The concept of "critical nutrient density" in complementary feeding: The demands on the "family foods" for the nutrient adequacy of young Guatemalan children with continued breastfeeding

Abstract

Background: The WHO recommends the introduction of nutritionally adequate, safe, and appropriate complementary foods at 6 mo of age, with continued breastfeeding up to 2 y and beyond. Suggested strategies to support continued breastfeeding often postulate optimal use of customary "family foods" and adequate amounts of indigenous foodstuffs and local foods. Objective: The objective was to determine the nutrient adequacy of the diet of Guatemalan children aged 6-24 mo receiving continued breastfeeding and "family foods" rather than specially formulated "baby foods" as complementary foods. Design: "Critical nutrient densities" for complementary foods were determined by using specific energy and protein requirements, assuming children to be in the 50th or 15th weight percentile of the 2006 WHO standards. Nutrient requirements for the total diet were determined by using the recommended nutrient intakes. Breast milk was assumed to provide 75% of total energy between 7 and 9 mo, 50% between 10 and 12 mo, and 40% between 13 and 24 mo. Gaps between computed critical nutrient densities and the best-scenario Guatemalan adult's diet, as a proxy for family foods, were examined. Results: Energy complementation with these diets provided adequate nutrient density for protein, thiamine, riboflavin, and vitamins B-6, B-12, and C but not vitamin A, niacin, and folate in some groups. Major gaps for calcium, iron, and zinc were ubiquitous. Conclusions: The critical nutrient density concept is useful to evaluate the nutrient adequacy of the young child's diet. Multiple micronutrients are likely to be limited in the diets of Guatemalan young children with continued breastfeeding and family foods. © 2012 American Society for Nutrition.