Dear Hatty,
you may find this references useful from WHO : http://www.who.int/nutrition/publications/micronutrients/WHO_WFP_UNICEFstatement.pdf?ua=1

Hello Hatty

You might consider using the new Cost of the Diet software developed by Save the Children to see whether and how a basket of foods meets specifications for energy, protein and micronutrients. Here is a link to a recent paper that describes the method: https://bmcnutr.biomedcentral.com/articles/10.1186/s40795-017-0136-4

The paper gives links to download the practitioners guide, both English and French versions, and register for the software, which is free.

If you provide a basket of foods you will need to find each one in the embedded food tables (there are >3000 listed or new foods can be added) and then enter the same nominal price for each food so that relative price is not an issue in the calculation and all foods have an equal chance of being included. You may want to adjust the number of times food are eaten in a week, to make the frequency of consumption is realistic, or just assume that the basket of foods is the only source of energy and nutrients and see how much has to be consumed to meet specifications, if it's possible. You can select from over 250 individuals to set the specifications for energy and nutrients for the calculations, or apply pre-selected standard families in the software.

The software applies the intake of micronutrients recommened by the WHO and FAO, the RNI, which is set at two standard deviations above the average (not at the average) to minimise the risk of deficiency. This means that the amounts exceed the requirements of 95% of people. The amount of energy however is set at the average, so only meets the needs of 50% of individuals. As the actual requirements for energy and nutrients of any given individual are usually unknown, the approach is based on probability, so I prefer to use the term 'specifications' rather than 'requirements'. The software also takes a probabilistic approach: users can adjust the RNIs in the software between the 1st and 99th percentile (the RNI is set at the 97.725th percentile), as well as many others, to do 'what if' calculations?

If you are concerned that amounts of micronutrients provided by the foods are grossly insufficient, you can add foods to the basket and see what happens. At that point cost may be an issue, so you may need to enter the actual cost per 100g of each food. The software could be a useful tool to help improve the nutritional quality of a food basket, if other foods can be added at low cost. The software, as its name implies, can help you estimate that cost.

Thank you both Alison and Andrew for your responses. Alison, I had already looked through the ‘Preventing and controlling micronutrient deficiencies in populations affected by an em’ joint statement, but I’m not sure it would be appropriate to use in our context. My concern with the use of this guide is that it refers to the management of micronutrient deficiencies during emergency contexts, but the population group we may be working with are new refugees in Turkey, living within the host population, accessing food independently and thus their situation wouldn’t be classified as an em’ with a finite timeline. Secondly, it’s only applicable to PLWs and children 6-59, whereas with recent refugees, it’s likely all household members will have been subjected to protracted nutrient deficiencies, during their time in Syria. As such, I am trying to identify whether it would be suitable to provide (through dedicated health services for refugee populations) something like a multiple micronutrient supplement (MMS) i.e. in the form of a powder to be added to family foods, or take home nutrient supplements for adults and children >6m, for a limited period of time (say 2mths), in attempts to build back up nutrient reserves (in the absence of food aid or access to fortified food rations). For the type 1 functional nutrients such as iron, calcium and various vitamins, whereby there are body stores, it is likely that these are depleted and need replenishing. For the type 2 growth nutrients where there are no significant bodily stores, these will obviously need to continue to be provided (in conjunction with type 1 nutrients) through their new diets after the cessation of any supplements.
Andrew, I’m not sure the cost of the diet tool would be appropriate here (although please do correct me if I’m wrong). As the paper you kindly referenced outlines, ‘..it is not a tool to plan a diet nor does it analyse the nutrient content of the foods in a given diet’. As we are not playing a role in food aid provisions in this context, rather looking to provide primary health care with integrated nutrition support, I am basing my assumption on the thinking that recently displaced refugees have been living with nutritionally incomplete diets for some time (in Syria) and thus will likely arrive in Turkey with a number of underlying deficiencies. I would like to try to ensure this is recognised and the issue is treated. Clinical manifestations of type 1 nutrients will not always be evident, less so with type 2 nutrients.

Has anyone had experience of treating population groups with assumed micronutrient deficiencies based on indirect assessment of dietary intake?