Diets Of Young Children Research Articles

Improving complementary feeding practices, programs and policies for optimal early childhood nutrition in Kenya: What would work?

Complementary feeding practices are greatly influenced by local contexts. Therefore, national home-grown evidence, policiesand guidelines are critical to improving infant and young children's diets. This Special Issue has provided a comprehensive, evidence-based analysis of the situation, gapsand context-specific opportunities for improving young children's diets in Kenya. The primary research findings of the Special Issue supported the identification of a set of recommendations articulated across the four systems (food, health, water, sanitation and hygiene[WASH]and social protection) to improve food availability and accessibility in Kenya at the national and subnational levels. It is anticipated that the decentralised government functions seen in Kenya provide a strong opportunity to develop and mainstream context-specific recommendations into action. This Special Issue recommends adopting a multi-sectoral systems approach, including a shared vision, joint planning, implementationand monitoring, towards improving young children's diets with a focus on service delivery as well as scaled-up community social behaviour change interventions. In particular, the approach should entail advocacy for policy revisions for service delivery that support complementary feeding and development of costed implementation strategies in support of the same, across four critical systems-food, health, WASHand social protection, along with, the strengthening of national coordination, monitoringand accountability structures as per the Kenya Nutrition Action Plan. Finally, the development of a legal framework for enhanced accountability from all relevant sectors towards sustainable, nutritious, safeand affordable children's diets. These recommendations provide a clear direction in addressing the complementary feeding challenges, which the primary research of this Special Issue has presented.

Dental Erosion and Diet in Young Children and Adolescents: A Systematic Review

Dental erosion is the irreversible loss of tooth enamel caused by acid attack without any bacterial involvement. Interest in dental erosion has increased considerably during the past decade. This paper aims to determine the prevalence of and association of dental erosion with diet or beverages in children. A systematic review of the literature has been carried out in accordance with the PRISMA recommendations. A search was performed in PubMed, Embase Scopus and Web of Science databases, and completed manually. Those studies that dealt with erosive risk factors related to diet and that included their effect on deciduous or mixed dentition were selected. Dual independent screening, data extraction and risk of bias assessment were concluded. A total number of 708 articles were identified from the initial electronic search of the four databases. Some 466 articles were selected after duplicated articles were discarded. After reading the title and abstract, we eliminated 376 articles; the remaining 90 were meant to be read in order that we could dispatch the ones that did not answer the research question or the inclusion criteria. A total of 25 articles remained for the systematic review. Erosive lesions are favored by the consumption of carbonated and isotonic drinks, fruit juices and acid sauces. Carbonated, isotonic drinks and fruit drinks favor the development of erosive lesions, not so the consumption of fruit juices mixed with dairy products such as milkshakes, yogurts and/or tea. The findings of this article will help researchers, academics and students to characterize the scientific results regarding dental erosion and diet, to evaluate management strategies and to identify significant topics and questions that will help to design future research with the aim of the prevention of the disease. Registration number: CDR42023389750.

Food Group, Macronutrient Intake, and Metabolic Status in the US-Affiliated Pacific’s Children’s Healthy Living (CHL) Program

The Children's Healthy Living study provided dietary intake information for understudied Native Hawaiian and Other Pacific Islander (NHOPI) young children. Our objective was to describe food group and macronutrient intakes of NHOPI children in the US-Affiliated Pacific region (USAP), overall and by jurisdiction, income level, and metabolic status. We evaluated 2-8-y-olds (n=3520) in a cross-sectional cluster sampled study using 2 d of dietary records completed by caregivers using provided tools, quantified by a specially developed food composition table and compared with US dietary recommendations. Overweight and obesity (OWOB) and acanthosis nigricans (AN) assessment (metabolic status) was completed by trained evaluators using standard tools. Demographic data were collected by questionnaire. Regression analysis identified differences in dietary component means by jurisdiction, World Bank income groups (WBIGs), and metabolic status, adjusted for age and sex. Few children met US recommendations for vegetable (2.4%) and milk (4.1%) food groups. US macronutrient recommendations were generally met. Food group and macronutrient intakes were significantly different by jurisdiction and WBIG. Means for food groups, except meats, and macronutrients, except protein, were higher in overweight/obese (OWOB) compared with healthy-weight children. Grain intake of 7.25 (SE: 0.08) oz was higher (P<0.05) and milk intake of 0.90 (SE: 0.05) cups was lower (P<0.05) in children with OWOB compared with those without OWOB [grains: 7.17 (SE: 0.07) oz; and milk: 0.96 (SE: 0.04) cups]. Monounsaturated fat intake of 11.68 (SE: 0.10) % energy was higher in those with OWOB, compared with healthy-weight children [11.56 (SE: 0.08) % energy, P<0.05]. Young children's diets in the USAP did not meet milk, vegetable, or fruit intake recommendations. There was variability in dietary patterns across the USAP and by WBIG. Grain intake and monounsaturated fat intake were lower and milk intake was higher in children with better metabolic status.

