Give your children food supplements

Children's food: extra dose more than superfluous

Research Institute for Child Nutrition

Parents are quick to worry if their child allegedly eats too little fruit and vegetables. Reaching for vitaminized foods or supplements often appears to be a simple solution. But they are often specifically called Food for children advertised products and nutritional supplements are anything but useful.

The Research Institute for Child Nutrition in Dortmund (FKE) has been scrutinizing children's eating habits for years. In the optimized mixed diet developed by the FKE, the same rules for choosing food apply to all age groups:

  • Abundant: Beverages and plant-based foods (more than 75% of the amount of food)
  • moderate: animal foods (about 20%) and
  • economical: foods rich in fat and sugar (maximum 5%)

To see how these recommendations are implemented in everyday life, the DONALD Study (Dortmund Nutritional and Anthropometric Longitudinally Designed Study) has been recording the food consumption of healthy infants, children and adolescents in detail since 1985. To date, there is data from more than 1,100 children with more than 10,000 three-day cradle feeding logs. As the practical implementation of the optimized mixed diet in menus shows, a sufficient intake of most vitamins is possible without additives. Plant foods, especially vegetables and cereal products, are of paramount importance for vitamin intake. The intake of folic acid can be effectively increased with folic acid-fortified table salt (100 mg / kg). In addition to food (about half of the recommended intake), the body's own production through exposure to sunlight also contributes to the supply of vitamin D.

Children's foods: More and more is being enriched

Nevertheless, more and more foods fortified with vitamins and minerals are being offered. A market survey in Germany in the mid-1990s identified 288 fortified foods. Vitamins were fortified more frequently, in a more varied and higher doses than minerals. Around 15 years later, there were already more than 400 products, limited to foods fortified with folic acid and the range of cereals, dairy products and juices. The range of foods that are marketed specifically for children has increased fivefold in the last eight years - to more than 350 products today. More than 80% of these “children's foods” contain added sugar, around 40% are fortified with vitamins, especially breakfast cereals. Assuming that a child consumed the lowest or highest enrichment dose from five product groups of “children's foods” each day, this would add up to considerable amounts. With eight vitamins (E, C, B1, B2, B12, niacin, pantothenic acid, folic acid) it would absorb at least one and a maximum of two to three times the nutrients recommended for its age, with vitamin B6 and biotin even up to seven times .

Pills for the little ones

A market survey at the end of the 1990s identified 110 food supplements that were offered for children and adolescents in addition to the fortified children's foods. They either advertised directly with their name, for example “junior vitamins” (42%), or explicitly stated dosage information for children (58%). In addition to 16 minerals, these preparations contained a total of 13 vitamins, most commonly vitamin C, followed by vitamin E and combinations of B vitamins. Similar to fortified foods, vitamins were used more frequently, in a more diverse and in higher doses than minerals. The Federal Institute for Risk Assessment (BfR) recommends for vitamin-enriched foods for general consumption, including products for children such as cereals, that the addition should not amount to more than the simple recommended daily intake for a normal consumption. Depending on the vitamin, supplements should not contain more than one to three times as much. The aim is to prevent such an accumulation of high doses of vitamins from different products.

The daily doses suggested by the manufacturers were mostly in the range between one to three times the recommended daily intake for adults. In principle, they corresponded to the recommendations of the BfR, but these values ​​cannot simply be transferred to children. A few preparations contained only the smallest doses, while others contained up to 30 times the recommended daily intake of individual vitamins.

Children's foods: from offer to consumption

At the beginning of the DONALD study in 1985, nutrient-enriched foods were found in around 70% of the protocols of children and adolescents, today these are found in practically every protocol: especially fortified breakfast cereals (60% of the protocols) and beverages (40%). Depending on the nutrient, these products make different contributions to the nutrient supply. A distinction can be made between three intake categories: For some nutrients, the recommended intake was already achieved with conventional foods - so fortifying them was pointless. For other nutrients, the supplement helped meet the recommendations - so it was useful. In still others, the recommendation was missed despite enrichment - so the addition was not very effective. In the course of the study period, nutrient-enriched foods provided an increasing proportion of energy and sugar intake. At the beginning of the study it was 5% of the energy and 10% of the sugar intake, in 2003 this proportion was 7% and 17% respectively. Obviously there is a trend towards making fortified foods even sweeter in child nutrition. It was also shown that consumers of foods fortified with folic acid consumed about twice as much folic acid as non-consumers. Up to 3% even exceeded the tolerable maximum intake.

