LAUSR

Every parent aspires to provide a nutritious diet for their children, but many struggle to realize this ambition. The authoring agencies of the 2020 State of Food Security and Nutrition in the World report estimated that one-quarter of the world’s population of > 1.5 billion people cannot afford even the cheapest possible nutrient-adequate diet that meets, according to the report, “all known requirements for essential nutrients.” According to the report, this diet is unaffordable for 53% of the population of sub-Saharan Africa, and 18% of the population of southern Asia, regions that, together, are home to 52% of the world’s children and a concentration of 86% of people living in extreme poverty worldwide. Young children, after 6 months of exclusive breastfeeding, require age-appropriate nutrient-dense foods in addition to breastmilk from 6 to 24 months of age to meet the needs of their rapidly growing bodies and brains. Well-established guidelines for this age group suggest that “meat, poultry, fish or eggs should be eaten daily,” as should vitamin A–rich fruits and vegetables. Providing such a diet is clearly impossible for the 185 million people (almost all in sub-Saharan Africa) who cannot afford even a single, cheap starchy staple in adequate quantities. These families do not have even enough maize meal to stave off hunger, so adding animal-source foods, fruits, or vegetables, even in small quantities, is a lot to ask. But for the remainder of the 1.5 billion people who can meet their basic energy needs yet still cannot afford all the nutrients their families should consume, it is conceivable that they could make improvements in the quality of their children’s diets by buying or growing just enough of the cheapest, locally available, nutritious foods. Children’s stomachs, after all, are much smaller than those of adults, so the quantities required to meet their needs are relatively small. This has been the underlying logic of decades of nutrition programming, which has attempted to convince parents to prioritize the needs of their very young children. The unaffordability of nutritious foods, coupled with affordable non-nutritious foods, is a critical driver of poor quality of children’s diets, contributing to all forms of malnutrition. Headey and Alderman have shown that the food groups most likely to contribute to preventing undernutrition are precisely the ones that are most expensive to acquire (with cost expressed on a per-kilocalorie basis), and the cost differential is greatest in the regions of the world where child undernutrition is most prevalent. Even home production of such foods has a significant opportunity cost in terms of land, inputs, and family time. Therefore, it is critical to take recommendations to a greater degree of granularity: Exactly which locally available, nutrient-dense foods, in each context, are best matched to the specific nutritional needs of young children and are most affordable for the greatest number of families? This is the question addressed by the 5 research papers in this Nutrition Reviews supplement. Answering this question is not straightforward. In an ideal world, we would know the current extent of multiple nutritional deficiencies in children, measured with a high level of accuracy, timeliness, and geographic disaggregation. We would also know the affordability of a wide range of local foods and their nutrient content in small volumes suitable for children’s consumption. Neither of these conditions is met in the real world, where we struggle with conflicting, dated, unrepresentative, and potentially biased information from multiple sources, and have no commonly agreed-on approach to describe and characterize the affordability of individual foods.