By: Talking Nutrition Editors
The first 1,000 days of life are a critical and vulnerable period of human development. During this time, proper nutrition is required to set the stage for long-term health.4 Micronutrients, which refer to trace elements and vitamins, play critical structural and functional roles throughout the body. Because early childhood is a period of intense physical and mental development, micronutrient deficiencies early in life can significantly impair a child’s long-term potential.5 Poor nutrition during early development not only increases a child’s risk of illness, but has also been reported to increase the risk and susceptibility to developing significant medical conditions such as rickets, anemia, coronary heart disease, type 2 diabetes, cancer, and osteoporosis.1,3,5,6
According to Dr. Van Dael, in addition to visible health conditions, nutrient deficiencies early in life also place infants and children at risk for a range of developmental inadequacies and other subclinical health issues that are not easily seen. Specifically, micronutrient deficiencies can impair physical development, reduce cognitive function and diminish immunity.5 Other manifestations of nutrient deficiency in infants and young children include faltering growth or weight loss, low energy levels, and changes in mood and behavior.7 These scenarios can also result in poorer educational and cognitive outcomes.1,8
Nutritional deficiencies during infancy and early childhood are a worldwide concern. Globally, 45% of deaths among children under the age of five are linked to undernutrition.3 Further, almost one third of the global population is affected by one or more micronutrient deficiencies.5
Studies have investigated the extent and significance of nutritional deficiencies in children across the globe. One study assessed the nutritional status of Thai children aged 6 months to 12 years and found more than 50% had low intakes of calcium, iron, zinc, vitamin A, and vitamin C.9 Another study evaluated the dietary risk of young children aged 12 to 36 months in Ireland, and found that many were deficient in key nutrients such as iron, zinc, vitamin D, riboflavin, niacin, folate, phosphorous, potassium, carotene, retinol, and dietary fiber.10 A recent US-based study examined the food and beverage intake of children one to six years of age and discovered insufficient intakes of iron, vitamin B6, calcium, fiber, choline, potassium, and docosahexaenoic acid (DHA).2
Dr. Van Dael explains that although specific nutrient deficiencies may vary from country to country, nutrient deficiencies in young children are a cause for concern in most regions around the world. Iron, vitamin A, and zinc deficiencies are among the most common globally, especially in young children.8,11,12 The significance of these specific deficiencies is highlighted below.
The body requires iron - a mineral - for growth and development, as well as for the synthesis of red blood cells that carry oxygen through the body. Iron status is critical in early development given its roles in energy metabolism and the developing nervous system.13 Adequate iron in early childhood is critical to organ development and function, especially for the brain and the immune system.14
Consequences of iron deficiency are particularly serious in childhood, driven by demands of growth and development. Infants who experience iron deficiency early in life are at high risk for developmental delays and cognitive deficits; these can persist throughout adulthood.15,16 Cognitive impairments associated with iron deficiency have been shown to hinder a child’s behavior, educational success and ultimately, economic potential.17 A common cause of iron deficiency in children is insufficient iron in the diet, combined with gastrointestinal losses due to excessive cow’s milk consumption.18
Iron deficiency also contributes to the global burden of anemia.11 Despite worldwide efforts to reduce iron deficiency anemia, the prevalence of anemia remains high in many regions.19 A 2008 report by the World Health Organization (WHO) revealed that approximately 47% of pre-school aged children were at risk for iron deficiency anemia.11
These findings have unique relevance, given iron’s role in supporting our immune system. A 2020 study by Stoffel et al. showed that iron deficiency in infants resulted in a reduced response to the diphtheria, pertussis, and pneumococcal vaccines.20 Infants with iron deficiency anemia saw an improved response to the measles vaccine when iron was supplemented at the time of vaccination.20
Vitamin A is a fat-soluble vitamin with roles in vision, red blood cell production and immune function. It is also needed for the normal formation and maintenance of the heart, lungs, kidneys, and other organs.21 Vitamin A is a nutrient essential for the body’s immune system and vision.22,23 Prolonged periods of inadequate vitamin A intake during early childhood can lead to night blindness, anemia, and reduced resistance to infection.23
Infants and young children are at the greatest risk for health consequences associated with vitamin A deficiency.23 According to a 2009 WHO global report, one third of all preschool-aged children were vitamin A deficient between 1995 and 2005.23
Zinc plays important roles in growth, wound healing and immunity. These roles include carbohydrate and fat metabolism, immune support, the ability to taste, and cognition.24 Growth retardation is known to occur in infants and children with severe zinc deficiency.25 Zinc deficiency can lead to alopecia, dysgeusia (reduced sense of taste), reduced immune competence and impaired wound healing.25
Supplementation of infants and children has been found to be effective in promoting growth. An analysis of multiple clinical trials showed that zinc supplementation improved both weight gain and linear growth in children, particularly in children over the age of two years.26
Dr. Van Dael outlines some of the main components involved in addressing nutrient deficiencies. These include 1) identifying key nutrients and the feasibility of supplementation, 2) examining nutrient quality and bioavailability, 3) seeking expert guidance and employing the guidance of nutritional science organizations, such as the European Food Safety Authority (EFSA) and the Early Nutrition Academy (ENA), and finally, 4) leveraging regulatory standards.
As Dr. Van Dael explains, scientific data are used to establish nutrient requirements, which are the nutrient intakes needed for the body to function properly. National authorities and institutes such as the Institute of Medicine (IOM), the EFSA, and the WHO then use these nutrient requirements to establish dietary recommendations for the general population, with nutrient values stratified by age group.
Regulatory standards also play a central role in helping to manage nutrient deficiencies, as they provide industry-wide criteria for providing high-quality and safe products for consumers. As Dr. Van Dael states, these guidelines inform safe nutrient levels and product labeling to help educate the consumer.
The Codex Alimentarius is one example of an international expert authority established by FAO and WHO aimed to develop and approve international regulations that help support global nutrition and health efforts. Dr. Van Dael explains, “Codex Alimentarius offers a forum to collaborate among key stakeholders and develop safe and suitable nutritional standards that can help to serve the nutritional goals that health authorities have defined to improve health and nutrition during childhood.”
One such example of the impactful role that expert guidance and regulatory standards can play in helping to improve nutrient intakes relates to young child formulas (YCF), also regularly referred to as growing up milks (GUMs)
According to a 2013 EFSA report, dietary intakes of alpha linoleic acid (ALA), DHA, iron, vitamin D, and iodine were low in infants and children living in Europe.27 Similarly, a study conducted in France found that the consumption of cow’s milk in children aged one to two years resulted in insufficiencies in ALA, iron, vitamin C, and vitamin D.28 In this study, the use of specifically formulated milk formulas targeting children from 1 to 3 years of age (YCF) was seen to significantly reduce the risk of these insufficiencies.
Additionally, a UK-based study found that young child formula consumption and supplementation was a more efficient way to meet established nutrient requirements, compared to implementing changes to the quantity or variety of food intake.29
As a result of studies such as these, various expert panels have provided guidance for the composition of YCFs, merging evidence from clinical trials with scientific expertise to bring useful guidance to regulators and manufacturers who design products to address nutrient concerns.30-32
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