Effective complementary feeding practices to provide the nutrients needed for growth and development once child growth demands exceed the nutrient content of breast milk are critical in preventing stunted growth trajectories.  Unfortunately, attaining the goals of an effective complementary feeding program is difficult in many low- and middle-income countries because of poverty, poor maternal education, and in some places because of infectious diseases.  One problem associated with identifying associations between complementary feeding approaches and nutritional status and malnutrition is the lack of a quantitative estimate of nutrient intakes.  Maciel and colleagues conducted a study in several countries to determine nutrient intakes and determine those that were associated with risk of underweight, wasting, and stunting.  Their observations are reported in a paper published in the January 2021 issue of The Journal of Nutrition.

Data for this study were generated through the use of 24-hour recalls when infants (n=1463) in seven low- and middle-income countries (Brazil, Peru, South Africa, Tanzania, Bangladesh, India, and Nepal) were between 9 and 24 months of age.  Associations between usual nutrient intakes and underweight, wasting and stunting at 12, 18, and 24 months of age were determined.

Intakes of energy and zinc were lower in children exhibiting malnutrition at 12, 18, and 24 months of age.  Higher energy intakes decreased the risk of being underweight at 12 and 24 months, and wasting at 18 and 24 months.  The risk of being underweight or of wasting at 12 months was reduced by higher zinc intakes, which also reduced the risk of wasting at 24 months.  These data led the authors to conclude that increasing energy and zinc intakes should be a focus of complementary feeding programs in low- and middle-income countries.

In a commentary on this article, Hoffman describes the importance of meeting zinc requirements, as deficient levels of this nutrient may prevent the complementary feeding program from preventing underweight and wasting, even when energy levels are sufficient.  Hoffman also points out that foods in these countries may have high levels of antinutrients, including phytates, that are known to limit zinc absorption.  Hoffman concludes that these quantitative data are an essential step in the efforts to end world hunger and its impacts on children, but they must be paired with policy initiatives that facilitate availability of foods that can be used to meet those needs.


Hoffman DJ. Nutrients in complementary feeding protect against wasting, but not stunting:  Results from a multi-country longitudinal cohort study.  The Journal of Nutrition, Volume 151, Issue 1, January 2021, Pages 5–6, https://doi.org/10.1093/jn/nxaa334.

Maciel BLL, Costa PN, Filho JQ, Ribeiro SA, Rodrigues FAP, Soares AM et al.  Higher energy and zinc intakes from complementary feeding are associated with decreased risk of undernutrition in children from South America, Africa, and Asia.  The Journal of Nutrition, Volume 151, Issue 1, January 2021, Pages 170–178, https://doi.org/10.1093/jn/nxaa271.

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