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In Southeast Asia, the increasing availability of commercially produced complementary foods (CPCF), including dry or instant cereals (CPCF cereals), has been noted, however, concerns exist around their nutrient profile and labelling practices. This 2021 study assessed the nutrient composition, labelling practices, and micronutrient content of CPCF cereals sold in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Vietnam), and Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older infants and young children. Micronutrient content of fortified CPCF cereals was assessed against fortification levels specified in the Codex Alimentarius guideline for formulated complementary foods. Of the 484 products assessed, 184 (38.0%) met all nutrient composition requirements. Around one‐third of CPCF cereals contained added sugars and/or sweeteners (37.2%) and high levels of sodium (28.9%). None of the CPCF cereals met all labelling requirements, primarily due to the presence of inappropriate claims on the labels. Most fortified CPCF cereals contained adequate amounts of critical micronutrients, such as calcium, iron, zinc, vitamin A, and vitamin D. However, rates of fortification varied across the seven countries, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. To support the appropriate promotion of CPCF in the region, Southeast Asian countries need to strengthen and enforce national binding legal measures, including national standards for the composition, labelling, and fortification of CPCF cereals. Key messages: Despite most commercially produced complementary foods (CPCF) cereals available in Southeast Asia met the majority of nutrient composition requirements, a considerable number of products contained added sugars/sweeteners (37.2%) and high levels of sodium (28.9%). Regulations that prohibit the use of added sugars/sweeteners and establish an upper limit for sodium in CPCF cereals are a policy priority in the region.None of the 484 CPCF cereals studied met all labelling requirements. Inappropriate claims were the most common. Three‐quarters of the products failed to meet labelling requirements on the protection and promotion of breastfeeding. National regulations on labelling must be strengthened and enforced to protect against inappropriate marketing of CPCF.Approximately two‐thirds or more of fortified CPCF cereals contained adequate amounts of micronutrients critical for older infants and young children (IYC), such as calcium, iron, zinc, vitamin A and vitamin D. Nonetheless, the fortification of CPCF cereals varied greatly by country, and almost a third (30.8%) of CPCF cereals were not fortified with any micronutrients. This is a missed opportunity to provide essential micronutrients to older IYC in contexts where nutrient‐poor diets are common. Future policies that stipulate mandatory minimum micronutrient levels for CPCF cereals are recommended for the region. [ABSTRACT FROM AUTHOR]

Commercially produced complementary foods (CPCF), including ready‐to‐eat CPCF purées and meals, are gaining popularity among caregivers of older infants and young children (IYC) as a convenient alternative to home‐prepared foods in low and middle‐income countries. However, there is growing concern regarding the suitability of these products for older IYC, as they can contain high levels of sugar and/or sodium. Given the rapidly evolving market in Southeast Asia, it is crucial to monitor the appropriate composition and promotion of CPCF in the region. This study examined the nutrient composition and labelling practices of CPCF purées and meals sold in 2021 in the capital cities of seven Southeast Asian countries: Phnom Penh (Cambodia), Jakarta (Indonesia), Manila (Philippines), Bangkok (Thailand), Vientiane (Lao PDR), Hanoi (Viet Nam), Kuala Lumpur (Malaysia). The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older IYC. The proportion of CPCF purées and meals that would require a high sugar front‐of‐pack warning based on the percentage energy from total sugar was also determined. Of the 459 CPCF purées/meals assessed, only 37.7% of the products met all nutrient composition requirements and none met all labelling requirements. In addition, most CPCF purées and meals were identified as having high total sugar content. To ensure that older IYC consume appropriate CPCF products, Southeast Asian countries need to implement and enforce regulations concerning the nutrient composition and labelling practices of CPCF purées and meals. Key messages: Only one‐third of CPCF purées/meals were identified as nutritionally suitable for promotion for older IYC, with performance varying by sub‐category, and over three‐quarters of products contained high levels of total sugar.None of the CPCF purées/meals presented fully appropriate labelling practices, with the use of inappropriate claims the most prevalent issue. Further, one‐third of products recommended an age of introduction of less than 6 months.To ensure that CPCF purées/meals sold in Southeast Asia have appropriate nutrient composition and labelling practices, it is essential that national standards are in accordance with global guidance and enforced. [ABSTRACT FROM AUTHOR]

