Three types of fortified products have been developed for consumption by infants and young children: fortified blended foods, complementary food supplements, and micronutrient powders. Fortified blended foods that have been successful in improving nutritional status have generally included cereal (or maltodextrin), a nutrient-dense fat source (such as full-fat soy flour or whole-milk powder), high-quality protein if limited in the diet (5% to 15% calories as protein), milk (whole milk or nonfat milk), and micronutrients. Complementary food supplements have contained a high-quality protein and a nutrient-dense fat source a good source of essential fatty acids (e.g., soy, canola, or fish oil), milk, and micronutrients. In some studies, their impacts on growth have been greater than effects seen with fortified blended foods [54,55] or micronutrient powders [11], but the costs of such products per serving may be higher than the costs of micronutrient powders. The nutrient levels and types of ingredients vary across different products. The formulations shown as examples in this document were based on available foods, their nutrient contents and costs, and local cultural practices. Until international recommendations are established, these examples may help governments and companies make decisions on types of products, levels and forms of nutrients to include, and composition when designing initiatives for the prevention of malnutrition. Micronutrient powders contain a mixture of minerals and vitamins that are added to foods in the home or at the point of use to increase the nutrient density of the food to which they are added. There is good documentation of their impact on iron status and some functional outcomes in children 6 to 24 months of age [11]. They are less expensive than other food-based supplements and are also well accepted by families and communities. There is an urgent need for basic research on the nutrient requirements of infants and young children, harmonization of current recommendations, and better definition of appropriate mineral compounds for use in products for young children. Some key gaps were evident during the preparation of this paper, including the following: Recommended amounts of nutrients are uncertain: -ULs are generally not available for infants; -Because data on usual dietary intakes are not generally available, the appropriate percentage of the RNI per serving to include is unclear; -Recommendations based on the average intakes of breastfed children may underestimate the amounts needed by non-breastfed children; -Nutrient requirements probably differ for children at risk for malnutrition living in poor environments with high rates of infection, compared with those for healthy children; Forms of nutrients differ in bioavailability, cost, and interaction with foods (i.e., suitability for fortification). The recent WHO/FAO guidelines on fortification do not clearly specify which forms of each nutrient should be used and their benefits and costs; Information is needed on the best sources of essential fatty acids (fish, algae, soy, rapeseed or canola oil) to be used in such products with respect to costs, availability, and amounts required; More data are needed on the value of including milk in such products, especially in relation to the type of milk product (whole, nonfat, whey), costs, and amounts needed to improve child growth. © 2009 (supplement), The United Nations University.
