Emma Jacquier

Total Usual Nutrient Intakes of US Children (Under 48 Months): Findings from the Feeding Infants and Toddlers Study (FITS) 2016

Abstract Background The US Dietary Guidelines will expand in 2020 to include infants and toddlers. Understanding current dietary intakes is critical to inform policy. Objective The purpose of this analysis was to examine the usual total nutrient intakes from diet and supplements among US children. Methods The Feeding Infants and Toddlers Study 2016 is a national cross-sectional study of children aged <48 mo (n = 3235): younger infants (birth to 5.9 mo), older infants (6–11.9 mo), toddlers (12–23.9 mo), younger preschoolers (24–36.9 mo), and older preschoolers (36–47.9 mo) based on the use of a 24-h dietary recall. A second 24-h recall was collected from a representative subsample (n = 799). Energy, total nutrient intake distributions, and compliance with Dietary Reference Intakes were estimated with the use of the National Cancer Institute method. Results Dietary supplement use was 15–23% among infants and toddlers and 35–45% among preschoolers. Dietary intakes of infants were adequate, with mean intakes exceeding Adequate Intake for all nutrients except vitamins D and E. Iron intakes fell below the Estimated Average Requirement for older infants (18%). We found that 31–33% of children aged 12–47.9 mo had low percentage of energy from total fat, and >60% of children aged 24–47.9 mo exceeded the saturated fat guidelines. The likelihood of nutrient inadequacy for many nutrients was higher for toddlers: 3.2% and 2.5% greater than the Adequate Intake for fiber and potassium and 76% and 52% less than the Estimated Average Requirement for vitamins D and E, respectively. These patterns continued through older ages. Intakes exceeded the Tolerable Upper Intake Level of sodium, retinol, and zinc across most age groups. Conclusions Dietary intakes of US infants are largely nutritionally adequate; concern exists over iron intakes in those aged 6–11.9 mo. For toddlers and preschoolers, high intake of sodium and low intakes of potassium, fiber, and vitamin D and, for preschoolers, excess saturated fat are of concern. Excess retinol, zinc, and folic acid was noted across most ages, especially among supplement users.

Cross-sectional analysis of eating patterns and snacking in the US Feeding Infants and Toddlers Study 2008

OBJECTIVE To explore eating patterns and snacking among US infants, toddlers and pre-school children. DESIGN The Feeding Infants and Toddlers Study (FITS) 2008 was a cross-sectional national survey of children aged 6-47 months, weighted to reflect US age and racial/ethnic distributions. Dietary data were collected using one multiple-pass 24h recall. Eating occasions were categorized as meals, snacks or other (comprised of all feedings of breast milk and/or infant formula). The percentage of children consuming meals and snacks and their contribution to total energy, the number of snacks consumed per day, energy and nutrients coming from snacks and the most commonly consumed snacks were evaluated by age. SETTING A national sample of US infants, toddlers and pre-school children. SUBJECTS A total of 2891 children in five age groups: 6-8 months (n 249), 9-11 months (n 256), 12-23 months (n 925), 24-35 months (n 736) and 36-47 months (n 725). RESULTS Snacks were already consumed by 37 % of infants beginning at 6 months; by 12 months of age, nearly 95 % were consuming at least one snack per day. Snacks provided 25 % of daily energy from the age of 12 months. Approximately 40 % of toddlers and pre-school children consumed fruit and cows milk during snacks; about 25 % consumed 100 % fruit juice. Cookies were introduced early; by 24 months, 57 % consumed cookies or candy in a given day. CONCLUSIONS Snacking is common, contributing significantly to daily energy and nutrient needs of toddlers and pre-school children. There is room for improvement, however, with many popular snacking choices contributing to excess sugar.

