National Pre-School Nutrition Survey Research Articles

Addressing nutrient shortfalls in 1- to 5-year-old Irish children using diet modeling: development of a protocol for use in country-specific population health

ABSTRACTBackgroundDietary habits formed in early childhood can track into later life with important impacts on health. Food-based dietary guidelines (FBDGs) may have a role in improving population health but are lacking for young children.ObjectivesWe aimed to establish a protocol for addressing nutrient shortfalls in 1- to 5-y-old children (12–60 mo) using diet modeling in a population-based sample.MethodsSecondary analysis of 2010–2011 Irish National Pre-School Nutrition Survey data (n = 500) was conducted to identify typical food consumption patterns in 1- to 5-y-olds. Nutrient intakes were assessed against dietary reference values [European Food Safety Authority (EFSA) and Institute of Medicine (IOM)]. To address nutrient shortfalls using diet modeling, 4-d food patterns were developed to assess different milk-feeding scenarios (human milk, whole or low-fat cow milk, and fortified milks) within energy requirement ranges aligned with the WHO growth standards. FBDGs to address nutrient shortfalls were established based on 120 food patterns.ResultsCurrent mean dietary intakes for the majority of 1- to 5-y-olds failed to meet reference values (EFSA) for vitamin D (≤100%), vitamin E (≤88%), DHA (22:6n–3) + EPA (20:5n–3) (IOM; ≤82%), and fiber (≤63%), whereas free sugars intakes exceeded recommendations of <10% energy (E) for 48% of 1- to 3-y-olds and 75% of 4- to 5-y-olds. “Human milk + Cow milk” was the only milk-feeding scenario modeled that predicted sufficient DHA + EPA among 1- to 3-y-olds. Vitamin D shortfalls were not correctable in any milk-feeding scenario, even with supplementation (5 µg/d), apart from the “Follow-up Formula + Fortified drink” scenario in 1- to 3-y-olds (albeit free sugars intakes were estimated at 12%E compared with ≤5%E as provided by other scenarios). Iron and vitamin E shortfalls were most prevalent in scenarios for 1- to 3-y-olds at ≤25th growth percentile.ConclusionsUsing WHO growth standards and international reference values, this study provides a protocol for addressing nutrient shortfalls among 1- to 5-y-olds, which could be applied in country-specific population health.

Intakes and sources of menaquinones (vitamin K2) in the Irish population aged 1–90 years

AbstractRecent evidence suggests that menaquinones (Vitamin K2) may be important for both bone health and cardiovascular health. With the exception of menaquinone-4 which is formed from the tissue specific conversion of phylloquinone or menadione, menaquinones are synthesized by bacteria. They are typically found in foods of animal origin such as meat, dairy and fermented foods and may account for up to 25% of total vitamin K intake. There are few data available on menaquinone intakes in population groups due to lack of available composition data. The Irish food composition database however has recently been updated to include data on menaquinones. Therefore, the aim of this study was to use these data to estimate the intakes and key dietary sources of menaquinones (menaquinone-4 &amp; menaquinone-5–10) in the Irish population.Analyses included data from four nationally representative surveys of the Irish population; The National Pre-School Nutrition Survey (1–4y; 2010–2011), the National Children's Food Survey (5–12y; 2003–2004), the National Teens’ Food Survey (13–17y; 2005–2006) and the National Adult Nutrition Survey (18–90y; 2008–2010) (www.iuna.net). For all of the surveys, food and beverage intake data (including supplements) were collected using food records and quantified using food scales, photographic atlases, household measures and standard portion sizes. Mean daily intakes of menaquinone-4 and menaquinone-5–10 were estimated using UK food composition tables and analytical values from published papers. The percent contribution of food groups to menaquinone intake was calculated by the mean proportion method (which provides information about the sources that are contributing to the nutrient intake ‘per person’). Statistical analyses were carried out using SPSS© V22.Mean intakes of menaquinone-4 ranged from 8–12μg/d and 10–14μg/d in children aged 1–17 years and adults aged 18–90 years, respectively. Mean combined intakes of menaquinone-5–10 ranged from 32–43μg/d and 32–50μg/d in children aged 1–17 years and adults aged 18–90 years, respectively. ‘Meat &amp; meat products’ were the top contributor of menaquinone-4 (50–66%) intakes across all population groups followed by ‘milks’ (9–25%). ‘Meat &amp; meat products’ (44–61%) and ‘cheeses’ (21–37%) were important contributors to menaquinone-5–10 intakes across all population groups examined.This study is the first of its kind to report the intakes and sources of menaquinones in the Irish population. ‘Meat &amp; meat products’, ‘cheeses’ and ‘milks’ are important contributors to intakes of menaquinones in the Irish diet. Further research is required to fully understand the role of the menaquinones in human health.

