Nutrient intakes and food choices of infants and toddlers participating in WIC

Nutrient trajectories during infancy and their associations with childhood neurodevelopment

PURPOSE

To examine the associations between infants' dietary nutrient trajectories and subsequent neurodevelopment during childhood in the Growing Up in Singapore Towards healthy Outcomes study.

METHODS

One-day food records were collected at ages 6, 9 and 12 months, whilst Bayley Scales of Infant and Toddler Development-III and Kaufman Brief Intelligence Test-2 were conducted at ages 24 and 54 months respectively. Nutrient trajectories were constructed using multi-level mixed modelling and associations with neurodevelopment (24 months: n = 484; 54 months: n = 444) were examined using adjusted multivariable linear regression.

RESULTS

At age 24 months, higher protein intake (at 6 months) and increasing rate of intake (from 6 to 12 months) were associated with higher fine motor score [β = 0.17 SD (95% CI 0.03, 0.31) and 0.62 SD (0.10, 1.14) respectively]. Higher fat intake was associated with higher receptive language score [0.04 SD (0.003, 0.07)], but increasing rate of intake was associated with lower expressive language [- 0.20 SD (- 0.39, - 0.01)] and fine motor [- 0.29 SD (- 0.48, - 0.10)] scores. Higher carbohydrate intake was associated with lower gross motor score [- 0.07 SD (- 0.14, - 0.005)], but increasing rate of intake was associated with higher receptive language [0.44 SD (0.08, 0.81)] and fine motor [0.56 SD (0.18, 0.93)] scores. Increasing rate of dietary fibre intake was associated with higher fine motor scores [0.63 SD (0.16, 1.10)]. No significant associations were observed with neurodevelopment at 54 months.

CONCLUSION

Our findings provide greater understanding of how nutrition over time could have varying effects on child neurodevelopment.

Technological tools for assessing children's food intake: a scoping review

Technological innovations can standardise and minimise reporting errors in dietary assessment. This scoping review aimed to summarise the characteristics of technological tools used to assess children's food intake. The review followed the Joanna Briggs Institute's manual. The main inclusion criterion was studied that assessed the dietary intake of children 0-9 years of age using technology. We also considered articles on validation and calibration of technologies. We retrieved 15 119 studies and 279 articles were read in full, after which we selected 93 works that met the eligibility criteria. Forty-six technologies were identified, 37 % of which had been developed in Europe and 32⋅6 % in North America; 65⋅2 % were self-administered; 27 % were used exclusively at home; 37 % involved web-based software and more than 80 % were in children over 6 years of age. 24HR was the most widely used traditional method in the technologies (56⋅5 %), and 47⋅8 % of the tools were validated. The review summarised helpful information for studies on using existing tools or that intend to develop or validate tools with various innovations. It focused on places with a shortage of such technologies.

Dietary and Complementary Feeding Practices of US Infants, 6 to 12 Months: A Narrative Review of the Federal Nutrition Monitoring Data

Complementary foods and beverages (CFBs) are key components of an infant's diet in the second 6 months of life. This article summarizes nutrition and feeding practices examined by the 2020 Dietary Guidelines Advisory Committees during the CFB life stage. Breastfeeding initiation is high (84%), but exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). Most infants (51%) are introduced to CFBs sometime before 6 months. The primary mode of feeding (ie, human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFBs is associated with the timing of introduction and types of CFBs reported. FMF infants (42%) are more likely to be introduced to CFBs before 4 months compared with HMF infants (19%). Different dietary patterns, such as higher prevalence of consumption and mean amounts, were observed, including fruit, grains, dairy, proteins, and solid fats. Compared with HMF infants of the same age, FMF infants consume more total energy (845 vs 631 kcal) and protein (22 vs 12 g) from all sources, and more energy (345 vs 204 kcal) and protein (11 vs 6 g) from CFBs alone. HMF infants have a higher prevalence of risk of inadequate intakes of iron (77% vs 7%), zinc (54% vs <3%), and protein (27% vs <3%). FMF infants are more likely to have an early introduction (<12 months) to fruit juice (45% vs 20%) and cow's milk (36% vs 24%). Registered dietitian nutritionists and nutritional professionals should consider tailoring their advice to caregivers on dietary and complementary feeding practices, taking into account the primary mode of milk feeding during this life stage to support infants' nutrient adequacy. National studies that address the limitations of this analysis, including small sample sizes and imputed breast milk volume, could refine findings from this analysis.

Social marketing applications in public policy programs: key learnings and applications

Purpose

Marketing tools used in public policy may not be purely commercial but based on non-commercial marketing exchanges also. This paper aims to make a case for the practice of social marketing principles to aid the context of public policy.

Design/methodology/approach

The approach is to draw out the key implementable learnings (KILs) from the analysis of the five public policy initiatives in the USA, India and Sri Lanka. A case situation with the context of child labour policy in India is proposed to use these KILs.

Findings

This paper concludes that the implementation of any policy is a challenging exercise and dependent on a large number of factors. However, KILs derived from successful social marketing programs deal with umbrella campaigns, prevailing socio-cultural environment, bottom-up communication, upstream approach to engage with stakeholders and targeted media advocacy could prove useful when the objective is to induce behaviour change as a part of the policy execution.

Originality/value

This paper evaluates the learnings from social marketing campaigns and their relevance to public policy programs. It also considers a case to demonstrate the application of the concept.

WIC Participation and Breastfeeding after the 2009 WIC Revision: A Propensity Score Approach

In this study, we examined the association between participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and breastfeeding outcomes before and after the 2009 revisions. Four-thousand-three-hundred-and-eight WIC-eligible children younger than 60 months were included from the 2005–2014 National Health and Nutrition Examination Survey (NHANES). We compared two birth cohorts with regard to their associations between WIC participation and being ever-breastfed and breastfed at 6 months. We estimated the average effect of the treatment for the treated to assess the causal effect of WIC participation on breastfeeding based on propensity score matching. The results showed that WIC-eligible participating children born between 2000 and 2008 were significantly less likely than WIC-eligible nonparticipating children to ever receive breastfeeding (p < 0.05) or to be breastfed at 6 months (p < 0.05). Among children born between 2009 and 2014, WIC-eligible participating children were no longer less likely to ever receive breastfeeding compared to WIC-eligible nonparticipating children; the gap remained in breastfeeding at 6-months (p < 0.05). The disparities in prevalence of ever breastfed between WIC-eligible participants and nonparticipants have been eliminated since the 2009 WIC revision. More efforts are needed to improve breastfeeding persistence among WIC-participating mother–infant dyads.

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.

Family Spirit Nurture (FSN) - a randomized controlled trial to prevent early childhood obesity in American Indian populations: trial rationale and study protocol

BACKGROUND

Childhood overweight and obesity is a persistent public health issue in the US. Risk for obesity and obesity-related morbidity throughout the life course begins in utero. Native Americans suffer the greatest disparities in the US in childhood overweight and obesity status of any racial or ethnic group. Existing early childhood home-visiting interventions provide an opportunity for addressing obesity during the first 1000 days. However, to date, no evidence-based model has been specifically designed to comprehensively target early childhood obesity prevention.

