Letters to the Editor

To the Editor,

The recent statements in the April 2013 issue of Paediatrics & Child Health by the Nutrition and Gastroenterology Committee (‘Nutrition for healthy term infants’) and the Community Paediatrics Committee (‘Weaning from the breast’) both make recommendations for first complementary foods in the six- month-old infant – meat, meat alternatives and iron-fortified cereals. The statements are vague in the types of offerings and in frequency. However, if the Health Canada statement published in September 2012 (1) is reviewed, the recommendations are more specific:

At this stage (six months of age), iron-rich foods, such as meat, meat alternatives (eg, eggs, tofu, and legumes), and iron-fortified infant cereals, are important to help meet the nutrient needs of the rapidly growing infant ... While meat and fish are traditional first foods for some Aboriginal groups, the common practice in North America has been to introduce infant cereal, vegetables, and fruit as first complementary foods ... However, the daily or frequent consumption of heme iron foods (meat, poultry and fish) can contribute considerably to meeting infant iron requirements ... Infants should be offered iron containing foods two or more times each day. They should be served meat, fish, poultry or meat alternatives daily.

The changes in feeding practice coincide with the admirable promotion of breastfeeding. Because breast milk does not have a high concentration of iron (although it is more bioavailable), concern is now increasing that iron deficiency (ID) and iron deficiency anemia (IDA) will increase in this population. Yet the Canadian cereal fortification program has been highly successful – IDA and ID are highly prevalent worldwide, but are only present in 1% and 3% of Canadians three years of age and older, respectively (2,3).

How can we advise elimination of red meat from adult diets because of health concerns but allow it in toddlerhood? Why limit fish intake in adults and eliminate it during pregnancy but offer it to infants? And why introduce high-cholesterol eggs to young children when there are so many other sources of iron to feed them?

In the long term, we all know that meat, red meat and processed meats in particular, are important contributors to many diseases in the adult population (4,5). Fish, particularly predatorial species, bioconcentrate mercury. We have observed some paediatric consequences of this (6), and Health Canada is sufficiently concerned that an advisory exists to limit intake (7). In addition, one egg yolk contains more cholesterol than the 200 mg/day that any adult with cardiovascular disease, diabetes, or known high cholesterol level is advised to consume (8).

It is our responsibility as health care providers to recommend dietary choices that encompass the entirety of health, not just the paediatric time frame. Highlighting IDA – which should be avoidable with fortified cereals or plant sources of iron – at the expense of safer, more balanced nutrition appears short-sighted.

If meat is being advised, at least caution parents about red meat and processed meats, and limit ingestion to a maximum of once or twice per week. Provide them with a reference to the Health Canada fish advisory and consider limiting ingestion of high-cholesterol eggs as well.

Dietary habits and preferences are formed early, as are the precursors of disease. Prevention starts young.

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