How achievable are free sugar recommendations in healthy dietary patterns for 1–5 year olds in Ireland?

The World Health Organisation (WHO) strongly recommends reducing free sugar intake to &lt; 10% energy, and suggests a further conditional reduction to &lt; 5% energy. This study aims to assess how achievable these free sugar intake recommendations are in healthy diets of 1–5 year olds in Ireland and to identify the main food contributors.Using minimal added sugar, fat and no added salt, four-day food intake patterns were developed for 1–5 year old children (n30 girls; n30 boys) representing different percentile levels on the WHO growth charts. These food intake patterns were based on foods commonly consumed in the Irish National Pre-school Nutrition Survey and adjusted to meet energy, macronutrient and micronutrient requirements. The free sugar content of each food used was identified according to the WHO definition and estimated using food composition tables. Free sugar content of the four-day patterns was assessed against the two WHO recommendations. Subjects were compared depending on recommendations achieved. Where necessary, nutrients were estimated per 500kcal to control for energy.Food intake patterns of all subjects (n60) achieved the WHO recommendation of &lt; 10% energy, with 50% (n30) meeting the further recommendation of &lt; 5% energy. Subjects with free sugar intakes &lt; 5% energy compared with those not meeting this recommendation, were younger (2 years vs. 3.5 years, p &lt; 0.001), had lower energy intakes (946kcal vs. 1263.8kcal, p &lt; 0.001), higher fat intakes (37% vs. 29%, p &lt; 0.001), higher saturated fat intakes (18% vs. 13%, p &lt; 0.001) and lower carbohydrate intakes (46% vs. 53%, p &lt; 0.001). When estimated per 500kcal they had lower intakes of fibre (5.0 g vs. 6.2 g, p &lt; 0.001) and vitamin D (5.9μg vs. 6.3μg, p &lt; 0.001) and higher intakes of vitamin A (177.3μg vs. 108.5μg, p &lt; 0.001) and DHA and EPA (0.3 g vs. 0.2 g, p &lt; 0.001). The main foods contributing to free sugar intakes in these subjects were cereals (29% of free sugar intake), yoghurts (27%), breads (5%) and ice cream (4%). By comparison the main foods contributing to free sugar in subjects whose intakes exceeded 5% energy included yoghurts (22%), stewed apples (9%) and puddings (6%).This analysis demonstrates the WHO strong recommendation of &lt; 10% energy for free sugar was easily achievable, but the further conditional recommendation (&lt; 5%) was more difficult. This was only achieved at younger ages and was associated with increased intakes of fat and saturated fat and lower intakes of fibre and vitamin D. The main food contributors to free sugar in healthy diets for 1–5 year olds are important sources of nutrients.