The complementary feeding period is a critical stage of child development when micronutrient needs are high and challenging to meet. Understanding if specific micronutrient gaps exist during this period is critical for effective programming. A Comprehensive Nutrient Gap Assessment (CONGA) was conducted in seven countries in Southeast Asia to estimate gaps in micronutrients commonly lacking in the diets of children aged 6–23 months and to establish the certainty of available evidence for each identified gap. Sixty‐eight evidence sources were identified during this analysis, and 310 micronutrient‐specific data points were identified across all seven countries. Data points varied in recency, representativeness and evidence type. The CONGA methodology enabled the estimation of a gap burden rating for each micronutrient in each country, as well as a rating of their evidence certainty. Micronutrient gaps were identified in vitamin D, zinc and iron and a potential gap was identified in calcium during the complementary feeding period in the region. Evidence relevant to intake and deficiency of folate, vitamin B12, thiamine, niacin, vitamin C and vitamin B6 was limited across the region. Proven strategies to address these gaps include increasing the availability and consumption of nutrient‐dense foods, micronutrient supplementation, large‐scale fortification of staple foods and condiments and point‐of‐use fortification through multiple micronutrient powders and fortified speciality foods. More recent data on micronutrient availability, intake and deficiency is urgently needed in Southeast Asia. Key messages: Older infants and young children aged 6–23 months experience micronutrient gaps during the complementary feeding period in Southeast Asia. Synthesis of evidence compiled across seven countries in the region identified gaps in vitamin D, zinc and iron and a potential gap in calcium during this critical period.National nutrition policies and programmes should consider multiple strategies to address these micronutrient gaps.Over half of the data points relevant to nutrient deficiency and intake compiled from the seven countries are over a decade old. More recent data on micronutrient availability, intake and deficiency is urgently needed in Southeast Asia. [ABSTRACT FROM AUTHOR]

Caregivers in low‐ and middle‐income countries increasingly feed commercially produced complementary foods (CPCF) to older infants and young children—shaped by factors including industry promotion. The dynamics of CPCF consumption and caregiver knowledge, attitudes and behaviours regarding complementary feeding practices are poorly understood in these settings. We examined how caregiver knowledge/attitudes/behaviours about CPCF shape the feeding of older infants and young children in the capital cities of five countries in Southeast Asia (Bangkok, Hanoi, Jakarta, Kuala Lumpur, Manila). An online, web‐based, cross‐sectional panel survey was conducted among mothers of a child aged 6−23 months. One hundred participants were included in each of the five capital cities. Questionnaires were undertaken in the official language of each city. Data were analysed in Stata (version 17.0), using χ2 tests to examine difference between variables of interest. All mothers purchased CPCF for their youngest child aged 6−23 months at the time of survey. CPCF were commonly fed to children at least once per day, and in many of the five cities at most or every feeding. While factors such as convenience and affordability influenced CPCF purchase, mothers primarily purchased CPCF for nutritional reasons. The most common source of feeding information was health care professionals, followed by social media. CPCF are ubiquitous in the diets of older infants and young children of educated middle–upper socioeconomic status mothers in capital cities of Southeast Asia, with perceived healthiness a key driver in selecting CPCF. A strong governmental regulatory response to industry marketing/promotion will be critical to addressing CPCF appropriateness, including health and nutritional claim use. Key messages: Commercially produced complementary foods (CPCF) are ubiquitous in the diets of older infants and young children of educated middle−upper socioeconomic status mothers in capital cities of Southeast Asia.While factors such as convenience and price and affordability influenced CPCF purchase, mothers in this study said they mainly purchased CPCF for perceived nutritional reasons.A strong government regulatory response to mandate CPCF standards for nutrient content, labelling and promotion will be critical in ensuring nutritional quality of CPCF and appropriate promotion. [ABSTRACT FROM AUTHOR]

Ensuring consumption of nutrient‐dense, safe and appropriate complementary foods among older infants and young children (IYC) 6–36 months of age is critical for enabling optimal growth and development. The ubiquitous availability of and high demand for commercially packaged snack foods has culminated in a growing trend of snack food products specifically produced and promoted for older IYC. Commercially produced complementary foods (CPCF) that are finger foods/snacks often contain added sugars, excessive sodium content and high total sugar content, making them inappropriate for this young population. This study benchmarked the nutrient composition and labelling practices of CPCF finger foods/snacks available for purchase in seven countries in Southeast Asia. The study adapted a nutrient profiling model from the WHO Regional Office for Europe to determine the proportion of products suitable for promotion for older IYC. Of the total 606 products identified, 8.2% were automatically categorized as not suitable because they were confectionery items. Of the remaining 556 products assessed, over 85% failed to meet all nutrient composition requirements, with the presence of added sugars/sweeteners and excessive sodium and total sugar contents the primary reasons for failure. Products also demonstrated concerning labelling practices, with all of the products (98.6%) displaying an inappropriate claim on the label. These findings reveal major concerns with the nutrient composition and labelling practices of CPCF finger foods/snacks in the SEA region and should serve as an alarm bell for regulatory action. National binding legal measures, such as mandatory standards for composition and labelling are urgently needed. Key messages: CPCF finger foods/snacks made up 18‐45% of CPCF products across the seven countries, indicating a normalization of commercially packaged, processed snacks products in older IYC diets.Over 85% of products failed to meet all nutrient composition requirements. Three‐quarters contained added sugars/sweeteners, half high total sugar, and half excessive levels of sodium, indicating that most products are not nutritionally appropriate for this young age group.No CPCF finger foods/snacks met all labelling requirements and most displayed inappropriate claims. With nearly all products containing excessive levels of total sugar, added sugar or sodium, use of persuasive claims on these products is alarming. [ABSTRACT FROM AUTHOR]

