3.2 Evidence Linking Complementary Feeding to Improved Outcomes
It is difficult to meet the zinc and iron requirements of children 6 to 24 months even in the best conditions.12 Inadequate micronutrient and energy intake is often coupled with a high prevalence of both clinical and subclinical morbidity, which is often associated with anorexia. This is the period of active growth faltering. Interventions to improve intake of complementary foods can result in improved infant and child growth among populations at risk of undernutrition. A review of efficacy trials and programmes in 14 countries showed that child growth could be improved by 0.10 to 0.50 standard deviation (SD) through increased dietary intakes. This range of improvement in growth would reduce prevalences of undernutrition (< - 2 SD) at 12 months by 1-19%.21 The effects of improved nutritional intake on growth are greatest in the first year of life, though significant effects continue into the second and third year.22, 23 Nutritional status during the first two years of life, which coincides with the period of peak diarrhoeal disease and high prevalences of respiratory infections, is particularly important in light of the fact that adequate nutrition mitigates the negative effect of diarrhoea on linear growth.24
In Central and South America and the Caribbean there is renewed interest in the role that processed complementary foods can play in providing a nutritionally complete infant and toddler food.25 Processed complementary foods, appropriately fortified, can complement breastmilk and traditional foods during the nutritionally vulnerable period. Because these foods can be produced inexpensively and require minimal rime for preparation and cooking, they alleviate other economic and time-related constraints to improved child feeding. Risk of food contamination may also be reduced through good packaging. Despite these advantages, processed complementary foods have not been shown to be effective outside the research setting at improving the nutritional status of children at risk of undernutrition. Sustainability is also an issue. Inadequate attention has been given to cultural acceptabability, as well as cost and financing, social marketing, targetting, and distribution. Processed complementary foods often fail to reach the poorest households, and when they do, breastfeeding practices and other key feeding behaviours have not been improved simultaneously.
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