considered energy and nutrient a healthy general population based on a 2 100
intake recommendations for the population Kcal diet are as shown in Table 3.
groups, affordability, ease of use and prevailing
portion sizes (the amount of food people usually
consume).

24
Zambia Food-Based Dietary Guidelines

Table 2: One serving size standard measure of different food groups

Food
Energy One serve equivalent
Food group weight
(common household measures)
(Kcal) (g)
Cereals • approximately 1 cup of rice, pasta, diced sweet potato
200 171
and tubers* and cassava, and ¾ cup cooked nshima
• one serving 1 cup milk or sour milk (245 g)
or
Dairy products 160 - • one ¾ cup or 1 small tin of yogurt (200g)
or
• four cubes of cheese (30g)
Fats and oil 125 - • one serving is about a tablespoon of cooking oil
• one medium banana or apple; or one large orange, or
peach; or two small tangerines, or peaches,
or
Fruits 80 135 • one cup cut fruit like papaya, mango or small fruit like
berries, grapes, masuku
or
• one quarter (1/4) cup baobab pulp
• two eggs (100 g)
or
• two matchbox sized ~60g red meat (beef, goat, sheep)
Meat, fish and
135 99 and insects
eggs
or
• three matchbox sized ~90g fish (kapenta); or poultry
(chicken, quails, duck); or rabbit
• one half cup of cooked beans, bambara nuts, soya
beans or cowpeas
or
Pulses, nuts
135 84 • three tablespoons of peanuts; or seeds like flax, chia,
and seeds
sunflower, pumpkin seeds
or
• one and half teaspoons peanut butter or flour
• one half cup cooked vegetable or
Vegetables 30 71
• one cup raw leafy or salad vegetables
*Select and combine foods from this food group to make the number of servings needed per day.

Note: Each food recommendation per food group has detailed food exchange list for one
serving size with Kcal, food weight and house measure

25
26
Table 3: Recommended serving size amounts and energy and nutrient contribution per food group for a healthy general population
based on a 2 100 Kcal diet

Recommended
Energy and nutrient values per serving^
amounts

Food group Car-


Total Energy† Protein Fat bohy- Ca Fe Zn Vit A* Retinol Folate Fibre
Number
food drates
Zambia Food-Based Dietary Guidelines

of serv-
weight
ings (mcg
(g) (Kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (g)
RAE)
IN TOTAL - 1558 2094 79 56 301 945 21 10 2364 966 518 32
Cereals
3.75** 559 781 17 2 168 65 2 2 317 0 57 9
and tubers

Dairy
1 248 124 7 7 8 230 0 1 63 60 19 0
products
Fats and oil 1 14 126 0 14 0 0 0 0 0 0 0 0
Fruits 2 291 189 2 3 36 52 2 0 283 0 74 6
Meat, fish and
1 99 149 20 7 1 45 4 2 957 907 89 1
eggs

Pulses, nuts and


2 181 425 21 22 32 53 5 3 4 0 151 10
seeds
Vegetables 3 222 131 12 1 15 496 8 1 739 0 126 5
The minimum cost of this food combination is approximately K14.95 (Kwacha)

^Provided by the diet model food combinations


*Measured in micrograms of retinol of activity equivalents (mcg RAE)
**Rounded to 4 servings
†Protein accounts for 15%, fat accounts for 24 % and carbohydrates account for 58% of the total energy amount
Zambia Food-Based Dietary Guidelines

5.7.5 Food amounts recommendations on the also be included in a diet. This is because, although
plate healthy fats are essential for various functions in
In general, over three-quarters of the foods eaten the body, they have a high calorie content and if
should include a variety of plant-based foods taken in large quantities may lead to overweight
which should form the basis of what we eat and obesity. FAO and WHO recommend that less
every day. Plant-based foods include vegetables, than 30 percent of total energy should come
fruits, grains, tubers, beans, pulses nuts and from fats and oils (WHO and FAO, 2002 and WHO
seeds. Small amounts of fish, poultry, eggs, mice 2018). This is about 70 g (five tablespoons of oils)
or insects should be added to meals as often as from all sources of fats and oils. Saturated fats
possible. Very small amounts of red meat could should be 10 percent or less of the total daily
be consumed occasionally or if possible avoided energy target. This is about 24 g (1.5 tablespoons)
completely. Milk and milk products should also from all sources. Industrial trans fatty acids found
be included in moderation. in ultra-processed foods and fried fast foods
increase coronary heart disease (CHD) risk factors
Finally, small amounts of foods that are rich and CHD events. There is no safe intake amount
in healthy (unsaturated) fats such as olive oil, for trans fats.
sunflower oil, canola oil, and rapeseed oil should

Figure 6: Proportion amounts of food groups that forms an healthy diet

27
Zambia Food-Based Dietary Guidelines

5.8 CONSIDER THE NUTRIENT DENSITY OF For example:


FOOD 1. Moringa leaves, black-jack, amaranth,
Consuming varied diets should be considered sweet potato leaves and okra are more
alongside nutrient density. A nutrient dense nutrient dense vegetables compared to
food has lots of nutrients with few calories. cabbage.
Nutrient dense foods are rich in vitamins, 2. Whole grain products are more nutrient
minerals, complex carbohydrates, lean protein dense than refined grain products.
and phytochemicals. Examples of nutrient dense
foods include fruits and vegetables, peas, beans, Thus, consuming nutrient dense foods is one
nuts, whole grains, fish, eggs, insects, etc. Less of the healthiest ways to eat, as it provides
nutrient dense foods include oils, fats, sugars, individuals with concentrated amounts of
salt and refined grains. valuable nutrients such as vitamins, minerals,
fibre, essential fatty acids, phytonutrients and
In addition, within each food group, there are lean protein for less calories.
foods that are more nutrient dense than others.
Nutrient dense foods are also called superfoods.

5.9: TIPS ON HOW TO CONSUME A VARIETY OF FOODS DAILY

Helpful Tips how to add variety to your diet

1. Choose a variety of in season local foods from all the six Zambian food groups. Fresh
produce that is in season is usually of a high nutritional quality and is affordable.
2. Make a meal with different coloured foods.
3. Rotate colours of food throughout the week. Try to add as many colours of vegetables
and fruits as possible.
4. Eat more mixed dishes. Add different types of pulses, vegetables and meats to
stews and relishes.
5. Eat nutrient dense foods. This is one of the healthiest ways to eat because these
foods give concentrated amounts of valuable nutrients such as vitamins, minerals,
fibre, essential fatty acids, phytonutrients and lean protein for less calories.
6. Plan meals in advance. Practice planning meals for the week in order to incorporate
different types of food into your diet.
7. Pay attention to the amount you eat per day from the different food groups.
8. Grow different types of food in a kitchen garden. Exchange vegetables with
neighbours for variety.
9. Raising small animals like chicken, ducks, quills or rabbits can provide more variety
and nutrients to a diet.
10. Enjoy eating homemade (cooked) meals and local dishes.
11. Eat together as a family or with friends.
12. Follow good food preparation and storage methods to maintain the best nutritional
qualities. For example, vegetables should not be overcooked or cooked in too much
water.
13. Choose whole foods such as whole fruit instead of industrially processed foods, like
fruit juice, which are rich in sugar. Choose minimally processed1 foods if processing
cannot be avoided.
1
Minimally processed foods are foods that have been subjected to cleaning, removal of inedible or unwanted parts, fractioning, grinding, drying,
fermentation, pasteurization, cooling, freezing or other processes that may subtract part of the food but which do not add oils, fats, sugar, salt
or other substances to the original food.

28
Overview of the Export Markets Zambia Food-Based Dietary Guidelines

Recommendation 2
Eat whole or milled
whole grains (cereals),
starchy roots and
tubers as part of meals
every day for a healthy
heart and weight

29
Zambia Food-Based Dietary Guidelines

6. RECOMMENDATION 2: Eat whole or


milled whole grains (cereals), starchy
roots and tubers as part of meals every
day for a healthy heart and weight.

6.1 GETTING TO KNOW WHOLE GRAINS, 6.1.2 What are whole grains?
STARCHY ROOTS AND TUBERS Whole grains are grains and grain products made
Grains or cereals include maize, rice, millet, from the entire grain seed, retaining all three
sorghum, wheat, barley, oats and rye. These parts of the grain (germ, endosperm and bran).
grains are usually processed into grain products An example of whole grain products include
such as flours, bread and pasta. roller meal, maize flour (mugaiwa), brown rice,
Starchy roots and tubers include cassava, yam, whole wheat flour or whole meal bread.
sweet potato, and Irish potatoes.
Plantains and breadfruit are also included in Refined grains are hulled grains. Refining grains
this food group due to their high carbohydrate usually removes the germ and outer layers
content. of the grain, thereby reducing the fibre and
micronutrients content (WCRF and AICR, 2018;
6.1.1 Foods not included in grains (cereals), Elia and Cummings, 2007). Examples of products
starchy roots and tubers with refined grains include white maize flour,
In the Zambian FBDGs, non-starchy roots like white bread, white bleached wheat flour and
carrot, ginger, beetroot and radish are classified white pasta.
as vegetables. Consequently, they are not
included under this food group.

30
Zambia Food-Based Dietary Guidelines

6.2 WHY ARE WHOLE GRAINS, OTHER and FAO, 2002). Furthermore, there is strong
CEREALS, STARCHY ROOTS AND TUBERS PART evidence that the consumption of whole grains
OF A HEALTHY DIET? probably protects against bowel (colorectal)
6.2.1 They are an important and main source cancer (WCRF and AICR, 2018).
of energy for the body
Whole grains, other 6.3.1 Dietary fibre has many important health
cereals, starchy roots benefits
and tubers are an Dietary fibre, also known as roughage, is the
important source part of plant foods that the body cannot digest
of carbohydrates. or absorb. Instead, dietary fibre passes through
Carbohydrates are the the stomach and the body nearly unchanged.
body's main fuel source. The brain and Although not a nutrient, fibre has many benefits
The body’s tissues other organs need for the body and is an essential part of a healthy
require a constant carbohydrates to diet.
supply of glucose, which function
is used as a fuel. The 1. Helps with bowel movement. Dietary
main source of glucose is dietary carbohydrate. fibre increases the weight and size of
the stool and softens it. A bulky stool is
The brain, kidneys, central nervous system easier to pass, and this can help prevent
and muscles need carbohydrates to function constipation. If one has loose, watery
properly. These carbohydrates are usually stored stools, fibre may help to solidify the stool
in the muscles and the liver, where they are later because it absorbs water and adds bulk.
used for energy. Carbohydrates also support 2. Helps maintain bowel health. A high-
other important body functions. fibre diet may lower the risk of developing
hemorrhoids. Studies have also found that
Carbohydrates are needed in large amounts a high-fibre diet reduces the chance of
by the body. According to WHO and FAO, over developing colorectal cancer.
half of the energy from food should come from 3. High amounts of fibre lower cholesterol
carbohydrates. These carbohydrates should be levels and help control blood sugar
in the form of whole grains, starchy roots and levels. Fibre slows the absorption of
tubers. carbohydrates, so it helps sugar to enter
the blood stream slowly. This can help
6.2.2 Whole grains supply the body with people with diabetes control their blood
vitamins, minerals, fibre and some proteins glucose levels. A diet high in fibre may
Since whole grain flours and products are also reduce the risk of developing type 2
produced without removing any part of the grain diabetes.
kernels, they contain vitamins, minerals and 4. Helps in achieving a healthy weight.
fibre. The bran, which is the outer layer of the High-fibre foods tend to be more filling,
grain, contains fibre, B vitamins, iron, copper, hence helping a person to eat less food.
zinc, magnesium, selenium, antioxidants and Fibre also helps one feel fuller for longer.
phytochemicals. The germ, which is the core 5. Helps one to live longer. Studies suggest
where the seed germinates, is rich in healthy that increasing dietary fibre intake —
fats, vitamin E, B vitamins, phytochemicals and especially cereal fibre — is associated with
antioxidants. When the grain is processed, only a reduced risk of dying from cardiovascular
the endosperm, which is the inner layer of the disease and all cancers.
grain, remains. The endosperm contains mainly 6. Whole grains also protect against dental
starch and very small amounts of protein, B caries as they require more mastication
vitamins and minerals. and stimulate increased saliva flow (WHO
and FAO, 2002).
6.3 THE RELATIONSHIP BETWEEN WHOLE
GRAINS INTAKE AND POSITIVE NUTRITION
AND HEALTH OUTCOMES
A high intake of whole grains and fibre from
grain sources has been associated with good
heart health, a reduced risk of type 2 diabetes
and overall mortality (Willet et al., 2019; WHO

31
Zambia Food-Based Dietary Guidelines

which are complex carbohydrates. Thus, eating


THE BEST FIBRE CHOICES whole grains will actually contribute to weight
loss. Starches, as complex carbohydrates, take
Whole grain cereals and their products a while to metabolise after eating and help
(wheat flour and unrefined maize or maintain a stable level of glucose in the body
sorghum) have a lot of fibre. Most fibre for several hours. Fibre promotes normal bowel
and vitamins are found on the outer movements, but contributes very few calories
surface of the grains. Whole grains to the diet. These types of carbohydrates are
are grain flours and products that are healthier and better than other carbohydrates.
produced without removing this outer Further, avoiding starchy foods in preference for
layer. animal source foods will not contribute to weight
loss. Gram for gram, carbohydrates contains the
same calories as protein, for example from ASF.
Other foods rich in fibre are vegetables,
Both protein and carbohydrates provide 4 Kcal
fruits, beans, peas, other legumes, nuts per 1 g. Gram for gram, carbohydrates contains
and seeds. less than half the calories of fat: 1 g of fat provides
9 Kcal. As explained in detail in the guidelines for
animal source foods, a high intake of ASF, such
6.3.2 Whole grains are important sources of
as meats, has negative health impacts. Only 10
vitamins, minerals and protein
percent of energy should come from protein
These vitamins and minerals have important
sources such as ASF (FAO and WHO, 2002; EAT
functions in the body. For example, B vitamins
Lancet, 2019).
help the body release energy from protein, fats
and carbohydrates. Minerals like iron help the
In addition, irrespective of the type of energy
body make haemoglobin (for red blood cells)
source (whether from starches, roots and tubers,
and myoglobin (for muscles), both of which help
legumes, animal source foods or fats), too much
carry and store oxygen. Iron also plays a role in
energy in the diet can lead to excess weight gain.
many other routine bodily functions. Magnesium
Other carbohydrates from sweets and sugars
is an essential mineral used in building bones
should be avoided as they are unhealthy. They
and teeth, converting food into energy, body
are discussed and appropriate guidance is
temperature regulation and releasing energy
provided in Chapter 16, under Guideline 8.
from muscles. Magnesium is also required for
hundreds of biochemical reactions, including the
6.5 ZAMBIA CONSUMPTION PATTERNS OF
transmission of nerve impulses. Magnesium and
CEREALS, STARCHY ROOTS AND TUBERS
selenium are important for maintaining a strong
Overall, the main source of dietary energy
immune system. Zinc is important for fighting off
for the Zambian population is from cereals
bacteria and viruses, helps in wound healing and
(Mwanamwenge and Harris, 2017), especially
also helps the body to make proteins and DNA.
maize (de Groote et al., 2019). At the provincial
Zinc is also essential for the proper functioning
level, starchy roots and tubers also make a
of senses of taste and smell.
significant contribution to the dietary energy
intake among households, particularly in the
6.4 MYTH BUSTERS!
Luapula and Northern provinces (Alaofè et al.,
Carbohydrates have a terrible reputation;
2014).
some people think starchy foods are fattening.
Contrary to what low-carb diets claim, consuming
whole grains together with vegetables and fruits
decreases the risk of weight gain, overweight
and obesity (WCRF and AICR, 2018). In addition, MYTH BUSTER
whole grains also have a lower glycemic index
than refined grains. Refined grains have a high Gram for gram, carbohydrates
glycemic index and provide more calories per contain the same calories as protein,
gram of food. for example from meats.

Although some people avoid carbohydrates Gram for gram, carbohydrates


fearing weight gain, the body needs carbohydrates contain less than half the
to function well. Cereals, especially whole grains, calories of fat.
starchy roots and tubers contain starch and fibre
32
Zambia Food-Based Dietary Guidelines

6.6 RECOMMENDED AMOUNTS TO EAT DAILY is 560 g, providing 995 kcal, which is 53 percent
For an optimum diet, FAO and WHO recommend for a 2 100 Kcal a day diet.
that 55 to 75 percent of total energy should
come from carbohydrates, while the EAT-Lancet 6.6.1 What does a typical serving size look like?
Commission recommends 60 percent of total A serving size is about one cup of rice, pasta, diced
energy should come from carbohydrates (FAO, sweet potato or cassava and a three-quarter cup
1998; FAO and WHO, 2002; Willet et al., 2019). of cooked nshima (nsima or ubwali), with an
Through diet modelling for Zambia, this translated average food weight of 170 g. A detailed single
to four servings of grains, starchy roots and serving size food exchange list with Kcal, food
tubers daily, making whole grain options a major weight and household measures are provided in
part of this food group. One serving is based on Table 4. Combine the foods listed below to make
~200 Kcal. The total amount for this food group four servings per day.

33
34
Table 4: One serving size equivalent for grains (cereals), starchy roots and tubers food exchange list

Food serving measure* Nutrient values per serving

Energy** Protein Folate Iron Calcium Zinc Fibre Vit A


Cooked foods
Grams
Cups Quantity
(g) (Kcal) (g) (mcg) (mg) (mg) (mg) (g) (mcg RAE)

Bread (thick slice) - 90 3 225 8 40.5 1.8 44.1 1.3 5.6 0

Bread rolls (white,


Zambia Food-Based Dietary Guidelines

- 75 3 200 6.8 21 0.9 19.5 0.6 2 0


small: 5x5cm)

Cassava (boiled,
1 132 - 210 1.6 21 0.9 56.5 0.4 2.5 1,7
diced)

Irish potato (boiled) 1.5 230 - 187 4.3 25.4 1.9 23.3 0.7 4.2 2.5

Nshima/pap (stiff) 3/4 161 - 210 5.3 1.6 0.2 3.2 0.2 2.1 0

Pasta 1 124 - 190 6.7 6.2 0.6 12.4 0,7 2 0

Potato chips/fries
- 70 - 223* 2.4 21 0.6 12.6 0.4 2,7 0
(fried)†

Rice 1 160 - 205 4.2 8.6 0.9 8 0.7 0.9 0

Sweet potato
1 200 - 225 2.9 65.5 2 51.9 0.7 6 6.1
(boiled)

Yams 1 170 - 230 3.4 29.7 1.4 43.9 1 7.3 4.2

*Based on the USDA 240ml cup measure and occasionally Australian FCTs; rounded values
**Based on the Zambia Diet Model FCT; rounded values
†Please note that one fast food order of chips has over double the amount of kcal (427 Kcal) for the same 150 g of other starchy foods. In
addition, chips have high a fat content which is discussed under the guideline to ‘’limit intake of oils, fats, salt and sugars”.
Zambia Food-Based Dietary Guidelines

6.7 RECOMMENDATIONS & GUIDANCE


ON EATING THE RIGHT AMOUNTS
OF CEREALS, STARCHY ROOTS
AND TUBERS
1. Include traditional grains like millet, sorghum and rice, and roots like potatoes,
sweet potatoes, and yams as part of the diet staples.
2. Choose whole grain cereal products like roller mealie meal, mgaiwa, whole meal
bread and brown rice to get the most nutrients and most health benefits.
3. Choose bio-fortified foods. Coloured grains like yellow maize, millet and sorghum
contain many other good nutrients for the body. For example, orange maize contains
a lot of vitamin A.
4. Choose flours fortified with vitamins and minerals.
5. Inspect grains before processing. If they look mouldy, discoloured or shrivelled,
discard them as they may contain harmful toxins.

6.8 TIPS ON ADDING WHOLE GRAINS TO A DIET AND EATING THE RIGHT AMOUNTS

Helpful Tips on how to add whole grains to a diet and eat


the right amounts

1. Make simple switches: Alternate starchy foods throughout the week. If ngaiwa
nshima is eaten on one day, sweet potatoes, cassava, rice or nshima from millet or
sorghum should be eaten the next day.
2. To make half of staple food whole grains, switch from a refined grain product to
a whole grain product. For example, eat ngaiwa or millet nshima and brown rice
rather than refined maize meal nshima or white rice. Choose whole wheat bread
instead of white bread.
3. Measure food to get the right amounts of the five servings a day and to avoid
overeating.
4. Mix whole grains with other dishes. Meals or snacks made of dried whole maize
mixed with beans or ground nuts are excellent ways of eating whole grains.
5. Make whole grain snacks: Popcorn, a whole grain, can be a healthy snack if made
with little or no added salt or oil. Roasted dried maize and boiled dried maize make
great snacks.
6. Porridge goodness: Whole grains make a good, healthy and wholesome breakfast
for the whole family. Porridge can be eaten alone or with added groundnuts or
legume flours.
7. Substitute bread for breakfast with roots such as cassava, sweet potatoes or yams.
8. Bake some whole grain goodness: Substituting part of the wheat flour with ngaiwa,
millet or oat flour when baking. There are plenty of recipes using whole grains.
9. Be a good role model for children. Set a good example for children by eating whole
grains every day as meals or snacks.
10. Be a smart shopper: Check the labels and ingredients list and chose products made
from whole grains.

35
Overview of the Export Markets
Zambia Food-Based Dietary Guidelines

Recommendation 3
Eat plenty of different
coloured vegetables
every day to provide
vitamins, minerals
and fibre to prevent
diseases

36
Zambia Food-Based Dietary Guidelines

7. RECOMMENDATION 3: Eat plenty of


different coloured vegetables every
day to provide vitamins, minerals and
fibre to prevent diseases.

7.1 ABOUT VEGETABLES leaves, amaranthus, pumpkin leaves, sweet


Vegetables are edible parts of a plant and they potato leaves, cassava leaves, black-jack leaves,
include leaves, flowers, some roots, stems and spinach, rape, kale and mustard greens.
fruits. Vegetables are a great source of vitamins,
minerals, dietary fibre and phytochemicals. Orange coloured vegetables. Orange and
yellow vegetables such as carrots, butternut,
7.2 DIFFERENT COLOURED VEGETABLES orange squash, pumpkin fruit and its flowers, and
AND THEIR UNIQUE NUTRIENTS red and yellow bell peppers (not when processed
Vegetables come in different colours, and into spices) are rich sources of vitamin A due to
each colour indicates an abundance of specific the carotenoids
important vitamins, minerals, dietary fibre that give these
and phytonutrients (plant compounds). Some vegetables
vegetables can be eaten raw, while some can orange, red and
only be eaten when cooked. Vegetables are yellow tints.
categorised as follows: These vegetables
are also rich in
Dark green leafy vegetables. These are rich vitamin C and
in vitamins A, B, C, K and folate, and minerals potassium.
such as iron, calcium, magnesium and fibre.
Examples include cowpea leaves, moringa
37
Zambia Food-Based Dietary Guidelines

Other vegetables. and healing wounds. Potassium is important for


These include root body fluid and blood pressure regulation and
vegetables like muscle and nerve control, while vitamin K helps
beetroot, radishes, the blood to clot.
onions and garlic;
fruit vegetables 7.3.1 Vegetables are low in calories and sodium
like lady’s fingers and are nutrient dense
okra, eggplant, Vegetables are low in calories and sodium, which
tomato, zucchini is important for good health. They are nutrient
(baby marrows), mushrooms, celery, cauliflower, dense, meaning they provide a lot of vitamins and
cucumber; and fresh seeds like green peas minerals but have very low calories compared to
and other green beans. These vegetables also other food groups. Most vegetables are naturally
provide a wide range of important nutrients low in fat and none have cholesterol.
and antioxidants that are high in dietary
fibre, as vegetables come in a wide variety of
colours, which reflects their varying nutritional
DID YOU KNOW?
Moringa is more nutrient dense than other foods. It
composition. Therefore, in order to maximise has 18 of the 20 amino acids including all the essential
the nutritional benefits of vegetables, it is amino acids as well as omega 3, 6 and 9.

recommended to combine different coloured


vegetables in every meal.

Foods that do not count as vegetables


Starchy roots and tubers like potato, sweet
potato, yam, cassava and taro are NOT part of
this food group. They are included in the grain,
roots and tubers group because they have a lot
of carbohydrates and are energy dense.

7.3 IMPORTANCE OF VEGETABLES IN A DIET


Vegetables are important components of a
healthy diet because they are a rich source of 7.3.2 Vegetables boost the body’s immune
vitamins and minerals, fibre, antioxidants and functions
phytochemicals. Eating plenty of vegetables boosts the body’s
immune system and helps to protect from
These vitamins include vitamin A, vitamin C, diseases and infections like colds and the flu.
vitamin K, vitamin B6, folate (vitamin B9), thiamin As detailed in the preceding section, vegetables
(vitamin B1) and niacin (vitamin B3). Vegetables are rich in vitamins, minerals, fibre and
are also important sources of minerals such as phytochemicals. The amounts of each of these
potassium, iron, dietary fibre, phytonutrients, components vary depending on the type, colour,
antioxidants and plant proteins. maturity, form of consumption (raw or cooked)
and preparation of the vegetables. Eating raw
Vitamin A, folate and iron are micronutrients vegetables results in more health benefits than
of public health importance in Zambia due to when they are cooked (FAO, WHO and UNU,
high deficiency rates. Folate is a key vitamin for 2004). Furthermore, consuming a variety of
cell development and is particularly important vegetables within the same meal results in many
during pregnancy to preventing neural tube more benefits than when they are individually
defects in infants, while vitamin B in general consumed (Leenders et al., 2013; Liu, 2003).
helps to release energy from food and supports
the nervous system. Vitamin A is important for 7.3.3 Vegetables are protective against non-
growth and development; it stimulates new cell communicable diseases
growth, keeps cells healthy, and is helpful for Several global sources of evidence indicate that
night vision and maintaining healthy skin, teeth eating a lot of vegetables and fruits (at least 400
and bones. It also supports proper functioning of g) daily helps to lower cholesterol levels and
the heart, lungs, kidneys and other organs, while blood pressure. In addition, vegetables reduce
vitamin C is important for the body’s immune the risk of obesity, heart disease, stroke, type
system by fighting infections, repairing the body 2 diabetes (sugar disease) and some types of
38
Zambia Food-Based Dietary Guidelines

cancers (WHO, 2020a; WCRF and AICR, 2018; prevention of diseases, including cancer,
GBD, 2017). heart diseases and intestinal problems like
constipation, and are important for the overall
7.3.4 Vegetables support weight loss and a health of the gastrointestinal system (Slavin and
healthy weight Lloyd, 2012). Some types of fibre are prebiotics
Additionally, vegetables are naturally low in and favour the growth of beneficial bacteria or
calories and are therefore not energy dense. probiotics in the colon. These bacteria ferment
Vegetables contain no cholesterol and have a the fibre, producing short chain fatty acids which
lot of fibre, which makes a person feel satisfied are a useful energy source for colon cells.
quickly and for longer periods. Due to their
low-calorie content and their filling effect while It should be emphasised that vegetables should
being healthy and nutritious, vegetables can form part of a varied diet, as described in the
significantly contribute towards the prevention preceding section, as other foods like whole
of overweight and obesity in Zambia. grains and fruits are also rich sources of fibre
and key micronutrients.
7.3.5 High consumption of vegetables is
associated with longevity 7.4.1 Most of the population in Zambia
Low consumption of vegetables and fruits is consume vegetables daily but not in enough
associated with mortality, and WHO estimated quantity
that in 2017, 3.9 million deaths worldwide were Vegetables are one of the most popular food
attributable to inadequate fruit and vegetable groups globally; they form the basis of diets
consumption. The majority of these deaths occur for many households across the world, Zambia
in low-income countries such as Zambia. Eating included.
vegetables is associated with a reduced likelihood
of developing several diet-related NCDs such In Zambia, most adults consume vegetables
as cancers, cardiovascular diseases, stroke as almost every day (WHO and MOH, 2017; Miller
well as a reduced risk of mortality (Liu, 2003; et al., 2016). However, the national average
Oyebode et al., 2014). Increased consumption of amount of vegetables consumed is low and
vegetables reduces body weight and therefore below the recommended amounts. The Zambian
indirectly contributes to a reduction in the risk adult population eat, on average, 2.1 servings of
of developing type 2 diabetes mellitus (Boeing et vegetables per day, with 90 percent consuming
al., 2012). The benefits of consuming vegetables less than the recommended amount of three
are dose dependent, therefore, increasing the servings (≥210 grams) (WHO and MOH, 2017)
amount and variety consumed is associated with with no marked differences between urban and
stronger beneficial effects. rural areas (Miller et al., 2016). These results
mean that everyone, whether young or old, living
7.4 THE SCIENTIFIC BASIS OF THE HEALTH in urban or rural areas should increase their daily
AND NUTRITIONAL BENEFITS OF EATING intake of vegetables. Considering the diversity of
PLENTY OF VEGETABLES vegetables available across the country all year
There are several potential mechanisms and round, either cultivated or wild, it is possible for
pathways for the protective action of vegetables. individuals to meet the recommendations while
The most common cited in the medical literature maintaining variety. Adequate vegetable intake
are related to their contribution of dietary can contribute to reducing and preventing
fibre, phytochemicals, low energy density and micronutrient deficiencies (WHO and FAO, 2002;
a wide range of vitamins and minerals (Boeing FAO and WHO, 2004). Micronutrient deficiencies
et al., 2012; Slavin, 2012). Phytochemicals in remain a public health problem in Zambia.
particular are singled out for their effects on Major deficiencies include iron, vitamin A and
the modulation of detoxification enzymes, zinc, especially among children and women.
antioxidant activities (removing dangerous free The main cause of micronutrient deficiencies is
radicals in the body), boosting of the immune low dietary intake of nutrient dense foods, such
system, and antibacterial, antiviral and blood as vegetables, and a lack of dietary diversity.
pressure lowering effects (Lampe, 1999). Consumption of a varied diet with plenty of
vegetables is the most sustainable approach
The different types of fibre, including insoluble to addressing micronutrient deficiencies. Dark
and soluble fibre, found in varying amounts green leafy vegetables are rich in vitamin A,
in different vegetables are essential for the iron and zinc. When these vegetables are
39
Zambia Food-Based Dietary Guidelines

prepared with vegetable oils, they significantly zinc from animal source foods. Consuming
contribute to vitamin A intake. The iron and vegetables together with vitamin C, such as
zinc in vegetables is not as readily available for citrus fruits, helps increase the absorption of
the body to use when compared to iron and iron (FAO, 2020).

