Title of Paper: Current and potential role of specially formulated foods and food supplements for preventing malnutrition among 6-23 months old and treating moderate malnutrition among 6-59 months old children
Type of Paper: Review
Purpose: In 2008, the World Health Organization (WHO) organized a meeting on the nutrient needs and the dietary management of moderate malnutrition in children under 5 years of age. This paper was written as a background paper for the meeting and was included in the special issue on the Dietary Management of Moderate Malnutrition in the Food and Nutrition Bulletin. The purpose of this paper was to review the options for providing a nutritious diet to prevent and treat moderate malnutrition in children given the common limitations faced by many malnourished populations, such as poverty and food insecurity.
- The treatment and prevention of moderate malnutrition requires:
- Consumption of nutritious foods
- Exclusive breastfeeding during the first 6 months of life
- Breastfeeding in combination with complementary foods between the ages of 6 and 24 months
- A hygienic environment
- Access to health care and prenatal care
- However, many moderately malnourished children are living in poor and/or food insecure environments making it difficult to consume a nutritious diet. This paper reviews several options for improving the diets to prevent and treat malnutrition in such children.
Dietary Intervention Options for Treating and Preventing Moderate Malnutrition:
- In populations with food security, making recommendations to improve local diets and giving advice about which foods to consume should be the primary approach. Dietary advice includes:
- Consuming foods from all food groups. Diets should include a wide variety of foods: legumes or lentils, animal-source foods, fruits and vegetables, oil, and iodine.
- Changing the kinds of foods within a food group (e.g., alternating animal and plant sources of protein).
- Giving frequent and responsive feedings
- Including foods with good energy density
- Improving plant-based diets by adding animal-source foods, adding fortified foods, and limiting antinutrients (e.g., phytates).
- In populations with food insecurity, several options for interventions include:
- Modified ready-to-use therapeutic foods (RUTFs):
- RUTFs are used to treat severe acute malnutrition, and there is emerging evidence that RUTFs can be modified to treat moderate malnutrition.
- Fortified blended foods:
- Fortified blended foods (e.g. a corn-soy blend) is the most widely used supplementary feeding program to treat moderately malnourished children.
- However, these foods have not been adapted to meet the needs of young or moderately malnourished children. For instance, they contain large amounts of antinutrients and fiber, too little fat content, too little energy, inadequate micronutrient content, and no milk powder (which is important for linear growth).
- Complementary food supplements:
- Complementary food supplements are food-based supplements (e.g., micronutrient powders) that provide essential nutrients and can be mixed with or consumed with the diet.
- The particular type of complementary food supplement that is most effective in treating malnutrition depends on the child’s existing diet. The complementary food must replace the specific dietary deficit for that child.
- Complementary food supplement programs are fairly new, and more research on their efficacy and cost-effectiveness is needed. However, the program shows potential.
The ideal method to treat and prevent moderate malnutrition in children is to give advice on how to improve the local diets, specifically, by giving advice on which foods to consume. However, this is only a feasible option in populations where there is no food insecurity. In populations with food insecurity, most supplementary feeding programs for moderately malnourished children have provided fortified blended foods; however these foods have not been adapted for children and have many dietary limitations for young children. More research is needed on modifying RUTFs and fortified blended foods so that they meet the nutritional requirements to prevent and treat moderate malnutrition in young children.
e Pee S, Bloem MW. Current and potential role of specially formulated foods and food supplements for preventing malnutrition among 6-23 months old and treating moderate malnutrition among 6-59 months old children. Food Nutr Bull. 2009;30:S434-463.