Missing Lunch Is Associated with Lower Intakes of Micronutrients from Foods and Beverages among Children and Adolescents in the United States

BACKGROUND In the United States, the lunch meal contributes more than 20% of the daily intakes of most micronutrients for children and adolescents consuming lunch. Seven percent to 20% of children and adolescents in the United States do not eat lunch on a given day. OBJECTIVE To identify differences in total micro- and macronutrient intakes of children consuming and missing lunch on a given day. DESIGN Cross-sectional secondary analysis of the combined National Health and Nutrition Examination Surveys 2009-2010 and 2011-2012. Dietary intake was assessed using the first day 24-hour recall of each respondent. PARTICIPANTS AND SETTINGS The National Health and Nutrition Examination Survey sample represents the total noninstitutionalized civilian population residing in the United States. The sample used in this study included 4,755 children aged 4 to 18 years with complete data for all analyses. MAIN OUTCOME MEASURES Total day, lunch, and nonlunch micronutrients, macronutrients, solid fats, and added sugar intakes were examined. STATISTICAL ANALYSES PERFORMED Linear regression models controlling for age, sex, race/ethnicity, household poverty status, and weekend were used to compare dietary intakes of lunch consumers and nonconsumers. Intakes from nonlunch sources were examined to determine the extent to which differences between lunch consumers and nonconsumers could be attributed to the lunch meal. RESULTS Missing lunch was associated with lower micronutrient intakes, with the lunch meal primarily responsible for the higher micronutrient intakes of lunch consumers compared with nonconsumers. Missing lunch was also associated with lower energy, fiber, and sodium intakes. Added sugar and solid fat intakes of lunch consumers and nonconsumers were not significantly different. CONCLUSIONS This study identifies potential concerns for children missing lunch with respect to micronutrient intakes and shows that the lunches consumed by children in the United States are an important source of essential nutrients, but also less healthful dietary components.

Food Consumption Patterns of Infants and Toddlers: Findings from the Feeding Infants and Toddlers Study (FITS) 2016

Abstract Background The prevalence of obesity and type 2 diabetes continues to increase. These conditions disproportionately affect minorities and are associated with poor nutrition early in life. Current food-consumption patterns can inform pending dietary guidelines for infants and toddlers. Objective The aim of this study was to describe infant feeding, complementary feeding, and food and beverage consumption patterns of 0- to 23.9-mo-olds in the general population. Methods The Feeding Infants and Toddlers Study 2016 is a cross-sectional survey of caregivers of children aged <4 y. Dietary data were collected from a national random sample by using a 24-h dietary recall (n = 3235). The percentage of children consuming foods from >400 food groups was calculated. Differences in the percentage consuming between Hispanic, non-Hispanic white, and non-Hispanic black children aged 0–23.9 mo were evaluated with the use of ORs and 95% CIs. Results Eighty-three percent of 0- to 23.9-mo-olds (n = 2635) were ever breastfed, 34% of 0- to 3.9-mo-olds (n = 305) and 15% of 4- to 5.9-mo-olds (n = 295) were exclusively breastfed, and 24% of 12- to 14.9-mo-olds (n = 412) consumed breast milk on the day of the recall. Complementary foods were more likely to be introduced before 4 mo in formula-fed infants (27%) than in infants who did not consume formula (5%). Half of 4- to 5.9-mo-olds consumed iron-fortified infant cereal, but few consumed iron-rich meats. Among toddlers (12–23.9 mo; n = 1133), >20% consumed no servings of fruit or vegetables on the day of the recall, approximately half consumed 100% fruit juice, and one-quarter to one-third consumed a sugar-sweetened beverage (SSB). Conclusions Breastfeeding initiation and duration have improved, but exclusivity remains low. Low consumption of iron-rich foods, fruit, and vegetables and lack of variety in vegetable consumption are problems. Efforts to reduce the consumption of SSBs and 100% fruit juice are warranted in early childhood.

