Micronutrient intake and the probability of nutrient adequacy among children 9–24 months of age: results from the MAL-ED birth cohort study

Abstract

<jats:title>Abstract</jats:title> <jats:sec id="S1368980020000877_as1" sec-type="other"> <jats:title>Objective:</jats:title> <jats:p>To estimate the total energy and micronutrient intakes of children 9–24 months of age and evaluate the probability of adequacy (PA) of the diet in seven MAL-ED sites.</jats:p> </jats:sec> <jats:sec id="S1368980020000877_as2" sec-type="other"> <jats:title>Design:</jats:title> <jats:p>Cohort study. Food intake was registered monthly using 24-h recalls beginning at 9 months. We estimated PA for thirteen nutrients and overall mean PA (MPA) by site and 3-month periods considering estimated breast milk intake.</jats:p> </jats:sec> <jats:sec id="S1368980020000877_as3" sec-type="other"> <jats:title>Setting:</jats:title> <jats:p>Seven sites in Asia, Africa and Latin America.</jats:p> </jats:sec> <jats:sec id="S1368980020000877_as4" sec-type="other"> <jats:title>Participants:</jats:title> <jats:p>1669 children followed from birth to 24 months of age.</jats:p> </jats:sec> <jats:sec id="S1368980020000877_as5" sec-type="other"> <jats:title>Results:</jats:title> <jats:p>Median estimated %energy from breast milk ranged from 4 to 70 % at 9–12 months, and declined to 0–39 % at 21–24 months. Iron bioavailability was low for all sites, but many diets were of moderate bioavailability for zinc. PA was optimal for most nutrients in Brazil and South Africa, except for iron and vitamin E (both), calcium and zinc (South Africa). PA for zinc increased only for children consuming a diet with moderate bioavailability. MPA increased 12–24 months as the quantity of complementary foods increased; however, PA for vitamin A remained low in Bangladesh and Tanzania. PA for vitamins D and E and iron was low for most sites and age groups.</jats:p> </jats:sec> <jats:sec id="S1368980020000877_as6" sec-type="other"> <jats:title>Conclusions:</jats:title> <jats:p>MPA increased from 12 to 24 months as children consumed higher quantities of food, while nutrient density remained constant for most nutrients. Ways to increase the consumption of foods containing vitamins D, E and A, and calcium are needed, as are ways to increase the bioavailability of iron and zinc.</jats:p> </jats:sec>

Gender and Age Differences in Meal Structures, Food Away from Home, Chrono-Nutrition, and Nutrition Intakes among Adults and Children in Tanzania Using a Newly Developed Tablet-Based 24-Hour Recall Tool

“…Only morning and evening meals appeared to be more structured (in terms of timing), perhaps reflecting the time use of caregivers and livelihoods. Children's micronutrient estimates were also comparable to another study conducted in rural Manyara, Tanzania, where paper-based 24-h recalls were collected from children 9–24 mo of age ( 30 ). In our study, we found very low intakes of vitamin A, calcium, and folate (especially among the younger age groups), and medium intakes of zinc and iron.…”

Declining diversity of wild-caught species puts dietary nutrient supplies at risk

“…Yet, dietary shifts to chicken, with lower iron and omega-3 fatty acid content, could also reduce nutrients supplied relative to diets based on wild fish ( 14 ). In Loreto, this chicken-for-fish substitution might exacerbate existing rates of anemia and malnutrition since fish provide a critical source of iron and omega-3 fatty acids for many of the region’s inhabitants ( 20 , 48 ). In addition, consuming other animal products could compensate for a limited set of nutrients, such as milk and calcium, but are otherwise not similarly used.…”

“…In addition, consuming other animal products could compensate for a limited set of nutrients, such as milk and calcium, but are otherwise not similarly used. Yet, other animal foods, such as beef and pork, are more expensive, making them less accessible and less frequently consumed even for wealthier households ( 20 , 21 , 48 ). Thus, shifting to other animal foods will likely remain particularly challenging for the poor who rely heavily on fish ( 18 ).…”

Higher Energy and Zinc Intakes from Complementary Feeding Are Associated with Decreased Risk of Undernutrition in Children from South America, Africa, and Asia

“…In the present study, dietary intakes were not compared to recommendations, rather we assessed intakes from complementary foods. Diet bioavailability varied among sites, and the probability of adequacy, considering breast-milk intake, was assessed in a previous analysis aiming to characterize the adequacy of dietary intake of study children ( 20 ). In the present study, we hypothesized that lower energy and nutrient intakes coming from complementary feeding in children from 9 to 24 mo of age would increase the risk of undernutrition in this life period.…”

“…Communication with the researchers at JHSPH resolved issues or questions identified during data collection. Then, energy and nutrient analyses were performed at JHSPH, using site-specific food composition tables created for the study in Excel 2013 (Microsoft) ( 14 , 20 , 21 ). For the present analysis, intakes of energy, macronutrients, fiber, 6 vitamins (niacin, riboflavin, thiamin, folate, and vitamins A and C), and 6 minerals (calcium, iron, magnesium, potassium, phosphorus, and zinc) were used.…”