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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine.
This study was supported by the U.S. Agency for International Development under the terms of Grant No. HRN-5110-G-00-3043-00. The opinions expressed herein do not necessarily reflect those of the U.S. Agency for International Development.
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COMMITTEE ON INTERNATIONAL NUTRITION
LINDSAY H. ALLEN
(Chair),
Department of Nutrition, University of California, Davis, California
KENNETH H. BROWN,
Department of Nutrition, University of California, Davis, California
JEAN-PIERRE HABICHT,
Division of Nutritional Sciences, Cornell University, Ithaca, New York
EILEEN T. KENNEDY,
U.S. Department of Agriculture, Food and Consumer Services, Washington, D.C.
JOANNE LESLIE,
University of California-Los Angeles School of Public Health, and Pacific Institute for Women's Health, Los Angeles, California
GILBERT A. LEVEILLE,
Research and Technical Services, Nabisco Food Group, East Hanover, New Jersey
Liaisons to the Committee
ADELINE WYNANTE PATTERSON
(Board on International Health), Caribbean Food and Nutrition Institute, Kingston, Jamaica
ALFRED SOMMER
(Food and Nutrition Board),*
School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
Staff
CHRISTOPHER P. HOWSON,
Project Director
SUSAN M. KNASIAK,
Project Assistant
JAMAINE L. TINKER,
Financial Associate
* Member, Institute of Medicine |
FOOD AND NUTRITION BOARD
JANET C. KING
(Chair),
Department of Nutritional Sciences, University of California, Berkeley, California
JOHN W. ERDMAN, JR.
(Vice Chair),
Division of Nutritional Sciences, University of Illinois, Urbana, Illinois
CUTBERTO GARZA
(Vice Chair),
Division of Nutritional Sciences, Cornell University, Ithaca, New York
PERRY L. ADKISSON,†
Department of Entomology, Texas A&M University, College Station, Texas
LINDSAY H. ALLEN,
Department of Nutrition, University of California, Davis, California
DENNIS M. BIER,
Children's Nutrition Research Center, Houston, Texas
FERGUS M. CLYDESDALE,
Department of Food Science and Nutrition, University of Massachusetts, Amherst, Massachusetts
HECTOR F. DeLUCA,†
Department of Biochemistry, University of Wisconsin, Madison, Wisconsin
MICHAEL P. DOYLE,
Department of Food Science and Technology, University of Georgia, Griffin, Georgia
JOHANNA T. DWYER,
Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts
SCOTT M. GRUNDY,
University of Texas Southwestern Medical Center, Dallas, Texas
K. MICHAEL HAMBIDGE,
Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado
LAURENCE N. KOLONEL,
Cancer Center of Hawaii and University of Hawaii, Honolulu, Hawaii
SANFORD A. MILLER,
Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio, Texas
ARTHUR H. RUBENSTEIN
(Institute of Medicine Liaison),*
Department of Medicine, The University of Chicago, Chicago, Illinois
ALFRED SOMMER,*
School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
STEVE L. TAYLOR
(Ex Officio),
Department of Food Sciences and Technology, University of Nebraska, Lincoln, Nebraska
VERNON R. YOUNG,†
School of Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
* |
Member, Institute of Medicine |
† |
Member, National Academy of Sciences |
BOARD ON INTERNATIONAL HEALTH
DEAN JAMISON
(Co-chair),
The World Bank, Washington, D.C.
DAVID E. BELL,
Harvard Center for Population and Development Studies, Cambridge, Massachusetts
JAN E. G. BLANPAIN,*
School of Public Health, Leuven University, Leuven, Belgium
MARGARET CATLEY-CARLSON,
Population Council, New York, New York
RICHARD G. A. FEACHEM,
London School of Hygiene and Tropical Medicine, London, England
BERNARD N. FIELDS
(Institute of Medicine Liaison),*†
Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts
JULIO FRENK,*
National Institute of Public Health, Cuernavaca, Mexico
DONALD A. B. LINDBERG
(Acting Institute of Medicine Liaison), *
National Library of Medicine, National Institutes of Health, Bethesda, Maryland
ADETOKUNBO O. LUCAS,*
Harvard School of Public Health, Boston, Massachusetts
W. HENRY MOSLEY,
Institute for International Programs, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland
ADELINE WYNANTE PATTERSON,
Caribbean Food and Nutrition Institute, Kingston, Jamaica
DAVID P. RALL (Retired),*
National Institute of Environmental Health Sciences, Washington, D.C.
FREDERICK C. ROBBINS
Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio
TIMOTHY ROTHERMEL,
Division for Global and Interregional Programmes, United Nations Development Programme, New York, New York
NOEL S. WEISS,*
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington
BARBARA L. WOLFE,
Departments of Economics and Preventive Medicine, University of Wisconsin, Madison, Wisconsin
* |
Member, Institute of Medicine |
† |
Member, National Academy of Sciences |
Preface
◆ ◆ ◆ ◆ ◆
Over the past 2 years, there has been growing awareness of the potential value for the U.S. Agency for International Development (USAID) to have a standing capability in the Institute of Medicine (IOM) for a more flexible, less costly response to agency needs for advice in the areas of nutrition, food, and health science policy. With support from USAID, the IOM responded in October 1993 by establishing the Committee on International Nutrition (CIN) under the aegis of the Food and Nutrition Board (FNB) and the Board on International Health (BIH).
