Topical Area: Maternal, Perinatal and Pediatric Nutrition
The purpose of this study was to determine the optimal composition of complementary diets for infants 6 to 12 months old (m.o), in terms of daily intake of food groups to ensure nutrient adequacy. A secondary goal was to determine differences in these optimized diets with fortified versus unfortified foods.
Methods : Dietary modelling using linear programming was applied to the Feeding Infants and Toddlers Study 2016 data set to develop theoretical diets that satisfy nutrient requirements, while meeting median energy needs, for 6 to 8 m.o. and 9 to 12 m.o. breast-fed, formula-fed, and mixed-fed infants. The food data set was adjusted to ensure, among other criteria, developmental appropriateness and safety. Using the Nutrition Data System for Research (NDSR, version 2015: University of Minnesota, Minneapolis, MN), the current US fortification for grains was included, and analyses were then performed without fortification.
Among modelled diets for 6 to 8 m.o., a greater amount of total food, particularly vegetables, was required to achieve nutrient adequacy in the absence of fortification. The quantity of vegetables ranged from 54 g/day (3.5 % of total energy (E)) in the formula based fortified diet up to 206 g/day (15 % of E) in the breast milk unfortified diet. The modelling showed that inclusion of starches and grains was negligible in the unfortified diets, being primarily replaced by vegetables and pulses. For 9 to 12 m.o., daily intake of vegetables were particularly high at 222 g/day (12% of E), in the breast-fed, unfortified group. Pulses, nuts and seeds were featured in the unfortified diets at a level of 61 g/day (10% of E) in both the breast milk diet and the mixed diet.
In terms of nutrient adequacy, all requirements were met apart from iron in the breast fed unfortified diet for 6 to 8 m.o.. Meeting Vitamin D was unachievable in all but the formula based diets for 6 to 8 m.o.
Conclusions : Fortification or supplementation is required to provide adequate iron to breast-fed infants, particularly in the early months of complementary feeding, and vitamin D to most infants. The diet optimization, which could be the basis for food based dietary guidelines, showed that complementary diets should be adapted according to the milk source in the infant diet.
Funding Sources : Nestlé Nutrition, Vevey, Switzerland