Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods

We assessed the adequacy of nutrient intakes of 135 rural Bangladeshi breast-fed infants 6-12 mo of age and examined nutritional trade-offs due to possible displacement of breast milk by complementary foods. Observers completed 12-h daytime measurements of breast milk and complementary food intakes; data for the previous 12 h were obtained from maternal recall, yielding estimates of total 24-h intakes. On average, infants were mildly wasted (mean +/- SD weight-for-length Z-score = -0.92 +/- 0.88) and moderately stunted (length-for-age Z-score = -1.49 +/- 0.96). Total energy intakes at 6-8 and 9-12 mo were 88 and 86% of absolute energy requirements (kJ/d), 106 and 105% of requirements per kg body weight, and 97 and 94% of requirements per kg median weight-for-length, respectively. Breast milk contributed 78% of energy intake at 6-8 mo and 75% at 9-12 mo. Mean meal frequency and energy density of complementary foods were generally consistent with recommendations, but only small amounts of food were offered. Nevertheless, only 72% of the food energy offered was consumed. Total energy intake was positively correlated with meal frequency, quantity consumed per meal, and energy intake from breast milk, but not with energy density of complementary foods. Energy intake from complementary foods was inversely related to energy intake from breast milk. The diets fell short of recommended intakes for numerous vitamins and minerals. We conclude that although greater intakes of complementary foods were associated with higher total energy intake, micronutrient intake remained low due to the low micronutrient density of the complementary foods consumed and the partial displacement of breast milk.     

Proposed nutrient composition for fortified complementary foods

A proposed nutrient composition for fortified processed complementary foods (FPCF) is developed based on the other papers in this publication, which consider a number of factors such as age range, daily ration size, recommended nutrient requirements, contribution of human milk to these requirements, macronutrient interactions, compound bioavailability, methods of production and overage. The proposed fortification levels are based on a daily ration size of 40 g for infants aged 6-12 mo and 60 g for children aged 12-23 mo. A desired protein-energy ratio of 6-10% is used to estimate energy from protein. The desired percentage of energy from lipid is estimated at 24% for infants aged 6-11 mo and 28% for children aged 12-23 mo, with the remaining energy to be supplied from carbohydrate. An FPCF should provide a quantity of iron sufficient to meet the Recommended Dietary Allowance in the form of dried ferrous sulfate of small particle size. Ascorbic acid, 70-140 mg for infants aged 6-11 mo and 50-100 mg for children aged 12-23 mo, will enhance iron absorption. Because of the lower bioavailability of zinc in cereal-based diets in developing countries, 4-5 mg of zinc in the form of zinc oxide is recommended. Proposed fortification levels are also provided for copper, calcium, vitamin D, magnesium, phosphorus, vitamin A, the B vitamins and iodine. To prevent micronutrient losses, it is recommended that the FPCF be precooked. The knowledge base to develop an FPCF is quite limited, and much additional research is needed before an optimal formulation can be recommended.     

An Assessment of the Impact of Fortification of Staples and Condiments on Micronutrient Intake in Young Vietnamese Children

Targeted fortification programs for infants and young children are an effective strategy to prevent micronutrient deficiencies in developing countries, but the role of large-scale fortification of staple foods and condiments is less clear. Dietary modeling in children aged 6–60 months was undertaken, based on food consumption patterns described in the 2009 national food consumption survey, using a 24-h recall method. Consumption data showed that the median intake of a child for iron, vitamin A and zinc, as a proportion of the Vietnamese Recommended Dietary Allowance (VRDA), is respectively 16%–48%, 14%–49% and 36%–46%, (depending on the age group). Potential fortification vehicles, such as rice, fish/soy sauces and vegetable oil are consumed daily in significant amounts (median: 170 g/capita/day, 4 g/capita/day and 6 g/capita/day, respectively) by over 40% of the children. Vegetable oil fortification could contribute to an additional vitamin A intake of 21%–24% of VRDA recommended nutrient intake, while fortified rice could support the intakes of all the other micronutrients (14%–61% for iron, 4%–11% for zinc and 33%–49% of folate requirements). Other food vehicles, such as wheat flour, which is consumed by 16% of children, could also contribute to efforts to increase micronutrient intakes, although little impact on the prevalence of micronutrient deficiencies can be expected if used alone. The modeling suggests that fortification of vegetable oil, rice and sauces would be an effective strategy to address micronutrient gaps and deficiencies in young children.     

