Background: Among the potentially critical nutrients for toddlers, vitamin D, iron and long-chain polyunsaturated fatty acids (LC-PUFA) have recently gained special attention. A high prevalence of vitamin D deficiency was reported worldwide, affecting also small children. Iron deficiency and iron deficiency anaemia was described to be outstanding among children and prevalent in toddlers. The results of the few available studies investigating LC-PUFA intake in toddlers indicate that docosahexaenoic acid (DHA) intake in this age group fails to agree with current nutritional recommendations. Key Messages: Supplementation of toddlers with vitamin D in form of drops or tablets is already part of feeding recommendations in the majority of European countries. It is the responsibility of practitioners to work on the effective implementation of these recommendations in practice. Untoward nutritional habits, but also other factors such as socioeconomic background, are predictors of iron deficiency. Toddlers should receive iron-rich complementary foods. The consumption of fish should be encouraged already with complementary feeding to improve the DHA supply to infants and toddlers. In Hungary, DHA levels in breast milk are spectacularly lower than median DHA levels usually reported in the literature; therefore, more awareness of the importance of DHA intake during pregnancy should be created. Conclusion: There is a need to address potentially critical nutrients for toddlers and young children in Europe, such as vitamin D, iron and n-3 PUFA.

1.
Smithers LG, Brazionis L, Golley RK, Mittinty MN, Northstone K, Emmett P, McNaughton SA, Campbell KJ, Lynch JW: Associations between dietary patterns at 6 and 15 months of age and sociodemographic factors. Eur J Clin Nutr 2012;66:658-666.
2.
Stang J: Improving the eating patterns of infants and toddlers. J Am Diet Assoc 2006;106:S7-S9.
3.
Briefel R, Hanson C, Fox MK, Novak T, Ziegler P: Feeding Infants and Toddlers Study: do vitamin and mineral supplements contribute to nutrient adequacy or excess among US infants and toddlers? J Am Diet Assoc 2006;106:S52-S65.
4.
EFSA NDA Panel: Scientific opinion on nutrient requirements and dietary intakes of infants and young children in the European Union. EFSA J 2013;11:3408.
5.
Domellof M, Braegger C, Campoy C, Colomb V, Decsi T, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van Goudoever J: Iron requirements of infants and toddlers. J Pediatr Gastroenterol Nutr 2014;58:119-129.
6.
Male C, Persson LA, Freeman V, Guerra A, van't Hof MA, Haschke F: Prevalence of iron deficiency in 12-mo-old infants from 11 European areas and influence of dietary factors on iron status (Euro-Growth study). Acta Paediatr 2001;90:492-498.
7.
Hicks PD, Zavaleta N, Chen Z, Abrams SA, Lonnerdal B: Iron deficiency, but not anemia, upregulates iron absorption in breast-fed peruvian infants. J Nutr 2006;136:2435-2438.
8.
Hurrell R, Egli I: Iron bioavailability and dietary reference values. Am J Clin Nutr 2010;91:1461s-1467s.
9.
Lind T, Hernell O, Lonnerdal B, Stenlund H, Domellof M, Persson LA: Dietary iron intake is positively associated with hemoglobin concentration during infancy but not during the second year of life. J Nutr 2004;134:1064-1070.
10.
Fox MK, Reidy K, Novak T, Ziegler P: Sources of energy and nutrients in the diets of infants and toddlers. J Am Diet Assoc 2006;106:S28-S42.
11.
Thane CW, Walmsley CM, Bates CJ, Prentice A, Cole TJ: Risk factors for poor iron status in British toddlers: further analysis of data from the National Diet and Nutrition Survey of children aged 1.5-4.5 years. Public Health Nutr 2000;3:433-440.
12.
Moshe G, Amitai Y, Korchia G, Korchia L, Tenenbaum A, Rosenblum J, Schechter A: Anemia and iron deficiency in children: association with red meat and poultry consumption. J Pediatr Gastroenterol Nutr 2013;57:722-727.
13.
Braegger C, Campoy C, Colomb V, Decsi T, Domellof M, Fewtrell M, Hojsak I, Mihatsch W, Molgaard C, Shamir R, Turck D, van Goudoever J: Vitamin D in the healthy European paediatric population. J Pediatr Gastroenterol Nutr 2013;56:692-701.
14.
Maguire JL, Birken CS, Loeb MB, Mamdani M, Thorpe K, Hoch JS, Mazzulli T, Borkhoff CM, Macarthur C, Parkin PC: DO IT Trial: vitamin D Outcomes and Interventions in Toddlers - a TARGet Kids! randomized controlled trial. BMC Pediatr 2014;14:37.