Promising trends and influencing factors of complementary feeding practices in Côte d'Ivoire: An analysis of nationally representative survey data between 1994 and 2016.

Poor complementary feeding (CF) challenges early childhood growth. We examined the trends and influencing factors of CF practices among children aged 6-23 months in Côte d'Ivoire. Using data from Demographic and Health Surveys (DHS, 1994-2011) and Multiple Indicator Cluster Surveys(MICS, 2000-2016), the trends and predictors of World Health Organization-United Nations International Children's Emergency FundCF indicators including the timely introduction of complementary foods (INTRO), minimum meal frequency (MMF), minimum dietary diversity (MDD)and minimum acceptable diet (MAD) were determined. Using 2016 MICS data, we applied multivariate logistic regression models to identify factors associated with CF indicators. Between 1994 and 2016, the mean proportion of children aged 6-8 months achieving INTRO was 56.9% and increased by about 25% points since 2006. Over 2011-2016, the proportion of children aged 6-23 months meeting MMF, MDDand MAD increased from 40.2% to 47.7%, 11.3% to 26.0%and 4.6% to 12.5%, respectively. Older children and those from urban households had higher odds of meeting MDD and MAD. Maternal TV watching was associated with higher odds of meeting MDD. The secondary or higher education levels of mothers significantly predicted higher odds of meeting INTRO and MDD. Currently, breastfeeding was also positively associated with odds of meeting MMF and MAD. Children from poorer households had lower odds of meeting MMF, MDDand MAD. Despite the improvements, CF practices remain suboptimal in Côte d'Ivoire. Influencing factors associated with CF were distributed across individual, household and community levels, calling for future programmes and policies to implement multi-level strategies to improve young children's diet in Côte d'Ivoire.

Priority Micronutrient Density of Foods for Complementary Feeding of Young Children (6-23 Months) in South and Southeast Asia.

Background: Given their high nutrient requirements and limited gastric capacity, young children during the complementary feeding period (6–23 months) should be fed nutrient-dense foods. However, complementary feeding diets in low- and middle-income countries are often inadequate in one or more essential micronutrients. In South and Southeast Asia infants' and young children's diets are commonly lacking in iron, zinc, vitamin A, folate, vitamin B12, and calcium, hereafter referred to as priority micronutrients.Objective: This study aimed to identify the top food sources of priority micronutrients among minimally processed foods for complementary feeding of children (6–23 months) in South and Southeast Asia.Methods: An aggregated regional food composition database for South and Southeast Asia was built, and recommended nutrient intakes (RNIs) from complementary foods were calculated for children aged 6–23 months. An approach was developed to classify foods into one of four levels of priority micronutrient density based on the calories and grams required to provide one-third (for individual micronutrients) or an average of one-third (for the aggregate score) of RNIs from complementary foods.Results: We found that the top food sources of multiple priority micronutrients are organs, bivalves, crustaceans, fresh fish, goat, canned fish with bones, and eggs, closely followed by beef, lamb/mutton, dark green leafy vegetables, cow milk, yogurt, and cheese, and to a lesser extent, canned fish without bones.Conclusions: This analysis provided insights into which foods to prioritize to fill common micronutrient gaps and reduce undernutrition in children aged 6–23 months in South and Southeast Asia.