METHODS

This study is a randomized controlled trial to test the efficacy of home-visiting intervention, called Family Spirit Nurture, on reducing early childhood obesity in Native American children. Participants are expectant Native American mothers ages 14-24 and their child, enrolled from pregnancy to 24 months postpartum and randomized 1:1 to receive the Family Spirit Nurture intervention or a control condition. The intervention includes 36 lessons delivered one-on-one by locally-hired Native American Family Health Coaches to participating mothers from pregnancy until 18 months postpartum. A mixed methods assessment includes maternal self-reports, maternal and child observations, and physical and biological data collected at 11 time points from 32 weeks gestation to 2 years postpartum to measure the intervention's primary impact on maternal feeding behaviors; children's healthy diet and physical activity; children's weight status. Secondary measures include maternal psychosocial factors; household food and water security; infant sleep and temperament; and maternal and child metabolic status.

DISCUSSION

None of the 20 current federally-endorsed home-visiting models have demonstrated impacts on preventing early childhood obesity. The original Family Spirit program, upon which Family Spirit Nurture is based, demonstrated effect on maternal and child behavioral health, not including obesity related risk factors. This trial has potential to inform the effectiveness of home-visiting intervention to reduce obesity risk for tribal communities and other vulnerable populations and expand public health solutions for the world's obesity crisis.

TRIAL REGISTRATION

Clinicaltrials.gov (Identifier: NCT03334266 - Preventing Early Childhood Obesity, Part 2: Family Spirit Nurture, Prenatal - 18 Months; Retrospectively registered on 07 November 2017).

Validation of a semi-quantitative FFQ for 18-month-old toddlers: the Growing Up in Singapore Towards Healthy Outcomes (GUSTO) study

OBJECTIVE

Dietary intake of toddlers has been of growing interest due to its long-term consequences on health. However, previous works have focused largely on Caucasian populations and less is known about Asian toddlers. We aimed to validate a semi-quantitative FFQ designed to assess dietary intakes of 18-month-old toddlers in a multi-ethnic Asian cohort.

DESIGN

An FFQ of ninety-four food items, identified based on food records of 12-month-old GUSTO children, the Southampton Women's Survey 12 Month Infancy Questionnaire and inputs from paediatric dietitians, was filled out two weeks before the 18th-month clinic visit. As the reference method, two non-consecutive 24 h recalls (24HR) were administered during and two weeks after the clinic visit. FFQ nutrient intakes were validated against averaged 24HR nutrient intakes, using the Wilcoxon signed-rank test, Spearman's rank-order correlation, cross-classification and the Bland-Altman method.

SETTING

Data from the Singapore Growing Up in Singapore Towards Healthy Outcomes (GUSTO) mother-offspring birth cohort.ParticipantsToddlers (n 188) aged 18 months.

RESULTS

Absolute nutrient intakes from the FFQ were significantly higher than from the 24HR, except for vitamin A. After energy adjustments, r range was 0·56-0·78 (macronutrients) and 0·40-0·54 (micronutrients). De-attenuation increased r to 0·58-0·96 and 0·45-0·65 for macro- and micronutrients, respectively. Of participants, ≥82·4 % (macronutrients) and ≥77·7 % (micronutrients) were classified in the same and adjacent quartiles. No clear systematic increase in intake differences with increasing mean intake was observed in Bland-Altman plots.

CONCLUSIONS

This FFQ can provide a satisfactory assessment of toddlers' energy-adjusted nutrient intakes, as well as accurately rank them in a group.

Diet Quality of US Infants and Toddlers 7-24 Months Old in the WIC Infant and Toddler Feeding Practices Study-2

Background

Despite the important implications of childhood dietary intakes on lifelong eating habits and health, data are lacking on the diet quality of low-income infants and toddlers.

Objective

The objective of this study was to characterize diet quality in low-income US infants and toddlers.

Methods

A national observational study was conducted of 7- to 12-mo-old (n = 1261), 13-mo-old (n = 2515), and 24-mo-old (n = 2179) children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) prenatally/at birth from 2013 to 2016. The study used a 24-h dietary recall and survey questions. For 7- to 12-mo-olds, an adapted Complementary Feeding Utility Index (CFUI) was used, and for 13- and 24-mo-olds, the Healthy Eating Index-2015 (HEI-2015) was used. Descriptive statistics were calculated for CFUI and HEI-2015 scores.

Results

For 7- to 12-mo-olds, the CFUI score (mean ± SE) was 0.56 ± 0.003 (range: 0.34-0.90, maximum possible 1.0). Most children met CFUI standards for exposure to iron-rich cereal (86.7%), and low exposure to energy-dense nutrient-poor foods (72.2%) and teas/broths (67.5%). Conversely, at 7-12 mo of age, exposure was low for vegetables (7.0%), fruits (14.4%), any sugary drinks (14.0%), and 12-mo breastfeeding duration (23.8%). At 13 and 24 mo of age, the HEI-2015 total score (maximum possible 100), on average, was 64.0. At both 13 and 24 mo of age, participants achieved, on average, maximal HEI-2015 component scores for total and whole fruits and dairy; however, scores for total vegetables, greens and beans, whole grains, seafood and plant proteins, fatty acids, and saturated fats were relatively low. Scores for refined grains, sodium, and added sugar were lower at 24 than at 13 mo of age, representing higher consumption, on average, over time.

Conclusions

Although findings demonstrate that young children are doing well on some dietary components, there is room for improvement, especially as children age. Findings may be used to inform the Pregnancy and Birth to 24-mo (P/B-24) Project. This trial was registered at clinicaltrials.gov as NCT02031978.

Usual Nutrient Intakes from the Diets of US Children by WIC Participation and Income: Findings from the Feeding Infants and Toddlers Study (FITS) 2016

Background

A recent report of the National Academies of Sciences, Engineering, and Medicine (NASEM) outlined priority nutrients for infants and children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Objective

The objective of this study was to assess usual nutrient intakes from foods and beverages (not supplements) among US children aged <4 y by WIC participation status.

Methods

A national random sample of children aged <4 y (n = 3,235) from the Feeding Infants and Toddlers Study (FITS) 2016 was categorized by WIC participation status (participants, lower-income nonparticipants, or higher-income nonparticipants) and age (younger infants aged 0-5.9 mo, older infants aged 6-11.9 mo, toddlers aged 12-23.9 mo, or preschoolers aged 24-47.9 mo). All participants contributed one 24-h dietary recall, with a second recall from a representative subsample (n = 799). Usual intakes and compliance with federal dietary recommendations were estimated by using the National Cancer Institute method. Differences between WIC participants and either lower-income nonparticipants or higher-income nonparticipants were tested using t tests.

Results

The diets of infants (aged <12 mo) were nutritionally adequate in general. Older infants participating in WIC had higher compliance with iron and vitamin D guidelines than either group of nonparticipants and greater compliance with calcium, zinc, and potassium guidelines than higher-income nonparticipants. WIC toddlers had a higher risk of inadequate calcium and excessive sodium intakes than higher-income nonparticipants. Eight percent of WIC toddlers exceeded added sugar guidelines compared with either nonparticipant group (∼2%). WIC toddlers and preschoolers had a lower risk of inadequate vitamin D intake than lower-income nonparticipants, but inadequacy was >75% across all subgroups. WIC preschoolers had higher compliance with saturated fat guidelines but lower compliance with sodium and added sugar guidelines than higher-income nonparticipants.

