Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

Abstract

(1) Background: Breastmilk provides all the nutrition an infant requires between 0–6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6–24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6–11.9 months. Low iron intake was also observed in one quarter of toddlers 12–24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed >1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6–11.9 months and toddlers 12–24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.

Does Food Intake of Australian Toddlers 12–24 Months Align with Recommendations: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

“…As detailed in our previous paper, breastmilk intake may have been underestimated or overestimated as volume assumptions do not account for variation in feeding efficiency between toddlers [ 34 ]. However, the energy intakes for toddlers reported in our study [ 12 ] closely match the estimated energy requirements for this age group [ 7 ]. Maternal age is a strong predictor of continued breastfeeding [ 35 ] and may explain the high breastfeeding rates observed in our sample compared to previous Australian studies.…”

“…Although breastmilk has the same amount of energy as toddler or cow’s milk, it contains less than a third of the calcium. Inadequate iron intakes were common in toddlers in our study and around 10% had low calcium intakes [ 12 ]. While the benefits of breastfeeding into the second year is beyond doubt, some toddlers may be receiving too much breastmilk as little practical guidance is given on how and when to offer breastmilk to optimize the consumption of core foods as toddlers transition from a milk-based diet to mostly family foods.…”

“…OzFITS 2021 was a cross-sectional survey conducted with caregivers of children 0–24 months old [ 11 , 12 ]. Between April 2020 and April 2021, 1140 participants were enrolled across Australia, with recruitment proportional to population size in each state and territory.…”

Feeding Infants and Toddlers Studies (FITS) Provide Valuable Information for Setting Dietary Guidelines

“…The FITS studies that have been completed and published are shown in Table 1 [ 5 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 ]. These studies have been ongoing, and since 2002, there have been seven countries having published results, including the OzFITS studies now published in this Special Issue [ 4 , 5 , 6 , 7 , 8 ]. With each survey this is an opportunity to improve or modify the methodology yet stay consistent with a common analysis approach in more recent FITS such as those in Australia, China, Mexico, the Philippines, Russia, and the United States [ 3 , 4 ].…”

“…In this Introduction to the Special Issue entitled “Australian Feeding Infant and Toddler Study 2021”, we provide the background to Feeding Infants and Toddlers Studies (FITS) which have, in the past two decades, provided much-needed data on early childhood nutrition that can lead to development of dietary guidelines specific for the first two years of life [ 3 , 4 ]. Appreciating the role FITS can play puts into context the findings of the most recent FITS conducted in Australia, called OzFITS [ 5 , 6 , 7 , 8 , 9 ]. Our purpose is to position OzFITS as a necessary and important step for healthcare professionals in Australia to have for developing dietary guidelines and nutrition education resources for its young children.…”