7.5 RECOMMENDATIONS & GUIDANCE


ON EATING A VARIETY OF
VEGETABLES EVERY DAY

1. Choose different colours and varieties of vegetables: dark green, yellow, orange,
red, purple, etc. Each colour contributes different combinations of nutrients and
phytonutrients.
2. Choose fresh vegetables that are in season – they are packed with lots of nutrients.
3. Indigenous, naturally growing vegetables like amaranthus, black-jack, cassava,
pumpkin and sweet potato leaves are packed with nutrients and are healthy options.
4. Add a little bit of oil to green, orange and yellow coloured root and leafy vegetables
to maximise the benefits of their vitamins.
5. Always have vegetables as a side dish to meals and add vegetables to other dishes
or smoothies.
6. The following simple changes in preparing and cooking vegetables will help get the
best out of the vegetables and prevent the loss of nutrients and phytochemicals.
7. Eat raw vegetables as much as possible. Make salads or try to puree vegetables into
smoothies to drink.
◊ Cook vegetables for a very short time. Vitamins and minerals are destroyed
with over-cooking (over ten minutes).
◊ Do not add soda or ash to vegetables, as they destroy certain vitamins.
◊ Add 1 to 2 tablespoons of vegetable oil when cooking leafy green or yellow
vegetables. Oil helps with vitamin A absorption.
◊ Use minimum amounts of water when cooking vegetables. Cooking water
should not be discarded. The water can be used to make soup or drunk directly
for a good nutrient intake.
◊ Cook with a lid on the pot when steaming or boiling vegetables.
8. Wash vegetables before cutting them. Vitamins are lost when washing cut vegetables,
as seen from the water changing colour.
9. Use a sharp knife to cut fresh vegetables to avoid bruising them.
10. Cut off only the inedible parts of vegetables – sometimes the best nutrients are
found in the skin, just below the skin or in the leaves.
11. Wash, cut, peel, prepare and/or cook vegetables within a short time and eat the
vegetables within 30 minutes after preparation or cooking.
12. Vegetables protect against diseases when they are eaten as food and not taken as
supplements.

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Zambia Food-Based Dietary Guidelines

7.6 HOW MUCH VEGETABLES SHOULD A recommends 200 to 600 g, while the Global
PERSON EAT EVERY DAY? Burden of Disease Study (GBD) recommends
Many people in Zambia do not eat enough 360 g per day (WHO and FAO, 2002, GBD, 2017;
vegetables and fruits, and hence do not get WHO, 2020a; WCRF and AICR, 2018;Willet et al.,
enough vitamin A. Many children and women in 2019).
Zambia suffer from vitamin A deficiency.
Based on the Zambia diet model, the
WHO recommends the consumption of 400 recommendation for Zambia is at least three
to 500 g and World Cancer Research Fund servings (about 230 g) of vegetables every day.
recommends the consumption of over 400 g of One serving is between 70 to 80 g of vegetables.
fruits and vegetables per day. Just for vegetable A single serving size is similar to one of the
consumption, the EAT-Lancet Commission following household measures:

Figure 7: One serving equivalent of vegetable exchange list


Add or combine any of the vegetable measures below to make three servings per day for vegetables.
Each measure is listed as a one/single serving equivalent

One cup raw or


cooked hard
vegetables

Carrots, beet root, green peas, green beans, radishes, cabbage, broccoli,
celery, etc.

One cup raw


leafy, or soft
vegetables and
salads

Leafy: cowpeas, bean, pumpkin, sweet potato, cassava, moringa, okra and
baobab leaves amaranths, and black jack, Chinese cabbage, mustard greens,
soft mushrooms, egg plants, etc.

Half cup cooked


leafy and soft
vegetables

Leafy: cowpeas, bean, pumpkin, sweet potato, cassava, moringa, and okra
leaves amaranths, and black jack, Chinese cabbage, and mustard greens, soft;
mushrooms, egg plants, etc.

41
42
Table 5: One serving equivalent of vegetables exchange list

Food serving measure* Nutrient values per serving**

Food description Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Cups Grams Table-
(g) spoons
(Kcal) (mg) (mg) (mg) (mcg) (mg) (mg) (g)

Amaranth leaves
0.5 66 4 28.5 12.5 150.5 3.2 27.7 250.8 0.4 1
(boiled)
Zambia Food-Based Dietary Guidelines

Baobab leaves
(boiled, without - 80 5 59.4 16 313 2.5 39.2 250.7 0.6 6.1
salt)†
Black-jack leaves
0.5 70 5 42 68.6 630 38.2 - 154 0.4 1.68
(cooked)***
Butternut squash
0.5 103 7 41 15.5 571.9 0.6 19.5 42 0.1 3.3
(cubed)†
Carrot (raw,
1 128 9 52 7.6 1068.8 0.4 24.3 42 0.3 3.6
chopped)†
Cassava leaves,
0.5 80 5 81.2 13.1 216.4 3.5 49.6 220.9 0.4 3
(boiled, without salt)
Chinese cabbage
0.5 85 6 11.1 38.3 189.6 0.7 56.1 89.3 0.2 0.9
(cooked)†
Collard greens
0.5 95 6 20.9 3.9 49 0.6 - 122.6 - 1.6
(cooked)†
Cowpea leaves
0.5 80 5 34.9 19.2 113.6 3.2 54.3 212.3 0.3 3
(boiled, without salt)
Cucumber, with peel
1 104 7 16 2.9 5.2 0.3 7.3 16.6 0.2 0.5
(raw, sliced)†
Eggplant (cooked) 1 100 7 32 4.1 2.5 0.8 15.3 13.2 0.1 2.8
Food serving measure* Nutrient values per serving**

Food description Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Cups Grams Table-
(g) spoons
(Kcal) (mg) (mg) (mg) (mcg) (mg) (mg) (g)

Green beans (boiled) 0.5 62.5 4 27 7.3 15.4 0.6 22.9 30 0.2 1.7
Kale/rape (cooked)† 0.5 65 4 23 11.6 94.9 0.5 42.3 97.5 0.2 2.6

Moringa powder
2 tbs 10 2 32 1.73 1890^ 2.8 - 250 - 1.9
(raw)^

Moringa/drumstick
0.5 68 5 40.8 66.2 475.3 3.3 73.4 392 0.5 1.4
leaves (cooked)
Okra leaves (boiled) 0.5 80 5 34.1 12.1 42.5 0.4 49.6 237.6 0.6 4.1
Okra/lady’s fingers
0.5 80 5 18 13 11.2 0.2 36.8 62 0.3 2
(boiled)†
Onion (boiled, with-
0.5 80 5 36 3.4 0 0.2 8 23.2 0.2 1.8
out salt)
Onion (raw) 0.5 80 5 30 8.2 0 0.2 12.8 20.1 0.2 1.4
Pumpkin (cooked,
0.5 122 8 24.4 6 132 0.7 5.7 18.4 0.36 1.3
mashed)
Pumpkin leaves
1 71 5 21 3.3 129.2 1.3 13.5 252 0.1 1.8
(boiled)
Snow pea (cooked) 0.5 80 5 34 38.3 41.6 1.6 23.2 34 0,3 2.2
Spinach (boiled) 0.5 90 6 26 13.5 348.3 2.3 83.7 119.7 0.5 2.1
Sweet potato leaves
1 64 4 34 3.2 296.3 0.4 26.9 92 0.1 1.5
(boiled)
Swiss chard
0.5 87.5 6 16.6 26.3 267.8 1.6 12.3 44.6 0.3 1.4
(cooked)†

Tomato (raw) 0.5 74 5 16 21.9 38.5 0.4 15.7 9.6 0.5 1

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Zambia Food-Based Dietary Guidelines
44
Food serving measure* Nutrient values per serving**

Food description Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Cups Grams Table-
(g) spoons
(Kcal) (mg) (mg) (mg) (mcg) (mg) (mg) (g)

Tsunga/mustard
0.5 70 5 18.2 17.7 432.6 0.6 6.3 82.6 0.1 1.4
greens (boiled)†
Zucchini with skin
0.5 115 8 17.3 14.8 64.4 0.5 32.2 20.7 0.3 1.2
(cooked)†
Zambia Food-Based Dietary Guidelines

Zucchini without skin


& summer squash all 0.5 90 6 18 5 9.9 0.4 18 24.3 0.4 1.3
varieties (cooked)†
Consume two daily vegetable servings by choosing any of the foods above. Each food amount listed is the equivalent of one serving.
*USDA; rounded values
**Based on the Zambia Diet Model FCT unless otherwise stated; rounded values
***Based on the National Food and Nutrition Commission (2009)
†Based on the FDC (USDA, 2020), FCT and Food Exchange List
^Moringa Harvest (2021)
Zambia Food-Based Dietary Guidelines

7.7 TIPS ON INCREASING CONSUMPTION OF VEGETABLES

Helpful Tips on easily getting your three servings (230 g) of


vegetables per day

1. Select from plenty of tasty and colourful vegetables growing locally and wildly.
2. Plant vegetables around the house. A very small space can yield plenty of vegetables.
Some vegetables look beautiful in flower beds.
3. Dry vegetables when they are plenty and in season. Eat them during a lean season.
4. Buy fresh vegetables in season for better value – they are cheaper and fresher.
5. Apart from being a side dish to meals, make vegetables a part of breakfast and
snacks.
◊ Add vegetables to other dishes. Carrots, extra onions, green peas and
mushrooms make dishes colourful, tasty and nutritious.
◊ Add grated carrots, mushrooms and sliced tomatoes to breakfast meals or
omelets.
◊ Add vegetables to smoothies and homemade juices. Carrots, beetroot,
cucumber, celery or leafy vegetables are perfect ingredients for a smoothie.
6. Snack on vegetables. Carrots, cucumbers and celery make a quick and easy grab-
and-go snack. They are easily carried to work or school.
7. There are many ways to prepare, cook and eat vegetables: Stir frying, steaming,
boiling, grilling or baking them etc.
8. Cook different vegetables together and add herbs to make fresh vegetable stews or
homemade vegetable soups.
9. Make a plate or pot colourful with vegetables. Use different coloured vegetables to
decorate and add interest to meals.
10. Try something new – prepare new recipes and buy new vegetables as part of
shopping each month.

7.7.1 Types of vegetables to enjoy in small amounts

1. When you eat butternut and pumpkins, they should count as one serving of vegetables per day.
Although butternut and pumpkins are part of the vegetable group and are excellent sources of
vitamin A and other nutrients, they also contain some carbohydrates.
◊ Always eat butternut and pumpkins with other vegetables.
◊ 1 cup or more of butternut or pumpkin will count as one portion of vegetables. Get the two
remaining servings from other types of vegetables.
◊ For a low-calorie meal, use butternut or pumpkin to replace other starches like rice or
nshima.
2. Limit the intake of salted and fermented or pickled vegetables. These have been associated
with risk of some cancers. Therefore, limit the intake of these foods.
3. Potatoes are not vegetables because they are very high in starch. They belong to the roots
and tubers group.

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Overview of the Export Markets
Zambia Food-Based Dietary Guidelines

Recommendation 4
Eat two different
coloured fruits
every day to provide
vitamins and minerals
to prevent diseases

46
Zambia Food-Based Dietary Guidelines

8. RECOMMENDATION 4: Eat two


different coloured fruits every day
to provide vitamins and minerals to
prevent diseases.

8.1 DEFINITION OF A FRUIT and supporting immune and anti-oxidant


Fruits are the fleshy part around the seeds of a functions.
plant and usually have a sweet taste, although • Dark yellow and orange non-citrus fruits
some have a sour or bitter taste. such as mango, papaya and melons are
rich in carotenoids (pro-vitamin A).
Fruits are a very good source of several vitamins, • Red fruits like watermelon, red apples,
minerals, fibre, phytochemicals and antioxidants cranberries and strawberries contain the
(FAO and WHO, 2004). Fruits come in different powerful antioxidant lycopene.
types and colours, and each colour and type • Purple and blue fruits like plums, purple
indicate the different nutrient compositions grapes, black currants and blackberries
of specific important vitamins, minerals and contain antioxidants and anthocyanins.
phytonutrients (FAO, 2019). • Wild fruits like marula, sour fig, mobola
plum, baobab and snot apple are also good
8.2 THE UNIQUE TYPES AND COLOURS OF sources of anthocyanins and flavonoids.
FRUITS AND THEIR UNIQUE NUTRIENTS AND • Other coloured fruits also have unique
ANTIOXIDANTS FOR GOOD HEALTH micronutrients, phytochemicals and
• Citrus fruits and other sour fruits like powerful antioxidants. For example,
baobab and tamarind are rich sources bananas and white peaches contain
of vitamin C, important for growth, anthoxanthins and potassium, while
development, repairing of body tissues green fruits like green apple, avocado,
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Zambia Food-Based Dietary Guidelines

green grapes, kiwifruit and limes contain 8.4.2 Prevents vitamin A deficiency
chlorophyll and vitamin K. Avocado pears Dark yellow and orange non-citrus fruits are
also supply significant amounts of minerals rich in vitamin A in the form of carotenoids
such as zinc. (pro-vitamin A). Consuming these fruits and
other green and orange vegetables can meet
Since different coloured fruits offer varied types all vitamin A requirements without the need for
of nutrients and antioxidants, individuals should supplements.
choose from a wide variety of colours in order
to maximise the benefits of fruits for health and 8.4.3 Contributes to the prevention of iron and
nutritional status. micronutrient deficiencies
Fruits like bananas, pomegranates, mulberries,
8.3 THE SCIENTIFIC BASIS OF THE HEALTH apples and black currants are a rich source of
AND NUTRITIONAL BENEFITS OF EATING A iron. When eaten together as part of a meal,
LOT OF FRUITS as salads or soon after a meal, fruits, especially
There are several potential mechanisms and those rich in vitamin C which enhances the
pathways for the protective action of fruits. absorption of iron, contribute to the prevention
The most common ones cited in the medical of iron deficiency which is one of the public
literature are related to their contribution of health problems in Zambia. Citrus fruits, baobab
dietary fibre; phytochemicals; antioxidants (both and tamarind are rich sources of vitamin C.
from nutrients and non-nutrient sources) such
as flavonoids and carotenoids; a wide range of Some fruits, such as avocados or pears, also
vitamins and minerals; and low energy density supply significant amounts of minerals such as
(Slavin and Lloyd, 2012; Lampe, 1999). Vitamins zinc. Bananas and citrus fruits are good sources
found in fruits include vitamin A, vitamin C, B of potassium.
vitamins (including folate), vitamin E and vitamin
K. Minerals found in fruits include potassium, Thus, a diet high in fruits, consumed together with
calcium, magnesium and some iron. vegetables, would help reduce micronutrient
deficiencies which are a public health problem
8.4 FRUITS ARE ESSENTIAL IN PREVENTING in Zambia.
MICRONUTRIENT DEFICIENCIES AND
PROMOTING GOOD HEALTH 8.5 FRUITS ARE DIET-RELATED NON-
Fruits are rich sources of vitamin C and are also COMMUNICABLE DISEASE PROTECTIVE
good sources of vitamin A, B vitamins including Due to their fibre, micronutrient, phytochemical
folate, vitamin B6, thiamine and riboflavin. Fruits and antioxidant contents, fruits are important
also provide several minerals such as potassium, in the prevention of diet-related NCDs such as
calcium, iron and zinc (FAO, 2020). heart diseases, obesity, type 2 diabetes and
some cancers, as well as in helping to control
Some of the health benefits of fruits include: blood pressure (FAO, 2020).

8.4.1 Lowers risk of neural tube defects 8.5.1 Fruits protect a healthy heart
Folate (folic acid i.e. vitamin B9) helps to prevent The potassium in fruit can reduce the risk of
neural tube birth defects, anencephaly and spina heart disease and stroke. Fruits rich in potassium
bifida during pregnancy (WHO, 2012a). Folic acid include bananas, mango, melons, apples,
is critical during periods of rapid growth, such prunes, plums, pears, cantaloupe, honeydew and
as during pregnancy and foetal development, apricots. Potassium is linked to blood pressure
particularly during the first trimester. regulation due to its vasodilation properties.

Eating fruits such as oranges, tangerines, The fruits mentioned above, as well as berries,
bananas and peaches which are good sources of grapefruit and oranges, protect the heart and
folate, in addition to taking folate supplements are also rich in flavonoids, carotenoids, fibre and
a few months before and during pregnancy, is magnesium. These fruits also contain vitamin A,
very important. vitamin B6, vitamin C, vitamin E, vitamin K and
folate, all of which aid in regulating cholesterol
Folate also helps the body form red blood cells, levels and preventing diseases like strokes,
DNA and RNA, and is also involved in protein atherosclerosis and heart attacks.
metabolism.

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Zambia Food-Based Dietary Guidelines

Dietary fibre from fruits, as part of an overall fights skin disorders, and keeps teeth and gums
healthy diet, helps to reduce blood cholesterol healthy. Fruits also effectively promote healthy
levels. Fruits contain minimal sodium and have hair growth. Fruits like grapefruit and oranges
no harmful fats, hence they support a healthy are rich in calcium and vitamin K, both of which
heart. aid in maintaining healthy bones and improving
bone mineral density. Potassium may also help
Due to their fibrous composition, fruits have to decrease bone loss and reduce the risk of
anticarcinogenic properties and are known to developing kidney stones (FAO, 2017; Haddy,
prevent colon cancer. Vanhoutte, and Feletou, 2006).

8.5.2 Fruits are type 2 diabetes protective 8.6.3 Fruits support a healthy digestion
Fruits help with reducing the risk of type 2 Fruits have high quantities of water and dietary
diabetes as they have a low glycemic index (GI) fibre which help improve the functioning of the
and they help with controlling blood sugar levels. digestive tract, thereby reducing the chances of
Dietary fibre changes the consistency of stools constipation.
by increasing the bulk and water content of the
stool. Increasing the bulk of the stool distends 8.7 FRUITS AND VEGETABLES AS SEPARATE
the colon wall and stimulates the expulsion of FOOD GROUPS
the stools. The nutritional and health benefits of fruits are
similar but also differ to those of vegetables with
8.5.3 Fruits reduce the risk of some cancers respect to the quantity and types of bioactive
Antioxidants in fruits provide protection against components they contain, which is why it is
cell damage. They help repair the damage done important to consider them as different food
to body cells by free radicals and they have the groups.
ability to show hepatoprotective properties
which contribute to lowering the risk of some The benefits accrued to fruits are dose
cancers. Inadequate intake of fruits is among the dependent; the more volume and the wider
top ten risk factors of death in the world (WCRF the variety of fruits consumed the more the
and AICR, 2018). protective effect. Fruits, when considered
independently, have significant positive impacts
8.6 FRUITS ARE A HEALTHY OPTION FOR on human nutrition and health.
WEIGHT LOSS AND WEIGHT MANAGEMENT
Along with their relatively high nutrient density However, fruits should form part of a varied diet
and fibre content, fruits also have low calories that includes other food groups. For example,
(except the avocado pear) and can be consumed consuming fruits together with vegetables
in relatively large amounts without significantly significantly reduces the risk of diet-related
contributing to weight gain. Fibre also makes NCDs such as cardiovascular diseases, diabetes,
one full quickly and for longer, thereby reducing cancer, as well as premature mortality.
the amount of food consumed. Fruits do not
have saturated fats or cholesterol. Except for Further, the consumption of fruits in Zambia
a few, fruits are usually fat-free. Avocados and is lower than of vegetables, hence, given the
olives contain healthy (unsaturated) fats in small importance of fruits in a healthy diet, the TWG
amounts. agreed that fruits will be in their own food group.
Thus, as a food group, fruits would be given the
8.6.1 Fruits prevent infections and speed up attention and emphasis they require to increase
recovery from illness their consumption among Zambians.
Fruits are rich in vitamin C, which is a powerful
antioxidant. It provides support for healing the 8.7.1 Zambians do not eat enough fruits daily
common cold, wound healing, the prevention Fruit consumption levels in Zambia are low. In
of illness and inflammations, and speeds up Zambia, adults consume fruits only two days in a
recovery. Vitamin C also keeps the lymphatic week instead of daily, for an average of 57 g per
system healthy. day, which is one-fifth of the recommended two
servings a day (290 g).
8.6.2 Fruits support healthy skin, hair, teeth,
gums and bone health Consuming two or more servings of fruits a day is
Vitamin C is important for the growth and repair possible through homegrown produce, utilising
of all body tissues, helps heal cuts and wounds, wild edible fruits, capitalizing on fruits that are
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Zambia Food-Based Dietary Guidelines

in season, as well as those that are available for such as mangoes, guavas, oranges, and most
purchase. wild fruits such as masuku, chibuyu (baobab)
and busika (tamarind).
Some fruits, such as bananas, papaya and even
watermelons, are available throughout the year. * Fruit juices are not a part of this food group.
Enjoy an additional variety of in-season fruits

8.8 RECOMMENDATIONS & GUIDANCE


ON EATING A VARIETY OF
FRUITS EVERY DAY

1. Choose a variety of and different coloured fruits.


2. Eat the whole fruit including the skin (if it is edible) in order to maximise the benefits
of high fibre found in skin as well. Whole fruits add fibre, water and bulk, which
helps a person feel fuller on fewer calories.
3. Eat raw fruits for maximum nutritional benefits. Cooked, preserved or processed
fruits usually lose some important nutrients due to high heat and extended storage.
4. Smoothies made of whole fruit (fruit pulp + water) are a healthier option than fruit
juice. 100 percent fruit juice strips away the fibre leaving lots of natural fruit sugars.
Whole fruit smoothies should have no added sugars, artificial flavours, colours or
preservatives.
5. Choose fresh fruits when in season – they cost less and are of better value and
quality.
6. Eat wild edible fruits – they are packed with nutrients.
7. Avoid any forms of processed fruits such as fruit juices and dried fruits that have
concentrated sources of natural sugar and a lot more calories. Some bottled fruit
juices also have added sugar.
8. Fruits are protective against diseases when they are eaten as food and not taken as
supplements.

8.9 RECOMMENDED AMOUNTS OF FRUITS PER


DAY
WHO recommends the consumption of 400 g to
500 g fruits and vegetables while the World Cancer
Research Fund recommends over 400 g per day. The
EAT-Lancet Commission recommends consuming
100 g to 300 g of fruits daily, while GBD recommends
250 g per day (WHO and FAO, 2002; WHO, 2020a;
Willet et al., 2019; WCRF and AICR, 2018; GBD, 2017).

For Zambia, through diet modelling, individuals


should eat at least two fruits (about 300 g) per
day. One serving provides approximately 80 Kcal.
As fruits come in different sizes, one fruit serving
is about 150 g, about 1 cup, or one medium-sized
banana, apple, orange or mango. For small fruits,
the serving size can be two small tangerines, guavas,
peaches, plums, kiwi and apricot, or a handful of

50
Zambia Food-Based Dietary Guidelines

masuku, tamarind or baobab. For berries and the approximate amount of grams and Kcal per
diced fruits like papaya, watermelon and mango, serving.
one serving is equivalent to one cup.
Make two daily servings of each food group by
To further benefit from fruits, choose from a adding or combining any of the listed foods.
wide variety of fruits such as citrus fruits, wild Each food listed is one serving equivalent.
fruits like baobab and tamarind, and dark yellow
and orange non-citrus fruits such as mango, Consume two daily fruit servings by choosing
papaya and melons. Table 6 shows examples of any of the fruits listed below. Each food amount
various edible fruits found in Zambia as well as listed is one serving equivalent.

8.10 TIPS ON EATING AT LEAST TWO SERVINGS OF FRUIT A DAY

Helpful Tips on easily eating two fruits per day

1. Eat actual fruits as snacks, instead of fruit juices, sugary, salty or fatty snacks.
2. Leave fruits in plain sight for convenient snacking.
3. Pack fruits as an office or school lunch.
4. Plant fruit trees around the house and farm to get more and diversified fruits. This
will optimise the health and nutritional benefits of fruits.
5. Indigenous, naturally growing fruits (e.g. masuku, baobab, tamarind,) are healthy
options with many essential nutrients.
6. Try to eat different coloured fruits every day. Different colours in foods indicate
different nutrients and compounds that promote good health.
7. Choose fruits that are in season as they are fresher and cheaper.
8. When using canned or dried fruits and vegetables, avoid those with added sugar, salt
or oil.

51
52
Table 6: One serving equivalent of fruits exchange list

Food serving measure* Nutrient values per serving**


Food
description Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Cups Grams Quantity &
(g) size
(Kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)

Banana, white 1 medium;


- 120 120 13 5 <1 23 8.4 0.2 2.4
flesh 7-19cm long
Zambia Food-Based Dietary Guidelines

African locust
bean fruit, pulp - 30 - 86 67 58 1 - 34 0.28 3.6
(raw)

Apple, with skin 1 medium;


- 140 75 6 4 <1 4 8.4 <1 3.4
(raw) 7cm diameter

Apricot† 4 140 - 70 14 134 0.6 13 18.2 0.3 2.8

Baobab pulp† 45 - 136 111 2.6 2.5 - 124.1 <1 3.1

Diced fruit - e.g.


papaya and other
1 145 - 51.9 84 116 1 36.3 29.6 <1 2.8
cut fruit (raw,
ripe)

Gooseberries† 1 150 - 65 55 1.5 0.5 9 58.5 0.2 6.5

Granadilla/pas-
sion fruit (raw, - 90 5 87 27 58 1.4 13 10.8 0.1 9
without refuse)†

Grapes† 1 90 - 60.3 4 4.5 0.3 3.6 12.6 0 0.8


Food serving measure* Nutrient values per serving**
Food
description Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Cups Grams Quantity &
(g) size
(Kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)

Guava (raw, with-


2 110 - 65 287 39 <1 8 25.3 <1 6.2
out refuse)

Kiwifruit† 2 140 - 85 130 5.6 0.42 35 47.6 0.1 4.2

Mango, orange
1 165 - 106.2 60 276 1.1 41.7 28.5 <1 3.5
flesh (raw)
Masuku/wild
loquat (raw, with- 5 70†† 5†† 90 118 - 10.6 - 12 1.2 1.6
out refuse†††)

Mulberry† 1 140 - 60 51 1.4 2.6 8.4 54.6 0.2 2.4

1 large;
Orange - 185 7.5-8cm diam- 80 87 14 <1 62 57 <1 3.1
eter
Peach, yellow
- 175 1 large 70 12 28 0.4 7 10.5 <1 2.6
flesh†

Peach, sliced† 1 154 - 60 10 25 3.5 9.5 9.2 <1 2.3

Plum† 2 130 - 60 12 22 0.3 7 7.8 0.1 1.8

Pear† - 150 1 small 85 7 1.5 <1 11 13.5 <1 -

Tamarind (raw,
- 30 - 75 - 0.3 <1 5 45.3 <1 5.5
ripe)

53
Zambia Food-Based Dietary Guidelines
54
Food serving measure* Nutrient values per serving**
Food
description Energy Vit C Vit A Iron Folate Calcium Zinc Fibre
Cups Grams Quantity &
(g) size
(Kcal) (mg) (mcg) (mg) (mcg) (mg) (mg) (g)

Tangerines (5-6 2 small; 5-6cm


- 150 84 40 51 <1 24 55.5 <1 -
cm)† diameter
Watermelon,
1.5 230 - 67.2 17 96 <1 8.8 16.1 <1 0.8
(raw)
Zambia Food-Based Dietary Guidelines

Consume two daily fruit servings by choosing any of the foods above. Each food amount listed is the equivalent of one serving.
*USDA; rounded values
**Calculated from the Zambia Diet Model FCT unless otherwise stated; rounded values
†Values based on the USDA FCT
††One wild loquat =14g
†††Chawafambira et al., (2020). All other values (plain) are from the diet model Food Composition Table (FCT) derived from the West Africa
FCT
Overview of the Export Markets

Recommendation 5
Zambia Food-Based Dietary Guidelines

Eat pulses, beans,


cowpeas, ground nuts
or other nuts daily to
maintain good health
– they are rich sources
of protein and a good
substitute for meat

55
Zambia Food-Based Dietary Guidelines

9. Recommendation 5: Eat pulses,


beans, cowpeas, ground nuts or other
nuts daily to maintain good health. All
these foods are rich sources of protein
and a good substitute for meat.

