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The market for commercially produced complementary foods (CPCF) is rapidly expanding in Southeast Asia; however, the existence and content of mandatory national policies, standards and legislation (binding legal measures) for CPCF in the region is unclear. To assess the status of national binding legal measures for CPCF in Southeast Asia, a legal and policy desk review was conducted in seven countries (Cambodia, Laos People's Democratic Republic, Indonesia, Malaysia, Philippines, Thailand and Viet Nam). The alignment of the national binding legal measures relevant to CPCF was assessed against guidance on CPCF nutrient composition and labelling requirements provided by Codex Alimentarius and the World Health Organization (WHO). Each of the seven countries had at least two national binding legal measures related to the nutrient composition or labelling of CPCF; however, there was limited alignment with the guidance from Codex and WHO. No country was fully aligned with the three CPCF‐specific Codex standards/guidelines and only one country was in full alignment with the recommendations related to the protection of breastfeeding from the 'WHO Guidance on ending the inappropriate promotion of foods for infants and young children'. The findings of the review indicate that the existing national binding legal measures are insufficient to ensure that the CPCF sold as suitable for older infants and young children are nutritionally adequate and labelled in a responsible manner that does not mislead caregivers. Improved and enforced national binding legal measures for CPCF, in alignment with global guidance, are required to ensure that countries protect, promote and support optimal nutrition for children 6–36 months of age. Key messages: Given the proliferation of commercially produced complementary foods (CPCF) in Southeast Asia, national binding legal measures are essential to ensure CPCF are nutritionally suitable for older infants and young children (IYC), and are labelled in a manner that does not mislead caregivers.All seven Southeast Asian countries included in this review were found to have at least two national binding legal measures related to the nutrient composition and/or labelling practices of CPCF. However, there was limited alignment between these binding legal measures and the available guidance documents.No country was fully aligned with the six relevant Codex Alimentarius (Codex) standards and only one country was fully aligned with guidance from the World Health Organization (WHO). Existing binding legal measures do not ensure that CPCF are nutritionally adequate and labelled in a responsible way that enables caregivers to make healthy choices for older IYC.Countries in Southeast Asia urgently require consolidated guidance on how to develop appropriate, legally binding and enforceable standards for CPCF nutrient composition and labelling. Existing guidance is fragmented and Codex standards are outdated and insufficient for this purpose. [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]

Little is known about factors influencing children's dietary intake in Mongolia, a country undergoing rapid nutrition transition. Using nationally representative data from the 2017 Mongolia National Nutrition Survey, we assessed the nutritional status of children aged <2 years and examined household, maternal, and child factors associated with feeding practices among children aged 6–23 months (n = 938). Multivariable logistic regression models were used to identify predictors of minimum meal frequency (MMF), minimum dietary diversity (MDD), and minimum acceptable diet (MAD). The prevalence of child stunting (length/height‐for‐age Z‐score < −2 SD) was 6.3%, and the prevalence of overweight (weight‐for‐height Z‐score > +2 SD) was 16.8%. The prevalence of anaemia and iron deficiency was 39.0% and 32.2%, respectively, and 73.5% and 85.5% of children had inadequate vitamin A and vitamin D status, respectively. Of children aged 6‐23 months, 92.1% (n = 864) had MMF, 49.6% (n = 465) had MDD, and 43.8% (n = 411) achieved MAD. Increased household wealth was positively associated with all three indicators, whereas severe food insecurity was not associated with MMF, MDD, or MAD. Older child age (odds ratio, 95% CI: 1.09 [1.06, 1.12]; p <.001) and maternal dietary diversity (odds ratio, 95% CI: 2.36 [1.67, 3.34]; p <.001) were positively associated with child MDD. Nutrition‐specific and nutrition‐sensitive efforts are needed to improve the dietary quality of infants and young children in Mongolia and reduce the high burdens of child micronutrient deficiency and overweight in the country. [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]