PLANNING NUTRIENT DENSE COMPLEMENTARY FOODS

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PLANNING NUTRIENT DENSE COMPLEMENTARY FOODS

• Lalita Bhattacharjee
• Nutritionist
• NFPCSP, FAO

2
Prevalence of LBW in Selected Asian Countries
(weight lt 2500 g at birth)
60
50
50
33
40
30
23
30
Prevalence
20
17
16
20
11
7.2
10
0
BAN
NEP
IND
MMR
MAV
SRL
BHU
INO
THA
Source WHO/SEARO, 2000
3
Global and regional trends in the estimated
prevalence of protein-energy malnutrition in
underweight children under five, since 1980
Region 1980 1980 1990 1990 1995 1995 2000 2000 Year-2000 Goal
Million Million Million Million
Africa 26.2 22.5 27.3 30.1 27.9 34.0 28.5 38.3 13.7
Asia 43.9 146.0 36.5 141.3 32.8 121.0 29.0 108 18.3
Latin America 14.2 7.3 10.2 5.6 8.3 4.5 6.3 3.4 5.1
Developing countries 37.4 175.7 32.1 177.0 29.2 159.5 26.7 149.6 16.1
Source Nutrition for Health and Development,
Progress and Prospects on the Eve of the 21st
Century (WHO/NHD/1999)
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Prevalence of PEM in children less than 5 years
in selected Asian countries.
63
56
54
51
50
50
49
40.1
38
36.1
42
38
30
30.7
31.2
Prevalence
18
16.1
16
BAN
NEP
IND
MMR
MAV
SRL
BHU
INO
THA
Prevalence of Underweight children (lt2sd
NCHS median for weight for age) Prevalence
of Stunted Children (lt- 2sd height/age)
Source WHO/SEARO, 2000
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Issues central to promoting appropriate infant
and young child (IYC) feeding

• A household food and nutrition security context
• Links of maternal and child nutrition
• Guidelines for IYC feeding
• Adoption of a community based approach

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Food based dietary guidelines (FBDGs)

• Basic health services
• Specific food nutrition programmes
• Prevention control of malnutrition, GMP CF,
• School meals, etc

Consumption
Individual / Household Community
as core for development
Food quality processing
Utilization
Monitoring and Surveillance
Food combinations/ Food-to-food enrichment
Food production
-Rice -Legumes -Fish -Chicken -Eggs
-Vegetables -Fruits -Milk others
Agriculture extension
Food and Nutrition Security Cycle
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Maternal and child nutrition links

• Malnutrition in pre pregnancy pregnancy
• SE factors, early pregnancy, food taboos, faulty
  diet,etc.
• Anemia LBW
• Lactation performance
• Existing practices fail to make up nutrient
  deficit
• Protein energy malnutrition

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Fetal development maternal environment

• Four relevant factors in fetal life
• intrauterine growth retardation (IUGR)
  premature delivery of a normal growth for
  gestational age fetus overnutrition in utero
  intergenerational factors
• Evidence on IUGR associated with increased risk
  of CHD, stroke,diabetes and raised blood pressure
• Large size at birth associated with increased
  risk of diabetes and CV disease

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Proper feeding in infancy and early childhood

• Achieving normal growth
• Increasing chances for developing maturing into
  well nourished , functionally capable adult
• Prevention of malnutrition
• Enhance eating behaviour
• Identifies a set of feeding and dietary practices
  to meet nutrient requirements

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Need for feeding recommendations

• Children at greatest risk of nutritional
  deficiency growth retardation between 6 24 mo
  (peaks at 12 -24 mo)
• Between 1-2 years relative contribution of breast
  milk declines as it is gradually replaced by
  appropriate CF
• Feeding recommendations to be expanded as CF
  guidelines

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Recommended practices for BF children 6-24 months

• Continue frequent on-demand BF including night
  feeding for infants
• Introduce CF beginning around 6 months
• Increase food quantity as child gets older while
  maintaining frequent BF
• (Approx. energy from CF for 6-8 months 280
  kcal 9-11 months 450 kcal 12-24 months 750 kcal
  ) Local research needed to determine best
  combination of foods and practices to achieve
  these levels of energy intake

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Recommended practices for BF children 6-24 months
(Contd).

• Increase feeding frequency as the child gets
  older, using a combination of foods
• ( Feed CF 6-8 month olds 2-3 times/d 9-11
  month olds 3-4 times/d 12-24 month olds 4-5
  times/d)
• Gradually increase food consistency and variety
• Diversify diet to improve quality micronutrient
  intake
• Practice active feeding also during and after
  illness
• Practice good hygiene and proper food handling

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Guidelines for Complementary feeding

• Ensure that children reach their proper and full
  potential for growth and development
• Prevent PEM and micronutrient malnutrition
• Foster development of desirable eating habits
  establish an eating pattern
• Need to be accompanied by systematic GMP
  activities

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Developing complementary feeding guidelines (CFG)

• Appropriate complementary feeding involves a
  combination of practices to maintain
  breast-feeding and, at the same time, improve the
  quantity and quality of foods given to the young
  child.

