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Providing perspectives on recent research into vitamins and nutritionals


Dietary Adequacy of Traditional and Supplemented Infant Diets

By Julia Bird

The first thousand days of a child’s life, from pre-conception to their second birthday, are the most important. Adequate nutrition during this critical window of opportunity helps children have healthier futures. Malnutrition is a significant worldwide problem, however, and many organizations are working hard to develop effective solutions (read key stakeholders’ positions via recently published book “The Road to Good Nutrition”. One problem occurs when children are offered complementary foods, which normally should begin when infants are around 6 months of age. Infants at this age have high relative nutrient demands as their rate of growth is high. Unfortunately, complementary foods may not be adequate to meet energy, protein or micronutrient needs.

This problem was highlighted in recent publication from Skau et al., who looked at the diets of Cambodian infants aged 6 to 11 months.  As background regarding baseline nutrient status of that population, Ikeda, Irie and Shibuya report that the incidence of stunting was 36% in 2010 in children aged to two years. The authors looked at the traditional diet of infants receiving complementary foods, and investigated the effect of adding four types of supplementary foods to this diet with a new tool, Optifood, being developed by the World Health Organization, on nutritional composition of the whole diet. WHO/FAO Reference Nutrient Intakes (RNIs) were used to test for nutrient adequacy of the diet for protein, vitamins and minerals. Two of the supplementary foods were developed in Cambodia based on foods that were locally available. All the supplemental foods were based on either rice or corn meal, and contained a source of protein. Notable differences in the supplemental foods are summarized in the following list.

·         WinFood: locally sourced ingredients, including small edible fish with bones and edible spiders, both sourced locally.

·         WinFood Lite: locally sourced, no small fish or spiders, fish meal as protein source, containing a vitamin and mineral premix.

·         Corn Soya Blend Plus Plus: a fortified blended food used in nutrition relief programs enhanced with skim milk powder and dehulled soy.

·         Corn Soya Blend Plus: with whole soya, no milk powder and higher fat levels.

The traditional diet included tropical fruits, rice as the main staple, modest quantities of eggs, white meats and fish, cabbage, gourd and tamarind, and breast milk. Optimal, best-case and worst-case scenarios were developed regarding dietary composition.

The authors found that nutrient requirements were only met for vitamins A, B6 and C in the baseline diet of older infants. Although supplementary foods tended to improve nutrient adequacy, thiamine, folate and iron remained “problem nutrients,” according to the authors. RNIs for vitamin B12, riboflavin, niacin, calcium and zinc were improved with the use of the supplemental foods. Deficiency in zinc,  vitamin B12, or riboflavin has been identified as nutritional problems that make a significant contribution to the global burden of disease.

Supplemental foods can make the difference between nutritional adequacy and malnutrition in at-risk populations. Diets of infants aged 6 to 11 months in Cambodia normally lack recommended levels of micronutrients. The Optifood tool offers potential to help organizations tailor food relief and model the effects of adding supplemental foods to baseline diets.

Main citation:

Jutta KH Skau, Touch Bunthang, Chhoun Chamnan, Frank T Wieringa, Marjoleine A Dijkhuizen, Nanna Roos, and Elaine L Ferguson. The use of linear programming to determine whether a formulated complementary food product can ensure adequate nutrients for 6- to 11-month-old Cambodian infants. Am J Clin Nutr 2014 ajcn.073700; First published online October 23, 2013. doi:10.3945/ajcn.113.073700

Supporting citations:

Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009 Feb;89(2):693S-6S. doi: 10.3945/ajcn.2008.26947A. Epub 2008 Dec 30.

Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, Ezzati M, Grantham-McGregor S, Katz J, Martorell R, Uauy R; Maternal and Child Nutrition Study Group. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet. 2013 Aug 3;382(9890):427-51. doi: 10.1016/S0140-6736(13)60937-X. Epub 2013 Jun 6.

Eggersdorfer M, Kraemer K, Ruel M, Van Ameringen M, Biesalski  HK, Bloem M, Chen J, Lateef A, Mannar V. The Road to Good Nutrition. 2013. Karger. ISBN: 978-3-318-02549-1  

Ikeda N, Irie Y, Shibuya K. Determinants of reduced child stunting in Cambodia: analysis of pooled data from three demographic and health surveys. Bull World Health Organ. 2013 May 1;91(5):341-9. doi: 10.2471/BLT.12.113381. Epub 2013 Feb 19.

Northrop-Clewes CA, Thurnham DI. The discovery and characterization of riboflavin. Ann Nutr Metab. 2012;61(3):224-30. doi: 10.1159/000343111. Epub 2012 Nov 26.