Food choices to meet nutritional needs of breast-fed infants and toddlers on mixed diets

The primary focus of this review is considerations for complementary feedings to meet micronutrient needs of infants aged 6-24 mo who are continuing with breast-feeding and minimal or no formula. The World Health Organization recommends initiation of complementary feeding to breast-fed infants at approximately 6 mo of age. Whether complementary foods will meet nutrient needs will depend on the types of food selected. One criterion for the selection of complementary foods is that they be rich sources of zinc and iron because both of these essential micronutrients are critical for normal growth and development, and requirements are not met by exclusive breast-feeding after approximately 6 mo. For an exclusively breast-fed 7-mo-old infant, human milk provides approximately 0.5 mg of zinc, and a little over half of that is absorbed. Adding some cereal can increase zinc intake modestly but will fall short of providing the estimated physiologic requirement because adaptive mechanisms are inadequate to compensate for moderately low zinc intake. Maize, wheat, rice, and roots are also relatively low in zinc and have the added factor of a high phytate-to-zinc molar ratio, which makes the zinc less bioavailable. Meats and liver have greater zinc and iron concentrations than unfortified plant foods and have been shown to have good acceptance by 7-mo-old infants. In contrast to current practices in both developed and developing countries, meats should be considered as an early complementary food for breast-fed infants to provide essential micronutrients.     

Proposed vitamin a fortification levels

Fortified complementary foods could be effective in preventing and controlling vitamin A and other common nutritional deficiencies in young children. Milk from well-nourished women is an excellent source of vitamin A. However, in Latin America many children are weaned prematurely and must receive the entire requirement of vitamin A from food. This paper proposes vitamin A fortification levels for foods targeted for children aged 6-23 mo to meet the existing intake gap among both breast-fed and weaned infants and young children. Estimates assume a nonsignificant contribution of common complementary foods and average levels of human milk intake by breast-fed infants and children. The estimated vitamin A gap for breast-fed infants aged 6-11 mo amounts to 63-92 microg RE [16-23% of recommended daily intake (RDI)] and for breast-fed children reaches 125 microg RE (31% of RDI). Weaned infants and children would have to fully meet the RDI (400 microg RE) from complementary foods. A fortified complementary food with 500 mg RE/100 g of dry product provided daily in a single ration of 40 g would meet 50% of the gap for weaned infants aged 6-11 mo and would raise the total intake above RDI for breast-fed infants aged 6-8 mo (125%) and 9-11 mo (127%). The same fortified food given in a daily ration of 60 mg would meet most of the gap (75%) for weaned children aged 12-23 mo and would increase total intake of breast-fed children aged 12-23 mo well above the RDI (144%), with no risk of exceeding established upper tolerable intake levels.     

Maternal and child nutrition in Sub-Saharan Africa: challenges and interventions

Women of child-bearing age (especially pregnant and lactating women), infants and young children are in the most nutritionally-vulnerable stages of the life cycle. Maternal malnutrition is a major predisposing factor for morbidity and mortality among African women. The causes include inadequate food intake, poor nutritional quality of diets, frequent infections and short inter-pregnancy intervals. Evidence for maternal malnutrition is provided by the fact that between 5 and 20% of African women have a low BMI as a result of chronic hunger. Across the continent the prevalence of anaemia ranges from 21 to 80%, with similarly high values for both vitamin A and Zn deficiency levels. Another challenge is the high rates of HIV infection, which compromise maternal nutritional status. The consequences of poor maternal nutritional status are reflected in low pregnancy weight gain and high infant and maternal morbidity and mortality. Suboptimal infant feeding practices, poor quality of complementary foods, frequent infections and micronutrient deficiencies have largely contributed to the high mortality among infants and young children in the region. Feeding children whose mothers are infected with HIV continues to remain an issue requiring urgent attention. There are successful interventions to improve the nutrition of mothers, infants and young children, which will be addressed. Interventions to improve the nutrition of infants and young children, particularly in relation to the improvement of micronutrient intakes of young children, will be discussed. The recent release by WHO of new international growth standards for assessing the growth and nutritional status of children provides the tool for early detection of growth faltering and for appropriate intervention.     

