A study series published in The Lancet in 2008 estimated that there were a total of 112.4 million underweight young children globally — 28 per cent of whom were in Africa and 70 per cent in Asia, with more than 90 per cent of those in Asia being in South Asia, particularly India. In addition, 13 million infants were born annually with intrauterine growth restriction resulting in low birth weight.
Worldwide, 178 million children under five were estimated to suffer from stunting, of which 112 million lived in Asia. The series also provided robust estimates of wasting for the first time and indicated that 10 per cent of all children globally (55 million) were wasted and 19 million children were severely wasted.
Often these situations were associated with inappropriate feeding practices. Many children, including millions in Asia, face a daily challenge in achieving optimal nutrition, often as a result of their families lacking sufficient knowledge, information or resources and leading to diets that are often micronutrient poor.
During the first two years of life, malnutrition has a profound effect on growth and development, and evidence shows that these consequences can be long lasting and is often irreversible. Stunting, for example, is most evident during this time, particularly when complementary feeding begins and foods of low nutritional value and of limited diversity begin to replace breast milk.
Micronutrient malnutrition presents another public health problem. Deficiencies in iron, vitamin A and iodine are the most prevalent worldwide. Together, these micronutrient deficiencies affect at least one third of the world’s population, the majority of whom are in developing countries.
Over the past 15 years, the International Life Sciences Institute (ILSI) Southeast Asia (SEA) Region has been involved in addressing issues and challenges in micronutrient deficiencies in the region. In 1996, it organised the Regional Conference on Food Fortification in cooperation with the Philippines national authorities, which prompted the Manila Declaration calling for a partnership to control micronutrient deficiencies through food fortification.
From 2000 to 2004, ILSI SEA Region collaborated with international bodies, such as the United Nations and the United Nations Children’s Fund (UNICEF), as well as regional organisations, such as the Asian Development Bank, to facilitate a series of workshops to address food fortification strategies to combat micronutrient deficiencies in both adults and young children in SEA. To this day, the work continues to harmonise the micronutrient fortification regulations in the region.
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.
After six months of age, when breast milk alone is not able to meet the nutritional needs of infants, it is important that parents introduce nutritious complementary food to their children’s diets.
According to the World Health Organisation, complementary feeding should be adequate –
meaning that the complementary foods should be given in a consistent manner (in terms of amounts and frequency) and using a variety of foods to cover the nutritional needs of the growing child, while maintaining breastfeeding. Foods should also be prepared and given in a safe manner – meaning that measures are taken to minimise the risk of contamination. Finally, the foods given should be of appropriate texture for the age of the child.
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.
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 nonprofit, 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%201_Page%20131-138.pdf – During the 2nd ILSI SEA Region Expert Consultation and Planning Meeting in 2011, the following information gaps were identified: (i) Some Southeast Asian countries did not have data on infant and young child feeding (IYCF) indicators; (ii) There is a need to know the reasons for the disparities in duration of breastfeeding, age of giving complementary foods, and other breastfeeding and complementary feeding practices in Southeast Asian populations; (iii) Optimal complementary feeding practices that are most suitable in the context of Southeast Asia need to be identified. This report presents highlights from a literature review regarding the above topics. Findings from nationwide surveys and small scale studies were compiled to provide a snapshot of the state of infant and young child feeding practices in the region. Results for Cambodia, Indonesia, Philippines, and Vietnam are presented here.
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.”