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Children have food preferences and they are quite fussy to take green leafy vegetables and fruits thus compromising their intake of micronutrients from dietary sources. The full genetic potential of the child for physical growth and mental development may be compromised due to subclinical deficiencies of micronutrients which are commonly referred to as "hidden hunger". Micronutrients are required for the integrity and optimal functioning of immune system. Children with subclinical deficiency of micronutrients are more vulnerable to develop frequent and more severe common day-to-day infections thus triggering a vicious cycle of undernutrition and recurrent infections. A number of micronutrients are required for optimal physical growth and neuromotor development. Isolated deficiencies of micronutrients are rare in clinical practice and usually deficiencies of multiple micronutrients co-exist. The first 3 years of life are most crucial and vulnerable to the hazards of undernutrition. However, it has been shown that it is not possible to meet cent per cent requirements of recommended dietary allowances (RDA’s) of micronutrients from dietary sources alone and most preschool children need administration of nutritional supplements to optimize their genetic potential for physical growth and mental development.
There is increasing evidence for metabolic inter-relationships between different micronutrients. For example, ascorbic acid is known to enhance the absorption of non-haem iron and high intake of zinc may interfere with absorption of iron and copper. Whereas, calcium helps in the absorption of vitamin B12 from the ileum but it interferes with absorption of zinc. Therefore, such metabolic interactions should be kept in mind while giving a "cocktail" of various micronutrients in clinical practice.
Physical Growth
Over 50 per cent of under-five children are stunted in India. They have sub-optimal vigour and stamina, poor neuromotor coordination, learning skills and mental capabilities. Vitamins and trace minerals are required for production of various enzymes, hormones and biochemical mediators for regulation of biological processes. They are required for energy production, synthesis of RNA and DNA and for providing protection against reactive oxygen-free radicals. Micronutrients are required for promotion of physical growth, sexual maturation and neuromotor development.
A number of vitamins (vitamins A, E, C, D, B2, B6 and folic acid) and trace minerals (iron, zinc, selenium, copper) are recognized to boost both cell-mediated and humoral immune defences of the body. Interaction between sub-optimal nutrition and occurrence of repeated infections is the leading cause of growth retardation in children in developing countries. Dietary inadequacies and recurrent infections, interact in a mutually reinforcing manner to further aggravate nutritional status. Calcium, phosphorus, vitamins A, C, D and K are required to maintain the integrity and mineralisation of bones.
Brain Development
It is not generally realized that neurons are more sensitive to nutrients and dietary chemicals compared to other body cells. Optimal nutrition during pregnancy and first 3 years of life is most crucial because 70 per cent of the human brain develops during fetal life and remaining 30 per cent during pre-school years. Micronutrients are required for production of several enzymes and co-factors for a number of metabolic pathways. It has been well known that pellagra (niacin deficiency) leads to reduced cognition and dementia. A number of other B-complex vitamins especially B1,B2,B6,B12 and folic acid are needed for synthesis of several neurotransmitters.
Some others include zinc ,copper , omega-3 fatty acids and decosahexaenoic acid (DHA). Omega-3 fatty acids are credited to reduce cellular and vascular inflammation in the brain, promote vasodilatation and ensure integrity of brain cell membranes to keep them soft and pliable. DHA is the building material for fabrication of synaptic communications and constitute almost one-half of the total fat in the brain cell membrane. It increases the level of "feel good" neurotransmitter serotonin and the "memory boosting" chemical acetylcholine.
Initiatives
Health and well being of mothers and children are intimately linked. Healthy mothers produce healthy babies while sick and malnourished mothers produce high-risk and low birth weight babies. Therefore, a life cycle approach should be followed to provide optimal nutrition and health care to girl children from infancy through childhood, adolescence, pregnancy and lactation .
The last 3 months of fetal life and first 3 years of post-natal life are most crucial and vulnerable to the hazards of undernutrition. During this period most of the brain growth is completed and a sound foundation is laid down for physical growth. Breast milk is a complete nutritional food during first 6 months of life. The nutritional quality of breast milk can be enhanced by improving the diet and providing nutritional supplements to the lactating mother. There is recent evidence to suggest that exclusively breastfed babies should be given supplements of vitamin D after the age of 2 months to prevent development of rickets. Breast feeding should be continued as long as possible but atleast upto the age of one year.
Home-cooked energy-dense complementary feeds should be introduced after 6 months of age. During this period supplements of micronutrients should be provided. All efforts should be made to provide optimal nutrition to children during first 3 years of life which are most crucial for optimal physical and mental growth. It is well recognized that the stature achieved by the child at 3 years of age is a good predictor of ultimate adult height. The short stature of adults in developing countries is largely due to poor physical growth during first 3 years of life.
During adolescence, there is a rapid spurt of physical growth and sexual maturation. During this period, junk food should be avoided and children be given extra calories, proteins and micronutrients like calcium, iron, iodine and zinc. Intake of soft drinks should be discouraged due to their health hazards and efforts should be made to make children more milk-friendly. A nutritional supplement can be added in the milk to change the colour, taste and flavour. When a child dislikes to take milk or milk intake is associated with bloating or abdominal discomfort, he should be encouraged to take milk products like yoghurt and cheese. The practice of missing the breakfast should be condemned and all attempts should be made to ensure that the breakfast is the most wholesome meal of the day.
All efforts should be made that children take a well balanced nutritious food by encouraging them to consume green leafy vegetables, lentils, soyabeans, seasonal fruits, milk and dairy products, fish, eggs and chicken. Healthy children do provide a solid foundation to the society in order to ensure optimal human resource development of a country.
*- Based on an article by M.Singh from ‘The Indian Journal Of Pediatrics’
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