Large numbers of infants and young children suffer from the short- and long-term health effects of poor breastfeeding and complementary feeding practices. Strategies to improve the availability of and access to low-cost fortified complementary foods can play an important corresponding role to that of behavior change in improving nutritional status of young children. However, the nutritional quality of complementary foods used in publicly funded programs is not always optimal, and such programs are costly and reach only a tiny fraction of those who could benefit. To broadly reach the target population, such foods need to be commercially available at affordable prices and promoted in a way that generates demand for their purchase. A sensible long-term policy for the promotion of low-cost fortified complementary foods calls for attention to their nutritional formulations and cost, the economics of production, and the legislative, regulatory, and competitive framework in which marketing occurs. This paper provides information on how to improve the nutritional formulations of fortified complementary foods and outlines the necessary conditions for a market approach to their production and promotion.
World Health Organization.The WHO/UNICEF Joint Meeting on Infant and Young Child Feeding.Geneva: WHO, 1979.
2.
World Health Organization.The international code of marketing of breast-milk substitutes.Geneva: WHO, 1981.
3.
World Health Organization.Complementary feeding of young children in developing countries: a review of current scientific knowledge. WHO/NUT/98.1.Geneva: WHO, 1998.
4.
DeweyK.G., BrownK.H.Nutrient composition of fortified complementary foods: Should age-specific micronutrient content and ration sizes be recommended?J Nutr 2002 (suppl), 2003.
5.
WHO/UNICEF.Global strategy for infant and young child feeding 2002. Document A55/15.Geneva: World Health Organization, 2002.
6.
LutterC.K.Processed complementary foods: summary of nutritional characteristics, methods of production and distribution, and costs. Food Nutr Bull2000; 21: 95–100.
7.
HortonS.Cost analysis of feeding and food subsidy programmes. Food Pol1993(June): 192–9.
8.
MusgroveP.Feeding Latin America's children. World Bank Research Observer1993; 8: 23–45.
9.
López de RomañaG.Experience with complementary feeding in the FONCODES project. Food Nutr Bull2000; 21: 43–8.
10.
HertramphE., OlivaresM., PizarroF., WalterT.Iron fortification in the Americas. Nutr Rev; 60(7 Part II): S22–5.
11.
DeweyK.G.Approaches for improving complementary feeding of infants and young children.Geneva: World Health Organization, 2000.
12.
RuelM.T.Urbanisation in Latin America: constraints and opportunities for child feeding and care. Food Nutr Bull2000; 21: 12–24.
13.
MaxwellD., LevinC., Armar-KlemesuM., RuelM., MorrisS., AhiadekeC.Urban livelihoods, food and nutrition security in greater Accra. IFPRI Research Report No. 112.Washington, DC: International Food Policy Research Institute, April2000.
14.
TartanacF.Incaparina and other Incaparina-based foods: experience of INCAP in Central America. Food Nutr Bull2000; 21: 49–54.
15.
BarenbaumM., PachónH., SchroederD.G., HurtadoE.Use, acceptability, and cost of Incaparina, a commercially processed food, in Guatemala. Food Nutr Bull2001; 22: 71–80.
16.
MoraJ.The need for a market-oriented approach. Food Nutr Bull2000; 21: 83–5.
17.
ZaferI.Social marketing of processed foods. Food Nutr Bull2000; 21: 91–4.
18.
DijkhuizenP.Processed complementary foods in the World Food Programme. Food Nutr Bull2000; 21: 62–4.
19.
TaylorA.Violations of the international code of marketing of breast-milk substitutes: prevalence in four countries. BMJ1998; 316: 1117–22.
20.
Association for Rational Use of Medication in Pakistan.Feeding fiasco: pushing commercial foods in Pakistan.Islamabad: Network Publications Services, 1998.
21.
IBFAN.Breaking the rules: stretching the rules.Penang, Malaysia: International Baby Food Action Network, 2001.
22.
ButteN.F., WongW.W., HopkinsonJ.M., HeinzC.J., MehtaN.R., SmithE.O.B.Energy requirements derived from total energy expenditure and energy deposition during the first 2 years of life. Am J Clin Nutr2000; 72: 1558–69.
23.
DaryO.Staple food fortification with iron: a multifactorial decision. Nutr Rev2002: 60(7 Part II): S30–3.
24.
RiveraJ., RodríguezG., ShamahT., RosadoJ.L., CasanuevaE., MaulénI., ToussaintG., García-ArandaA.Implementation, monitoring, and evaluation of the nutrition component of the Mexican Social Programme (PRO-GRESA). Food Nutr Bull2000; 21: 35–42.
25.
Institute of Medicine, Food and Nutrition Board.Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D and fluoride.Washington, DC: National Academy Press, 1997.
26.
Institute of Medicine.Dietary reference intakes for thiamine, riboflavin, niacin, vitamin B6, folate, vitamin B12, pantothenic acid, biotin, and choline.Washington, DC: National Academy Press, 1998.
27.
Institute of Medicine.Dietary reference intakes for vitamin C, vitamin E, selenium, and carotenoids.Washington, DC: National Academy Press, 2000.
28.
Institute of Medicine.Dietary reference intakes: applications in dietary assessment.Washington, DC: National Academy Press, 2000.
29.
United Kingdom Department of Health.Report on health and social subjects. Dietary reference values for food and energy and nutrients for the United Kingdom.London: Her Majesty's Stationery Office, 1991.
