Special nutritious solutions to enhance complementary feeding.

This special issue of Maternal & Child Nutrition brings together cutting edge research that addresses specific aspects of the composition, distribution and impact of special nutritious solutions to improve nutrient intake of young children, especially during the complementary feeding period. Most articles focus on nutritious commodities that were provided from 6to 23or 6to 59-month-old children: lipid-based nutrient supplements (LNS, mainly small quantity, i.e. 20g/day) (Abbeddou et al. 2015; Arimond et al. 2015; Flax et al. 2015; Ickes et al. 2015; Lesorogol et al. 2015; Mangani et al. 2015; Segrè et al. 2015; Thakwalakwa et al. 2015), micronutrient powder (MNP; Barth-Jaeggi et al. 2015; Jefferds & FloresAyala 2015; Jefferds et al. 2015; Osei et al. 2015) fortified complementary food (Bauserman et al. 2015; Chavasit et al. 2015; Mangani et al. 2015; Thakwalakwa et al. 2015 – the latter two studies compared it to LNS) and ready-to-use therapeutic food (RUTF) (Irena et al. 2015). The remaining papers assessed impact of fortified wheat flour among school-age children (Rahman et al. 2015), discussed issues around the inclusion of folic acid in MNP for home fortification where malaria is endemic (Kupka 2015) and interpreted data on indicators of iron status in the presence of infection (Nel et al. 2015). Complementary feeding refers to foods that are consumed in addition to breastfeeding, which should be practiced between 6 and 23months of age, after exclusive breastfeeding for the first 6months of life, and could still be continued after 24months. During this period of life, nutrient needs are very high, due to rapid growth and development, and they may be further increased in case of frequent illness, such as diarrhoea and others. Exclusive breastfeeding is recommended for the first 6months of life. Thereafter, breast milk in combination with nutrient stores that were present at birth (e.g. iron) cannot adequately meet the nutrient requirements of the child anymore. Meeting the additional nutrient needs from the complementary feeding diet is challenging, because the child’s food intake is small compared with his or her nutrient needs. For example, the 6to 11-month-old infant requires nine times as much iron from 100kcal of food, compared with an adult male, because the adult consumes many more kcals. This challenge has likely been a characteristic of the human infant’s diet since the agricultural revolution approximately 10000years ago when diets became more cereal-based (Dewey 2013). When the complementary feeding diet largely consists of watery plant source-based gruels and porridges, it will be deficient in several nutrients and the child’s needs will not be met. The guiding principles for complementary feeding of the breastfed child (PAHO and WHO 2001) as well as results of linear programming analyses (Briend et al. 2001; Baldi et al. 2013; Skau et al. 2013) confirm the following: (i) the complementary feeding diet has to include several servings of different types of animal source and/or fortified foods per week in addition to plant-source foods; and (ii) that obtaining such a diet is beyond the financial means of many households in low and middle income countries. Furthermore, there are practical constraints to meeting dietary diversity requirements, including distance to and frequency of market days, inability to keep fresh foods cool (food safety requirement) and availability of time to prepare and feed frequent, balanced meals to young children. Therefore, in addition to improving infant and young child feeding practices, including breastfeeding, choice of foods, frequency of meals, hygienic preparation and feeding practices, to the fullest extent possible, the nutrient content of complementary foods often needs further improvement, especially for nutrients