Conclusions

WIC participants had better intakes of iron (ages 6-23.9 mo), zinc and potassium (ages 6-11.9 mo), saturated fat (ages 24-47.9 mo), and vitamin D (all ages). Regardless of WIC participation status, most infants and children met the calcium and zinc guidelines, but large proportions had intakes not meeting the recommendations for iron (ages 6-11.9 mo), vitamin D, potassium, fiber, saturated fat, and sodium.

Total Usual Nutrient Intakes of US Children (Under 48 Months): Findings from the Feeding Infants and Toddlers Study (FITS) 2016

Background

The US Dietary Guidelines will expand in 2020 to include infants and toddlers. Understanding current dietary intakes is critical to inform policy.

Objective

The purpose of this analysis was to examine the usual total nutrient intakes from diet and supplements among US children.

Methods

The Feeding Infants and Toddlers Study 2016 is a national cross-sectional study of children aged <48 mo (n = 3235): younger infants (birth to 5.9 mo), older infants (6-11.9 mo), toddlers (12-23.9 mo), younger preschoolers (24-36.9 mo), and older preschoolers (36-47.9 mo) based on the use of a 24-h dietary recall. A second 24-h recall was collected from a representative subsample (n = 799). Energy, total nutrient intake distributions, and compliance with Dietary Reference Intakes were estimated with the use of the National Cancer Institute method.

Results

Dietary supplement use was 15-23% among infants and toddlers and 35-45% among preschoolers. Dietary intakes of infants were adequate, with mean intakes exceeding Adequate Intake for all nutrients except vitamins D and E. Iron intakes fell below the Estimated Average Requirement for older infants (18%). We found that 31-33% of children aged 12-47.9 mo had low percentage of energy from total fat, and >60% of children aged 24-47.9 mo exceeded the saturated fat guidelines. The likelihood of nutrient inadequacy for many nutrients was higher for toddlers: 3.2% and 2.5% greater than the Adequate Intake for fiber and potassium and 76% and 52% less than the Estimated Average Requirement for vitamins D and E, respectively. These patterns continued through older ages. Intakes exceeded the Tolerable Upper Intake Level of sodium, retinol, and zinc across most age groups.

Conclusions

Dietary intakes of US infants are largely nutritionally adequate; concern exists over iron intakes in those aged 6-11.9 mo. For toddlers and preschoolers, high intake of sodium and low intakes of potassium, fiber, and vitamin D and, for preschoolers, excess saturated fat are of concern. Excess retinol, zinc, and folic acid was noted across most ages, especially among supplement users.

100% Juice, Fruit, and Vegetable Intake Among Children in the Special Supplemental Nutrition Program for Women, Infants, and Children and Nonparticipants

INTRODUCTION

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides monthly food packages to low-income children (aged 1-4 years) in the U.S., including 128 ounces of 100% fruit juice and an $8 cash value voucher for purchasing fruits and vegetables. The fruit juice allowance translates to 71%-107% of the maximum intake recommended by the American Academy of Pediatrics (4-6 ounces/day). Careful examination of WIC food package allocations is necessary because overconsumption of fruit juice among young children has been linked to weight gain and juice lacks important nutrients found in whole fruit (e.g., fiber).

METHODS

A total of 1,576 children aged 2-4 years were assessed using the 2009-2014 National Health and Nutrition Examination Surveys. Multiple linear regressions were conducted in 2017 to analyze the association between WIC program participation and intake of 100% fruit juice, whole fruits, and vegetables. Logistic regression was used to examine the association between WIC program participation and the odds of exceeding the American Academy of Pediatrics maximum intake for juice.

RESULTS

Adjusting for child and parent/caregiver characteristics, WIC participants consumed significantly more 100% fruit juice (β=0.22 cup equivalents/day, 95% CI=0.04, 0.40) compared with income-eligible nonparticipants, but not more whole fruits or total vegetables. WIC participants had 1.51-times greater odds (95% CI=1.06, 2.14) of exceeding the age-specific American Academy of Pediatrics maximum intake for juice compared with income-eligible nonparticipants.

CONCLUSIONS

These findings support recommendations to reduce 100% fruit juice allowances in the WIC program and reallocate those funds to the cash value voucher to increase whole fruit and vegetable consumption.

Preferences and Perceived Value of WIC Foods Among WIC Caregivers

OBJECTIVE

To evaluate preferences for and values of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) foods and packages and understand what factors may influence these preferences and values.

DESIGN

Using a mixed-methods approach, surveys and individual in-depth interviews were conducted to measure and understand preferences for specific WIC foods and how much WIC food packages are worth to participants.

SETTING

Eight WIC clinics across Illinois.

PARTICIPANTS

Caregivers of infants enrolled in WIC for at least 3-6 months.

PHENOMENON OF INTEREST

Preferences for WIC foods, WIC food package values, and factors that influence these categories.

ANALYSIS

Frequencies were gathered to analyze survey data and interview transcripts were analyzed using constant comparative analysis to identify emergent themes.

RESULTS

Survey (n = 150) and interview (n = 31) participants valued the food packages in WIC but they valued the infant packages more. The cash value fruit and vegetable voucher increased the perceived value of the program for many participants. Restrictions on food choice preferences (eg, type of milk) detracted value from the program.

CONCLUSIONS AND IMPLICATIONS

This study shows that providing more choice in the program could improve satisfaction with WIC overall. More research is warranted with a more representative sample to assess whether expanded food choice would improve value of and preference for WIC foods.

Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial

OBJECTIVE

To determine the iron intake and status of infants following a version of baby-led weaning (BLW) modified to prevent iron deficiency (Baby-Led Introduction to SolidS; BLISS) compared with those of infants following traditional spoon-feeding.

DESIGN, PARTICIPANTS AND INTERVENTION

This randomised controlled trial included 206 participants assigned to control (n=101) or BLISS (n=105) groups. Both groups received standard midwifery and 'Well Child' care. BLISS participants received eight additional visits (from before birth to 9 months) providing education and support on the BLISS approach to complementary feeding (ie, BLW modified to increase iron intake). The primary outcome of the BLISS study (growth) has been previously reported. This paper reports the key prespecified secondary outcomes, iron intake and iron status.

OUTCOME MEASURES

Intake of iron and key absorption modifiers were assessed using weighed 3-day diet records at 7 and 12 months. A venipuncture blood sample was collected at 12 months to determine plasma ferritin, haemoglobin, soluble transferrin receptor, C-reactive protein and α1-acid glycoprotein concentrations; and body iron was calculated.

RESULTS

Differences in median dietary iron intakes between the control and BLISS groups were not significant at 7 (difference 0.6 mg/day; 95% CI -1.0 to 2.3) or 12 (-0.1 mg/day; -1.6 to 1.4) months of age. Similarly, there were no significant differences in plasma ferritin concentration (difference -2.6 µg/L; 95% CI -10.9 to 5.8), body iron (0.04 mg/kg; -1.1 to 1.2) or the prevalence of depleted iron stores, early functional iron deficiency or iron deficiency anaemia (all p≥0.65) at 12 months of age.

