Linear programming to build food-based dietary guidelines: Romanian food baskets

As in many Member States of the WHO European Region, Romania is seeing an increase in the prevalence of overweight and obesity, particularly among children and adolescents. This is a major risk factor for the development of noncommunicable diseases (NCDs), and innovative approaches using a (“healthy”) diet which prevents NCDs and promotes health are required to reduce their prevalence. One of the obstacles to reducing the prevalence of overweight and obesity is considered to be too high prices for fresh foods rich in micronutrients and low in energy density.
This document describes a new approach using linear programming methodology to design national dietary recommendations which aim to prevent both NCDs and micronutrient deficiencies and still be affordable by low income groups. This new approach is applied within the context of food availability in Romania in 2014. Eating the same food every day is unrealistic and too monotonous to be maintained, so this novel approach is used to select a wide range of diverse foods that can be recommended for a period of up to, for example, one month.

The following are the key findings of this report.
• The simplest version of the Romanian food basket that incorporates only WHO food-based dietary guidelines does not meet all the recommended nutrient intake values for, for example, vitamins A, D, K, iodine and calcium.
• The version of a Romanian fully nutritious, health-promoting food basket for a family (two adults, two children) costs 19.65 lei (~€ 4.46) for a day.
• Key nutrients, primarily vitamin D, calcium, potassium and iron, were found to control the overall price.
• The least expensive basket (one day’s rations) is monotonous and the linear programming approach is used to select a wide range of foods that can be recommended for a period of up to, for example, one month and still be optimized for the lowest possible cost.
• Compared with the food consumption patterns of the Romanian population in 2011, the dietary recommendations designed here, using the linear programming approach, contain significantly more root vegetables, potatoes and fish and considerably less meat, fats, oils and sugar.

In conclusion, the linear programming methodology can facilitate the development of national dietary recommendations that meet both recommended nutrient intake values and WHO food-based dietary guidelines in a cost-efficient manner. How best to implement these dietary recommendations at population and individual level still has to be investigated.