Nutrient composition of fortified complementary foods: should age-specific micronutrient content and ration sizes be recommended?

Designing a fortified complementary food that meets the nutrient needs of all breast-fed children 6-24 mo of age is a challenge because of variability in the amounts of complementary foods consumed and the very high nutrient requirements of children < 12 mo of age. A single formulation targeted for infants 6-8 mo of age will result in excessive intakes of certain nutrients (e.g., calcium, iron and zinc) if consumed by children 12-23 mo of age (up to six times the recommended daily allowance (RDA) for iron), whereas a formulation targeted for children 12-23 mo of age will provide insufficient levels of nutrients for infants 6-8 mo of age (e.g., only 4-44% of the RDA for iron). Options for resolving this dilemma include developing 1). two or more different formulations for different age groups, 2). a high nutrient-density product but specifying a maximum ration per day or 3). a lower nutrient-density product and using a combination of approaches (e.g., a separate iron supplement) to reach the higher levels needed by infants. More information is needed on efficacy, costs and feasibility of these options.     

Comparison of Micronutrient Intervention Strategies in Ghana and Benin to Cover Micronutrient Needs: Simulation of Bene-Fits and Risks in Women of Reproductive Age

Overlapping micronutrient interventions might increase the risk of excessive micronutrient intake, with potentially adverse health effects. To evaluate how strategies currently implemented in Benin and Ghana contribute to micronutrient intake in women of reproductive age (WRA), and to assess the risk for excess intakes, scenarios of basic rural and urban diets were built, and different on-going interventions were added. We estimated micronutrient intakes for all different scenarios. Four types of intervention were included in the scenarios: fortification, biofortification, supplementation and use of locally available nutrient-rich foods. Basic diets contributed poorly to daily micronutrient intake in WRA. Fortification of oil and salt were essential to reach daily requirements for vitamin A and iodine, while fortified flour contributed less. Biofortified products could make an important contribution to the coverage of vitamin A needs, while they were not sufficient to cover the needs of WRA. Iron and folic acid supplementation was a major contributor in the intake of iron and folate, but only in pregnant and lactating women. Risk of excess were found for three micronutrients (vitamin A, folic acid and niacin) in specific contexts, with excess only coming from voluntary fortified food, supplementation and the simultaneous overlap of several interventions. Better regulation and control of fortification and targeting of supplementation could avoid excess intakes.     

Analysis of nutritional adequacy of local foods for meeting dietary requirements of children aged 6-23 months in rural central Tanzania

Background

Under nutrition remains a serious problem among children in Sub-Saharan Africa. Analysing how diets composed of local foods could achieve nutritional goals for infants and young children in low-income settings is essential. The objective of this study was to analyse how local foods can be used rationally and to what extent these foods can be supplemented to achieve nutrient requirements for children aged 6 – 23 months in resource-poor settings.

Methods

A cross-sectional study was carried out to estimate dietary intakes of 400 children aged 6-23 months using a 12-h weighed dietary record, 24-h dietary recalls, and 7-days food records. Anthropometric measurements on each subject were also taken. Analyses were done to establish the level of nutrient intake, and nutritional status of the study population using Microsoft Excel 2013 and ProPAN software version 2.0.

