THE FIRST FIVE YEARS. FORTIFIED.

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1 THE FIRST FIVE YEARS. FORTIFIED. Presented By: Cathy Arnold Supervisor, Senior Formulation Scientist Date: June 2012

2 A vast amount of research is dedicated to the field of children's health and nutrition, with a majority of it devoted to gaining a better understanding of the health requirements and nutritional needs of the developing child. Meeting those needs will ensure the healthy, physical, social, and emotional development of today's young children and tomorrow's adults. From zero to 60 months (newborn through five years old) are when the crucial nutritional building blocks are put into place that impact a child s body, heart and mind. Understanding the right nutrients and combination of nutrients, that are needed to affect proper development is important to creating a nutritional plan that optimizes a child s health and well-being. Pregnancy Reach out to our technical team for product development ideas at info@fortitech.com. Prior to the birth of the baby, moms can take steps to ensure the child has a solid nutritional start. Clearly, a healthy mom has the best chance of having a healthy baby. Mothers-to-be need to get regular checkups and follow their obstetrician s advice to ensure a safe and healthy pregnancy. As part of this plan, it is important to consume the appropriate amount of nutrients and energy needed to keep both mother and developing baby healthy. That means that pregnancy is not the time to be thinking about restricting your energy intake to either restrict the weight gain normally associated with pregnancy, or attempting to lose weight. On average, a pregnant mother will need about 300 kcal extra, each day, to meet the energy needs of the growing child. While it is important to make sure that the mother is eating a balanced diet that is rich in micronutrients, it is especially important that all women of reproductive age ensure that they consume the Recommended Daily Intake (RDI) of 400 µg of the B vitamin folate. Adequate folate (folic acid) intake has been shown to reduce the risk of certain birth defects, such as spina bifida. It is likely that an obstetrician will also recommend that a pregnant woman take a prenatal supplement to cover her increased micronutrient needs during pregnancy, including iron, calcium, and other essential micronutrients. Certain fatty acids are also important, such as DHA (docosahexaenoic acid), which accumulates in the brain and eyes of the developing fetus, especially during the last trimester of pregnancy. Newborn Once the healthy baby is born, the best way to keep the baby healthy is by providing breast milk for the first four to six months. But, supplements for the baby are also recommended at this time. According to the American Academy of Pediatrics and Center for Disease Control, moms that breast feed should also give their babies a vitamin D supplement (400 IU daily) to assure adequate vitamin D status. 1 Although breast milk is best, if mom cannot or chooses not to breastfeed, then infant formulas are a safe and nutritionally adequate alternative for the growing infant. Regardless of whether the baby is fed with breast milk or infant formula, frequent small feedings will be the rule, and as the baby grows the amount consumed at each feeding will increase and the number of feedings per day will naturally decline. It is important to monitor a child s growth and development by getting regular medical checkups. 2

3 Transition to Solid Foods Usually around four to six months of age, certain developmental milestones related to the control of voluntary muscles in the head, neck and trunk indicate that the baby is ready for a transition to solid foods. The initiation of solid foods should begin with the use of iron-fortified infant cereal diluted at first to a thin consistency with breast milk or infant formula and gradually increasing the thickness of the cereal gruel as the baby s control of the food in its mouth develops. Introduction of finger foods are typically begun between six to eight months, after the baby has mastered cereals, strained fruits and vegetables. Attention needs to be paid to nutrients that support overall development, as well as cognitive function and development. The most important period of development of the central nervous system begins before birth and continues until a child is three years old. During this period thousands of neuron connections are formed; 70 percent of the brain develops during the fetal stage and the remaining 30 percent during the preschool period. The nutrients that scientific studies have shown that are most critical for overall brain development, as well as those specific to cognitive development, are shown in the table below. Specific Nutrients Key to Brain Development and Cognitive Function 2 Protein Iron Selenium Energy Zinc Vitamin A Certain Fatty Acids Copper Folate Iodine Choline Toddlers (age one to three years) Toddlers often develop a sharp decline in their appetite after their first birthday. You might notice that the baby is beginning to become a picky-eater or will turn their head away after a few bites of food. Don t be alarmed. The baby s growth rate has declined and he does not require as much food. Babies grow at a rapid pace three inches or so every three months. A toddler, in contrast, grows at a much slower rate only three to five inches in an entire year. 3 A one year-old only needs about 1000 kcal per day to meet their energy needs, but the food needs to be highly nutritious. A baby will eat when hungry and having high-nutrient dense foods available will lead to ultimate feeding success and a healthy child in the long run. At one year of age, whole full-fat milk can be introduced into the baby s diet. The baby will need the same basic food groups as the rest of the family; meat, fish, poultry, eggs, dairy products, fruits and vegetables, cereal, grains, potatoes, rice, breads and pasta. Don t neglect the oily fish, like salmon and mackerel, because they are important sources of long-chain omega 3 fatty acids, such as DHA and EPA (eicosapentaenoic acid), which are needed for proper brain, vision and cognitive development in young children. However, if there are concerns about getting sufficient amounts of DHA and EPA fatty acids in the child s diet during this period of time; consider using a growing up milk to supplement the baby s diet. Growing up milk is a milk-based formula that is designed for children at least one year of age and is fortified with micronutrients and important longchain fatty acids, as well as being an excellent source of protein. It is specifically made to meet the nutritional concerns of the one to three year old child. Remember that babies and young toddlers need more fat (about half their caloric intake) than older children and adults, so don t start worrying about fat intake yet and try to keep the fat calories appropriately high at least until age two. 3

