What Children Eat in Developing Countries: Diet in the Etiology of Undernutrition?

Christiani Jeyakumar Henry

It has been reported that nearly 50% of all deaths in children under 5 years may be attributed to undernutrition [1]. An understanding of what children eat is at the heart of our ability to prescribe an optimal diet for growth, development, and well-being. Undernutrition during the first 1,000 days of life has far-reaching consequences. It is a time when body tissues and brain development are forged, with long-term metabolic consequences. Stunting (short height for a child’s age), underweight (low body weight for age), and wasting (low weight for height) are the 3 commonly measured parameters of undernutrition. Around 25% of all children in low-/middle-income countries are permanently stunted in both their height and cognitive development. Stunting rates are up to 35% in Asia [2]. In fact, of the 34 countries where 90% of all the stunted children live, a significant number are in Asia. This statistic prompts us to reexamine the “the Asian enigma” to describe the lack of clarity on why the prevalence of childhood undernutrition and poor growth is much higher in this region than the rest of the world. An obvious starting point to explore this question is to examine critically what children eat in this region. There are surprisingly little reliable quantitative data on the energy intake in children living in many emerging economies. With increasing number of observational studies from around the world, some generalization can be made. The primary staples given to young children (in Asia and Africa) are largely composed of gruels made from rice, maize, cassava, yam, millet, and sago. These gruels are usually prepared by cooking these starches with water. During the process of cooking, the starch granules swell, gelatinize, and form thick, viscous pastes that are very low in energy density. Fed on such viscous foods, children are unable to consume sufficient feed to meet their energy and nutrient needs [3]. In an attempt to make such feeds acceptable to the infants, mothers may further tend to increase the water content of these porridges. This enables the porridge to be fed using a drinking cup. However, the further dilution of the porridge with water, although reducing the viscosity, drastically reduces the energy density of the feed. The first challenge in preparing foods with adequate nutrients for growth and maintenance in children is to construct and formulate foods with sufficient energy density, optimal viscosity, and mouthfeel. The opportunities and technical solutions that will enable us to develop foods of high nutrient value and energy for infant feeding will form the first part of this paper. 

It is now well recognized that linear growth (height) is significantly influenced by the quality and quantity of protein intake along with the bioavailability of certain micronutrients, notably zinc and other trace elements. A major challenge facing infant feeding in Asia, Africa, and Latin America is the poor quality of protein consumed and the bioavailability of micronutrients. Novel strategies to improve protein quality and enhance bioavailability will be the focus of the final part of the paper. Despite nearly 8 decades of nutrition research on improving child nutrition, many children around the world have poor access to energy and nutrient-rich foods. Modern advances in agriculture, technology, and nutrition will enable us to develop a range of foods that will optimize growth, development, and human well-being.


  1. Black RE: Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013;382:427–451.
  2. Bloem MW, de Pee S, Le Hop T, et al: Key strategies to further reduce stunting in Southeast Asia: lessons from the ASEAN countries workshop. Food Nutr Bull 2013;34(2 suppl 1):S8–S16.
  3. Kimmons JE, Dewey KG, Haque E, et al: Low nutrient intakes among infants in rural Bangladesh are attributable to low intake and micronutrient density of complementary foods. J Nutr 2005;135:444–451.