Location influences snacking behavior of US infants, toddlers and preschool children.

BACKGROUND: Compare at-home and away-from-home snacking patterns of US infants and young children. METHODS: A secondary analysis was conducted using nationwide, cross-sectional dietary survey data from the US Feeding Infants and Toddlers Study (FITS) 2008. The sample included infants (6-11.9 months, n = 505), toddlers (12-23.9 months, n = 925), preschool children (24-47.9 months, n = 1461). Weighted population descriptive statistics (means and standard errors) were calculated using SAS. Significance was determined at P ≤ 0.05. The main outcome measures of the analyses were the percent of children consuming snacks by location (at home, away from home) and snacking period (morning, afternoon and evening), energy and food groups consumed during snacks. RESULTS: Snacking at home was more prevalent than snacking away from home (toddlers, 73% vs 27%; preschoolers, 67% vs 33%). Away-from-home snacks provided about 50 additional calories per day for toddlers (346 vs 298 kcal/day, P ≤ 0.05) and preschoolers (371 vs 326 kcal/day, P ≤ 0.05) versus snacks consumed at home. Caregivers made similar snack choices for toddlers and preschoolers (milk/milk products, fruit/juice, grains and sweets) but differed in frequency of consumption by location. Among toddlers, milk/milk products were the most frequently consumed snacks at home (66%), while sweets were the top snacks consumed away from home (69%). Among preschoolers, sweets were the top snacks both at home (60%) and away (83%). CONCLUSIONS: Location is an important factor influencing snacking patterns of young children and should be considered when developing feeding guidelines. This data may be of use in the upcoming development of dietary guidelines in the U.S. for the population aged 0-2 years.

Food Consumption Patterns and Micronutrient Density of Complementary Foods Consumed by Infants Fed Commercially Prepared Baby Foods.

Nutrition is critically important in the first 1000 days, and while most American babies are fed commercial baby foods, there is little or no evidence from nationally representative data to understand the implications of such consumption. We used 24-hour dietary recall data for 505 infants from The Feeding Infants and Toddlers Study to describe food consumption patterns and micronutrient density of complementary foods consumed by infants fed commercially prepared baby food fruit, vegetables, and dinners and compared with those eaten by nonconsumers of these products. Results show that consumers were significantly more likely to report eating all vegetables (excluding white potatoes, 71% vs 51%), deep yellow vegetables (42% vs 18%), and fruits (79% vs 65%) and were less likely to report eating white potatoes (10% vs 24%), dark green vegetables (4% vs 20%), and sweets (23% vs 47%) than were nonconsumers. Nutrient density of the complementary foods of consumers was greater for fiber, potassium, vitamin A, vitamin C, vitamin E, and magnesium, but lower in sodium and vitamin D. We conclude that infants fed commercially prepared baby foods were more likely to eat vegetables and fruits, and their diets were higher in several micronutrients. These findings provide important insights on complementary feeding and are useful to support the development of evidence-based infant-feeding guidelines.

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 cow's 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.

Picky eating: Associations with child eating characteristics and food intake.

Food rejection behaviors such as picky eating are of concern for many parents and attempts to increase healthy food intake can cause distress at mealtimes. An important limitation in most of the picky eating studies is that they cover few characteristics of picky eating behaviors and use limited measures of food intake. The objective of this study was to explore the associations between picky eating, child eating characteristics, and food intake among toddlers 12-47.9 months old (n = 2371) using data from the 2008 Feeding Infants and Toddlers Study (FITS). Logistic regression was used to examine associations between demographic and feeding characteristics and picky eater status. Differences in food group intake between picky and non-picky eaters were analyzed. Picky eaters were more likely to be neophobic, texture resistant, and to eat only favorite foods, In addition, the parents of picky eaters tend to offer new food a greater number of times than those of non-picky eaters before deciding that the child does not like it. Picky eaters showed significant lower intakes of eggs, burritos/tacos/enchiladas/nachos and sandwiches than non-picky eaters. Picky eaters consumed fewer vegetables from the "other vegetables" category and less raw vegetables than non-picky eaters. Neophobia, eating only favorite foods and difficulties with texture are all important characteristics of picky eaters which need to be integrated in studies measuring picky eating behaviors. Food intake of picky eaters differs only slightly from non-picky eaters. Because picky eating is a major parental concern, feeding strategies and advice related to the relevant characteristics of picky eating behavior need to be developed and assessed for their effectiveness.

