National trends in beverage consumption in children from birth to 5 years: analysis of NHANES across three decades

Assessment of Beverage Trends and Replacing Nondairy Caloric Beverages with Milk at Meals across Childhood Improves Intake of Key Nutrients at Risk of Inadequate Consumption: An NHANES Modeling Study

Background

Milk is a key source of important nutrients including the nutrients of public health concern. However, most Americans do not meet current (dairy) United States Department of Agriculture (USDA) dietary guideline recommendations, and the intake has been declining.

Objective

The aim of this study was to investigate milk and beverage intake trends and nutrient intakes from these products in United States children aged 6-18 y and to model the effect of isocaloric substitution of nondairy beverages with milk.

Methods

Data from National Health and Nutrition Examination Survey (NHANES) 2001-2018 for children age 6-8 (N = 4696), 9-13 (N = 8117) and 14-18 y (N = 8514) were used with milk and other beverage intakes determined from the first 24-h in-person dietary recall. Nutrient intake was determined using the NHANES cycle-specific total nutrient intake files. Nutrient modeling was performed by isocaloric substitution with milk of all nondairy beverages consumed during lunch and dinner meals combined. Sample-weighted analyses were performed using SAS 9.4.

Results

Between ages 6-8 and 14-18 y, daily intake of milk and flavored milk decreased by 10% and 62%, respectively, while daily intake of caloric beverages excluding milk increased by 96%. Daily intake from caloric beverages and milk combined decreased for fiber, protein, fat, saturated fat, calcium, magnesium, potassium, vitamin A, and vitamin D and increased for energy, carbohydrates, added sugars, and folate between ages 6-8 y and 14-18 y. Isocaloric substitution of all caloric nondairy beverages at meals with milk (using nutrient contribution of USDA milk, not further specified (NFS)) resulted in increases in protein, fat, saturated fat, calcium, magnesium, potassium, sodium, vitamin A, folate, vitamin B12, and vitamin D and decreases in carbohydrate, fiber, and added sugar.

Conclusion

These findings provide additional evidence to support dietary recommendations for milk, and efforts should be made on behalf of leading health professionals and childhood meal programs to highlight milk as a beverage of choice in children and adolescents.

Perspective: The Benefits of Including Flavored Milk in Healthy Dietary Patterns

The Dietary Guidelines for Americans recommend two-and-a-half cup equivalents of low-fat and fat-free dairy foods per day for children 4-8 y and 3 cup equivalents per day for adolescents aged 9-18 and adults. Currently, the Dietary Guidelines for Americans recognizes 4 nutrients as being of public concern because of suboptimal levels in the diet. These include calcium, dietary fiber, potassium, and vitamin D. In the American diet, dairy foods are leading contributors of calcium, vitamin D, and potassium. Milk, because of its unique nutrient package that provides shortfall nutrients to the diets of children and adolescents, remains an underpinning of dietary recommendations and is included with school meals. Despite this, milk consumption is declining, and >80% of Americans do not meet recommendations for dairy. Data indicate that children and adolescents who consume flavored milk are more likely to consume more dairy and adhere to healthier overall dietary patterns. Flavored milk, however, receives more scrutiny than plain milk because of its contribution of added sugar and calories to the diet and concerns over childhood obesity. Therefore, the purpose of this narrative review is to describe trends in beverage consumption in children and adolescents aged 5-18 y and highlight the science that has examined the impact of including flavored milk in overall healthy dietary patterns within this population.

Effects of pictorial warnings on parents' purchases and perceptions of sugar-sweetened beverage categories

BACKGROUND

Sugar-sweetened beverage (SSB) consumption remains high among US children. Warning labels on SSBs hold promise for reducing consumption, but their impact may differ by SSB category.

OBJECTIVES

This study examined the effects of pictorial warnings on parents' beverage purchases and perceptions across SSB categories.

METHODS

Parents of children ages 2-12 (n = 326) visited a convenience store laboratory in North Carolina. Participants were randomly assigned to see SSBs carrying either pictorial warning labels or control labels. Parents purchased a beverage for their child and completed a survey.

RESULTS

Responses from parents in the control arm suggest underlying perceptions of flavoured milk (2.8 on scale ranging from 1 to 5), flavoured water (2.6), and fruit-flavoured drinks (2.5) as the most healthful SSB categories. Compared to the control, pictorial warnings led to the largest reductions in purchases of fruit drinks (-61%), soda (-36%) and flavoured milk (-32%). Warnings also lowered the perceived healthfulness of flavoured water (d = -0.34), flavoured milk (d = -0.28), sports drinks (d = -0.25), and a reduction in intentions to give one's child sports drinks (d = -0.30), flavoured water (d = -0.24) and sweet tea (d = -0.22, all p < 0.05).

