Tackling nutrient inadequacy in toddlers and preschool children

Key message

The prevalence of nutrient inadequacy is high and diet diversity is low among toddlers and preschool children in many parts of the world. We observed a reduction in dairy consumption among children with age. Using modelling technique, this study explores the impact of milk beverages on reducing nutrient inadequacy in young and preschool children in Philippines and Mexico. 

Abstract

Toddler nutrition is an important milestone beyond infancy. Toddlers and pre-schoolers, typically children aged 1 to 5 years, begin to have more established family meal and snack patterns to fulfil their nutritional needs. The USDA MyPlate for pre-schoolers for example, recommends healthy offerings from fruit, vegetables, grains, protein and dairy groups at every meal[1]. Similar food-based dietary guidelines can also be found globally[2]. However, the literature suggests that in practice, children of this age group are not eating a balanced diet, and nutrient inadequacy exists in early years in many parts of the world. In the U.S., Mexico and 13 Toddlers and young children: An early start toward adult health Russia sweets and snacks are commonly consumed in children aged 2 years[3, 4, 5]. In China and the Philippines, refined white rice rather than whole grain is consumed[6,7]. Worryingly, inadequate consumption of fruit and vegetable is common across many countries. Particularly in Mexico, less than 20% of children aged 1 to 3 years consumed vegetables daily, while the same was observed in the Philippines for fruit consumption. Moreover, there is a decreasing trend in milk and dairy consumption with age. Milk and dairy are part of an important food group for toddlers and preschool children, as it greatly contributes to total energy, protein, calcium, vitamins such as riboflavin and B12. Milk is also an ideal carrier of micronutrients, in some countries such as US, Canada, Finland, Norway, Sweden and Mexico, mandatory and voluntary fortification strategies exist to enrich cow’s milk and/
or dairy products with additional nutrients such as vitamin D, in order to help individuals to increase intake of key nutrients that are often found missing in daily diets.

Furthermore, young child milks (YCM, for children aged 1 to 2 years) and preschool
children milks (PCM, for children 3 years +), fortified with a wider range of macronutrients such as fibre, EPA and DHA, as well as vitamins and minerals tailored to children’s needs, may also help to optimise intakes and minimise nutrient gaps.
Previous studies have found that children who consume YCM/ PCM have nutrient intakes closer to recommended levels[8,9]. Nutrient inadequacies (also commonly known as nutrient gaps) defined as nutrient intake below the estimated average requirement (EAR), can vary across the world depending on food availability
and local dietary habits[10]. However globally speaking, inadequate intakes vitamin D, calcium, iron are prevalent in early childhood. Taking Philippines and Mexico as examples; a previous study found that 3 in 4 Filipino children aged 1 to 2 years and 90% of children aged 3 to 4 years had inadequate intakes in iron; and over 50% of Filipino children are inadequate of calcium. Zinc, vitamin A, folate, vitamin C and B-vitamin inadequacies are also common in this population[3]. In Mexico, a quarter of
children aged 1 to 4 years are inadequate of calcium, over 50% inadequate of iron and vitamin E, and nearly all children are inadequate of vitamin D (96%)[11, 12]. Vitamin D is a particularly interesting nutrient gap, as inadequacy can be seen across many countries regardless of the level of economic development. To tackle nutrient inadequacy, we conducted two studies to assess the theoretical impact of adding YCM or PCM into the diets of toddlers (1 to 2 years) and preschool children (3 to 4 years)
on reducing nutrient inadequacy in Mexico and the Philippines. Using data from national nutrition surveys, children who consumed no or low dairy were identified, and YCM and PCM were theoretically added to their diets to meet government recommended dairy consumption levels. Nutrient intakes and percentage of children with inadequate intakes were calculated before and after modelling. Our findings suggested that while
adding YCM or PCM to children’s diet would increase intakes of all nutrients, the proportions of children with inadequate intakes of key micronutrients would dramatically reduce in both countries, to the extent that some nutrient inadequacies would be eliminated. 

References
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