Pediatric Nutrition in Practice

120 Przyrembel

Recommended Diet Composition

OptimiX provides about 53% of the energy intake
mostly from complex carbohydrates, 33% of the
energy from fat mostly of plant origin (saturated
fatty acids: 10%; monounsaturated fatty acids:
15%; polyunsaturated fatty acids: 7% of total en-
ergy) and 14% of the energy from protein, half of
animal and half of plant origin. The energy den-
sity is about 70 kcal/100 g, the fiber density 17 g/
1,000 kcal and the water density about 1.2 g/kcal.
The most suitable fat intake for toddlers is not
known; it should not be <25% of the energy [2, 5,
6]. Protein sources will reflect country- and cul-
ture-specific dietary habits, and plant protein can
provide the majority of protein intake. In that
case, a variety of plant foods should be consumed,
which compensate for each other’s deficiencies in
certain indispensable amino acids. A vegan diet
with no animal-derived food is not suitable for
toddlers.

Meals and Meal Patterns

Whenever possible, meals should be consumed in
the company of others and at regular times, while
snacking should be avoided. The distribution of
basic and tolerated foods over different meals can
vary, but all meals together should add up to pro-
vide an adequate intake of all nutrients and en-
ergy. Toddlers will need more frequent meals
than older children. The types of meal, both hot
and cold, and the time of day at which they are
consumed will vary between countries and fami-
lies. Both cold and hot meals should be accompa-
nied by a beverage. Cold meals will mostly consist
of bread and cereals, dairy products, and raw fruit
and vegetables, and thus provide the majority of
the daily carbohydrate, fiber and calcium intake
besides significant percentages of vitamin C and
folate intake. Hot meals are based on potatoes,
rice or pasta, vegetables and salads, while meat or
fish serves as a supplement and therefore need

not be eaten every day of the week. Hot meals thus

contribute significantly to the intake of numerous

vitamins and minerals such as vitamins B 6 and

B 12 , magnesium, phosphorus and iodine.

Choice of Foods

Foods particularly manufactured and specially

fortified with nutrients are not a necessary part of

a healthy toddler’s diet, although a wide variety of

such foods is available and is convenient to use. In

circumstances where nutrient-dense foods are

scarce, fortification or supplementation can,

however, become necessary, particularly with re-

gard to iron, iodine, zinc and calcium. Self-pre-

pared food for toddlers should not be salted. Low-

salt varieties of processed foods should be chosen.

Bread and cereals , but also rice and pasta,

should preferably be wholegrain products, which

contain B vitamins, magnesium, iron, fiber, pro-

tein and unsaturated fatty acids. A mixture of

wholegrain and more refined products may be

better accepted by young children.

Ve g e t a b l e s a n d f r u i t s , if not served raw, should

be boiled as briefly and in as little water as pos-

sible to reduce inevitable losses of vitamins, min-

erals and secondary plant substances such as ca-

rotenoids, phytosterins and polyphenols. While

the primary choice of fruit, legumes and vegeta-

bles should be those which are in season, it may

be necessary to be more f lexible in the case of

strong dislikes. Fruit juices can substitute for

fruit in exceptional cases.

Milk and dairy products are indispensable in

all children’s diets as sources of calcium and oth-

er minerals as well as of vitamins. From the age

of about 2 years, whole milk and milk products

can be replaced by reduced-fat products.

Meat and meat products are important be-

cause of well-available iron and zinc, particularly

for toddlers and young children. Moreover, they

provide high-quality protein and important B vi-

tamins. Products low in fat should be preferred.

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 118–121

DOI: 10.1159/000360329