Micronutrient Deficiency in Children.pptx

Complimentary feeding practices to be followed

1. Micronutrient Deficiency in Children “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

2. 2 Breastfeeding: The Gold Standard in Infant Nutrition Start Breastfeeding ASAP, within first hour of birth. Exclusive breastfeeding till 6 months. Continue breastfeeding 2 years and beyond….. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

3. 3 Start complementary feeding at 6 months with continued breast feeding to ≥2 yrs Provide appropriate complementary feeding: - Timely - Adequate - Safe - Properly fed WHO, Report of Global Consultation, 2002 WHO Global Infant Feeding Recommendations, 2002 Complementary Feeding “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

4. Is micronutrient deficiency common among children? 4 “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

5. Globally, millions of children suffer from micronutrient deficiencies “Too few children are getting the nutrition they need to survive, grow and develop” – UNICEF 3 At least 50% of children aged 6 months to 5 years suffer from one or more micronutrient deficiency (MND) 1 155 million children are stunted 2 52 million children are wasted 2 CDC. https://www.cdc.gov/immpact/micronutrients/index.html . Global nutrition report. https://www.globalnutritionreport.org/files/2017/11/Report_2017.pdf . UNICEF. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/ . “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

6. Most common MNDs 1 Bailey RL, et al. Ann Nutr Metab . 2015;66 Suppl 2:22-33. WHO website. http://www.who.int/nutrition/topics/ida/en/ . In developing countries, about 40% of preschool children are estimated to be anemic 2 “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

7. National Data NFHS-4 (2015-16) – Nutritional status of children District level household & facility survey. http://rchiips.org/NFHS/pdf/NFHS4/India.pdf .. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

8. Suboptimal iron and zinc status is observed in young children Iron and Zinc Status of 6-Month to 5-Year-Old Children From Low-Income Rural Families of Punjab, India 80 70 60 50 40 30 20 10 Energy Percent Adequacy Iron Zinc 63.6 71.7 55.4 65.8 33.8 42.3 1-3 Years 4-5 Years Percentage of adequacy of energy, iron and zinc Energy, iron, zinc intake, vitamin C, folate, riboflavin, vitamin B6, and niacin was observed to be inadequate among children 1-5 years of age 2 Kiran Bains , PhD 1 , Harpreet Kaur, PhD 1 , Navjot Bajwa , MD 2 , Gurpreet Kaur, MSc 1 , Sherry Kapoor, MSc 1 , and Anupriya Sing, MSc 1 2. Bains K, et al. Food and nutrition bulletin. 2015 Sep;36(3):254-63. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

9. Reasons for high prevalence of micronutrient deficiencies More than 70% of pre-school children consume less than 50% of the recommended daily allowance for vitamin A, iron, folic acid and riboflavin Few common reasons for high prevalence 2 National nutrition monitoring bureau. http://nnmbindia.org/NNMB%20MND%20REPORT%202004-Web.pdf . The Changing Scenario of Micronutrient Deficiencies in India. http://www.nutritionfoundationofindia.org/pdfs/BulletinArticle/nfi_bull_0413_1.pdf . “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

10. What is the role of micronutrients? “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

11. Importance of Early Nutrition in Brain Development During the First 1,000 Days Physiological Development of the Brain Across the First 1,000 Days 1 1. Thompson RA and Nelson CA. Am Psychol. 2001;56(1):5–15; 2. Martorell R, et al. J Nutr . 2010;140:348–354. 2 “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

12. Glucose, branched chain amino acids, oxygen and iron play a crucial role in optimal brain development 1 Timing of the nutrient deficit and nutrient requirement of region of the brain at that time determine vulnerability to nutrient deficit 2 Nutrients responsible for brain development a Nutrients that meet the principles for demonstrating a critical or sensitive period during development Wullschleger S, et al. Cell. 2006;124(3):471-84. Cusick SE, et al. The Journal of pediatrics . 2016;175:16-21. Georgieff MK, et al. Development and psychopathology . 2015;27(2):411-423. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

13. Implications of micronutrient deficiencies Iron Deficiency Kretchmer N, et al. American Journal of Clinical Nutrition. 1996; 63:997S–1001S. Georgieff MK, et al. Development and psychopathology . 2015;27(2):411-423. . “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

14. How important is complementary feeding period? “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

15. 15 Infant and toddler period is the best time to promote acceptance of healthy foods Nutrient needs of infants and toddlers are different from those of older children and adults There is a need for dietary guidance to parents as to when, how and what to feed infants and toddlers F eeding practices play an important role in child’s eating behaviors Birch LL, et al. Am J Clin Nutr . 2014;99(3):723S-8S. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