CONCLUSIONS

A baby-led approach to complementary feeding does not appear to increase the risk of iron deficiency in infants when their parents are given advice to offer 'high-iron' foods with each meal.

TRIAL REGISTRATION NUMBER

ACTRN12612001133820; Pre-results.

Eating Patterns and Food Choices of Latvian Infants during Their First Year of Life

Introduction: Pregnancy, infancy, and early childhood are periods of rapid growth and development. The role of nutrition is very important during these critical growth and development periods. The aim of the study was to investigate infant feeding practices through the first year of life in Latvia, and to compare feeding practices with nutritional guidelines in Latvia and other European countries. Methods: We analysed cross-sectional study data from food frequency questionnaires with additional questions on breastfeeding and complementary feeding introduction. A total of 266 infants from all Latvian regions from birth to 1-year-old were included in the study. Breastfeeding rates were assessed by month of age. Complementary feeding was assessed using three age groups (0⁻3.9 months, 4⁻6.9 months, and 7⁻12.9 months), whereas two groups were used to assess food frequency and portion sizes (0⁻5.9 months and 6⁻12.9 months). Results: The breastfeeding rate during the first month of life was 89%. At 6 months, 68% of infants received breast milk, but by 12 months, only 45% still received breast milk. Complementary foods were introduced at a mean age of 5 months (standard deviation = 1). Before 4 months of age, 9% of infants were receiving complementary food, the majority (85%) between 4 and 6 months of age. There were 6% of infants who were introduced to complementary foods after 7 months of age. First complementary food choices were mainly porridge (64%), vegetables (21%), and fruits (10%). After 6 months of age, foods from almost all food groups were present in each infant diet at least once per day, such as vegetables (85%), potatoes (85%), fruits (81%), dairy (78%), and meat (73%), less than once per day-grains (88%), fats (73%), cow's milk (66%), eggs (45%), fish (36%), and legumes (28%). Conclusion: Breastfeeding rate during first months of life is high in Latvia. Breastfeeding was sustained at the age of 6 months, in the highest rate among Baltic countries. However, only 45% continued breastfeeding at the age of 12 months, in accordance with WHO recommendations. A guideline on complementary feeding is followed by the majority of parents. There are deviations from guidelines in inclusion of some foods in the diet and frequency of consumption.

Food Sources of Energy and Macronutrient Intakes among Infants from 6 to 12 Months of Age: The Growing Up in Singapore Towards Healthy Outcomes (GUSTO) Study

Adequate nutrition during complementary feeding is important for the growth, development and well-being of children. We aim to examine the energy and macronutrient intake composition and their main food sources in a mother-offspring cohort study in Singapore. The diets of infants were assessed by 24 h dietary recalls or food diaries collected from mothers when their offspring were 6 (n = 760), 9 (n = 893) and 12 (n = 907) months of age. Food sources of energy and macronutrients were determined using the population proportion methodology. Energy intakes per day (kcal; mean (standard deviation, SD)) of these infants were 640 (158) at 6 months, 675 (173) at 9 months, and 761 (208) at 12 months. Infant formula, breastmilk and infant cereals were the top three food sources of energy and macronutrient intakes in infants through the period 6 to 12 months. Other main energy and carbohydrate sources at 9 and 12 months of age were rice porridge, infant biscuits and fresh fruits, while fish, red meat and eggs were the other main protein and total fat sources. Breast-fed and mixed-fed infants had a more varied diet as compared to formula-fed infants. Formula-fed infants had consistently higher protein and lower total fat consumption compared to those who were breastfed. An understanding of these main food sources during complementary feeding can inform local dietary recommendations and policies.

Beyond Food Access: The Impact of Parent-, Home-, and Neighborhood-Level Factors on Children's Diets

Despite the growth in empirical research on neighborhood environmental characteristics and their influence on children’s diets, physical activity, and obesity, much remains to be learned, as few have examined the relationship between neighborhood food availability on dietary behavior in children, specifically. This analysis utilized data from a community-based, cross-sectional sample of children (n = 199) that was collected in New Orleans, Louisiana, in 2010. This dataset was linked to food environment data to assess the impact of neighborhood food access as well as household and parent factors on children’s diets. We observed a negligible impact of the neighborhood food environment on children’s diets, except with respect to fast food, with children who had access to fast food within 500 m around their home significantly less likely (OR = 0.35, 95% CI: 0.1, 0.8) to consume vegetables. Key parental and household factors did play a role in diet, including receipt of public assistance and cooking meals at home. Children receiving public assistance were 2.5 times (95% CI: 1.1, 5.4) more likely to consume fruit more than twice per day compared with children not receiving public assistance. Children whose family cooked dinner at home more than 5 times per week had significantly more consumption of fruit (64% vs. 58%) and vegetables (55% vs. 39%), but less soda (27% vs. 43%). Findings highlight the need for future research that focuses on the dynamic and complex relationships between built and social factors in the communities and homes of children that impact their diet in order to develop multilevel prevention approaches that address childhood obesity.

Likelihood of Breastfeeding Within the USDA's Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children Population

BACKGROUND

Breastfeeding is an important public health initiative. Low-income women benefiting from the U.S. Department of Agriculture's Food and Nutrition Service Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are a prime population for breastfeeding promotion efforts. Research aim: This study aims to determine factors associated with increased likelihood of breastfeeding for WIC participants.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guided the systematic review of literature. Database searches occurred in September and October 2014 and included studies limited to the previous 10 years. The following search terms were used: low-income; WIC; women, infants, and children; breastfeeding; breast milk; and maternal and child health. The criterion for inclusion was a study sample of women and children enrolled in the WIC program, thereby excluding non-United States-based research.

RESULTS

Factors that increased the likelihood of breastfeeding for WIC participants included sociodemographic and health characteristics ( n = 17); environmental and media support ( n = 4); government policy ( n = 2); intention to breastfeed, breastfeeding in hospital, or previous breastfeeding experience ( n = 9); attitudes toward and knowledge of breastfeeding benefits ( n = 6); health care provider or social support; and time exposure to WIC services ( n = 5).

CONCLUSION

The complexity of breastfeeding behaviors within this population is clear. Results provide multisectored insight for future research, policies, and practices in support of increasing breastfeeding rates among WIC participants.

Development of a Diet Quality Score for Infants and Toddlers and its association with weight

OBJECTIVE

To create a Diet Quality Index Score (DQIS) for infants and toddlers and to assess its relative validity.

DESIGN

Three DQIS were created (0-5, 8-11 and 12-24 months) based on a validated food frequency questionnaire (FFQ). Nine components were included, scored from 0 (inadequate) to 5 (adequate consumption) based on guidelines for timing of food's introduction and portion sizes; the component on breastfeeding (Yes/No) was scored (0-15). Infants 6-7 months were excluded as new foods are introduced during this period. The total score (0-55 points) was categorized as Excellent (≥45), Good (35-44), Needs improvement (25-34), and Poor (<25). Relative validity was assessed against weight status among a sample of 296 children using logistic regression.

RESULTS

In infants 0-5 months (n=100), mean DQIS was 42.4±9.3 and 52% had 'Excellent' diets. In infants 8-11 months (n=42), mean DQIS was 36.1±7.7 and most had 'Good' diets (47.6%). Among toddlers 12-24 months (n=117), mean DQIS was 25.7±8.0 and most had 'Poor' diets (50.4%). There was a trend for a higher odd of Excessive weight in those with 'Poor' diets compared to those with 'Excellent' diets, after controlling for confounders (OR 2.01; 95% CI: 0.85, 5.18).