U.S. Households’ Children's Drink Purchases: 2006–2017 Trends and Associations With Marketing

Sugar-sweetened beverages contribute a large proportion of added sugar in young children's diets; yet, companies market sugar-sweetened children's drinks extensively to children and parents. This study examines the changes in children's drink purchases by U.S. households with young children and the associations with marketing practices. Longitudinal Nielsen U.S. household panel data provided monthly volume purchases by children's drink category (sugar-sweetened fruit drinks and flavored water and unsweetened juices) among households with young children (aged 1-5 years) from 2006 to 2017. Differences by household race/ethnicity and income were assessed. The 2-part models examined the associations between household purchases and marketing (including price and brand TV advertising) for each category, controlling for sociodemographics. Data were collected and analyzed in 2019-2020. Households' volume purchases of children's fruit drinks and unsweetened juices declined from 2006 to 2017, whereas flavored water purchases increased. Non-Hispanic Black households purchased significantly more fruit drinks (351.23 fluid ounces/month, 95% CI=342.63, 359.82) than non-Hispanic White (204.43 fluid ounces/month, 95% CI=201.81, 207.05) and Hispanic (222.63 fluid ounces/month, 95% CI=217.11, 228.15) households. Low-income households purchased more fruit drinks and fewer unsweetened juices than higher-income households (p<0.001). TV brand advertising was positively associated with purchases across all categories, and this relationship was stronger for low-income households (p<0.05). Despite expert recommendations that young children do not consume Sugar-sweetened beverages, households with young children purchase more sweetened fruit drinks than unsweetened juices. Extensive TV advertising for children's drink brands may exacerbate the racial and income disparities in sugar-sweetened beverage purchases. Public health initiatives to address sugar-sweetened beverage consumption by young children and restrictions on marketing sugar-sweetened beverages to children are necessary.

Impact of changes to the Child and Adult Care Food Program on children's dietary intake in family child care homes.

To estimate the impact of recent changes to the Child and Adult Care Food Program (CACFP) meal pattern on young children's diets in family child care homes (FCCHs) serving racially/ethnically diverse children. In a natural experimental study of thirteen CACFP-participating FCCHs, we used digital photographs taken of children's plates before and after meals matched with menus to measure children's dietary intake both prior to implementation of the new meal patterns (summer/fall of 2017) and again 1 year later (summer/fall of 2018). Generalised estimating equations tested for change in intake of fruits, vegetables, whole grains, 100 % juice, grain-based desserts, meat/meat alternates and milk, adjusting for clustering of observations within providers. FCCHs in Boston, MA, USA. Three- to 5-year-old children attending FCCHs. We observed 107 meals consumed by twenty-eight children at the thirteen FCCHs across an average of 2·5 (sd 1·3) d before the CACFP policy change, and 239 meals consumed by thirty-nine children across 3·8 d (sd 1·4) 1 year later. During lunch, fruit intake increased by about a third of a serving (+0·38 serving, 95 % CI 0·04, 0·73, P = 0·03), and whole grain intake increased by a half serving (+0·50 serving, 95 % CI 0·19, 0·82, P = 0·002). No changes were seen in other meal components. Young children's dietary intake in CACFP-participating FCCHs improved following the CACFP meal pattern change, particularly for fruits and whole grains, which were targets of the new policy. Additional research should examine impacts of the changes in other child care settings, age groups and locales.

Dietary exposure to pesticide residues and associated health risks in infants and young children – Results of the French infant total diet study

A total diet study (TDS) was undertaken to estimate the chronic dietary exposure to pesticide residues and health risks for the French infants and young children below 3 years old. As a whole, 516 pesticides and metabolites were analysed in 309 food composite samples including 219 manufactured baby foods and 90 common foods, which cover 97% of infants and young children's diet. These composite samples were prepared using 5,484 food products purchased during all seasons from 2011 to 2012 and processed as consumed. Pesticide residues were detected in 67% of the samples and quantified in 27% of the baby food samples and in 60% of the common foods. Seventy-eight different pesticides were detected and 37 of these quantified at levels ranging from 0.02 to 594 µg/kg. The most frequently detected pesticides (greater than 5% samples) were (1) the fungicides 2-phenylphenol, azoxystrobin, boscalid, captan and its metabolite tetrahydrophthalimide, carbendazim, cyprodinil, difenoconazole, dodine, imazalil, metalaxyl, tebuconazole, thiabendazole, (2) the insecticides acetamiprid, pirimiphos-methyl and thiacloprid, (3) the herbicide metribuzin and (4) the synergist piperonyl butoxide. Dietary intakes were estimated for each of the 705 individuals studied and for 431 pesticides incl. 281 with a toxicological reference value (TRV). In the lower-bound scenario, which tends to underestimate the exposure, the TRV were never exceeded. In the upper-bound scenario that overestimates exposure, the estimated intakes exceeded the TRV for dieldrin and lindane (two persistent organic pollutants) and propylene thiourea, a metabolite of propineb. For these three substances, more sensitive analyses are needed to refine the assessment. For 17 other detected and/or prioritised pesticides, the risk could not be characterised due to the lack of a valid TRV, of certain food analyses or the absence of analytical standards for their metabolites.

