ecause dietary fibres are slowly absorbed and fermented by intestinal flora, thus causing a laxative effect, the crude fibre content of the supplementary food should not exceed 5 g per 100 g dry matter .
Vitamins and Minerals
Minimum Adequate Daily Intakes
The addition of extra vitamins should take the following into account:
- the vitamin and
mineral content of the ingredients of the supplementary food
- local nutrition and health problems, - the distribution of vitamins and minerals at MCH centres, and
- relevant national legislation.
Minimal safe daily intake levels from the total diet are shown in table 1. Only those vitamins and minerals listed by the Codex committee to be contained in supplementary foods are shown. These minimum levels of daily intake and the estimated energy requirement are based on infants 6 months and children 3 years of age [7, 8].
Maximum Safe Daily Intakes
Excessive intake of fat-soluble vitamins and some minerals over a long period of time may result in toxicities. The margin of safe intake varies considerably by nutrient. In this document we consider safe maximum levels only for vitamins A, D, and E and for the minerals calcium, phosphorus, iron, and iodine since these are the micronutrients in the Codex proposed model composition for supplementary foods.
Chronic toxicity is reported from daily ingestion of vitamin A in excess of 2,500 IU per kilogram of body weight (750 µg/kg) by infants 4-6 months old  (1 IU = 0.3µg retinol = 1 retinol equivalent [RE]). On the other hand, single doses of 100,000 IU given twice yearly to infants 6-12 months old and 200,000 IU given to children over 12 months old at similar intervals have been safely used in several large-scale vitamin A distribution programmes . In view of the uses intended for the supplementary foods considered in these guidelines, maximum levels of vitamin A should not exceed 4,000-6,000 IU if the supplement is consumed daily as the sole food. Recognition of local circumstances, for example, an area where periodic high-dosage supplementation programmes are in operation, may be a reason to fortify the supplementary food at the minimum level.
TABLE 1. Safe minimum daily intake of some micronutrients for infants and young children from 4-6 months to about 3 years old, based on energy requirements
Safe minimum range
|4-6 months||3 years|
|vitamin A (retinol or its ester)|
|vitamin D (cholecalciferol), IU||320||540|
|vitamin E (a -tocopherol), IU||5.6||9.4|
|ascorbic acid, mg||64||108|
|thiamine, m g||320||540|
|riboflavin, m G||480||810|
|niacin, m g||2,000||3,375|
|vitamin B6, m g||280||470|
|folic acid, m G||32||54|
|vitamin B12, m g||1.2||2.0|
|iodine, m g||40||68|
Figures are based on a daily average energy requirement of 800 kcal for an infant 46 months old and 1,350 kcal for a 3 year-old child [7, 9-11].
Hypercalcaemia in infants and young children is reported when total daily intake of vitamin D exceeds 2,000-4,000 IU for several months (1 IU = 0.025 m g vitamin D). Since the need for this vitamin is determined, in part, by exposure to sunlight and intensity of skin pigmentation, the safe level in the diet varies. These two factors also may affect whether it is appropriate to add vitamin D to formulated supplementary foods.
There are no reports of toxicities from ingestion of vitamin E in high levels, although excessive intake can interfere competitively with the absorption of other fat-soluble vitamins. It is unlikely that natural diets of infants or young children would contain vitamin E at toxic levels, and high-dose supplementation is also unlikely. Daily diets should aim at total intake of about 10-15 IU (1 IU = 1 mg a -tocopherol acetate).
Ingestion of calcium, phosphorus, iron, or iodine at toxic levels in the natural diets is unusual in the age groups for which supplementary foods are meant. In addition, the absorption efficiency of calcium is regulated by vitamin D. The greater concern with respect to safety is to maintain a habitual diet in which the ratio of dietary calcium to phosphorus is about 2 or less.
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