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PEDIATRICS Vol. 106 No. 5 Supplement November 2000, pp. 1295-1297

Iron and Zinc Intake From Complementary Foods: Some Issues From Pakistan

Zulfiqar Ahmed Bhutta, MB, PhD

Husein Lalji Dewraj Professor of Pediatrics The Aga Khan University, Karachi Karachi, Pakistan

    ARTICLE
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Background

The recent WHO/UNICEF review of complementary feeding in developing countries recognized that iron and zinc requirements may be difficult to meet from nonfortified complementary foods.1 This may be compounded by iron and zinc deficiency in mothers,2 predisposing to deficiency in young and especially low birth weight infants.3 Diarrheal illnesses and helminthiasis may increase micronutrient requirements. Figure 1 shows plasma levels for retinol-binding protein and zinc among young infants presenting with diarrhea in Karachi, Pakistan, indicating that plasma zinc concentration was significantly lower among those who were considered "small" at birth.


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  		Fig. 1.   Plasma levels for retinol-binding protein and zinc among young infants presenting with diarrhea in Karachi, Pakistan.

Although low rates of exclusive breastfeeding are a major predisposing factor to high infant morbidity rates, delayed introduction of suitable complementary foods, sometimes to beyond 12 months of age, is another contributory factor to malnutrition.3 Table 1 summarizes complementary feeding practices in Pakistan; complementary foods were often introduced late and in too small amounts.4-23 The majority of culturally acceptable and affordable complementary foods are plant- and cereal-based with relatively high phytate content which decreases iron and zinc bioavailability.24 Tables 2 and 3 indicate the iron, zinc, and phytate content of the complementary foods most commonly consumed by young infants in Pakistan, as well as the estimated daily intakes and absorption from these diets.25-29 The intakes were barely sufficient to meet requirements for growth, and replenishment of depleted body stores. Various dietary strategies are available eg, improved bioavailability of iron and zinc by fermentation and malting of cereal-based staples, adding vitamin C to increase iron uptake, fortification of complementary foods, and maternal/infant supplementation. These strategies require evaluation in large-scale effectiveness studies.

                              
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TABLE 1
Complementary Feeding in Pakistan: A Country Review of Available Information

                              
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TABLE 2
Iron and Zinc Content of Complementary Foods in Pakistani Infants (6-12 Months of Age)

                              
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TABLE 3
Average Daily Intake and Estimated Absorption of Iron and Zinc (mg/day) From Commonly Consumed Complementary Foods by Young Infants (6-12 Months Old) in Pakistan

Research Issues for Improving Iron and Zinc Intake From Complementary Foods

The following merit further effort:

  1. The effect of maternal iron and zinc supplementation in pregnancy on micronutrient needs of young infants.
  2. An evaluation of exclusive breastfeeding for 6 months on micronutrient, especially iron, status in diverse populations, particularly among those with high rates of maternal malnutrition and low birth weight.30
  3. Qualitative studies of diet preferences for feeding young infants in traditional populations.
  4. Effectiveness studies to assess impact of soaking, germination, or fermentation of foods on bioavailability of iron and zinc from home-available diets.
  5. Impact of improving intake of citrus fruits and fermented milk (yogurt) on iron and zinc status in infancy.
  6. Fortification of dietary staples with iron or zinc (eg, iron supplementation of wheat flour, low-phytate maize). Alternatively, production of genetically modified staples eg, rices with improved micronutrient content and bioavailability.
  7. Evaluation of multiple micronutrient supplements in developing countries in comparison with balanced food-based approaches such as with multimixes.

