Targeting Pregnant and Lactating Women and Young Children with Fortified Foods

  • Saskia J. M. Osendarp
  • Lynnette M. NeufeldEmail author
Part of the Nutrition and Health book series (NH)


Micronutrient deficiencies are highly prevalent among pregnant women, infants, and young children because of their high nutrient needs relative to energy intake. In resource poor setting, limited dietary diversity, particularly low consumption of micronutrient rich foods, and the effects of frequent infection on appetite, nutrient absorption, and nutrient losses exacerbate the problem of low intake.


Birthweight Birth outcomes Targeted fortified foods Complementary foods Growth Development 



Confidence interval






Length for age Z-score


Low birth weight


Lipid-based nutritional supplements




Odds ratio


Recommended nutrient intakes


Weight for age Z-score


  1. 1.
    Victora CG, Adair L, Fall C, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371:340–57.PubMedCrossRefGoogle Scholar
  2. 2.
    Lozoff B, Beard J, Connor J, Barbara F, Georgieff M, Schallert T. Long-lasting neural and behavioral effects of iron deficiency in infancy. Nutr Rev. 2006;64(Suppl):S34–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Christian P, Stewart CP. Maternal micronutrient deficiency, fetal development, and the risk of chronic disease. J Nutr. 2010;140:437–45.PubMedCrossRefGoogle Scholar
  4. 4.
    Lozano R, Wang H, Foreman KJ, Rajaratnam JK, Naghavi M, Marcus JR, et al. Progress towards millennium development goals 4 and 5 on maternal and child mortality: an updated systematic analysis. Lancet. 2011; 378(9797):1139–65.PubMedCrossRefGoogle Scholar
  5. 5.
    Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371:243–60.PubMedCrossRefGoogle Scholar
  6. 6.
    Copenhagen Consensus 2012: Solving the world’s challenges. Copenhagen Consensus Center, 2012, Accessed May 20, 2012.
  7. 7.
    Allen L, de Benoist B, Dary O, Hurrell R. Guidelines on food fortification with micronutrients. Geneva: World Health Organisation/Food and Agricultural Organisation of the United Nations; 2006.Google Scholar
  8. 8.
    Verkaik-Kloosterman J, McCann MT, Hoekstra J, Verhagen H. Vitamins and minerals: issues associated with too low and too high population intakes. Food Nutr Res. 2012;56.Google Scholar
  9. 9.
    De Pee S, Bloem MW. Current and potential role of specially formulated foods and food supplements for preventing malnutrition among 6- to 23-month-old children and for treating moderate malnutrition among 6- to 59-month-old children. Food Nutr Bull. 2009;30(3 Suppl):S434–63.PubMedGoogle Scholar
  10. 10.
    Yang Z, Huffman SL. Review of fortified food and beverage products for pregnant and lactating women and their impact on nutritional status. Matern Child Nutr. 2011;7:19–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Latham MC, Ash DM, Makola D, Tatala SR, Ndossi GD, Mehansho H. Efficacy trials of a micronutrient dietary supplement in school children and pregnant women in Tanzania. Food Nutr Bull. 2003;24:S120–8.PubMedGoogle Scholar
  12. 12.
    Mardones F, Urrutia MT, Villarroel L, Rioseco A, Castillo O, Rozowski J, et al. Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women. Public Health Nutr. 2008;11:30–40.PubMedCrossRefGoogle Scholar
  13. 13.
    Prentice AM, Cole TJ, Foord FA, Lamb WH, Whitehead RG. Increased birthweight after prenatal dietary supplementation of rural African women. Am J Clin Nutr. 1987;46:912–25.PubMedGoogle Scholar
  14. 14.
    Ceesay SM, Prentice AM, Cole TJ, Foord F, Weaver LT, Poskitt EM, et al. Effects on birth weight and perinatal mortality of maternal dietary supplements in rural Gambia: 5 year randomised controlled trial. BMJ. 1997;315:786–90.PubMedCrossRefGoogle Scholar
  15. 15.
    Huybregts L, Roberfroid D, Lanou H, Menten J, Meda N, Van Camp J, et al. Prenatal food supplementation fortified with multiple micronutrients increases birth length: a randomized controlled trial in rural Burkina Faso. Am J Clin Nutr. 2009;90:1593–600.PubMedCrossRefGoogle Scholar
