Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Mar 9, 2025; 14(1): 101769
Published online Mar 9, 2025. doi: 10.5409/wjcp.v14.i1.101769
Diet fortification for mild and moderate picky eating in typically developed children: Opinion review of Middle East consensus
Mohammed Al-Beltagi, Elie Choueiry, Najat Alahmadi, Zeinab Demerdash, Wafaa Helmi Ayesh, Khoula Al-Said, Fatima Al-Haddad, Sanaa Y Shaaban, Eslam Tawfik
Mohammed Al-Beltagi, Department of Pediatric, Faculty of Medicine, Tanta University, Tanta ‎ 31511‎, Egypt
Mohammed Al-Beltagi, Department of Pediatric, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama 26671, Manama, Bahrain
Elie Choueiry, Paediatric Intensive and Critical Care Unit, Hospital Hôtel Dieu de France, Beirut 166830, Beyrouth, Lebanon
Najat Alahmadi, Department of Pediatric Gastroenterology, Hepatology and Nutrition, Madina Maternity and Children Hospital, King Salman Medical City, Almadina Almonawarh 41412, Almadina Almonawarh, Saudi Arabia
Zeinab Demerdash, Department of Gastroenterology, Hepatology and Nutrition, Al Amiri Hospital, Kuwait City 999044, Kuwait
Wafaa Helmi Ayesh, Department of Nutrition, Altadawi Speciality Hospital, Dubai 1853, Dubayy, United Arab Emirates
Khoula Al-Said, Department of Paediatric Gastroenterology, Royal Hospital, Muscat 1331, Muscat, Oman
Fatima Al-Haddad, Department of Dietetic, Salmaniya Medical Complex, Government Hospitals, Al Salmaniya 12, Manama, Bahrain
Sanaa Y Shaaban, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo 11591, Egypt
Eslam Tawfik, Department of Paediatric, Faculty of Medicine, Suez University, Suez 41522, Egypt
Eslam Tawfik, Department of Paediatric, Sheikh Khalifa Medical City, Abu Dhabi 00000, Abu Dhabi, United Arab Emirates
Author contributions: All authors contributed substantially to developing the opinion review; Al-Beltagi M conceptualized the study, coordinated the virtual roundtable discussion, and led the manuscript writing process; Tawfik E contributed to the study design and provided expertise in pediatric nutrition; Choueiry E shared insights on pediatric intensive care and its relation to picky eating; while Alahmadi N offered expertise in gastroenterology and nutrition, providing critical feedback on the manuscript; Demerdash Z reviewed the clinical aspects of nutrition and contributed to the discussion on regional dietary practices; Helmi Ayesh W provided a public health perspective and contributed to recommendations on diet fortification; Al-Said K assisted with data interpretation and shared her expertise in pediatric gastroenterology; Al-Haddad F reviewed the manuscript and provided insights on pediatric dietary practices in Bahrain; Shaaban SY participated in the roundtable discussion and reviewed the manuscript for intellectual content; All authors reviewed and approved the final version of the manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Beltagi, PhD, Research Scientist, Department of Pediatric, Faculty of Medicine, Tanta University, Al-Bahr Street, The Medical Complex, Tanta ‎ 31511‎, Egypt. mbelrem@hotmail.com
Received: September 25, 2024
Revised: October 30, 2024
Accepted: November 26, 2024
Published online: March 9, 2025
Processing time: 85 Days and 14.4 Hours
Abstract
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.

Keywords: Picky eating; Diet fortification; Children; Protocol; Roundtable discussion; Middle East

Core Tip: Picky eating among typically developed children is a growing concern in the Middle East, where micronutrient deficiencies are common in moderate cases. This review highlights insights from a virtual roundtable discussion of experts in the region who emphasized the importance of a food-first approach to diet fortification. They identified key red flags, such as growth faltering and food fixation, to aid in early identification. While dietary supplementation is crucial, the panel found commercial food fortification less effective in the region. Their recommendations aim to guide healthcare professionals in managing picky eating by prioritizing balanced nutrition and systematic intervention.