4 Then begin to transition to a lower portion of calories coming from fat, for example by transitioning to a lower fat content in milk. Meeting Micronutrient Needs More information on any of the nutrients noted in this technical paper can be accessed through our nutrient monographs at According to a recent report 4 that examined dietary intake in US infants, toddlers and preschoolers in a cross-sectional survey of a national random sample of US children from birth to 47 months (FITS 2008 Study), 25% of toddlers and 40% of preschoolers took multivitamin/mineral supplements. However, 63% of toddlers (12 to 23 months old) and 37% of preschoolers (24 to 47 months old) still failed to meet the Estimated Average Requirement (EAR) for vitamin E of 5 mg per day. The EAR is the average requirement, meaning that only 50% of subjects will have their physiological nutrient requirement met at this level of dietary intake. Dietary fiber was another issue of concern for toddlers and preschoolers in the United States. The Adequate Intake recommendation is 19 g per day of dietary fiber, but the mean intake in toddlers and preschoolers was only nine and 10 g per day, respectively. On the other hand, 31% of toddlers and 59% of preschoolers exceed the recommended Upper Limit for preformed vitamin A. Zinc exceeded the Upper Limit of intake in 47% of toddlers and 72% of preschoolers. In a similar cross-sectional study, Manios and colleagues 5 assessed the nutrient intake of Greek children using a representative sample of toddlers and preschoolers. This European study found that 22% of toddlers and preschoolers had vitamin E intakes less than the Estimated Average Requirement. Additionally, the percentage of children with intakes less than the EAR were 6% for riboflavin, 15% for niacin, and 20% for folate. Intakes exceeding the Upper Limit were found for zinc, where 52% of subjects exceeded the Upper Limit recommendation and copper, where 8% of the subjects exceeded the Upper Limit recommendation. Dietary nutrient availability for toddlers and preschoolers can vary widely in different countries and between different geographic areas and socioeconomic strata. Calloway and colleagues 6 investigated the vitamin intakes of toddlers (18 to 30 months old) by food consumption records recorded multiple times over a one year period at village sites in Egypt, Kenya, and Mexico. They found among Egyptian toddlers that 32% had inadequate intakes of vitamin A and 20% had inadequate riboflavin intakes. In Mexico, 68% of toddlers had inadequate intakes of vitamin A, 63% inadequate intakes of vitamin C, and 52% inadequate intakes of riboflavin. In Kenya, 44% of toddlers had inadequate intakes of vitamin B12. In all three localities, vitamin E intakes were low. This research group 7 also assessed the adequacy of mineral intakes in toddlers and found that iron intakes were inadequate in Egypt (35%), Kenya (13%), and Mexico (43%). Inadequate zinc intakes were found in 57% of Kenyan toddlers, 25% of Mexicans, and 10% of Egyptians. Inadequate calcium intake was highly prevalent in Kenyan and Egyptian toddlers. Preschoolers (age four to five years) Preschool is a good time to finish the transition of a child s diet from the high fat phase (50% of calories) during the first two years of life to a more adult-like fat intake (25-35% of calories). Most of the fats consumed should be good fat ; i.e., rich in mono- and polyunsaturated fatty acids. Fat is also important in the diet because it provides the fatsoluble vitamins A, D, E and K and facilitates the absorption of carotenoids. Serving lower-fat meals will help control body weight and reduce the risk of heart disease and other chronic diseases later in life. As with earlier in life, gender is not an important factor in determining nutritional needs at this stage of life, which is mainly affected by growth rates. 4