Room for improvement remains in food consumption patterns of young children aged 2-4 years:

Abstract Background Healthy food consumption patterns in early childhood support optimal growth and development and promote lifelong health. Objective The objective of the Feeding Infants and Toddlers Study (FITS) 2016 is to provide updated information on food consumption patterns of children aged 0 to <4 y. This article focuses on several key aspects of the food consumption patterns of 2- and 3-y-olds and how those patterns differ between racial/ethnic groups. Methods The FITS 2016 is a cross-sectional study in caregivers of children aged 0 to <4 y living in the United States. Dietary data were collected in a national random sample of children (n = 3235, of whom 600 were aged 24–47.9 mo) by using a 24-h dietary recall telephone survey with the primary caregiver of the child. Data from the recall were used to calculate the percentage of children consuming specific food groups on the day of the recall and energy from these foods (kilocalories per consumer). Differences in food patterns between racial/ethnic groups were analyzed by using ANOVA and t tests. Results On the day of the 24-h dietary recall, 27% of 2- and 3-y-olds did not consume a distinct portion of vegetables. Fried potatoes were the most commonly consumed vegetable. Approximately 75% consumed a distinct portion of fruit and 45% consumed 100% fruit juice. Eighty-one percent of children consumed cow milk. Almost all (95%) consumed a grain product, and 59% consumed a whole grain–rich product. The majority of children (88%) consumed meat or another protein food. Nearly all (90%) consumed a dessert, sugar-sweetened beverage (SSB), or sweet; and 45% consumed an SSB. Thirty-six percent of children consumed a savory snack. There were some differences in food consumption patterns between racial/ethnic groups. Conclusion Findings from the FITS 2016 indicate that individual-, community-, and policy-level strategies are needed to improve the diets of young children in the United States.

Intakes and sources of total and added sugars among 4 to 13-year-old children in China, Mexico and the United States

Intakes of dietary sugars is a global concern, and many national and international organizations have set targets to limit consumption. However, it is unclear to what extent intakes of total and added sugars vary between geographies.

WIC and Non-WIC infants and children differ in usage of some WIC-provided foods

Abstract Background USDAs Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides expert-chosen supplemental foods to improve the diets and health of low-income infants and children <5 y of age, but dietary behaviors of WIC participants are not well characterized. Objective The purpose of this analysis was to examine differences in food consumption patterns between WIC participants and nonparticipants. Methods FITS 2016 is a nationwide cross-sectional study of children <4 y (n = 3235). Data were weighted to provide US population–representative results. Children were categorized as WIC participants or nonparticipants, with the latter divided into lower- and higher-income nonparticipants. Group differences were assessed via the Wald test (demographics) and Rao-Scott modified chi-square test (breastfeeding prevalence). Differences in percentage consuming WIC-provided and selected other foods between WIC participants and nonparticipants were evaluated with the use of ORs and 95% CIs. Results WIC infants were less likely to breastfeed than were higher-income nonparticipants at 0–5.9 mo (45% compared with 74%) and less likely than both nonparticipant groups at 6–11.9 mo (30% compared with 49–60%). WIC 6- to 11.9-mo-olds were more likely to consume infant cereals and vegetables than were lower-income nonparticipants. WIC 12 to 23.9-mo-olds were more likely to drink whole milk (which WIC provides at this age) than were nonparticipants (72% compared with 59–64%), whereas WIC participants 24–47.9 mo were more likely to drink low- and nonfat milks (which WIC provides at this age) than were nonparticipants (45% compared with 13–22%). WIC participants 6–47.9 mo were more likely to drink juice than were nonparticipants. Conclusions Continued improvements in early dietary patterns are warranted for WIC and non-WIC children. Breastfeeding among WIC participants is a continuing challenge. Findings suggest that baby-food cereals, vegetables, and fruits (all provided by WIC) contribute importantly to WIC infants’ diets, whereas WIC children are more likely to use lower-fat milks after 2 y of age than are non-WIC participants.