Developing food-based dietary guidelines for 1–5 year old children: a protocol for use in population health globally

AbstractEarly childhood is a well-established critical period for growth and development, potentially impacting on life-long health. Healthy dietary habits formed during the transition from a predominantly milk-based to a food-based diet track into later life. Globally, there is no established process for developing food-based dietary guidelines (FBDG) for 1–5 year old children. This study aims to establish a protocol for developing FBDG for 1–5 year old children for use in population health globally.Foods consumed by &gt; 10% of consumers aged 1–5 years (at each eating occasion) were identified by secondary analysis of the Irish National Pre-School Nutrition Survey (NPNS; 2012). Consultations were held with registered dietitians to update the NPNS data and reflect current dietary habits. Dietary modelling, based on healthy eating principles, was conducted on boys (n30) and girls (n30) at five percentiles on the World Health Organisation (WHO) growth charts (0.4th; 25th; 50th; 75th; 99.6th) and at six age time-points (1y; 1.5y; 2y; 3y; 4y and 5y). Intake targets were identified for energy, macronutrients and 6 key micronutrients. For those with inadequate nutrient intakes, key contributing foods were identified and used in the modelling.Dietary modelling yielded 640 four-day food intake patterns. For 1–3 year olds, especially those &lt; 25th growth percentile, iron was identified as an at-risk nutrient as the intake target was not achieved. For all 1–5 year olds, vitamin D was identified as an at-risk nutrient. Red meat and iron-fortified cereal (&gt; 12mg/100g) were identified as key contributors to iron intake. A combination of red meat (30 g, 3 days/week) and iron-fortified cereal (30 g, 5 days/week) resolved inadequate iron intakes for 1–3 year olds, except those &lt; 25th growth percentile. For those children, the additional inclusion of 4 mg iron from use of iron-fortified milk (1.2mg/100mL) or a low-dose iron supplement (7 mg, 4 days/week) resulted in adequate iron intakes. For all children aged 1–5 years, vitamin D intakes improved by including a daily 5μg vitamin D supplement, but still did not reach the intake target.Worldwide, significant resources are invested in assessing growth and development of 1–5 year olds. This study provides a protocol for developing FBDG to meet nutritional needs of 1–5 year olds at various growth parameters (age and percentiles), using WHO charts. This enables the provision of practical food-based interventions to nutritionally vulnerable children. Using national dietary data, this approach can be applied for developing FBDG specific to a country's needs.

Estimation and consumption pattern of free sugar intake in 3-year-old Irish preschool children

PurposesDietary free sugars (FS) are the most important risk factor for dental caries and can contribute to excess energy intake. Measuring FS intake is limited by food composition databases and appropriate dietary assessment methods. The aim of this analysis was to estimate total sugar (TS) and FS intakes for Irish pre-schoolers and examine the proportion of dietary TS and FS captured using a short food questionnaire (SFQ).MethodsThis is a secondary analysis of 3-year-old children from two national surveys; Growing Up in Ireland (GUI), N = 9793 of whom 49% were girls and the National Preschool Nutrition Survey (NPNS), N = 126 and 52% were girls. GUI used SFQs and NPNS used semi-weighed food diaries to collect dietary data from 3-year-old children. Dietary intake databases were linked using an established approach. Mean daily TS and FS intakes and frequency were calculated, and consumption patterns from foods and meals are presented. The proportion of foods that were covered or non-covered by the GUI SFQ was calculated by comparison with the NPNS food diary.Results75% of 3 year-olds had FS intake greater than the maximum recommended by WHO guidelines for free sugar intake, while 4% met the lower threshold. The median frequency of TS and FS consumption was 5.0 (4.0–6.0) and 4.0 (3.0–5.0) times/day. Less than one-quarter of TS intake (g/day) was non-covered by the GUI SFQ while less than one-third of FS intake was non-covered.ConclusionsA large majority of 3-year-old Irish children do not meet the WHO recommended guidelines for FS intake and almost none meet the desired conditional recommendation. SFQs only capture two-thirds of FS intake at this early age.

Data Mapping From Food Diaries to Augment the Amount and Frequency of Foods Measured Using Short Food Questionnaires.