9.1 GETTING TO KNOW PULSES, NUTS AND peas, black-eyed beans, green grams and lentils
SEEDS are pulses.
Nuts and seeds have similar nutritional
properties and health benefits to pulses and are Examples of nuts include dried groundnuts,
an essential part of a healthy diet. At the same peanuts, bambara nuts, mungongo nuts,
time, pulses, nuts and seeds also have unique walnuts, almonds, cashew nuts and their butters
essential nutrients. such as peanut butter.

Legumes refer to any plant from the Fabaceae Examples of seeds include pumpkin, sunflower,
family that would include its leaves, stems and chia, flaxseed, and sesame seeds.
pods. A pulse is the edible dried seed from a
legume plant, usually with seed pods that have
two halves. Pulses come in a range of types,
colours, shapes, flavours and textures. The dried
seeds of legumes like common beans, cowpeas,
peas, pigeon peas, lima beans, soya beans, chick
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Zambia Food-Based Dietary Guidelines

9.2 HEALTHY BENEFITS OF EATING PULSES, In a vegetarian diet, nuts and seeds contribute,
NUTS AND SEEDS among other things, zinc, selenium, iron, calcium
9.2.1 Pulses, nuts and seeds are a healthy and and vitamin B6, which can otherwise be difficult
sustainable alternative to animal source foods to get sufficient amounts of from other plant
Pulses are an affordable source of protein when sources (Konde et al., 2015).
compared to animal source foods (ASFs). Pulses
can be used as alternatives to ASFs. Pulses, when 9.3 KEY FUNCTIONS OF MICRONUTRIENTS
eaten together with nuts or grains, provide all OF PUBLIC HEALTH IMPORTANCE IN ZAMBIA
the essential amino acids the body needs. This Folate helps tissues grow, cells to work and
is because when combined, the essential amino helps form red blood cells, hence is key for
acids in pulses complement the amino acids anemia prevention; helps produce DNA; and
found in nuts or grains to provide all the essential works with vitamin B12 and vitamin C to help the
amino acids that ASFs provide. body break down, use and create new proteins.
Thus, folate is essential during pregnancy and
9.2.2 Pulses, nuts and seeds are key for the foetal development, specifically for preventing
prevention of micronutrient deficiencies and neural tube defects. High in folic acid, pulses
proper body function can improve brain function, and mental and
Pulses contain high amounts of protein, emotional health.
fibre (both insoluble and soluble) and are
rich in micronutrients, macronutrients and Iron: Pulses are a source of non-haem iron (iron
phytochemicals, all of which play important roles coming from plants) which is absorbed well
in maintaining health. Micronutrients found by the body, especially when eaten with foods
in pulses include iron, folate, vitamin E, zinc, rich in vitamin C, and thus is key for anemia
selenium, copper and manganese, all of which prevention. Iron also transports electrons within
are important antioxidants that can neutralise cells and is part of enzymes such as cytochromes
the effects of damaging agents in the body which transfer energy within cells.
(Polak, Phillips and Campbell, 2015).
Zinc is key for the proper functioning of the
Pulses have no cholesterol and are also body's immune system, for cell division, cell
naturally low in fat, and are good sources of growth and wound healing. Thus, zinc is essential
polyunsaturated and monounsaturated fatty during pregnancy, infancy and childhood as the
acids including linoleic and oleic acids (healthy body needs zinc to grow and develop properly.
fats). Pulses have moderate amounts of complex Zinc also enhances the action of insulin and the
carbohydrates and therefore provide the perfect breakdown of carbohydrates.
base for a nutritious and filling meal.
Calcium and manganese and other important
Pulses are also rich in bioactive components like nutrients in pulses promote the formation of
phytochemicals (phytoestrogens, phytosterols, strong bones and a healthy bone structure.
lycopene, lectins and phytic acid) (Singh et al.,
2017). These phytochemicals, which are found 9.4 PULSES, NUTS AND SEEDS AND THEIR
naturally in plants and act as antioxidants, RELATIONSHIP TO HEALTH
remove harmful free radicals in the body, thus 9.4.1 Protect against diet-related non-
lowering the risks of cancers and CVDs (WCRF communicable diseases
and AICR, 2018). Scientific evidence confirms that pulses, nuts and
seeds help protect against developing NCDs due
Nuts and seeds contain many important to the high non-starch polysaccharides (NSPs)
nutrients, such as protein; iron; zinc; folate they contain. Consumption of pulses contributes
and other B vitamins like thiamine, vitamin to a reduction in total energy intake and an
B6 and niacin; and vitamin E. Nuts and seeds improvement in micronutrient intake (WHO and
also contain minerals like magnesium, copper, FAO, 2002).
potassium and phosphorus. Certain nuts, like
Brazil nuts, can also contain very high amounts 9.4.2 Reduce the risk of heart disease
of selenium. Nuts and seeds contain healthy fats There is strong evidence that the protective
(monounsaturated and polyunsaturated fats), effects of pulses, nuts and seeds against heart
as well as several bioactive substances with a disease are provided through fibres that reduce
potential antioxidant effect. the plasma total and LDL cholesterol (WCRF and

57
Zambia Food-Based Dietary Guidelines

AICR, 2018; WHO and FAO, 2002). Pulses may and early adult life was inversely associated with
prevent sharp rises in blood sugar, which is also the risk of premenopausal breast cancer (WCRF
a risk factor for cardiovascular disease (Afshin et and AICR, 2018).
al., 2014). In addition, pulses are cholesterol-free
and low in fat. 9.5 PULSES ARE A HEALTHIER ALTERNATIVE
TO ASF AND ARE NCD PROTECTIVE
9.4.3 Control diabetes Replacing animal sourced proteins, especially
Plant-based foods, including pulses with complex processed red meat, with plant proteins is
carbohydrates which are rich in NSPs and high in associated with lower all-cause mortality and
fibre, have a low Glycemic Index (WHO and FAO, cardiovascular mortality (Song et al., 2016). A
2002). These pulses, nuts and seeds have the meta-analysis of 36 randomised controlled trials
potential to improve glycemic control in people also found that substituting plant-based proteins
with diabetes by providing a steady glucose like pulses for red meat reduced risk factors
release to regulate insulin in the blood (Mann, for cardiovascular disease (blood cholesterol,
2007). triglycerides, blood pressure) (Guasch-Ferré
et al., 2019). The intake of legumes is inversely
The fibres in legumes may especially help to lower associated with the risk of cardiovascular disease
blood cholesterol even without weight changes (Kaliwile, 2019; Liu, 2003; Van Duyn and Pivonka,
and may prevent sharp rises in blood sugar, 2000). Consumption of legumes at least four
both of which are risk factors for cardiovascular or more times a week was associated with a 22
disease (Boeing et al., 2012). percent lower risk of CVD (Flight, 2006; Hutchins,
2012).
9.4.4 Decrease the risk of obesity
A high intake of NSPs reduces the risk of 9.6 HOW NUTS AND SEEDS PROTECT THE
developing obesity (WHO and FAO, 2002). In BODY FROM NCDS.
addition, the soluble fibre makes one feel fuller Nuts and seeds reduce blood lipid
for longer thereby protecting against weight concentrations, oxidative stress, inflammation,
gain, overweight and obesity. visceral adiposity, hyperglycaemia and insulin
resistance. In addition, a high consumption of
In spite of the high energy content in nuts, there nuts has been associated with a reduced risk
is a link between the intake of nuts and seeds of cardiovascular disease and overall mortality,
and the ability to maintain weight and reduce the while replacing dairy foods with nuts and other
risk of obesity, as nuts strongly reduce hunger plant-source protein is likely to decrease overall
and induce satiety two to four hours after pulse and cardiovascular-related mortality (Johnsons
consumption (Afshin, 2014). et al., 2009).

9.4.5 Protect against cancers 9.7 PULSES, NUTS AND SEEDS ARE
World Cancer Research Fund concluded that A PROTEIN SOURCE FOR A HEALTHIER
there is strong evidence to show that eating ENVIRONMENT
foods containing dietary fibre like pulses, fruits, Generally, the production of plant-based foods
vegetables and whole grains protects against results in lower greenhouse gas emissions and
colorectal cancer (WCRF and AICR, 2018). uses less land and water than producing animal-
Further, the fibre and the prebiotics in pulses, based foods. Legumes release up to seven
nuts and seeds are the body’s natural digestive times less greenhouse gas emissions per area
regulators, thereby maintaining gut health. compared to other crops, and can sequester
carbon in soils. Pulses are water efficient and
In the case of the soya bean, it is linked to can also make their own nitrogen from the
reducing 11 types of cancers (WCRF and atmosphere, thus reducing the application of
AICR, 2018). Soya foods, which contain high nitrogen fertilizers. This leaves nitrogen-rich
concentrations of phytoestrogens, have weak residues in the soil after harvesting; a benefit for
oestrogenic effects which might block actions of the next crop planted in its place (Stagnari et al.,
endogenous oestrogens and thus reduce the risk 2017). Dry and uncooked pulses do not require
of breast cancer and other hormonally-related refrigeration and can be stored for a long time.
cancers. In the Shanghai Women's Health Study,
the consumption of soya foods during childhood

58
Zambia Food-Based Dietary Guidelines

9.8 RECOMMENDATIONS & GUIDANCE


ON EATING A VARIETY OF
PULSES, NUTS AND SEEDS

1. Eat a variety of pulses such as different types of beans, dry peas, cowpeas etc.
2. Eat a variety of seeds such as sunflower, chia, sesame, pumpkin and amaranth
grains, which are a good source of protein, healthy fat and micronutrients.
3. Make soya beans part of your pulses, nuts and seeds options.
4. Eat nuts and seeds as healthy snacks, rather than sugary, salty or fatty snacks.
5. Combine pulses with whole grains, nuts or seeds. Meals or snacks made up of
pulses mixed with nuts, seeds and whole grains are excellent ways of getting high
quality proteins from just plant-based foods.
6. Sort nuts before eating and throw away any that look mouldy, discoloured or
shrivelled. They may contain harmful toxins.
7. Eat beans and lentils with foods high in vitamin C (e.g. oranges, lemon juice or
baobab fruit). Vitamin C helps the body absorb iron from these foods.
8. Avoid drinking coffee or tea up to two hours after eating beans and lentils. Coffee
and tea can reduce the amount of iron and zinc absorbed by the body from these
foods.

9.9 HOW MUCH LEGUMES TO EAT PER DAY g (3 tablespoons). There are plenty of options
EAT-Lancet Commission recommends the to choose from in this food group to make two
consumption of 125 g of legumes, nuts and servings, as per the examples in Table 7. Each
seeds daily, while the Global Burden of Disease food amount in Table 7 is listed is one serving
Study indicates a daily consumption of over 60 equivalent. Chose any two or combine any food
g of legumes in order to reduce the risk of diet- from that table to make two servings
related diseases ( Willet et al. 2019; and GBD
2017). For vegetarians and those who are not eating
fish, insects and ASF, a single serving is 1 cup
For Zambia, through diet modelling, the (180 g) cooked dried pulses or 60 g nuts and
recommended amount is two servings of pulses, seeds. Taking two servings of pulses, nuts and
nuts and seeds every day. One serving is an seeds will ensure an adequate intake of proteins
average that provides 120 Kcal (100 to 140 Kcal) and other micronutrients that fish, insects and
which is about 90 g or half a cup for pulses. ASF provide.
For nuts and seeds, a serving is about 27 to 30

59
60
Table 7: One serving equivalent of pulses, nuts and seeds exchange list

Food serving measure* Nutrient values per serving**

Food description Energy Protein Iron Folate Calcium Zinc Fibre


Cups** Grams Table-
(g) spoons (Kcal) (g) (mg) (mcg) (mg) (mg) (g)

Bambara nuts
0.5 90 - 125 6.7 0.9 - 18.5 1 1.3
(boiled)
Cowpeas 0.5 80 - 94 6.3 1.8 61.8 20.6 1.2 4.5
Zambia Food-Based Dietary Guidelines

Peanut butter† - 24 1.5 134 5.3 0.5 8.4 13 0.6 1.4

Peanuts (dry roasted)† - 27 3 159 6.5 0.4 26.2 0.96 0.756 2.3

Peanuts (raw)† - 27 3 153 7 1.3 64.8 24.8 0.9 2.3

Pumpkin and squash


- 30 3 145† 9 2.6 17.4 13.8 2.3 1.8
seeds (shelled, dried)†

Red kidney beans


0.5 90 - 111 8.6 2.5 66.6 39.6 0.81 8.4
(boiled)†

Seeds, flax , chia sun- 1-


- 25-30 3 145-175 4.8-5.7 59-71 1.3 - 1.6 13-1.6 2.8-3.3
flower (roasted)† 1.14

Soya beans 0.5 85 - 151 11.8 2.4 69.7 72.7 1.6 3.4
White beans 0.5 90 111 7.4 1.6 65.7 20.7 1.1 3.4
Consume two daily servings of pulses, nuts and seeds by choosing any of the foods above. Each food amount listed is the equivalent of one
serving.
*Zambia Diet Model FCT unless otherwise stated; rounded values
**USDA; rounded values
†Values based on the USDA FCT
Zambia Food-Based Dietary Guidelines

9.10 TIPS ON INCREASING INTAKE OF PULSES, NUTS AND SEEDS

Helpful Tips to eating more pulses nuts or seeds daily

1. Mix pulses with whole grains, nuts or seeds to make powerful combinations of
plant-based proteins.
2. Adding beans, peas and lentils to soups, stews and starchy dishes is an excellent
way to add pulses to the diet.
3. Porridge goodness: Mixed whole grain, pulse, nut or seed flours make a good,
healthy and whole some breakfast for the whole family.
4. Powders made from nuts and seeds can be added to foods as condiments.
5. Use pulses, nuts and seed in baked goods – either whole or as a flour.
6. Soak beans and lentils overnight and rinse with fresh water before cooking. This
reduces cooking times.
7. Soak pulses before cooking to reduce stomach gas and to make iron more available
for absorption.
8. Add vitamin C-rich foods to meals when eating beans, peas and lentils. Vitamin C
helps the body absorb iron.
9. Use nut butters (e.g. peanut butter and almond butter) as a spread for bread rather
than hard margarine and butter, which are unhealthy.
10. If possible, grow beans, nuts and seeds sustainably.

61
Overview of the Export Markets
Zambia Food-Based Dietary Guidelines

Recommendation 6
Eat fish, insects or
animal source foods
daily

62
Zambia Food-Based Dietary Guidelines

10. RECOMMENDATION 6: Eat fish,


insects or animal source foods daily.

10.1 A CLOSER LOOK: FISH, EGGS, INSECTS modified through salting, curing, smoking,
AND ANIMAL SOURCE FOODS drying or other processes to preserve them
This group includes eggs, fish, insects and ASFs. or enhance their flavour. Examples include
ASFs refer to meats (muscles or organs) from hot dogs, sausages, bacon and luncheon
mammals, including mice, poultry, birds, frogs meats such as bologna, salami, polony,
and reptiles, that are consumed as food. Meats corned or canned meats, deli meat cuts
are categorised as white and red meat based on and ready-to-eat sausages.
their health and risk factors. White meat includes
poultry i.e. chicken, quails, ducks, guinea fowls, 10.2 IMPORTANCE OF EATING FISH, EGGS
rabbits, etc. Red meat includes beef, goat, lamb, AND ASF
mutton, veal, pork and horse. Fish, eggs and ASFs are a very good source of
complete protein, meaning they provides all
10.1.1 Foods not included in this food group nine essential amino acids. ASFs also have
• Milk and milk products have their own high amounts of vitamin B12 and other B
distinct food group because of their vitamins, as well as vitamin D, omega-3 fatty acid
essential functions related to calcium. docosahexaenoic acid (DHA), heme-iron, zinc and
• Animal products such as butter, ghee and selenium, in addition to other micronutrients. For
lard are excluded from this group and are example, one serving (100 g) of fish like tilapia
classified as fats and oils because of their contains 26 g of protein, a cooked chicken breast
high fat content. contains about 31 g and lean beef contains
• Ultra-processed meats are not part of this about 27 g, while two eggs provide about 13 g
food group due to their risk factors. Ultra- of protein. The recommended daily amount of
processed meats are meats that have been
63
Zambia Food-Based Dietary Guidelines

protein is 0.83 g per kilogram (kg) body weight White meat like poultry, when eaten without the
for proteins with a protein digestibility-corrected skin, is lower in saturated fat but is abundant in
amino acid score (PDCAAS) value of 1.0. Thus, the good polyunsaturated and monounsaturated
recommended daily intake of protein works out fatty acids like omega-3 and omega-6 fatty acids,
to 50 g for a man/woman with a body weight of which help to reduce the 'bad cholesterol' like
60 kg. Extra protein is required for pregnancy and low-density lipoprotein (LDL) and increase the
lactation (Leenders et al., 2013). This shows that 'good cholesterol' like high-density lipoprotein
small quantities such as 100 g of ASF, combined (HDL) (Bowen, Harris and Etherton, 2016; Farell,
with other sources of protein like pulses, grains, 2012). Further, chicken meat does not contain
nuts and seeds, will be adequate to provide the trans fats, unlike red meat (Farell, 2012).
protein and amino acids requirements to sustain
life. Red meat contains higher levels of total fat,
including bad fats such as saturated fats and
A human body requires around 20 essential and trans fats. Saturated fats can increase the bad
non-essential amino acids to build proteins. ASF, cholesterol (LDL), causing a risk of heart disease
fish, eggs and mice contain all essential amino and stroke. Trans fats increase CVD risk factors
acids that the body needs to function effectively. and diabetes (WHO and FAO, 2002; GBD, 2017).
While the body is able to produce non-essential
amino acids, essential amino acids need to come 10.4 LIMIT THE INTAKE OF RED MEAT AND
from food sources as the body is not able to PROCESSED MEATS TO REDUCE THE RISK OF
make them. DISEASES
Consuming too much meat, specifically red
ASFs also contain some nutrients not found in meat containing saturated fat which increases
plant sources or that are highly bio-available the bad cholesterol (LDL), can increase the risk
compared to plant sources. Vitamin B12 is mainly of diseases such as heart diseases and strokes
found in fish, poultry meat and dairy products. (WHO, 2015), type 2 diabetes, certain types of
Not consuming ASF can lead to vitamin B12 cancers, and weight gain and mortality (Abete et
deficiency. Vitamin D is found in oily fish, eggs al., 2014; Bernstein et al., 2010). However, even
and dairy. Some plants contain vitamin D, but with the same number of servings of red meat,
the body better utilises vitamin D found in ASFs. the consumption of fish, poultry, dairy products
Heme-iron is predominantly found in meat, and especially nuts were associated with a lower
especially red meat, which is easily absorbed in risk of diseases (IARC, 2015; WHO, 2015).
the body. Zinc is mainly found in animal protein
sources such as meat, and is also more easily Processed meats are meats processed or
absorbed and used from animal protein sources preserved by smoking, curing, salting or by
than plant sources. DHA is an essential omega-3 adding chemical preservatives. Examples include
fat found in fatty fish. It is important for brain bacon and hot dogs. Processed meats are
health and is difficult to get from plant sources. linked to cancer. In 2015, WHO placed the risk
of eating processed meat in the same category
10.3 WHITE MEAT IS A HEALTHIER MEAT as smoking, which could be attributable to the
OPTION THAN RED MEAT amount of nitrates found in processed meats.
As the name suggests, red meat from beef, goat, Processed meats also have a very high sodium
lamb, mutton, veal, pork and horses is red in content.
colour because it contains a large amount of
myoglobin, a muscle pigment. White meat from Therefore, adopting a diet containing a reduced
poultry, such as chicken, quails, ducks, guinea amount of meat, especially red meat, and
fowls and rabbit, is white in colour because it limiting/avoiding processed meat products is
has a lower concentration of myoglobin. The ideal. Select fish, insects, eggs or white meat
nutrient content differs slightly between red and daily as healthier options, rather than red
white meats. Red meat contains higher levels of meat, for this food group. If you eat red meat,
iron, zinc and B vitamins (thiamine, riboflavin limit consumption to 160 g per week and avoid
and vitamins B6 and B12) than white meat. processed meats. The Global Burden of Disease
Study defines exposure to a diet high in red meat
However, the biggest difference between red (beef, pork, lamb and goat but excluding poultry,
and white meat is the fat content. White meat is a fish, eggs and all processed meats) as an average
leaner source of protein, with a lower fat content. daily consumption greater than 22.5 g. The GBD

64
Zambia Food-Based Dietary Guidelines

defines exposure to a diet high in processed meat, it does not provide saturated fatty acids
meats as an average daily consumption of (SFAs) (WHO and FAO, 2002). Eating eggs does
greater than 2 g of ultra-processed meat (GBD, not seem to raise cholesterol levels the way
2017). other cholesterol-containing foods do, such as
trans fats and saturated fats.
10.5 THE ROLE OF LIVER AND KIDNEY IN
ADDRESSING IRON DEFICIENCY In the past, there have been concerns about
Iron deficiency anaemia is a serious public health possible increases in the risk of heart disease
problem that particularly affects young children because of the high content of cholesterol
and pregnant women. Iron is required by the in eggs. However, a large meta-analysis of
body to make haemoglobin. Haemoglobin is prospective cohort studies concluded that
found in the red blood cells and helps in the “higher consumption of eggs (up to one egg
transport of oxygen around the body. Iron also per day) is not associated with increased risk of
helps in the production of energy throughout the CHD or stroke, except among diabetic patients”
body. Liver and kidney meats are nutrient dense (Rong et al., 2013). Another recent meta-analysis
and rich sources of iron. About one serving (100 showed that consumption of up to one egg daily
g) of beef liver provides about 13 mg/100 g of may contribute to a decreased total risk of stroke,
iron, while one serving of beef kidney provides and that a daily egg intake does not appear to be
about 7 mg of iron. The recommended daily associated with a risk of CHD (Alexander et al.,
allowances for the general population aged 19 2016).
to 50 years is 8 mg per day for men and 18 mg
per day for women (NIH, 2021; FAO and WHO, However, if eggs are eaten daily, limit
2011). consumption of eggs to one egg per day since
studies have found that each additional half
Women need more iron than men during their egg consumed per day was tied to an 8 percent
reproductive age because of menstruation and greater risk of death from all causes, and each
to build stores for childbearing. (Ka He et al., extra 300 mg of cholesterol was linked to an 18
2004) percent higher risk of premature death (Zhong
et al., 2019).
10.6 FISH, INSECTS AND WHITE MEAT ARE
HEALTHIER AND SUSTAINABLE OPTIONS. 10.6.3 White meat
Fish, insects, eggs and white meat are healthier One of the conclusions from a meta-
and sustainable options in the following ways: analysis of 13 prospective cohort studies of
1 674 272 individuals by Abete et al., (2014)
10.6.1 Fish stated that “white meat consumption might be
Fish and insects are the healthiest options of the ‘healthy’ alternative to red and processed
ASF. People who eat fish regularly are also likely meat consumption”. This is because even with
to have a lower risk of heart attacks, strokes and the same number of servings of red meat, the
death from heart disease. One study of more consumption of fish, poultry, dairy products
than 40 000 men found that those who regularly and especially nuts was associated with a
ate one or more servings of fish per week had lower risk of heart diseases like stroke, type 2
a 15 percent lower risk of heart disease (Ka He, diabetes, certain types of cancer, weight gain
2004). It is recommended to eat fish several and mortality (Abete et al., 2014; IARC, 2015).
days a week with at least two servings (200 g) of
oily fish per week. In addition, make small fish
eaten with bones a major part of the fish options
chosen per week.

10.6.2 Eggs
Eggs are a source of high-quality protein, essential
fatty acids and other essential nutrients, and
they are relatively low cost and nutrient dense
which is beneficial for low-income populations
with a poor quality of diet (Alexander et al. 2016
and Willett et al., 2019). Egg yolk is particularly
rich in cholesterol but unlike dairy products and
65
Zambia Food-Based Dietary Guidelines

Further, a meta-analysis of 22 studies globally environment compared to ASF. Insects do not


showed an inverse association between white require much land to reproduce and require less
meat consumption and all-cause mortality and a feed resources, as they have a feed conversion
neutral association with CVDs and mortality and efficiency where they can convert 2 kg of feed
morbidity (Alexander et al., 2016). into 1 kg of insect mass (FAO, 2013). Insects like
crickets require about 2 000 times less water
10.6.4 Edible insects than beef and produce less greenhouse gas
Insects are good sources of complete protein emissions.
and high levels of vitamin B12, iron, zinc, fibre,
essential amino acids, omega-3 and omega-6 fatty
acids, and antioxidants. Insects contain higher
amounts of proteins, hence they provide more
essential amino acids compared to traditional
sources of proteins, such as meat, dairy
products and seeds, on the same weight basis
(Defoliart, 2002; Banjo, Lawal and Songonuga,
2006; Cerritos, 2009; Siulapwa, 2014; Oibiokpa
et al., 2018). Insects contain between 12 g and
77 g of protein per 100 g (Xiaoming et al., 2010)
while fish, chicken and beef contain between 13
g and 31 g protein. Protein digestibility of insects
ranges from 76 percent to 98 percent (Ramos-
Elorduy, 1997).

Studies have shown that in some insects


like crickets, grasshoppers and mealworms,
micronutrients like copper, zinc, manganese,
magnesium and calcium were more readily
available for absorption than the same nutrients
found in beef. Some insects like crickets contain
more omega-6 and omega-3 than beef. Insects
also contain comparatively high amounts of iron,
zinc, manganese, selenium and phosphorus
(Rumpold and Schluter, 2013).

Farming insects and including them in the diet


is not only good for nutrition but also for the
environment. Insects are a very sustainable Image courtesy of Western Exterminator company
source of protein with less impact on the (https://www.westernexterminator.com)

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Zambia Food-Based Dietary Guidelines

10.7 RECOMMENDATIONS & GUIDANCE


ON EATING A VARIETY OF
FISH, INSECTS OR ANIMAL
SOURCE FOODS
1. Eat fish, including oily and small fish eaten with bones, as often as possible per
week.
2. Choose insects, white meat like poultry, rabbits, mice or eggs as healthier options
instead of red meats.
3. If red meat such as beef, goat and lamb is eaten, cut consumption down to less than
160 g or the equivalent of 2 servings a week to help protect against heart diseases
and some cancers.
4. Avoid charring meat while cooking. High-temperature cooking, like grilling, can form
carcinogenic (cancer-causing) compounds in the meat.
5. Avoid ultra-processed meat like polony, bacon, ham, salami, sausages and hot dog.

10.8 RECOMMENDED AMOUNTS OF FISH, However, most Zambians in urban areas eat
INSECTS OR ANIMAL SOURCE FOODS more meat than the body requires, which can
The body only needs small amounts of protein lead to weight gain, obesity and heart disease.
for its function. For example, an adult requires To enjoy the nutritional benefits of meat, poultry
0.83 kg proteins per 1 kg body weight (WHO, or fish without compromising your health, eat
FAO and UNU, 2007). This translates to 46 g of no more than the recommended one serving
protein for a 55 kg woman and 58 g of protein amount per day.
for a 70 kg man. In addition, FAO and WHO,
2002 recommend that 8 to 12 percent of total For Zambia, in order to get the benefits from
energy should come from protein food sources, ASFs without overeating, it is recommended that
include pulses. Thus, very small portions of individuals eat one serving of fish, insects or ASF
chicken, other poultry or meat will meet daily per day. One standard serving from this group
requirements for protein or other essential provides about 135 Kcal per day, except for
nutrients found in these foods, as shown in some insects. Eat one serving daily by choosing
Table 8. any one of the foods listed in Table 8. Each food
amount listed is one serving equivalent.

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68
Table 8: One serving equivalents of fish, eggs, insects and ASF exchange list

Food serving
Nutrient values per serving*
measure*

Food description
Energy Protein Iron Folate Zinc B12 Calcium
Grams
(g)
(Kcal) (g) (mg) (mcg) (mg) (mg) (g)

Beef meat, lean (boiled,


65 137 23 2.3 5.2 4 0.9 4.6
without salt)*
Zambia Food-Based Dietary Guidelines

Chicken liver (braised,


80 135 22 9.6 596.8 3.5 19.2 12
without salt)

Chicken meat, light flesh


95 135 29.5 0.6 5.7 1 0.2 9.5
(boiled, without salt)

Eggs [2 large] (hard-


100 135 12.6 1.7 38 1.2 0.7 53
boiled)

Flying ant 50 257** 21 11 47 4.9 - 56

Goat meat (boiled, with-


65 135 17 2.3 2.9 3.3 0.7 8.3
out salt)

Grasshopper, locust and


50 217 27 13 185 6.9 6 122
cricket (dry)

Grasshopper (cooked) 100 145 21 5 - - - -


Food serving
Nutrient values per serving*
measure*

Food description
Energy Protein Iron Folate Zinc B12 Calcium
Grams
(g)
(Kcal) (g) (mg) (mcg) (mg) (mg) (g)

Kapenta/anchovy
85 135 23.5 3.2 6 2.2 0.7 109.7
(steamed)

Kapenta/kapenta powder
50 104 33 4.5 - 7 - 398
(dry)†††

Mole cricket (blanched) 105 137 16 44 - - - 79.8

Mopane worm (cooked) 140 135 19.7 9.8 5 4.5 7 54

Rabbit meat (stewed or


70 135 22 1.2 3 1.7 7 13.3
grilled)

Tilapia (steamed, without


115 135 25.4 1.4 23 1.1 1.7 23
salt)

Consume one daily serving of fish, eggs, insects and ASFs by choosing any of the foods above. Each food amount listed is the equivalent
of one serving.