  16. 16.
    Dewey KG, Adu-Afarwuah S. Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Matern Child Nutr. 2008;4 Suppl 1:24–85.PubMedCrossRefGoogle Scholar
  17. 17.
    Lartey A, Manu A, Brown KH, Peerson JM, Dewey KG. A randomized, community-based trial of the effects of improved, centrally processed complementary foods on growth and micronutrient status of Ghanaian infants from 6 to 12 mo of age. Am J Clin Nutr. 1999;70:391–404.PubMedGoogle Scholar
  18. 18.
    Adu-Afarwuah S, Lartey A, Brown KH, Zlotkin S, Briend A, Dewey KG. Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: effects on growth and motor development. Am J Clin Nutr. 2007;86:412–20.PubMedGoogle Scholar
  19. 19.
    Obatolu VA. Growth pattern of infants fed with a mixture of extruded malted maize and cowpea. Nutrition. 2003;19:174–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Owino VO, Kasonka LM, Sinkala MM, Wells JK, Eaton S, Darch T, et al. Fortified complementary foods with or without alpha-amylase treatment increase hemoglobin but do not reduce breast milk intake of 9-mo-old Zambian infants. Am J Clin Nutr. 2007;86:1094–103.PubMedGoogle Scholar
  21. 21.
    Kuusipalo H, Maleta K, Briend A, Manary M, Ashorn P. Growth and change in blood haemoglobin concentration among underweight Malawian infants receiving fortified spreads for 12 weeks: a preliminary trial. J Pediatr Gastroenterol Nutr. 2006;43:525–32.PubMedCrossRefGoogle Scholar
  22. 22.
    Oelofse A, Van Raaij JM, Benade AJ, Dhansay MA, Tolboom JJ, Hautvast JG. The effect of a micronutrient-fortified complementary food on micronutrient status, growth and development of 6- to 12-monthold disadvantaged urban South African infants. Int J Food Sci Nutr. 2003;54:399–407.PubMedCrossRefGoogle Scholar
  23. 23.
    Beckett C, Durnin JV, Aitchison TC, Pollitt E. Effects of an energy and micronutrient supplement on anthropometry in undernourished children in Indonesia. Eur J Clin Nutr. 2000;54(Suppl2):S52–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Santos IS, Gigante DP, Coitinho DC, Haisma H, Valle NC, Valente G. Evaluation of the impact of a nutritional program for undernourished children in Brazil. Cad Saude Publica. 2005;21:776–85.PubMedCrossRefGoogle Scholar
  25. 25.
    Smuts CM, Dhansay MA, Faber M, van Stuijvenberg ME, Swanevelder S, Gross R, et al. Efficacy of multiple micronutrient supplementation for improving anemia, micronutrient status, and growth in South African infants. J Nutr. 2005;135:653S–9.PubMedGoogle Scholar
  26. 26.
    Giovannini M, Sala D, Uselli M, Livio L, Francescato G, Braga M, et al. Double-blind, placebo-controlled trial comparing effects of supplementation with two different combinations of micronutrients delivered as sprinkles on growth, anemia, and iron deficiency in Cambodian infants. J Pediatr Gastroenterol Nutr. 2006;42:306–12.PubMedCrossRefGoogle Scholar
  27. 27.
    Faber M, Kvalsvig JD, Lombard CJ, Benade AJ. Effect of a fortified maize-meal porridge on anemia, micronutrient status, and motor development of infants. Am J Clin Nutr. 2005;82:1032–9.PubMedGoogle Scholar
  28. 28.
    Dhingra P, Menon VP, Sazawal S, Dhingra U, Marwah D, Sarkar A, et al. Effect of fortification of milk with zinc and iron along with vitamins C, E, A and selenium on growth, iron status and development in preschool children—a community-based double-masked randomized trial. Report from the 2nd World Congress of Pediatric Gastroenterology, Hepatology and Nutrition. Paris, France, 3–7 July 2004.Google Scholar
  29. 29.
    Nutrition and Infection (CIGNIS) Study Team. Micronutrient fortification to improve growth and health of maternally HIV-unexposed and exposed Zambian infants: a randomized controlled trial. PLoS One. 2010; 5(6):e11165.CrossRefGoogle Scholar
  30. 30.