Results

The results showed that the prevalence of stunting, wasting and underweight for children aged 6–23 months was 30–41%, 1.5–3% and 4–9%, respectively. In addition, the results showed that diets that were consumed by the subjects comprised of local foods met vitamin A, vitamin C, protein and energy requirements for children aged 6–23 months. However, the extent of deficit in iron, zinc and calcium in baseline diets was large and difficult to meet under the existing feeding practices.

Conclusions

The study shows that local foods in the study area have a potential to achieve recommended dietary intakes of some essential nutrients, and that interventions are needed to meet the required amount of iron, zinc and calcium for children aged 6–23 months. The interventions we propose here may encourage changes in traditional feeding habits and practices of the target population. Possible intervention options are (1) supplementation of local foods with nutrient-dense foods that are not normally consumed in the locality (2) providing new avenues for increasing the production and wide consumption of local nutrient-dense foods, or optimizing the way local diets are constituted so as to achieve nutrient recommendations for infants and young children.

     

Intake of micronutrients high in animal-source foods is associated with better growth in rural Kenyan school children

Observational studies have shown that children in developing countries consuming diets containing high amounts of bioavailable nutrients, such as those found in animal-source foods, grow better. The present study investigated which specific nutrients from the diet of Kenyan school children predicted their growth. The children (n 544, median age 7 years) participated in a 2-year long food supplementation study with animal-source foods. Height gain during the intervention period was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Weight gain was positively predicted by average daily intakes of energy from animal-source foods, haem Fe, preformed vitamin A, Ca and vitamin B12. Gain in mid-upper-arm muscle area was positively predicted by average daily intakes of energy from animal-source foods and vitamin B12. Gain in mid-upper-arm fat area was positively predicted by average daily intakes of energy from animal-source foods. Gain in subscapular skinfold thickness was not predicted by any of the nutrient intakes. Negative predictors of growth were total energy and nutrients that are contained in high amounts in plant foods. The study shows that growth was positively predicted by energy and nutrients that are provided in high amounts and in a bioavailable form in meat and milk, and their inclusion into the diets of children in developing countries should be part of all food-based programmes in order to improve micronutrient status and growth.     

Effect of the consumption of high energy dense and fortified gruels on energy and nutrient intakes of 6–10-month-old Vietnamese infants

The aim of this study was to test the ability of two new products, an instant infant flour and a food supplement containing amylases, to increase energy and micronutrient intakes of infants older than 6 months. Three groups of 48 infants were randomly constituted. Infants in groups 1 and 2 consumed at least twice a day gruel made either from the instant flour or from the food supplement. Infants from the control group received complementary foods prepared in the usual way. Each infant was surveyed during a whole day in order to measure feeding frequencies and characteristics as well as amounts of the different types of complementary foods consumed. Foods consumed by infants in the two experimental groups differed considerably in energy, micronutrient density and in consistency from the home-made complementary foods. Due to the incorporation of amylases, gruels made from the food supplement had a higher energy density, a more appropriate consistency and resulted in higher intakes per meal than gruels made from instant flour. In comparison with home-made complementary foods, both experimental products resulted in significantly higher energy and nutrient intakes. The two experimental products appeared to increase sufficiently both energy and nutrient intakes of infants to complement their breastmilk intake.     

Exclusive breast-feeding for 6 months, with iron supplementation, maintains adequate micronutrient status among term, low-birthweight, breast-fed infants in Honduras

