Food pattern modeling to inform global guidance on complementary feeding of infants

Nutrient needs are difficult to meet during infancy due to high nutrient requirements and the small quantities of food consumed. Guidelines to support food choice decisions are critical to promoting optimal infant health, growth and development and food pattern modeling can be used to inform guideline development. We employed the Optifood modeling system to determine if unfortified complementary foods could meet 13 nutrient targets for breastfed infants (6-11 months), and to describe food patterns that met, or came as close as possible to meeting targets. We also examined the impacts of eliminating food groups, increasing starchy staple foods or adding sentinel unhealthy foods. We collated a global food list from dietary studies in 37 countries and used this list to develop nutrient values for a set of 35 food subgroups. We analyzed infant dietary intakes from studies in eight countries to inform maximum quantities and frequencies of consumption for these subgroups in weekly food patterns. We found that unfortified foods could meet targets for most infants for 12 nutrients, but not for iron. For the smallest and youngest infants, with the lowest energy intakes, there were additional deficits for minerals. Best-case food patterns that met targets or came as close as possible to meeting targets included ample amounts of diverse vegetables, diverse plant- and animal-source protein foods, small amounts of whole grain foods and dairy and no refined grains or added fats or sugar. There were nutrient deficits if animal-source foods or vegetables were eliminated or if unhealthy foods were included. We modeled infant diets to support development of global guidance and found that high-quality diets including only unfortified complementary foods could meet most nutrient targets for breastfed infants. The best diets included ample amounts of diverse vegetables, diverse plant- and animal-source protein foods and small amounts of whole grain foods and dairy.image When diverse foods are available, affordable and acceptable, unfortified complementary foods can meet most infants' needs for a set of 12 key nutrients, but not for iron.For the smallest infants, there are deficits for calcium, iron, potassium and zinc even in best-case food patterns.Best-case food patterns include ample amounts of diverse vegetables, diverse plant- and animal-source protein foods and small amounts of whole grain foods and dairy.These include no refined grains or added fats or sugar.Nutrient deficits arise if animal-source foods or vegetables are eliminated, or if unhealthy foods are included.