CHOICE OF FOODS AND INGREDIENTS FOR MODERATELY MALNOURISHED CHILDREN 6 MONTHS TO 5 YEARS OLD Kim F Michaelsen, Camilla Hoppe, Nanna Roos, Pernille Kæstel, Maria Stougaard, Lotte Lauritzen, Christian Mølgaard, Tsinuel Girma*, Henrik Friis Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen and *Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia Disclaimer: This publication reflects the personal views of the authors and does not necessarily represent the decisions or the policies of the World Health Organization. This background paper was presented at the WHO, UNICEF, WFP and UNHCR Consultation on the Dietary Management of Moderate Malnutrition in Under-5 Children by the Health Sector September 30th October 3rd, 2008 1 TABLE OF CONTENT ...................................................................................................5 LIST OF ABBREVIATIONS ...................................................................................................7 ABSTRACT ....................................................................................................................8 INTRODUCTION .........................................................................................................9 NUTRITIONAL QUALITIES OF FOODS AND INGREDIENTS ...........................................13 Energy Density......................................................................................................13 Conclusions and recommendations on energy density ...........................................15 Water Content.......................................................................................................15 Macronutrients ......................................................................................................16 Protein ..............................................................................................................16 Protein quality ................................................................................................17 Conclusions and recommendations on protein ...................................................21 Fat....................................................................................................................23 Fat content.....................................................................................................23 Conclusions and recommendations on fat content..............................................24 Fatty acid composition and content of essential fatty acids .................................24 Conclusions and recommendations on fat quality...............................................27 Carbohydrate.....................................................................................................28 Simple Sugars.................................................................................................28 Starch ............................................................................................................29 Dietary Fibre...................................................................................................29 Conclusions and recommendations on carbohydrates.........................................32 Minerals and vitamins ............................................................................................32 Minerals ............................................................................................................32 Iron ...............................................................................................................32 Phosphorus ....................................................................................................35 Iodine ............................................................................................................36 Selenium........................................................................................................36 Potassium and Magnesium...............................................................................37 Vitamins ............................................................................................................37 Water soluble vitamins ....................................................................................37 Thiamine........................................................................................................37 Vitamin B12....................................................................................................37 Vitamin C .......................................................................................................38 Fat soluble vitamins ........................................................................................38 Vitamin A .......................................................................................................38 Vitamin D .......................................................................................................41 Conclusions and recommendations on minerals and vitamins .................................41 Bioactive Substances .............................................................................................42 Milk peptides .....................................................................................................42 The “meat factor”...............................................................................................43 Phytoestrogens ..................................................................................................44 Conclusions and recommendations on bioactive substances ...................................44 Antinutritional Factors............................................................................................45 Phytate (Phytic Acid) ..........................................................................................45 Polyphenols .......................................................................................................53 Other anti-nutrients............................................................................................55 2 Conclusions and recommendations on antinutrients ..............................................57 Contaminants........................................................................................................58 Aflatoxins ..........................................................................................................58 Conclusions and recommendations on contaminants .............................................59 Food Processing ....................................................................................................59 Mechanical methods ...........................................................................................62 Heat processing .................................................................................................63 Soaking .............................................................................................................64 Germination and Malting.....................................................................................65 Fermentation .....................................................................................................65 Cooking in iron pots ...........................................................................................68 Conclusions and recommendations on food processing..........................................68 RELEVANT FOODS AND INGREDIENTS .......................................................................69 Starchy Vegetable Foods........................................................................................69 Cereals..............................................................................................................69 Wheat............................................................................................................70 Rice ...............................................................................................................70 Maize.............................................................................................................74 Oat ................................................................................................................74 Sorghum and Millet .........................................................................................75 Quinoa...........................................................................................................77 Teff ...............................................................................................................77 Conclusions and recommendations on cereals ...................................................78 Legumes and Pulses ...........................................................................................78 Lentils............................................................................................................79 Beans ............................................................................................................82 Soybean.........................................................................................................82 Peanut ...........................................................................................................83 Conclusions and recommendations on legumes and pulses.................................84 Roots ................................................................................................................84 Cassava .........................................................................................................84 Potatoes and sweet potatoes