There is little information on the risk of micronutrient deficiencies during the period of exclusive breast-feeding. We evaluated this among term, low-birthweight (LBW; 1500-2500 g) infants in Honduras. Mother-infant pairs were recruited in the hospital and assisted with exclusive breast-feeding during the first 4 mo. At 4 mo, infants were randomly assigned to either continue exclusive breast-feeding to 6 mo (EBF; n = 59) or be given iron-fortified complementary foods (rice, chicken, fruits, and vegetables) from 4 to 6 mo while continuing to breast-feed (SF, n = 60). Blood samples were collected at 2, 4, and 6 mo and analyzed for hemoglobin (Hb), hematocrit, plasma ferritin, % transferrin saturation, vitamin A, vitamin B-12, folate, zinc, and erythrocyte folate. Infants with Hb < 100 g/L at 2 or 4 mo were given medicinal iron supplements for 2 mo; the proportion administered iron drops did not differ significantly between groups. There was no significant effect of complementary foods on indices of vitamin A, B-12, folate, or zinc status. Among infants not given medicinal iron at 4-6 mo, iron status was higher in the SF group than the EBF group. In those given medicinal iron at 4-6 mo, iron status was higher in the EBF group, suggesting that complementary foods interfered with iron utilization. About half of the infants were anemic by 2 mo, before the age when complementary foods would be recommended. This supports the recommendation that LBW infants should receive iron supplementation in early infancy. Given that infants given iron supplements did not benefit from complementary foods at 4-6 mo, we conclude that exclusive breast-feeding for 6 mo (with iron supplementation) can be recommended for term, LBW infants.     

B vitamins: proposed fortification levels for complementary foods for young children

The B vitamins, except for folate, can be classified as group I nutrients during lactation. Nutrients in this category share the following characteristics: low maternal intake or stores during lactation reduce the concentration in human milk, and infants' stores are readily depleted. For some of these nutrients, the infants' stores at birth may be depleted by maternal deficiency during pregnancy. The prevalence of some B vitamin deficiencies, especially deficiencies of riboflavin and vitamin B-12, is probably much higher than is usually assumed. Taken together, these considerations emphasize the importance of supplying adequate amounts of B vitamins to infants and young children. Recommendations are made here on the amounts and densities of B vitamins that should be present in fortified complementary foods fed to children aged 6-24 mo. The values are based on the difference between recommended daily intakes and the amount that the child will receive from maternal milk using estimates reported in the literature. There are few concerns about the potential toxicity of any of these vitamins at the levels likely to be added to complementary foods. If there are losses during food preparation or concentrations of the vitamins are low in human milk, the estimates provided may need to be increased. The adequacy of these recommendations must be evaluated thoroughly.     

Late introduction and poor diversity were the main weaknesses of complementary foods in a cohort study in rural Burkina Faso

ObjectiveIn developing countries, the complementary feeding period is critical to the growth of children, notably because of inappropriate complementary feeding practices. A longitudinal study was carried out in a food vulnerable area in Burkina Faso to better understand and describe these practices.MethodsA cohort of 114 children was followed at the ages of 6, 9, 12, 15, 18, and 24 mo. At each visit details on the complementary foods (CF) were recorded and intakes were measured by direct weighing.ResultsAt 6 mo of age all infants were breastfed and 61% were still breastfed at 24 mo. Infants not receiving any CF were 97% at enrollment, 53% at 9 mo, and 11% at 12 mo (mean age of introduction = 9.2 ± 1.7 mo). Porridge was the type of CF introduced first (46%) but was of poor diversity; special dishes were less often given but did contain more numerous ingredients. However, less than half of the children received the recommended minimum of four different food groups/d before being 2 y old. At 12 mo and after, more than 75% of the children had at least 3 meals/d. Quantities of CF consumed increased from 133 ± 121 g/d (19 ± 17 g per kg of body weight/d) at 9 mo to 480 ± 237 g/d (49 ± 25 g/kg/d) at 24 mo (for breastfed children).ConclusionLate introduction of CF and poor diversity of ingredients, more than quantity of food, were the main weaknesses observed in this context. At least part of these issues can be addressed through educational activities.     

