title: Several 'problem nutrients' are identified in complementary feeding of Guatemalan infants with continued breastfeeding using the concept of 'critical nutrient density'.
abstract: OBJECTIVE
  The World Health Organization (WHO) recommends nutritionally adequate complementary feeding (CF) through the introduction of indigenous foodstuffs and local foods while breastfeeding for at least 2 years. To determine the adequacy of the contribution of CF to the diets of Guatemalan infants at the 7th-12th month of life receiving high-intensity continued breastfeeding.
  
  
  METHODS
  Critical nutrient densities for CF were modelled using age- and sex-specific energy and protein requirements assuming children to be at the 50th weight percentile of local peers and 15th weight percentiles of the 2006 WHO standards. Nutrient requirements for the total diet were determined using the recommended nutrient intakes. Breast milk was assumed to provide 75% of total energy at the 7th-9th month and 50% at the 10th-12th month. Gaps between computed critical nutrient densities and the CF consumption of 128 Guatemalan infants based on data collected by means of three nonconsecutive 24-h quantitative intake recalls were examined. Locally consumed foods with nutrient densities above the modelled critical densities were identified.
  
  
  RESULTS
  Observed non-breast milk complementation would result in total diets providing inadequate nutrient density for vitamin A, niacin and vitamin C in some age groups. Major gaps for calcium, iron and zinc were ubiquitous across all groups. Few foods commonly consumed among Guatemalan infants had adequate densities of 'problem nutrients'.
  
  
  CONCLUSIONS
  The critical nutrient density concept is useful to evaluate the nutrient adequacy of the infant's diet. Fortified foods are essential sources of the main 'problem nutrients', namely calcium, iron and zinc, given that natural sources are scarce.
authors.affiliation: Center for Studies of Sensory Impairment, Aging and Metabolism, Guatemala City, Guatemala. mvossenaar@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Vossenaar
authors.forename: L
authors.initials: L
authors.lastname: Hernández
authors.forename: R
authors.initials: R
authors.lastname: Campos
authors.forename: N W
authors.initials: NW
authors.lastname: Solomons
mesh_terms: D018798:Anemia, Iron-Deficiency / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D001206:Ascorbic Acid Deficiency / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D001942:Breast Feeding / Q000208:ethnology; D002118:Calcium / Q000172:deficiency; D002657:Child Development; D005260:Female; D063427:Food Quality; D006166:Guatemala; D017408:Guidelines as Topic; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena / Q000208:ethnology; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage* / Q000032:analysis / Q000172:deficiency; D008895:Milk, Human / Q000737:chemistry; D008954:Models, Biological; D009525:Niacin / Q000008:administration & dosage / Q000032:analysis / Q000172:deficiency; D009751:Nutritional Requirements; D009753:Nutritive Value; D014802:Vitamin A Deficiency / Q000208:ethnology / Q000209:etiology / Q000517:prevention & control; D014944:World Health Organization; D015032:Zinc / Q000008:administration & dosage / Q000032:analysis / Q000172:deficiency
chemical_list: D018977:Micronutrients; D009525:Niacin; D015032:Zinc; D002118:Calcium