CONCLUSIONS

Warning labels may have heterogeneous effects across SSB categories. Future research should assess the psychological mechanisms underlying these heterogeneous effects.

The association of maternal sugary beverage consumption during pregnancy and the early years with childhood sugary beverage consumption

OBJECTIVES

A woman's food choices during pregnancy may be associated with her offspring's food choices. Several studies support an association between childhood sugary beverage (SB) consumption and poor cardiometabolic health. This study aimed to assess the association of maternal SB consumption during pregnancy and later, with her offspring's SB consumption in early infancy and childhood.

METHODS

A total of 1945 women and 1595 children participating in 3 Canadian studies reported SB consumption during pregnancy, at 2 years of age, and/or at school age (5 to 8 years old). Mother and offspring SB intakes were self-reported by mothers. Multivariable linear regression analyses were conducted within each cohort and cohort data were combined using fixed effect meta-analyses.

RESULTS

Maternal SB consumption during pregnancy was associated with higher offspring SB consumption at 2 years of age (standardized β = 0.19 predicted change in the number of standard deviations of offspring SB intake for an increase of 1 standard deviation in maternal serving [95% CI: 0.16 to 0.22]). Concurrent maternal SB consumption was associated with higher offspring SB intake when children were aged 5 to 8 years (standardized β= 0.25 [95% CI: 0.10 to 0.40]).

CONCLUSION

Maternal SB consumption during pregnancy is associated with a marginally higher SB intake among their offspring at age 2, and concurrent maternal consumption is associated with a higher SB intake among school-aged offspring (5 to 8 years old). Future interventions tailored for pregnancy and early childrearing years to reduce SB intakes of mothers may reduce young children's SB intake.

Child-Directed Marketing, Health Claims, and Nutrients in Popular Beverages

INTRODUCTION

Fruit drinks are a major source of added sugar in children's diets. This study describes the associations between front-of-package child-directed marketing (i.e., sports, fantasy, or child-directed imagery; child-directed text) and (1) health-related claims and (2) nutrient content of fruit drinks, 100% juices, and flavored waters.

METHODS

Beverage purchase data from a national sample of 1,048 households with children aged 0-5 years were linked with front-of-package label and nutrition data to conduct a content analysis on fruit drinks (n=510), 100% juices (n=337), and noncarbonated flavored waters (n=40) in 2019-2020. Unstratified and stratified regression models assessed the differences in the prevalence of claims (macronutrient, micronutrient, natural/healthy, and fruit and juice), non-nutritive sweeteners, and nutrient content (calories, total sugar, and percent daily value of vitamin C) between drinks with and those without child-directed marketing in 2021.

RESULTS

Fruit drinks with child-directed marketing were more likely to show front-of-package micronutrient claims (OR=2.1, 95% CI=1.5, 3.1) and contained more vitamin C (18.5% daily value, 95% CI=1.6, 35.5) than fruit drinks without child-directed marketing. 100% juices with child-directed marketing contained less vitamin C (-35.6% daily value, 95% CI= -57.5, -13.8) and 3.0 (95% CI= -5.5, -0.4) fewer grams of sugar than 100% juices without child-directed marketing. Flavored waters with child-directed marketing contained less vitamin C (-37.9% daily value, 95% CI= -68.1, -7.6) than flavored waters without child-directed marketing.

CONCLUSIONS

The combination of child-directed marketing with health-related claims may mislead parents into believing that fruit drinks are healthy and appealing to their children, highlighting the need for government regulation of sugary drink marketing.

Total water intake and its contributors in infants and young children

Hydration is a particular concern for infants and young children due to their greater risk of dehydration. However, studies on their water intakes are scarce. The current survey aimed to analyse total water intake (TWI) in non-breastfed children aged 0·5-35 months compared with the adequate intake (AI) for the same age group set by the European Food Safety Authority and to examine the different contributors to TWI as well as beverage consumption patterns. Nationally representative data from the Nutri-Bébé cross-sectional survey were used to assess food, beverage and plain water consumption by age group over three non-consecutive days. With age, median TWI in 1035 children increased from 732 to 1010 ml/d, without differences between sexes, but with a great inter-individual variation, and the percentage of children who did not meet the AI increased from 10 to 88 %. Median weight-related TWI decreased from 136·6 to 69·0 ml/kg per d. Among infants, 90 % had a ratio of water:energy below the AI, similarly for about 75 % of toddlers. Milk and milk products were the main contributors to TWI, while the part of plain water increased gradually to be 25 % in the older toddlers, half of which was tap water. The beverage consumption pattern varied in types and timing, with little consumption of juices and sweetened beverages. Vegetables and fruits accounted for 20 % of TWI after the age of 6 months. These initial results, showing strong discrepancies between actual and recommended water intakes in young children, should help identify ways to increase children's water consumption.

