Good early life nutrition is the cornerstone of lifelong health. Scientific experts around the world recognise that the first years of a child’s life are critical for long-term physical and mental development[1]. In particular, adequate intake of both macro- (protein, carbohydrates and fats) and micronutrients (vitamins, minerals and trace elements) is particularly important in the early months and years of life, when growth and brain development are most rapid – 85% of brain growth occurs within a toddler’s first three years[2].

Children in Asia however, face a ‘double burden’ of obesity and undernutrition despite decades of economic growth. The region is home to nearly half of the world’s overweight or obese children under 5 years (48% in 2014). Yet, at the same time, undernutrition remains persistent. In 2013, about half of all stunted children and approximately two thirds of all wasted children lived in Asia[3]. Also, various micronutrient deficiencies remain prevalent, with Vitamin A deficiency linked to around 6.5% of deaths in children under five years, and zinc deficiency to around 4.4% of deaths in Asia[4].

Experts agree that the age of 12–36 months is usually a period of transition from breastfeeding combined with complementary feeding to consuming a variety of regular family foods. The transition period presents a greater risk of inadequate nutrient supply as compared to the age of full breastfeeding or older ages. Young children around the world, particularly those in developing countries as well as those in disadvantaged groups in all countries, are prone to developing nutrient deficiencies and growth faltering due to inadequate amounts and/or poor quality of complementary feeding and family foods, often aggravated by high infection rates[5].

While improvements in undernutrition (i.e. stunting, wasting and underweight) have been reached[6], the global target of reducing stunting in young children may not be fully met by 2025[7].

Micro-nutrient deficiencies of public health importance, such as vitamin A, iron and iodine deficiencies, remain a major challenge. 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 following nutrients to be often limited in the diets of young children globally, not meeting the FAO/WHO daily recommendations, namely vitamins A, D, B12, C and folate and calcium, iodine, iron, zinc and DHA[8].

The NAT report also found that young children in developing countries or disadvantaged groups are particularly prone to nutrient deficiencies due to inadequate and poor quality complementary feeding as well as due to infection. In developing countries, the usual problem nutrients are iron and zinc. In children who consume plant-based diets predominantly, the bioavailability of iron and zinc is also lowered. Other nutrients which may be insufficient include the B vitamins (B1, B2, niacin, B6, B12 and folate), vitamins A, C and E and calcium and iodine[9]. Recent reports both by the WHO[10] and the EFSA[11] highlight the need to improve dietary iron supply to older infants and young children and, in some situations, also iodine supply[12].

The continued prevalence of under-nutrition and stunting on such a large scale poses a significant threat to Asia’s children. Nutritional deficiency in early life increases susceptibility to infection and illness, and can cause reduced adult physical stature, and impaired cognitive abilities, all of which have long term negative consequences both for the child and society.

Even after they recover, the damage to the children’s health continues. Studies show that rapid weight gain after age two among stunted children can increase the risk of becoming overweight or obese later in life and can contribute to heart disease, stroke, hypertension, or Type-2 diabetes.

People with childhood stunting tend to have learning challenges. As a result, they are less prepared when they enter the job market and tend to earn lower wages than those without childhood stunting. Their lifetime earnings are estimated to be 10 percent less than their counterparts.

Collectively, this translates into reduced economic productivity in developing countries and billions of dollars in lost revenue. Research shows that reducing the prevalence of stunting can increase gross domestic product by up to 11 percent a year in Asia and Africa.

The challenge of providing optimal infant and young child nutrition is complex and multi-faceted. Some of the best solutions include protecting and promoting exclusive breastfeeding for the first six months of a child’s life. Fortunately, UNICEF reports that breastfeeding rates are no longer declining at the global level, with many countries experiencing “significant increases” in the last decade.

Infants and young children who are not exclusively breastfed should have access to suitable and safe alternatives – specifically infant formula or special, therapeutic foods for malnourished infants.

The WHO itself recognises that inadequate knowledge is often a greater determinant of malnutrition than the lack of food. Therefore, access to factual information is critical to educating parents and caregivers, which in turn reduces the risk of malnutrition in infant and young children.