Addition is not without risk

In the period from 1985 to 2003, the DONALD study also recorded a total of 123 vitamin supplements, more than half of which were combined with minerals. Vitamin C was represented most frequently with 90% of the preparations, followed by mixtures of B vitamins (60-70%). The use was shown to be dependent on age: study participants aged 15 to 18 took vitamin supplements more often (11%) than 2 to 14 year olds (7%). If you take in nutrients in the food compound, an imbalance due to an excessive intake of individual nutrients is not to be expected. It is different with added nutrients. Under certain circumstances, the intake can quickly exceed the recommendations, with the risk of pharmacological and toxicological effects. However, there are still considerable gaps in our knowledge to assess the potential risk of individual nutrients. With the current fortification of foods and also with the use of nutrients in supplements, it is difficult to identify a nutritional concept. Rather, there is the impression of a watering can principle, the various effects of which on the supply of nutrients in infants, children and adolescents are difficult to predict, even for experts. Most parents are likely to be overwhelmed by this.

Children's food: the amount of nutrients can hardly be controlled

The nutrient intake of the individual child can hardly be controlled through fortified foods. How much children eat depends on their current hunger and taste preferences, not on the amount of vitamins they contain. As the intake of foods fortified with folic acid shows, with current eating habits it cannot be ruled out that the maximum tolerable intake will be exceeded - and supplements containing folic acid are not yet taken into account. In addition, the actual content of storage-sensitive vitamins such as vitamin C in the products is likely to be higher than the declared amount. Because the specified amount must be contained in the product by the best before date.

Children's foods: Lots of extra sugar

The manufacturers of fortified foods in particular advertise that their product covers a certain part of the recommended nutrient intake. But this mostly refers to the recommendations for adults. In doing so, the manufacturers overestimate the need, for example, of 7 to 9 year old children, a main target group for marketing “children's food”, by around 30%. Parents could be led unconsciously into giving their child more than it actually needs. Side effects cannot be ruled out. Many parents are also unlikely to be aware that with the additional vitamins, additional sugar is often consumed. Highly sugared products, like most of the breakfast cereals offered for children, are among the sweets in the Optimized Mixed Diet that should only be consumed sparingly, but not as a daily breakfast. Unfortunately, the practice looks very different. So far, there is also no evidence of health benefits from vitamins used in isolation - apart from the supplementation of folic acid before conception. With high-dose, long-term ingestion of beta-carotene, for example, the risk of cell-damaging effects can even be increased. On the other hand, there is increasing evidence from large intervention studies that antioxidant vitamins can only fully develop their preventive effects when combined with foods. The hypothesis that vitamin supplements improve cognitive performance in children has not yet been convincingly confirmed. At most, children who are generally not well nourished could benefit from nutrient supplements for their non-verbal intelligence. Such children would also benefit from having a regular breakfast.

Correct advice to concerned parents

Often parents have exaggerated ideas about the amount of food that children need. An explanation, for example based on age-appropriate food quantities, can help them to make a better assessment. Children eat more vegetables and fruits when their preferences are taken into account. They like sweet-tasting fruit far more than bitter-tasting vegetables, raw vegetables are more popular than cooked ones. Most will accept at least some vegetables or fruit. For this they should be praised rather than blamed. Children also use fruit and vegetables more often if they are offered bite-sized as finger food. For very picky children, fruit juices or the new smoothies can also replace part of the fruit consumption.

Even if a healthy child's vitamin intake is found to be below the age-appropriate recommendation with the help of a nutritional protocol lasting several days, this alone is not a sufficient reason to resort to nutritional supplements. Because the recommendations made are very generous. Rather, it is then worthwhile to seek advice on suitable foods, taking existing eating habits into account. A vegetarian (meat-free) diet also poses no risks for the supply of vitamins. On the contrary: With their high consumption of plant-based foods, vegetarians usually take in more vitamins than the majority of the population with the usual mixed diet. If you do without all animal foods (vegan diet), on the other hand, vitamin B12 must be supplemented in order to prevent the masking of megaloblastic anemia with copious folic acid intake. A nutrition log can provide clues as to whether the intake of further vitamins (B2, D) or other nutrients should be classified as critical.

Better to eat varied

As before, healthy children and adolescents can be well supplied with a balanced mixture of conventional foods with vitamins. This also applies to complementary foods in the second half of life. A vitamin intake that goes beyond the existing recommendations offers no benefits for health and performance. Switching to vitamin supplements may take some of the parents' concerns about an undersupply of their child. However, this must not be a license for unfavorable eating habits. As the DONALD study shows, many children and adolescents still consume too much fat and sugar, but too few vegetables, fruit and grain products. Such an energy-dense diet increases the risk of obesity and the secondary diseases that can already occur in children and adolescents. It is therefore more important than fortified foods and nutritional supplements that the whole family eats varied and balanced meals and often uses fresh foods.

The article was compiled after publications by the Research Institute for Child Nutrition and authorized by the head of PD Dr. Mathilde Kersting.

Source: Research Institute for Child Nutrition. UGB-FORUM 1/08 pp. 13-16

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