Scientific Opinion on nutrient requirements and dietary intakes of infants and young children in the European Union

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Article
Panel on Dietetic Products, Nutrition and Allergies
EFSA Journal
EFSA Journal 2013;11(10):3408 [103 pp.].
doi
10.2903/j.efsa.2013.3408
Panel members at the time of adoption
Carlo Agostoni, Roberto Berni Canani, Susan Fairweather-Tait, Marina Heinonen, Hannu Korhonen, Sébastien La Vieille, Rosangela Marchelli, Ambroise Martin, Androniki Naska, Monika Neuhäuser-Berthold, Grażyna Nowicka, Yolanda Sanz, Alfonso Siani, Anders Sjödin, Martin Stern, Sean (J.J.) Strain, Inge Tetens, Daniel Tomé, Dominique Turck and Hans Verhagen
Acknowledgements

The Panel wishes to thank the members of the Working Group on Dietetic Products: Carlo Agostoni, Roberto Berni Canani, Tamás Decsi, Lotte Lauritzen, Hildegard Przyrembel, Yolanda Sanz, Inga Thorsdottir, Daniel Tomé and Dominique Turck for the preparatory work on this scientific opinion.

Contact
Type
Opinion of the Scientific Committee/Scientific Panel
On request from
European Commission
Question Number
EFSA-Q-2013-00263
Adopted
9 octobre 2013
Published
25 octobre 2013
Affiliation
European Food Safety Authority (EFSA), Parma, Italy
Note
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Abstract

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on the nutrient requirements and dietary intakes of infants and young children in the European Union. This Opinion describes the dietary requirements of infants and young children, compares dietary intakes and requirements in infants and young children in Europe and, based on these findings, concludes on the potential role of young-child formulae in the diets of infants and young children, including whether they have any nutritional benefits when compared with other foods that may be included in the normal diet of infants and young children. The Panel concluded on the levels of nutrient and energy intakes that are considered adequate for the majority of infants and young children, and evaluated the risk of inadequate nutrient intakes in infants and young children in living Europe. Dietary intakes of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D and iodine (in some European countries) are low in infants and young children living in Europe, and particular attention should be paid to ensuring an appropriate supply of ALA, DHA, iron, vitamin D and iodine in infants and young children with inadequate or at risk of inadequate status of these nutrients. No unique role of young-child formulae with respect to the provision of critical nutrients in the diet of infants and young children living in Europe can be identified, so that they cannot be considered as a necessity to satisfy the nutritional requirements of young children when compared with other foods that may be included in the normal diet of young children (such as breast milk, infant formulae, follow-on formulae and cow’s milk).

Summary

Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver a Scientific Opinion on the nutrient requirements and dietary intakes of infants and young children in the European Union. This Opinion describes the dietary requirements of infants and young children, compares dietary intakes and requirements in infants and young children living in Europe and, based on the findings, concludes on the potential role of young-child formulae in the diets of infants and young children, including whether they have any nutritional benefits when compared with other foods that may be included in the normal diet of infants and young children.

In this Opinion, the Panel provides advice on the levels of nutrients which it considers adequate for healthy, term, normal-weight infants and young children, but does not derive any Dietary Reference Values (DRVs). This will be done in the framework of setting DRVs for individual micronutrients.

For infants up to the age of six months, the nutrient content of breast milk from healthy, well-nourished, unsupplemented mothers was used for most nutrients as a basis to provide advice on intake levels of nutrients considered adequate for the majority of infants in the first half-year of life.

For levels of nutrient intakes considered adequate for the majority of infants in the second half-year of life and in young children, the Panel reviewed reference values set by the Scientific Committee for Food in 1993 in the light of more recent recommendations given by other scientific or authoritative bodies, i.e. the French Food Safety Agency (Afssa) and the Health Council of the Netherlands (Gezondheidsraad) as well as the recommendations given by Nordic Council of Ministers, the German-speaking countries (D-A-CH), the US Institute of Medicine (IoM), the National Health and Medical Research Council of the Commonwealth (NHMRC) of Australia and the Ministry of Health of New Zealand and the World Health Organization (WHO), unless the Panel has already given an Opinion or endorsed an Opinion for public consultation on a DRV for a specific nutrient, in which case the previous advice given by the Panel was taken as a basis of the current Opinion (i.e. for energy, protein, fat, carbohydrates and dietary fibre, water, molybdenum, fluoride, manganese, pantothenic acid, biotin and vitamin C).