Useful links and resources:

http://www.who.int/nutrition/publications/gs_infant_feeding_text_eng.pdf – The Global Strategy for Infant and Young Child Feeding aims to revitalise efforts to promote, protect and support appropriate infant and young child feeding. It builds upon past initiatives, in particular the Innocenti Declaration and the Baby-friendly Hospital initiative and addresses the needs of all children including those living in difficult circumstances, such as infants of mothers living with HIV, low-birth-weight infants and infants in emergency situations.

http://www.who.int/nutrition/topics/complementary_feeding/en/index.html – WHO articles, recommendations and consultations related to complementary feeding.

https://www.karger.com/Article/Pdf/438495 – This is 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.

https://www.frieslandcampinainstitute.com/app/uploads/2012/11/SEANUTS-Proceedings_KL.pdf – In 2009, the South East Asian Nutrition Survey (SEANUTS), was conducted to improve insight on the current nutritional status of children between the ages of six months and 12 years in selected Southeast Asian countries – Indonesia, Malaysia, Thailand and Vietnam. Results from SEANUTS highlight how regional differences, a double burden of malnutrition and vitamin D deficiency are increasingly problematic.

http://www.nestle.com/asset-library/Documents/Creating%20Shared%20Value/expert-opinions.pdf – Under‑nutrition and obesity are issues around the world, but particularly in low‑ and middle‑income countries (LMICs), where the World Health Organization has called the simultaneous presence of both the “double burden” of malnutrition.

http://www.ilsi.org/sea_region/Pages/HomePage.aspx – ILSI SEA Region is the regional branch of the International Life Sciences Institute (ILSI) a non-profit, worldwide organization whose mission is to provide science that improves public health and well-being.
It achieves this mission by fostering collaboration among experts from academia, government, and industry on conducting, gathering, summarizing, and disseminating science. Its activities focus primarily on nutrition and health promotion; food safety; risk assessment; and the environment. Its Southeast Asia branch was established in1993 and is headquartered in Singapore to co-ordinate scientific programs, research and information dissemination in Southeast Asia (Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, the Philippines, Singapore, Thailand, and Vietnam), Australia, New Zealand and the Pacific islands.

http://www.ilsi.org/SEA_Region/Publications/ILSI%20SEA%20Region%20Report%20-%20Micronutrient%20Fortification%20Regulations.pdf – Report on the Regulatory Status of Micronutrient Fortification in Southeast Asia, ILSI

http://nutriweb.org.my/publications/mjn0019_1/12%20ILSI%20SEAR_PART%202_Page%20139-142.pdf – The Infant and Early Childhood Nutrition Task Force, International Life Sciences Institute Southeast Asia (ILSI SEA) Region, organised the 1st and 2nd Expert Consultation and Planning Meeting on Infant and Early Childhood Nutrition in 2009 and 2011, respectively. The goal of the consultations was “to generate and promote relevant science-based information that will help improve nutritional status, growth and development of infants and young children in Southeast Asia.”

[1] United Call to Action Organization Global Report (2009). Investing in the future: A united call to action on vitamin and mineral deficiencies.

[2] Dobbing J, Sands J. Quantitative growth and development of human brain. Arch Dis Child. 1973;48:757-767.

[3] UNICEF-WHO-The World Bank Joint Child Malnutrition Estimates, 2013

[4] Black R et al 2008 “Maternal and child undernutrition: global and regional exposures and health consequences” Lancet (371) : 243-260.

[5] 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

[6] Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al; Maternal and Child Nutrition Study Group: Maternal and child undernutrition and overweight in low income and middle-income countries. Lancet 2013; 382: 427–451.

[7] 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

[8] ibid

[9] Dewey KG: The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: an evolutionary perspective. J Nutr 2013; 143: 2050–2054.

[10] WHO Guidelines Approved by the Guidelines Review Committee: Essential Nutrition Actions: Improving Maternal, Newborn, Infant and Young Child Health and Nutrition. Geneva, World Health Organization, 2013.

[11] 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.

[12] 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