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November 24, 2021

Nutrient Deficiency in Early Life: Addressing a Global Concern

Discover expert insights on the latest scientific research regarding nutritional deficiencies in infants and young children, and how to address nutrient gaps in early life.

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Nutrition Plays a Critical Role in the Development of Infants and Young Children
  • Infancy and early childhood are periods of rapid growth and development. During this critical window of development, nutrition sets the stage for lifelong health.1,2
  • Nutritional deficiency during infancy and childhood is a common problem worldwide. In 2020, 149 million children under the age of five were considered too short for their age, and 45 million were underweight in relation to their height, both strong indicators of malnutrition.3
  • In a recent virtual event hosted by the International Special Dietary Foods Industries, Dr. Peter Van Dael, dsm-firmenich’s Senior Vice President of Nutrition Science and Advocacy, explores the latest scientific research on nutritional deficiencies in infants and young children. He also describes the main components of addressing nutrient deficiencies, including the need for strong regulatory standards.
Nutrient Deficiencies are of Particular Concern in Early Life

The first 1,000 days of life are a critical and vulnerable period of human development. During this time, proper nutrition is required to set the stage for long-term health.4 Micronutrients, which refer to trace elements and vitamins, play critical structural and functional roles throughout the body. Because early childhood is a period of intense physical and mental development, micronutrient deficiencies early in life can significantly impair a child’s long-term potential.5 Poor nutrition during early development not only increases a child’s risk of illness, but has also been reported to increase the risk and susceptibility to developing significant medical conditions such as rickets, anemia, coronary heart disease, type 2 diabetes, cancer, and osteoporosis.1,3,5,6

According to Dr. Van Dael, in addition to visible health conditions, nutrient deficiencies early in life also place infants and children at risk for a range of developmental inadequacies and other subclinical health issues that are not easily seen. Specifically, micronutrient deficiencies can impair physical development, reduce cognitive function and diminish immunity.5 Other manifestations of nutrient deficiency in infants and young children include faltering growth or weight loss, low energy levels, and changes in mood and behavior.7 These scenarios can also result in poorer educational and cognitive outcomes.1,8

Global Evidence of Nutrient Deficiency During Early Life

Nutritional deficiencies during infancy and early childhood are a worldwide concern. Globally, 45% of deaths among children under the age of five are linked to undernutrition.3 Further, almost one third of the global population is affected by one or more micronutrient deficiencies.5

Studies have investigated the extent and significance of nutritional deficiencies in children across the globe. One study assessed the nutritional status of Thai children aged 6 months to 12 years and found more than 50% had low intakes of calcium, iron, zinc, vitamin A, and vitamin C.9 Another study evaluated the dietary risk of young children aged 12 to 36 months in Ireland, and found that many were deficient in key nutrients such as iron, zinc, vitamin D, riboflavin, niacin, folate, phosphorous, potassium, carotene, retinol, and dietary fiber.10 A recent US-based study examined the food and beverage intake of children one to six years of age and discovered insufficient intakes of iron, vitamin B6, calcium, fiber, choline, potassium, and docosahexaenoic acid (DHA).2

Dr. Van Dael explains that although specific nutrient deficiencies may vary from country to country, nutrient deficiencies in young children are a cause for concern in most regions around the world. Iron, vitamin A, and zinc deficiencies are among the most common globally, especially in young children.8,11,12 The significance of these specific deficiencies is highlighted below.