CONCLUSIONS

These scores could be used to assess diet quality in infants and toddlers. There was a trend for a higher odd of Excessive weight among those with 'Poor' diets. To our knowledge, this is the first algorithm for the assessment of diet quality in infants and toddlers considering intake of each food group and their portion sizes.

Dietary Pattern Trajectories from 6 to 12 Months of Age in a Multi-Ethnic Asian Cohort

Little is known about the dietary patterns of Asian infants in the first year of life, nor of their associations with maternal socio-demographic factors. Based on the Growing Up in Singapore towards healthy Outcomes (GUSTO) mother-offspring cohort, cross-sectional dietary patterns were derived by factor analysis using 24-h recalls and food diaries of infants at 6-, 9- and 12-months of age. Dietary pattern trajectories were modeled by mapping similar dietary patterns across each age using multilevel mixed models. Associations with maternal socio-demographic variables, collected through questionnaires during pregnancy, were assessed using general linear models. In n = 486 infants, four dietary pattern trajectories were established from 6- to 12-months. Predominantly breastmilk: mainly breastmilk and less formula milk,

GUIDELINES

rice porridge, vegetables, fruits and low-fat fish and meat, Easy-to-prepare foods: infant cereals, juices, cakes and biscuits and Noodles (in soup) and seafood: noodle and common accompaniments. In adjusted models, higher maternal education attainment was correlated with higher start scores on Predominantly breastmilk, but lowest education attainment increased its adherence over time. Older mothers had higher start scores on Easy-to-prepare foods, but younger mothers had increased adherence over time. Chinese mothers had higher start scores on Predominantly breastmilk but greater adherence to GUIDELINES over time, while Indian mothers had higher start scores on Easy-to-prepare foods but greater adherence to Predominantly breastmilk with time (p < 0.05 for all). Changes in trajectories over time were small. Hence, dietary patterns established during weaning are strongly influenced by maternal socio-demographic factors and remain stable over the first year of life.

Types of Infant Formulas Consumed in the United States

We examined consumption of different types of infant formula (eg, cow's milk, soy, gentle/lactose-reduced, and specialty) and regular milk among a nationally representative sample of 1864 infants, 0 to 12 months old, from the National Health and Nutrition Examination Survey, 2003-2010. Among the 81% of infants who were fed formula or regular milk, 69% consumed cow's milk formula, 12% consumed soy formula, 5% consumed gentle/ lactose-reduced formulas, 6% consumed specialty formulas, and 13% consumed regular milk products. There were differences by household education and income in the percentage of infants consuming cow's milk formula and regular milk products. The majority of infants in the United States who were fed formula or regular milk consumed cow's milk formula (69%), with lower percentages receiving soy, specialty, gentle/sensitive, or lactose-free/reduced formulas. Contrary to national recommendations, 13% of infants younger than 1 year consumed regular milk, and the percentage varied by household education and income levels.

Comparison of Feeding Practices in Infants in the WIC Supplemental Nutrition Program Who Were Enrolled in Child Care as Opposed to Those with Parent Care Only

BACKGROUND

The environment or setting to which an infant is exposed is crucial to establishing healthy eating habits and to preventing obesity. This study aimed to compare infant feeding practices and complementary food type between parent care (PC) and childcare (CC) settings among infants receiving the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

MATERIALS AND METHODS

This study sampled 105 dyads of mothers and infants between 2 to 8 months of age from a WIC office in Central Illinois. Mothers completed a cross-sectional survey to assess their infant feeding practices and demographic characteristics. CC was defined as infants receiving 10 hours or more per week of care from a nonparental caregiver.

RESULTS

Almost half of the infants (44%) were enrolled in CC. Infants in CC had an average of 29 hours of care per week compared with 0.64 hours in the PC group (p<0.01). There were no differences between the two groups in age, sex, race/ethnicity, preterm birth, and birth weight. Overall, there were no significant differences in breastfeeding initiation and duration. The average age at formula introduction was earlier for PC infants (0.90 ± 1.16 months) than for CC infants (1.66 ± 1.64 months) (p = 0.03). PC infants stopped breastfeeding at 1.96 ± 1.15 months compared with 2.31 ± 1.64 months for CC infants (p = 0.080). Among complementary foods introduced to infants, the primary food type was infant cereal, followed by baby food of fruits and vegetables, 100% fruit juice, and meat-based baby food. The timing of introduction and the types of complementary foods were similar between study groups.

CONCLUSIONS

CC use is not a significant influence on breastfeeding rates, introduction of complementary foods, and types of complementary foods; however, it does influence when formula is introduced. The findings support the need for infant nutrition education and breastfeeding promotion targeting WIC mothers, regardless of their pattern of CC.

Ethnic differences in dietary intake at age 12 and 18 months: the Born in Bradford 1000 Study

OBJECTIVE

To compare the intake of key indicator foods at age 12 months and 18 months between infants of Pakistani and White British origin.

DESIGN

Logistic regression was used to model associations between ethnicity and consumption of key indicator foods defined by high or low energy density using an FFQ at age 12 and 18 months.

SETTING

Born in Bradford 1000 study, Bradford, UK.

SUBJECTS

Infants (n 1259; 38 % White British, 49 % Pakistani), mean age 12·7 (sd 1·0) months and toddlers (n 1257; 37 % White British, 49 % Pakistani), mean age 18·7 (sd1·0) months.

RESULTS

At 12 months, Pakistani infants consumed more commercial sweet baby meals than White British infants, with greater odds for being above average consumers (adjusted OR (AOR)=1·90; 95 % CI 1·40, 2·56), more chips/roast potatoes (AOR=2·75; 95 % CI 2·09, 3·62), less processed meat products (AOR=0·11; 95 % CI 0·08, 0·15), more fruit (AOR=2·20; 95 % CI 1·70, 2·85) and more sugar-sweetened drinks (AOR=1·68; 95 % CI 1·29, 2·18). At 18 months these differences persisted, with Pakistani infants consuming more commercial sweet baby meals (AOR=4·57; 95 % CI 2·49, 8·39), more chips/roast potato shapes (AOR=2·26; 95 % CI 1·50, 3·43), more fruit (AOR=1·40; 95 % CI 1·08, 1·81), more sugar-sweetened drinks (AOR=2·03; 95 % CI 1·53, 2·70), more pure fruit juice (AOR=1·82; 95 % CI 1·40, 2·35), more water (AOR=3·24; 95 % CI 2·46, 4·25) and less processed meat (AOR=0·10; 95 % CI 0·06, 0·15) than White British infants.

CONCLUSIONS

Dietary intake during infancy and the early toddlerhood period is associated with ethnicity, suggesting the importance of early and culturally adapted interventions aimed at establishing healthy eating behaviours.