Collecting accurate and detailed dietary intake data is costly at a national level. Accordingly, limited dietary assessment tools such as Short Food Questionnaires (SFQs) are increasingly used in large surveys. This paper describes a novel method linking matched datasets to improve the quality of dietary data collected. Growing Up in Ireland (GUI) is a nationally representative longitudinal study of infants in the Republic of Ireland which used a SFQ (with no portion sizes) to assess the intake of “healthy” and “unhealthy” food and drink by 3 years old preschool children. The National Preschool Nutrition Survey (NPNS) provides the most accurate estimates available for dietary intake of young children in Ireland using a detailed 4 days weighed food diary. A mapping algorithm was applied using food name, cooking method, and food description to fill all GUI food groups with information from the NPNS food datafile which included the target variables, frequency, and amount. The augmented data were analyzed to examine all food groups described in NPNS and GUI and what proportion of foods were covered, non-covered, or partially-covered by GUI food groups, as a percentage of the total number of consumptions. The term non-covered indicated a specific food consumption that could not be mapped using a GUI food group. “High sugar” food items that were non-covered included ready-to-eat breakfast cereals, fruit juice, sugars, syrups, preserves and sweeteners, and ice-cream. The average proportion of consumption frequency and amount of foods not covered by GUI was 44 and 34%, respectively. Through mapping food codes in this manner, it was possible, using density plots, to visualize the relative performance of the brief dietary instrument (SFQ) compared to the more detailed food diary (FD). The SFQ did not capture a substantial portion of habitual foods consumed by 3-year olds in Ireland. Researchers interested in focussing on specific foods, could use this approach to assess the proportion of foods covered, non-covered, or partially-covered by reference to the mapped food database. These results can be used to improve SFQs for future studies and improve the capacity to identify diet-disease relationships.

Nutrient intakes and compliance with nutrient recommendations in children aged 1-4 years in Ireland.

The early childhood years represent a period of rapid growth and development characterised by unique requirements for energy and individual nutrients. The present study uses data from the National Pre-School Nutrition Survey, a nationally representative sample of Irish children (1-4 years) (n = 500), aiming to estimate energy and nutrient intakes across age and compliance with recommendations (UK and European). A 4-day weighed food-record was used to collect dietary data and statistical modelling (National Cancer Institute method) was applied to estimate usual nutrient intakes. Intakes of carbohydrate [48-50% energy (E)], protein (15-16%E), total fat (32-34%E), dietary fibre (2.5 g MJ-1 ), α-linolenic acid (0.45%E) and most micronutrients were in good compliance with recommendations. However, intakes of long chain polyunsaturated fatty acids (LCPUFA) (65-80 mg) were low and significant proportions of children had inadequate intakes (< estimated average requirement) of vitamin D and iron. Small proportions of children with intakes exceeding the upper level for retinol, folic acid, zinc, copper and iodine, are unlikely to give rise to adverse health effects. Mean intakes of free sugars (12%E) and salt (3.1 g day-1 ) exceeded recommendations and increased with age, whereas mean intake of saturated fat (15%E) decreased with age. By the age of 4 years, patterns established for intakes of salt, saturated fat and free sugars were unfavourable and similar to those observed in the diets of older children. Further research is needed to identify dietary strategies that improve the quality of the diet in young children, particularly in relation to excess of saturated fat, free sugars and salt, as well as inadequacy of iron, vitamin D and LCPUFA.

Dietary strategies for achieving adequate vitamin D and iron intakes in young children in Ireland.

Inadequate intakes of vitamin D and iron have been reported in young children in Ireland. The present study aimed to identify the main foods determining vitamin D and iron intakes and to model the impact of dietary strategies to improve adequacy of these micronutrients in young children. The present study is based on the Irish National Pre-School Nutrition Survey (NPNS), which estimated food and nutrient intakes in a representative sample (n=500) of children (aged 1-4years) using a 4-day weighed food record. Dietary strategies were modelled using DaDiet© software (Dazult Ltd, Co. Kildare, Republic of Ireland) and the usual intake distribution, prevalence of inadequate intakes and risk of excessive intakes were estimated using the National Cancer Institute method. Fortified foods and nutritional supplements were the key foods influencing the intakes of vitamin D and iron. Adding a 5μgday-1 vitamin D supplement, fortifying cow's milk (CM) with vitamin D or replacing CM with growing-up milk (GUM) would modestly increase intakes of vitamin D. A combined strategy of fortifying CM with vitamin D or replacing CM with GUM plus a 5μgday-1 vitamin D supplement would increase mean intakes of vitamin D (from 3.5μgday-1 at baseline to ≥11μgday-1 ) and substantially reduce the prevalence of inadequate intakes (from >95% to 12-36%). Fortifying CM with iron or replacing CM with GUM would increase mean intakes of iron (from 7.3mgday-1 to >10mgday-1 ), achieving adequate intakes across all ages. Based on real food consumption data in a representative sample of Irish children, we have shown that through targeted dietary strategies adequate intakes of iron are achievable and intakes of vitamin D could be greatly improved.

