Title: PLANNING NUTRIENT DENSE COMPLEMENTARY FOODS
1PLANNING NUTRIENT DENSE COMPLEMENTARY FOODS
- Lalita Bhattacharjee
- Nutritionist
- NFPCSP, FAO
2Prevalence 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
3Global 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)
4Prevalence 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
5Issues 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
6Food 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
7Maternal 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
8Fetal 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
9Proper 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
10Need 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
11Recommended 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
12Recommended 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
13Guidelines 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
14Developing 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.
15 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
16Developing 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
17- 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.
18Promotion, 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.
19Ingredients for CF
Rice (4)pulse(1)nuts(1)veg(2)
20Suggested 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
21Energy 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.
22Timing 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.
23 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.
24Hygienic 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.
25A 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
26Service 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
27Community-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
28Community 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.
29Community 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.
30 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.
31Conclusions (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.
32- Thank You
- for
- Your Attention