The power of vitamins

Although a healthy, varied diet should be sufficient for the majority, certain population groups are at risk of micronutrient deficiencies, particularly young women of childbearing age, whose diets are commonly micronutrient poor and whose requirements increase peri-conceptually and throughout pregnancy and lactation. Infants and young children are also vulnerable to micronutrient deficiencies, associated with the high nutritional demands of rapid growth alongside the transition from milk to solids during weaning. The DH and NICE recommend i) periconceptual folic acid supplementation ii) vitamin D supplementation during pregnancy and lactation, for breastfed infants over 6 months of age (> 1 month if at high risk of deficiency), in those taking less than 500ml infant formula and for all 1-5 year olds iii) vitamin A supplementation during infancy and early childhood. The vitamin and mineral supplement industry is vast, with a third of the UK population and half of children being reported to be taking micronutrient supplements, although it is predominantly by those who do not need them. Guidance on suitable micronutrient supplementation from health professionals, supported by dietitians if required, is therefore likely to be welcomed by many families.     

The contribution of ready-to-eat cereals to daily nutrient intake and breakfast quality in a Mediterranean setting

OBJECTIVES: To examine if and how ready-to-eat cereals (RTEC) contribute to the quality of the diet of children, adolescents and young adults in a Mediterranean setting. METHODS: A random sample of 3534 subjects aged 2 to 24 years in Spain was studied. Food and nutrient intakes were determined by a 24 hour recall. RTEC consumption was assessed by a quantitative food frequency questionnaire. Additional questions on socioeconomic level and nutritional knowledge were administered. Cereal consumption was classified into non-consumers and daily intakes between 1 and 20g, 21 and 40g, and more than 40g. After excluding the underreporters the final sample consisted of 2852 individuals. RESULTS: About half of the population (49.8%) reported eating RTEC. Macronutrient profile improved with increasing cereal consumption. Intakes of thiamine, riboflavin and vitamin B6 increased significantly with increasing consumption of RTEC in all age-sex groups, whereas niacin and folate intake improved in almost all groups and calcium, iron and vitamin D in at least half of the groups. Except for magnesium, vitamin B12 and vitamin E in males, consumption of RTEC was significantly associated with increased coverage of the daily nutrient requirements for all micronutrients studied. Higher levels of RTEC consumption was associated with a greater consumption of dairy products, and related to better breakfast quality. CONCLUSIONS: Level of RTEC consumption is associated with a better nutritional profile in the diets of Spanish children, adolescents and young adults and a lower risk for inadequate micronutrient intakes. RTEC consumers have better quality breakfasts, in terms of both food choices as well as energy and nutrient content.     

Complementary feeding: clinically relevant factors affecting timing and composition

Exclusive breastfeeding for the first 6 mo of life followed by optimal complementary feeding are critical public health measures for reducing and preventing morbidity and mortality in young children. Clinical factors, such as birth weight, prematurity, and illness, that affect the iron and zinc requirements of younger infants are discussed. Maternal diet and nutritional status do not have a strong effect on the mineral content of human milk, but physiologic changes in milk and the infants' status determine the dependence of the infant on complementary foods in addition to human milk to meet iron and zinc requirements after 6 mo. The nature of zinc absorption, which is suitably characterized by saturation response modeling, dictates that plant-based diets, which are low in zinc, are associated with low absolute daily absorbed zinc, which is inadequate to meet requirements. Foods with a higher zinc content, such as meats, are much more likely to be sufficient to meet dietary requirements. Current plant-based complementary feeding patterns for older fully breastfed infants in both developed and developing countries pose a risk of zinc deficiency. The strong rationale for the potential benefits of providing meat as an early complementary food, and the examples of successful intervention programs, provide potent incentives to pursue broader implementation programs, with concurrent rigorous evaluation of both efficacy and effectiveness.     