The Feeding Infants and Toddlers Study (FITS) 2016: Study Design and Methods

Abstract Background Diet and feeding patterns during the infant, toddler, and preschool years affect nutrient adequacy or excess during critical developmental periods. Understanding food consumption, feeding practices, and nutrient adequacy or excess during these periods is essential to establishing appropriate recommendations aimed at instilling healthy eating behaviors in children. Objective The objective of the 2016 Feeding Infants and Toddlers Study (FITS 2016) was to update our knowledge on the diets and feeding patterns of young children and to provide new data in related areas such as feeding behaviors, sleep, physical activity, and screen use. This article describes the study design, data collection methods, 24-h dietary recall (24-h recall) protocol, and sample characteristics of FITS 2016. Methods FITS 2016 is a cross-sectional study of caregivers of children aged <4 y living in the 50 states and Washington, DC. Data collection occurred between June 2015 and May 2016. A recruitment interview (respondent and child characteristics, feeding practices, physical activity, screen use, and sleep habits) was completed by telephone or online. This was followed by a feeding practices questionnaire and the 24-h recall conducted by telephone. A second 24-h recall was collected for a random subsample of 25% of the total sampled population. Results Among the 4830 recruited households with an age-eligible child, 3248 (67%) completed the 24-h recall. The respondents were more likely to be white, less likely to be Hispanic, and more highly educated than the US population of adults in households with a child <4 y of age. The sample was subsequently calibrated and weighted, and the distribution of respondents was compared with known population distributions. Conclusions FITS 2016 provides data based on sound methods that can inform researchers, policymakers, and practitioners about the food and nutrient intakes of young children. New findings may also be compared with previous FITS studies.

Caregiver experiences, attitudes and perceptions about feeding toddlers and preschool children in Switzerland: a qualitative study

BackgroundYoung children depend upon caregivers to make healthy food and beverage choices on their behalf. Research to understand caregiver perspectives may help develop interventions to improve diets and offer new insights for healthcare professionals and future nutrition studies. The main study aim was to explore caregiver feeding experiences, with a focus on portion sizes and attitudes towards beverages, for the first time in Switzerland, and contribute to the European perspective in this field.MethodsInductive, qualitative study with purposive sampling of 19 male and female caregivers (low-high income, 20–46y) of children (1–5y) using in-depth interviews. The model, “Food Choice Process over the Life Course”, was used as a theoretical framework. Full transcripts underwent a thematic analysis. Key themes were developed from the data.ResultsKey themes were a) Rules and routines b) Tacit knowledge c) Explicit knowledge d) Managing. Rules about foods and beverages to encourage/limit were widespread. Participants struggled to explain how they portioned foods but offered volume-estimates of beverages portions. Perceptions about health effects of beverages influenced choices. Managing time and budget influenced purchases and meal preparation. There was good agreement with the theoretical framework.ConclusionsRules and routines reflected anti-obesity recommendations and food-choice values. Perceived health effects of certain beverages, cultural classifications of snacking and the influence of income and time highlight multi-level determinants influencing dietary choices about feeding young children. Health-care professionals may wish to consider these emergent themes when advising on early-childhood feeding. Future studies are required to understand more about the attitudes and perceptions of beverages in the diets of toddlers and preschooler, along with perceptions related to snacking behaviours.

Snacking Patterns in Children: A Comparison between Australia, China, Mexico, and the US

Snacking is common in children and influenced by many factors. The aim of this study is to provide insight of both common and country-specific characteristics of snacking among 4–13 year old children. We analyzed snacking prevalence, energy and nutrient contributions from snacking across diverse cultures and regions, represented by Australia, China, Mexico, and the US using data from respective national surveys. We found that the highest prevalence of snacking was in Australia and the US (over 95%) where snacking provided one-third and one-quarter of total energy intake (TEI), respectively, followed by Mexico (76%, provided 15% TEI) and China (65%, provided 10% TEI). Compared to 4–8 year-olds, the consumption of fruits and milk was lower in 9–13 year-old children, with a trend of increasing savory snacks consumption in China, Mexico, and the US. The nutrient density index of added sugars and saturated fat was higher, especially in Australia, Mexico, and the US. Results suggested that snacking could be an occasion to promote fruit and vegetable consumption in all countries, especially for older children. Snacking guidelines should focus on reducing consumption of snacks high in saturated fat and added sugars for Australia, Mexico, and the US, whereas improving dairy consumption is important in China.