Estimation of Total Usual Dietary Intakes of Pregnant Women in the United States.

Importance: Nutrition during pregnancy is a critical dimension not only for women's health but also for the lifelong health of the offspring. Very limited national data exist on the usual dietary intakes of pregnant women. Objective: To estimate total usual nutrient intakes (from foods and dietary supplements) and the population prevalence of meeting or exceeding the National Academies of Sciences, Engineering, and Medicine Dietary Reference Intake recommendations among pregnant US women. Design, Setting, and Participants: A cross-sectional analysis was performed of a nationally representative sample of 1003 pregnant US women aged 20 to 40 years from the 2001-2014 National Health and Nutrition Examination Survey. Exposure: Usual dietary intakes assessed by two 24-hour dietary recalls (including dietary supplements) adjusted for within-person variation using the National Cancer Institute method. Main Outcomes and Measures: The proportion of women at risk of inadequate dietary intake as determined by the Estimated Average Requirement, the proportion of women assumed to have adequate dietary intake as determined by the Adequate Intake, and the proportion of women at risk of excess dietary intake as determined by the Tolerable Upper Intake Level. Demographic differences between pregnant and nonpregnant women were compared with t tests. Results: As representative of the US population, this sample of 1003 pregnant women had a mean (SE) age of 28.0 (0.3) years, was predominantly non-Hispanic white (mean [SE], 54.5% [3.1%]), and was at above 185% of the income to poverty ratio (mean [SE], 56.8% [3.0%]). Most pregnant women used a dietary supplement (mean [SE], 69.8% [2.3%]). A total of 10% or more of pregnant women had a total usual intake that is less than the Estimated Average Requirement for magnesium (mean [SE], 47.5% [2.8%]), vitamin D (mean [SE], 46.4% [2.7%]), vitamin E (mean [SE], 43.3% [2.7%]), iron (mean [SE], 36.2% [2.8%]), vitamin A (mean [SE], 15.5% [2.1%]), folate (mean [SE], 16.4% [1.6%]), calcium (mean [SE], 12.9% [2.4%]), vitamin C (mean [SE], 11.5% [1.9%]), vitamin B6 (mean [SE], 11.5% [1.5%]), and zinc (mean [SE], 10.9% [1.9%]). Some pregnant women exceeded the Adequate Intake for potassium (mean [SE], 41.7% [2.9%]), choline (mean [SE], 7.9% [3.2%]), and vitamin K (mean [SE], 47.9% [4.3%]). Most women exceeded the Tolerable Upper Intake Level for sodium (mean [SE], 95.0% [2.2%]), and some women exceeded the Tolerable Upper Intake Level of folic acid (mean [SE], 33.4% [2.8%]), iron (mean [SE], 27.9% [2.8%]), calcium (mean [SE], 3.0% [0.8%]), and zinc (mean [SE], 7.1% [1.6%]). For iron, the prevalence of an at-risk intake from foods alone was lower among women who used supplements (mean [SE], 80.3% [4.3%]) than those who did not use supplements (mean [SE], 95.3% [7.3%]); however, supplement use increased the risk of excessive iron and folic acid intakes given the amounts that are being consumed from supplemental products. Conclusions and Relevance: This study suggests that a significant number of pregnant women are not meeting recommendations for vitamins D, C, A, B6, K, and E, as well as folate, choline, iron, calcium, potassium, magnesium, and zinc even with the use of dietary supplements. Almost all pregnant women in this study were at risk of excessive consumption of sodium, and many were at risk of excessive consumption of folic acid and iron. Improved dietary guidance to help pregnant women meet but not exceed dietary recommendations is warranted.

Feeding infants and toddlers study: What foods are infants and toddlers eating?

