Perspective: Putting the youngest among us into the nutrition “call for action” for food fortification strategies

Abstract

Adequate iron intake is essential for optimal child development, but iron deficiency and anemia among infants and young children are widespread in low- and middle-income countries. Large-scale food fortification strategies hold great promise for reducing micronutrient deficiencies; however, for children <2 y of age, the impact of such strategies is limited because their intake of staple foods is relatively low and fortification levels are targeted at the adult population. Iron supplementation, iron fortification of foods targeted to infants, and point-of-use fortification with iron-containing products such as multiple micronutrient powders (MNPs) and small-quantity lipid-based nutrient supplements are evidence-based approaches recommended to reduce anemia among infants and young children when used in the right context. Since 2003, the WHO, with support from UNICEF, has recommended the use of MNPs to control iron deficiency. However, the percentage of children with anemia has changed very little over the past 10 y. Five years ago the UN declared a decade of action on nutrition, including World Health Assembly (WHA) targets for maternal, infant, and young child nutrition, yet the WHA set no anemia targets for children. In July 2020 the leaders of 4 UN agencies issued a call for action to protect children's right to nutrition in the face of the COVID-19 pandemic and beyond. Given persistently high rates of anemia among young children, the negative developmental impact, the challenge of meeting iron needs from typical complementary food diets, and the availability of successful evidence-based fortification strategies for this age group, we encourage planners, speakers, and donors at this year's UN Food Systems Summit and the Tokyo Nutrition for Growth Summit to 1) call for the WHA to set anemia targets for infants and young children and 2) promote investment in evidence-based interventions to improve the iron status of young children.

Health outcomes associated with micronutrient-fortified complementary foods in infants and young children aged 6–23 months: a systematic review and meta-analysis

“…Micronutrient deficiencies and their health consequences remain a global health problem, and several factors, including age of the target population, baseline anaemia status, malaria prevalence, and presence of other causes of infection or inflammation, need to be considered. 22 , 63 Beside products from multinational companies, locally manufactured, lower-cost fortified complementary food products are available in low-income countries; however, access to these products is still far from optimal in several settings. 64 , 65 WHO states: “To ensure their success and sustainability, especially in resource-poor countries, food fortification programmes should be implemented in concert with poverty reduction programmes and other agricultural, health, education and social intervention programmes that promote the consumption and utilization of adequate quantities of good quality nutritious foods among the nutritionally vulnerable.” 9…”

“…Furthermore, there is a need to investigate the sustainability of different evidence-based interventions and factors that enhance or impede their implementation. 63 …”

Estimating the cost and cost‐effectiveness of adding zinc to, and improving the performance of, Burkina Faso's mandatory wheat flour fortification programme

“…While children under 5 years of age are commonly the target population for zinc interventions, LSFF alone is unlikely to meet the zinc requirements of young children because of the relatively small quantities of staple foods consumed and fortification levels designed not to exceed the tolerable upper intake level in any population group. Thus, young children in countries with a high prevalence of zinc deficiency are likely to require additional interventions (Zlotkin & Dewey, 2021 ). Given this, we selected pregnant and nonpregnant women age 15–49 years (hereafter WRA) as our target population.…”

Accelerating action to reduce anemia: Review of causes and risk factors and related data needs

“…40 As 2025 nears, there will be an opportunity to revisit and revise these targets or call for their extension to 2030 to align with the United Nations’ SDGs. 41 Although actions that effectively address conditions relating to the current six global nutrition targets may contribute to reducing childhood anemia, the addition of a global target on reducing anemia in children under 5 years of age could also be considered to draw needed attention and action to reducing the global burden of anemia, 83 currently estimated at 269 million children. 9 In the meantime, countries may decide to set their own national targets as they implement and monitor their programs designed to prevent and manage anemia.…”