    Sazawal S, Dhingra U, Dhingra P, Hiremath G, Kumar J, Sarkar A, et al. Effects of fortified milk on morbidity in young children in north India: community based, randomised, double masked placebo controlled trial. BMJ. 2007;334:140.PubMedCrossRefGoogle Scholar
  31. 31.
    Manno D, Siame J, Larke N, Baisley K, Kasonka L, Filteau S. Effect of multiple-micronutrient fortified food on mild morbidity and clinical symptoms in Zambian infants: results from a randomized controlled trial. Eur J Clin Nutr. 2011;65:1163–6.PubMedCrossRefGoogle Scholar
  32. 32.
    Roy SK, Fuchs GJ, Mahmud Z, Ara G, Islam S, Shafique S, et al. Intensive nutrition education with or without supplementary feeding improves the nutritional status of moderately-malnourished children in Bangladesh. J Health Popul Nutr. 2005;23:320–30.PubMedGoogle Scholar
  33. 33.
    Bhandari N, Bahl R, Nayyar B, Khokhar P, Rohde JE, Bhan MK. Food supplementation with encouragement to feed it to infants from 4 to 12 months of age has a small impact on weight gain. J Nutr. 2001;131:1946–51.PubMedGoogle Scholar
  34. 34.
    Moursi M, Mbemba F, Treche S. Does the consumption of amylase-containing gruels impact on the energy intake and growth of Congolese infants? Public Health Nutr. 2003;6:249–58.PubMedCrossRefGoogle Scholar
  35. 35.
    Pollitt E, Jahari A, Husaini M, Kariger P, Saco-Pollitt C. Developmental trajectories of poorly nourished toddlers that received a micronutrient supplement with and without energy. J Nutr. 2002;132:2617–25.PubMedGoogle Scholar
  36. 36.
    Chen CM, Wang YY, Chang CY. Effect of in-home fortification of complementary feeding on intellectual development of Chinese children. Biomed Environ Sci. 2010;23:83–91.PubMedCrossRefGoogle Scholar
  37. 37.
    Phu PV, Hoan NV, Salvignol B, Treche S, Wieringa FT, Khan NC, et al. Complementary foods fortified with micronutrients prevent iron deficiency and anemia in Vietnamese infants. J Nutr. 2010;140(12):2241–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Ouedraogo HZ, Traore T, Zeba AN, Dramaix-Wilmet M, Hennart P, Donnen P. Effect of an improved local ingredient-based complementary food fortified or not with iron and selected micronutrients on Hb concentration. Public Health Nutr. 2010;13(11):1923–30.PubMedCrossRefGoogle Scholar
  39. 39.
    Lo NB, Aaron GJ, Hess SY, Dossou NI, Guiro AT, Wade S, et al. Plasma zinc concentration responds to short-term zinc supplementation, but not zinc fortification, in young children in Senegal. Am J Clin Nutr. 2011;93(6):1348–55.PubMedCrossRefGoogle Scholar
  40. 40.
    WHO/FAO. Vitamin and mineral requirements in human nutrition. 2nd ed. Geneva: WHO; 2004.Google Scholar
  41. 41.
    Food and Nutrition Board, Institute of Medicine. Vitamin A 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. p. 65–126.Google Scholar
  42. 42.
    WHO. Proceedings of the WHO UNICEF WFP UNHCR informal consultation on the management of moderate malnutrition in under-5 children. Geneva 2008. Food Nutr Bull. 2009;30(3):S464–74.Google Scholar
  43. 43.
    Lopriore C, Guidoum Y, Briend A, Branca F. Spread fortified with vitamins and minerals induces catch-up growth and eradicates severe anemia in stunted refugee children aged 3–6 y. Am J Clin Nutr. 2004;80:973–81.PubMedGoogle Scholar
  44. 44.
    WHO. Complementary feeding of young children in developing countries: a review of current scientific knowledge. WHO/NUT/98. Geneva: WHO; 1998.Google Scholar
  45. 45.
    Dewey KG, Brown KH. Update on technical issues concerning complementary feeding of young children in developing countries and implications for intervention programs. Food Nutr Bull. 2003;24:5–28.PubMedGoogle Scholar
  46. 46.
    IYCN working group-Subgroup on Formulation guidelines. Formulations for fortified complementary foods and supplements: review of successful products for improving nutritional status of infants and young children. Food Nutr Bull. 2009;30(2):S239–55.Google Scholar
  47. 47.