Effects of children's self-regulation of eating on parental feeding practices and child weight

The purpose of this study was to determine whether self-regulation of eating in minority preschool-aged children mediates the relationship between parent feeding practices and child weight. Participants were 299 low-income African American and Hispanic parents and their preschool-aged children who participated in Head Start. Parents completed questionnaires about controlling feeding practices (pressure to eat, restriction) and children's appetitive characteristics (enjoyment of food, food responsiveness, satiety responsiveness). Path analyses were used to determine whether children's self-regulation of eating mediated the relationship between feeding practices and child weight. Greater satiety responsiveness in African American preschool-age children partially mediated the inverse association between pressure to eat and children's weight, B (SE) = -0.073 (0.036), P < .05. Enjoyment of food and food responsiveness did not mediate the relationship between pressure to eat and weight in the African American sample, ps > .05, nor did appetitive characteristics mediate the relationship between restriction and child weight, ps > .05. Appetitive characteristics did not mediate the relationship between controlling feeding practices and child weight in the Hispanic sample, ps > .05. Implications include the need for culturally sensitive self-report measures and for researchers to account for the possible effects of racial/ethnic differences when designing interventions.

Development of an estimated food record for 9-36-month-old toddlers

OBJECTIVES

Adequacy of dietary intake in the sensitive period of toddler development is a key determinant of health in a short- and long-term perspective. Therefore, studies focussing the nutrition of toddlers are of importance. For this purpose, tailored dietary record methods are an important prerequisite. The objective of this work is to develop a toddler-specific estimated food record (EFR) in a booklet providing photographs of age-specific foods and portion sizes that should be accurate and simple.

SUBJECTS/METHODS

For a toddler study in Germany, a 7-day consecutive EFR was developed. Data were obtained from a sample of toddlers in Germany. The basis is an evaluation of 3-day weighing food records on food choice and portion size of the DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study for 227 toddlers (118 boys) aged 9-36 months from January 2004 to March 2008.

RESULTS

In the analysed food records, a total of 15.147 eating occasions with 24.820 dishes were reported and grouped in 17 food groups. To estimate the portion size, the median consumption amounts of the 194 most frequently consumed dishes were calculated and photographed. Formula and commercial complementary food are collected separately. EFR was structured into seven eating occasions of the day: before breakfast, breakfast, mid-morning, lunch, mid-afternoon, dinner, and before bed.

CONCLUSIONS

The EFR booklet provides a simple, feasible and validated instrument that can be used to update information on dietary habits during the transition from infant to childhood diet for families in different social classes.

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.

WIC Infant and Toddler Feeding Practices Study: protocol design and implementation

The federal Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which began in the 1970s, has undergone revisions in the past several years, including revision to contents of the supplemental food "packages" in 2009 based on recommendations provided by an Institute of Medicine (IOM) committee of The National Academies. In 2010, the IOM held a workshop to examine and recommend research priorities for the program. The overall purpose of the current (ie, second) WIC Infant and Toddler Feeding Practices Study (ITFPS-2) is to conduct a nationally representative, longitudinal study of contemporary WIC infant and toddler feeding practices. This study will update earlier studies and collect information on variations in WIC program components. The study will also assess ways in which WIC may address obesity in early childhood and examine changes in feeding practices that may stem from the 2009 food package revisions. The sample is drawn from the universe of WIC sites nationally, excluding only those with an insufficient volume of eligible participants. Eligibility for the study includes the ability to be interviewed in English or Spanish. Approximately 8000 women and infants are being sampled, and ∼ 4000 are expected to participate. Eligible women are invited to participate during their WIC enrollment visit, and informed consent is sought. The design includes a core sample to be followed until the infant reaches age 2 y and a supplemental sample to be used in some cross-sectional analyses to ensure adequate representation of groups that might be underrepresented in the core sample. Participants will complete up to 11 interviews (core sample) or 4 interviews (supplemental sample) each except for the prenatal interview, which includes a quantitative 24-h recall of food intake for the infant. Eighty sites have been sampled across 26 states and 1 territory. Instruments have been developed and pretested in both English and Spanish, and interviewers have been rigorously trained. Recruitment and interviewing began in July 2013. This study will provide the only current large-sample longitudinal feeding data available on a nationally representative sample of infants in low-income families, and results will be available to inform the 2020 Dietary Guidelines for Americans for the 0- to 24-mo age group.

The critical period of infant feeding for the development of early disparities in obesity

Childhood obesity is an increasing public health problem, particularly among minority infants and young children. Disparities in overweight prevalence persist and widen with age, highlighting the need to identify factors contributing to early excess weight gain. We review the behavioral, social and macro-environmental factors contributing to the development of obesogenic early feeding practices among African-American infants and young children. We then examine the sociodemographic, household factors, feeding beliefs and infant characteristics associated with age-inappropriate feeding of liquids and solids (inappropriate feeding) among mothers and infants participating the U.S. Infant Care and Risk of Obesity Study, a cohort study of 217 low-income, first-time mothers and infants followed from 3 to 18 months of age. Maternal and infant anthropometry, infant diet, and maternal and household characteristics were collected at home visits at 3, 6, 9, 12 and 18 months of age. Mixed logistic regression was used to estimate the association between maternal and infant characteristics and inappropriate feeding. Rates of age-inappropriate feeding are high; over 75% of infants received solids or juice by 3 months of age. The odds of age-inappropriate feeding were higher among mothers who were single, depressed or believed that their infant is a "greedy" baby. Inappropriate feeding was associated with higher daily energy intake in infants (β = 109.28 calories, p = 0.01) and with increased odds of high infant weight-for-length (WFL; OR = 1.74, 95%CI: 1.01-3.01). Our findings suggest that age-inappropriate complementary feeding influences current energy intakes and infant WFL, factors that may increase long-term obesity risk by shaping infant appetite, food preferences, and metabolism. Given the intractability of pediatric obesity, understanding the role of early feeding in shaping long-term health disparities is critical for developing prevention strategies to stem obesity in early childhood.

WIC participation and breastfeeding in South Carolina: updates from PRAMS 2009-2010

Few studies examined breastfeeding initiation and duration among mothers who were eligible for the Women Infants Children (WIC) program and did not participate. This study is sought to understand the role of WIC participation and poverty level in breastfeeding initiation and duration in South Carolina. The data came from the 2009-2010 South Carolina Pregnancy Risk Assessment Monitoring System (unweighted N = 1,796). All participants were classified as WIC participants, income-eligible non-WIC participants, and income-ineligible non-WIC participants. Logistic regression models were used to analyze the association between breastfeeding initiation and WIC participation. The Kaplan-Meier method and Cox proportional hazards models were used to determine whether the continuation of breastfeeding and hazards of discontinuing breastfeeding differed by WIC participation groups. In South Carolina, two out of three women (67.2%) initiated breastfeeding. The breastfeeding initiation rate was higher among income-ineligible (84.0%) and income-eligible (78.9%) non-WIC participants than among WIC participants (55.5%). Compared to WIC participants, both income-ineligible [odds ratio (OR) = 2.1, 95% confidence interval (CI) 1.2-4.0] and income-eligible (OR = 2.6, 95% CI 1.1-4.3) non-WIC participants were more likely to initiate breastfeeding. Among mothers who already initiated breastfeeding, after adjusting covariates, the hazard ratios for weaning within 34 weeks postpartum were not significantly different by WIC participation groups. This study confirmed WIC participants were less likely to initiate breastfeeding. Once initiated, WIC participation did not significantly impact breastfeeding duration in the early postpartum period. Poverty status may not play an important role in explaining disparities in breastfeeding initiation between WIC and non-WIC participants.