Vegan Diet in Young Children.

The prevalence of restrictive diets, mainly vegetarian and vegan, is markedly on the increase in Europe and other Western countries. In young children and adolescents, not only weight and height but also neurocognitive and psychomotor development are all strongly influenced by the source, quantity, and quality of their nutrition. In studies done mainly in adult populations, a plant-based diet showed benefits in the reduced risk of chronic diseases such as obesity, type 2 diabetes, cardiovascular diseases, and some types of cancer. However, there is no clear evidence that a vegan diet started in early childhood confers a lasting health benefit. On the other hand, a vegan diet can be potentially critical for young children with risks of inadequate supply in terms of protein quality and energy as well as long-chain fatty acids, iron, zinc, vitamin D, iodine, calcium, and particularly vitamin B12. Deficiencies in these nutrients can lead to severe and sometimes irreversible developmental disorders. If such a diet is chosen for ethical, ecological, or health reasons, a well-planned, diversified diet with additional supplementation of vitamin B12, vitamin D, iodine, and potentially other micronutrients is crucial to ensure a healthy and nutritious intake during childhood.

The Role of Young Child Formula in Ensuring a Balanced Diet in Young Children (1-3 Years Old).

During the nutritional vulnerable period of 1–3 years of age, nutrient intake is often inadequate due to an unbalanced diet. Young child formula (YCF) has been proposed as a means of improving nutrition in this age group. We compared the food consumption and nutrient intake of 241 YCF consumers (YCF-C) to those of 206 non-consumers (YCF-NC), selected from among the children enrolled in the Nutri-Bébé survey, an observational cross-sectional survey, conducted from 3 January to 21 April 2013. Food consumption and nutrient intake were analyzed from a three-day dietary record. The YCF-C < 2 years group had a protein (−8 g/d; p < 0.0001) and sodium (−18%; p = 0.0003) intake that was lower than that of YCF-NC, but still above the respective EFSA (European Food Safety Authority) Average Requirement (AR) or Adequate Intake (AI). At all ages, the YCF-C group had higher intakes of essential fatty acids (p < 0.0001), vitamins C (p < 0.0001), A, D, and E (p < 0.0001), all B vitamins (p < 0.001) except B12, iron (9 vs. 5 mg/d, p < 0.0001), reaching the Dietary Reference Values (DRVs, AR or AI), but similar DHA and ARA intakes. Getting closer to the reference values proposed by EFSA required at least 360 mL/d of YCF. The consumption of YCF may help infants and children at risk of nutrient deficiencies to meet their nutritional requirements. However, protein, sodium, and vitamin A intakes remained above the EFSA DRVs, and DHA, ARA, and vitamin D remained below.

Feasibility and development of a cariogenic diet scale for epidemiological research.

Diet cariogenicity plays a major role as both a protective and risk factor in the development of early childhood caries (ECC). Develop a scale measuring the cariogenicity of foods and beverages and employ it to describe the cariogenicity of young children's diets and predict dental caries outcomes. Scores of cariogenicity and consumption frequency were applied to food frequency questionnaire (FFQ) collected from an Australian children's cohort study with three time-points of data. One-way ANOVA, with post hoc Tukey test compared mean cariogenic scale measured at 18months between the subsample of children with caries classification at age 5years. At 6months, children's mean cariogenic score was 10.05, increasing to 34.18 at 12 and 50.00 at 18months. Mean cariogenic scale score at 18months was significantly higher in children with advanced disease at 5years (mean scale score: 59.0±15.9) compared to those that were healthy (mean score 47.7±17.5, P=0.007) or had mild-moderate disease (mean score 48.2±17.3, P=0.008). The cariogenic diet scale provides a useful indication of the increasing cariogenicity of children's diets with age and highlights the incorporation of discretionary choice foods and beverages into the diets of young children much earlier than nutritionally recommended.