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Developing CFGs

• A set of guidelines for the addition of
  nutrient-dense foods to diets of breast fed
  infants between 6 and 12 months of age serves as
  a point of reference for appropriate adaptation
  to varying country contexts
• Can be implemented through national FBDGs
• Rationale for CFG should stem from traditional
  food pattern, food availability and food
  production data

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Developing CFGs (Contd).

• At the household level, FAO in conjunction with
  WHO UNICEF facilitates country efforts to
  develop and promote use of FBDGs for feeding
  infants young children
• Work in various countries provides illustration
  of the effectiveness of such guidelines in
  improving IYC feeding behaviours when the
  guidelines are part of an overall strategy to
  increase household food security

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• Some important considerations
• Ideal infant and young child feeding comprises
  exclusive breast feeding for 6 months
• Followed by sequential inclusion of semi-solid
  and solid foods to complement breast milk
• Till the child is able to gradually eat the
  normal household diet by about 2 years.

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Promotion, protection and support of
breast-feeding

• Essential that the newborn gets the initial
  breast milk called colostrum as the first feed,
  because of its immense immunologic value.

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Ingredients for CF
Rice (4)pulse(1)nuts(1)veg(2)
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Suggested complementary feeding guidelines

• 0-6 months - Exclusive breast feeding
• At 6 months - Begin with rice gruel, ripe
  banana
• add egg yolk, chicken liver or
• legumes, fish and DGLVs/pumpkin/
• carrots
• 7 months - Add ground meat
  including chicken,
• whole
  egg, well cooked soft fish
• other fruits( ripe
  papaya/mango)
• progressing until child takes 1 full
  meal
• 8 - 9 months - Give 2 complete meals
• 10 - 12 months- Give 3 complete meals

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Energy Needed from Complementary Foods to Meet
Daily Requirements by Level of Breast milk Intake
Level of Breast milk Intake a
Age in months Daily energy requirement (kcal)b High breast milk intake (Mean 2.S.D.) Average breast milk intake Low breast milk intake (Mean 2 S.D.)
Kilocalories needed from complementary foods
6-8 9-11 12-23 680 830 1090 75 230 490 270 450 750 465 675 1000

• Source Brown et al., 1998
• Figures have been rounded
• Estimates of average breast milk intake are 410
  kcal for 6-8 month old, 340 kcal for 12-23
  months old. These estimates need to be adjusted
  for the size of the infant.

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Timing of introduction of complementary foods

• To minimize interference with normal pattern of
  breast-feeding, complementary foods should
  preferably be given between breast feeds.
• Along with introduction of CF, breast-feeding
  should remain an important component of the
  infants diet preferably continue into the
  second year of life.

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Preparation of locally appropriate
complementary mix

• An example of a complementary food mix could
  include 3 parts of rice 1 part of beans 1
  part of nuts/oilseeds suitably roasted, ground
  cooked to a gruel to be fed to the young child .
• Culturally appropriate combinations can be
  adapted for use.

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Hygienic preparation and care

• Guidelines for hygienic preparation and storage
  of complementary foods need to be developed to
  prevent risks of contamination.
• Mothers/caregivers should be instructed to wash
  their hands thoroughly before preparation and
  feeding.

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A community based approach

• Way of empowering individuals, households and
  communities to develop human capital
• Based on the notion that community needs to
  obtain some basic understanding on how to improve
  essential food, nutrition and related indicators
• Evokes community participation

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Service driven programmes
- Vertical, many become welfare oriented -
Little intra/inter sectoral coordination -
Little people /community participation -
Dependency creation - Not sustainable -
Inadequate coverage
Individual Family Community
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Community-Based Nutrition Programme Components
Minimum Basic Services (Health, Education, Agr.
Extension)

• Support System
• Training
• Funding
• Problem Solving
• Supervision

Facilitators

• Menus of activities)
• Food Production
• Nutrition education
• Food sanitation/safety
• Antenatal care
• GMP
• BF/CF
• Other activities

• Interface
• (service providers and
• community leaders)
• Plan/goals
• Implementation
• Monitoring evaluation

Mobilizers (110 households)
Community Leaders Household Individual
Essential Minimum Needs Goals/Indicators
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Community based programmes to link CF and GMP

• Mothers can be mobilized by community mobilizers
  to participate in processing, preparation
  feeding of complementary foods.
• Malnourished children can be identified timely
  dietary guidance given to mothers.
• Serve as practical guidance tools to monitor
  childrens growth and nutritional status.

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Community based programmes to improve
complementary feeding (contd)

• One mobilizer can take responsibility for 10
  households in a community to promote the
  mothers concerted involvement in nutrition
  improvement of their children.
• A village nutrition development fund can be
  created for use of complementary food mixtures
  mix can be given free to children whose growth
  falters.

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Conclusions

• For infants up to 6 months exclusive
  breast-feeding should be encouraged promoted as
  the most desirable feeding practice.
• For older infants young children, raising
  community awareness of the critical importance of
  the timely introduction of adequate quantities of
  safe nutritious complementary foods is key for
  improving nutrition.

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Conclusions (Contd)

• FBDGs for infants and young children need to be
  developed and promoted considering local
  agro-ecological contexts the potential for
  increasing production of nutritious
  foods,processing techniques capacities.

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• Thank You
• for
• Your Attention