Effectiveness of subsidies in promoting healthy food purchases and consumption: a review of field experiments

OBJECTIVE

To systematically review evidence from field interventions on the effectiveness of monetary subsidies in promoting healthier food purchases and consumption.

DESIGN

Keyword and reference searches were conducted in five electronic databases: Cochrane Library, EconLit, MEDLINE, PsycINFO and Web of Science. Studies were included based on the following criteria: (i) intervention: field experiments; (ii) population: adolescents 12–17 years old or adults 18 years and older; (iii) design: randomized controlled trials, cohort studies or pre–post studies; (iv) subsidy: price discounts or vouchers for healthier foods; (v) outcome: food purchases or consumption; (vi) period: 1990–2012; and (vii) language: English. Twenty-four articles on twenty distinct experiments were included with study quality assessed using predefined methodological criteria.

SETTING

Interventions were conducted in seven countries: the USA (n 14), Canada (n 1), France (n 1), Germany (n 1), Netherlands (n 1), South Africa (n 1) and the UK (n 1). Subsidies applied to different types of foods such as fruits, vegetables and low-fat snacks sold in supermarkets, cafeterias, vending machines, farmers’ markets or restaurants.

SUBJECTS

Interventions enrolled various population subgroups such as school/ university students, metropolitan transit workers and low-income women.

RESULTS

All but one study found subsidies on healthier foods to significantly increase the purchase and consumption of promoted products. Study limitations include small and convenience samples, short intervention and follow-up duration, and lack of cost-effectiveness and overall diet assessment.

CONCLUSIONS

Subsidizing healthier foods tends to be effective in modifying dietary behaviour. Future studies should examine its long-term effectiveness and cost-effectiveness at the population level and its impact on overall diet intake.

Assessing dietary intake among infants and toddlers 0-24 months of age in Baltimore, Maryland, USA

OBJECTIVE

To characterize food and nutrient intake and develop a population-specific food list to be used as a comprehensive dietary assessment tool for Baltimore infants and toddlers aged 0-24 months. The data were used to inform the Growing Leaps and Bounds (GLB) program, which promotes early obesity prevention among Baltimore infants and toddlers.

RESEARCH METHODS & PROCEDURES

A cross-sectional dietary survey using 24-hour recalls among randomly selected primary caregivers of infants and toddlers was conducted.

RESULTS

Data were collected from 84 children, (response rate 61%) 45 boys; 39 girls. Mean daily energy intakes were 677 kcal, 988 kcal, and 1,123 kcal for children 0-6 months, 7-12 months and 13-24 months, respectively. Infants 0-6 months had higher percentage of energy from fat (48%) than infants 7-12 months (34%) and 13-24 months (31%). Mean daily intakes for all nutrients among 0-12 months old were ≥ Dietary Reference Intakes (DRI), while toddlers 13-24 months had inadequate vitamins A, D, and E intake. Breastfeeding occurred in 33% of infants and toddlers 0 to 6 months, while less than 3% of those aged 7 to 24 months were breastfed. A 104-item food list with eight food and drink categories was developed.

CONCLUSIONS

Infants were formula fed with a higher frequency than they were breastfed. The consumption of high-sugar and high-fat foods (e.g. sweetened drinks, French fries) increased with each age group, which can increase the risk of childhood obesity.

Maternal mental health and infant dietary patterns in a statewide sample of Maryland WIC participants

The study's objective was to examine the relation between maternal mental health and infant dietary intake. A cross-sectional, population-based telephone survey was employed within a statewide sample of Maryland Special Supplemental Nutrition Program for Women, Infants and Children participants. A 24-h diet recall was performed using the United States Department of Agriculture Automated Multiple-Pass Method. Analyses presented were based on 689 mother-infant pairs. Overall, 36.5% of mothers reported introducing solids to their infants early (<4 months of age), and 40% reported adding cereal to their infant's bottle. Among 0-6-month-old infants, higher infant energy intake was associated with symptoms of maternal stress [β=0.02; confidence interval (CI): 0.01, 0.04], depression (β=0.04; CI: 0.01, 0.06) and overall maternal psychological distress (β=0.02; CI: 0.003, 0.03). With early introduction of solids in the model, the significant associations between infant energy intake and maternal stress and maternal psychological distress became marginal (P's=0.06-0.10). The association between infant energy intake and maternal depression remained significant (β=0.03; CI: 0.01, 0.06). Among 4-6-month-old infants, intakes of breads and cereals were higher among mothers who reported more symptoms of stress (β=0.12; CI: 0.04, 0.23), depression (β=0.19; CI: 0.03, 0.34), anxiety (β=0.15; CI: 0.02, 0.27) and overall psychological distress (β=0.04; CI: 0.01, 0.07). Among 7-12-month-old infants, dietary intake was not related to mental health symptoms. Findings suggest poorer infant feeding practices and higher infant dietary intake during the first 6 months of age in the context of maternal mental health symptoms. Further research is needed to evaluate these effects on child dietary habits and growth patterns over time.

Revised WIC food package improves diets of WIC families

OBJECTIVE

To explore the impact of the new Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package on WIC participant consumption of fruit, vegetables, whole-grain food, and lower-fat milk.

DESIGN

Telephone surveys of cross-sectional samples of California WIC families before and after the changes to the food package.

PARTICIPANTS

Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,004 in September, 2009; 2,996 in March, 2010.

MAIN OUTCOME MEASURES

Consumption of fruit, vegetables, whole-grain food, and lower-fat milk.

ANALYSIS

Comparisons of outcome variables were made by examining the differences by time point, adjusted for sociodemographic variables, using ANOVA (for means) or logistic regression (for percentages).

RESULTS

Following the changes to the WIC food package, consumption of whole-grain food increased by 17.3 percentage points, a 51% increase over baseline. Caregivers and children who usually consumed whole milk decreased by 15.7 and 19.7 percentage points, respectively, a 60%-63% reduction over baseline. Accompanying increases in lower-fat milk consumption were demonstrated. Small but significant increases in consumption of fruits and vegetables were also observed.

CONCLUSIONS AND IMPLICATIONS

Federal policy changes to the WIC program had the intended effect of increasing consumption of the prescribed food items.

Breastfeeding duration in relation to child care arrangement and participation in the special supplemental nutrition program for women, infants, and children

This study was conducted to examine associations among breastfeeding duration, child care arrangement, and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). The authors analyzed the nationally representative sample of infants born in 2001 who were enrolled in the Early Childhood Longitudinal Study-Birth Cohort (9 months). They estimated the risks of short breastfeeding duration (< 6 months of age) among infants according to the child care arrangement and WIC participation (n = 7515). Approximately 50% of US infants were enrolled in WIC, and 47% received child care on a regular basis. Both WIC participation and child care use were independently associated with short breastfeeding duration. Compared to those under parental care, WIC participants under relative care were more likely to discontinue breastfeeding before the age of 6 months. A breastfeeding support program targeted toward relative care users may be useful for WIC participants.