Consumption of sugars, saturated fat, and sodium among US children from infancy through preschool age, NHANES 2009–2014

Expert guidelines advise that intake of added sugars (ASs), free sugars, and saturated fats be limited to <10% total energy (TE), and that children's sodium not exceed 1500-1900 mg, yet intake among many older children and adolecents exceeds these limits. Although research suggests young children's diets influence future eating patterns, little is known about the intake of these nutrients throughout early childhood. The objective of this study was to describe intake and leading sources of sugars, saturated fats, and sodium among US children from infancy through preschool age. Cross-sectional data from the NHANES 2009-2014 were used to estimate 1) mean intake of sugars [%TE from ASs, naturally occurring sugars (NOSs), and free sugars], saturated fats (%TE), and sodium (milligrams), 2) the proportion exceeding recommended limits, and 3) the leading sources of these nutrients in the diets of US (nonbreastfeeding) children <5 y old (n=3345). Sampling weights and procedures to account for the complex sampling design were used to estimate intake by age and to compare across race/ethnicity, sex, and income subgroups. Nonbreastfeeding children <5 y old consumed a mean ± SE %TE of 10.1% ± 0.2% from ASs, 13.9% ± 0.2% from free sugars, 12.8% ± 0.1% from saturated fats, and 1804 ± 26 mg Na . Sugary beverages (sugar-sweetened beverages+100% juices) contributed 6.7% ± 0.2% TE, with consumption lowest among higher-income children. AS and sodium consumption rose rapidly from infancy to age 1-<2 y and gradually thereafter. Saturated fat intake was highest in infancy and decreased to a mean ± SE of 11.3% ± 0.3% TE among 4-<5-y-olds. Intake exceeded recommended limits for ASs, free sugars, saturated fats, and sodium for 45%, 63%, 72%, and 67% of all children, respectively. The consumption of sugars, fats, and sodium exceeds recommended guidelines before many US children reach school age.

Family stress predicts poorer dietary quality in children: Examining the role of the parent–child relationship

AbstractThe present prospective study investigated a comprehensive model of family stress to explain changes in young children's diet quality from age 3 to 5 years. The direct associations of family stress with child diet quality were examined, as well as the indirect associations via features of the parent–child relationship, including inconsistent parenting practices, negative parent–child interactions, and poor emotional bond. Using an Australian sample of 579 mother–child dyads (child Mage = 3.05 years; 45% boys), higher levels of family stress were predictive of less adequate child dietary quality (i.e., lower fruit and vegetable intake) over time with the effect on fruit intake occurring indirectly via impaired parent–child relationship quality. Notably, it was the relatively less well‐studied indicators of family stress (maternal physical and psychological health difficulties) that were consistently associated concurrently and prospectively with poorer child diet quality. These results provide support for an ongoing broader focus on the family context in which children and parents are embedded, including their exposure to stress, as well as the continued focus on parent–child relationship factors, such as inconsistent parenting practices and negative parent–child interactions, as specific and modifiable predictors of children's diet quality over time.Highlights A comprehensive model of family stress was examined to explain changes in young children's dietary intake from age 3‐5 years. Family stress was predictive of less adequate child dietary intake, with one effect occurring indirectly via impaired parent‐child relationship quality. Results support a broader focus on the family context, including stress exposure, as well as on specific parent‐child relationship factors.

Emerging issues in complementary feeding: Global aspects.

The complementary feeding period (6-24months) is a window of opportunity for preventing stunting, wasting, overweight, and obesity and for improving long-term development and health. Because WHO published its guiding principles for complementary feeding in 2003, new knowledge and evidence have been generated in the area of child feeding. The aim of this paper is to highlight some of the emerging issues in complementary feeding and potential implications on the guidelines revision. Evidence on the effect of the quality and quantity of protein and fat intake on child growth during the complementary feeding period is summarized. The increased availability of sugar-containing beverages and unhealthy snack foods and its negative effect on young child's diet is described. Negative effects of nonresponsive feeding and force feeding are also discussed, although few scientific studies have addressed these issues. There are several emerging research areas that are likely to provide a better understanding of how complementary feeding influences growth, development, and health. These include the effect of the young child's diet on body composition, gastrointestinal microbiota, and environmental enteric dysfunction. However, at present, findings from these research areas are not likely to influence guidelines. Several emerging issues will be relevant to address when complementary feeding guidelines will be updated. With the increasing prevalence of obesity globally, it is important that guidelines on complementary feeding address both prevention of undernutrition and prevention of overweight, obesity, and noncommunicable diseases later in life.