5 Snacking is an important opportunity to provide good nutrition to your preschooler. Don t waste the opportunity by serving sugary drinks, cookies or confections that are low in micronutrients. Better alternatives would be foods such as fresh fruit or vegetables, air-popped corn, fat-free yogurt, or low-fat, fortified products with high nutrient value. Visit our tech library at to read our other tech paper on children s nutrition entitled Growing Opportunities in Kids Health. The transition from sole source breastfeeding or formula feeding, which meets an infant s nutritional needs to the I ll eat what I want, when I want to! attitude of many preschoolers can be a difficult and anxiety-provoking transition for many parents who are concerned with providing optimal nutrition for their child. The question of whether preschoolers need to be taking a multivitamin and mineral supplement to ward off micronutrient deficiencies frequently comes up. According to the American Academy of Pediatrics, even though many children are not perfect, vegetable-loving, cooperative eaters, they conclude that most children don t need vitamin supplements. 8 Nevertheless, vitamin and mineral supplementation is widely used for children in some countries, such as the United States where 40% of preschoolers take supplements. If a parent feels that their child has an unbalanced diet due to poor eating habits or distinct food likes and dislikes, it is reassuring to know that in addition to vitamin supplements, various fortified foods are available in many markets that are acceptable to young children and could be used to fill in any dietary nutrient gaps and provide nutritional insurance at a reasonable cost. Fortified products come in a variety of options that can be used depending upon the child s age and circumstance, including specialized infant formulas and growing up milk for the younger child and various beverage choices and solid food alternatives for the toddler and preschooler. Product Applications (not limited to only these) Formula Milk/Growing Up Milk Juice Water Snacks Cereals Prototypes: Prenatal Enhanced Beverage Nutrient %DV/Per Serving Folic Acid 100% Vitamin B1 10% Vitamin B2 10% Vitamin B6 10% Calcium 10% Iron 10% 5

6 Toddler Cereal - Physical and Cognitive Development Nutrient %DV/Per Serving Vitamin A 10% Niacin 10% Vitamin B1 10% Vitamin B2 10% Vitamin B6 10% Calcium 10% Selenium 10% Zinc 10% Choline 55 mg DHA 32 mg EPA 50 mg Visit today to start a dialogue with our technical experts about your formulation challenges. Cookie/Biscuit - Overall Wellness Nutrient Vitamin A 10% Vitamin E 10% Vitamin B1 10% Vitamin B12 10% Vitamin C 10% Calcium 10% Iron 10% Phosphorus 3.5% Zinc 10% Protein 2% %DV/Per Serving A Special Mention Regarding Bone Health When most of us think about bone health, we think of the elderly as the group impacted most by issues surrounding osteoporosis. However, parents should view bone health as a type of bank account for their children s later lives. Bone is a living tissue that is constantly being lost and replaced by new bone. According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, up to 90 percent of peak bone mass is acquired by age 18 in girls and age 20 in boys, which makes youth the best time for your kids to invest in their bone health. Getting plenty of calcium and vitamin D can help ensure optimal peak bone mass. Challenges in Product Formulation, Stability and Production We cannot place enough emphasis on the fact that the key to wide consumer acceptance of any fortified food or beverage product, especially those targeting children, is taste. Regardless of the nutritional value it may provide, if it does not immediately taste good, then the product is destined for failure right from the start. The challenges associated with formulations that incorporate multiple nutrients include the type of finished product as well as the desired taste, flavor and color of the finished product, solubility, bioavailability, ph levels, safety/toxicity, shelf-life, interactions, texture, mouth-feel, etc. For example, we know that the long-chain fish oils like EPA (eicosapentaenoic acid) are beneficial ingredients in products aimed at children. However, fish oils can be technically difficult to incorporate at functional levels because they can impart an unpleasant fishy taste to a product and reduce shelf-life by increasing the chances of developing rancidity. 6

7 It is also good to remember that some nutrients don t mix well with others. For example, it is well known that certain iron compounds can have unfavorable effects on product quality and consumer acceptance by increasing the oxidation of polyunsaturated fatty acids or other food ingredients. On the other hand, inclusion of suitable amounts of antioxidants, like a vitamin E, is important to protect polyunsaturated fatty acids from oxidation. In liquid beverages, adverse interactions between calcium and phosphorus can be tricky and can result in unsightly mineral precipitation products under certain conditions. These and other technical challenges in product development can be overcome by partnering with premix experts during product development who can help you with the judicious selection of ingredient sources and strategies for employing appropriate taste masking techniques when needed. To keep up-to-date and to find out more about conditions, nutrients and product applications for children s products and many more types of fortified products log on to Literature Cited: Georgieff MK. (2007 Feb). Nutrition and the developing brain: nutrient priorities and measurement. American Journal of Clinical Nutrition; 85(2):614S-620S Butte NF, Fox MK, Briefel RR et al. (2010). Nutrient intakes of US infants, toddlers, and preschoolers meet or exceed dietary reference intakes. Journal of the American Dietetic Association; 110:S27-S Manios Y, Grammatikaki E, Papoutsou S et al. (2008). Nutrient intakes of toddlers and preschoolers in Greece: The GENESIS Study. Journal of the American Dietetic Association; 108: Calloway DH, Murphy SP, Beaton GH, Lein D. (1993). Estimated vitamin intakes of toddlers; predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. American Journal of Clinical Nutrition; 58: Murphy SP, Beaton GH, Calloway DH. (1992). Estimated mineral intakes of toddlers; predicted prevalence of inadequacy in village populations in Egypt, Kenya, and Mexico. American Journal of Clinical Nutrition; 56: Fortitech, Inc. All Rights Reserved. 7