This position paper considers different aspects of complementary feeding (CF), focussing on healthy term infants in Europe. After reviewing current knowledge and practices, we have formulated these ...

/pdf/complementary-feeding-a-position-paper-by-the-european-31nldw4km2.pdf

Complementary Feeding: A Position Paper by the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) Committee on Nutrition.

Iron deficiency (ID) is the most common micronutrient deficiency worldwide and young children are a special risk group because their rapid growth leads to high iron requirements. Risk factors associated with a higher prevalence of ID anemia (IDA) include low birth weight, high cow's-milk intake, low intake of iron-rich complementary foods, low socioeconomic status, and immigrant status. The aim of this position paper was to review the field and provide recommendations regarding iron requirements in infants and toddlers, including those of moderately or marginally low birth weight. There is no evidence that iron supplementation of pregnant women improves iron status in their offspring in a European setting. Delayed cord clamping reduces the risk of ID. There is insufficient evidence to support general iron supplementation of healthy European infants and toddlers of normal birth weight. Formula-fed infants up to 6 months of age should receive iron-fortified infant formula, with an iron content of 4 to 8 mg/L (0.6-1.2 mg(-1) · kg(-1) · day(-1)). Marginally low-birth-weight infants (2000-2500 g) should receive iron supplements of 1-2 mg(-1) · kg(-1) · day(-1). Follow-on formulas should be iron-fortified; however, there is not enough evidence to determine the optimal iron concentration in follow-on formula. From the age of 6 months, all infants and toddlers should receive iron-rich (complementary) foods, including meat products and/or iron-fortified foods. Unmodified cow's milk should not be fed as the main milk drink to infants before the age of 12 months and intake should be limited to <500 mL/day in toddlers. It is important to ensure that this dietary advice reaches high-risk groups such as socioeconomically disadvantaged families and immigrant families.

/pdf/iron-requirements-of-infants-and-toddlers-4i0x8fxnwz.pdf

Iron requirements of infants and toddlers

Metabolism and functional effects of plant-derived omega-3 fatty acids in humans

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on the nutrient requirements and dietary intakes of infants and young children in the European Union. This Opinion describes the dietary requirements of infants and young children, compares dietary intakes and requirements in infants and young children in Europe and, based on these findings, concludes on the potential role of young-child formulae in the diets of infants and young children, including whether they have any nutritional benefits when compared with other foods that may be included in the normal diet of infants and young children. The Panel concluded on the levels of nutrient and energy intakes that are considered adequate for the majority of infants and young children, and evaluated the risk of inadequate nutrient intakes in infants and young children in living Europe. Dietary intakes of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D and iodine (in some European countries) are low in infants and young children living in Europe, and particular attention should be paid to ensuring an appropriate supply of ALA, DHA, iron, vitamin D and iodine in infants and young children with inadequate or at risk of inadequate status of these nutrients. No unique role of young-child formulae with respect to the provision of critical nutrients in the diet of infants and young children living in Europe can be identified, so that they cannot be considered as a necessity to satisfy the nutritional requirements of young children when compared with other foods that may be included in the normal diet of young children (such as breast milk, infant formulae, follow-on formulae and cow‘s milk). © European Food Safety Authority, 2013

Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union

Arachidonic acid (ARA, 20:4n-6) is an n-6 polyunsaturated 20-carbon fatty acid formed by the biosynthesis from linoleic acid (LA, 18:2n-6). This review considers the essential role that ARA plays in infant development. ARA is always present in human milk at a relatively fixed level and is accumulated in tissues throughout the body where it serves several important functions. Without the provision of preformed ARA in human milk or infant formula the growing infant cannot maintain ARA levels from synthetic pathways alone that are sufficient to meet metabolic demand. During late infancy and early childhood the amount of dietary ARA provided by solid foods is low. ARA serves as a precursor to leukotrienes, prostaglandins, and thromboxanes, collectively known as eicosanoids which are important for immunity and immune response. There is strong evidence based on animal and human studies that ARA is critical for infant growth, brain development, and health. These studies also demonstrate the importance of balancing the amounts of ARA and DHA as too much DHA may suppress the benefits provided by ARA. Both ARA and DHA have been added to infant formulas and follow-on formulas for more than two decades. The amounts and ratios of ARA and DHA needed in infant formula are discussed based on an in depth review of the available scientific evidence.

/pdf/the-essentiality-of-arachidonic-acid-in-infant-development-1qw4e02id5.pdf

The Essentiality of Arachidonic Acid in Infant Development

Iron intake and iron status in breastfed infants during the first year of life

Background
To investigate whether a low meat content of complementary food as accepted by EU law increases the risk of well-nourished infants to develop iron deficiency during the complementary feeding period.

Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial.

Objective: To study the effect of modified PUFA profiles of complementary food on LC-PUFA composition in healthy infants. Design: Double blinded, randomized, controlled intervention trial. Setting: Dortmund, Germany. Patients: free-living sample of healthy term infants. Methods: Participants were randomized within the first 2 months of life. During the intervention period from 4 to 10 months, the control group (CG, n=53) received commercial complementary meals with corn oil (3.4 g/meal) rich in n-6 linoleic acid (LA), the intervention group (IG, n=49) received the same meals with rapeseed oil (1.6 g/meal) rich in n-3 alpha-linoleinic acid (ALA). FA intake was assessed from dietary records throughout the intervention period. FA proportions (% of total FA) in total plasma were analyzed before and after the intervention. Results: Plasma FA profiles did not differ between the IG and CG before the intervention. During the intervention, the only difference in FA intake between the IG and CG was a higher intake of ALA in the IG, 21 % deriving from study food, and a lower ratio of LA/ALA (10.7 vs 14.8). At the end of the intervention, the plasma proportions of total n-3 FA and of n-3 LC-PUFA, but not of ALA were higher and the ratios of n-6/n-3 FA were lower in the IG. Conclusions: Feasible dietary modifications of the precursor FA profile via n-3 PUFA rich vegetable oil favored n-3 LC-PUFA synthesis in the complementary feeding period when LC-PUFA intake from breast milk and formula is decreasing.

https://adc.bmj.com/content/archdischild/94/11/876.full.pdf

Modification of dietary polyunsaturated fatty acids via complementary food enhances n-3 long-chain polyunsaturated fatty acid synthesis in healthy infants: a double blinded randomised controlled trial

Background
The breastfed infant is usually used as standard for formula feeding, also regarding long-chain polyunsaturated fatty acids (LC-PUFA). Here, plasma fatty acid concentrations in formula fed infants and the effects of LC-PUFA supplementation were investigated under real-life conditions.

Dietary intake and plasma concentrations of PUFA and LC-PUFA in breastfed and formula fed infants under real-life conditions

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Iron intake and iron status in breastfed infants during the first year of life

Complementary food with low (8%) or high (12%) meat content as source of dietary iron: a double-blinded randomized controlled trial.

Modification of dietary polyunsaturated fatty acids via complementary food enhances n-3 long-chain polyunsaturated fatty acid synthesis in healthy infants: a double blinded randomised controlled trial

Dietary intake and plasma concentrations of PUFA and LC-PUFA in breastfed and formula fed infants under real-life conditions