Lessons from the Feeding Infants and Toddlers Study in North America: What Children Eat, and Implications for Obesity Prevention

Abstract

The latest exhaustive survey of dietary patterns in infants from the Feeding Infants and Toddlers Study (FITS) in North America documents and quantifies current trends in infant feeding. These include higher than generally recommended energy, protein, and saturated fat intakes. The majority of infants are bottle fed at some point in their first year of life, and their weaning diet often includes low intakes of fruits and vegetables, with high starchy, rather than green or yellow, vegetables. Early introduction of solids, use of cow's milk prior to 1 year of age, and high juice intake in the first 2 years - all less desirable diet practices - are improving, but are still prevalent. More preschoolers are likely to get sweets or sweetened beverages than a serving of fruit or a vegetable on a given day. These food intake patterns mimic the adult American diet and are associated with an increased risk of obesity in childhood and later life. But more importantly, these patterns appear to be set as early as 18 months of age, and by 20 months of age, they mimic the adult diet. Despite increase in total energy intake, and greater variety of foods, the basic characteristics of macronutrient intake distribution and food group contribution of energy to the diet before 2 years of age remain remarkably stable and similar to the family table. Obesity prevention needs to include specific targets in terms of breastfeeding and adequate formula feeding, as well as appropriate introduction of weaning foods with goals of changing the inadequate patterns documented in the FITS. These interventions will also require addressing parent and caregiver behaviors, including attending to hunger satiety cues (responsive feeding), and shaping early food preferences. This needs to be done starting at birth, in the first months of life. Early intervention offers a unique and potentially efficacious opportunity to shape the future dietary patterns of the next generation.

Infant feeding practices and dietary consumption of US infants and toddlers: National Health and Nutrition Examination Survey (NHANES) 2003–2012

“…However, FITS used a commercial list of infants and toddlers, which under-represented children from groups of lower socio-economic status and certain race/ethnicities (28,29,33) . IFPS II was also limited by lower participation of minority groups and higher participation of infants of higher socio-economic status.…”

“…However, there are few studies reporting anthropometric measurements and early feeding practices in children from birth to age 24 months, and they are based on samples which are less ethnically diverse and higher income than the US population (28)(29)(30)(31)(32)(33) . While Mexican-American infants have higher rates of overweight compared with other groups, data on feeding practices or nutrient intakes stratified according to race/ethnicity or income have not been reported (14) .…”

Early feeding patterns among Mexican babies: findings from the 2012 National Health and Nutrition Survey and implications for health and obesity prevention

“…These recommendations support optimal growth and development, the establishment of healthy eating habits and the prevention of obesity. Specific feeding practices and dietary factors associated with overweight/obesity in infants and young children such as lack/short duration of breastfeeding [20][21][22][23], early introduction to complementary foods [24][25][26][27], intake of sugar-sweetened beverages [28][29][30], and low fruit and vegetable consumption [31,32], are now recognized to begin in infancy [9], and have been a focus in describing early dietary patterns in infants and young children from national dietary intake surveys in the United States (US) [33].…”

Development and evaluation of a stand-alone index for the assessment of small children’s diet quality

“…In some contexts, such as in epidemiological studies or clinical settings, it may be more important to know the quality of the overall diet rather than the intake of single nutrients (15) . Studies on diet and chronic diseases have focused on the relationship between consumption of single nutrients and disease risk, and have identified several individual dietary components, such as total fat (16) , SFA (17) , PUFA (18,19) , refined carbohydrates and fibre (20)(21)(22) , and fruits, vegetables and berries (23) , to either protect against or lead to chronic diseases also in childhood. However, even though single nutrients have beneficial properties, it is the diet as a whole that has the most impact on health.…”