OBJECTIVE: To describe the food consumption patterns of US infants and toddlers, 4 to 24 months of age. DESIGN: Descriptive analysis of data collected in the 2002 Feeding Infants and Toddlers study based on telephone interviews and 24-hour dietary recalls. SUBJECTS: A national random sample of 3,022 infants and toddlers age 4 to 24 months. STATISTICAL ANALYSES PERFORMED: The percentage of infants and toddlers consuming foods from specific food groups was estimated for six age groups, using a single 24-hour recall. RESULTS: Infants as young as 7 months of age showed food patterns that have been observed in older children and adults. From 18% to 33% of infants and toddlers between ages 7 and 24 months consumed no discrete servings of vegetables, and 23% to 33% consumed no fruits. French fries were one of the three most common vegetables consumed by infants 9 to 11 months of age. By 15 to 18 months, french fries were the most common vegetable. Almost half (46%) of 7- to 8-month-olds consumed some type of dessert, sweet, or sweetened beverage, and this percentage increased as age increased. By 19 to 24 months, 62% of toddlers consumed a baked dessert, 20% consumed candy, and 44% consumed a sweetened beverage. APPLICATIONS: Parents and caregivers should be encouraged to offer a wide variety of vegetables and fruits daily, with emphasis on dark green, leafy, and deep yellow vegetables and colorful fruits. They should offer desserts, sweets, sweetened beverages, and salty snacks only occasionally, offering nutrient-dense, age-appropriate foods as alternatives (eg, fruit, cheese, yogurt, and cereals). Water, milk, and 100% fruit juices should be offered as alternative beverages. Because family food choices influence what foods are offered to children, family-based approaches to developing healthy eating habits may be helpful.

Nutrient intakes of infants and toddlers.

OBJECTIVES: To assess the nutrient adequacy of the diets of US infants and toddlers 4 to 24 months of age. DESIGN: Descriptive analysis of the usual nutrient intakes of infants and toddlers using 24-hour recall data from the 2002 Feeding Infants and Toddlers Study. SUBJECTS: A national random sample of 3,022 infants and toddlers, with 2 days of recall available for 703 sample members. Sample sizes by age were: infants 4 to 6 months (n=862), infants 7 to 11 months (n=1,162), and toddlers 12 to 24 months (n=998). STATISTICAL ANALYSES PERFORMED: Using the personal computer version of the Software for Intake Distribution Estimation, we estimated (where applicable) the percentage of infants and toddlers with usual intakes below the estimated average requirement, compared the means of usual nutrient intake distributions with adequate intake levels, and compared the 99th percentile of usual intake distributions with tolerable upper intake levels. RESULTS: For infants under 12 months of age, mean usual intakes exceeded the adequate intake for all nutrients. For toddlers 12 to 24 months of age, the estimated prevalence of inadequacy was low for most nutrients; however, 58% of toddlers had usual vitamin E intakes less than the estimated average requirement. Mean energy intake exceeded the estimated energy requirement by 10% for infants 4 to 6 months, 23% for infants 7 to 12 months, and 31% for toddlers 12 to 24 months of age. The discrepancy between mean energy intake and the estimated energy requirement for infants 4 to 6 months of age was larger for infants fed solids than for infants consuming only breast milk or formula. Fiber intakes of toddlers were below the adequate intake. APPLICATIONS: Studies should examine whether parents overreport foods consumed by infants and toddlers, and whether infants and toddlers are consuming more energy than required. Additional research is indicated to substantiate some of the new Dietary Reference Intakes for infants and children 1 to 3 years of age.

Meal and snack patterns of infants and toddlers.

OBJECTIVE: To describe meal and snack patterns of infants and toddlers. DESIGN: A cross-sectional telephone survey in which mothers reported their infants' and toddlers' food and beverage intakes for a 24-hour period. SUBJECTS: Subjects included 3,022 infants and toddlers, ages 4 to 24 months, in the Feeding Infants and Toddlers Study. STATISTICAL ANALYSES PERFORMED: Means+/-standard deviations, frequencies, percentages, energy and nutrient analyses, nutrient densities. RESULTS: On average, infants and toddlers were fed seven times per day. The breakfast, lunch, and dinner pattern, plus snacks, emerged at 7 to 8 months and was well established by 9 to 11 months. Breakfasts were higher in nutrient density for iron, folate, and calcium than other meals. The percentage of children reported to be eating snacks increased with age. The afternoon snack was consumed by over 80% of toddlers (12 to 24 months), and snacks provided about 25% of toddlers' daily energy intakes. Typical snack foods for toddlers were milk, water, cookies, crackers, chips, and fruit drinks. APPLICATIONS/CONCLUSIONS: Results of this study provide parents and professionals with specific information about meal and snack patterns, thereby allowing development of targeted messages and/or strategies to improve the dietary patterns of infants and toddlers. Although most foods provided to the Feeding Infants and Toddlers Study infants and toddlers were nutritionally and developmentally appropriate, snack choices could be improved by delaying introduction of and limiting exposures to foods low in nutrients and high in calories.