30.
FAO/WHO/UNU.Energy and protein requirements. WHO Technical Report Series No. 724.Geneva: World Health Organization, 1985.
31.
DeweyK.G., BrownK.H.Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs. Food Nutr Bull2002; 24: 5–28.
32.
World Health Organization.Iron deficiency anaemia: assessment, prevention, and control. (WHO/NID/01.3).Geneva: WHO, 2001.
33.
DeweyK.G.Nutrition, growth, and complementary feeding of the breastfed infant. Pediatr Clin North Am2001; 48: 87–104.
34.
HurrellR.Influence of vegetable protein sources on trace element and mineral bioavailability. J Nutr2002 (suppl), 2003.
35.
LynchS.Iron and ascorbic acid: proposed fortification levels and recommended iron compound. J Nutr2002 (suppl), 2003.
36.
RosadoJ.L.Zinc and copper: proposed fortification levels and recommended zinc compounds. J Nutr2002 (suppl), 2003.
37.
AbramsS.A., AtkinsonS.A.Calcium, magnesium, phosphorus and vitamin D fortification of weaning foods. J Nutr2002 (suppl), 2003.
38.
MoraJ.Proposed vitamin A fortification levels. J Nutr2002 (suppl), 2003.
39.
AllenL.B vitamins: proposed fortification levels for complementary foods for young children. J Nutr2002 (suppl), 2003.
40.
Food and Nutrition Board, Institute of Medicine.Dietary reference intakes for vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.Washington, DC: National Academy Press, 2001.
41.
DunnJ.Iodine should be routinely added to complementary foods. J Nutr2002 (suppl), 2003.
42.
DaltonM.A., SargetJ.D., O'ConnorG.T., OlmsteadE.M., KleinR.Z.Calcium and phosphorus supplementation of iron-fortified infant formula: no effect on iron status of healthy full-term infants. Am J Clin Nutr1997; 65: 921–6.
43.
AbramsS.A., GriffinI.J., DavilaP., LiangL.Calcium fortification of breakfast cereal enhances calcium absorption in children without affecting iron absorption. J Pediatr2001; 139: 522–6.
44.
WhittakerP.Iron and zinc interactions in humans. Am J Clin Nutr1998; 68(S): 442–4.
45.
ZlotkinS., ArthurP., AntwiK.Y., YeungG.Treatment of anemia with microencapsulated ferrous fumarate plus ascorbic acid supplied as “sprinkles” added to complementary (weaning) foods. Am J Clin Nutr2001; 74: 791–5.
46.
BriendA., LacsalaR., PrudhonC., MounierB., GrelletyY., GoldenM.H.Ready-to-use therapeutic food for treatment of marasmus. Lancet1999; 353: 1767–8.
47.
BriendA.Highly nutrient-dense spreads: a new approach to deliver multiple micronutrients to high-risk groups. Br J Nutr2001; 85(suppl 2): 2175–9.
48.
BriendA.Possible use of spreads as a FOODlet for improving the diets of infants and young children. Food Nutr Bull2002; 23: 239–43.
49.
BriendA., FergusonE., DarmonN.Local food price analysis by linear programming: a new approach to assess the economic value of fortified food supplements. Food Nutr Bull2001; 22: 184–9.
CollinsS.Changing the way we address severe malnutrition during famine. Lancet2001; 358: 498–501.
52.
MastersW.A., SanogoD.Welfare gains from quality certification of infant foods: results from a market experiment in Mali. Am J Agric Econ2002; 84: in press.
53.
AkerlofG.A.The market for “lemons”: quality uncertainty and the market mechanism. Q J Econ1970; 84: 488–500.
54.
WolinskyA.Prices as signals of product quality. Rev Econ Studies1983; 50(October): 647–58.
55.
NicholsM.W.Advertising and quality in the U.S. market for automobiles. Southern Econ J1998; 64: 922–39.
56.
MilgromP.R.D., RobertsJ.M.Price and advertising signals of product quality. J Political Econ1986; 94(August): 796–821.
57.
CaswellJ.A., PadbergD.I.Toward a more comprehensive theory of food labels. Am J Agric Econ1992; 74: 460–8.
58.
AuriolE., SchilliziS.Quality signaling through certification. Theory and an application to agricultural seed markets. Toulouse, France: L'Institut d'Economie Industrielle. www.idei.asso.fr
59.
CrespiJ.M., MaretteS.How should food safety be financed?Rennes, France: Institut National de la Recherche Agronomique, Département d'Economie et Sociologie (INRA-ESR), 2000.
60.
MarchioneT.Title II food aid and the nutrition of children in Latin America and the Caribbean. Food Nutr Bull2000; 21: 65–72.
61.
SanogoD., MastersW.A.A market-based intervention to improve child nutrition: mothers’ demand for quality certification of infant foods in Bamako, Mali. Food Pol2002; 27: 251–68.
62.
ClarkD., ShrimptonR.Complementary feeding, the Code, and the Codex. Food Nutr Bull2000; 21: 25–9.
63.
WHO/FAO.Codex standard for processed cereal-based foods (including guidelines on formulated supplementary foods for older infants and young children).Geneva: World Health Organization, 1991.
64.
World Health Assembly.Resolution WHA54.2: Infant and young child nutrition.Geneva: World Health Organization, 2001.