Estimating usual intakes mainly affects the micronutrient distribution among infants, toddlers and pre-schoolers from the 2012 Mexican National Health and Nutrition Survey.

OBJECTIVE: To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children. DESIGN: In order to obtain usual nutrient intakes, the National Cancer Institute's method was used to correct the first 24 h dietary recall collected in the entire sample (n 2045) with a second 24 h recall collected in a sub-sample (n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na. SETTING: 2012 Mexican National Health and Nutrition Survey. SUBJECTS: A total of 2045 children were included: 0-5·9 months old (n 182), 6-11·9 months old (n 228), 12-23·9 months old (n 537) and 24-47·9 months old (n 1098). From these, 178 provided an additional dietary recall. RESULTS: Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v. usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake (P6 months. CONCLUSIONS: There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used.

Parents' Perceptions and Adherence to Children's Diet and Activity Recommendations: the 2008 Feeding Infants and Toddlers Study.

INTRODUCTION: Solving the childhood obesity problem will require strategies for changes in policy, the environment, the community, and the family. Filling the data gap for children younger than 4 years could facilitate interventions aimed at this critical age group. The objective of this study was to describe parents' and caregivers' perceptions of the healthfulness of their young child's diet and body weight and to assess their adherence to the American Academy of Pediatrics' 5-2-1-0 recommendations. METHODS: We conducted a descriptive analysis of parents' and caregivers' survey data for 887 infants younger than 12 months, 925 toddlers aged 12 to 23.9 months, and 1,461 preschoolers aged 24 to 47.9 months. Data were from the national, cross-sectional 2008 Feeding Infants and Toddlers Study (FITS). RESULTS: Most parents considered their child's weight to be about right but were more likely to think their child was underweight (8%-9%) than overweight (2%-3%). Most parents thought their child consumed enough fruits and vegetables: however, only 30% of preschoolers met the recommendation for 5 daily servings. Only 2% of toddlers met the recommendation for no screen time, whereas 79% of preschoolers met the recommendation to limit daily screen time to 2 hours or less. About 56% of toddlers and 71% of preschoolers met the recommendation of at least 1 hour of daily outdoor play. About 56% of toddlers and 52% of preschoolers met the recommendation to limit consumption of sugar-sweetened beverages. CONCLUSION: The FITS 2008 findings underscore the ongoing need for research on policies and strategies to prevent childhood obesity from infancy through preschool. Health care providers can play a vital role because they are an important and early point of contact for parents.

Infant feeding practices and food consumption patterns of children participating in WIC.

OBJECTIVE: To describe feeding practices and food consumption of infants and children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). DESIGN: National, cross-sectional analysis of 24-hour dietary recall data from the 2008 Feeding Infants and Toddlers Study. PARTICIPANTS: Random sample of infants (6-11 months of age), toddlers (12-23 months of age), and preschoolers (24-47 months of age); WIC participants (n = 794) and nonparticipants (n = 2,477). MAIN OUTCOME MEASURES: Breastfeeding rates, introduction to solids, food consumption. ANALYSIS: Used weighted descriptive statistics, chi-square tests, and t tests to identify dietary outcomes unique to WIC participants vs nonparticipants. RESULTS: Compared with nonparticipants, fewer WIC infants were breastfed (P < .01) and consumed any vegetable (P < .05) but more consumed 100% juice (P < .05). Fewer WIC toddlers and preschoolers consumed any fruit vs nonparticipants (P < .01). The WIC toddlers were more likely to consume any sweet vs nonparticipants (P < .05), especially sugar-sweetened beverages (P < .01). Over 80% of all preschoolers consumed any sweet, and nearly half consumed sugar-sweetened beverages on an average day. CONCLUSIONS AND IMPLICATIONS: Findings identify feeding and dietary issues that begin during infancy and are also present in toddler and preschool stages. These findings are useful for WIC nutritionists and health care practitioners to encourage the early development of healthful eating patterns.

