Re: [pronut-hiv] Question about Weaning Foods (2)

["Marlou Bijlsma" <marloubijlsma@yahoo.co.uk>]

Dear Eileen

Your question may seem basic, but very important. I include an
exercise that I use in some of my classes. For you, the answer is
included.

Hope this is of help 

Marlou Bijlsma
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Exercise replacement feeding 

A mother has a 6 months old baby. She is breast-feeding 5 times a
day, an average of 200 ml of breast milk per feed. 

The mother is advised to change over to replacement feeding, to
increase the total energy and protein given to the child. The health
worker asks her to discuss options to prepare the feeds. The mother
suggests she can prepare maize porridge, with some sugar. She plans to
feed the child 210 ml of porridge and 5 g of sugar per plate.

a) Calculate the energy content of the suggested porridge and compare
with the energy content of the breast milk.

Nutrient content per 100 gram

                             Kcal 
Breast milk               70
Maize flour              335 
Rice                     335
Cow's milk                66
Ground nuts              570
Beans(dry)               320
Lentils(dry)             325
Egg                      140
Margarine                745
Sugar                    400
 

Conversion factors (this refers to the amount of water that is taken
up or evaporated when cooking the dish) 
                                    from 1 g raw
maize flour/porridge             7 g
rice porridge                    5 g
dry/cooked beans                 2.5 g
dry/cooked rice                  2.5 g
stiff maize porridge (sadza)     3.5 g
leafy vegetables                 0.8 g
beets/roots                      1 g
b) Improve the menu suggestion for the child. Calculate the energy
content of the food with the use of the food composition table.

Answer

a) 
Breastmilk provides 200/100 ml x 70 Kcal = 140 Kcal per feed (or
5x140=700 Kcal per day)

Maize with sugar porridge
Maize provides (210/7)/100 x 335 Kcal= 100 Kcal 
Sugar provides 5/100 x 400 = 20 Kcal 
Total energy porridge 100+20=120 Kcal per feed. This is inferior to
the energy content of the breastmilk. Maize porridge alone provides 100
Kcal per feed, the sugar added another 20 Kcal per feed, but this is not
enough. A child needs more energy than breast milk can provide after 6
months as it becomes more active, so the replacement feeds should be
fortified with other foods to make them more energy dense. It is not
possible to increase the amount of porridge fed to the child as its
stomach can not cope.

b)
Fortify porridge with for instance peanut butter (1 tablespoon per
feed= 10g)
Maize provides (210/7)/100 x 335 Kcal= 100 Kcal 
Peanut butter provides 10/100 x 57 = 57 Kcal
Total energy of the porridge is now 100+57=157 per feed (220 ml)

Other alternative is for instance boiling 100 ml of stiff maize
porridge (sadza/nsima) with 100 ml of milk, add 5 g of sugar (1
teaspoon)
Maize provides (100/3.5)/100 x 335 Kcal= 100 Kcal 
Milk provides 100/100 x 66 Kcal = 66 Kcal
Sugar provides 5/100 x 400 = 20 Kcal 
Total energy 186 Kcal (215 ml)

Aim for replacement feeds for a 6 months old child some 200-220 ml
per feed, aim for an energy concentration of at least 75Kcal per 100 ml
feed.