15.
Grindulis H, Scott PH, Belton NR, Wharton BA: Combined deficiency of iron and vitamin D in Asian toddlers. Arch Dis Child 1986;61:843-848.
16.
Lawson M, Thomas M: Vitamin D concentrations in Asian children aged 2 years living in England: population survey. BMJ 1999;318:28.
17.
Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, Cox JE: Prevalence of vitamin D deficiency among healthy infants and toddlers. Arch Pediatr Adolesc Med 2008;162:505-512.
18.
Maguire JL, Birken CS, O'Connor DL, Macarthur C, Thorpe KE, Mamdani M, Parkin PC: Prevalence and predictors of low vitamin D concentrations in urban Canadian toddlers. Paediatr Child Health 2011;16:e11-e15.
19.
Dawodu A, Wagner CL: Prevention of vitamin D deficiency in mothers and infants worldwide: a paradigm shift. Paediatr Int Child Health 2012;32:3-13.
20.
Dawodu A, Tsang RC: Maternal vitamin D status: effect on milk vitamin D content and vitamin D status of breastfeeding infants. Adv Nutr 2012;3:353-361.
21.
Biró L, Szeitz-Szabó M, Biró G, Sali J: Dietary survey in Hungary, 2009. Part II. Vitamins, macro-and microelements, food supplements and food allergy. Acta Alimentaria 2011;40:301-312.
22.
Koletzko B, Lien E, Agostoni C, Bohles H, Campoy C, Cetin I, Decsi T, Dudenhausen JW, Dupont C, Forsyth S, Hoesli I, Holzgreve W, Lapillonne A, Putet G, Secher NJ, Symonds M, Szajewska H, Willatts P, Uauy R: The roles of long-chain polyunsaturated fatty acids in pregnancy, lactation and infancy: review of current knowledge and consensus recommendations. J Perinat Med 2008;36:5-14.
23.
Burdge GC: Metabolism of α-linolenic acid in humans. Prostaglandins Leukot Essent Fatty Acids 2006;75:161-168.
24.
Brenna JT, Varamini B, Jensen RG, Diersen-Schade DA, Boettcher JA, Arterburn LM: Docosahexaenoic and arachidonic acid concentrations in human breast milk worldwide. Am J Clin Nutr 2007;85:1457-1464.
25.
Minda H, Kovacs A, Funke S, Szasz M, Burus I, Molnar S, Marosvolgyi T, Decsi T: Changes of fatty acid composition of human milk during the first month of lactation: a day-to-day approach in the first week. Ann Nutr Metab 2004;48:202-209.
26.
Hilbig A, Kersting M: Effects of age and time on energy and macronutrient intake in German infants and young children: results of the DONALD study. J Pediatr Gastroenterol Nutr 2006;43:518-524.
27.
Sioen I, Huybrechts I, Verbeke W, Camp JV, De Henauw S: n-6 and n-3 PUFA intakes of pre-school children in Flanders, Belgium. Br J Nutr 2007;98:819-825.
28.
Minns LM, Kerling EH, Neely MR, Sullivan DK, Wampler JL, Harris CL, Berseth CL, Carlson SE: Toddler formula supplemented with docosahexaenoic acid (DHA) improves DHA status and respiratory health in a randomized, double-blind, controlled trial of US children less than 3 years of age. Prostaglandins Leukot Essent Fatty Acids 2010;82:287-293.
29.
Harslof LB, Larsen LH, Ritz C, Hellgren LI, Michaelsen KF, Vogel U, Lauritzen L: FADS genotype and diet are important determinants of DHA status: a cross-sectional study in Danish infants. Am J Clin Nutr 2013;97:1403-1410.
30.
Innis SM, Vaghri Z, King DJ: n-6 docosapentaenoic acid is not a predictor of low docosahexaenoic acid status in Canadian preschool children. Am J Clin Nutr 2004;80:768-773.
31.
United States Department of Agriculture Agricultural Research Service: Nutrient intakes from food: mean amounts consumed per individual, one day, 2003-2004. 2007. http://www.ars.usda.gov/SP2UserFiles/Place/12355000/pdf/0506/Table_2_NIF_05.pdf.
32.
Koletzko B, Uauy R, Palou A, Kok F, Hornstra G, Eilander A, Moretti D, Osendarp S, Zock P, Innis S: Dietary intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) in children - a workshop report. Br J Nutr 2010;103:923-928.
33.
EFSA NDA Panel: Scientific opinion on dietary reference values for fats, including saturated fatty acids, polyunsaturated fatty acids, monounsaturated fatty acids, trans fatty acids, and cholesterol. EFSA J 2010;8:1461.
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