As per recent estimates, globally 20% of young children are underweight, 32% are stunted and 10% are wasted, over 50% of world’s undernourished children are in South Asia ^{(1, 2)}.

Problems of poor calorie intake, provision of macro & micronutrient deficient weaning food seem to potential factors of poor growth in these children ⁽³⁾.

Deficiencies of essential micronutrients, vitamin A and iron seem to be major problems in Indian children. It has been found that iron deficiency anemia is prevalent in 74% of preschoolers and vitamin A deficiency ranges from 26.3% in New Delhi to 80.1% in Hyderabad ^{(4, 5)}.

Though exclusive breast feeding in first 6 months of life is essential for improved infant survival and reduction of morbidity; improvisation of complementary feeding is essential to improve growth ⁽³⁾. A study from Mumbai, conducted in urban slum children found that among complementary feeds in children between 13-24 months, cereal based items were predominant with only small amount of vegetables/fruits and it was found that intake of all nutrients and especially of calcium and iron was low ⁽⁶⁾.

Thus, causes of nutrient deficiency in preschoolers seem to be inadequate intake of mineral rich complementary foods (due to poverty, unavailability of mineral rich food, poor biological value food where deficiency of one nutrient may lead to deficiency of another and parasitic infections leading to blood loss, reduced appetite and decreased absorption of nutrients) ⁽⁷⁾.

Main solutions to control these micronutrient deficiencies consists of food diversification and intake of food rich in particular micronutrients; food fortification by adding a nutrient to a food that is widely consumed such as addition of iodine to common salt to prevent iodine deficiency; and micronutrient supplements to prevent deficiency ⁽⁸⁾.

Several studies have documented improvement of growth in preschoolers who had multiple micronutrient supplements as compared to those receiving only iron, or only vitamin A or combination and iron and vitamin A with/without zinc ^{(9, 10)}. However higher compliance and adherence to multimicronutrient supplements is needed to achieve increase in length ⁽⁹⁾. Thus, multimicronutrient supplements in preschoolers helps to improve growth and till food diversification (production, availability and consumption of foods rich in micronutrients) is available, additional micronutrients in form of supplementation or fortification is essential.

1.		UNICEF. The state of the world’s children. 2007. New York. NY:UNICEF 2006.
2.		Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008; 371: 243-260.
3.		Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008; 371: 417-440.
4.		International Institute for Population Sciences. National Family Health Survey (NFHS2). 1998-99. Mumbai, India: IIPS, 2000.
5.		Mason JB, Lotfi M, Dalmiya N, Sethuraman K, Deitchler M. The micronutrient report: current progress and trends in the control of vitamin A, iodine and iron deficiencies. Ottawa, Canada: Micronutrient Innitiative, 2001.
6.		Jani R, Udipi SA, Ghugre PS. Mineral content of complementary foods. Indian J Pediatr. 2009; 76: 37-44.
7.		Latham M, Human nutrition in the developing world. Rome: Food and Agriculture Organization, 1997.
8.		World Bank. Enriching lives: overcoming vitamin and mineral malnutrition in developing countries. Washington DC;World Bank, 1994.
9.		Ramakrishnan U, Neufeld LM, Flores R, Rivera J, Martorell R. Multiple micronutrient supplementation during early childhood increases child size at 2 y of age only among high compliers. Am J Clin Nutr. 2009; 89: 1125-1131.
10.		Ramakrishnan U, Aburto N, McCabe G, Martorell R. Multimicronutrient interventions but not vitamin a or iron interventions alone improve child growth: results of 3 meta-analyses. J Nutr. 2004; 134: 2592-2602.