Front-of-package claims & imagery on fruit-flavored drinks and exposure by household demographics

Young children regularly consume sugary fruit drinks, in part because parents may falsely believe they are healthful due to front-of-package (FOP) claims and imagery. The goal of this study was to assess: 1) the prevalence of FOP claims/imagery on fruit-flavored beverages purchased by U.S. households with 0-5-year-olds, and 2) proportional differences in beverages purchased with FOP claims/imagery across household demographic groups. A content analysis of FOP claims/imagery (e.g., nutrient claims, fruit imagery) on beverages (n = 1365) purchased by households with 0-5-year-olds was conducted by linking beverage sales with FOP marketing data. Results were merged with purchasing data from a nationally representative sample of households (FoodAPS), and survey-weighted logistic regression was used to assess differences in the proportions of 100% juices and fruit drinks with specific FOP claims/imagery purchased by household race/ethnicity, income, and SNAP/WIC participation. The most common claims on fruit-flavored beverages included nutrient claims (fruit drinks: 73%; 100% juices: 68%; flavored waters: 95%), which most commonly highlighted vitamin C (35-41% across beverage categories) and the absence of sugar (31-48%). Most beverages also contained implied-natural claims (fruit drinks: 60%; 100% juices: 64%; flavored waters: 95%) and natural imagery (fruit drinks: 97%; 100% juices: 96%; flavored waters: 73%). A large proportion of fruit drinks and 100% juices purchased by households across all demographic groups contained FOP claims and imagery, with a few minor differences between racial/ethnic groups. In conclusion, most fruit drinks, 100% juices, and flavored waters purchased by households with 0-5-year-olds contained FOP claims and imagery that may lead consumers to believe the beverages are healthy and natural. FDA regulations should ensure parents are not misled by this marketing.

Consumption of Milk and alternatives decreased among Canadians from 2004 to 2015: evidence from the Canadian community health surveys

Background

Milk and milk products make important contributions to the diet of Canadians. The aim of this study was to examine trends in Milk & Alternatives consumption among Canadians (≥2 years) from 2004 to 2015.

Methods

We used nutrition data from 2 nationally representative cross-sectional surveys conducted in 2004 and 2015 [Canadian Community Health Survey (CCHS) 2004 Cycle 2.2 and CCHS-Nutrition 2015] to compare Milk & Alternatives consumption between 2004 and 2015. Data from 24-h dietary recalls were collected using the Automated Multiple-Pass Method (AMPM).

Result

From 2004 to 2015, the proportion of Canadians consuming Milk & Alternatives food group significantly decreased from 89.5 to 87.7% and the number of servings consumed per day dropped from 1.9 to 1.7. Despite their low energy contribution (12.3% of energy), Milk & Alternatives contributed 45.8% of calcium, 39.9% of vitamin D, and 36.0% of vitamin B12 to the diet of the Canadian population in 2015. Milk & Alternatives were among the top sources of vitamin A, phosphorus and riboflavin. Milk & Alternatives food group was a major contributor to saturated fat intake in both 2004 (31.2%) and 2015 (28.6%). In 2015, dietary intakes of calcium and vitamin D among Milk & Alternatives consumers were 137.8, and 59.4% higher, respectively, than those of non-consumers.

Conclusion

Daily intake of Milk & Alternatives has decreased in the Canadian population over time, which may adversely affect the nutritional profile of the diet.

