Modification of Local Diets Could Fill Gaps in B-Vitamin Intakes but Calcium, Iron, and Zinc Intake Gaps Require External Solutions for Breastfed Children in Rural Kenya

Abstract

Objectives: The objective of this study was to identify gaps in the adequacy of nutrient intakes, and food-based recommendations to fill those gaps, from complementary diets of 6-23 mo old children in two agro-ecological zones of rural Kenya. Methods: In a high rainfall area of Western Kenya (Vihiga) and a semi-arid area of Eastern Kenya (Kitui), food and nutrient intakes from complementary diets of 6-8, 9-11, and 12-23 mo old breastfed children were quantified using 24-hour dietary recalls. Optifood, an automated linear programming tool, was used to identify recommended nutrient intakes (RNIs) that could not be achieved using locally available foods (problem nutrients) and optimal food-based recommendations that would improve dietary adequacy for 11 nutrients, if adopted. Model constraints ensured they conformed to local food patterns. Results: Problem nutrients were iron and zinc (all age/location subgroups), plus calcium in Vihiga and vitamin B12 in 12-23 mo olds in Kitui. Dietary vitamins A and C were adequate in most subgroups, while most B-vitamins were moderately inadequate in most subgroups. Specific recommendations varied somewhat by subgroup, but included increased weekly servings of green leafy vegetables, legumes, existing fortified cereals, dairy products, plus millet flour and meat, fish or egg in Kitui, and sardines in Vihiga. Conclusions: In conclusion, food-based recommendations alone can ensure >65% of RNIs for all nutrients, except for iron and zinc (all subgroups), and folate or niacin (12-23 mos), which require external solutions such as new targeted fortified foods. These results provide an evidence base for designing appropriate interventions for improved complementary diets.