Fruit and vegetable intakes, sources and contribution to total diet in very young children (1-4 years): the Irish National Pre-School Nutrition Survey.

Although the importance of fruit and vegetable (F&V) intakes in the prevention of chronic diseases is well established, there are limited data on intakes in very young children. This study estimates F&V intakes and sources and the contribution to the total diet using data from the National Pre-School Nutrition Survey, a nationally representative sample (n 500) of Irish children aged 1-4 years. A 4-d weighed food record was used to collect food intake data. Of 1652 food codes consumed, 740 had a fruit/vegetable component. The percentage of edible fruits and/or vegetables in each food code was calculated. Intakes (g/d), sources (g/d) and the contribution of F&V to the weight of the total diet (%) were estimated, split by age. All children consumed F&V. Intakes of total fruits, in particular fruit juice, increased with age. The contribution to total fruit intake was discrete fruits (47-56 % range across age), 100 % fruit juice, smoothies and pureés (32-45 %) as well as fruits in composite dishes (7-13 %). Total vegetable intake comprised of discrete vegetables (48-62 % range across age) and vegetables in composite dishes (38-52 %). F&V contributed on average 20 % (15 % fruit; 5 % vegetables) to the weight of the total diet and was <10 % in sixty-one children (12 %). F&V contributed 50 % of vitamin C, 53 % of carotene, 34 % of dietary fibre and 42 % of non-milk sugar intakes from the total diet. F&V are important components of the diet of Irish pre-school children; however, some aspects of F&V intake patterns could be improved in this age group.

Dietary intake of four artificial sweeteners by Irish pre-school children

ABSTRACTIn spite of rigorous pre- and post-market reviews of safety, there remains a high level of debate regarding the use of artificial sweeteners in foods. Young children are of particular interest when assessing food chemical exposure as a result of their unique food consumption patterns and comparatively higher exposure to food chemicals on a body weight basis when compared with the general population. The present study examined the intakes of four intense sweeteners (acesulfame K, aspartame, saccharin, sucralose) in the diets of children aged 1–4 years using food consumption and sweetener presence data from the Irish National Pre-school Nutrition Survey (2010–11) and analytical data for sweetener concentration in foods obtained from a national testing programme. Four exposure assessment scenarios were conducted using the available data on sweetener occurrence and concentration. The results demonstrated that the mean daily intakes for all four sweeteners were below the acceptable daily intake (ADI) (17–31%), even considering the most conservative assumptions regarding sweetener presence and concentration. High consumer intakes (P95) were also below the ADI for the four sweeteners when more realistic estimates of exposure were considered. Both sweetener occurrence and concentration data had a considerable effect on reducing the estimated intake values, with a combined reduction in intakes of 95% when expressed as a proportion of the ADI. Flavoured drinks were deemed to be a key contributor to artificial sweetener intakes in this population cohort. It was concluded that there is no health risk to Irish pre-school children at current dietary intake levels of the sweeteners studied.