16. The Developmental Window of Opportunity to Experience New Tastes and Textures It is imperative that the texture is gradually adapted to the baby’s stage of development and mastication skills and introduced at the optimal timing. Coulthard H, et al . Matern Child Nutr . 2009;5(1):75-85. Northstone K, et al . J Hum Nutr Diet . 2001;14(1):43-45. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

17. 17 First two years of life is a highly significant time for development of dietary patterns Reidy KC, et al. BMC Nutrition. 2017 Dec;3(1):5. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

18. 18 Complementary feeding practices are inadequate in India Systematic review of 68 studies Manikam L, et al. Public Health Nutr . 2018 Mar;21(4):637-654. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

19. How to ensure adequate nutrition? “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

20. Home-made Preparations Breastmilk 20 Fortified Food “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

21. Children during 6-24 months of age are most vulnerable to undernutrition, which negatively impacts growth and development. 21 Complementary Feeding: Key to Prevention of Undernutrition Inadequate complementary feeding which lacks in quality and quantity can limit growth and endanger child’s survival and development “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

22. Iron from birth stores Iron from breast milk Iron Gap 22 Energy and Iron Requirements in First 2 Years of Life Post 6 months, if complementary foods are not administered, there is a resultant energy gap as well as iron deficiency “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

23. Why 6 months 23 Ideal Time to Initiate Complementary Feeding 6 months Complementary foods should be introduced at 6 months of age while continuing breastfeeding; else, may result in growth faltering “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

24. 7 Food Groups 24 Minimum Diet Diversity “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

25. No. of Meals Required When Energy Density of the Meals Is Between 0.8 and 1 kcal/g Age (months) Breast-feeding Status Recommended Daily Meal Frequency 6 – 8 Yes 2–3 meals 9 – 23 Yes 3–4 meals 1–2 additional snacks 6 – 23 No 1 – 2 cups of milk* 4 – 6 meals 1–2 additional snacks 25 Minimum Meal Frequency “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

26. 26 Minimum Acceptable Diet “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

27. 27 IYCF Guidelines, IAP recommendations- 2016 Age Texture Frequency Average amount each meal (energy density= 0.8 to 1.0 Kcal/gm) 6-8 months Start with thick porridge, well mashed foods 2-3 meals per day plus frequent BF Start with 2-3 table spoonfuls 9-11 months Finely Chopped or mashed foods, and foods that baby can pick up 3-4 meals plus BF. Depending on appetite offer 1-2 snacks ½ of a 250mL cup/ bowl 12-23 months Family foods, chopped or mashed, only if necessary 3-4 meals plus BF. Depending on appetite offer 1-2 snacks ¾ to 1 cup/bowl of 250 ML If baby is not breastfed, give in addition: 1-2 cups of milk per day, and 1-2 extra meals per day Tiwari S, Bharadva K, Yadav B, Malik S, Gangal P, Banapurmath C et al. Infant and Young Child Feeding Guidelines, 2016. Indian Pediatrics. 2016;53. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

28. Addressing the nutrient gap “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

29. Fortified Foods Provide Adequate Nutrient Intake and can combat MND Nutrient rich food That is varied in flavour and texture helps infants to avoid malnutrition Prepared in a safe and hygienic manner Develop healthy food habits and transition to adult foods Fortification of complementary foods can help fill the nutrition gaps in infant’s diet It is vital to provide infants with adequate nutrition and prevent nutrition gaps during this early period WHO. http://apps.who.int/iris/bitstream/10665/44117/1/9789241597494_eng.pdf?ua=1&ua=1 . “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

30. 30 Benefits of iron fortification – Clinical evidence Reduction in proportion of children with anemia Fortified complementary food – 67% (n=101) Sprinkles – 27% (n=97) Control group – 22% (n=94) Sazawal S, et al. Journal of Health, Population, and Nutrition . 2014;32(2):217-226. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

31. 31 Very Few Foods Contribute to Iron Intake in the First Year Finn K, et al. Nutrients. 2017;9(12):733. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

32. Liu et al, 2014 Forty-seven studies, of which 25 were randomized controlled trials, were included for analysis All studies with iron fortification or multiple micronutrients showed iron or hemoglobin improvements Studies with salt iodization showed improvement in iodine levels Indian scenario - Food fortification improves biological markers, particularly iron and hemoglobin Liu P, et al. Indian Journal of Community Health. 2014;26( Supp 1):59-74. “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

33. 33 Food fortification is beneficial WHO website. http://www.who.int/nutrition/publications/micronutrients/GFF_Part_1_en.pdf . “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

34. Breastmilk Home-made Preparations 34 Bridging the nutrition gap Fortified Food: “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

35. Key Messages “For View of Healthcare Professional Only. Breastfeeding: The Gold Standard in Infant Feeding”

36. 36 THANK YOU