Diet fortification for mild and moderate picky eating in typically developed children: Opinion review of Middle East consensus.

Background: Picky eating is a commonly observed behavior among children globally, negatively impacting their physical and mental growth. Although common characteristics distinguish peaky eaters, including food selectivity, food neophobia, and food avoidance, there is no clear definition to assess this behavior. Due to the unavailability of data regarding picky eating, it wasn't easy to estimate its prevalence.

Aim: To develop a regional protocol to help healthcare professionals identify and manage mild and moderate picky eating cases.

Methods: A virtual roundtable discussion was held in April 2021 to gather the opinions of seven pediatricians and two pediatric dietitians from eight Middle Eastern countries who had great experience in the management of picky eating. The discussion covered different topics, including clearly defining mild and moderate picky eating, identifying the role of diet fortification in these cases, and the possibility of developing a systematic approach to diet fortification.

Results: The panel identified picky eating as consuming an inadequate amount and variety of foods by rejecting familiar and unfamiliar food. Most of the time, moderate picky eating cases had micronutrient deficiencies with over- or undernutrition; the mild cases only showed inadequate food consumption and/or poor diet quality. Paying attention to the organic red flags like growth faltering and development delay and behavioral red flags, including food fixation and anticipatory gagging, will help healthcare professionals evaluate the picky eaters and the caregivers to care for their children. Although dietary supplementation and commercial food fortification play an important role in picky eating, they were no benefit in the Middle East.

Conclusion: The panel agreed that food fortification through a food-first approach and oral nutritional supplements would be the best for Middle Eastern children. These recommendations would facilitate identifying and managing picky-eating children in the Middle East.