Micronutrient gaps during the complementary feeding period in South Asia: A Comprehensive Nutrient Gap Assessment

Abstract

Micronutrient malnutrition is a key driver of morbidity and mortality for millions of children in South Asia. Understanding the specific micronutrients lacking in the diet during the complementary feeding period is essential for addressing undernutrition caused by inadequate diets. A Comprehensive Nutrient Gap Assessment was used to synthesize diverse evidence and estimate the public health significance of complementary-feeding micronutrient gaps and identify evidence gaps in 8 countries in South Asia. There were important gaps across the region in iron, zinc, vitamin A, folate, vitamin B12, and, to a lesser extent, calcium and vitamin C. The most nutrient-dense, whole-food sources of these micronutrients include liver, small fish, eggs, ruminant meat, and dark leafy greens. Investment is needed in some countries to collect data on micronutrient biomarkers and dietary intakes. A food systems approach is essential for improving child diets and reducing malnutrition, which affects millions of children, their futures, and society at large across South Asia and beyond.

Priority micronutrient density in foods

“…A similar approach was previously used to identify micronutrient-dense complementary foods for young children 4,30 . Ratings were calculated for different population groups according to the following thresholds for Average Requirements (ARs) of energy for a moderately active individual and hypothetical ARs for mass, assuming an energy density of 1.3 kcal/g (the mean energy density of a minimally processed plant-based, low-fat diet and animal-based, ketogenic diet 31 ):…”

“…As indicated in the formula for the aggregate score, each micronutrient's contribution was capped at 100% of recommended intakes, which means that each micronutrient can contribute nothing or up to one-half of the total score 4,30 . To illustrate this, a food containing only two of the six nutrients would provide 100% of recommended intakes of both nutrients, while a food with a perfectly even proportion of recommended intakes across all six nutrients would provide 33.3% of recommended intakes of all six nutrients-each micronutrient thus contributing an equal onesixth of the total score.…”

“…An important aspect of food, among others, is the vitamins and minerals it provides. Yet in many low-and middle-income countries (LMICs) diets are known to be lacking in micronutrients, especially for population groups with increased needs, leading to deficiencies, particularly in iron, zinc, folate, vitamin A, calcium, and vitamin B12 (hereafter referred to as "priority micronutrients"), that can have severe and lasting effects [1][2][3][4][5][6] . Even in high-income countries (HICs) like the United States, iron deficiency is common, especially among women 7 .…”

Priority micronutrient density of foods for complementary feeding of young children (6-23 months) in South and Southeast Asia

“…Recommended Nutrient Intakes (RNIs) from complementary foods for children aged 6-23 months were calculated from the WHO and the Food and Agriculture Organization (FAO) recommendations ( 13) for calcium, zinc and iron, and from the Institute of Medicine (IOM) recommendations ( 14) for folate, vitamin A and vitamin B 12 , based on a previously adopted approach to identify affordable nutritious complementary foods (7,15). Average Energy Requirements (AERs) from complementary foods for children 6-23 months of age were calculated from the WHO and the United Nations Children's Fund (UNICEF) recommendations, accounting for average breast milk intake in developing countries (1,3).…”

Nutrient shortfalls in young children’s diets and the role of affordability

“…This approach was then used to estimate the burden of micronutrient gaps in young children's diets in six countries in Eastern and Southern Africa (2) and eight countries in South Asia (3). In both regions, biomarker data are available for iron and vitamin A.…”