Based on the available publications reporting on nutrient intakes in infants and young children living in Europe, the Panel evaluated the risk of inadequate nutrient intakes in infants and young children in Europe by comparing the habitual nutrient intakes with the Average Requirement (AR) or with the Adequate Intake (AI). The Panel also reviewed available evidence with respect to studies in infants and young children living in Europe reporting on status markers of nutrient adequacy to complement information provided by nutrient intake studies.

Dietary intakes of linoleic acid (LA), calcium, phosphorus, magnesium, copper, selenium, chromium, molybdenum, manganese, fluoride, vitamin A, vitamin E, vitamin K, thiamin, riboflavin, niacin, pantothenic acid, pyridoxine, biotin, folate, cobalamin, vitamin C and choline in infants and young children living in Europe do not give rise to concern over the risk of inadequate intakes.
Dietary intakes of energy, protein, salt and potassium in infants and young children living in Europe are generally high while intakes of dietary fibre in young children are low. Intakes of protein, salt and potassium are not at levels which are of concern, whereas energy intakes above requirements will lead to an unfavourable gain in body mass.

In the case of n-3 polyunsaturated fatty acids (PUFAs) and zinc, the risk of inadequate intakes in infants and young children living in Europe cannot be quantified. However, as zinc intakes are mainly above the AR and no overt deficiency in this population group in Europe has been reported, it is considered that current zinc intakes in infants and young children living in Europe are not of particular concern.

Dietary intakes of alpha-linolenic acid (ALA), docosahexaenoic acid (DHA), iron, vitamin D and iodine (in some European countries) are low in infants and young children living in Europe and particular attention should be paid to ensuring an appropriate supply of ALA, DHA, iron, vitamin D and iodine in infants and young children with inadequate or at risk of inadequate status of these nutrients, in particular in the view of the poor iron, vitamin D and iodine status of some sub-groups of infants and young children living in Europe.

Several European countries have translated nutrient intake recommendations for infants and young children into food-based dietary guidelines (FBDG) to help caregivers in the choice of age-appropriate foods to meet dietary needs. It has been shown in one European country that a specific modular dietary schedule for the first year of life and an optimised mixed diet for children aged 1 to 18 years are able to provide an adequate energy and nutrient supply for these age groups, with the exception of vitamin D.

Although dietary habits markedly differ within Member States, these diets can be taken as an example of dietary patterns which can ensure a sufficient energy and nutrient supply in infants and young children.

Fortified formulae, including young-child formula, are one of several means to increase n‑3 PUFA, iron, vitamin D and iodine intakes in infants and young children living in Europe with inadequate or at risk of inadequate status of these nutrients. However, other means, such as fortified cow’s milk, fortified cereals and cereal-based foods, supplements or the early introduction of meat and fish into complementary feeding and their continued regular consumption, are efficient alternatives to increase intakes of these nutrients. The selection of the appropriate form and vehicle through which these nutrients are provided in the diet will depend on national dietary habits, health authorities, the regulatory context and caregivers’ preference. However, it is recommended that guidelines for vitamin D supplementation of infants and children established at national level be followed.

In comparison with cow’s milk, currently marketed young-child formulae contain more ALA, DHA (if added), iron and vitamin D but similar amounts of iodine.

The mean content of these nutrients in young-child formulae is within the range of permitted concentrations in follow-on formulae and, except for iron, also in infant formulae.

No unique role of young-child formulae with respect to the provision of critical nutrients in the diet of infants and young children living in Europe can be identified, so that they cannot be considered as a necessity to satisfy the nutritional requirements of young children when compared with other foods that may be included in the normal diet of young children (such as breast milk, infant formulae, follow-on formulae and cow’s milk).

Keywords
nutrient requirements, dietary intakes, infants, young children, young-child formula
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Number of Pages
103