*Zambia Diet Model FCT; USDA FCT; West Africa FCT; rounded values
Other sources: Steiner-Asiedu et al.,1993; Hlongwane Z.T. et al., 2020; Huis et al., 2013

Note: To match and reach an adequate intake of the key nutrients, the quantity gives a higher than targeted energy. Where fields are
blank, no value was available in the food composition table.

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Zambia Food-Based Dietary Guidelines

10.9 TIPS ON CONSUMING FISH, EGGS, INSECTS AND ASF

Helpful Tips on healthier consumption of fish, eggs, insects


and ASF

1. Make a few meals meatless per week. An extra portion of dried beans and peas
(legumes) are a good substitute for meat.
2. Eat fish as often as possible, including oily fish and small fish eaten with bones. This
is because fish is possibly the healthiest form of white meat. Watch your portion
sizes: a palm of your hand is about 85 to 115 grams of meat. So two palm sizes of red
meat exceeds the recommended amount to eat per week.
3. Choose lean meat and trim visible fat to further reduce the amount of saturated fat.
4. Remove the skin from chicken or poultry before cooking.
5. Make sure the meat is cooked thoroughly to eliminate the risk of foodborne illnesses.

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Overview of the Export Markets
Zambia Food-Based Dietary Guidelines

Recommendation 7
Take milk and dairy
products for strong
bones and teeth

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11. RECOMMENDATION 7: Take milk


and dairy products for strong bones
and teeth.

11.1 A CLOSER LOOK: MILK AND DAIRY Animal milk is not recommended for infants
PRODUCTS younger than one year old. This is because
Milk is a nutrient-rich fluid that female mammals babies this age cannot digest cow's milk as
produce to feed their young. As such, milk completely or as easily as breast milk or formula.
contains valuable nutrients that help support Further, cow’s milk contains higher amounts
a growing body, including calcium and protein. of protein and minerals, which can stress the
Breast milk for children under six months is the baby's immature kidneys. Cow's milk does not
best and only food for an infant. This is because have the right amounts of iron, vitamin C and
breast milk contains all the nutrients that an other nutrients, and does not provide the right
infant less than six months old needs. From six types of fat for growing infants (WHO, 2015b;
months up to two years and beyond, breast milk CDC, 2021).
continues to be an important source of food for
children, in addition to complementary foods. This food group includes only milk and milk
products such as cheese, sour milk and yogurt.
For babies older that one year, animal milk Other products derived from milk, like butter
improves diet quality and nutrient density. The and ghee, are not part of this food group and
most commonly consumed types of milk come are considered as fats and discussed in Chapter
from cows, sheep and goats. 12 under recommendation 8 on reducing fats,
oils, sugars and salt.

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11.2 IMPORTANCE OF MILK AND MILK from milk are essential for maintaining strong,
PRODUCTS IN A DIET AND FOR GOOD HEALTH healthy bones and teeth. The calcium in milk is
Milk provides many essential nutrients of public readily absorbable for the normal development
health concern, as the Zambian population and maintenance of the skeleton, muscle
under-consumes them. Milk is an important movement and nerve signals. Animal milk can be
source of calcium, potassium and B12, which are fortified with vitamin D and other nutrients that
lacking in many diets. benefit bone health. Thus, milk and milk products
may prevent bone diseases like osteoporosis.
Milk is rich in high-quality protein and is
considered a “complete protein,” as it contains 11.2.2 Milk is essential in preventing non-
all nine of the essential amino acids necessary communicable diseases
for the body to function at an optimal level. Milk High milk consumption is associated with a
contains magnesium; vitamin A; B vitamins like reduced risk of colorectal cancer and possibly
thiamine (B1), riboflavin and pantothenic acid bladder cancer, as well as a reduced risk of diabetes
(vitamin B5); and zinc, which make a significant and obesity. However, high consumption of milk
contribution towards meeting the body’s needs is associated with an increased risk of prostate
for these nutrients. Milk also contains hundreds cancer in men (FAO, 2013a; Willet et al., 2019).
of different fatty acids, including conjugated Conjugated linoleic acid and omega-3 fatty acids
linoleic acid (CLA) and omega-3s (FAO, 2013). are linked to many health benefits, including
a reduced risk of diabetes and heart disease
11.2.1 Milk is important for bones and teeth (Castro-Webb, Ruiz-Narváez and Campos, 2012).
A combination of nutrients, including calcium,
phosphorus, potassium, proteins and vitamin K

11.3 RECOMMENDATIONS & GUIDANCE


ON EATING A VARIETY OF
MILK AND MILL PRODUCTS
EVERY DAY
1. Milk is nutrient dense and packed with calcium, high quality protein and essential
micronutrients.
2. Milk is an ideal ingredient for many recipes and for addition to many meals.
3. Stay hydrated with milk as a natural alternative to highly-processed and sugary
drinks.

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Zambia Food-Based Dietary Guidelines

11.4 TAKE MILK AND MILK PRODUCTS FOR Lancet recommends taking 250 g/day with a
HEALTHY BONES AND TEETH. range of 0 to 500 g (Willett, 2019).
11.4.1 How much milk and milk products should In order to optimise their health, Zambia’s
be taken? general population should consume one serving
The Global Burden of Disease study defines of milk (245 g) per day (fresh or fermented)
exposure to a diet low in milk as an average or dairy products such as yoghurt (mabisi),
daily consumption of less than 435 g per day of especially those with reduced fat. One serving
animal milk and milk products (GBD, 2017) while is based on 125 Kcal, with equivalent amounts
the ‘’Healthy Reference Diet” proposed by EAT- listed in Table 9.

Table 9: One serving equivalents of milk and milk products - and key nutrients
Pro- Calci-
Milk or milk Grams Energy Iron Folate Zinc B12* Fibre
Cups tein* um*
product (g) (Kcal) (mg) (mg) (mg) (mcg) (g)
(g) (mg)
Milk, cow 2% fat
1 245 120 8.1 0 12.3 1.2 294 1.2 0
(low fat)**
Milk, cow 3.5% fat
1 245 160 8.3 0.1 24.5 1 294 1.5 0
(whole milk)
2
Yoghurt, low fat** (small 200 126 8 0 22 1.8 308 - 0
tins)

Yoghurt (low fat)* 3/4 200 125 8 0 22 1.8 308 - 0

Yoghurt (whole milk,


3/4 185 115 7 0.2 22.2 1.1 281.2 0.6 0
plain)

Cheese (shredded)** 1/3 40 150 9.2 0.1 10.8 1.5 283.9 0.4 0

*Diet Model (DM) conversions based on DM FCT


**USDA FDC (2020)
†The smallest tin of commercial yogurt is 100 g

11.5 ALTERNATIVES IF ONE IS NOT ABLE TO There are plenty of alternative foods that
TAKE MILK AND MILK PRODUCTS provide similar amounts of calcium the body
The FBDGs Pretesting results show that milk and needs. Individuals who are not able to eat
milk products, just as ASFs, are not affordable for dairy products should take one or more of the
many Zambians (Zambia MoA; FAO, 2021c). GAIN following foods daily: moringa leaves; cassava
and UNICEF (2021) also had similar findings. Due leaves; okra (lady finger) fruits and their leaves;
to unaffordability of ASF like milk, many people jute (bush okra); amaranthus; baobab fruit pulp
are not able to consume the calcium they need and leaves; tamarind pulp and leaves; African
from this milk. One serving of milk and milk locust beans; dried figs; cow pea leaves; spinach
products contains approximately 300 mg of and taro leaves; and small fish eaten with bones
calcium. like kapenta, sardines, and anchovies. Table 10
lists the amounts that provide 300 mg of calcium,
which is equivalent to 1 serving of milk (250 g).

Kapenta Amaranths Cassava Leaves Baobab Fruit Moringa Leaves


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Zambia Food-Based Dietary Guidelines

DID YOU KNOW?


One serving of dry kapenta (50g) provides over four times the amount of calcium and
meets the protein requirements per day.

Make kapenta part of a healthy food choice.

11.6 TIPS ON TAKING MILK AND MILK PRODUCTS

Helpful Tips on increasing the intake of milk and milk


products

1. Add milk, yoghurt or sour milk to porridge or breakfast cereals.


2. Make soups creamy by adding milk, sour milk or plain yogurt.
3. Use milk in casseroles and omelets.
4. Add plain yogurt to fruit salads as a snack or desert.
5. Drink plain milk as a beverage during or between meals, instead of fizzy and
sugary drinks.
6. Add milk to your teas, coffees and other beverages.
7. Make smoothies with milk or yoghurt.

Table 10: Foods high in calcium in the amount needed to get 300 mg of calcium which is
equivalent to one serving of milk (245 g or one cup)

Calcium
Food group Food name in Food quantity
(mg) per food Notes
name English (grams)
amount
Milk Low fat milk 244 g 293 mg
Baobab, pulp (pow-
Fruits 100 g 342 mg
der)
Baobab, pulp (pow-
Fruits 90 g 308 mg
der)
Fruits Fig (dried) 150 g 303 mg
Tamarind fruit,
Fruits 200 g 302 mg
(raw, ripe)
African locust bean,
Fruits 300 g 353,78 mg
fruit, pulp (raw)
African locust bean,
Fruits flour from fruit, 200 g 323 mg
pulp
Dattock, dried pulp
Fruits 300 g 330 mg
(raw)
One serving meets
Fish Kapenta (dry) 11 g 308 mg all daily calcium
needs

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Zambia Food-Based Dietary Guidelines

Calcium
Food group Food name in Food quantity
(mg) per food Notes
name English (grams)
amount
Kapenta powder
Fish 10 g 300 mg
(dry)
Sardines in oil,
Fish canned (drained 80 g 305.6 mg
solids with bone)
Pulses & Le- African locust bean,
120 g 349.2 mg
gumes seeds (dried)
Pulses & Le-
Soya bean (boiled) 344 g 351 mg 2 cups
gumes
Sesame seeds,
Nuts & seeds 35 g 328.3 mg 4 tablespoons
whole (dried, raw)
Amaranth, leaves
Vegetables 80 g 304 mg 3/4 cup
(boiled)
Baobab, leaves
Vegetables 100 g 312 mg 3/4 cup
(boiled)
Baobab, leaves
Vegetables 25 310 mg 1/4 cup
(dried)
Cassava, leaves
Vegetables 120 g 331.2 mg 1 cup
(boiled)
Cowpea, leaves
Vegetables 130 g 345.02 mg 2.5 cups, chopped
(boiled)
Cowpea, leaves
Vegetables 30 g 318 mg 1 1/4 tablespoon
(dried)
Vegetables Moringa powder 12 g 300 mg 6 tablespoons
Moringa/drumstick,
Vegetables 68g 392 mg 1 cup, chopped
leaves (cooked)
False sesame,
Vegetables 75 g 348.75 mg 3 tablespoons
leaves (boiled)
False sesame,
Vegetables 25 g 327.5 mg 1 tablespoon
leaves (dried)
Jute (bush okra)
Vegetables leaves, (boiled, 90 g 324 mg 4 tablespoons
without salt)
Okra leaves (boiled,
Vegetables 115 g 342 mg 3/4 cup
without salt)

Vegetables Okra fruit (boiled) 400 g 308 mg 2.5 cups

Vegetables Onions (dried) 130 g 310.05 mg 1 cup


Pumpkin leaves
Vegetables 100 g 330 mg 4 tablespoons
(dried)
Spinach (boiled,
Vegetables 250 g 333 mg 1.5 cups
without salt)
Tamarind, leaves
Vegetables 75 g 302 mg 3 tablespoons
(boiled)

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Zambia Food-Based Dietary Guidelines

Calcium
Food group Food name in Food quantity
(mg) per food Notes
name English (grams)
amount
Tamarind, leaves
Vegetables 20 g 300 mg 2 tablespoons
(dried)
Vegetables Taro, leaves (boiled) 300 g 315 mg 2.5 cups
Spices & Herbs Anis seed 50 g 323 mg 7 tablespoons

Spices & Herbs Bay leaf (dried) 40 g 333,6 mg

Spices & Herbs Chili pepper (dried) 140 g 336 mg

Spices & Herbs Cinnamon (ground) 30 g 300 mg

Spices & Herbs Cumin, seed 35 g 325.9 mg

Spices & Herbs Black pepper 70 g 308 mg

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Zambia Food-Based Dietary Guidelines

Recommendation 8
Limit eating ultra-
processed foods
and foods high in
salt, sugar, and fats
and oils to prevent
non-communicable
diseases

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Zambia Food-Based Dietary Guidelines

12. RECOMMENDATION 8: Limit eating


ultra-processed foods and foods high
in salt, sugar, and fats and oils to
prevent non-communicable diseases.

Blood Pressure

12.1 ABOUT PROCESSED FOODS the basis of their diets (FAO and WHO, 2019).
Most food needs some degree of processing for This is because minimally processed foods do
them to be edible, digestible and to maintain not add substances such as salt, sugar, oils or
their health benefits. Some processing will make fats to the original food except during the final
food unhealthy while other types of processing cooking stage at home or in restaurants. Limited
does not necessarily do so. The NOVA food amounts of Group 2 foods – processed culinary
classification system has categorised foods into ingredients – can be used to add variety and taste
four groups according to their nature, purpose, to foods from Group 1 to make freshly prepared
the extent of processing they undergo after they dishes and drinks at home and in restaurants.
are separated from nature, and before they Small amounts of Group 3 foods – processed
are consumed or made into dishes and meals foods – can also be used as part of meals, with
(Monteiro et al., 2019). limited frequency of consumption.

For example, products from Group 1 – The great concern is with Group 4 – ultra-
unprocessed or minimally processed foods – are processed foods (UPF) – since these are
healthy, and individuals should make natural, not modified natural foods but industrial
whole foods and minimally processed foods formulations, as they contain a lot of added salt,

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Zambia Food-Based Dietary Guidelines

trans fats, refined carbohydrates and sugars. 12.1.1 Group 1: Unprocessed or minimally
They have additives only found in UPFs such as processed foods
chemical flavourings, preservatives or artificial According to Monteiro et al. (2016), ‘’unprocessed
colours and emulsifiers. During manufacturing, (or natural) foods are edible parts of plants
UPFs are manipulated to be addictive and/or (seeds, fruits, leaves, stems, roots) or of animals
hyper-palatable (PAHO, 2015; Monteiro et al., (muscle, offal, eggs, milk), and also fungi, algae
2019). and water, after separation from nature”. These
foods do not undergo any alteration.
Figure 8: Examples of ultra-processed foods
Minimally processed foods are “natural foods
altered by processes such as removal of
inedible or unwanted parts, drying, crushing,
grinding, fractioning, filtering, roasting, boiling,
pasteurisation, refrigeration, and freezing,
placing in containers, vacuum packaging, or
non-alcoholic fermentation”. The purpose of
processing is exclusively to increase shelf life
and storability and enhance the edibility and
digestibility of a food without changing its major
composition and properties of the original food.
None of these processes add substances such as
salt, sugar, oils or fats to the original food except
during the final cooking stage. Examples include
fresh, frozen or dried fruits, vegetables and fish,
eggs, meat, raw or pasteurised milk, and whole
grain flours (Educhange, 2018; Heart and Stroke
Foundation, 2021; Monteiro et al., 2019; Reardon,
2021). Make these natural, whole foods the basis
of your diet.

Figure 9: Cereal (grains) examples of natural/minimally processed, processed and ultra-


processed foods

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Zambia Food-Based Dietary Guidelines

12.1.2 Group 2: Processed culinary ingredients


Processed culinary ingredients are food products mainly used as condiments such as plant oils,
animal fats (e.g. butter), sugar, honey, salt, vinegar and aromatic herbs which are extracted and
purified from Group 1 foods by processes such as pressing, grinding, crushing, pulverizing and
refining. They are used as ingredients to add taste to foods from Group 1 to make freshly prepared
dishes and drinks in homes and restaurants (EduChange, 2018; Heart and Stroke Foundation, 2021;
Monteiro et al., 2019). The products in this group are often produced industrially or by artisanal
enterprises rather than by the consumer itself. Processed culinary ingredients typically consist of
only one macronutrient in a highly purified form (mainly fat, sugar or carbohydrate) and therefore
have low a nutrient density.

Figure 10: Culinary ingredients examples

This group does not include ingredients that Heart and Stroke Foundation, 2021; Monteiro et
underwent further modifications, such as al., 2019).
hydrogenated fats (margarine or other trans
fats) or modified starches (Monteiro et al., 2019). Monteiro et al. (2016) also indicates that
processed foods can have some additives to
12.1.3 Group 3: Processed food preserve their original properties or prevent
Processed foods are simple food products made spoilage and increase food safety: “Examples
by adding Group 2 foods like salt, sugar, oil and include fruits in syrup with added antioxidants,
others substances to natural foods (Group 1 and dried salted meats with added preservatives.
foods). Most processed foods have two or three When alcoholic drinks are identified as foods,
ingredients. These foods are recognisable as those produced by fermentation of Group 1
modified versions of Group 1 foods and retain foods such as beer, cider and wine, are classified
most constituents of the original food. The as Group 3 foods.” Some foods like flours are
purpose of processing is to extend the shelf life fortified to add nutrients like vitamin A, calcium
of food and make food more palatable (PAHO, or vitamin D.
2015; Monteiro et al., 2016). Processing includes
canning fish; bottling vegetables, fruits and The addition of large amounts of sugar, salt
legumes in brine; preserving fruits in syrup; or oil can make processed foods nutritionally
curing or smoking fish or meat; and preserving unbalanced. Therefore, just like processed
tinned fish in oil. Salting or sugaring nuts and culinary ingredients, they should be used
seeds, as well as non-alcoholic fermentation to sparingly and only occasionally. Make delicious
produce, for example, unpackaged freshly-made dishes and meals from natural and minimally
bread, cheese and sweet beer (mahewu), are processed foods the basis of your diet.
other examples of processing (Educhange, 2018;

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Figure 9b: Starchy roots and tubers examples of natural/minimally processed, processed
and ultra-processed foods

Figure 11: Vegetable group examples of natural/minimally processed, processed and ultra-
processed foods

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12.1.4 Group 4: Ultra-processed foods these foods, or to disguise undesirable sensory


UPFs (foods and drinks) are defined as qualities of the final product.
formulations of ingredients, most exclusively of
industrial use, and are typically created through UPFs are manipulated into being addictive and
a series of industrial techniques and processes more palatable compared to other foods. The
(hence the term 'ultra-processed') (Monteiro et processing and ingredients used also make
al., 2016). These ingredients include those used UPFs nutritionally unbalanced (Moss, 2013;
in processed foods and other ingredients only Brownell, 2012). Other characteristics of UPFs
found in UPFs. Ingredients only found in UPFs include attractive packaging, a long shelf life and
are rarely used during home cooking. aggressive marketing and health claims. Various
chemical additives give UPFs intense sensory
Since UPFs are not modified foods and have properties, making them especially attractive to
little or no natural foods from Group 1, they use see, taste, smell and/or touch (Monteiro et al.,
additives to imitate the sensory qualities of Group 2019).
1 foods or the culinary preparation ingredients of

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Figure 12: Fish, animal source food and insect examples of natural/minimally processed,
processed and ultra-processed foods

12.2 SUBSTANCES ONLY FOUND IN ULTRA- other colours, colour stabilisers, flavours,
PROCESSED FOODS. flavour enhancers, non-sugar sweeteners,
Monteiro et al., (2016, 2019) also indicate that and processing aids such as emulsifiers,
“substances only found in ultra-processed carbonating, gelling, firming, bulking
products include some directly extracted from and anti-bulking, de-foaming, anti-
foods such as: caking and glazing agents, sequestrants
and humectants” (FAO and WHO, 2017;
• sugars (fructose, high-fructose corn syrup, Monteiro et al., 2016).
‘fruit juice concentrates’ invert sugar,
maltodextrin, dextrose, lactose). Monteiro et al. (2016) note that Group 4 includes
• hydrolysed proteins, soya protein foods from Groups 1 or 3 that have additives,
isolate, gluten, casein, whey protein, and such as plain yoghurt with added artificial
‘mechanically separated meat’). sweeteners and bread with added emulsifiers.
• hydrogenated (trans fats) or interesterified In addition, alcoholic drinks fermented and then
oils, derived from further processing of distilled to make alcohol such as whisky, gin, rum
food constituents, like natural oils. and vodka are also considered Group 4 foods.
• Classes of additives only found in ultra- (Monteiro et al., 2016).
processed products include dyes and

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Figure 13: Milk and milk product examples of natural/minimally processed, processed and
ultra-processed foods

12.3 IDENTIFYING ULTRA-PROCESSED breads made only from wheat flour, water,
FOODS salt and yeast are processed foods, while
It is very easy to recognise foods that are ultra-processed breads are those with
minimally processed and/or culinary processed lists of ingredients under ‘’substances only
ingredients. Fresh vegetables, fruits, roots and found in ultra-processed foods”.
tubers are definitely not ultra-processed; just • Look for ingredients such as emulsifiers,
as pasteurised milk and frozen fresh meat are flavouring or flavour enhancers, food
not. Plant oils, sugar and salt are used as culinary colouring or any such ingredient in the
preparations and hence are not ultra-processed. list. The practical way to remember UPF
However, distinguishing processed foods from ingredients is that they are rarely or not
UPFs, especially with foods like breads, breakfast ever used in the kitchen, or are an extracted
cereals and meat products can be difficult part of a nutrient component like lactose
sometimes. However, there are a few tricks to or fructose, etc.
help identify ultra-processed foods. • The high number of ingredients used.
• Above all, the presence of components
• Examine the ingredients labels that, by law, with very unfamiliar names indicates that
must be included on pre-packaged food and the product is ultra-processed.
drink products. For example, commercial

Figure 14: Fruit examples of the differences between natural/minimally processed,


processed and ultra-processed foods

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86
Table 11: Examples of ultra-processed foods

UPFs only
Ultra-processed Salt Sugar Trans fats
additives

Carbonated drinks/soft drinks, sodas and sweet-


ened drinks, sweetened beverages and juices x x x
including fruit flavoured juices

Margarines and spreads x x x


Zambia Food-Based Dietary Guidelines

Reconstituted meats such as bacon, sausages, hot-


x x x x
dogs, burgers and salami
Crisps, chips* and other sweet, fatty or salty pack-
x x x x
aged snacks
Stock cubes and gravy granules x x x
Salad dressings, mayonnaise x x x x x
Packaged soup powders or mix and liquids, instant
x x x
noodles, soups, sauces
Yeast extracts like Marmite and Bovril x x x

Packaged baked goods, biscuits, cookies, cakes, and


pastries, pies, crackers (sold on shelves and with a x x x x x
long shelf life)

Cake mixes, premixed pancakes x


Breakfast cereals (cornflakes, crispies) x x x x
Candy and chewing gum x x x
Mass-produced packaged breads and buns (long-
x x x x
life)
Infant formulas, follow-on milks x x x
UPFs only
Ultra-processed Salt Sugar Trans fats
additives

Other baby food products (canned and cereals) x x x x

Health’ and ‘slimming’ products such as powdered


x x
or ‘fortified’ meal and dish substitutes

Prepared and ready-to-heat products including


pre-prepared pies, pasta and pizza dishes; nuggets x x x x x
(fish/meat)
Packaged sauces like tomato sauces, soya sauce,
x x x x
oyster sauce, instant sauces
Many fast-food restaurants foods x x x x
Candy and ice cream; chocolates x x x
Doughnuts x x x

‘Energy’ bars; ‘energy’ drinks; milk drinks, ‘fruit’ yo-


x x
gurts and ‘fruit’ drinks; cocoa drinks

Ready-to-eat packaged meals and snack foods sold


x x x x x
in shops (pizzas)
Ready-to-drink tea and coffee and hot chocolate
x x x
mix
*Although fast-food chips may look much the same as home-cooked food, their formulations and the ingredients used in their pre-prepara-
tion and cooking render them ultra-processed.

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Zambia Food-Based Dietary Guidelines

Figure 15: Beans and nuts examples of the differences between natural/minimally
processed, processed and ultra-processed foods

12.4 ADDITIVES IN PROCESSED AND ULTRA- do not have to disclose exactly what it means,
PROCESSED FOODS and it is usually a combination of chemicals.
Processed foods often contain preservatives
and other chemicals to make them last longer
and to improve their texture, flavour and colour. 12.4.1 Ultra-processed foods and processed
Some preservatives, like nitrates and nitrites, foods have been linked to non-communicable
are used to preserve processed meats. Nitrates diseases
and nitrites can react with proteins or high heat UPFs are linked to an increased risk of NCDs such
to form N-nitrosamine, a carcinogen, increasing as cardiovascular disease (CVD), coronary heart
the risk of developing colon cancer. Other disease, (CHD) and cerebrovascular disorders,
food additives such as artificial food colours, due to added salt and sodium, sugar, saturated
benzoates, saccharin and sorbates can bring fats, trans fats and additives (Pagliai et al., 2021;
on an array of negative health effects including Costa et al., 2018; Askari et al., 2020; Chen et al.,
headaches, allergies and asthma (Dwivedi, 2020; Srour et al., 2019; Reardon, 2021). UPFs
2017). It is best to eat more natural whole foods are also linked to obesity due to the excess
and limit or avoid processed foods as much as calorie intake and are also associated with early
possible. mortality (Srour et al., 2019; Rico-Campà, 2019;
Hall et al., 2019). The negative effects of salt and
UPFs can contain additional chemicals that are sodium, sugar, saturated fats, trans fats and
not listed on their labels. For example, “artificial additives are discussed in detail in the sections
flavour” is a proprietary blend. Manufacturers that follow.

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12.5 RECOMMENDATIONS & GUIDANCE


FOR LIMITING THE
CONSUMPTION OF
ULTRA-PROCESSED FOODS
Limit eating ultra-processed foods, as they are high in salt, sugar and fats and
oils, to prevent diseases such as high blood pressure, sugar disease (diabetes) and
cancer.

1. Eat fresh, unprocessed or minimally processed whole foods; these foods provide
many benefits.
2. Cook more often: make delicious meals with fresh ingredients. Heating up frozen
pre-made foods does not count.
3. Cook and cut back on unhealthy ingredients.
4. There are quick and easy recipes for homemade pizza, meatballs, fishcakes and
baked beans.
5. Dine out on better choices: Restaurant meals can be fresh and healthy. Half the
plate should be filled with vegetables, and baked, poached, stir-fried or grilled foods
should be chosen instead of deep-fried.
6. Do not be swayed by food marketing and advertising hype. Ultra-processed foods
are often marketed as “healthy,” “natural” and “organic.” While these words may
describe the original ingredients, they do not refer to the process of how the food
was made. Remember, an organic, natural cookie is still an ultra-processed food.
7. Read food labels and avoid foods that end with ‘’ose’’ or have emulsifiers,
hydrogenated oil, nitrates, nitrites, artificial food colours, flavouring, texturisers,
benzoates, saccharin and sorbates, etc.

12.6 LIMIT INTAKE OF SALT the secretion of digestive (stomach) juices and
12.6.1 GETTING TO KNOW SALT AND ITS plays a part in the immune system where the
COMPONENTS cells require chloride, while red blood cells use
“Salt’’ is a common name for sodium chloride chloride anions to remove carbon dioxide from
(NaCl) and is the main source of sodium in the body (Munteanu and Iliuta, 2011). Most salts
diets. Salt is 40 percent sodium and 60 percent are fortified with iodine (WHO, 2014a).
chloride (Durack et al., 2008). The body requires
a small amount of salt for various essential Salt in Zambia is fortified with iodine, making
functions in the body. Sodium is important it the main source of iodine for its population.
for regulating body fluid balance, maintaining Iodine is important for the production of thyroid
normal blood pressure and for nerve and muscle hormones which control the body’s metabolism
function (Munteanu and Iliuta, 2011; WHO, and many other important functions. The body
2012b). The body needs chloride to regulate also needs thyroid hormones for proper bone
the proper balance of body fluids and the acid– and brain development, especially during
base balance. It is one of the most important pregnancy and infancy. Iodine deficiency leads
electrolytes in the blood as it helps maintain to goiter and mental developmental problems
proper blood volume, blood pressure and body in children.
fluid pH levels (WHO, 2012b). Chloride is part of
the gastric acid (hydrochloric acid composed of Although salt is essential, it is needed in small
chlorine and hydrogen) which aids in digestion. amounts and most people eat too much without
Chloride is also an essential part of regulating being aware of it. This is because salt is found
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naturally in unprocessed foods like meat and the salt in Zambian diets is added during cooking
seafood. Major sources of salt are processed and meal times to enhance flavour. A significant
and UPFs like breads, cottage cheese, cured amount of salt is also consumed from processed
meats, canned goods, ready-to-eat meals, and ultra-processed foods. A big proportion of
manufactured condiments like stock cubes, salt eaten is already added in everyday foods,
packaged sauces and soup mixes. A high salt including bread and breakfast cereals although
intake causes health problems. they may not taste salty. A good way to know
how much salt (including hidden salt) is in the
12.6.2 How much salt should we consume? food is to read the food labels. Pay attention
WHO recommends that the daily intake of salt to the following terms: salt, monosodium
in adults should be less than 5 g per day (i.e. glutamate and any other name containing the
less than 2 g of sodium per day) – that is around word sodium.
1 teaspoon. (WHO, 2012b; WHO, 2014a). Five
grams of salt (sodium chloride) contain the Table 12 has examples of UPFs high in salt,
sufficient amount of sodium required per day. which are therefore high in sodium, and a list of
processed foods high in salt, sugar and oils.
12.6.3 Negative health effects of high salt in diets
and its consumption levels among Zambians Literature sources have demonstrated that
A high intake of salt (over 5 g) is unhealthy. an increase in urbanisation is characterised
Adding more salt than recommended to food by, among other things, the consumption of
or frequently consuming salty foods, such as processed foods high in salt, as well as fast-
processed or ultra-processed meals, increases foods from restaurants and fast-food outlets.
the risk of blood pressure, cardiovascular Zambia is one of the most urbanised countries
diseases, stroke and CHD (He, Li and MacGregor, in Africa, and therefore the need to pay attention
2013; WHO, 2012b; GBD, 2017; HSPH, 2021). to salt intake is critical in reducing the burden
Hypertension is on the rise in Zambia, with about of hypertension associated with sodium intake
20 percent of Zambians aged 18 to 69 affected. (WHO and MOH, 2017).

