HMPs are good source of iron

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Given that a majority of young term infants are largely protected from iron deficiency by their birth iron stores, iron deficiency is not often considered in infants less than six months of age. However, even in the context of the exclusively breastfed, term infant, iron deficiency and iron deficiency anaemia may be observed, with population estimates in the range of 0%–15% (ID) and 0%–4% (IDA) of six-month-old infants in different settings worldwide [Ziegler et al., 2011].

What is the recommended daily intake of iron for infants as per guidelines?

Expert group of the ICMR recommends 5 mg/day iron for 7-12 month old and 9 mg/day iron for 1-3 year old infants and young children [Dietary guidelines forIndians, 2011]. Thus, they require special foods of adequate nutrient density, consistency, and texture, and they need to be fed more often than adults [Ruel et al., 2004].

Nutrient deficiencies that is incredibly common among Indian foods

Studies on homemade diets of Indian children aged 6 months to 12 years have highlighted that diet was of poor quality and was also unable to provide sufficient quantity of iron, calcium and zinc. Jani et al found that mean densities of all the nutrients especially calcium and iron was low in the various foods fed to the children of Mumbai, India. The calcium, iron and zinc contents for the selected recipes, according to the dilution are shown in table 1 [Jani et al, 2009].

Table 1: Energy and Nutrient Density Calculated in Terms of Kcal/1g and Mg/100 gm Respectively for Nutrients Calcium, Iron and Zinc [Jani et al., 2009]

Items

Mixing ratio (Raw item + water)

Energy Density

(Kcal/gm)

Calcium (Ca) mg/100 gm

Iron (Fe) mg/100 gm

Zinc (Zn) mg/100 gm

Chapatti (gm)

3 : 1

2.69

16.8

0.9

1.0

Rice

1 : 3

0.91

4.6

1.0

1.0

Khichdi

1 : 3

0.99

20.5

2.4

1.9

Mung Dal

1 : 3

0.87

23.7

0.9

0.8

Milk

Undiluted

1.18

148.0

1.7

2.0

Potato vegetable

-

1.12

13.8

0.2

0.1

 

Data on dietary nutrient deficiencies from other South Asian countries

In a study from Guatemala, main homemade complementary foods were found to be significantly short in micronutrients, such as iron, zinc, and calcium, even if adequate amounts of protein, B vitamins [vitamins B1 (thiamine), B2 (riboflavin), B6, and B12], and vitamin C were supplied [Allen LH, 2012]. Similarly, in Philippines, homemade complementary foods were not able to supply sufficient energy and important nutrients such as calcium, iron, zinc, vitamins A and vitamin C to infants and young children as percentage WHO estimated needs [Perlas LA, 2013].

Unfortified complementary foods that are predominantly plant based generally provide insufficient amounts of certain key nutrients (particularly iron, zinc, and calcium) to meet the recommended nutrient intakes during 6–23 months of age [Abeshu et al., 2016].

Current child-feeding recommendations state that children at 6-23 months of age should be fed animal source foods daily, especially if they do not have access to fortified foods or vitamin and mineral supplements [Ruel et al., 2004].

Inference

Homemade complementary foods are based pre-dominantly on cereals and legumes, and are mostly an extension of family foods, such as porridge. Thus, HMPs such as dal water, suji kheer and dalia may provide good energy density, however, intake of micronutrients, such as iron, zinc, and calcium, from such foods are not adequate.

Reference

  • Ziegler EE, Nelson SE, Jeter JM. Iron supplementation of breastfed infants. Nutr Rev. 2011 Nov;69Suppl 1:S71-7.
  • Burke RM, Leon JS, Suchdev PS. Identification, prevention and treatment of iron deficiency during the first 1000 days. Nutrients. 2014 Oct 10;6(10):4093-114.
  • Ruel MT, Menon P, Loechl C, Pelto G. Donated fortified cereal blends improve the nutrient density of traditional complementary foods in Haiti, but iron and zinc gaps remain for infants. Food Nutr Bull. 2004 Dec;25(4):361-76.
  • Jani R, Udipi SA, Ghugre PS. Mineral content of complementary foods. Indian J Pediatr. 2009 Jan;76(1):37-44.
  • Allen LH. Adequacy of family foods for complementary feeding. Am J ClinNutr. 2012; 95:785–6.
  • Perlas LA. Nutrient Adequacy of Complementary Diets in Cebu, Philippines and Evaluation of Household Methods for Their Improvement. Graduate Student’s thesis, University of Otago, New Zealand 2013.
  • Abeshu MA, Lelisa A, Geleta B. Complementary Feeding: Review of Recommendations, Feeding Practices, and Adequacy of Homemade Complementary Food Preparations in Developing Countries - Lessons from Ethiopia. Front Nutr. 2016 Oct 17;3:41.
  • Dietary guidelines for Indians. Nat Inst Nutrition. 2011;2:89-117.