The CIN's mandate is to answer questions of interest and concern, evaluate current nutrition activities undertaken by the agency, and make recommendations for future activities based on this review. Topics are chosen through systematic consultation with the Office of Nutrition in USAID's Bureau for Research and Development. Representing the areas of human nutrition, maternal and child health, epidemiology, economics, and program design and evaluation, the committee's six members will convene three times to produce brief reports that review specific programs, research projects, or project designs. With an initial project life of 18 months, the CIN is designed to be flexible (e.g., capable of responding to specific nutrition concerns that arise abruptly) and to provide quick turnaround, with the time from meeting date to document availability being 2 months.
This report is the result of the second meeting of the CIN, which was held on 6–7 October 1994. The report topic was requested by USAID 's Bureau for Humanitarian Response (BHR).
CHARGE TO THE COMMITTEE
The charge to the committee by USAID was as follows: “Based on the scientific and technical knowledge of individual members and the background information [provided by USAID], the Committee is requested to make a recommendation as to a mean per capita daily energy requirement for emergency situations (citing and defining the scientific and technical information which supports this mean value).” (For further background information and details on USAID 's request to the CIN, see the memoranda to the committee from Samuel Kahn, USAID Office of Health and Nutrition, and Thomas Marchione, Nutrition Advisor, USAID BHR, in the Appendix).
During the 2-day meeting, the CIN reviewed the following background information provided it by USAID: a description of the United Nations High Commissioner Emergency Training Program-Nutrition; a draft copy of the “Supplement on Emergency Rations” to be added to the Commodities Reference Guide published by USAID's Office of Food for Peace; and background correspondence among agencies relevant to the topic under study. The committee gathered the following additional information for consideration at the meeting: the 1992 CDC report entitled Famine-Affected, Refugee, and Displaced Populations: Recommendations for Public Health Issues (CDC, 1992); a 1992 letter to the journal Lancet on “Misconceptions on Nutrition of Refugees” (Mason et al., 1992); the 1985 report of the Joint FAO/WHO/UNU Expert Consultation on Energy and Protein Requirements; “Methodological Basis for Estimating the Mean per Capita Daily Energy Requirements for a Typical Refugee Camp Population” (Clugston, 1993); a paper commissioned by the United Nations' Administrative Committee on Coordination/Subcommittee on Nutrition on “Evaluating the Energy Adequacy of Rations Presented to Refugees and Displaced Persons” (Schofield, 1994); and miscellaneous personal correspondence among agencies.
USAID representatives were invited to attend the first day of the meeting to answer questions related to the committee's charge and to provide additional background as needed. The following USAID representatives attended: Eunyong Chung and Samuel G. Kahn, Office of Nutrition and Maternal Health, and Rita Hudson, Office of Food for Peace. The CIN thanks these individuals for their important contributions to its review.
On the second day of the meeting, the CIN met in executive session to review the previous day's discussions and to begin drafting the report.
ORGANIZATION OF THE REPORT
The report contains three chapters and one appendix. Chapter 1 describes the project scope and its rationale. Chapter 2 provides a historical view of energy recommendations for refugee populations and describes the methods of estimating energy requirements of individuals and of populations of refugees and dis
placed persons. The committee describes the calculation of an estimated mean per capita energy requirement for use in planning the food energy needs of populations of refugees and displaced persons, and the assumptions underlying the estimate. The effects of varying the population distribution and of assuming different body sizes, physical activity levels, and proportions of breastfed infants are presented. The impact on the estimate of considering the energy requirements for catch-up growth and for cold environmental conditions is also reviewed. Chapter 3 provides a brief summary of the report and presents the committee 's recommendations. The Appendix contains the two USAID memoranda outlining the specific charge for this second CIN meeting.
ACKNOWLEDGMENTS
The committee gives special thanks to the USAID staff who graciously made themselves available for questions during the open session on 6 October. The committee would also like to express its appreciation to the IOM staff who facilitated the work of the CIN: Christopher P. Howson, study director; Susan M. Wyatt, financial associate; Michael Edington, managing editor; Claudia Carl, administrative associate; and Gail Spears, administrative assistant. The committee especially thanks Susan M. Knasiak, project assistant, for her help in conducting the second meeting and for her valuable editorial advice in preparing the report draft. Finally, the committee thanks Richard G. Seifman, formerly at USAID; Polly Harrison, IOM; and Catherine Woteki, formerly of the FNB, for their vision and hard work in realizing this project and Allison A. Yates, FNB, for her useful editorial advice and support of the CIN's activities.
Lindsay H. Allen, Chair
Committee on International Nutrition