A Substantial Proportion of 6- to 12-Month-Old Infants Have Calculated Daily Absorbed Iron below Recommendations, Especially Those Who Are Breastfed.

OBJECTIVE: To calculate the amount of bioavailable iron consumed among 6- to 12- month-old infants considering differences in iron bioavailability among dietary iron sources and to compare this with current recommended intakes. STUDY DESIGN: We used the Feeding Infants and Toddlers Study database of dietary intakes from 2016 and the estimated bioavailability of dietary iron sources to evaluate the proportion of infants whose calculated total daily absorbed iron fell below physiologic requirements, that is, the recommended amount needed to fully support growth and erythropoiesis. RESULTS: The calculated daily iron absorption was below the recommended amount in 54.3% of infants evaluated ranging from 19.5% of 448 exclusively formula-fed infants, to 95.8% of 296 exclusively breastfed infants and 72.2% of 102 mixed fed infants. The calculated mean iron absorption of 6- to 9- month-old breastfed infants was 0.27 mg/day, far less than the estimated physiologic requirement of 0.69 mg/day. The most highly bioavailable iron, heme iron, was <12% of the contributor to total iron absorbed in breastfed infants. CONCLUSIONS: These data indicate a need for further education and public health policies to support increased iron intake in 6- to 12- month-old infants, emphasizing those receiving any breast milk. Exclusively formula-fed infants are at lower risk, but rates of low absorbed iron indicate that all infants may need monitoring for clinical evidence of low iron status. Consideration should be given to increasing the proportion of heme iron obtained from animal products in the diet where feasible.

The Special Supplemental Nutrition Program for Women, Infants, and Children is Associated with Several Changes in Nutrient Intakes and Food Consumption Patterns of Participating Infants and Young Children, 2008 Compared with 2016.

BACKGROUND: In 2009 the USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) updated the food packages provided to participants. OBJECTIVES: This study investigates associations between WIC participation and nutrients and food groups consumed using data from the Feeding Infants and Toddlers Study's 2008 and 2016 nationwide, cross-sectional surveys of children <4 y, weighted to be representative of the US population. METHODS: The study data included 2892 children aged 6-47.9 mo in 2008 and 2635 in 2016. Differences were analyzed by WIC participation, survey year, and child age (infants 6-11.9 mo old, toddlers 12-23.9 mo old, preschoolers 24-47.9 mo old). Usual nutrient intake distributions were estimated using National Cancer Institute methodology. Daily food group consumption differences were tested via multivariate regression. All analyses controlled for income. RESULTS: In 2016 18.6% of infants had iron intakes below the estimated average requirement (EAR), compared to 7.6% in 2008; 87% of WIC infants met the EAR, compared with 69% of non-WIC infants. In 2016 37% of WIC preschoolers met saturated fat guidelines, compared with 25% in 2008; in both years, fewer than one-third of non-WIC preschoolers met the guidelines. More WIC infants than non-WIC infants consumed infant cereals in 2016 (58% compared with 45%, respectively). More WIC infants ate vegetables daily in 2016 than in 2008 (74% compared with 59%, respectively).  In 2016, as compared with 2008, more WIC infants consumed baby-food vegetables (55% compared with 29%, respectively) and fruits (56% compared with 41%, respectively). In 2016 47% of WIC preschoolers drank low-fat milk, compared with 19% of non-WIC preschoolers. CONCLUSIONS: Infant iron intakes are concerning, although more WIC infants meet the EAR. WIC infants' vegetable intakes have improved; baby-food vegetables have become important contributors to their intakes. In 2016 WIC children were more likely than non-WIC children to shift to lower-fat milks at 2 y of age, likely contributing to lower saturated fat intakes.

Trends in Mean Nutrient Intakes of US Infants, Toddlers, and Young Children from 3 Feeding Infants and Toddlers Studies (FITS).