New findings from the Feeding Infants and Toddlers Study 2008.

The purpose of this chapter is to describe the infant feeding practices among infants and toddlers (aged 0-24 months) and to describe food group consumption patterns of these infants and young children (0-48 months) participating in the 2008 Feeding Infants and Toddlers Study (FITS). The FITS 2008 is a cross-sectional survey of a national sample of US children (n = 3,273). Results indicate a longer duration of breastfeeding; however, 17% of infants received cow's milk before the recommended age of one year. Introduction of complementary foods also appears to be delayed until about 4-6 months. There was a decline in consumption of infant cereal after 8 months that may be contributing to iron deficiencies in the 9-11 months age group. Consumption of 100% juice (particularly among infants) and the daily consumption of desserts or candy, sweetened beverages (particularly among 12-to 20-month-olds), and salty snacks is lower than in the 2002 survey. Overall, 10-20 and 30% of children were not consuming any fruit or vegetable, respectively, in a given day. More preschoolers were drinking 2% milk than whole milk, but about one third were still drinking whole milk. Despite some of these positive changes, improvements in young children's diet still are needed.

The Feeding Infants and Toddlers Study 2008: study design and methods.

OBJECTIVE: Describe the study design, data collection methods, 24-hour dietary recall protocol, and sample characteristics of the Feeding Infants and Toddlers Study (FITS) 2008. DESIGN: A cross-sectional study designed to obtain information on the diets and feeding patterns of US infants, toddlers, and preschoolers ages birth to 47 months. Telephone interviews with parents and caregivers were conducted from June 2008 through January 2009 and included a household interview to recruit the household and collect information on household and child demographics and nutrition-related characteristics, and a dietary interview, including a 24-hour dietary recall collected using the 2008 Nutrition Data System for Research. A second dietary recall was collected on a random subsample to estimate usual nutrient intake distributions. Data collection instruments were built on those used in FITS 2002, with expanded survey content to address emerging issues in childhood nutrition and obesity. The dietary protocol was improved to increase reporting accuracy on portion sizes, and a bridging study was conducted to test effects of the changes in the food model booklet and protocol since FITS 2002 (n=240 cases aged 4 to 23 months). SUBJECTS: A national random sample of 3,273 infants, toddlers, and preschoolers from birth up to age 4 years, with 2 days of dietary intake data for 701 cases. RESULTS: Among sampled households with an age-eligible child, the response rate was 60% for the recruitment interview. Of recruited households, the response rate for the dietary interview was 78%. CONCLUSIONS: The FITS 2008 provides rigorous, well-tested methods and survey questions for nutrition researchers to use in other dietary studies of young children. FITS 2008 findings on the food and nutrient intakes of US children from birth up to age 4 years can inform dietetics practitioners, pediatric health practitioners, and policymakers about the dietary issues of young children.

Nutrient intakes of US infants, toddlers, and preschoolers meet or exceed dietary reference intakes.