Iron deficiency

The body requires iron - a mineral - for growth and development, as well as for the synthesis of red blood cells that carry oxygen through the body. Iron status is critical in early development given its roles in energy metabolism and the developing nervous system.13 Adequate iron in early childhood is critical to organ development and function, especially for the brain and the immune system.14

Consequences of iron deficiency are particularly serious in childhood, driven by demands of growth and development. Infants who experience iron deficiency early in life are at high risk for developmental delays and cognitive deficits; these can persist throughout adulthood.15,16 Cognitive impairments associated with iron deficiency have been shown to hinder a child’s behavior, educational success and ultimately, economic potential.17  A common cause of iron deficiency in children is insufficient iron in the diet, combined with gastrointestinal losses due to excessive cow’s milk consumption.18

Iron deficiency also contributes to the global burden of anemia.11 Despite worldwide efforts to reduce iron deficiency anemia, the prevalence of anemia remains high in many regions.19 A 2008 report by the World Health Organization (WHO) revealed that approximately 47% of pre-school aged children were at risk for iron deficiency anemia.11

These findings have unique relevance, given iron’s role in supporting our immune system. A 2020 study by Stoffel et al. showed that iron deficiency in infants resulted in a reduced response to the diphtheria, pertussis, and pneumococcal vaccines.20 Infants with iron deficiency anemia saw an improved response to the measles vaccine when iron was supplemented at the time of vaccination.20

Vitamin A deficiency

Vitamin A is a fat-soluble vitamin with roles in vision, red blood cell production and immune function.  It is also needed for the normal formation and maintenance of the heart, lungs, kidneys, and other organs.21 Vitamin A is a nutrient essential for the body’s immune system and vision.22,23 Prolonged periods of inadequate vitamin A intake during early childhood can lead to night blindness, anemia, and reduced resistance to infection.23

Infants and young children are at the greatest risk for health consequences associated with vitamin A deficiency.23 According to a 2009 WHO global report, one third of all preschool-aged children were vitamin A deficient between 1995 and 2005.23

Zinc deficiency

Zinc plays important roles in growth, wound healing and immunity. These roles include carbohydrate and fat metabolism, immune support, the ability to taste, and cognition.24 Growth retardation is known to occur in infants and children with severe zinc deficiency.25   Zinc deficiency can lead to alopecia, dysgeusia (reduced sense of taste), reduced immune competence and impaired wound healing.25

Supplementation of infants and children has been found to be effective in promoting growth.  An analysis of multiple clinical trials showed that zinc supplementation improved both weight gain and linear growth in children, particularly in children over the age of two years.26

Establishing Dietary Recommendations to Help Manage Nutrient Deficiencies

Dr. Van Dael outlines some of the main components involved in addressing nutrient deficiencies. These include 1) identifying key nutrients and the feasibility of supplementation, 2) examining nutrient quality and bioavailability, 3) seeking expert guidance and employing the guidance of nutritional science organizations, such as the European Food Safety Authority (EFSA) and the Early Nutrition Academy (ENA), and finally, 4) leveraging regulatory standards.

As Dr. Van Dael explains, scientific data are used to establish nutrient requirements, which are the nutrient intakes needed for the body to function properly. National authorities and institutes such as the Institute of Medicine (IOM), the EFSA, and the WHO then use these nutrient requirements to establish dietary recommendations for the general population, with nutrient values stratified by age group.

Regulatory standards also play a central role in helping to manage nutrient deficiencies, as they provide industry-wide criteria for providing high-quality and safe products for consumers. As Dr. Van Dael states, these guidelines inform safe nutrient levels and product labeling to help educate the consumer.

The Codex Alimentarius is one example of an international expert authority established by FAO and WHO aimed to develop and approve international regulations that help support global nutrition and health efforts. Dr. Van Dael explains, “Codex Alimentarius offers a forum to collaborate among key stakeholders and develop safe and suitable nutritional standards that can help to serve the nutritional goals that health authorities have defined to improve health and nutrition during childhood.”

Expert Guidance Helps Establish the Role of Young Child Formulas in Addressing Nutrient Deficiencies

One such example of the impactful role that expert guidance and regulatory standards can play in helping to improve nutrient intakes relates to young child formulas (YCF), also regularly referred to as growing up milks (GUMs)

According to a 2013 EFSA report, dietary intakes of alpha linoleic acid (ALA), DHA, iron, vitamin D, and iodine were low in infants and children living in Europe.27 Similarly, a study conducted in France found that the consumption of cow’s milk in children aged one to two years resulted in insufficiencies in ALA, iron, vitamin C, and vitamin D.28 In this study, the use of specifically formulated milk formulas targeting  children from 1 to 3 years of age (YCF) was seen to significantly reduce the risk of these insufficiencies.