Identifying Prenatal and Postnatal Determinants of Infant Growth: A Structural Equation Modelling Based Cohort Analysis

Background: The growth and maturation of infants reflect their overall health and nutritional status. The purpose of this study is to examine the associations of prenatal and early postnatal factors with infant growth (IG). Methods: A data-driven model was constructed by structural equation modelling to examine the relationships between pre- and early postnatal environmental factors and IG at age 12 months. The IG was a latent variable created from infant weight and waist circumference. Data were obtained on 274 mother–child pairs during pregnancy and the postnatal periods. Results: Maternal pre-pregnancy BMI emerged as an important predictor of IG with both direct and indirect (mediated through infant birth weight) effects. Infants who gained more weight from birth to 6 months and consumed starchy foods daily at age 12 months, were more likely to be larger by age 12 months. Infant physical activity (PA) levels also emerged as a determinant. The constructed model provided a reasonable fit (χ² (11) = 21.5, p < 0.05; RMSEA = 0.07; CFI = 0.94; SRMR = 0.05) to the data with significant pathways for all examined variables. Conclusion: Promoting healthy weight amongst women of child bearing age is important in preventing childhood obesity, and increasing daily infant PA is as important as a healthy infant diet.

Predictors of Age at Juice Introduction and Associations with Subsequent Beverage Intake in Early and Middle Childhood

BACKGROUND

The American Academy of Pediatrics recommends that if parents choose to introduce juice, they wait until ≥12 months, citing concerns of obesity and dental caries.

OBJECTIVES

We sought to identify correlates of early juice introduction (<6 months) and determine whether early introduction establishes a pattern of sugary beverage intake in childhood.

METHODS

Upstate KIDS is a prospective birth cohort study with follow-up through 7 years (n = 4989). The age of juice introduction was assessed from responses on periodic questionnaires from 4-18 months and categorized as <6,  6 to <12, and ≥12 months. Sociodemographic information was reported using vital records or maternal questionnaires. At 24, 30, and 36 months and 7 years, mothers reported their child's regular juice, soda, water, and milk intakes. The analysis was restricted to singletons and 1 randomly selected twin from each pair with information on juice introduction (n = 4067). We assessed associations of sociodemographic correlates with juice introduction using Cox proportional hazard models. The relations of juice introduction with beverage intake were evaluated using Poisson or logistic regression for adjusted risk ratios (aRR) or ORs, adjusting for sociodemographic covariates and total beverage intake.

RESULTS

Of the mothers, 25% and 74% introduced juice prior to 6 and 12 months, respectively. Younger maternal age; black or Hispanic race/ethnicity; lower educational attainment; Special Supplemental Nutrition Program for Women, Infants, and Children participation (yes); smoking during pregnancy; a higher pre-pregnancy BMI; a lower household income; and living in a townhouse/condominium or mobile home were associated with earlier juice introduction. Earlier juice introduction was related to a higher childhood juice intake, any soda intake, and lower water intake, holding total beverage intake constant [aRR, 1.5 (95% CI: 1.3-1.7; P-trend < 0.0001); adjusted OR 1.6 (95% CI: 1.0-2.4; P-trend = 0.01); aRR 0.9 (95% CI: 0.8-0.9; P-trend < 0.0001), respectively].

CONCLUSIONS

Markers of lower socioeconomic status are strongly associated with earlier juice introduction, which, in turn, relates to sugary beverage intake in childhood, potentially replacing water.

A Comparison of Maternal Health Status and Weight-Related Cognitions, Behaviors, and Home Environments by Race/Ethnicity

This cross-sectional study compared weight-related cognitions, behaviors, and home environments of 568 mothers of young children (ages 2 to <9 years) by racial/ethnic group. Maternal health status was good and did not differ by race/ethnicity. Mothers were somewhat confident in their ability to promote healthy physical activity and eating behaviors in their children, with White and Asian mothers having greater confidence than Hispanic mothers. Mothers had low physical activity, with Hispanic mothers getting more sedentary screentime than White and Asian mothers. Mothers' dietary intake did not differ. Modeling of healthful behaviors was more frequent in White than Hispanic mothers. Asian mothers tended to use non-recommended feeding patterns more than White, Hispanic, and Black mothers. Children's physical activity and screentime did not differ by race/ethnicity. Asian children tended to drink less sugar-sweetened beverages and more milk than counterparts. All reported frequent family meals, with Hispanic mothers reporting more family meals eaten in less healthful locations. Household food environments did not differ. However, White mothers reported greater access to physical activity space and supports than Hispanic mothers. Race/ethnicity may link with maternal weight-related cognitions, behaviors, and home environments and thus can help inform the development of interventions tailored by race/ethnicity.

Trends in Store-Level Sales of Sugary Beverages and Water in the U.S., 2006-2015

INTRODUCTION

Previous research on sugar-sweetened beverage trends has focused on self-reported consumption from surveys. Few studies used objective store sales or explored differences by area-level demographics and store type.