12.6.4 Salt consumption in Zambia


Zambians consume 10 g of salt, which is double
the recommended safe intake per day. Most of

12.7 RECOMMENDATIONS & GUIDANCE


ON REDUCING SALT INTAKE TO
LESS THAN 5 G PER DAY

1. Use only iodised salt.


2. Use less salt when preparing food and do not add salt to food when eating the food.
3. Limit consumption of processed and ultra-processed foods, as well as fast foods, as
they contain high amounts of salt.
4. Read food labels and do not rely on taste alone.
5. Look for the total sodium amount on food labels not just added salt.
6. It is easy to meet sodium requirements without adding more salt when eating meals.

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12.8 TIPS ON REDUCING SALT INTAKE

Helpful Tips on reducing salt intake

1. Choose fresh foods as much as possible.


2. Avoid adding salt at the table.
3. Use less or no salt during cooking.
4. Replace salt with locally available herbs, spices, garlic, ginger, pepper, onions, lemon
and vinegar to add flavour to foods.
5. Keep an eye on foods consumed outside the home and limit consumption of fast
food and takeaway meals.
6. Limit fluids containing high salt amounts, including sports drinks and vegetable juice.
7. Limit intake of ultra-processed foods like savoury snacks, breads, pies, sauces, etc.
8. Make fresh stock and gravy using vegetables, fish or poultry instead of using cubes,
granules or soup mixes.

12.9 LIMIT INTAKE OF FOODS HIGH IN biscuits and pastries, and some fried foods also
SATURATED FATS contain saturated fats. Some plant-based oils,
12.9.1 About fats and oils such as palm oil, palm kernel oil and coconut oil,
Dietary fats belong to the macronutrient group, also have saturated fats (WHO, 2020a). Saturated
together with proteins and carbohydrates. Fats fats, and especially palmitic acids (C16:0), have
are energy dense; they provide 9 Kcal of energy negative health effects as they increase LDL
per gram while protein and carbohydrate cholesterol.
provide 4 Kcal per gram. The major categories of
dietary fats are unsaturated fats, saturated fats Some meat and dairy products have a small
as well as trans fats. amount of naturally occurring trans fats. It is not
clear whether this naturally occurring trans fat
Unsaturated fats: Unsaturated fatty acids that has any benefits or is harmful.
include monounsaturated fatty acids (MUFA) and
polyunsaturated fatty acids (PUFAs) are liquid Trans fatty acids (TFAs) are predominantly a
at room temperature. MUFA include olive oil, by-product of trans fat industrial processing
canola oil, sunflower and safflower oil, mustard (partial hydrogenation), where hydrogen atoms
seed oil and rapeseed oil (FAO and WHO, 2010). are added to vegetable oil to cause it to become
Of the PUFAs, eiocosapentaenoic acid (EPA) solid at room temperature. TFA is also found in
and docosahexaenoic acid (DHA) are the most ruminant fat in dairy and meat products (WHO,
important n-3 fatty acids in human nutrition. EPA 2020a). Industrial hydrogenation increases
and DHA are components of marine lipids, and the shelf life and flavour stability of foods.
fish such as mackerel, salmon, sardine, herring, Some restaurants use partially hydrogenated
cod liver oil and smelt are excellent sources vegetable oil (TFA) in their deep fryers to avoid
(WHO, 2018). Alpha-linolenic acid (ALA) is the changing the oil as often as they would with
parent fatty acid of the n-3 family and is found other oils. The main sources of TFA in a diet are
in oils such as flaxseed oil, perilla oil, canola oil processed foods, fast foods, snack foods, fried
and soya bean oil. These are considered good foods, frozen pizza, pies, cookies, margarines
fats, specifically long chain PUFAs, alpha linolenic and spreads (WHO, 2020a). TFAs increase CHD
acid, EPA and DHA, as they contribute to the risk factors and CHD events.
prevention of CHD as well as to healthy neonatal,
infant and child development (WHO, 2020a). 12.9.2 Importance of fats in a diet
Fats and oils are great sources of energy as
Saturated fats are usually solid at room they contain almost twice as much energy per
temperature. The major sources of saturated gram when compared to other food groups.
fats are ASFs including meats and meat products Fats and fatty acids are important for cell
such as fatty beef, pork, poultry with skin, butter, membrane function, control gene transcription
ghee, lard and cheese. Many baked foods e.g. and expression, and interact with each other. In
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addition to providing essential fatty acids, dietary and trans fats are linked to an increased risk of
fats also provide the medium for the absorption NCDs, hence their intake should be limited.
and transportation of fat-soluble vitamins (A,
D, E and K) and hormones. Many children and 12.10 THE HEALTH RISKS OF SATURATED FATS
women in Zambia are deficient in vitamin A. AND TRANS FATS
Eating foods that contain saturated fats raises
Fats and fatty acids are a key nutrient for cholesterol levels in the blood, which increases
the growth and healthy brain and cognitive the risk of heart disease and stroke. Dietary
development of unborn babies and young fat is more energy dense than carbohydrates
children. PUFAs, eicosapentaenoic acid (EPA) and protein, thus eating foods high in fats also
and (DHA play a crucial role in neonatal and increases the risk of weight gain, overweight and
infant mental development (WHO, 2020a). EPA obesity (Forouhi et al., 2018).
and DHA are found in fish like mackerel, salmon,
sardines, herring, cod liver oil and smelt. Trans fats increase CHD risk factors, as well
as the risk of heart attacks and stroke. This is
Fats and oils make food more palatable and because TFAs increase LDL, or "bad" cholesterol,
are frequently used in cooking, Fats slow down and decrease the good HDL cholesterol, thereby
gastric emptying and intestinal motility, thereby affecting the arteries through fatty deposits.
prolonging satiety. TFAs are also associated with a higher risk of
developing type 2 diabetes. Trans fats have no
Thus, unsaturated fats, especially the long- known health benefits and there is no safe level
chain PUFAs, alpha linolenic acid, EPA and DHA of consumption. In the Global Burden of Disease
can be part of a healthy diet contributing to the Study, exposure to a diet high in TFAs is defined
prevention of CHD. as an average daily consumption of greater
than 0.5 percent of trans fat from all sources,
However, all fats are energy dense and provide mainly partially hydrogenated vegetable oils
a lot of calories. Consuming large amounts of and ruminant products (Willet et al., 2019). This
any fat can lead to overweight and obesity, even is equivalent to 1 g of fat (note that 1 teaspoon
healthier unsaturated fats. In addition, saturated of oil is about 5 g).

Number of
Food group 1 serving equivalent
servings
Fats and oils 1 14 g (1 table spoon) * Choose vegetable
oils

12.10.1 Recommended intake of saturated fats n-3 and n-6 PUFAs, as evidence indicates it can
In order to meet the body’s requirement for decrease the risk of CHD (FAO and WHO, 2019;
dietary fat, it should contribute a minimum of USDA and USDHHS, 2015; American Heart
15 percent of the total energy requirement per Association, 2017).
day, in order to ensure adequate consumption
of essential fatty acids and fat-soluble vitamins Based on the Zambia diet modelling, on average,
(WHO,2020a). Total fat intake should not exceed Zambian adults should aim to consume one
30 percent to avoid unhealthy weight gain (WHO, serving of added oils per day. One serving is
2020a). about 1 tablespoon (14 g), of added oil/fat,
most of which should come from vegetable oils
Total intake of saturated fatty acids should not and fish oil (FAO,2010). This lower limit takes
exceed 10 percent of total dietary energy. For a into account other fat sources in the diet that
2 000 Kcal diet, this translates to a maximum of contributes to the 30% total fat intake aside from
200 calories or 22 g of saturated fats per day. the added oil/fat.
Replace SFAs with unsaturated fats, especially

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12.11 RECOMMENDATIONS & GUIDANCE


ON AVOIDING TRANS FATS,
LIMITING SATURATED FATS AND
REPLACING THEM WITH ESSENTIAL
POLYUNSATURATED FATS
1. Limit intake of foods high in saturated and trans fats, for example biscuits, cakes,
pastries, pies, fatty meats, processed meats, burgers, pizza and ice cream.
2. Limit the consumption of fast foods such as potato chips, pizza and fried chicken.
3. Use vegetable oils when preparing foods. Vegetable oils are rich in healthy
unsaturated fats.

12.12 TIPS ON HOW TO REDUCE INTAKE OF SATURATED FATS

Helpful Tips on reducing salt intake

1. Remove visible fats on meat before cooking.


2. Remove the skin from chicken before cooking.
3. Reduce the amount of cooking oil added to foods during cooking.
4. Use cooking methods which enhance the loss of fat from meat i.e. grilling instead of
frying.
5. Choose healthy vegetable cooking oils.
6. Read food/nutrition labels when using packed foods.

12.13 LIMIT INTAKE OF FOODS CONTAINING sweet taste. Major sources of added sugars in
ADDED SUGAR diets are sugar-sweetened beverages such as
12.8.1 Description of sugars soft drinks, fruit drinks, sweet bakery products
Naturally occurring sugars and ready-to-eat cereals.
Sugars, also known as simple carbohydrates,
are one of the components of foods with several 12.14 LINK BETWEEN ADDED SUGARS AND
important physiological functions. Some foods DISEASES
naturally contain sugars (also called intrinsic Added sugars increase the energy density while
sugars) in various amounts and types. Sugars reducing the nutrient density of foods (Elia and
naturally occurring in foods such as fruits, Cummings, 2007). The body breaks down refined,
vegetables, milk and honey do not adversely or simple, carbohydrates quickly, leading to rapid
affect human health. spikes in blood sugar and insulin levels. When
these levels then drop, a person may experience
Added sugars food cravings and low energy.
Extrinsic/free sugars can also be added to foods
for various reasons, including enhancing flavour, Because refined carbohydrates cause frequent
as a sweetener and as a preservative (Clemens increases and decreases in blood sugar,
et al., 2016). consuming them is linked with an increased risk
of type 2 diabetes. In addition, added sugars
Sugars are added to foods and beverages by are associated with weight gain, overweight and
the manufacturer, cook or consumer. Thus, it is obesity, and increased cardiovascular mortality
important to know the foods to which sugar has (Johnson et al.,2009; WHO, 2015b; Gibney, 2019;
already been added, even if they do not have a Louzada et al., 2018; Monteiro, 2009; Luger et al.,
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2017; Malik et al., 2013; Malik et al., 2010; Tavares person of healthy body weight consuming
et al.,2012). Free sugars – particularly in the form approximately 2 000 calories per day. This
of sugar-sweetened beverages – increase the quantity can be met by only eating natural foods
overall energy intake and may reduce the intake like fruits, vegetables and milk. Thus, limit or
of foods containing more nutritionally adequate avoid adding sugars to foods and drinks like tea,
calories and nutrients, leading to micronutrient or taking foods and drinks high in added sugars.
deficiencies. Dietary free sugars are the most WHO suggests further reducing the intake of
important risk factor for dental caries (Gibney, sugar to less than 5 percent of total energy (25
2019). Examples of foods high in added sugars g or 6 tablespoons) to protect dental health
are shown in Table 12. and for additional health benefits throughout
life (Gibney, 2019; WHO, 2015). The recent EAT-
12.14.1 Recommended intake of added Lancet Commission paper also indicated that
sugars and consumption levels in Zambia because sugar has no nutritional value and
WHO guidelines recommend that the intake of has adverse metabolic effects, a limited intake
free sugars should provide less or equal to 10 of less than 5 percent of total energy per day is
percent of total energy intake. This is equivalent recommended (Johnson et al., 2009).
to 50 g (or around 12 level teaspoons) for a

How to calculate the amount of sugar from food and drinks?

1 teaspoon of sugar = 4 g of sugar

For example, if a product has 45 g of sugar, then the number of teaspoons is equivalent to:

Number of teaspoons = 45 g ÷ 4 g

= 11 ¼ teaspoons

Figure 16: Amount of sugar found in


popular soft drinks and beverages DO YOU KNOW HOW
MUCH SUGAR IS IN YOUR
BEVERAGES?
250 ml to 330 ml beverages, sodas and
fruit-flavoured drinks have between 5
to 9 teaspoons (25 g to 45 g) of sugar.
Although these drinks have a high
sugar content, some do not taste
sweet but sour.

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Sugar consumption in Zambia as a way to lower the consumption of sugar-


There is every reason to believe that a good sweetened beverages and contribute towards
number of Zambians consume foods high in the prevention of overweight and obesity
added sugars. In the 2019 national budget, the (Gibney, 2019; USDA and USDHHS, 2015; Bailey
Government of Zambia introduced excise duty et al., 2018; Chi and Scott, 2019; Leme et al.,
on each litre of sugar-sweetened beverages 2018; Singh et al., 2015; GRZ, 2018).

12.15 RECOMMENDATIONS & GUIDANCE


ON SUGAR INTAKE

1. Limit consumption of sugar-sweetened foods such as pastries, sodas and beverages,


soft drinks and fruit flavoured drinks, and sweetened yogurts.
2. Reduce the intake of sugary drinks (e.g. fizzy drinks, juices and cordials) to small
amounts and to occasional consumption.
3. Limit the intake of sugary foods (e.g. cakes, banana fritters, chocolates and candies).
4. Limit the intake of condiments containing added sugar such as canned or bottled
tomato sauces.
5. Minimise the intake of highly-processed foods such as biscuits and cakes.
6. Limit the intake of dried fruits and choose natural and fresh fruits. Although dried
fruits have natural sugars, they are concentrated sources of sugar since the water
has been removed, making it a very high-sugar snack. Dried fruits also stick more
easily to teeth, hence increasing the risk of dental caries.

12.16 TIPS ON REDUCING SUGAR INTAKE

Helpful Tips on reducing intake of added sugars

1. Choose water as the main drink instead of sugar-sweetened beverages like sodas,
juices and squashes.
2. Other healthier beverage options are those with no added sugar, such as sparkling
water, coffee and herbal tea.
3. Use fruits instead of sugar to sweeten foods. For example, add fruits to breakfast
cereals in place of sugar.
4. Use fruits and vegetables as snacks instead of sugar-sweetened snacks.
5. Check the ingredients list of food and drinks and look for other names for sugar.
Anything that ends with ‘ose’ is a form of sugar, e.g. maltose, dextrose and sucrose,
and anything which contains any form of syrups or concentrates has sugar in it, even
if it claims to be sugar-free.
6. Choose fresh fruits and low-fat yoghurt with no added sugar instead of high-sugar
desserts such as ice-cream and mousse.
7. Add little or no sugar to foods and drinks. Replace table sugar with honey (which has
a lower blood sugar raising effect).
8. While choosing breakfast cereals, opt for whole grain varieties e.g. All-Bran cereal,
Weetabix and oatmeal instead of sugar-coated ones like coco pops and fruit loops.

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Table 12: Examples of ultra-processed Foods high in salt, sugar and other additives

Salt Sugar Fat Other additives


Salt x
Salted/cured/processed
meats, e.g. bacon and x x x
ham
Canned foods in brine
x x
(salt-water)
Fresh-baked bread x
Pickles, olives in brine x
Salty snacks, e.g. salted
x x x
groundnuts
Cheese x x
Processed vegetables
canned or bottled in x x
brine
Canned fruits in sugar
x x
syrup
Fruit juices, vegetable
x x
juices and drinks
Canned beans x x
Ready-to-drink tea and
x x
coffee

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Overview of the Export Markets Zambia Food-Based Dietary Guidelines

Recommendation 9
Handle, prepare and
store food safely

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13. RECOMMENDATION 9: Handle,


prepare and store food safely.

©A. K. Suleiman
Eating safe food is as important as eating absorption for both children and adults. For
nutritious food. When food is contaminated with children, each diarrhoeal episode worsens
germs or chemicals, it can cause fever, diarrhoea, malnutrition, and malnourished children are
vomiting, malnutrition and even death (WHO, more susceptible to diarrhoea and other
2015c). Everyone is at risk of foodborne diseases, infections (Selimoglu et al., 2021). Another
but children, pregnant women, the elderly, the severe threat posed by diarrhoea is dehydration
sick and the immunocompromised are the most for both children and adults. Severe dehydration
vulnerable. WHO indicates that the burden of for all age groups is life threatening.
foodborne diseases is comparable to the human
immunodeficiency virus (HIV), malaria and even This is why ensuring food safety is cardinal to
tuberculosis (Havelaar et al., 2015). ensuring the health of the whole population,
which is one of the prerequisites for national
In Zambia, diarrhoea and cholera are the most economic development.
common foodborne diseases responsible for
a high burden of diseases and mortality (Chan, 13.1 WAYS THROUGH WHICH FOOD GETS
2014). According to UNICEF and WHO, diarrhoea CONTAMINATED
remains a leading killer of young children There are several ways through which food can
globally. In Zambia, diarrhoea accounted for become contaminated (Nyachuba, 2010), such as
approximately 8 percent of all deaths among microbial, chemical and physical contamination.
children under the age of five in 2017 (UNICEF Bacteria exist everywhere in nature. They are in
2021,a; WHO, 2018b; Carvajal-Vélez et al., 2016). the soil, air, water and the foods we eat. Germs
Further, diarrhoea infections contribute to can contaminate food through handling food with
long-term gut damage that prevents nutrient unclean hands, not cooking the food thoroughly,

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and not keeping cooked or perishable food fruits and vegetables and a separate one for raw
below 5 degrees Celsius (°C) for a long time. meat, poultry and seafood. If it is not possible
to have separate cutting boards, cut fruit and
Food may also be contaminated through the use vegetables first before cutting raw animal source
of contaminated food storage and preparation foods to prevent germs from touching fruit
areas; (Kapaya et al.,2018) and improper holding and vegetables. When animal source foods are
temperatures (Bryan et al., 1997; Kachapulula prepared first, always wash knives and cutting
et al., 2018; Schmitt et al., 1997). In Zambia, boards or surfaces with soap and hot water
poor transport and storage infrastructure for before preparing fruit and vegetables. Never
perishable foods, such as milk, also contributes place cooked food on a plate that previously
to food spoilage (Knight-Jones et al.,2016). held raw meat, poultry, seafood or eggs.
Another cause of food contamination is the use
of sewage-containing water for irrigation, hand 13.3 COOKING AND STORING FOOD SAFELY
washing and washing foods such as fruits and Bacteria grow most rapidly in temperatures
vegetables (Lanata, 2003; Hald et al.,2016). Food between 5 °C and 60 °C with some doubling in
may also be contaminated through unhygienic number in as little as 20 minutes. Keeping foods
practices by food handlers (NHMRC, 2013; Di below 5 °C can slow bacterial growth. Cooking
Renzo et al., 2015). food above minimum internal temperatures will
kill bacteria.
In addition, food such as maize, groundnuts,
other cereals and milk can be contaminated To kill germs naturally present in food, cook
with aflatoxins (moulds). In Zambia, food the food with heat thoroughly. Cook all food to
contamination with aflatoxins is very high reach minimum internal temperatures before
(Kachapulula et al., 2017). Livestock that eat removing food from the heat source. Internal
grains with aflatoxins can also get contaminated. temperatures vary between foods from 63 °C
While all foods can be contaminated, some are to 74 °C (USDA, 2021). Cooked food should be
more at risk, for example raw or undercooked eaten right away, and leftovers should be stored
foods of animal origin (Kapaya et al., 2018). Extra in a food-safe closed lid container and put away
care is needed when handling these foods. The in a refrigerator. Discard all refrigerated cooked
guidelines presented here, however, place an foods or leftovers older than three days .
equal importance on all foods.
13.3.1 If a refrigerator is not available
13.2 KEEPING FOOD SAFE BEFORE AND If a refrigerator is not available, cooked food
WHILE COOKING should not be left out at room temperature for
Wash hands and surfaces often: Our hands touch more than two hours. Food that has been out
many things during the day. When hands are at room temperature for more than two hours
not washed properly, especially during critical should be discarded for safety purposes. If
times such as after using the toilet or touching food is left out in a room or outdoors where the
nappies, germs from faeces can be transferred temperature is 32 °C or hotter, refrigerate or
to the food and then ingested. Wash your hands eat the food within just one hour. Share leftovers
with warm water and soap for at least 20 seconds with others within two hours of cooking to avoid
before and after handling food and after using wasting food. Cook raw meat, poultry and fresh
the bathroom, changing diapers and handling fish as soon as it is bought or slaughtered, and
pets. In addition, wash all the areas used for food do not let them keep for more than two hours
preparation and the surfaces touching the foods before cooking. Once cooked, apply the relevant
with hot soapy water to get rid of dirt, debris and rules.
faecal matter. Protect cooking and food storage
areas from insects and rodents. Foods contaminated with germs may look and
smell alright, but remember that germs do not
Do not cross-contaminate: Germs that are have to carry a certain smell or be visible to the
naturally present in raw meats, poultry and fish naked eye to be considered harmful. To save
can be transferred to other foods upon contact. food from being wasted, try to cook only what is
Keep raw meats, poultry and fish separated needed, especially if there is no fridge. Although
from fresh fruit and vegetables and other cooking kills germs, toxins produced by the germs
cooked foods. Use one cutting board or plate for can cause serious illness or death. Therefore, it

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is important to throw away any cooked food that temperature for more than two hours before
has stayed over an hour at temperatures of 32 putting them in the refrigerator or freezer. In
°C and above or after two hours at temperatures warm temperatures (over 32 °C ), do not keep
between 5 °C and 32 °C. the food outside the fridge for over one hour
(FAO, 2017b).
13.3.2 Where a refrigerator is available
The ideal refrigerator temperature should be
between 1°C and 5 °C, while for the freezer just
below 0°C. Do not keep cooked foods in the
fridge for over three days. Freezing will keep
foods up to 6 months or more.

Check your fridge to make sure that food is


properly stored and kept fresher for longer in
your fridge. Store products in the right places
in the fridge, and follow the instructions on the
packaging or the fridge manual. The coldest parts
of the fridge are at the back and the bottom so
foods that require the coldest temperatures
should be stored there. Do not pack the fridge
too full: you will use less energy and you will be
less likely to forget to use the food you bought
(FAO, 2017b). If keeping raw meats in the fridge,
keep them in a closed container to avoid blood
spillage. Keep the refrigerator clean to prevent
the spread of harmful bacteria. Wipe spills
Where a fridge is available, refrigerate or freeze immediately and regularly clean the inside of
meat, poultry, eggs and other perishables as the fridge with hot water and soap, and dry with
soon as you get them home from the store or a clean cloth or paper towels. Clean the fridge
farm. Never let raw meat, poultry, eggs, cooked quickly to prevent keeping the refrigerated foods
food or cut fresh fruits or vegetables sit at room out for too long.

13.4 TIPS ON HANDLING, PREPARING AND STORING FOOD

Helpful Tips on handling, preparing and storing food

1. Wash hands with warm water and soap for at least 20 seconds before
and after handling food and after using the toilet, changing nappies and
handling animals and pets.
2. Separate raw meats, poultry and fish from fresh fruit and vegetables and
other cooked foods to avoid cross contamination.
3. Cook raw poultry, fish and meats immediately where refrigeration is not
available.
4. Cook food thoroughly to kill microorganisms.
5. Store foods at below 5 °C to prevent microbial growth.
6. Eat or refrigerate cooked foods immediately. Discard cooked food that has
stayed out of the fridge for more than two hours or more than one hour in
hot weather (above 32 °C).
7. Use clean and safe water for food preparation.
8. Clean food preparation areas with hot water and soap to remove dirt and germs before and
after preparing each food item.
9. Wash fresh fruits and vegetables with clean water even when you plan to peel them because
bacteria can spread from the outside to the inside during cutting or peeling.
10. Scrub firm-skinned fruits and vegetables in clean water and rinse well.

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13.5 KEEP FOOD SAFE FROM PHYSICAL AND the storage area and maintaining environmental
QUALITATIVE LOSS AND DAMAGE conditions that discourage the growth of micro-
Proper food handling and storage is essential organisms. Keep the moisture content of foods
in order to prevent post-harvest losses and low and maintain the right temperature and
contamination at every stage, from harvesting, humidity in storage areas. Harvest crops at
drying and storage. Minimise physical losses by appropriate stages of maturity; do not harvest
preventing the entry of insects and rodents into too early or delay harvesting.

13.6 KEEP FOOD SAFE FROM AFLATOXIN humid environment. Aflatoxin-producing moulds
CONTAMINATION can be found in the soil and can contaminate
Proper food preparation and storage is essential grains while they are still in the field. Countries
in order to prevent food contamination with with high temperatures, like Zambia, offer good
aflatoxins and avoid foodborne diseases conditions for aflatoxin-producing moulds to
including diarrhoeal diseases and some cancers. grow and affect crops while still in the field.
(Devi, 2015).

13.6.1 Getting to know aflatoxins Although moulds are destroyed by cooking,


When some moulds grow on crops, they the toxins they produce may remain. Thus,
produce toxic substances that can remain in the it is important to avoid foods that may have
crops. These are called mycotoxins. A common been stored for a relatively long time in warm,
example are aflatoxins, which affect maize, ambient temperatures with high humidity, even
groundnuts and other cereals and legumes if they show no visible signs of mould (WCRF and
which are highly consumed in Zambia (Nleya, AICR, 2018).
Adetunji and Mwanza, 2018). In addition to
eating contaminated nuts and seeds, humans 13.7 HEALTH CONCERNS OF AFLATOXINS
can be exposed to aflatoxins through consuming 1. Chronic exposure to aflatoxins can
animal milk. When lactating animals are fed with cause liver cancer (Afshin et al., 2014),
contaminated feeds, the toxin is passed into the immunosuppression and stunting.
milk (Mohamed, 2011). Therefore, it is advised 2. Some aflatoxins cause severe illness
not to feed animals with mouldy grains or nuts. immediately after eating contaminated
food, while acute outbreaks can cause
These toxic compounds are naturally produced death. The Kenya outbreak of 2004 to 2005
by certain moulds that can grow on plants any had 125 known fatal cases.
time before or after harvest. According to the 3. Sources of aflatoxins in commonly
World Cancer Research Fund, aflatoxins are consumed foods in Zambia include maize,
produced by some moulds when foods are groundnuts, peanut butter, bambara nut
stored for too long at warm temperatures in a and milk (Mohamed, 2011).

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13.8 RECOMMENDATIONS & GUIDANCE


ON AFLATOXINS

1. Throw away grains and legumes that are mouldy because they are not safe for
people and animals to eat. They can cause cancer and affect child growth.
2. Aflatoxins are one of many serious hazards transmitted by foods.
3. Dry grains and legumes completely and quickly before storing. Store grains and
legumes under dry conditions. Do not allow grains and legumes to become wet.

13.9 HELPFUL TIPS ON DECREASING EXPOSURE TO AFLATOXINS

Helpful Tips on decreasing exposure to aflatoxins

1. Inspect grains, dried fruits and nuts. If they look mouldy, discoloured or shrivelled,
discard them.
2. Store all dry food like grains, nuts, dried fruits and spices in a closed-lid container in
a cool, dry area safe from air, heat and moisture to prevent toxic compounds from
growing.
3. Store dry foods in closed containers to keep away insects and rodents.
4. Do not keep dried foods for long periods of time before using them.
5. Eat a variety of foods to reduce the chance of eating the same potentially contaminated
foods.

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Recommendation 10
Engage in physical
activity at least 30
minutes every day

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14. RECOMMENDATION 10: Engage in


physical activity at least 30 minutes
every day.

