Infant nutrition needs are similar to that of an adult

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Infants need high energy and nutrients as compared to an adult

The child’s stomach capacity limits how much can be consumed in a single feeding. Generally, a child who weighs 8 kg will have a stomach capacity of 240 ml, about one large cupful, and cannot be expected to eat more than that at one meal. Thus, energy density of complementary foods should be more than breast milk beyond 6 months of age, that is, at least 0.8 kcal per gram. If the energy density of food is lower, a larger volume of food is needed to fill the gap, which may need to be divided into more meals, which is a challenge to achieve [WHO, 2009]. 

Infants have a much higher proportion of their body weight as highly active tissues (brain and viscera) than adults. Ensuring adequate infant nutrition during 6 to 24 month of age (the period of high energy and nutrient requirement) is a major global health priority as this is the age of foundation for these tissues which might have long term serious consequences in the absence of adequate nutrition. In a review article on complementary feeding, Dewey KG noted that infants need complementary foods with much higher nutrient density than is required for adult diets. It was calculated that per 100 kcal of food, a breast-fed infant at 6–8 month needs 9 times as much iron and 4 times as much zinc as an adult male (who needs 0.5 mg iron and 0.26 mg zinc/100 kcal based on 2700 kcal/d and recommended intakes of iron and zinc).

What are the problems in achieving it?

The greatest challenge for meeting iron, zinc & other micronutrient needs of breast-fed children typically occurs post 6 months of life up to 2 years. Traditional staples inherently contain certain anti-nutrients e.g. phytates, which is present in cereal and legume-based diets, has a strong negative effect on iron and zinc absorption from composite meals. This is problematic for infants as the needs for iron and zinc are high during infancy. Target nutrient densities are lower from breast-feeding infants at 9–11 month than at 6–8 month, as average expected intake from complementary foods increases to 300 kcal/d at 9–11 month. This again increases to 550 kcal/d at 12–23 month. During this age while the need for iron is lower than during infancy, the need for zinc stays the same. But since the iron stores in the body is exhausted thus the intake of iron becomes crucial.

Also the iron and zinc densities of complementary foods are also considerably lower in the second year of life (1.0 and 0.46 mg/100 kcal, respectively) than in the first year. [Dewey KG, 2013].

It has been reported that adults should get 45 percent to 65 percent of their calories from carbohydrates, 20 percent to 35 percent from fat, and 10 to 35 percent from protein. Acceptable ranges for children are similar to those for adults, except that infants and younger children need a slightly higher proportion of fat (25 -40 percent) [Hoeger WWK and Hoeger SA, 2016]. Table 1 depicts the current infant meal pattern in India.

The Child and Adult Care Food Program, US in its recommendations on revised meal requirements for different age groups highlights that the amount of food in the meal patterns increases across the four younger age groups (age 1 year, 2–4 years, 5–13 years, and 14–18 years), and then decreases for adults to approximately the same level as for children 5–13 years of age [Murphy et al., 2001].

Table 1: Current Infant Meal Pattern in India [Tewari et al., 2016]

Food Components

6-8 months

9-11 months

12-23 months

Thick Porridge + Well mashed foods

2-3 meals/day (2-3 tablespoon full) + Breastfeed

 

 

Fine chopped or well mashed foods or foods that can baby pick up

 

3-4 meals/day (1/2 of a 250ml cup) + Breastfeed

 

Family foods chopped or meshed if necessary

 

 

3-4 meals/day (3/4 to 1 250ml cup) + Breastfeed

Snacks

 

Depending on appetite

Depending on appetite

 

Inference

This concludes that the infant need complementary foods with much higher nutrient density than is required for adult diets. High energy and varied nutrient requirement requires infants to be fed more number of meals than adults which should be high in nutrient and energy density. Young children even in the high wealth index families are at risk of micronutrient deficiencies, including those of iron, zinc, and vitamin A. Thus strategies for achieving adequate nutrition for infants and young children must be different from those of adults, and shall be sustainable over the long term.

Reference

  • Dewey KG. The challenge of meeting nutrient needs of infants and young children during the period of complementary feeding: an evolutionary perspective. J Nutr. 2013 Dec;143(12):2050-4.
  • Institute of Medicine (US) Committee to Review Child and Adult Care Food Program Meal Requirements; Murphy SP, Yaktine AL, West Suitor C, et al., editors. Child and Adult Care Food Program: Aligning Dietary Guidance for All. Washington (DC): National Academies Press (US); 2011. Summary. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209813/
  • Hoeger WWK, Hoeger SA. Lifetime Physical Fitness and Wellness: A Personalized Program. 2016; Page 74.
  • Tiwari S, Bharadva K, Yadav B, Malik S, Gangal P, Banapurmath CR, Zaka-Ur-Rab Z, Deshmukh U, Visheshkumar -, Agrawal RK. Infant and Young Child Feeding Guidelines, 2016. Indian Pediatr. 2016 Aug 8;53(8):703-13.
  • World Health Organization. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals.. 2009.