    Dewey KG. Complementary feeding. In: Caballero B, Allen L, Prentice A, editors. Encyclopedia of human nutrition. Amsterdam: Elsevier; 2005. p. 465–70.CrossRefGoogle Scholar
  48. 48.
    Lutter CK, Dewey KG. Proposed nutrient composition for fortified complementary foods. J Nutr. 2003;133: 3011S–20.PubMedGoogle Scholar
  49. 49.
    Rivera JA, Sotres-Alvarez D, Habicht JP, Shamah T, Villalpando S. Impact of the Mexican program for education, health, and nutrition (Progresa) on rates of growth and anemia in infants and Young children: a randomized effectiveness study. JAMA. 2004;291:2563–70.PubMedCrossRefGoogle Scholar
  50. 50.
    Leroy JL, Garcia-Guerra A, Garcia R, Dominguez C, Rivera J, Neufeld LM. The Oportunidades program improves child growth in urban Mexico. J Nutr. 2008;138:793–8.PubMedGoogle Scholar
  51. 51.
    Rosado JL, Rivera J, López G, Solano L, Rodríguez G, Casanueva E, et al. Development and evaluation of food supplements for the education, health, and nutrition program. Salud Publica Mex. 1999;41(3):153–62.PubMedCrossRefGoogle Scholar
  52. 52.
    Habicht JP, Martorell R, Rivera JA. Nutritional impact of supplementation in the INCAP longitudinal study: analytic strategies and inferences. J Nutr. 1995;125:1042S–50.PubMedGoogle Scholar
  53. 53.
    Pollitt E, Gorman KS, Engle PL, Rivera JA, Martorell R. Nutrition in early life and the fulfillment of intellectual potential. J Nutr. 1995;125:1111S–8.PubMedGoogle Scholar
  54. 54.
    Perez-Exposito AB, Villalpando S, Rivera JA, Griffin IJ, Abrams SA. Ferrous sulfate is more bioavailable among preschoolers than other forms of iron in a milk-based weaning food distributed by PROGRESA, a national program in Mexico. J Nutr. 2005;135:64–9.PubMedGoogle Scholar
  55. 55.
    Morales J, Vargas F, Cassis L, Sanchez E, Villalpando S. Sensorial evaluation of nutrition supplements (PROGRESA) enriched with 3 different forms of iron in a rural Mexican community. J Food Sci. 2008;73:S1–5.PubMedCrossRefGoogle Scholar
  56. 56.
    Shamah-Levy T, Villalpando S, Rivera-Dommarco JA, Mundo-Rosas V, Cuevas-Nasu L, Jimenez-Aguilar A. Ferrous gluconate and ferrous sulfate added to a complementary food distributed by the Mexican nutrition program Oportunidades have a comparable efficacy to reduce iron deficiency in toddlers. J Pediatr Gastroenterol Nutr. 2008;47:660–6.PubMedCrossRefGoogle Scholar
  57. 57.
    Neufeld LM, Sotres Alvarez D, Flores López M, Tolentino Mayo L, Jiménez Ruiz J, Rivera Dommarco J. [Study of the consumption of the food supplements Nutrisano and Nutrivida in children and women beneficiaries of Oportunidades en urban areas.] External evaluation of the Impact of the Oportunidades Program 2004, Nutrition, vol. III. Mexico City: Secretary of Social Development; 2005. p. 119–47.Google Scholar
  58. 58.
    Escalante-Izeta E, Bonvecchio A, Theodore F, Nava F, Villanueva MA, Rivera-Dommarco JA. [Facilitators and barriers for the consumption of a micronutrient supplement]. Salud Publica Mex. 2008;50:316–24.PubMedCrossRefGoogle Scholar
  59. 59.
    Bonvecchio A, Pelto GH, Escalante E, Monterrubio E, Habicht JP, Nava F, et al. Maternal knowledge and use of a micronutrient supplement was improved with a programmatically feasible intervention in Mexico. J Nutr. 2007; 137:440–6.PubMedGoogle Scholar
  60. 60.
    Neufeld LM, Mejía F, Fernández Gaxiola AC, García Guerra A, Méndez I, Domínguez CP. [Diagnosis of the nutritional status of children less than 2 years of age and their mothers, beneficiaries of Oportunidades in rural areas]. In: External evaluation of the Oportunidades Program 2008. At 10 years of intervention in rural areas (1997–2007), The challenge of service quality: results in health and nutrition, vol. II. Mexico City Mexico: Secretary of Social Development; 2008.Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Micronutrient InitiativeOttawaCanada

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