Additionally, a UK-based study found that young child formula consumption and supplementation was a more efficient way to meet established nutrient requirements, compared to implementing changes to the quantity or variety of food intake.29

As a result of studies such as these, various expert panels have provided guidance for the composition of YCFs, merging evidence from clinical trials with scientific expertise to bring useful guidance to regulators and manufacturers who design products to address nutrient concerns.30-32

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References

  1. World Health Organization. The importance of infant and young child feeding and recommended practices. In: Infant and Young Child Feeding: Model Chapter for Textbooks for Medical Students and Allied Health Professionals. World Health Organization; 2009:Session 1. Accessed August 16, 2021. https://www.ncbi.nlm.nih.gov/books/NBK148967/
  2. Bailey ADL, Fulgoni III VL, Shah N, et al. Nutrient Intake Adequacy from Food and Beverage Intake of US Children Aged 1–6 Years from NHANES 2001–2016. Nutrients. 2021;13(3):827. doi:10.3390/nu13030827
  3. World Health Organization. Malnutrition. World Health Organization. June 9, 2021. Accessed August 16, 2021. https://www.who.int/news-room/fact-sheets/detail/malnutrition
  4. Martorell R. Improved Nutrition in the First 1000 Days and Adult Human Capital and Health. Am J Hum Biol. 2017;29(2):10.1002/ajhb.22952. doi:10.1002/ajhb.22952
  5. Ahmed T, Hossain M, Sanin KI. Global burden of maternal and child undernutrition and micronutrient deficiencies. Ann Nutr Metab. 2012;61 Suppl 1:8-17.
  6. Haimi M, Lerner A. Nutritional deficiencies in the pediatric age group in a multicultural developed country, Israel. World J Clin Cases. 2014;2(5):120-125. doi:10.12998/wjcc.v2.i5.120
  7. National Health Service. Malnutrition – Symptoms. National Health Service. October 23, 2017. Updated February 7, 2020. Accessed August 29, 2021. https://www.nhs.uk/conditions/malnutrition/symptoms/
  8. World Health Organization Western Pacific Region. Micronutrients. World Health Organization Western Pacific Region. Accessed August 16, 2021. https://www.who.int/westernpacific/health-topics/micronutrients
  9. Rojroongwasinkul N, Kijboonchoo K, Wimonpeerapattana W, et al. SEANUTS: the nutritional status and dietary intakes of 0.5-12-year-old Thai children. Br J Nutr. 2013;110 Suppl 3:S36-44. doi:10.1017/S0007114513002110
  10. Rice N, Gibbons H, McNulty BA, et al. Development and validation testing of a short nutrition questionnaire to identify dietary risk factors in preschoolers aged 12-36 months. Food Nutr Res. 2015;59:27912. doi:10.3402/fnr.v59.27912
  11. World Health Organization. Worldwide Prevalence of Anaemia 1993-2005: WHO Global Database on Anaemia. World Health Organization; 2008. Accessed August 16, 2021. 
  12. Black RE, Fischer, Walker C. Role of zinc in child health and survival. Nestle Nutr Inst Workshop Ser. 2012;70:37-42.
  13. Bastian TW, von Hohenberg WC, Mickelson DJ, Lanier LM, Georgieff MK. Iron Deficiency Impairs Developing Hippocampal Neuron Gene Expression, Energy Metabolism, and Dendrite Complexity. Dev Neurosci. 2016;38(4):264-276.
  14. Gombart AF, Pierre A, Maggini S. A Review of Micronutrients and the Immune System-Working in Harmony to Reduce the Risk of Infection. Nutrients. 2020;12(1).
  15. Beard JL. Why Iron Deficiency Is Important in Infant Development. J Nutr. 2008;138(12):2534-2536.