METHODS

The average volume of beverages sold per store per 3-digit zoning improvement plan code from 2006 to 2015 was calculated using national Nielsen Retail Scanner point-of-sale data from 24,240 stores. A multilevel regression model analyzed annual trends, with random intercepts for state and separate models for beverage type (regular soda, no/low-calorie soda, other sugary drinks, 100% fruit juice, bottled water). Differences by store type (convenience, supermarkets, drug stores, mass merchandisers) and area-level demographics (categorized as tertiles) were examined. Data were analyzed in 2019.

RESULTS

The model-based estimates indicated that sales of regular soda (-11.8%), no/low-calorie soda (-19.8%), and 100% fruit juice (-31.9%) decreased over time, whereas sales of bottled water (+34.4%) increased and sales of other sugary drinks remained stable (+2.4%). Decreases in sugar-sweetened beverage sales were largely concentrated in supermarkets and larger in areas with high income and education levels and a high percentage of black and Hispanic people. There were also relatively larger increases in bottled water sales in states located in the South and Midwest.

CONCLUSIONS

The finding that sales of sugar-sweetened beverages decreased over time, whereas sales of bottled water increased is encouraging because sugar-sweetened beverage consumption is linked to obesity and other chronic conditions. This study provides a novel, rigorous assessment of U.S. beverage sales trends and differences by community and store characteristics.

A longitudinal study of fruit juice consumption during preschool years and subsequent diet quality and BMI

Background

The role of fruit juice in pediatric dietary guidelines continues to be controversial, particularly with respect to concerns about unhealthy dietary habits and the potential promotion of excessive weight gain. The objective of the current study was to determine the association between preschool fruit juice consumption and the following outcomes during childhood and adolescence: whole and total fruit intake, diet quality, likelihood of meeting current dietary recommendations, and BMI change.

Methods

The data were previously collected from 100 children enrolled in the Framingham Children’s Study at 3–6 years of age and subsequently followed for 10 years. Dietary data were collected annually using multiple sets of 3-day diet records. Compliance with dietary recommendations was estimated based on 2015–2020 Dietary Guidelines for Americans and diet quality was measured using the associated Healthy Eating Index (HEI). Mixed linear and logistic regression models were used for statistical analyses.

Results

Preschool children (3–6 years) who drank ≥1.0 (vs. < 0.5) cup of 100% fruit juice/day consumed 0.9 cups/day more total fruit (p < 0.0001) and 0.5 cups/day more whole fruit (p < 0.0001) during adolescence (14–18 years). Total HEI scores during adolescence for those with the highest preschool juice intakes were almost 6 points higher than those with the lowest fruit juice intakes (p = 0.0044). Preschoolers consuming < 0.5 cups/day of fruit juice had sharply declining whole fruit intake throughout childhood compared with those preschoolers consuming ≥1.0 cups/day who had stable intakes of whole fruit throughout childhood. Those children who consumed ≥0.75 cups/day of fruit juice during preschool (vs. less) were 3.8 times as likely to meet Dietary Guidelines for whole fruit intake during adolescence (p < 0.05). Finally, in multivariable models, there was no association between fruit juice consumption and BMI change throughout childhood.

Conclusion

These data suggest that preschool consumption of 100% fruit juice is associated with beneficial effects on whole fruit intake and diet quality without having any adverse effect on BMI during childhood and into middle adolescence.

Cow's Milk Fat Obesity pRevention Trial (CoMFORT): a primary care embedded randomised controlled trial protocol to determine the effect of cow's milk fat on child adiposity

INTRODUCTION

Cow's milk is a dietary staple for children in North America. Though clinical guidelines suggest children transition from whole (3.25% fat) milk to reduced (1% or 2%) fat milk at age 2 years, recent epidemiological evidence supports a link between whole milk consumption and lower adiposity in children. The purpose of this trial is to determine which milk fat recommendation minimises excess adiposity and optimises child nutrition and growth.