OBJECTIVES: To assess the usual nutrient intakes of 3,273 US infants, toddlers, and preschoolers, aged 0 to 47 months, surveyed in the Feeding Infants and Toddlers Study (FITS) 2008; and to compare data on the usual nutrient intakes for the two waves of FITS conducted in 2002 and 2008. DESIGN: The FITS 2008 is a cross-sectional survey of a national random sample of US children from birth through age 47 months. Usual nutrient intakes derived from foods, beverages, and supplements were ascertained using a telephone-administered, multiple-pass 24-hour dietary recall. SUBJECTS: Infants aged birth to 5 months (n=382) and 6 to 11 months (n=505), toddlers aged 12 to 23 months (n=925), and preschoolers aged 24 to 47 months (n=1,461) were surveyed. METHODS: All primary caregivers completed one 24-hour dietary recall and a random subsample (n=701) completed a second 24-hour dietary recall. The personal computer version of the Software for Intake Distribution Estimation was used to estimate the 10th, 25th, 50th, 75th, and 90th percentiles, as well as the proportions below and above cutoff values defined by the Dietary Reference Intakes or the 2005 Dietary Guidelines for Americans. RESULTS: Usual nutrient intakes met or exceeded energy and protein requirements with minimal risk of vitamin and mineral deficiencies. The usual intakes of antioxidants, B vitamins, bone-related nutrients, and other micronutrients were adequate relative to the Adequate Intakes or Estimated Average Requirements, except for iron and zinc in a small subset of older infants, and vitamin E and potassium in toddlers and preschoolers. Intakes of synthetic folate, preformed vitamin A, zinc, and sodium exceeded Tolerable Upper Intake Level in a significant proportion of toddlers and preschoolers. Macronutrient distributions were within acceptable macronutrient distribution ranges, except for dietary fat, in some toddlers and preschoolers. Dietary fiber was low in the vast majority of toddlers and preschoolers, and saturated fat intakes exceeded recommendations for the majority of preschoolers. The prevalence of inadequate intakes, excessive intake, and intakes outside the acceptable macronutrient distribution range was similar in FITS 2002 and FITS 2008. CONCLUSIONS: In FITS 2008, usual nutrient intakes were adequate for the majority of US infants, toddlers, and preschoolers, except for a small but important number of infants at risk for inadequate iron and zinc intakes. Diet quality should be improved in the transition from infancy to early childhood, particularly with respect to healthier fats and fiber in the diets of toddlers and preschoolers.

Food consumption patterns of infants and toddlers: where are we now?

OBJECTIVES: To describe current infant-feeding practices and current food group consumption patterns of infants and toddlers and to compare 2008 data with 2002 data to identify shifts in these practices and food consumption over time. DESIGN: The Feeding Infants and Toddlers Study (FITS) 2008 is a cross-sectional survey of a national random sample of US children from birth up to age 4 years. Data for three age subgroups (infants 4 to 5.9 months and 6 to 11.9 months and toddlers 12 to 23.9 months) were used from the 2002 (n=2,884) and 2008 surveys (n=1,596). STATISTICAL METHODS: All analyses use sample weights that reflect the US population aged 4 to 24 months. Descriptive statistics (means, proportions, and standard errors) and t tests were calculated using SUDAAN (release 9, 2005, Research Triangle Park Institute, Research Triangle Park, NC). RESULTS: These data show a higher percentage of infants receiving breast milk from 4 to 11.9 months of age with a concurrent decreasing percentage of infants receiving formula, which is significantly different from data for the 9- to 11.9-month-old age group. The use of complementary foods also appears to be delayed in FITS 2008: There is a significantly lower proportion of infants consuming infant cereal at 9 to 11.9 months in FITS 2008 compared to 2002 data. Fruit and vegetable consumption remains lower than desired. Significant reductions in the percentage of infants and toddlers consuming any desserts or candy, sweetened beverages, and salty snacks were seen in 2008. CONCLUSIONS: The findings presented here provide important insights to the content of messages and types of interventions that are still needed to improve the diets of infants and toddlers.

Food consumption patterns of young preschoolers: are they starting off on the right path?

OBJECTIVE: To describe the food consumption patterns of US children aged 2 and 3 years. DESIGN: Descriptive analysis of data collected in the Feeding Infants and Toddlers Study 2008 based on a single 24-hour dietary recall collected by telephone. SUBJECTS: A national random sample of children aged 2 and 3 years (n=1,461). STATISTICAL ANALYSES PERFORMED: The percentage of children consuming foods from specific food groups was estimated for the full sample of children aged 2 and 3 years and separately by year of age. RESULTS: About a third of 2-year-olds and a quarter of 3-year-olds consumed whole milk at least once in a day. About 70% of 2- and 3-year-olds consumed vegetables as a distinct food item at least once in day. French fries and other fried potatoes were the most commonly consumed vegetable. Almost three quarters of children (73%) consumed fruit as a distinct food item at least once in a day, and 59% consumed 100% juice. Fresh fruit was the most commonly consumed type of fruit. About 85% of children consumed some type of sweetened beverage, dessert, sweet, or salty snack in a day. Percentages of children consuming such foods were consistently higher for 3-year-olds than for 2-year-olds. CONCLUSIONS: Parents and caregivers should be encouraged to expose young children to a wide variety of fruits and vegetables, whole grains, low-fat dairy products, and healthier fats, and to limit consumption of low-nutrient, energy-dense foods and beverages. Dietary guidance should stress the fact that children in this age group have high nutrient needs and relatively low energy requirements, leaving little room for such foods. Parents need advice that is specific, practical, and actionable.