  16. Carter RC, Jacobson JL, Burden MJ, et al. Iron deficiency anemia and cognitive function in infancy. Pediatrics. 2010;126(2):e427-434. doi:10.1542/peds.2009-2097
  17. Pivina L, Semenova Y, Doşa MD, Dauletyarova M, Bjørklund G. Iron Deficiency, Cognitive Functions, and Neurobehavioral Disorders in Children. J Mol Neurosci. 2019;68(1):1-10.
  18. Özdemir N. Iron deficiency anemia from diagnosis to treatment in children. Turk Pediatri Ars. 2015;50(1):11-19. doi:10.5152/tpa.2015.2337
  19. Gardner W, Kassebaum N. Global, Regional, and National Prevalence of Anemia and Its Causes in 204 Countries and Territories, 1990–2019. Curr Dev Nutr. 2020;4(Suppl 2):830. doi:10.1093/cdn/nzaa053_035
  20. Stoffel NU, Uyoga MA, Mutuku FM, et al. Iron Deficiency Anemia at Time of Vaccination Predicts Decreased Vaccine Response and Iron Supplementation at Time of Vaccination Increases Humoral Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants. Front Immunol. 2020;11:1313. doi:10.3389/fimmu.2020.01313
  21. National Institutes of Health – Office of Dietary Supplements. Vitamin A Fact Sheet for Health Professionals. National Institutes of Health; 2021. Accessed September 18, 2021. https://ods.od.nih.gov/factsheets/VitaminA-HealthProfessional/
  22. UNICEF Data. Coverage at a Crossroads: New directions for Vitamin A supplementation programmes. UNICEF. May 1, 2018. Accessed August 16, 2021. https://data.unicef.org/resources/vitamin-a-coverage/
  23. World Health Organization. Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995-2005: WHO Global Database on Vitamin A Deficiency. World Health Organization; 2009. Accessed August 16, 2021. 
  24. National Research Council. Zinc. Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. Washington, DC: The National Academies Press; 2001. pp. 442–501.
  25. Willoughby JL, Bowen CN. Zinc deficiency and toxicity in pediatric practice. Curr Opin Pediatr. 2014;26(5):579-584.
  26. Liu E, Pimpin L, Shulkin M, Kranz S, Duggan C. Mozaffarian D and Fawzi W. Effect of Zinc Supplementation on Growth Outcomes in Children under 5 Years of Age. Nutrients. 2018;10:377; doi:10.3390/nu10030377
  27. European Food Safety Authority. Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. European Food Safety Authority. October 25, 2013. Accessed August 16, 2021. https://www.efsa.europa.eu/en/efsajournal/pub/3408
  28. Ghisolfi J, Fantino M, Turck D, de Courcy GP, Vidailhet M. Nutrient intakes of children aged 1-2 years as a function of milk consumption, cows’ milk or growing-up milk. Public Health Nutr. 2013;16(3):524-534. doi:10.1017/S1368980012002893
  29. Vieux F, Brouzes CMC, Maillot M, et al. Role of Young Child Formulae and Supplements to Ensure Nutritional Adequacy in U.K. Young Children. Nutrients. 2016;8(9):539. doi:10.3390/nu8090539
  30. Suthutvoravut U, Abiodun PO, Chomtho S, et al. Composition of Follow-Up Formula for Young Children Aged 12-36 Months: Recommendations of an International Expert Group Coordinated by the Nutrition Association of Thailand and the Early Nutrition Academy. Ann Nutr Metab. 2015;67(2):119-132.
  31. Han J, Kang L, Liang D, et al. Composition requirements of follow-up formula for 6-12 month-old infants: recommendations of a Chinese expert group. Asia Pac J Clin Nutr. 2019;28(2):347-355.
  32. Lippman HE, Desjeux JF, Ding ZY, et al. Nutrient Recommendations for Growing-up Milk: A Report of an Expert Panel. Crit Rev Food Sci Nutr. 2016;56(1):141-145.
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