First foods: Why improving young children's diets matter.

Globally, only 52% of children aged 6-23months meet the minimum meal frequency and a mere 29% meet the minimum dietary diversity, with large disparities across and within regions. With most of the stunting occurring during the first thousand days-from conception to age 2years-improving complementary feeding in children 6-23months old is an urgent priority. With this evidence in mind, UNICEF collaborated with the governments of India and Maharashtra to convene a global meeting in Mumbai, India, under the theme: First Foods: A Global Meeting to Accelerate Progress on Complementary Feeding in Young Children (November 17-18, 2015). The global meeting provided a platform that aimed to (a) synthesize the biological and implementation science on complementary feeding; (b) review the practice and experience in improving access to nutritious complementary foods and good complementary feeding practices; and (c) consolidate a strong evidence base that can inform the development of strategies and approaches to improve complementary feeding that are fit to context. This overview paper summarizes the rationale on why improving complementary foods and feeding for infants and young children matters and what it takes to improve them. It builds on the papers presented at the First Foods Global Meeting and those commissioned as a follow on to it.

Executive summary for the Micronutrient Powders Consultation: Lessons Learned for Operational Guidance.

Iron deficiency anaemia is estimated to be the leading cause of years lived with disability among children. Young children's diets are often inadequate in iron and other micronutrients, and provision of essential vitamin and minerals has long been recommended. With the limited programmatic success of iron drop/syrup interventions, interest in micronutrient powders (MNP) has increased. MNP are a mixture of vitamins and minerals, enclosed in single‐dose sachets, which are stirred into a child's portion of food immediately before consumption. MNP are an efficacious intervention for reducing iron deficiency anaemia and filling important nutrient gaps in children 6–23 months of age. As of 2014, 50 countries have implemented MNP programmes including 9 at a national level. This paper provides an overview of a 3‐paper series, based on findings from the “Micronutrient Powders Consultation: Lessons Learned for Operational Guidance” held by the USAID‐funded Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) Project. The objectives of the Consultation were to identify and summarize the most recent MNP programme experiences and lessons learned for operationalizing MNP for young children and prioritize an implementation research agenda. The Consultation was composed of 3 working groups that used the following methods: deliberations among 49 MNP programme implementers and experts, a review of published and grey literature, questionnaires, and key informant interviews, described in this overview. The following articles summarize findings in 3 broad programme areas: planning, implementation, and continual programme improvement. The papers also outline priorities for implementation research to inform improved operationalization of MNP.

Counselling parents on young children's healthy diet: A modified scoping review.

To map and describe key information in existing research about counselling of parents of children aged 0-2years on the child's healthy diet in preventive healthcare settings, particularly in public health nursing. Many parents are likely to be concerned with their infant's food-related happiness "here and now," disregarding the child's long-term health and development related to feeding practices. Hence, a focus on counselling parents in considering young children's healthy diet is important. A modified scoping review with an inductive qualitative content analysis of selected empirical studies. Systematic searches in EMBASE (1996-2015 Week 46), Ovid Nursing Database (1946-2015 November Week 1), Ovid MEDLINE and Ovid OLDMEDLINE (2000-18 November 2015) and CINAHL (2000-22 December 2015), using search terms based on aims. Eight included studies, with participants per sample ranging from 19->500. Research designs were focus group discussions and/or interview study (n=2), cluster-randomised trials (n=2), randomised controlled trials (n=2), a follow-up interview study (n=1) to a previous randomised controlled trial and a cross-sectional electronic questionnaire study (n=1). The studies included a total sample of 2,025 participants, 42 of them in interview studies. Findings indicate parents' perceptions of inconsistency, misconceptions and uncertainty related to the recommendations on child feeding from the authorities. Thus, adapted advice could impact healthier child diet. Maternal knowledge on child feeding and reduced use of food as a reward are mediators for improved diet quality in children. Counselling on young children's healthy diet should be anticipatory, consistent and adapted to the family. Due to inconsistent recommendations and omitted focus on anticipatory counselling on child feeding, parents might perceive pressure and uncertainty related to the child's diet.