All-trans beta-carotene appears to be more bioavailable than 9-cis or 13-cis beta-carotene in gerbils given single oral doses of each isomer.

Male gerbils (28 d old) were used to investigate the beta-carotene (betaC) isomer pattern in the intestine and tissues 6 h after ingestion of three betaC isomers. After a 49- to 52-d period of consuming the AIN93G diet without vitamin A (VA) or betaC, three groups (n = 7) were gavaged with crystalline all-trans (at)betaC, 9-cis (9c)betaC or 13-cis (13c)betaC solubilized in oil and a control group (n = 5) with oil alone. Total betaC per dose for gerbils in the atbetaC, 9cbetaC and 13cbetaC groups was 384 +/- 3, 391 +/- 2 and 386 +/- 2 nmol, respectively. After 6 h, gerbils were killed and serum, stomach contents, small intestinal contents (SIC), small intestinal mucosal scrapings (SIM) and liver were collected. betaC and VA in tissues were quantified using HPLC. Nonspecific isomerization of betaC occurred in the digestive tracts of gerbils administered betaC; the greatest effect was in the SIC of the 13cbetaC (50:50 cis:trans) and 9cbetaC (70:30 cis:trans) groups. Concentrations of total betaC in the SIM of gerbils administered at betaC were greater than those intubated with 9cbetaC and 13cbetaC (P < 0.05). Gerbils that received atbetaC had greater total betaC concentrations in serum (P < 0.05) and total betaC stores in liver (P < 0.01) compared with those administered 9cbetaC and 13cbetaC. Gerbils intubated with 9cbetaC had higher levels of total betaC in serum (P = 0.05) and liver (P < 0.01) compared with those intubated with 13cbetaC. Because of its preferential uptake, transport and tissue accumulation, atbetaC appears to be a more bioavailable isomer than 9cbetaC or 13cbetaC in gerbils.

The relative vitamin A value of 9-cis beta-carotene is less and that of 13-cis beta-carotene may be greater than the accepted 50% that of all-trans beta-carotene in gerbils.

The effectiveness of beta-carotene (betaC) as a vitamin A (VA) precursor may be influenced by the proportions of cis isomers of betaC consumed in the diet. Although the metabolic fates of cis isomers of betaC are poorly understood, their retinol equivalency has been assigned a value 50% that of all-trans (at) betaC. A dose-response design was used to estimate the relative VA value (VAV) of atbetaC, 9-cis (9c) betaC and 13-cis (13c) betaC in gerbils using total liver retinol as a measure of VAV. Ten groups of gerbils received a daily dose of oil with or without betaC isomer by gavage for 7 d. Nine groups (n = 5) were divided equally among the three betaC dosing treatments with each isomer provided at 141, 275 and 418 nmol/d. Total liver VA (171-259 nmol) in gerbils administered atbetaC was higher than total liver betaC (25-53 nmol). Stores of VA and betaC in livers from gerbils administered atbetaC were higher than stores of VA and betaC in livers from those given 9cbetaC or 13cbetaC. The relative VAV of cis betaC isomers was estimated by comparing slopes of dose-response lines of all three betaC isomers using atbetaC as a reference. Total liver VA and betaC increased linearly (P < 0.05) with increasing betaC intake in gerbils gavaged with all three betaC isomer oils. The relative VAV of 9cbetaC was less (38%) and 13cbetaC was more (62%) than the assigned value of 50% that of atbetaC. Thus, the proportions of cis isomers of betaC contained in a food could negatively affect the vitamin A value of the diet.