14.1 WHAT IS PHYSICAL ACTIVITY? 14.2 PHYSICAL ACTIVITY AMONG ZAMBIANS


Physical activity is defined as "any bodily The STEPS survey (WHO, 2017b) indicated that
movement produced by skeletal muscles that 10.4 percent of participants had insufficient
results in energy expenditure” (WHO, 2020b). physical activity, defined as having spent less
Generally, one works up a sweat, breathes than 150 minutes of moderate-intensity activity
heavily and increases their heart rate during per week or equivalent. The proportion of males
exercise. Exercise on the other hand is defined with insufficient physical activities was 5.7 percent
as "physical activity that is planned, structured, and that of females was 18 percent. Females
repetitive" (Caspersen, Powell and Christenson, were more likely to have insufficient time for
1985) for the purpose of conditioning any part of moderate-intensity physical activity than males.
the body used to improve health and maintain The proportion of participants not engaging in
fitness. Examples of physical activities include, vigorous activity was 35 percent (24 males and
but are not limited to, walking, stretching, 45.5 percent females). The median time spent
gardening, digging, carrying water/wood, on physical activity per day was 187 minutes
chopping wood, dancing, jumping ropes, lifting (249 males and 137 females). According to WHO
weights, running and bicycling. Exercise is a guidelines (2020b), adults should do at least 150
subcategory of physical activity that is planned, to 300 minutes of moderate-intensity aerobic
structured and repetitive, with a primary purpose physical activity; or at least 75 to 150 minutes
of improving or maintaining physical fitness, of vigorous intensity aerobic physical activity;
physical performance or health (WHO, 2020b). or an equivalent combination of moderate- and
vigorous-intensity activity throughout the week,
for substantial health benefits.
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In the Global School-based Student Health bone health and functional ability (WHO, 2020b).
Survey (GSHS 2004–2013), the prevalence of Physical activity focused on balance training
physical activity of 60 minutes daily was about and moderately intense muscle strengthening
91 percent among adolescents boys and 89 activities reduces nearly 30 percent of the risk of
percent among adolescent girls but for less than falls in older adults with poor mobility (Paterson
seven days per week. This clearly shows that and Warburton, 2010). Physical inactivity
the level of physical activities was low among levels are rising in many countries, with major
adolescents in Zambia (Darfour-Oduro, 2018). implications for the prevalence of NCDs and
WHO (2020) recommends that children and the general health of the population worldwide.
adolescents should do at least an average of Additionally, physical activity is a key determinant
60 minutes per day of moderate- to vigorous- of energy expenditure, and thus is fundamental
intensity, mostly aerobic, physical activity across to energy balance, weight control and ultimately
the week. Moderate-intensity aerobic physical overweight and obesity control (Alexander et al.,
activity of more than 300 minutes; or more 2016).
than 150 minutes of vigorous-intensity aerobic
physical activity; or an equivalent combination 14.3.1 Importance of achieving and maintaining
of moderate- and vigorous-intensity activity a healthy weight
throughout the week provides additional health Obesity can predispose and lead to many
benefits (WHO, 2020b). conditions and diseases such as diabetes, high
blood pressure and high cholesterol, leading to
14.3. PHYSICAL ACTIVITY AND ITS heart disease; stroke; and certain cancers of the
RELATIONSHIP TO HEALTH breast, colon, kidney, liver and endometrium
The WHO global recommendations (WHO, 2010; (WHO, 2018c). Overall, people who are obese
Reiner et al., 2013,) report that physical inactivity, have a lower quality of life and lower productivity
and overweight and obesity are responsible for (Goettler, Grosse and Sonntag, 2017; Raozjabek
6 percent and 5 percent of total global deaths, et al., 2020).
respectively, after high blood pressure (13
percent), tobacco use (9 percent) and high blood 14.4 CURRENT GLOBAL RECOMMENDATIONS
glucose (6 percent). It has been shown that ON PHYSICAL ACTIVITY
participation in regular physical activity provides All children and young people should engage in
the following health outcomes: improved all- moderate to vigorous intensity physical activity
cause mortality, decreased cardiovascular for at least 60 minutes and up to several hours
disease mortality, incident hypertension, incident every day. Vigorous-intensity activities, including
site-specific cancers and incident type 2 diabetes. those that strengthen muscle and bone, should
Physical activity also improves mental health be incorporated at least three days a week. All
(reduced symptoms of anxiety and depression); children and young people should minimise the
cognitive health and sleep (WHO, 2018c; WHO, amount of time spent being sedentary (sitting)
2020b). Physical activity is also negatively related for extended periods (Damian, M., Oltean,
to weight gain or obesity, Alzheimer's disease Damian, C., 2018; Olusola and Olanipekun, 2017;
and dementia (Reiner et al., 2013). WHO, 2020c).

In children and adolescents, physical Adults aged 18 years and above should do at
activity confers benefits for the following least 150 minutes of moderate-intensity aerobic
health outcomes: improved physical fitness physical activity throughout the week or at
(cardiorespiratory and muscular fitness), least 75 minutes of vigorous-intensity aerobic
cardiometabolic health (blood pressure, physical activity throughout the week. Aerobic
dyslipidaemia, glucose and insulin resistance), activity should be performed in bouts of at least
bone health, cognitive outcomes (academic 10 minutes duration. Muscle strengthening
performance, executive function), mental health activities should be done involving major muscle
(reduced symptoms of depression) and reduced groups two or more days a week. For additional
adiposity (WHO, 2020b). health benefits, adults should increase their
moderate-intensity aerobic physical activity to
In addition to the benefits mentioned earlier, 300 minutes per week or engage in 150 minutes
physical activity in older adults helps prevent of vigorous-intensity aerobic physical activity per
falls and fall-related injuries, as well as declines in week or an equivalent combination of moderate-

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and vigorous-intensity activity (WHO, 2020c). Planning a big exercise regimen can seem
Adults 65 years and above with poor mobility daunting, especially if one has not been physically
should perform physical activity on three or more active in the past. It would be smart to start with
days a week to enhance balance and prevent an activity one can do and enjoys doing. Some
falls. When adults of this age group cannot do easier activities include gardening, walking,
the recommended amounts of physical activity dancing and cleaning. More vigorous activities
due to health conditions, they should be as include running, hiking, cycling and jumping
physically active as their abilities and conditions ropes. If one has not been very active before, it is
allow. advisable to start with a small goal and increase
the intensity or duration of the activities as
14.4.1 How to be more physically active one progresses. Intensity and consistency are
Incorporating enjoyable physical activities as part important in maintaining physical fitness.
of a daily or weekly routine can help one become
more physically active. Being physically active Activity-related adverse events such as
with other people can make it more engaging musculoskeletal injuries can be reduced by
and enjoyable. Also, including other people can progressively increasing the activity level and by
mean more encouragement and accountability. selecting low-risk activities (WHO, 2020b).

14.5 RECOMMENDATIONS & GUIDANCE


FOR PHYSICAL ACTIVITY

1. Aim to be active daily. Sit less, move more! Break up long periods of sitting by taking
brief, active breaks.
2. People who sit less and do any amount of moderate-to-vigorous physical activity
gain some health benefits.
3. Over a week, activity should add up to recommended minutes (hours) based on the
age group. Break up the total hours in short segments per day.

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14.5.1 Recommendation for physical activity - Children and adolescents

Source: WHO, 2020b

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14.5.2 Recommendation for physical activity - adults

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Source: WHO, 2020b

14.6 TIPS FOR INCREASED DAILY PHYSICAL EXERCISE

Helpful Tips for being more physically active

1. Choose activities that are enjoyable and can be done regularly at home and at work.
Walking, dancing, gardening, cleaning and other daily activities that require physical
movement count towards being physically active.
2. Be physically active with other people to make it more enjoyable and to keep each
other accountable.
3. Sit less, move more! Break up long periods of sitting by taking brief, active breaks.
4. Move about every 30 minutes after working on a computer, studying or watching
television .
5. Walk or bike instead of using a vehicle whenever possible. Use the stairs instead of
the elevator.
6. Set a time aside for structured physical activities. Start small and increase intensity
and duration as you progress.
7. Be consistent to form a habit.
8. Over the course of a week, total activity should add up to the recommended minutes
(hours) based on your age group. Break up the total hours into short segments per
day.
9. Reduce screen time on computers, phones or the television.
10. Move while watching television. Try simple movements like stretching, squats, lunges
or crunches.
11. People who sit less and do any amount of moderate-to-vigorous physical activity
experience health benefits.

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Special dietary

SECTION 3
requirements
for under-
five children,
adolescent girls,
and pregnant
and lactating
women in
Zambia
The most critical time for good nutrition is during the 1 000-day period from
pregnancy until a child’s second birthday. Optimal nutrition and care during
this period determines whether the child will survive, thrive and reach his/
her full potential. The first 1000 days sets the foundation for life long health,
development and prosperity. Sub-optimal diets during this foundation affects
brain development and intelligence (Cusick and Georgieff, 2016). Further, poor
nutrition is associated with an increased risk of obesity, hypertension, diabetes
and coronary heart disease in future adult life. In addition, the general eating
habits and patterns are formed in the first few years of life (UNICEF 2020 b).

Children from 3 to 5 years continue to grow and develop rapidly and begin to
consume food more independently. They therefore require a diversified diet to
avoid growth faltering and nutrient deficiencies (UNICEF 2020a)

Good nutrition during pregnancy and lactation is important not only for the
baby but also for the mother’s survival and wellbeing. Adolescent nutrition
especially foe girls in critical due to their rapid growth and development.
Zambia Food-Based Dietary Guidelines

15. RECOMMENDATION A: Begin


breastfeeding your baby within one
hour of birth.
15.1 IMPORTANCE OF EARLY INITIATION OF
BREASTFEEDING
Early initiation of breastfeeding, particularly
within the first hour of birth, provides infants
with colostrum; prevents infections that can lead
to death in newborns; and ensures successful
breastfeeding (FAO, 2004; UNICEF, 2016)

Colostrum is the special breastmilk that the baby


gets the first few days after birth. It is the thick,
yellowish milk formed during pregnancy and
lasts for a few days post-delivery. Colostrum is
high in antibodies and vitamin A which provides
the first immunization for the newborn baby
and prevents death (FAO, 2004; WHO, 2019).
In addition, colostrum helps the child to pass
the first stools with ease whilst getting rid of
meconium and preventing suboptimal intake
jaundice or breastfeeding jaundice (Y de Vries
et al., 2018; Toscano et al., 2017; CDC, 2021b).
Colostrum comes in very small amounts and
the flow is slow so that a baby can learn to Photo credit: UNICEF and URC/CHS

breastfeed, a skill that requires a baby to suck,


breathe and swallow at the same time.

15.2 TIPS TO ENSURE SUCCESSFUL EARLY INITIATION

Helpful Tips on ensure successful early initiation

1. To facilitate early initiation of breastfeeding within the baby’s first hour of life, place
the newborn’s body skin-to-skin with the mother immediately after birth.
2. Skin-to-skin contact immediately after birth until the baby’s first breastfeeding
is important because it increases the chances of babies being breastfed, helps to
extend the length of breastfeeding, and improves rates of exclusive breastfeeding
(UNICEF, 2020).

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16. Recommendation B: Feed your


baby breastmilk only for the first six
months of life and no water, herbs
or porridge because mother’s milk
contains all the food and water your
baby needs.

Photo credit: UNICEF and URC/CHS

16.1 MOTHER’S BREASTMILK 16.2 IMPORTANCE OF EXCLUSIVE


Breastfeeding is the best, safest and healthiest BREASTFEEDING FOR BABIES
way to feed infants in every country of the Breastfeeding saves lives and improves the
world. New and stronger evidence continuously health of children: Breastfed infants are
proves the many nutrition, health, psychological protected against dying before the age of
and economic benefits of breastfeeding (Lancet six months. According to the EAT-Lancet
2016; UNICEF, 2016). Commission report, breastfeeding could prevent
13 percent of all deaths of children under five
Breastmilk provides all the nutrients and energy globally. Breastfeeding protects children from
that the infants need to grow and develop from illness such as respiratory infections, diarrhoeal
0 to 6 months (FAO, 2004; WHO, 2017c). It is the diseases and other life-threatening ailments
most ideal food for babies because it is nutritious, (FAO, 2004; WHO, 2009; WHO, 2021a; Lancet,
easy to digest and prevents constipation. 2016). Infants who are exclusively breastfed
are also protected against obesity (Victora et
Breastmilk alone can quench the thirst of babies al., 2016; WHO, 2019a) and non-communicable
aged 0 to 6 months because breastmilk consists diseases such as diabetes later in life (WHO,
of 88 percent water (WHO, 2009; UNICEF, 2020a; 2009; Pereira et al., 2014).
WHO, 2019b).

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Breastfeeding helps prepare children for a 16.4 BREASTFEEDING BENEFITS FOR


successful future: Breastmilk is a rich source of MOTHERS
fatty acids that contribute to brain development • Breastfeeding is associated with decreased
(UNICEF, 2020a). As a result, breastfeeding risks of diabetes and overweight and
improves cognitive intelligence in children obesity for mothers (Horta et al., 2015;
who are breastfed versus those who are not Victora et al., 2016).
(WHO, 2009; UNICEF, 2016; Victora et al., 2016). • Women who breastfeed have a reduced
This improved cognitive performance of up to risk of breast cancer of 6 percent for every
three points on average on an intelligence test 12 months of breastfeeding in a woman’s
translates to improved academic performance, lifetime. Breastfeeding also reduces the
increased long-term earnings and productivity. risk of ovarian cancer (WHO, 2017c; WHO,
2021a; Victora et al., 2016; Lancet, 2016).
16.3 BREASTFEEDING BENEFITS THE • Since during breastfeeding the mother
COUNTRY ECONOMY uses up the fat stored during pregnancy,
Economic losses due to not breastfeeding are a mother who exclusively breastfeeds
about US$ 302 billion annually at a global level, her baby loses pregnancy weight faster
and about US$ 70 billion annually in low- and than a mother who does not (Riordan and
middle-income countries representing 0.39 Auerbach, 1999; Eiger and Wendkos Olds,
percent of Gross National Income (GNI) (Rollin 1999).
et al., 2016; Lancet, 2016). The losses are due • Breastmilk is readily available, does not
to high maternal and child mortality, higher require any special preparation, saves time
healthcare costs due to increased illness and and makes night feeding easier.
disease, and loss of future wages because of • Breastfeeding delays the return of fertility,
reduced cognitive development in infants not hence can improve birth spacing. Mothers
breastfed (UNICEF and WHO, 2017c). who breastfeed exclusively and frequently
have less than a 2 percent risk of becoming
Breastfeeding not only has nutrition, health and pregnant in the first 6 months postpartum,
future earning potential benefits, but it also provided that they still have amenorrhoea,
saves the family the money which would be where menstruation has not returned
spent on buying infant formula. (WHO, 2021a).

In addition to economic gains, breastfeeding 16.5 RATES OF EXCLUSIVE BREASTFEEDING


reduces millions of US dollars in annual IN ZAMBIA
healthcare costs (Lancet, 2016). The Zambia Demographic Health Survey (ZDHS)
found that in Zambia, almost all children (98
percent) were breastfed. However, only 68
percent of the children were breastfed within the
first hour of birth and seven out of ten children
aged between 0 to 6 months were exclusively
breastfed (ZamStats, MOH and ICF, 2019).

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16.6FORRECOMMENDATIONS
EXCLUSIVE
& GUIDANCE
BREASTFEEDING FOR CHILDREN
AGED 0 TO 6 MONTHS
1. Breastfeed your baby within 1 hour of birth.
2. Give your baby only breastmilk from 0 to 6 months.
3. Breastfeed on demand, day and night.
4. Do not give any other food or liquids to your baby, not even water, during your
baby’s first 6 months.
5. Even during very hot weather, breastmilk will satisfy your baby’s thirst.
6. Breastmilk provides all the food and water that the baby needs during this time.
Breastmilk also protects your baby against sickness and infection.
7. Giving your baby anything other than breastmilk will cause him or her to suckle less
and will reduce the amount of breastmilk that you will produce and may make your
baby sick.

16.7 TIPS FOR BREASTFEEDING SUCCESS

Helpful Tips ensure successful breastfeeding

1. Place the newborn skin-to-skin with the mother immediately after birth to facilitate
successful breastfeeding.
2. Look for the following signs to know whether the baby is getting adequate breastmilk:
◊ A baby will have at least 6 to 8 very wet nappies/diapers in 24 hours from day
five (a baby’s urine frequency increases from two wet diapers on day 2 to three
to four wet diapers on day 3 and 4).
◊ The baby’s urine is clear as water a few days after birth.
◊ A baby will produce bright yellow stools from day 5. The first few days after birth
the baby’s stool is a dark green, almost black, as the baby passes meconium
during that time. Frequency of passing stools varies from baby to baby. A baby
may also change the frequency as she or he grows older.
◊ Your baby has good skin colour and muscle tone.
◊ Your baby will be alert, responsive and contented.
◊ Your baby will gain weight and grow in length and head circumference starting
with regaining their birth weight by 10 to 14 days old.

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17. Recommendation C: From six


months, introduce a variety of foods
from the six food groups and continue
to breastfeed up to two years and
beyond.

Image credit: UNICEF and URC/CHS

Around the age of six months, an infant’s need for energy and nutrients starts to exceed what is
provided by breastmilk, and complementary foods are necessary to meet those needs. An infant of
this age is also developmentally ready for other foods.

17.1 WHY SHOULD CHILDREN AGED 6 TO (WHO, 201821a; UNICEF, 2016). Breastmilk
23 MONTHS EAT A VARIETY OF FOODS IN provides energy and nutrients required for
ADDITION TO BREASTFEEDING? growth and development, and prevents illness.
17.1.1 From 6 months, children need a variety of Between 6 to 12 months, breastmilk provides
foods to complement breastmilk half or more of the child’s energy needs whilst
From birth until 6 months, breastmilk provides it provides slightly more than a third of the
all the nutrients and energy required for the energy needs between 12 to 24 months (PAHO
growth and development of the infant. and WHO, 2002; WHO, 201821a). Breastmilk is
also a critical source of energy and nutrients
As per Table 13, from six months, breastmilk during illness, and reduces mortality among
cannot meet all the energy and nutritional needs children who are malnourished (WHO, 201821a).
of a growing child that support optimal growth In addition, continued breastfeeding up to age
and development (WHO, 2006; PAHO and WHO, two or older can provide children with nutrients
2002; WHO, 2009). where access to a diverse range of foods is
limited (UNICEF, 2016).
However, breastmilk continues to be important
for children between 6 to 23 months and beyond

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Table 13: Estimate of energy and nutritional requirements compared to what is provided by
breastmilk (WHO 2002, WHO, 2006

Energy Iron from Vitamin A


Child Energy Energy Iron Iron Vitamin A Vitamin
from breast- from
age needed gap needed gap needed A gap
breastmilk milk breastmilk
(mg/ (mg/ (mcg RE/ (mcg RE/ (mcg RE/
(months) (Kcal) (Kcal) (Kcal) (mg/day)
day) day) day) day) day)
0-2 405 405 0 1.18 0.05 0* 400 365 0*
3-5 500 500 0 0.9 0.05 0* 400 390 0*
6-8 600 400 200 0.79 0.04 0.75 400 340 60
9-11 700 400 300 0.65 0.04 0.61 400 310 90
12-23 900 350 550 0.5 0.04 0.46 400 280 120
*Although breast milk does not supply enough vitamin A and iron, the gap of iron and vitamin A is zero in
the first six months because it is covered from the baby’s birth stores.

Figure 17: Nutrient gaps to be filled by complementary foods for a breastfed child 12 to 23
months (WHO, 2009)

17.1.2 Increased nutritional needs for children introduction of complementary foods may lead
from 6 months of age to malnutrition due to inadequate nutrition (FAO,
The nutritional needs for children 6 to 23 months 2004; UNICEF, 2016). As per Table 13, after six
of age are greater per kilogram of body weight months, breastmilk cannot meet all the energy
than at any other time in life. If children are not and nutrients needs for a baby. Additional energy,
fed a variety of foods from the six groups in the proteins, vitamins, minerals and healthy fats are
right amounts and frequency, they are at risk of important for children aged 6 to 23 months and
undernutrition and poor growth (WHO, 2021a; two to five years. As children grow, they need
UNICEF, 2020b; WHO, 2019a). Young children are additional energy and proteins and healthy
more susceptible to the consequences of poor fats to support their growth and development.
dietary diversity compared to older age groups In addition, they require micronutrients such
given that young children’s growing brains and as vitamin A, iron, zinc and calcium. Specific
bodies need good nutrition the most (UNICEF, nutrient requirements are provided in Table 28
2016). in Annex 1.

The increase in body size and developmental 17.1.3 Importance of vitamin A for children aged
needs should be fulfilled by introducing age- 6 months to 5 years
appropriate foods (PAHO and WHO, 2002). Vitamin A is required to support rapid growth
Complementary foods are not meant to replace and reduces the risk of respiratory and
breastmilk but to complement it. Delaying the gastrointestinal infections (FAO and WHO, 2004).
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Vitamin A deficiency is a public health problem quite high in comparison to their energy needs
in children under six years of age (FAO and (FAO and WHO, 2004).
WHO, 2004). About a quarter of the children are
deficient in vitamin A (Alaofè et al., 2014). There 7.1.5 Importance of Zinc
is a high risk of infant mortality in the first year Zinc is important for cell division and the
of life due to vitamin A deficiency (Christian et synthesis of protein and growth in children (FAO
al., 2001). Deficiency in vitamin A can cause night and WHO, 2004). Deficiency in zinc affects the
blindness especially in children aged less than growth of children and increases their risk of
three years (Sommer, 1994; FAO and WHO, 2004). severe infectious diseases (FAO and WHO, 2004).
Diarrhoea is worsened by Vitamin A deficiency Results from zinc supplementation studies
and prolonged diarrhoea causes vitamin A loss suggest that a low zinc status in children not
in young children (WHO, 2019b). In addition, only affects growth but is also associated with
vitamin A deficiency in children under six years an increased risk of severe infectious diseases
of age is associated with concurrent infections (Black, 1998).
which may lead to death (Beaton et al., 1993;
FAO and WHO, 2004). 17.1.6 Importance of calcium
Calcium is needed for building strong bones and
In well-nourished populations, the levels of teeth during childhood (FAO and WHO, 2004).
vitamins A and B6 in breastmilk, as well as From zero to five years, children are growing
the infant’s birth reserves of vitamin A, are rapidly and by three years, a child doubles his/
adequate to meet the requirements for infants her height and quadruples his/her weight.
throughout the first six months of life. Between
6 to 23 months, breastfeeding provides most of Infants and young children with low calcium
the 400 µg RE/day of vitamin A required by the and vitamin D intake are at an increased risk
body with only few amounts needed from the of developing rickets (WHO, 2019c). Vitamin D
diet. Complimentary dietary sources are only aids in calcium absorption. Rickets is a bone-
60 µg RE for 6 to 8 months; 90 µg RE for 9 to softening condition that can cause severe leg
11 months; and 120 µg RE for 12 to 23 months bending (bowing), poor growth and sometimes
(WHO, 2002; WHO, 2006; WHO, 2009). From the muscle pain and weakness.
age of two, children transition from dependency
on breastmilk for vitamin A to dietary sources Developing strong bones in childhood is
(FAO and WHO, 2004). important, as bone calcium begins to decrease
in young adulthood and progressive bone loss
17.1.4 Importance of iron can occur as a person ages, especially in women.
Iron is required for growth and survival in
children. It is important for children’s cognitive 17.1.7 Importance of fats
development and brain function. Iron is needed Fats are an energy-dense source (FAO, 2004):
in the formation of blood haemoglobin and in Dietary fats play an important role as energy
the production of energy throughout the body. sources for the body, especially for growing
Iron deficiency anaemia in children under five children who are at risk of suffering energy
is a serious problem in Zambia, which can lead deficiency due to the high energy demands at
to infant deaths. Fifty-eight percent of children this stage of rapid growth. Fats are energy-dense
aged 6 to 59 months are anaemic (Alaofè et al., as they contain 9 Kcal/g of fat compared to 4
2014, ZamStats, MOH and ICF, 2019). Kcal/g of protein or carbohydrates.

Children’s iron needs double during the first year Weaning foods are starch-based and are
of life. For the first six month, an infant’s iron characterised by a low energy density and
requirements are met by birth reserves (WHO, an unpalatable viscosity in many developing
2002; WHO, 2006; WHO, 2009). From around six countries, including Zambia (Sakala and Curry,
months, the child’s iron reserves in the body will 2017). Oils and fats can play a critical role in
start to deplete. A breastfed infant aged 6 to 8 reducing the viscosity and improving the energy
months old needs more than eight times the density of weaning foods. Breastmilk contains 40
amount of iron and four times the amount of to 55 percent of its energy in the form of fat (FAO
zinc per 100 Kcal food of an adult male (Dewey and WHO, 2010). During the complementary
and Vitta, 2013). The body’s iron content is feeding period, it has been suggested that 30
doubled again between 1 and 6 years of age. to 45 percent of energy should come from
The absorbed iron requirements in children are fat and the rest from other sources such as
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carbohydrates and proteins (Dewey and Brown, are stunted, 12 percent underweight and 4
2003). percent wasted (ZamStats, MOH and ICF, 2019).
Overweight in children is becoming a burden in
Fats are important for brain development and for Zambia, with 5 percent of children under the age
immunity: Fats and oils are an important source of five weighing more than expected for their
of polyunsaturated fatty acids. PUFAS, especially height (ZamStats, MOH and ICF, 2019).
omega 3 and omega 6 fatty acids, play a key role
in cognitive development, immune functions 17.3 GUIDING PRINCIPLES FOR APPROPRIATE
and early growth and development in infants COMPLEMENTARY FEEDING FOR CHILDREN 6
and children (WHO, 2020a; FAO and WHO, 2010). TO 23 MONTHS
In addition, dietary fats also provide the medium After six months of age, the babies require
for the absorption of fat-soluble vitamins (A, D, E additional foods while continuing to receive
and K). The role of fat in absorption of vitamins breastmilk, since an infant’s need for energy
is key since vitamin A deficiency in under-five and nutrients starts to exceed what is provided
children is a problem in Zambia. by breastmilk, necessitating the introduction of
complementary foods to meet the additional
17.2 DIETARY PATTERNS AND NUTRITION needs. If complementary foods are not
STATUS FOR CHILDREN AGED 6 TO 23 MONTHS introduced at the age of six months, or if they
IN ZAMBIA are given inappropriately, an infant’s growth
On average, children aged 6 to 23 months in may falter. In addition, unlike infants from 0 to 6
Zambia eat a diet composed of two to three months, children at the age of six months are also
different types of foods in a day (Sakala and developmentally ready for other foods besides
Curry, 2017). The same study found that 60 to breastmilk (WHO, 2019a; WHO, 2021a). Guiding
80 percent of children were fed on diets mainly principles for appropriate complementary
composed of starchy foods and vegetables, while feeding are based on WHO, UNICEF and FAO
animal source foods were eaten by less than 40 guidance (WHO, 2021a; UNICEF, 2016, UNICEF
percent. GAIN and UNICEF (2021) also found low 2011; UNICEF 2020a; FAO, 2004).
consumption of animal source foods.
These include the following:
Children in Zambia are prone to malnutrition • Continue frequent, on-demand
due to poor dietary practices, especially low breastfeeding until 2 years of age or
dietary diversity. Only 13 percent of children beyond.
between the ages of 6 to 23 months were fed • After 6 months of exclusive breastfeeding,
a minimal acceptable diet (ZamStats, MOH and introduce safe, adequate, diversified foods
ICF, 2019). Less than half of children (42 percent) from the six food groups. These foods are
were given meals at the recommended minimum rich in energy, protein and micronutrients
frequency, while 23 percent achieved minimum such as iron and vitamin A and C.
dietary diversity (ZamStats, MOH and ICF, 2019). ◊ Give children iron-rich foods especially
from animal sources such as puréed or
The low dietary diversity is characterised by a diet mashed liver meats, fish and poultry;
mostly composed of grains (84 percent among and plant sources such as pulses and
breastfeeding children and 88 percent among iron-fortified cereals to address the
non-breastfeeding children) followed by fruits issue of iron deficiency anaemia.
and vegetables rich in Vitamin A. Animal source ◊ Give foods rich in vitamin A such as
foods which include meat, fish and poultry are orange and yellow-coloured fruits
included in less than half of the children’s diets. (like pawpaw and ripe mangoes);
Only 40 percent of breastfed and 47 percent of orange vegetables (like carrots and
non-breastfed children eat flesh foods. Further, pumpkin fruit and flowers); dark green
eggs are eaten by 21 percent of breastfed and leafy vegetables such as amaranthus,
31 percent of non-breastfed children aged 6 to spinach and moringa leaves; yellow
23 months. and orange grains; and roots and
tubers like orange-flesh sweet potatoes
The poor infant and young child feeding and yellow maize. Liver is also rich in
practices in Zambia have resulted in high levels vitamin A. All these foods help prevent
of malnutrition among children under five years vitamin A deficiency.
of age. Approximately 35 percent of the children