A systematic review of responsive feeding and child obesity in high-income countries

Child overweight/obesity continues to be a serious public health problem in high-income countries. The current review had 3 goals: 1) to summarize the associations between responsive feeding and child weight status in high-income countries; 2) to describe existing responsive feeding measures; and 3) to generate suggestions for future research. Articles were obtained from PubMed and PsycInfo using specified search criteria. The majority (24/31) of articles reported significant associations between nonresponsive feeding and child weight-for-height Z-score, BMI Z-score, overweight/obesity, or adiposity. Most studies identified were conducted exclusively in the United States (n = 22), were cross-sectional (n = 25), and used self-report feeding questionnaires (n = 28). A recent trend exists toward conducting research among younger children (i.e. infants and toddlers) and low-income and/or minority populations. Although current evidence suggests that nonresponsive feeding is associated with child BMI or overweight/obesity, more research is needed to understand causality, the reliability and validity between and within existing feeding measures, and to test the efficacy of responsive feeding interventions in the prevention and treatment of child overweight/obesity in high-income countries.

Food insecurity and weight status among U.S. children and families: a review of the literature

CONTEXT

Food insecurity disproportionately affects U.S. demographic groups of children and adult family members at the highest risk for obesity and may lead to weight gain through various pathways. This article reviews research regarding the relationship between food insecurity and weight status, and the potential role of federal food and nutrition assistance programs.

EVIDENCE ACQUISITION

A search for relevant peer-reviewed research studies among U.S. children and nonelderly adults, published between 2000 and March 2010, identified 42 studies regarding the relationship between food insecurity and weight status. There were 22 studies regarding the potential role of food and nutrition assistance programs.

EVIDENCE SYNTHESIS

Among children and men, support for an association between food insecurity and weight status has been mixed. Women who experience food insecurity are more likely to be overweight or obese compared to women with adequate household resources for food; however, there is little evidence that food insecurity promotes increased weight gain over time. Long-term participation in the Supplemental Nutrition Assistance Program may increase risk for excess weight gain.

CONCLUSIONS

Additional research addressing the limitations of current studies is needed to fully understand the observed linkages between food insecurity and risk for obesity. Nevertheless, there is substantial evidence these nutritional problems coexist, and it is critical that future efforts to eliminate hunger consider opportunities to promote healthy food choices and physical activity. Evaluations of policy changes and other intervention strategies are needed to determine the potential for food and nutrition assistance programs to more effectively reduce obesity among participants.

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.

The nutritional requirements of infants. Towards EU alignment of reference values: the EURRECA network

This paper presents a review of the current knowledge regarding the macro- and micronutrient requirements of infants and discusses issues related to these requirements during the first year of life. The paper also reviews the current reference values used in European countries and the methodological approaches used to derive them by a sample of seven European and international authoritative committees from which background scientific reports are available. Throughout the paper, the main issues contributing to disparities in micronutrient reference values for infants are highlighted. The identification of these issues in relation to the specific physiological aspects of infants is important for informing future initiatives aimed at providing standardized approaches to overcome variability of micronutrient reference values across Europe for this age group.

Using learner-centered education to improve fruit and vegetable intake in California WIC participants

OBJECTIVE

To examine the effectiveness of learner-centered education in conveying the message to change participants' fruit and vegetable consumption.

DESIGN

Focus groups were conducted with sites participating in the Finding the Teacher Within (FTW) program and comparison sites 4-6 months after participants attended the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) fruit and vegetable class.

SETTING

Six California WIC agencies.

PARTICIPANTS

Sixty predominantly Latina mothers with young children, 30 from 3 participating intervention agencies and 30 from 3 comparison agencies, participated in focus groups. Each agency independently recruited mothers for participation. Apart from selecting only mothers, no other exclusion criteria were applied.

INTERVENTION

An FTW learner-centered fruit and vegetable class.

ANALYSIS

An analytic team independently reviewed transcripts and coded themes. The long-table analytic approach was used to categorize results. Results from intervention and comparison groups were compared and ranked to create a textual summary.

RESULTS

The most significant difference between the intervention and comparison groups' reports was that intervention participants identified more value, importance, and relevance of the fruit and vegetable information and adopting new fruit and vegetable practices after attending the class.

CONCLUSIONS AND IMPLICATIONS

California WIC demonstrated that messages delivered through this process can be retained and integrated into family life practices.

First- and second-trimester WIC participation is associated with lower rates of breastfeeding and early introduction of cow's milk during infancy

BACKGROUND

Existing literature suggests prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may reduce breastfeeding among low-income mothers. However, little is known about whether the timing of WIC entrance during pregnancy influences infant feeding decisions.

OBJECTIVE

This study assesses the association between the timing of prenatal participation in WIC and various infant feeding practices, including breastfeeding initiation, breastfeeding for at least 4 months, exclusive breastfeeding, formula feeding, and early introduction of cow's milk and solid food.

DESIGN

Cross-sectional survey matching of birth certificate data to mothers' interviews 9 months after the child's birth. Mothers provided information on participation in the WIC program, infant feeding practices, and sociodemographic characteristics.

SUBJECTS

A nationally representative sample of 4,450 births in 2001 from the Early Childhood Longitudinal Survey-Birth Cohort.

ANALYSES

Multivariate logistic regression techniques (using STATA 9.0 SE, Stata Company, College Station, TX) estimated the relationship between the timing of prenatal WIC participation and infant feeding practices.

RESULTS

Entry into the WIC program during the first or second trimester of pregnancy is associated with reduced likelihood of initiation of breastfeeding and early cow's milk introduction; and entry during the first trimester is associated with reduced duration of breastfeeding. WIC participation at any trimester is positively related to formula feeding.

CONCLUSIONS

Prenatal WIC participation is associated with a greater likelihood of providing babies infant formula rather than breastmilk after birth. Findings also indicate that there are critical prenatal periods for educating women about the health risks of early cow's milk introduction. Given the health implications of feeding infants cow's milk too early, WIC may be successful in educating women on the health risks of introducing complementary foods early, even if direct counseling on cow's milk is not provided.

Season-related variation in dietary recalls used in a paediatric population

BACKGROUND

The effect of seasonality in estimating population mean nutrient intake using a single dietary recall has not been fully explored. The present study aimed to evaluate variation in energy and nutrient intake using a single 24-h recall between two seasons (spring/summer and autumn/winter) in a sample of children and adolescents.

METHODS

  A randomly selected subgroup (n = 623) of a representative sample of 3-18-year-old Greek children and adolescents was used in the present analysis. Information on participants' socio-demographic characteristics, body weight/height and dietary intake were collected through telephone interviews. Dietary assessment was based on two 24-h recalls (the first during the spring/summer season and the second 6 months later, during autumn/winter season).

RESULTS

Reported daily energy intake in spring/summer was 344 ± 130 kJ (82 ± 31 kcal) higher compared to the one in autumn/winter after adjusting for potential confounders (P = 0.008). However, the contribution of the macronutrients to the total energy intake was not statistically different between the two periods and the same was also true for vitamin C and calcium. The results remained unchanged after excluding low energy reporters.

CONCLUSIONS

The use of a second 24-h recall in a different season of the year does not confer additional information with regard to a population assessment of macronutrient contribution to the total energy intake in paediatric samples; its use appears to be justified in the light of a more accurate assessment of energy intake.