Critical vitamin D and iron intakes in infants aged 6 to 11 months: results from the nationwide German KiESEL study

Leonie Burgard ¹ Clarissa Spiegler ¹ Sara Jansen ² Anna-Kristin Brettschneider ² Andrea Straßburg ¹ Ute Alexy ³ Stefan Storcksdieck genannt Bonsmann ¹ Regina Ensenauer ² Thorsten Heuer ^1*

• ¹ Department of Nutritional Behaviour, Max Rubner Institute Karlsruhe, Karlsruhe, Germany
• ² Department of Child Nutrition, Max Rubner Institute Karlsruhe, Karlsruhe, Germany
• ³ Department of Nutritional Epidemiology, Institute of Nutrition and Food Sciences, University of Bonn, Bonn, Germany

Background: Nutrient intake during the phase of complementary feeding is pivotal for healthy development, yet current data for European infants are lacking. Objective: To provide latest data on energy and nutrient intake of infants in Germany, to compare these with the Dietary Reference Values (DRVs) of the European Food Safety Authority, and to assess the contribution of vitamin D supplementation and commercial infant foods to nutrient intake. Design: Analyses are based on weighed food records (3+1 day) of 118 infants aged 6-11 months from the representative crosssectional Children's Nutrition Survey to Record Food Consumption (KiESEL) conducted in Germany from 2014 to 2017. Energy and nutrient intake was calculated using the German Nutrient Database BLS 3.02, the LEBTAB database, and a supplement database. Results: Median energy and protein intakes were above DRVs, while fat intake was below. Dietary vitamin and mineral intakes mostly met or exceeded the DRVs. However, iron intake reached neither the Population Reference Intake nor the Average Requirement. Vitamin D intake from foods was below half the Adequate Intake (AI). When additionally considering vitamin D supplements, administered to 51.7 % of infants, the AI was reached. Girls' iodine intake was below the DRVs. In contrast, the intakes found for retinol equivalents, vitamin K, and vitamin C were about four times the DRVs. Commercial infant foods were key dietary sources for all nutrients for which intakes deviated considerably from DRVs. Conclusions: Micronutrient intake, particularly of iron and vitamin D, needs improving in infants aged 6-11 months in Germany. Vitamin D supplementation was a prerequisite for meeting the AI, confirming the necessity for vitamin D supplements in infancy and the promotion of the respective recommendations. The considerable up-and downward deviations from DRVs point to a need for adjusting fortification levels of commercial infant foods in European legislation.