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• Gradually increase food consistency, ◊ Wash hands with soap and clean
amount and variety as the child gets older, running water for 20 seconds before
as per Tables 14, 15 and 16. Give infants preparing and eating food; before
puréed foods at 6 months and make the feeding young children; after using the
food thicker as the child gets older and toilet or latrine; and after cleaning your
develops his/her chewing and swallowing baby’s bottom.
abilities. Avoid giving children foods such ◊ Wash hands frequently after cleaning
as whole grapes, raw carrots or nuts as your home and compound, after
they can cause choking since they are still practicing agriculture, and after
learning to chew food properly. handling livestock or other animals
• Give small amounts of food and increase and especially after blowing your nose,
the quantity as the child grows. coughing or sneezing.
◊ Practice responsive feeding which ◊ Cook food thoroughly and do not keep
includes feeding infants slowly and food at room temperature for more
patiently whilst talking to them and than two hours.
encouraging them to eat without force.
Talk to the child and maintain eye 17.4 THE RECOMMENDED INTAKE FOR
contact. CHILDREN AGED 6 TO 23 MONTHS
• Use fortified complementary foods or Diet must fill up the energy and nutrients gaps
vitamin-mineral supplements as needed. left by breastfeeding for children from 6 to 23
This ensures adequate intake of vital months of age. Table 13 and Figure 17, based on
vitamins and minerals. Otherwise, the WHO, 2002 report and WHO 2006, show the
preparing a complementary feed using a energy requirements to be met by diet. However,
mixture of foods from the six food groups the report warns that it is important not to be
will improve the quality of nutrients in the overly prescriptive about such guidance, as
feed. each child’s needs will vary due to differences in
• Additional care and feeding during illness body size and growth rate. In addition, children
is important. During illness, increase fluid recovering from illness or living in environments
intake including more breastfeeding, and where energy expenditure is high may require
offer soft, favourite foods. more energy than the average quantities listed
• Do not feed babies under 12 months of in Table 13.
age cow’s milk. This is because they cannot
digest cow's milk as completely or as Since in practice, caregivers will not be able
easily as breastmilk or formula. Cow's milk to measure the energy content of foods to
contains high concentrations of protein be offered, the report recommends that the
and minerals, and has a high potential amounts of food to be offered are based on the
renal solute load, which can stress the principles of responsive feeding, while assuring
baby's immature kidneys. Cow's milk does that energy density and meal frequency are
not have the right amounts of iron, vitamin adequate to meet the child’s needs. Tables
C and other nutrients for the baby, and 14, 15, 16, 17 and 18 show examples of food
neither does it provide healthy fats that combinations and the approximate quantities
an infant needs to support growth. It may of foods from the six food groups that would
even cause iron-deficiency anaemia in meet the energy and nutrients needs described
some babies, since cow's milk protein can in Table 13 and Table 28 in Annex 1. The
irritate the lining of the digestive system, recommended amounts in Tables 14 to 18 are
leading to blood loss in the stools (WHO, derived from diet modelling through linear
2015b; CDC, 2021a). programing that optimised various combinations
• Do not add honey, sugar and salt to of food items from the six food groups, to come
complementary foods. A baby’s small up with a proportion contribution of each food
kidneys cannot handle these foods which group to meet the calorie and nutrient targets
make the kidney work extra hard. Sugary per age group considering affordability of foods
food can cause tooth decay and honey has in Zambia (GAIN 2021). The recommended
bacteria which can cause illness in babies amounts are given in number of serving sizes
younger than 12 months of age. whose serving size equivalents are described in
• Follow the general food safety guidelines in Table 19. Table 20 provides practical guidance
Section Two at all times before, during and on the quality, frequency and amount of food to
after food preparation as well as feeding: offer children aged 6 to 23 months.
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Table 14: Recommended amounts per food group for 6-8 months

Recommended
Energy and nutrient values per serving*
amounts

Total
Food
food Energy Protein Fat Carbohydrates Ca Fe Zn Vit A Retinol Folate Fibre
group Number weight
of servings
(mcg
(g) (Kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (g)
RAE)
Totals 2 216 268.9 11.3 10.7 29.5 74.8 2.8 1.3 456.1 308.6 88.6 5

Cereals
0.25 50 64.4 1.5 0.2 13.7 5.3 0.2 0.1 19 0 4.1 0.8
and tubers

Dairy
0 0 0 0 0 0 0 0 0 0 0 0 0
products

Fats and
0.25 4 31.5 0 3.5 0 0 0 0 0 0 0 0
oil
Fruits 0.75 100 79.2 0.9 3.1 10.7 18 0.5 0.2 52.9 0 27.5 2.5

Meat, fish
0.25 23 36.1 5.3 1.6 0.1 9.3 0.9 0.6 326.2 308.6 29 0.1
and eggs

Pulses,
nuts and 0.25 22 47.4 2.6 2.2 3.8 6 0.6 0.4 0.5 0 18.2 1.2
seeds

Vegetables 0.25 18 10.3 0.9 0.1 1.2 36.3 0.6 0.1 57.4 0 9.8 0.4

*Provided by the diet model food combinations

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Zambia Food-Based Dietary Guidelines
122
Table 15: Recommended amounts per food group for 9 -12 months

Recommended
Energy and nutrient values per serving*
amounts

Total
Food group food Energy Protein Fat Carbohydrates Ca Fe Zn Vit A Retinol Folate Fibre
Number weight
of servings
(mcg
(g) (Kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (g)
RAE)
Zambia Food-Based Dietary Guidelines

Totals - 225 310.2 12.8 12.4 34.4 145.7 3.5 1.6 498.8 351.3 92.3 5

Cereals
0.25 50 64.4 1.5 0.2 13.7 5.3 0.2 0.1 19 0 4.1 0.8
and tubers

Dairy
0.25 61 41.3 1.5 1.7 4.9 70.9 0.7 0.3 42.7 42.7 3.7 0
products

Fats and oil 0.25 4 31.5 0 3.5 0 0 0 0 0 0 0 0

Fruits 0.75 100 79.2 0.9 3.1 10.7 18 0.5 0.2 52.9 0 27.5 2.5

Meat, fish
0.25 23 36.1 5.3 1.6 0.1 9.3 0.9 0.6 326.2 308.6 29 0.1
and eggs

Pulses, nuts
0.25 22 47.4 2.6 2.2 3.8 6 0.6 0.4 0.5 0 18.2 1.2
and seeds

Vegetables 0.25 18 10.3 0.9 0.1 1.2 36.3 0.6 0.1 57.4 0 9.8 0.4

*Provided by the diet model food combinations


Table 16: 12-23 Months -Option 1

Recommended
Energy and nutrient values per serving*
amounts
Total Car-
Food group Ener- Pro- Reti- Fo- Fi-
Number food Fat bohy- Ca Fe Zn Vit A
gy tein nol late bre
of serv- weight drates
ings (mcg
(g) (Kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (g)
RAE)
Totals 3.75 497 570.5 24 21.8 66 247 4.3 2.7 878.2 655.1 147.1 7.3
per food group for 12-23 months

Cereals
0.75 150 193.3 4.5 0.7 41.2 15.8 0.5 0.3 57 0 12.2 2.3
and tubers
Dairy
0.5 122 78.7 4.1 4.5 5.4 146.4 0.1 0.5 40.3 37.8 12.2 0
products
Fats and oil 0.5 7 63 0 7 0 0 0 0 0 0 0 0
foods or milk. Option 1 suggests more dairy and
for those that may not afford animal source of
options are available to provide some flexibility
For children aged 12-23 months, three model
Tables 16, 17 and 18: Recommended amounts

Fruits 1 133 105.6 1.2 4.1 14.2 24 0.7 0.3 70.6 0 36.6 3.3
Meat, fish
0.5 46 72.2 10.6 3.2 0.2 18.5 1.9 1.1 652.5 617.3 58.1 0.1
and eggs
Pulses, nuts
0.25 22 47.4 2.6 2.2 3.8 6 0.6 0.4 0.5 0 18.2 1.2
and seeds
Vegetables 0.25 18 10.3 0.9 0.1 1.2 36.3 0.6 0.1 57.4 0 9.8 0.4
*Provided by the diet model food combinations
fruits and increased amounts of vegetables.

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Zambia Food-Based Dietary Guidelines

the costs of fruit, option 2 was rerun to provide a


also suggested more fruit than vegetables. Given

third option (option 3) with reduced amounts of


amounts of ASF and dairy. Both options 1 and 2
less of ASF; option 2 suggests similar serving
124
Table 17: 12-23 Months -Option 2

Recommended
Energy and nutrient values per serving*
amounts

Total
Food group Carbohy- Fibre
food Energy Protein Fat Ca Fe Zn Vit A Retinol Folate
drates
Number weight
of servings
(mcg (g)
(g) (Kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg)
RAE)
Zambia Food-Based Dietary Guidelines

Totals 3.75 546 548.6 21.4 24.5 57.5 378.9 3.2 2.5 573.3 384.3 126.2 6.5

Cereals 1.5
0.5 100 128.9 3 0.4 27.4 10.5 0.3 0.2 38 0 8.2
and tubers

Dairy 0
1 244 157.4 8.3 9 10.7 292.8 0.1 1 80.5 75.6 24.4
products

Fats and oil 0.5 7 63 0 7 0 0 0 0 0 0 0 0

Fruits 1 133 105.6 1.2 4.1 14.2 24 0.7 0.3 70.6 0 36.6 3.3

Meat, fish and 0.1


0.25 23 36.1 5.3 1.6 0.1 9.3 0.9 0.6 326.2 308.6 29
eggs

Pulses, nuts 1.2


0.25 22 47.4 2.6 2.2 3.8 6 0.6 0.4 0.5 0 18.2
and seeds

Vegetables 0.25 18 10.3 0.9 0.1 1.2 36.3 0.6 0.1 57.4 0 9.8 0.4

*Provided by the diet model food combinations


Table 18: 12-23 Months -Option 3

Recommended amounts Energy and nutrient values per serving*

Food group Total food Carbohy-


Energy Protein Fat Ca Fe Zn Vit A Retinol Folate Fibre
weight drates
Number
of servings
(mcg
(g) (Kcal) (g) (g) (g) (mg) (mg) (mg) (mcg) (mcg) (g)
RAE)

Totals 4 456 591 24.3 26.8 60 271.3 4.5 2.6 900.4 655.1 138.7 6.1

Cereals
0.75 150 193.3 4.5 0.7 41.2 15.8 0.5 0.3 57 0 12.2 2.3
and tubers

Dairy
0.5 122 78.7 4.1 4.5 5.4 146.4 0.1 0.5 40.3 37.8 12.2 0
products

Fats and oil 1 14 126 0 14 0 0 0 0 0 0 0 0

Fruits 0.5 66 52.8 0.6 2.1 7.1 12 0.4 0.1 35.3 0 18.3 1.6

Meat, fish and


0.5 46 72.2 10.6 3.2 0.2 18.5 1.9 1.1 652.5 617.3 58.1 0.1
eggs

Pulses, nuts
0.25 22 47.4 2.6 2.2 3.8 6 0.6 0.4 0.5 0 18.2 1.2
and seeds

Vegetables 0.5 35 20.6 1.9 0.2 2.4 72.6 1.1 0.2 114.8 0 19.7 0.9

*Provided by the diet model food combinations

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Zambia Food-Based Dietary Guidelines

17.5 ONE SERVING SIZE EQUIVALENTS OF DIFFERENT FOOD GROUPS


Table 19 provides a serving size which is a standardized amount of food set by the Kcal amount
provided. An approximate average food weight amount from the standardised Kcal amount is also
provided for each food group. Table 19 also gives one serving equivalent of commonly consumed
individual foods for each food group in everyday measures for ease of measurements for the general
public.

Table 19: Examples of one serving size equivalents for different food groups

Food
Energy One serve equivalent
Food group weight
(common household measures)
(Kcal) (g)
Cereals • approximately 1 cup of rice, pasta, diced sweet potato
200 171
and tubers* and cassava, and ¾ cup cooked nshima
• one serving 1 cup milk or sour milk (245 g)
or
Dairy products 160 - • one ¾ cup or 1 small tin of yogurt (200g)
or
• four cubes of cheese (30g)
Fats and oil 125 - • One serving is about a tablespoon of cooking oil
• one medium banana or apple; or one large orange, or
peach; or two small tangerines, or peaches,
or
Fruits 80 135 • one cup cut fruit like papaya, mango or small fruit like
berries, grapes, masuku
or
• one quarter (1/4) cup baobab pulp
• two eggs (100 g)
or
• two matchbox sized ~60g red meat (beef, goat, sheep)
Meat, fish and
135 88 and insects
eggs
or
• three matchbox sized ~90g fish (kapenta); or poultry
(chicken, quails, duck); or rabbit
• one half cup of cooked beans, bambara nuts, soya
beans or cowpeas
or
Pulses, nuts
135 84 • three tablespoons of peanuts; or seeds like flax, chia,
and seeds
sunflower, pumpkin seeds
or
• one and half teaspoons peanut butter or flour
• one half cup cooked vegetable**
Vegetables 30 71 or
• one cup raw leafy or salad vegetables**
*Select and combine foods from this food group to make the number of servings needed per day.
**This is about 70 grams of vegetables.
Note: Section 2 has detailed food exchange lists for one serving size with Kcal, food weight and household
measures.

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DID YOU KNOW?


Red meat (~60 g) is the size Fish, poultry e.g. chicken and Cheese (~30g) is
of two matchboxes (~90g) is three matchboxes about four dice

Table 20: Practical guidance on the quality, frequency and amount of food to offer children
aged 6 to 23 months

Child age
Texture Frequency Amount of food
(months)
Start with 2-3 table-
Start with thick, well-mashed,
spoons per feed, in-
6-8 semi-solid/blended/pureed 2-3 meals per day
creasing gradually to ½
foods
cup (125ml)
Finely chopped or mashed
3-4 meals per day*
9-11 foods and foods that baby ½ cup (125ml)
can pick up
Family foods, chopped or ¼ cup (190ml) to 1 cup
12-23 3-4 meals per day*
mashed if necessary (250ml)
*Depending on the child’s appetite, 1-2 snacks may be offered.

N.B. If a baby is not breastfed, give an additional 1-2 cups of milk per day, and 1-2 extra meals per day.

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18. Recommendation D: Give a


variety of foods from the six food
groups to children 2 to 5 years to help
them grow to their full potential.

Image Credit: Adapted from UNICEF & URC/CHS

18.1 IMPORTANCE OF OPTIMAL NUTRITION 18.2 DIETARY PATTERNS AND NUTRITION


FOR CHILDREN 2 TO 5 YEARS OF AGE STATUS FOR CHILDREN AGED 24 TO 59
Good nutrition for children two to five years of age MONTHS IN ZAMBIA
is important to meet the needs of rapid physical According to the Zambia Food Consumption and
growth and development (UNICEF, 2020b). Micronutrient Status Survey report, (Alaofè et al.,
Inadequate nutrition at this stage is associated 2014) children aged 24 to 59 months are mostly
with high risks of illness and infections which fed miscellaneous roots and tubers (>80 percent).
can have lifelong consequences on education A greater proportion also ate beans, nuts and
attainment and health (UNICEF, 2020b). seeds, vegetables (60 percent), and grains (70
percent). Animal source intake was mostly fish
From two years of age, children start to choose and seafood (60 percent), meat and poultry (8.6
their own food, can feed themselves, can eat percent), milk and dairy products or eggs or
family meals and some can start to eat outside beverages (9 to 11 percent), with no insects (8
the home (UNICEF, 2020b; FAO, 2004). Families percent). Of concern was the low intake of fruits
and caregivers should continue to provide a (44 percent) and high intake of sugar and sweets
diversified diet from all the six food groups for (27 percent) (Alaofè et al., 2014).
children in this age group. Children during this
age need to be encouraged to eat during meal
times especially during sickness (FAO, 2004).

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Zambia is endowed with a variety of foods that the six food groups to ensure they get all the
meet children’s nutrient needs, however a lot of nutrients they require (FAO, 2004). Children in
households cannot afford these foods to meet this age group should be fed three meals and
dietary requirements especially protein, iron, one to two nutritious snacks a day (FAO, 2004).
calcium, folate, and zinc since animal sources
are unaffordable. Avoid adding too much spice, sugar and salt to
children’s food (FAO, 2004). To ensure children
18.3 THE RECOMMENDED INTAKE FOR eat enough food, they should be served food in
CHILDREN AGED 2 TO 5 YEARS their own plate or bowl (FAO, 2004).
Children aged two to five years should be given
family meals that contain a variety of foods from

Table 21: Diet model-calculated recommended food amounts and serving sizes and the
nutrients this eating pattern will provide 2 to 5-year-olds

Recommended
Energy and nutrient values per serving*
amounts

Food group Total Food Carbo-


Energy** Protein Fat Ca Fe Zn Vit A
number of weight hydrates
servings
(g) (Kcal) (g) (g) (g) (g) (g) (mcg) (mcg RAE)
Total
nutrients - - 1157 41.5 35.4 160 405.8 8.83 4.98 908.8
provided
Cereals
2.25 385 568.4 13.28 2.3 120.5 46.3 1.9 1.4 145.7
and tubers
Dairy
0.5 124 80 4.22 4.59 5.5 148.8 0.06 0.48 40.92
products
Fats and oil 1 13 117 0 13 0 0 0 0 0
Fruits 1 135 105.6 1.24 4.13 14.23 24.03 0.7 0.27 70.58
Meat, fish
0.5 44 66.6 9.84 2.89 0.21 17.97 1.78 1.08 419.93
and eggs
Pulses,
nuts and 1 85 177.7 9.14 8.06 14.92 23.5 2.17 1.33 2.01
seeds
Vegetables 1 70 41.2 3.75 0.43 4.72 145.2 2.24 0.37 229.63
*Provided by the diet model food combinations
**Protein accounts for 14.34%, fat accounts for 27.54 % and carbohydrates account for 55.34% of the total energy
amount

Refer to Table 19 for serving sizes and serving size equivalents for each food group.

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18.4 TIPS ON FEEDING CHILDREN AGED 6-59 MONTHS

Helpful Tips quality, frequency and amount of food to offer


children aged 6 to 59 months

1. Include fish, insects, or animal source foods like eggs, poultry meat, and milk products
to ensure the child gets all the nutrient he/she needs.
2. Give children orange-coloured vegetables, fruits and tubers like paw-paw, ripe
mango, pumpkins, pumpkin flowers, orange-fleshed sweet potatoes, whole grain
yellow maize, and dark leafy vegetables.
3. Give pulses, nuts and seeds to children. Adding pulse or nut powders is a great way
to add nutrients to children meals.
4. Grow and use bio-fortified crops like orange-fleshed sweet potatoes, yellow maize
and beans.
5. Add nutrient-rich food powders like insect and moringa powder to children’s meals.
Adding moringa is a great way to enrich child meals because the moringa leaf
contains a much higher nutritional value of iron, calcium and complete protein, as
well as vitamins A, C, B2, B6 and various minerals compared to other foods. The
moringa tree grows easily and quickly.
6. The need for iron and zinc is sometimes difficult to meet. Reports suggest that a
breastfed infant aged 6 to 8 months needs more than eight times as much iron
and four times as much zinc per 100 Kcal food as an adult male (Dewey and Vitta,
2013). Therefore, in contexts where nutrient-rich foods are limited or not available
or during lean seasons, the use of specialised fortified products, such as fortified
blended foods, micronutrient powders, or a small quantity of lipid-based nutrients
supplements, may be needed (Michaelsen et al., 2017; WHO, 2005).

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19. Recommendation E:
Adolescents, especially girls, should
eat a variety of foods from the six
food groups for healthy weight and
growth.

Adolescence is the phase of life between adolescent years can slow down physical growth
childhood and adulthood during ages 10 to and development. It also affects the attention
19 years. During the adolescent stage, there is span, learning and school performance (FAO,
rapid growth physically including weight, height, 2004; WHO, 2006).
neurological and psychosocial development
(FAO, 2004; WHO, 2006). Adolescence also marks Lack of good nutrition may also lead to
the beginning of puberty and sexual maturity micronutrient deficiencies and anaemia
(FAO, 2004; UNICEF, 2021b). (UNICEF, 2021b). Micronutrients are essential
for supporting skeletal mass, body size and body
19.1 NUTRITIONAL NEEDS FOR density (WHO, 2006).
ADOLESCENTS AGED 10 TO 19 YEARS
The growth spurts and development require Adolescents are at risk of overweight and
additional nutrients (WHO, 2006; UNICEF, obesity due to lifestyle and food habits which
2021b). The adolescence period, also referred to include consuming energy-rich foods which
as the ‘second window of opportunity’, provides are high in fats, and sugary foods, and too
an opportunity for growth and cognitive many fizzy drinks, plus a lack of physical activity
development and makes up for poor childhood (FAO, 2004; UNICEF, 2021b). A high intake of
nutrition (FAO, 2004; WHO 2021b; WHO, 2006; foods rich in fats in adolescents and adults is
UNICEF, 2021b). Inadequate nutrition during the associated with increased risk of heart disease

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Zambia Food-Based Dietary Guidelines

(WHO, 2006). During the ages between 10 to 19 19.1.5 Iodine needs for 10 to 19-year-olds
years, adolescents establish dietary and lifestyle Iodine is important for growth spurts and during
patterns that continue into adulthood (UNICEF, pregnancy in adolescence (WHO, 2006).
2021b; FAO, 2004; WHO,2006).
19.1.6 Vitamins needs for 10 to 19-year-olds
19.1.1 Energy and protein needs for 10 to Vitamins, especially thiamine, riboflavin and
19-year-olds niacin are needed for the metabolisation
Adolescent boys have high energy needs due of carbohydrates to meet the high energy
to physical activity, which results in them being demands (WHO, 2006). Folic acid and vitamin
hungry often and eating large quantities of food B12 are needed for increased growth and
(FAO, 2004). In addition to energy needs, protein sexual maturation (Spear, 2002; WHO, 2006).
needs also increase during this stage to support The increased amount of new cell growth in
growth including building muscle, especially in adolescents requires additional vitamins A, C
boys (WHO, 2006). and E (WHO, 2006).

19.1.2 Iron needs for 10 to 19-year-olds 19.2 DIET AND NUTRITION OUTCOMES FOR
Iron needs increase due to the increase in ADOLESCENTS IN ZAMBIA
growth, lean body mass, blood volume and red A study conducted on adolescent girls aged
blood cell mass (WHO, 2006). In girls, iron needs 15 to 19 years found that dark green leafy
increase and almost double during adolescence vegetables (68.7 percent) were the most
due to menstruation. They will continue to need commonly consumed food group, while the
additional iron throughout their reproductive least consumed food groups were milk and dairy
ages until menopause (FAO, 2004; WHO, 2006). products (15.2 percent,) eggs (14.2 percent) and
meat organs (7.3 percent). Further, the study
19.1.3 Calcium needs for 10 to 19-year-olds found that 76.6 percent of girls had consumed
Calcium is needed for muscular, skeletal and foods rich in vitamin A, while two-thirds (62.7
endocrine development (WHO, 2006). To percent) consumed animal source iron-rich
prevent osteoporosis later in life, the process foods (Bwalya, 2015). The 2020 Global Nutrition
of laying down minerals on the bones (bone Report shows that underweight in children and
mineralization) should be maximized during adolescents aged 5 to 19 years is higher in boys
puberty (FAO and WHO, 2004; Lytle, 2002). (29.9 percent) compared to girls (17.6 percent).
However, overweight and obesity is higher in
19.1.4 Zinc needs for 10 to 19-year-olds girls. About 16.7 percent of girls are overweight
Zinc is important for growth and sexual and 3.4 percent are obese. About 8.4 percent of
maturation during puberty (WHO, 2006). In boys are overweight while 2.1 percent are obese.
addition, it promotes bone formation and
prevents bone loss (WHO, 2006).

132
Table 22: Diet model-calculated recommended food amount and serving sizes and the nutrients this eating pattern will provide for
adolescents girls (10-19 years)

Recommended
Energy and nutrient values per serving*
amounts

Food Carbohy- Fo-


Food group Total Energy Protein Fat Ca Fe Zn Vit A
weight drates late
number
of serv-
ings
(g) (Kcal) (g) (g) (g) (g) (g) (mcg) (mcg RAE) (mcg)

Total nutri-
- 1861.275 2327.1 86.9 77.1 307.1 1208.9 18.7 10.5 2934.8 511
ents provided

Cereals
5 712 1051.9 24.6 4.3 222.9 85.7 3.5 2.7 269.6 74.1
and tubers

Dairy
2 496 319.9 16.9 18.4 21.8 595.2 0.2 1.9 163.7 49.6
products

Fats and oil 2 28 252 0 28 0 0 0 0 0 0

Fruits 1.25 118.25 211.2 2.5 8.3 28.5 48.1 1.4 0.5 141.2 73.2

Meat, fish
1 83.05 141.9 21 5.8 1.3 34.5 4.6 2.5 1785.9 118.3
and eggs

Pulses, nuts
1.25 118.25 250.8 12.9 11.4 21.1 33.2 3.1 1.9 2.8 96.7
and seeds

Vegetables 2.5 158.375 99.4 9.1 1 11.6 412.2 5.8 0.9 571.6 99.1
*Provided by the diet model food combinations

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Zambia Food-Based Dietary Guidelines

20. Recommendation F: When


pregnant or breastfeeding, enjoy
a variety of food including animal
source foods, pulses, fruits and
vegetables with your meals for your
and your baby’s health.

Image Credit: Adapted from UNICEF & URC/CHS

Everybody, young and old, should enjoy eating a body’s needs. It is important therefore to include
variety of foods from six food groups every day to a variety of foods from all the six food groups
stay healthy and strong. However, three months to ensure that both the mother and the future
before and during pregnancy, and after the baby baby get the right types of food and amounts of
is born, are the times when good nutrition is most nutrients they need.
important in pregnant and lactating women’s
lives, as they have special nutrition needs. Eating 20.1 NUTRITIONAL NEEDS FOR PREGNANT
a variety of foods therefore becomes more WOMEN
important during pregnancy and breastfeeding, Pregnant women are nutritionally vulnerable
as it benefits both the mother and the baby. because of the physiological demands that come
with pregnancy (FAO, 2021b). During pregnancy,
The amount of specific nutrients needs vary a woman needs to meet both her and her baby’s
based on the stage of the pregnancy, the nutritional needs. Healthy, well-nourished
mother’s nutritional status, and whether the women should gain an average of 12 kg (10 to 14
mother is carrying one or more babies, amongst kg) in weight during pregnancy to increase the
many other factors. The nutrient requirements probability of delivering a full-term infant with
also change during breastfeeding, (Table 29 in an average birth weight of 3.3 kg, and to reduce
Annex 1 demonstrates the different nutrient the risk of foetal and maternal complications
requirements). There is no single food source (FAO, 2004b).
with all the nutrients necessary to meet the
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Inadequate nutrition during pregnancy risks 20.1.2 Importance of folic acid (folate or vitamin
the mother becoming malnourished. When B9) during pregnancy
the mother’s nutritional needs are not met, the Folic acid is critical during periods of rapid
baby’s nutritional needs are prioritised by the growth, such as during pregnancy and foetal
body by taking from the mother’s nutritional development, particularly during the first
stores, hence causing a reduction in her own trimester. Women need additional folic acid
stores. before and during pregnancy. This is important
for preventing neural tube defects where the
Pregnant women should increase their food baby’s spinal cord and brain fail to develop
intake from the six food groups to cater for the properly (WHO and FAO, 2004). Folate also
increased energy and nutritional demands. It is helps to form DNA and RNA and is involved
important that women eat well before, during in protein metabolism. Folic acid deficiency
and after pregnancy so that they build and during pregnancy increases the risk of maternal
rebuild their bodies’ nutrient stores (FAO, 2004). anaemia, pre-term delivery and low birth weight
Pregnant women are at risk of micronutrient (WHO, 2012a).
deficiencies especially iron, iodine, calcium, folic
acid, and vitamins A. 20.1.3 Importance of vitamin A during pregnancy
Pregnant women need additional vitamin A,
20.1.1 Importance of Iron during pregnancy which plays a role in supporting maternal and
Demands for iron are quite high during foetal tissue growth and development (FAO
pregnancy and iron deficiency anaemia is and WHO, 2004) and strengthens the immune
common among pregnant women globally. Iron function (Fanzo, 2013). Vitamin A is also needed
deficiency anaemia in women of reproductive to provide a limited reserve in the foetal liver.
ages is highest among pregnant women, affecting In addition, vitamin A is also important for
almost half (41 percent) of pregnant women in preventing night blindness (FAO and WHO, 2004;
Zambia, compared to those breastfeeding (28 WHO,2016).
percent) and women who are neither pregnant
nor breastfeeding (31 percent) (ZamStats, MOH Pregnant women are more susceptible to
and IDF, 2019). According to the Zambia Food vitamin A deficiency during the third trimester
Consumption and Micronutrient Status Survey (WHO, 2019a; Radhika et al., 2002). Deficiency
Report, Luapula and Northern provinces had in pregnant women can lead to night blindness
more than 86 percent inadequate intake of iron- (West, 2003; FAO and WHO, 2004; WHO, 2016)
rich foods (Alaofè et al., 2014). and maternal mortality (Christian et al., 2000).
There is high risk of infant mortality in the first
Anaemia increases the risk of maternal blood year of life due to a vitamin A deficiency during
loss, low birth weight, pre-term delivery and pregnancy (Christian et al., 2001). In addition,
infections during childbirth (WHO, 2003; WHO, Vitamin A deficiency during pregnancy can lead
2012a). In addition, anaemia may cause the to pre-term delivery and maternal anaemia
death of the mother and baby (Fanzo, 2013; (Radhika et al., 2002).
WHO, 2012a).
According to the last survey on vitamin A in 2003,
Rich dietary sources of iron include liver, meat, about 13.4 percent of women between 15 to 49
fish, poultry, green leafy vegetables and pulses. years old have a vitamin A deficiency defined as
However, during pregnancy, diet alone cannot a serum retinol level < 0.70 mol/L (WHO, 2007).
meet iron requirements. Pregnant women Good sources of vitamin A include organ meats
need to maintain iron stores of 500 mg during such as liver, kidneys and tripe; orange-coloured
the second and third trimesters, and it is not fruits and vegetables such as carrots, pumpkins,
common for them to achieve this from diet squash and orange fleshed sweet potatoes;
alone (FAO and WHO, 2004). WHO therefore as well as dark green leafy vegetables such
recommends that pregnant women take iron as amaranthus, moringa leaves, spinach and
supplements daily as prescribed at their ante- cowpea leaves.
natal clinic or by a doctor. The recommended
daily supplementation of iron is equivalent to 60 20.1.4 Importance of calcium during pregnancy
mg of elemental iron, which is 300 mg ferrous Women are especially at risk of calcium deficiency
sulphate heptahydrate, 180 mg ferrous fumarate in the third trimester (FAO and WHO, 2013).
or 500 mg of ferrous gluconate (WHO, 2012a). Calcium deficiency in a pregnant woman can

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Zambia Food-Based Dietary Guidelines

result in complications such as pre-eclampsia Pregnant women should therefore consume


(Villar et al., 2004; WHO, 2013). Deficiency in carbohydrate-rich foods like whole grains, roots
calcium can also lead to complications for the and tubers, pulses, and nuts and seeds. Not only
unborn baby which include poor mineralisation, are these foods rich in carbohydrates, they are
retarded foetal growth and low birth weight also rich in other important nutrients such as
(Hofmeyer et al., 2010). vitamins, minerals, fibre and some proteins.