Development and validation testing of a short nutrition questionnaire to identify dietary risk factors in preschoolers aged 12–36 months

BackgroundAlthough imbalances in dietary intakes can have short and longer term influences on the health of preschool children, few tools exist to quickly and easily identify nutritional risk in otherwise healthy young children.ObjectivesTo develop and test the validity of a parent-administered questionnaire (NutricheQ) as a means of evaluating dietary risk in young children (12–36 months).DesignFollowing a comprehensive development process and internal reliability assessment, the NutricheQ questionnaire was validated in a cohort of 371 Irish preschool children as part of the National Preschool Nutrition Survey. Dietary risk was rated on a scale ranging from 0 to 22 from 11 questions, with a higher score indicating higher risk.ResultsChildren with higher NutricheQ scores had significantly (p<0.05) lower mean daily intakes of key nutrients such as iron, zinc, vitamin D, riboflavin, niacin, folate, phosphorous, potassium, carotene, retinol, and dietary fibre. They also had lower (p<0.05) intakes of vegetables, fish and fish dishes, meat and infant/toddler milks and higher intakes of processed foods and non-milk beverages, confectionery, sugars and savoury snack foods indicative of poorer dietary quality. Areas under the curve values of 84.7 and 75.6% were achieved for ‘medium’ and ‘high’ dietary risk when compared with expert risk ratings indicating good consistency between the two methods.ConclusionNutricheQ is a valid method of quickly assessing dietary quality in preschoolers and in identifying those at increased nutritional risk.

Nutritional adequacy of diets containing growing up milks or unfortified cow's milk in Irish children (aged 12–24 months)

BackgroundGrowing up milks (GUM) are milk-based drinks with added vitamins and minerals intended for children aged 12–36 months. Few data are available on the consumption of GUM and their role in the diets of young children.ObjectiveTo determine the nutritional adequacy of two groups of 12–24-month-old Irish children by type of milk consumption (consumers or non-consumers of GUM).DesignUsing data from a cross-sectional study of Irish children, the National Pre-School Nutrition Survey (2010–2011), two groups of children were defined. The groups included children aged 12–24 months with an average daily total milk intake of at least 300 g and consuming GUM (≥100 g/day) together with cow's milk (n=29) or cow's milk only (n=56).ResultsWhile average total daily energy intakes were similar in both consumers and non-consumers of GUM, intakes of protein, saturated fat, and vitamin B12 were lower and intakes of carbohydrate, dietary fibre, iron, zinc, vitamins C and D were higher in consumers of GUM. These differences in nutrient intakes are largely attributable to the differences in composition between GUM and cow's milk. For both consumers and non-consumers of GUM, intakes of carbohydrate and fat were generally in line with recommendations while intakes of protein, dietary fibre and most micronutrients were adequate. For children consuming cow's milk only, high proportions had inadequate intakes of iron and vitamin D; however, these proportions were much lower in consumers of GUM.ConclusionsConsumption of GUM reduced the risk of inadequacies of iron and vitamin D, two nutrients frequently lacking in the diets of young children consuming unfortified cow's milk only.

Dietary fibre (DF) intakes in pre–school children aged 1–4 years in Ireland

Currently, there are limited data available on the dietary habits of pre-school children in Ireland. The National Pre-school Nutrition Survey (NPNS) was therefore carried out to establish a database of habitual food and beverage consumption in a representative sample of preschool children in the Republic of Ireland. A 4-day weighed food diary was used to collect dietary intake data from 500 pre-school children aged 1‐4 years. Analysis of dietary intake data was carried out using WISP g , which is based on McCance and Widdowson’s The Composition of Foods 6 th edition (1) and the Irish food composition database (2) . DF intake and sources of DF in the diets of pre-school children are reported.

Fruit and vegetable intakes and sources in Irish pre-school children (1–4 years): The National Pre-School Nutrition Survey

Fruit and vegetable intakes and sources in Irish pre-school children (1–4 years): The National Pre-School Nutrition Survey

Sex and population differences in the incidence of a plasma cholinesterase variant.

Accumulating knowledge of polymorphic enzyme systems poses intriguing possibilities of anthropologic genetics. Development of an automated procedure for determination of heterozygosity or homozygosity of the atypical plasma cholinesterase allele (E(1)(a)) permitted screening of 2317 individuals during a national Preschool Nutrition Survey and several smaller population studies. Frequencies of the allele (E(1)(a)) closely parallel those previously reported. Caucasians manifested a heterozygote male preponderance of 1.85: 1.