Vitamins and minerals: A model for safe addition to foods

BACKGROUND: Significant subgroups in most European populations have intakes below nationally recommended levels for several vitamins, minerals and trace elements, placing individuals at risk of suboptimal intake of important vitamins and minerals. The voluntary addition of micronutrients to the appropriate foods may help address the risks associated with low micronutrient intakes. However, concerns need to be addressed regarding the potential for unacceptably high intakes, particularly for those people consuming very large amounts of food. AIM OF THE STUDY: To develop a model to estimate the level of each micronutrient that can be added safely to foods. METHODS: A theoretical model was developed based on the critical factors which determine the risk of unacceptably high intake for each micronutrient at high levels of food/energy intakes. These included 1) Tolerable Upper Intake Levels (UL), 2) high micronutrient intakes in Europe at the 95(th) percentile intake for each nutrient, 3) the proportion of fortified foods in the diets of individuals at the 95(th) percentile for energy intakes, 4) the proportion of foods to which micronutrients could practically be added, and 5) a range of estimates for the fractions of foods which might be actually fortified for each nutrient. A maximum level was set up for each micronutrient per typical serving or 100 kcal portion. The outputs of the model were then compared against a recent model developed by AFSSA, based on the food intake data in France. RESULTS: Three categories of micronutrients were identified, in which micronutrients could be added safely to foods at levels (per serving, e. g., 100 kcal) 1) greater than 1 European Commission Recommended Daily Intake (EC RDA): vitamin B12, vitamin C, vitamin E, riboflavin, panthothenic acid, niacin and thiamine; 2) between 50 and 100 % of the EC RDA: vitamin B6, vitamin D, folic acid, biotin, copper, iodine and selenium; 3) between 10 and 40 % of the EC RDA: iron, zinc, calcium, phosphorus and magnesium. A fourth category consisting of retinol, for which high end intake levels are close to UL for some population subgroups in Europe and thus requires further consideration. CONCLUSIONS: A wide range of vitamins and minerals can be added safely to foods at nutritionally important levels in the current diets of Europeans.     

To what extent can food-based approaches improve micronutrient status?

The main dietary sources of micronutrients are animal source foods, fruits, vegetables and legumes. Animal source foods are the only source of some micronutrients and the main dietary source of others. Micronutrient status and child development are improved by animal source food interventions in populations that habitually consume low amounts. Of particular concern is the high global prevalence of vitamin B12 depletion, which is associated with low animal source food intake. Some fruits and vegetables can supply vitamin A requirements even with the lower amounts of fat typically consumed in many countries. However, plant source foods are unlikely to supply enough iron, zinc and vitamin B12, even if strategies such as consuming ascorbic-acid rich foods to increase iron absorption are adopted. Identification of mineral-rich varieties of cereals and legumes may improve the future situation. Complementary foods for infants and young children are unlikely to meet micronutrient requirements, especially for iron and zinc, unless they are fortified. Other strategies to improve micronutrient status, such as fortification and supplementation, have limitations and should not replace food-based strategies. Moreover, food-based strategies will improve dietary quality in general and are consistent with the global need to lower the risk of chronic disease and overweight.     

Micronutrient adequacy of women's diet in urban Burkina Faso is low

In developing countries, urban populations are deemed to have better access to a wider variety of foods than their rural counterparts. Yet, data on micronutrient status are scarce and the impact of urban food consumption behaviors on micronutrient adequacy is not well known. The objective of this study was to assess individual micronutrient adequacy of the diet along with food consumption behaviors of women of reproductive age in Ouagadougou, Burkina Faso. A cross-sectional survey of 182 women was conducted in 2 districts of the city. Nutrient intakes were derived from 3 nonconsecutive quantitative 24-h recalls for each woman. Balance in macronutrients was in the range of recommendations except that mean sugar intake was somewhat high. Mean probability of adequacy across 11 micronutrients was low (0.38). The most problematic micronutrients were vitamin B-12 (only 4% of our sample had sufficient intake), folate (12%), riboflavin (13%), and niacin (20%). Higher intakes of organ meat, flesh foods, vitamin A- and vitamin C-rich fruits and vegetables, and legumes and nuts were significantly associated with lower risk of micronutrient inadequacy. Ready-to-eat foods bought outside the home provided 46% of overall energy intake, 52% of fat intake, and 72% of sugar intake but were not associated with micronutrient inadequacy (P > 0.05). These results highlight the low micronutrient intakes among women of reproductive age in Burkina Faso, even in an urban area.