Child undernutrition is a public health and development problem in Myanmar that is jeopardizing children's physical and cognitive development and the country's social and economic progress. We identified key drivers of child stunting (low height‐for‐age) and wasting (low weight‐for‐height) in a nationally representative sample (n = 3,981) of children 0–59 months of age. The national prevalence of child stunting and wasting was 28% and 7%, respectively. Boys were more likely to be stunted or wasted than girls. Older children 24–35 months were at the highest risk of stunting compared with children under 6 months (risk ratios [RR] 10.34; 95% CI [6.42, 16.65]) whereas the youngest, under 6 months, were at the highest risk of wasting compared with children 36–59 months (RR 2.04; 95% CI [1.16, 3.57]). Maternal height <145 cm (RR 5.10; 95% CI [3.15, 8.23]), perceived small child size at birth (RR 2.08; 95% CI [1.62, 2.69]), and not benefiting from institutional delivery (RR 1.52; 95% CI [1.24, 1.87]) were associated with an increased risk of child stunting, as were maternal occupation, unimproved household drinking water, living in delta, coastal or upland areas, and poorer household wealth index quintile. Increased risk of child wasting was associated with maternal underweight (RR 1.64; 95% CI [1.11, 2.42]) and open defecation (RR 1.91; 95% CI [1.25, 2.92]) as well as maternal occupation and residence in a coastal area. Our findings indicate that the key drivers of child undernutrition in Myanmar are multifaceted and start in utero. Investing in scaling‐up multisectoral approaches that include nutrition‐specific and nutrition‐sensitive interventions with a focus on improving maternal nutrition is essential for reducing child undernutrition and contributing to further gains in the country's human and economic development. [ABSTRACT FROM AUTHOR]

Thailand is now faced with a double burden of malnutrition. Using nationally representative data from the 2015–2016 Multiple Indicator Cluster Survey, we utilized multinomial logistic regression models to examine factors associated with stunting only, wasting only, overweight only, concurrent stunting and overweight, and concurrent stunting and wasting among children 0–59 months of age (n = 11,068). The prevalences of <5 stunting only (height‐for‐age Z score < −2 SD) and wasting only (WHZ < −2 SD) were 8.5% and 4.7%, respectively. The prevalence of <5 overweight only (WHZ > +2 SD) was 7.8%. Children 12–23 months (risk ratio [RR], 95% confidence interval [CI]: 1.47 [1.18, 1.83]; p <.01) and 24–35 months (RR, 95% CI: 1.56 [1.26, 1.94]; p <.001) were at increased risk for stunting only, compared with children 48–59 months. The strongest risk factor for stunting only was low birth weight (RR, 95% CI: 3.42 [2.86, 4.10]; p <.001). Children 0–5 months were at highest risk for wasting only, compared with children 48–59 months (RR, 95% CI: 2.91 [2.16, 3.92]; p <.001). Children 48–59 months and male children were more likely to be overweight only. Higher household wealth and smaller household size were also significant predictors of overweight only. A small proportion of children were concurrently stunted and overweight (1.3%) and concurrently stunted and wasted (0.6%). A multipronged approach focused on adequate prenatal care, improving breastfeeding and complementary feeding practices, and mitigating the growing burden of overweight is needed to address the double burden of malnutrition in Thailand. [ABSTRACT FROM AUTHOR]

Since 2004, twice-yearly mass vitamin A supplementation (VAS) has equitably reached over 85 % of children 6-59 months old in Sierra Leone. However infants who turn 6 months after the event may wait until they are 11 months old to receive their first dose. The effectiveness of integrating VAS at 6 months into the Expanded Program of Immunization (EPI) in a revised child health card was studied. Health facilities matched according to staff cadre and work load were assigned to provide either a 'mini package' of VAS and infant and young child feeding (IYCF), a 'full package' of VAS, IYCF and family planning (FP), or 'child health card' only. 400 neonates were enrolled into each group, caregivers given the new child health card and followed until they were 12 months old. More infants in the full: 74.5 % and mini: 71.7 % group received VAS between 6 and 7 months of age compared with the new CH card only group: 60.2 % ( p = 0.002, p < 0.001 respectively). FP commodities were provided to 44.5 % of caregivers in the full compared with <2.5 % in the mini and new child health card only groups ( p < 0.0001). Integration of VAS within the EPI schedule achieved >60 % coverage for infants between 6 and 7 months of age. Provision of FP and/or IYCF further improved coverage. Funding was provided by the Canadian Department of Foreign Affairs, Trade and Development who had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. [ABSTRACT FROM AUTHOR]