Calcium needs during pregnancy can be met 20.2 SPECIAL NUTRIENT NEEDS FOR A
with foods alone. Such foods include dairy PREGNANT ADOLESCENT
products like milk and yoghurt; dark green leafy Adolescent girls who are pregnant need good
vegetables such as moringa leaves, cassava nutrition to support their own growth as well
leaves, amaranthus and spinach; small fish eaten as their foetus’ (WHO, 2006; WHO, FAO and
with bones such as kapenta, and baobab pulp. UNU, 2007). Apart from the additional nutrients
required during pregnancy, adolescents need
20.1.5 Importance of vitamin D during pregnancy extra nutrients and energy to support their own
Pregnant women are prone to vitamin D growth (FAO, WHO and UNU, 2004). To get extra
deficiency which may result in pre-eclampsia, energy and nutrients, they should eat larger
pregnancy induced diabetes mellitus, premature and more frequent meals and snacks that are
delivery and low birthweight (FAO and WHO, nutrient dense and diverse (FAO, 2004).
2004).
Vitamin D is essential for bone metabolism by Malnutrition among adolescents who are
maintaining the calcium and phosphate balance. pregnant results in poor pregnancy outcomes
(WHO, 2006). Adolescents who become
20.1.6 Importance of extra energy during pregnant are at risk of pre-term delivery, giving
pregnancy birth to infants with a low birth weight or small in
Energy needs increase in pregnancy particularly size for the gestational age, and requiring special
during the second and third trimesters. Pregnant obstetrical assistance compared to older women
women require extra energy to support the (Gortzak-Uzan et al., 2001; FAO, WHO and UNU,
woman’s own changing metabolism and the 2004; UNICEF, 2021c).
rapid growth of the foetus, placenta and maternal
tissues (Institute of Medicine, 1990). In addition, Adolescent mothers are likely to be
pregnant women need extra energy to maintain undernourished and to have undernourished
adequate maternal weight, body composition babies because their bodies are still developing,
and physical activity during pregnancy (FAO,WHO so their nutrient needs during pregnancy are
and UNU, 2001). especially high. They are more likely to die during
pregnancy and childbirth than older women
During pregnancy, there is great variability in (FAO, 2004). Adolescents need additional energy,
the energy requirements between individuals protein, iron, calcium, folic acid, zinc, iodine and
in accordance to their body size, age, and how vitamins to support their own growth and their
active they are. However, on average, pregnant baby’s.
women take an additional 360 Kcal on a daily
basis in the second semester and 475 Kcal in the
third (FAO, 2004b).

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Zambia Food-Based Dietary Guidelines

20.3 RECOMMENDATIONS & GUIDANCE


FOR PREGNANT WOMEN

1. Eat a variety of foods from all the six food groups as stated in the dietary guidelines
for all the general population with more emphasis on eating additional amounts of
fish, insects or animal source foods; additional amounts of pulses like beans, nuts
and seeds, fruits and vegetables; and additional amounts of whole grains. This will
ensure meeting the key nutrients needed during pregnancy.
2. Eat one additional serving of fish and animal source foods or two servings of
pulses, nuts and seeds in order to get the additional 14 g of protein needed during
pregnancy. It is important to eat more animal source foods such as liver, meat,
chicken, fish, and eggs as they contain more bioavailable iron and zinc. It is easy
to obtain the additional nutrients required during pregnancy from animal source
foods.
3. Eat dark green vegetables and orange-coloured fruits and vegetables such as
pumpkin, amaranthus, sweet potato leaves, pawpaw, mango, orange-flesh sweet
potatoes, yellow pumpkins and pumpkin flowers, and carrots for vitamin A and
other key micronutrients.
4. Take daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental
iron and 400 g (0.4 mg) of folic acid provided from the clinic or as prescribed by the
doctor to prevent maternal anaemia, puerperal sepsis, low birth weight, and pre-
term birth (WHO 2016). Where possible, women should take folic acid supplements
before conception.
5. Keep physically active during pregnancy to stay healthy and to prevent excessive
weight gain during pregnancy (WHO, 2016).

137
138
Table 23: Pregnant women

Recommended
Energy and nutrient values per serving*
amounts

Total Food Ener- Carbo-


Food group Protein Fat Ca Fe Zn Vit A Folate
number weight gy** hydrates
of serv-
ings (mcg
(g) (Kcal) (g) (g) (g) (g) (g) (mcg) (mcg)
RAE)

Total nutri-
Zambia Food-Based Dietary Guidelines

ents provid- - 1929.75 2454.4 88.2 56.4 379.9 1060.4 24 10.9 3895.6 646.1
ed

Cereals
5 745.25 1040.8 23 3.3 223.6 86.7 3.3 2.4 422.9 75.5
and tubers
Dairy
1 248 160 8.4 9.2 10.9 297.6 0.1 1 81.8 24.8
products

Fats and oil 1 14 126 0 14 0 0 0 0 0 0

Fruits 3 436.35 283.2 3.1 4 53.9 77.5 2.6 0.6 424.8 111.5
Meat, fish
1 85.8 146.9 20.9 6.4 1.4 31.4 5.2 2.7 2243 155.1
and eggs

Pulses, nuts
2 189.6 402.1 20.7 18.2 33.8 53.2 4.9 3 4.6 155.1
and seeds

Vegetables 3 210.75 125.9 11.9 1.3 14.2 509.4 7.6 1.1 718.6 123

*Provided by the diet model food combinations


**Protein accounts for 14%, fat accounts for 21% and carbohydrates account for 62% of the total energy amount

Refer to Table 19 for serving sizes and serving size equivalents for each food group.
Zambia Food-Based Dietary Guidelines

20.4 NUTRITION FOR LACTATING WOMEN If the nutrient intake is lower than the total
Lactating women are nutritionally vulnerable demand for both maternal maintenance needs
because of the physiological demands of and milk production, the mother's body will
breastfeeding (FAO, 2021b). Breastfeeding mobilise available nutrients from body tissues in
mothers require additional calories for producing order to maintain consistent breastmilk quality
breastmilk to feed their infants. and quantity.

While some of the energy will come from the Besides energy, breastfeeding mothers also
fat that was stored during pregnancy, well- need an extra 20 g of protein and micronutrients.
nourished women need an extra 505 Kcal per Lactating women need additional vitamin A to
day from the diet (FAO, WHO and UNU, 2004; replace the lactation losses and to prevent night
CDC, 20201b). blindness. (FAO and WHO, 2004). Other nutrients
of importance to lactating women are vitamins
Undernourished women, including those who like B3, B6, B12 and C, folate, and minerals like
do not gain adequate weight during pregnancy, selenium, calcium and zinc as per Table 29 (FAO,
should add 675 Kcal per day during the first 2004; FAO, WHO and UNU1981).
six months post-delivery (FAO, WHO and UNU,
2004). Breastfeeding mothers should take folic acid and
iron supplements three months post-delivery to
Lactating adolescents also need additional replenish the stores (WHO, 20134b).
energy and nutrients to replace their nutrient
stores as well as to meet the demands of milk 20.5 DIETARY PRACTICES AND NUTRITION
production. STATUS FOR PREGNANT AND LACTATING
WOMEN IN ZAMBIA
After six months, energy needs for continued According to the Food Consumption and
breastfeeding depend on the levels of milk Micronutrient Status Survey conducted in two
production, baby’s milk intake, mothers body provinces (Alaofè et al., 2014), all lactating
size, proportion of fat stored during pregnancy women had low intake of vitamin A, iron and Zinc
and physical activity level (FAO, WHO and UNU, in all the surveyed provinces. The proportions
2004). varied between provinces; about 50 percent had
low intake of iron in Luapula and 32 percent in
Although the quality of a mother’s diet does not Northern, while 64 percent had low zinc intake
affect the quality of breastmilk she produces in Luapula and 45 percent in Northern (Alaofè
unless a woman is severely malnourished et al., 2014). However, the 2018 Demographic
(Prentice et al., 1989; Hartmann et al., 1985; and Health Survey found that the prevalence of
Greiner, 1994), breastfeeding mothers should eat anaemia was lower among breastfeeding women
a healthy diet which has a variety of foods from (28 percent) than among pregnant women (41
the six food groups. A diversified diet is important percent) and women who are neither pregnant
as the mother will have to replace the amounts nor breastfeeding (31 percent).
of these nutrients lost through breastfeeding.

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Zambia Food-Based Dietary Guidelines

20.6 RECOMMENDATIONS & GUIDANCE


FOR LACTATING WOMEN

1. Follow the dietary recommendations by eating a variety of foods from all the six
food groups as stated in the guidelines for the general population under Section
Two.
2. Eat an extra meal to get the additional energy (505 Kcal) and requirements as well
as the additional 20 g protein. Simply eating more than the usual amount and
variety of foods from all the six groups will allow the mothers to meet the additional
energy, protein, vitamin and mineral requirements and support the women’s health
and wellbeing during lactation.
3. Lactating women should take iron and folic acid supplementation for at least three
months after delivery (WHO, 2014b).

20.7 TIPS FOR LACTATING WOMEN

Helpful Tips ensure successful breastfeeding

1. Avoid caffeine intake.


2. Avoid alcohol and smoking. They can affect the baby in many ways such as make the
baby feel sleepy, nervous and irritable.
3. Avoid harmful drugs.
4. Do not take medication without consulting a doctor.

140
Table 24: Breastfeeding women

Recommended
Energy and nutrient values per serving*
amounts
Total Food Ener- Pro-
Food group num- Fat Carbohydrates Ca Fe Zn Vit A Folate
weight gy** tein
ber of
serv-
ings (g) (Kcal) (g) (g) (g) (g) (g) (mcg) (mcg RAE) (mcg)

Total nutri-
- 2092.8 2619.1 92.6 71.1 382.5 1073.1 24.4 11.2 3980.2 660.1
ents provided

Cereals
6 894.3 1249 27.5 4 268.3 104 4 2.9 507.5 90.6
and tubers

Dairy
1 248 160 8.4 9.2 10.9 297.6 0.1 1 81.8 24.8
products

Fats and oil 2 28 252 0 28 0 0 0 0 0 0

Fruits 3 436.35 283.2 3.1 4 53.9 77.5 2.6 0.6 424.8 111.5

Meat, fish and


1 85.8 146.9 20.9 6.4 1.4 31.4 5.2 2.7 2243 155.1
eggs

Pulses, nuts
2 189.6 402.1 20.7 18.2 33.8 53.2 4.9 3 4.6 155.1
and seeds

Vegetables 3 210.75 125.9 11.9 1.3 14.2 509.4 7.6 1.1 718.6 123

*Provided by the diet model food combinations


**Percent energy contribution: 58% carbohydrate; 24% for protein, and 14% for fat
Refer to Table 19 for serving sizes and serving size equivalents for each food group

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Zambia Food-Based Dietary Guidelines

Annexes

SECTION 4
and
References

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Zambia Food-Based Dietary Guidelines

21. ANNEXES
21.1 ANNEX 1: DIET MODEL OUTPUTS
21.1.1 The standardised amounts defining a serving in Kilocalories and approximate food weights per
food group for the diet models used or the FBDG technical Recomenation

Table 25: Standardised amounts defining a serving in Kilocalories and approximate food
weights per food group

Energy target
One serving size
Food Group per food group serving

(Kcal) (g)
IN TOTAL
Cereals and tubers 200 149.05
Dairy products 160 245
Fats and oil 125 14
Fruits 80 145.45
Meat, fish and eggs 135 98.9
Pulses, nuts and seeds 135 90.5
Vegetables 30 74
Miscellaneous and beverages 170 52

143
21.1.2 Lowest cost diet model for the general population at ZMW 12/person/day

144
The cheaper model, setting energy as 2 100 kcal and changing the weightings of some of the foods used for the FBDG model to favour the
cheaper foods, based on prices provided by WFP:

21.1.3 How the K12 Kwacha model meets energy and nutrient requirements
Table 26: How the K12 Kwacha model meets energy and nutrient requirements

Recommended
Energy and nutrient values per serving
amounts

Food Total Food Pro- Carbohy- Reti-


Energy Fat Ca Fe Zn Cu Vit A Folate Fibre Cost
group number weight tein drates nol
of
Zambia Food-Based Dietary Guidelines

servings (mcg (Kwa-


(g) (Kcal) (g) (g) (g) (g) (g) (mcg) (mcg) (mcg) (mcg) (g)
RAE) cha)

Total nu-
trients 14 1631 1977.1 73.8 50.5 290.5 926.7 20.1 8.9 1.7 1895.9 446.9 485.2 32.6 12
provided

Cereals
and tu- 4 711 993.3 21.9 3.1 213.4 82.7 3.2 2.3 0.5 403.6 0 72.1 11.9 2.2
bers

Dairy
2.5 219 89.5 4.7 5.1 6.1 166.5 0.1 0.5 0 45.8 43 13.9 0 2.5
products

Fats and
1.5 20 175.5 0 19.5 0 0 0 0 0 0 0 0 0 0.7
oil
Fruits 1 136 80 0.8 1.7 12.4 17.9 0.6 0.2 0.1 96 0 26.7 2.3 0.9

Meat,
fish and 0.5 44 66.5 9 3.2 0.2 19.9 1.8 1.1 0.1 426.4 403.9 39.7 0.2 1.5
eggs

Pulses,
nuts and 2.5 219 414.9 22.3 16.1 39.5 58.9 5.5 3.4 0.7 5.7 0 175.5 11.2 2.9
seeds

Vegeta-
4 283 164.8 15 1.7 18.9 580.8 9 1.5 0.4 918.5 0 157.4 6.9 1.4
bles
Zambia Food-Based Dietary Guidelines

21.1.4 The foods and food weights used in the diet models

Table 27: Foods and food weights used in the diet models

K12 model
Food group Food
weighting
Cereals and tubers Maize, white, stiff porridge (without salt) 55.00
Rice, brown, boiled (without salt) 15.00
Cassava, tuber, boiled (without salt) 10.00
Bread/rolls, white 5.00
Sweet potato, deep yellow, boiled (without salt) 15.00
Dairy products
Milk, cow, whole, 3.5% fat* 100.00

Fats and oil


Vegetable oil 100.00

Fruits Papaya, fruit, ripe, raw 20.00


Banana, white flesh, raw 15.00
Mango, orange flesh, raw 45.00
Avocado, pulp, raw 10.00
Orange, raw 10.00
Meat, fish and eggs Beef, meat, 15-20% fat, boiled (without salt) 10.00
Tilapia, steamed*(without salt) 10.00
Chicken, light meat, flesh, boiled (without salt) 10.00
Egg, chicken, boiled (without salt) 30.00
Mopane worm, canned 20.00
Chicken liver, braised (without salt) 10.00
Beef liver boiled (without salt) 0.00
Anchovy, fillet, grilled (without salt and fat) 10.00
Pulses, beans, nuts and seeds Cowpea, brown, boiled (without salt) 42.00
Beans, white, boiled (without salt) 43.00
Groundnut, shelled, dried, raw 15.00
Vegetables Pumpkin leaves, boiled (without salt) 20.00
Cassava, leaves, boiled (without salt) 20.00
Tomato, red, ripe, boiled (without salt) 15.00
Amaranth leaves, boiled (without salt) 10.00
Spinach, boiled* (without salt) 10.00
Drumstick leaves, boiled (without salt) 20.00
Sweet potato leaves, boiled (without salt) 5.00
*Includes pasteurised, sterilised and ultra-high temperature (UHT) processed milk
Note: Similar foods were used for all models with few modifications of children 6-12 months. The
food weighting for the lowest cost diet above differs from the weighting for other models since the
other models used common food combinations and portions, unlike the lowest cost model which
put more weighting on the lowest cost foods.

145
Table 28: Nutrient requirements per day for 7-12 month, and children aged 1-3; 4-6; and 10-18 years

146
Recommended intake per day per age group*

6-12 1-3 4-6 10-18 years 10-18 years


Nutrients
months years years (girls) (boys)
Energy (Kcal/day) 1036 (boys) 1333 (boys) 2344.5 2838.6
703
956 (girls) 1223 (girls) (34.7-56.7 kg) (33.3-67.8 kg)
Protein (g/day) 40.5
10.9 (boys) 12.1 (boys) 17.1 (boys) 41 (11-14 yrs)
(11-14yrs, 45 kg)
57.9
10.1 (girls) 11.5 (girls) 16.2 (girls) 47.4 (15-18 yrs)
Zambia Food-Based Dietary Guidelines

(15-18 yrs, 66.5 kg)


Vitamin A** (ug RE/day) 400 400 450 600 600
Iron 15% bio-availability 9.3 (11-14 yrs)**
9.7 (11-14 yrs)
(mg/day)
6.2*** 3.9 4.2 21.8 (11-14 yrs)
20.7 (15-17 yrs) 12.5 (15-17 yrs)
12% bio-availability 11.7 (11-14 yrs)** 12.2 (11-14yrs)
7.7*** 4.8 5.3 27.7 (11-14 yrs)
25.8 (15-17 yrs) 15.7 (15-17 yrs)

10% bioavailability 14 (11-14 yrs)** 14.6 (11-14 yrs)


9.3*** 5.8 6.3 32.7 (11-14 yrs)
31 (15-17 yrs) 18.8 (15-17 yrs)
5% bioavailability 28 (11-14 yrs)** 29.2 (11-14 yrs)
18.6*** 11.6 12.6 65.4 (11-14 yrs)
62 (15-17 yrs) 37.6 (15-17 yrs)
Folate (µg/day) 80 150 200 400 400
Zinc High bioavailability 0.8†
(mg/day) 2.4 2.9 4.3 5.1
2.5††
Moderate bioavailability 4.1 4.1 4.8 7.2 8.6
Low bioavailability 8.4 8.3 9.6 14.4 17.1
Recommended intake per day per age group*

6-12 1-3 4-6 10-18 years 10-18 years


Nutrients
months years years (girls) (boys)
Calcium (mg/day) 400 500 600 1300^ 1300^
Vitamin C (mg/day) 30 30 30 40 40
Selenium (µg/day) 10 17 22 26 32
Magnesium (mg/day) 54 60 76 220 230
Iodine (µg/day) 90^^ 90^^ 90^^ 150 (13-18 yrs) 150 (13-18 yrs)
Thiamine (mg/day) 0.3 0.5 0.6 1.1 1.2
Riboflavin (mg/day) 0.4 0.5 0.6 1.0 1.3
Niacin (mg NE/day) 4 6 8 16 16
Vitamin B6 (mg/day) 0.3 0.5 0.6 1.2 1.3

*Age divisions are based on those used in FAO and WHO (2004) unless otherwise stated. Energy requirements from FAO/WHO/UNU (2004) were specifically re-calculated to suit the
WHO and FAO (2004) age group divisions.
**Vitamin A levels are based on safe intake levels not on recommended nutrient intake (RNI). Conversion factors for carotenoids are under review, with the pending conclusion that
servings of green leafy vegetables needed to meet vitamin A requirements probably need to be at least doubled. In view of this uncertainty, only “recommended safe intakes” rather
than RNIs are provided for this vitamin.
***Bioavailability of dietary iron during this period varies greatly
†Breastfed
††Not applicable to infants exclusively breastfed
^ Particularly during the growth spurt
^^Recommendation for the age group 0–4.9 years

Note:
Energy and all other nutrients listed above can be met by simply eating a variety of foods.
The FAO and WHO breakdown of age for vitamin and mineral requirements is from 7- 12 months; 1-3 years; 4-6 years, 10-18yr girls.

Sources: FAO and WHO (2004); FAO, WHO and UNU (2004); FAO, WHO and UNU (2007).

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Table 29: Nutrient requirements per day for non-pregnant, pregnant and lactating women and women aged 19 to 50 years)

148
Pregnant women Lactating women
19-50 years
Nutrients non-pregnant
women 1st 2nd 3rd 0-3 4-6 7-12
trimester trimester trimester months months months

Energy (Kcal/day) 2100 - 2460 2575 2605 2605 2560


Average energy [rounded] (Kcal/day)
2100 2460 2600

Protein* (g/day) 41.3 42.3 50.3 72.3 60.3 54.3


Zambia Food-Based Dietary Guidelines

Vitamin A** (ug RE/day) 500 800 850


Iron 15% bio-availability
(mg/day) 20 n , s, d 10

12% bio-availability
25 n , s, d 12

10% bioavailability
29 n , s, d 15

5% bioavailability
59 n , s, d 30

Folate (µg/day)
400 600 + s^ 500

Zinc High bioavailability


(mg/day) 3 3.4 4.2 6 5.8 5.3 4.3

Moderate bioavailabil-
ity 4.9 5.5 7 10 9.5 8.8 7.2

Low availability 9.8 11 14 20 19 17.5 14.4


Calcium† (mg/day) 1000 1000 1000 1200 1000 1000 1000
Vitamin C (mg/day) 45 55 70
Pregnant women Lactating women
19-50 years
Nutrients non-pregnant
women 1st 2nd 3rd 0-3 4-6 7-12
trimester trimester trimester months months months

Selenium†† (µg/day) 26 26 28 30 35 35 42
Magnesium (mg/day) 220 220 220 220 270 270 270
Iodine (µg/day) 150 200 200 200 200 200 200
Thiamine (mg/day) 1.1 1.4 1.5
Riboflavin (mg/day) 1.1 1.4 1.6
Niacin (mg NE/day) 14 18 17
Vitamin B6 (mg/day)
1.3 1.9 2.0

*Protein calculated based on pre-pregnancy weight of 55 kg; protein requirement based on 0.75 g/kg; increase in requirements
based on FAO/WHO/UNU (2007); calculations correspond with FAO/WHO/UNU (1981) recommendations
**Vitamin A levels are based on safe intake levels not on recommended nutrient intake (RNI). Conversion factors for carotenoids
are under review, on servings of green leafy vegetables needed to meet vitamin A requirements.
^Pregnant women take daily oral folic acid supplementation and where possible, before conception
†No calcium levels for 1st and 2nd trimester given, hence pre-pregnancy levels are assumed
††No selenium levels for 1st trimester given, hence pre-pregnancy levels are assumed

n: No figures are given for dietary iron requirements in pregnant women because the iron balance in pregnancy depends not only
on the properties of the diet but also on the amounts of stored iron.
d: Dietary sources
s: The increased iron requirement cannot be obtained from the diet and thus daily supplemental iron and folic acid is recommend-
ed during pregnancy and for at least three months after delivery (WHO, 2013).

Note:
Energy and all other nutrients listed above can be met by simply eating a variety of foods.

Sources: FAO and WHO (2004); FAO, WHO and UNU (2004); FAO, WHO and UNU (2007).

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21.2 ANNEX 2: LIST OF TWG AND ATTENDANCE DURING THE FBDG DEVELOPMENT PROCESS

150
11 - 17 Feb 22 - 25 29 Oct - 2 22 - 26 July 3 - 8 Novem- 2020 May 2021 4-5
2018 May 2018 Nov 2018 2019 ber 2019 August
TWG 2021
Launch Training Validation Message Pre-test Pre-test validation Editori-
Name Institution
and first workshop/ creation als Valida-
training of situation tion
FBDGs analysis list
1 Nancy Chella* MoA X X X X X X
2 Rose Silyato* MoA X X X X X
3 Sibeso Mulele* MoA X X X
4 Rita Syafunko* MoA X X X
5 Moses Mwale MoA X
Zambia Food-Based Dietary Guidelines

6 Penelope Malilwe MoA X


7 Yotam Nyirenda MoA X
8 Clara Hamayuwa MoA X
9 Mabula Chriginoe MoA X
10 Conrad Busiku MoA X
11 Mwitwa Mambwe ACF X
12 Dorothy Namuchimba CARE X
13 Wila Zambezi* CDH X X X X X X
14 Mathews Mhuru CSO-SUN X
15 Jessica Mayenda CSO-SUN X X X
16 Nsungwe Mulende* CSO-SUN X X
17 Malumo Nawa DoA X
18 Zyangam Chirambo* DoF/MFL X X
19 Pamela Munjoma FAO (in SFS) X
20 Celestina Lwatula* FAO (in Zambia) X X X X X X X X
21 Dr. Mercy Chikoko* FAO (in SFS) X X X X X X X X X
22 Veronica Mwaba FAO (in Zambia) X
23 Mukaba Mukaba FAO (in Zambia) X
24 Patrick Chilumba FAO (in Zambia) X
FAO (in SFS) /
25 Elizabeth Mcunu X
Admin
11 - 17 Feb 22 - 25 May 29 Oct - 2 Nov 22 - 26 July 3-8 2020 May 2021 4-5
2018 2018 2018 2019 November August
2019 TWG 2021
Launch and Training Validation Message Pre-test valida- Edito-
Name Institution
first training workshop/ creation Pre-test tion rials Valida-
of FBDGs situation tion
analysis list
26 William Chilufya* HIVOS X X X X X X
27 Mary Lubungu IAPRI X
Dr. Rhoda Mofya Muku- IAPRI/FAO (in
28 X X X
ka* Zambia)
29 Beauty Mweene K/Mission X
30 Selina Phiri Kafue X
31 Charity Mwawo Kasaka camp X
32 Dr. Luke Mugode* LAMU X X X X X X X
33 Precious Nzala* MCDSS X X
34 Luwindi Kabondo* MCDSS X X
35 Weka Banda* MCDSS X X X
36 Wilbroad Zimba* MCDSS X X X
Dr. Venantious Mulenga
37 MFL X X X X X
Musonda*
38 Ephraim Luhanga MFL X
39 Christine Inambao MFL X
40 Ellison Musimuko MFL X
41 Bwalya Tembo MFL X
42 Chileshe Kaoma MFL X
43 Adrene Banda MFL X
44 Tresphore Chanda* MOGE X X X X
45 Maybin Luulu MOGE X
46 Chilekwa Mibenge MoH X
47 Martin Mzumara MoH X
48 Purity Simasiku MoH X X
49 Chola S. Chileshe MoH X
50 Doreen Sakala MoH X
51 Yaled Sichvula* MoH X X

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Zambia Food-Based Dietary Guidelines
152
11 - 17 Feb 22 - 25 May 29 Oct - 2 Nov 22 - 26 July 3-8 2020 May 4 - 5 Au-
2018 2018 2018 2019 November 2021 gust 2021
2019
Launch and Training Validation Message Pre-test TWG Editori- Valida-
Name Institution
first training workshop/ creation Pre-test valida- als tion
of FBDGs situation tion list
analysis
52 Davies Chutu* MoH X X X X
53 Rachel Malambo MoH X
54 Mary Ngulube MoH X
55 Wilson Kapenda* MoH X X X
56 Casper Miti MoH X
57 Agnes Aongola* MoH X X X X X
Zambia Food-Based Dietary Guidelines

58 Dorothy Sikazwe MoH X


59 Natasha Mhango* NAIS/MoA X X X
60 Chris Kakunta (late)* NAIS/MoA X X X
61 Lilian Mumba NAIS/MoA X X X
62 Lemana Washington NAIS/MoA X X X X
63 Rose Musumali Lungu* NAZ X X X
64 Rose Shangala Silyato NAZ X
65 Gloria Chola* NAZ/LIUTEBM X X X X X
66 Belinda T. Tembo* NFNC X X X
67 Chisela Kauwile* NFNC X X
68 Albertina Mweemba* NFNC X X X X X
69 Freddie Mubanga NFNC
70 Patricia Sakala* NFNC/SUNLE X X X X
Dr. Hilda Nyambe Si-
71 NISIR X X X X X X X
lovwe*
72 Brenda Sinonge* NRDC X X X X X X
James Shabiti Mukomb-
73 PAM X X X
we*
74 Betty Thewo PAM X
75 Maureen Chitundu* PAM X X X
PEP II/MoA/
76 Catherine Mkanjama* X X X
MFL
77 Richard Chanda SCCI X
11 - 17 Feb 22 - 25 May 29 Oct - 2 Nov 22 - 26 July 3 - 8 Novem- 2020 May 2021 4 - 5 Au-
2018 2018 2018 2019 ber 2019 gust 2021
TWG
Name Institution Launch and Training Validation Message Pre-test Pre-test validation Editorials Valida-
first training workshop/ creation tion
of FBDGs situation list
analysis
SUNTA/US-
78 Kelly Mwaba X
AID
Sylva Food
79 Vanessa Zimba X
Solutions
80 Ruth Siyandi UNICEF X X X
81 Josephine Ippe UNICEF X X
82 Beatrice Nyambe UNICEF X
Dr. Chiza Kumwenda
83 UNZA X X X X X X X
*
84 Lukonde M. Zgambo* UNZA X X X X X
85 Murambiwa Nyala* UNZA X
86 Kabunga Nchiyunme UNZA X
Dorothy Nyami
87 UNZA X X X X
Nthani (late)*
Emily Heneghan Kaso-
88 WFP X
ma
89 Emma Gondelach WFP X
Marjolein Mwanam-
90 WFP X
uenge
91 Phililo Nambeye WFP X
92 Chipo Mwelwa WHO X
93 Chiboola Milimo ZARI X X
94 Mwila Chongwe X
*FBDG TWG members

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Zambia Food-Based Dietary Guidelines

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