BACKGROUND: Many updates to young child feeding recommendations have been published over the past decade, but concurrent intake trends have not been assessed. OBJECTIVE: The aim of this study was to evaluate adequacy and trends in energy and nutrient intakes of US infants and children aged 0-47.9 mo through use of Feeding Infants and Toddlers Study (FITS) data from 2002, 2008, and 2016. METHODS: FITS are cross-sectional surveys of parents/caregivers of infants and young children (FITS 2002, n = 2962; FITS 2008, n = 3276; FITS 2016, n = 3235). Dietary intakes were assessed by telephone with trained interviewers using the Nutrition Data System for Research. Mean ± SE nutrient intakes were calculated. Diet adequacy was assessed with the nutrient adequacy ratio (NAR) for 17 nutrients and the corresponding mean adequacy ratio. RESULTS: Energy and macronutrient intakes were generally stable across surveys, but significant decreases for saturated fat and total sugars and an increase in fiber were observed among 6-11.9-mo-olds and 12-23.9-mo-olds (P-trend < 0.0001). Mean sodium intakes exceeded Adequate Intakes (AI) for all ages, whereas fiber intakes were universally below the AI. Nutrients with the lowest NAR values were vitamin D (range 0.41-0.67/1.00) and vitamin E (range 0.60-0.79/1.00 for 2008 and 2016). For iron, infants aged 6-11.9 mo had the lowest NAR values at 0.77-0.88/1.00, compared to 0.85-0.89/1.00 for 12-47.9-mo-olds. Potassium was low from 12 to 47.9 mo (NAR range 0.55-0.63/1.00 across survey years). The nutrients with the greatest decline in mean intakes were iron and vitamins D and E among 6-11.9-mo-olds, and vitamin D and potassium among 12-23.9-mo-olds in 2016 compared to 2002. CONCLUSIONS: The diets of US infants and young children were generally adequate for most micronutrients and stable over time, but sodium intakes were too high, and nutrient gaps still existed, especially for vitamins D, E, and fiber across ages and for iron among infants.

Nutrient Intakes among Brazilian Children Need Improvement and Show Differences by Region and Socioeconomic Level.

Brazil is the most populous country in South America. Using 24 h dietary data, we compared the nutrient intakes of 4-13-year-olds to reference values and tested for regional and socioeconomic (SES) differences. A considerable proportion reported intakes below the Estimated Average Requirements (EAR) for vitamins E (78.1%, 96.5%), D (100% for both), and calcium (80.5%, 97.7%) for 4-8 and 9-13-year-olds, respectively. Few exceeded Adequate Intakes (AI) for potassium or fiber. Older children reported greater inadequacies and, while there was regional variability, patterns of inadequacy and excess tended to be similar. For vitamin C, the percent of children below EAR in the Northeast and Southeast was lower than in the South. Most children, regardless of SES, had energy intakes within the Acceptable Macronutrient Distribution Ranges (AMDRs) for carbohydrates and protein. Over a quarter reported total energy from fat less than the AMDR, and inversely associated with SES (low 50.9%, moderate 26.0%, and high 15.0%), but also exceeding the percentage of energy recommendation for saturated fat, increasing with SES (low 18.1%, moderate 38.9%, and high 48.8%). The contrast observed between the diets of young Brazilians and recommendations underscores the need for individual and regional environmental interventions to promote healthier dietary patterns.

Development and Application of a Total Diet Quality Index for Toddlers.

For the first time, the 2020-2025 Dietary Guidelines for Americans include recommendations for infants and toddlers under 2 years old. We aimed to create a diet quality index based on a scoring system for ages 12 to 23.9 months, the Toddler Diet Quality Index (DQI), and evaluate its construct validity using 24 h dietary recall data collected from a national sample of children from the Feeding Infants and Toddlers Study (FITS) 2016. The mean (standard error) Toddler DQI was 49 (0.6) out of 100 possible points, indicating room for improvement. Toddlers under-consumed seafood, greens and beans, and plant proteins and over-consumed refined grains and added sugars. Toddler DQI scores were higher among children who were ever breastfed, lived in households with higher incomes, and who were Hispanic. The Toddler DQI performed as expected and offers a measurement tool to assess the dietary quality of young children in accordance with federal nutrition guidelines. This is important for providing guidance that can be used to inform public health nutrition policies, programs, and practices to improve diets of young children.