Contribution of snacks to dietary intakes of young children in the United States

Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005-2012 NHANES data, dietary intakes of 2- to 5-year-old children were analysed from a parent-reported 24-hour dietary recall (n=3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1-quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy-dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.

Food Sources of Fiber and Micronutrients of Concern in Diets of Young Children

The Feeding Infants and Toddlers Study (FITS), 2008, identified iron and zinc as the nutrient gaps for infants and vitamin E, potassium and fiber as the nutrient gaps for toddlers, whereas sodium was reported as being consumed in excess among toddlers and preschoolers. Many studies have found vitamin D to be a dietary shortfall during early childhood. Data from FITS was used to assess the relative contributions of foods to said nutrients. Dietary intake interviews (24‐hr recalls) were carried out by telephone with parents or primary caregivers of infants 6–11 months (n=505), toddlers 12–23 months (n=925), and preschoolers 24–47 months (n=1,461). Reported foods and supplements were assigned to one of 71 food groups based on nutrient similarities and uses. Food mixtures were disaggregated into their constituent ingredients and ingredients were classified into one of the 71 groups. The population percentage contribution of each of these foods to total nutrient intake was determined for each nutrient and age group. Infant cereal was the leading source of iron in infants, providing 41% of their iron intake. Infant cereal was also the second source of zinc for infants, providing 16% of their zinc intake, with infant formula being the highest source, providing 48% of zinc intake. The top sources of fiber for all ages were grain products, which provided 14% of infants’ intake and 11% of toddlers’ and preschoolers’ intakes. Salt and seasonings were the major sources of sodium for all children, contributing approximately 20% of their sodium intake. Milk, all types combined, was the major source of potassium for all ages, contributing 46% to 32% of potassium intake, with 100% juice, potatoes and bananas making up the next three sources for both toddlers and preschoolers. Dietary supplements were the leading contributor to vitamin E for toddlers and preschoolers, contributing 22% and 44% of intake, respectively. Milk and butter/margarine were also in the top 5 sources of vitamin E for toddlers and preschoolers. Peanut butter and salty snacks were top sources of vitamin E for preschoolers (5% each) and ready‐to‐eat (RTE) cereals for toddlers (5%). Milk was the major source of vitamin D for all ages, contributing 47% to 74% of vitamin D intakes, depending on age, followed by supplements, which provided 14% to 39% of intake. Overall, supplements and foods that are typically fortified made substantial contributions to micronutrient intakes. Caregivers should be strongly advised to choose lower sodium food options and not depend on supplements for mineral and vitamin intakes. Instead, they should be encouraged to provide a wide variety of nutrient dense foods, which would instill healthy eating habits from the beginning.Support or Funding InformationNestle

Nutrient intakes and iron and vitamin D status differ depending on main milk consumed by UK children aged 12-18 months - secondary analysis from the Diet and Nutrition Survey of Infants and Young Children.

Nutrition in the second year is important as this is a period of rapid growth and development. Milk is a major food for young children and this analysis evaluated the impact of the type of milk consumed on nutrient intakes and nutritional status. Data from the Diet and Nutrition Survey of Infants and Young Children were used to investigate the intakes of key nutrients, and Fe and vitamin D status, of children aged 12-18 months, not breastfed, and consuming >400 g/d fortified milk (n 139) or >400 g/d of whole cows' milk (n 404). Blood samples from eligible children for measurement of Hb (n 113), serum ferritin and plasma 25-hydroxyvitamin D (25(OH)D) concentrations (n 105) were available for approximately 20 % of children. Unpaired Mann-Whitney tests were used to compare nutrient intakes and status between consumers of fortified and cows' milk. Mean daily total dietary intakes of Fe, Zn, vitamin A and vitamin D were significantly higher in the fortified milk group. Mean daily total dietary intakes of energy, protein, Ca, iodine, Na and saturated fat were significantly higher in the cows' milk group. Hb was not different between groups. The fortified milk group had significantly higher serum ferritin (P = 0·049) and plasma 25(OH)D (P = 0·014). This analysis demonstrates significantly different nutrient intakes and status between infants consuming >400 g/d fortified milk v. those consuming >400 g/d whole cows' milk. These results indicate that fortified milks can play a significant role in improving the quality of young children's diets in their second year of life.