    REFERENCES
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Article
References
  1. WHO/UNICEF. Complementary Feeding of Young Children in Developing Countries: A Review of Current Scientific Knowledge. Geneva, Switzerland: WHO; 1998. WHO/NUT/98.1
  2. Ramakrishnan U, Mangrekar R, Revia J, Gonzales-Cossio T, Martorell R Micronutrients and pregnancy outcome: a review of the literature. Nutr Res. 1999; 19:103-159 [CrossRef]
  3. Kilbride J, Baker TG, Parapia LA, Khoury SA, Shuqaidef SW, Jerwood D Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy: a case-control study in Jordan. Int J Epidemiol. 1999; 28:461-468 [Abstract/Free Full Text]
  4. Rahimtoolah RJ, Qureshi AF. A Nutrition Survey in Mahmoodabad, Karachi (1976-1979). Final Report. Karachi, Pakistan: Pakistan Science Foundation; 1979
  5. Akram DS Weaning practices in Karachi. J Pakistan Med Assoc. 1978; 28:124-126
  6. Ahmad A. Collaborative Study on Infant Feeding and Weaning Practices in Some Countries of Eastern Mediterranean Regions of WHO (EMRO). World Health Organization/EMRO; 1982
  7. Mahmood S. Breastfeeding in Pakistan. Karachi, Pakistan: Report Planning & Development Division, Government of Pakistan; 1984
  8. Latif S. A Study of the Attitudes of Fifty Young Mothers Attending a Local Private Clinic Toward Breast Feeding and Weaning Practices and Its Effect on the Infant's Health. Karachi, Pakistan: University of Karachi; 1984. MSc Thesis
  9. Ilyas Z. A Study of Environmental Condition and Dietary Patterns of Children Under 2 Years of Age, Suffering From Gastrointestinal Disorders and the Type of Diet Suggested by the General Practitioners in Such Condition. Karachi, Pakistan: University of Karachi; 1986. MSc Thesis
  10. Khan M, Lambert J. Feeding Patterns and Nutritional Status of Karachi Infants: Report for UNICEF. Karachi, Pakistan: UNICEF; 1984
  11. Memon IYM. Study on Health and Nutrition in Rural Karachi: Report. Karachi, Pakistan: Pakistan Council for Scientific and Industrial Research; 1986
  12. Nagra SA, Gilani AH Variations in infant feeding practices in Pakistan with socioeconomic stratification. J Trop Paediatr. 1987; 33:103-106 [Abstract/Free Full Text]
  13. UNICEF. Complementary Foods: Practices and Perceptions in Rural Baluchistan, Vol I. Quetta, Pakistan: UNICEF; 1988
  14. Nutrition Division, National Institute of Health, Government of Pakistan. National Nutrition Survey. Karachi, Pakistan: Nutrition Division, National Institute of Health, Government of Pakistan; 1985-1987
  15. Pakistan Demographic and Health Survey. MD: National Institute of Population Studies, IRD/Macro International Inc; Islamabad, 1992
  16. Malik IA, Azim S, Good MJ, Feeding practices for young Pakistani children: usual diet and diet during diarrhoea. J Diarrhoeal Dis Res. 1991; 9:213-218 [Medline]
  17. Ashraf RN, Jalil F, Khan SR Early child health in Lahore, Pakistan: V. feeding patterns. Acta Paediatr Suppl. 1993; 390:47-61
  18. UNICEF. Situation Analysis of Children and Women in Sindh. Sindh, Karachi: UNICEF; 1993
  19. Ali FM. To Compare the Weaning Practices of Educated and Uneducated Mothers. Karachi, Pakistan: University of Karachi; 1994. MSc Thesis
  20. Paracha PI, Khan AH. Growth Monitoring and Nutritional Status of Infants and Toddlers in North West Frontier Province, Pakistan: Report. Karachi, Pakistan: Pakistan Science Foundation; 1994
  21. Ministry of Health, Government of Pakistan, UNICEF and Gallup Pakistan, Government of Pakistan. Multiple Indicators Cluster Survey of Pakistan. Ministry of Health, Government of Pakistan, UNICEF and Gallup Pakistan, Government of Pakistan; 1995
  22. CIET International and Bureau of Statistics Government of Sindh and UNICEF. The Bond of Care: Technical Report Sindh Province. CIET International and Bureau of Statistics Government of Sindh and UNICEF; 1998
  23. The Asia Foundation. Taking Charge---What Families in Pakistan Can Do to Improve the Health of Mothers and Young Children: Report. The Asia Foundation; 1998
  24. Gibson RS, Donovan VM, Health ALM Dietary strategies to improve the iron and zinc nutriture of young women following a vegetarian diet. Plant Foods Human Nutr. 1997; 51:1-16 [CrossRef][Medline]
  25. Nutrition Cell, Planning & Development Division, Islamabad. Khan MA, Hussain T. Supplementary Weaning Food Mixes. Nutrition Cell, Planning & Development Division, Islamabad, 1981
  26. Gopalan C, Rama Sastri BV, Balasubramanian SC. Nutritive Value of India Foods. NIN, India Council of Medical Research, Hyderabad, India, 1996
  27. Pakistan Council for Scientific and Industrial Research. Food Composition Tables for Pakistani Foods. Peshawar, Pakistan: University of Agriculture; 1988
  28. World Health Organization. Zinc absorption and bioavailability. Trace Elements in Human Nutrition & Health. Geneva, Switzerland: World Health Organization; 1996:87-92
  29. Yip R, Dallman PR. Iron. In: Ziegler EE, Filer LJ, eds. Present Knowledge in Nutrition. Washington, DC: ILSI; 1996:277-289
  30. Dewey KG, Cohen RJ, Rivera LL, Brown KH Effects of age of introduction of complementary foods on iron status of breastfed infants in Honduras. Am J Clin Nutr. 1998; 67:878-884 [Abstract]
Pediatrics (ISSN 0031 4005). Copyright ©2000 by the American Academy of Pediatrics



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