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Contextual diets or chemical nutrient products for preventing malnutrition in low- and middle-income countries?
  1. Harshpal Singh Sachdev1,
  2. Ankita Mondal2,
  3. Anura Kurpad3
  1. 1Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi, Delhi, India
  2. 2Nutrition, St John's Research Institute, Bangalore, Karnataka, India
  3. 3Department of Physiology, St John's Medical College, Bangalore, Karnataka, India
  1. Correspondence to Professor Harshpal Singh Sachdev, Pediatrics and Clinical Epidemiology, Sitaram Bhartia Institute of Science and Research, New Delhi 110016, Delhi, India; hpssachdev{at}

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Appropriate complementary feeding is socioculturally diverse, rooted in cultural and historical wisdom, respecting the complementarity of local and seasonal foods. If food diversity is suboptimal, as in many low- and middle-income countries (LMICs), there can be an increased risk of some nutrient deficiencies, which result in functional consequences. It is usually possible to correct this lack of diversity by the intake of small amounts of diverse foods in children (as shown below). This increase in intake can be achieved by the community themselves, through horticultural initiatives or by the provision of these foods in subsidies. However, alternative approaches that use concoctions of chemical nutrient pastes and powders are now seen as ‘unavoidable’ solutions to low-dietary diversity, and a shortcut to preventing nutrient deficiencies. Invariably, the advocacy for using these nutrient supplements (instead of diet-based interventions) is for the short term, until food availability improves. However, explicit ‘stop-conditions’ for a supplement programme are rare. Once instituted, programmes persist indefinitely or for inordinately long periods of time. Probably the most insidious effect is that supplementary programmes make local governments less concerned with the harder task of developing a sustainable food environment. This inactivity is bolstered by the impression that the gap between nutrient intakes and requirements is too large to be met by foods alone, or the entry of commercial supplements into local markets, with their ‘superfood’ claims. More than a decade ago, it was foreseen that ‘…(products) branded with the logos of transnational companies…could indeed become monster sellers…when presented to mothers who are led to believe that the products have saved the lives of their children’.1 When dietary nutrient deficiencies or food shortages are not grave, when natural and social conditions …

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  • Contributors HSS and AK both conceived and drafted the manuscript together and approved the final version. AM performed the diet modelling and calculations.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.