Using protein and good Nutrition to build a stronger population

The COVID-19 pandemic has disrupted life in Bangladesh and around the world, and has underscored the importance of focusing on our personal health and well being. While there are many things we can do to stay safe, such as social distancing and wearing masks, one of the biggest tools in the fight against COVID-19 is maintaining good personal nutrition.

The importance of good nutrition is nothing new for Bangladesh, as the country has made significant progress in building a stronger population through addressing malnutrition. The country has reduced the rate of malnutrition from 42% in 2013 to 28% in 2019; however, challenges still remain. Bangladesh faces a triple burden of malnutrition – “under nutrition” (underweight, stunted growth, muscle wasting), “over nutrition” (overweight) and micro nutrient deficiencies (i.e. lacking a balanced diet). 

Malnutrition impacts physical and mental cognitive development of children, and increases the risk of communicable diseases and critical infections in adults as it hampers immunity. Malnutrition in Bangladesh is aggravated by poor dietary diversity, with excessive carbohydrate intake (70 % cereal mainly rice) and inadequate quality protein, fat and micronutrient (vitamin A, iron, zinc) intake.

A key nutrient to fight malnutrition is a proper diet of proteins. One of the reason Bangladesh ranks 104 out of 112 countries on the Global Food Security Index (GFSI)-Quality and Safety of Food- 2020 (Economic Intelligence Unit) is that GFSI considers diet diversification, nutritional standards, availability of dietary micronutrients that includes vitamin A, animal iron and vegetal iron, zinc and quality of proteins.

We get our protein from 2 sources - plants and animals. Animal sources of protein are considered higher quality as they contain all the essential amino acids and can be easily digested and utilized by the human body. Global trends indicate high income countries maintain a balanced diet of proteins from both animal and plant sources while lower income countries such as Bangladesh depend more on plant sources. In Bangladesh, the demand for meat is also driven by affordability with urban areas consuming greater proportion of meat in its diet than rural areas.

Two important developments in the last 30 years in Bangladesh have been steadily improving the balance of protein intakes. The first is the growth of aquaculture. Availability of fish at a national level has increased animal protein intake. The second is the increased availability of poultry, eggs, and milk. Since the early 1990’s the considerable increase in protein intake has been largely in line with recommended global protein levels, but 80% of the intake is still from plant sources.

According to the Food and Agriculture Organization’s food balance sheet, the total protein intake in Bangladesh is 60g/day/person, of which only 12g/day/person is from animal sources and 48g/day/person from plant sources.

Protein is a macronutrient like carbohydrate and fat, providing a source of energy. The building block of proteins are amino acids (AA). Nine of them are essential AAs as we cannot store them in our body and so they have to be obtained from our diet. Food that contains all or most 9 AAs are of high biological value as our bodies can break them down and use them efficiently. Therefore, those proteins that provide the 9 AAs are considered quality proteins, and are included as one of the determinants in the GFSI rankings.

Protein is critical for building bones and tissues (muscle). It plays a role in metabolic reactions, cell functions, cell and tissue repair, and forms blood cells. The daily requirement for protein for an average person is about 0.75-0.80 g/kg/day depending on factors such as weight, age, activity levels, gender and health condition. The requirements are higher during pregnancy, lactation, childhood, recovery from major illness, trauma, infection, and surgery. Therefore, to tackle malnutrition, Bangladesh needs to meet increased protein requirements in critical stages of development. Even though Bangladesh is on track to meet maternal, infant and child nutrition targets, the rate of stunted growth is higher than average for Asia with 30.8% of children under the age of 5 affected. 

To understand the sources of protein, it is important to mark out its widely available sources as below:

 Sources of animal protein 

Red meat: beef, lamb, mutton, goat, pork meat. Also good sources of heme iron and zinc. Even though red meat is considered as high quality protein, its intake should be in moderation due to saturated fat content. In most high income countries, high intakes have been linked to obesity and non-communicable diseases (strokes, heart disease, diabetes type 2, cancers) in the long run.

Poultry & eggs: Chicken, duck. Good source of vitamins B, iron, zinc and copper. Eggs are an excellent source of protein and vitamin D is present in small amounts in egg yolks.

Fish & seafood: Oily fish- Pangaish, Hilsa, Carp, Katla. Oily fish is a good source of omega 3 fatty acids (DHA) and vitamin D. It promotes healthier brain cells and is also anti-inflammatory.

Milk & dairy products: milk, yogurt and cheese. Good sources of calcium, phosphorus and riboflavin. It is recommended to have 2-3 servings of low fat dairy products a day to meet calcium requirements.

 Sources of plant protein

Whole grains: Wheat(gom), buckwheat, millet (bajra), wild rice, spelt, sorghum (jowar), barley, oats, quinoa. Whole grains are good sources of protein with added fibre, vitamin B, anti-oxidant and magnesium. If plant sources of protein are dominant in diet it is important to include a variety.

Legumes: lentils, beans (chickpeas, kidney, lima, mung, pinto), peas (green, snow, snap, split), edamame/soybeans (soy products: tofu, tempeh). Packed with fibre and iron, zinc, folate and magnesium it is important to include a variety to get all essential protein in diet.

Nuts: Almonds, pistachios, cashews, walnuts, hazelnuts, pecans, peanuts, Brazil nuts. Excellent sources of protein and unsaturated (good) fats. It is important to keep in mind nuts are high in calories and should be taken in moderation, not more than 28g a day (with no added salt and sugar).

Seeds: Pumpkin seeds, sunflower seeds, flax seeds, sesame seeds, chia seeds. Chia and pumpkin seeds contain all of the essential amino acids. Seeds are a rich source of fibre, good fats and also omega 3 fatty acids.

 To target malnutrition and subsequently our overall nutritional balance across the population, certain measures can be taken by the relevant authorities:

•      Update national dietary guidelines - to include the reference intake of amino acids for targeted population groups such as infants, children, adolescents, pregnant and lactating women and the elderly.

•      Creating awareness - through nutritional education programs aimed at schools. For example, making nutritional education compulsory at school, including in the national curriculum. Creating awareness through media advertisements and television programs about alternative sources of protein and how it can be obtained from everyday diet can also build general awareness.

•      Food fortification - commercial and industrial fortification e.g. by fortifying flour, cooking oil or rice with essential amino acids and micronutrients. Another form of fortification is bio fortification (i.e., increasing nutritional value of crops). Educational programs for farmers can also be beneficial.

•   Targeted drives – providing vitamins drops or fortified foods to targeted groups. Example: distributing eggs and whole grains to over 65s to prevent sarcopenia or providing nutritious school meals to school children at national levels.

•     Economic incentives - Providing incentives to farmers to cultivate more legumes such as soybeans, peas, lentils etc.

 Tackling malnutrition is a key to productivity, economic prosperity, meeting the United Nations’ Sustainable Development Goals (SDGs), and most importantly, helping in the fight against COVID-19. With the remarkable success that Bangladesh has achieved to date, it should be within Bangladesh’s grasp to use good nutrition to make its population healthier and stronger for the future. 

*Author, Registered Dietitian, NHS UK, Specialist Consultant, Praava Health Bangladesh