Growing-Up Milks Can Contribute to Balanced Nutrition in Young Children

The infant and young child nutrition industry believes that it is most important to address the underlying causes of malnutrition: it’s not just a matter of not having enough to eat. In fact, many children in families that have escaped poverty continue to suffer from inappropriate infant and young child feeding and a lack of nutritious complementary foods.

A review of global data on nutrient intakes of young children aged 12-36 months and on dietary intake performed by the Nutrition Association of Thailand (NAT) and the Early Nutrition Academy in 2015 found the nutrients, vitamin A, D, B12, C and folate and calcium, iodine, iron, zinc and DHA, often to be limited in the diets of young children globally, not meeting FAO/WHO daily recommendations[1]. The results of this review were in agreement with the European Food Safety Authority (EFSA) review of dietary intakes of young children in Europe[2].

We recognise the challenge of providing optimal infant and young child nutrition is complex and multifaceted. We recommend exclusive breastfeeding for the first six months of life as the best nutrition option. After six months of age, when breast milk alone is not able to meet the nutritional needs of infants, it is important that parents and caregivers introduce nutritious complementary food to their children’s diets.

The World Health Organisation (WHO) recommends introducing complementary foods when the child is around the age of 6 months – starting with 2-3 meals per day when the child is 6-8 months of age, and increasing to 3-4 meals per day when the child is 9-23 months of age.  Given the relatively small amounts of complementary foods that are consumed at 6-23 months, the complementary foods introduced need to be very nutrient dense. For example, at 12-23 months of age, complementary foods need to provide 97% of iron, 42% of zinc, 50-83% of riboflavin, 90-100% of vitamin D and 26-86% of calcium to ensure that the child meets its nutritional requirements.

In addition, UNICEF data also shows that significant proportions of children aged 6-23 months across Asia do not achieve a minimum acceptable diet, defined as the combination of two indicators: minimum dietary diversity[3] and minimum meal frequency[4].

In many countries in Asia, cereals or starchy roots and tubers are commonly used during early infancy as a basis for gruels, which have a low-energy density and micronutrient content. As Asian toddlers switch to table foods and eventually share family meals, the typical Asian diet, which is low in iron- and zinc-rich foods such as meat or fortified foods, could perpetuate micronutrient deficiencies – leaving the children short of what they need for growth, development and immunity.

At the same time, with increasing globalisation and urbanisation, Asian children are increasingly being raised in obesogenic environments, where they are faced with an unhealthy diet and low physical activity. Available research on the food and beverage consumption of infants and toddlers in urban areas of China[5], Phnom Penh[6] and Singapore[7]) show that young children, some as young as 6-8 months, consume sweets, salty snacks and sugar-sweetened beverages.

Against this context, growing-up milks or science-based drinks fortified with additional nutrients, vitamins and minerals such as protein; calcium; iron; vitamins D, E and C; zinc and the omega 3 fatty acid DHA, for children 1 to 6 years of age can be part of a child’s balanced diet to provide important nourishment when nutrient intake is sub-optimal. They support balanced nutrition in children and their long-term physical and mental development.

In 2013, the European Food Safety Authority (EFSA) concluded that follow-up formulas and growing-up milks are one of several means to increase intakes of critical nutrients in young children wherever inadequate intakes are common, along with the possible contribution from other sources, such as fortified cow’s milk, fortified cereals and cereal-based foods, supplements or the regular consumption of meat and fish[8].

The panel of experts brought together for the 2015 report from the Nutrition Association of Thailand and the Early Nutrition Academy agreed that that follow-up formulas and growing-up milks with an appropriate composition under appropriate conditions of use can provide a major and valuable contribution towards improving the supply of critical nutrients, overall nutritional status and hence help to support child health[9].

 


[1] Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy, Annals of Nutrition & Metabolism 2015; 67: 119-132

[2] European Food Safety Authority (EFSA): Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA Journal 2013; 11: 3408.

[3] Minimum dietary diversity is defined as a child consuming at least 4 of 7 food categories in a day (WHO, 2008).

[4] Minimum meal frequency is defined as a child consuming food at least 2 times for breastfed children 6-8 months, at least 3 times for breastfed children 9-23 months, and at least 4 times for non-breastfed children 6-23 months (WHO, 2008).

[5] Food & Nutrition Research (2016) Pan Yu et al

[6] Helen Keller International: Assessment and Research on Child Feeding (ARCH) – Assessment of Promotion of Foods Consumed by Infants and Young Children in Phnom Penh

[7] An exploratory study of eating patterns of Singapore children and teenagers. Ang, K.L., & Foo, S. (2002) Health Management, 102(5), 239-248

[8] European Food Safety Authority (EFSA): Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA Journal 2013; 11: 3408

[9] Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy, Annals of Nutrition & Metabolism 2015; 67: 119-132