METHODS AND ANALYSIS

Cow's Milk Fat Obesity pRevention Trial will be a pragmatic, superiority, parallel group randomised controlled trial involving children receiving routine healthcare aged 2 to 4-5 years who are participating in the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=534) will be randomised to receive one of two interventions: (1) a recommendation to consume whole milk or (2) a recommendation to consume reduced (1%) fat milk. The primary outcome is adiposity measured by body mass index z-score and waist circumference z-score; secondary outcomes will be cognitive development (using the Ages and Stages Questionnaire), vitamin D stores, cardiometabolic health (glucose, high-sensitivity C-reactive protein, non-high density lipoprotein (non-HDL), low density lipoprotein (LDL), triglyceride, HDL and total cholesterol, insulin and diastolic and systolic blood pressure), sugary beverage and total energy intake (measured by 24 hours dietary recall) and cost effectiveness. Outcomes will be measured 24 months postrandomisation and compared using analysis of covariance (ANCOVA), adjusting for baseline measures.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from Unity Health Toronto and The Hospital for Sick Children. Results will be presented locally, nationally and internationally and published in a peer-reviewed journal. The findings may be helpful to nutrition guidelines for children in effort to reduce childhood obesity using a simple, inexpensive and scalable cow's milk fat intervention.

TRIAL REGISTRATION NUMBER

NCT03914807; pre-results.

Nutritional problems in childhood and adolescence: a narrative review of identified disparities

To inform programmes and policies that promote health equity, it is essential to monitor the distribution of nutritional problems among young individuals. Common nutritional problems include overall low diet quality, the underconsumption and overconsumption of certain dietary components, unhealthy meal and snack patterns, problematic feeding practices and disordered eating. The objective of the present narrative review was to summarise recent evidence of disparities among US children (2-19 years) according to age, sex, socio-economic status, ethnicity/race and rural-urban location. Searches in PubMed® and MEDLINE® were completed to identify peer-reviewed research studies published between January 2009 and January 2019. Findings from the ninety-nine reviewed studies indicate adolescent females, young individuals from lower socio-economic households and individuals who identify as non-Hispanic Black race are particularly vulnerable populations for whom targeted strategies should be developed to address evidence of increased risk with regards to multiple aspects of nutritional wellbeing. Limitations of the existing evidence relate to the accuracy of self-reported dietary data; the need for consistent definitions of disordered eating; the focus on individual dietary components v. patterns; the complexities of categorising socio-economic status, ethnicity/race, and rural and urban areas; and the cross-sectional, observational nature of most research designs. There is an urgent need for research to address these limitations and fill a large gap in evidence on rural-urban differences in nutritional problems. It will further be important for future studies to build greater understanding of how nutritional problems cluster among population groups.

Sugar-containing beverage consumption and cardiometabolic risk in preschool children

Objective

Sugar-containing beverages (SCBs) including 100% fruit juice, fruit drinks and soda substantially contribute to total caloric intake in young children. The objective of this study was to examine whether consumption of SCB is associated with cardiometabolic risk (CMR) in preschool children, along with whether 100% fruit juice and sugar sweetened beverage (SSB) is associated with CMR.

Study Design

We used a repeated measures study design examining SCB consumption and CMR outcomes measured concurrently in children 3-6 years of age participating in TARGet Kids!, a primary-care, practice-based research network in Canada (2008-2017). To account for within-person variability, multivariable linear regression models using generalized estimating equation was used to examine the association between SCB consumption and CMR score and the individual CMR score components including systolic blood pressure, waist circumference, high-density lipoprotein cholesterol (HDL-c), triglycerides, and glucose.

Results

After adjusting for sociodemographic, familial and child-related covariates, higher SCB consumption was associated with elevated CMR score [0.05 (95% CI -0.0001 to 0.09), p = 0.05], including lower HDL-c [-0.02 mmol/L (95% CI -0.03 to -0.01), p = 0.01] and higher triglycerides [0.02 mmol/L (95% CI 0.004 to 0.04), p = 0.02]. When examined separately, higher 100% fruit juice [-0.02 mmol/L (95% CI -0.03 to -0.003), p = 0.02] and SSB[-0.03 mmol/L (95% CI -0.06 to -0.001), p = 0.04] consumption were each associated with lower HDL-c.

Conclusion

Higher SCB consumption was associated with small elevations of CMR in preschool children. Our findings support recommendations to limit overall intake of SCBs in early childhood, in effort to reduce the potential long-term burden of CMR.

Trends in Food Consumption Patterns of US Infants and Toddlers from Feeding Infants and Toddlers Studies (FITS) in 2002, 2008, 2016

The Feeding Infants and Toddlers Study (FITS) is the largest survey of dietary intake among infants and young children in the United States. Dietary patterns in early childhood are a key component of prevention of diet-related chronic diseases, yet little is known about how food consumption patterns of infants and young children have changed over time. The objective of this study is to examine trends in food and beverage consumption among children ages 6–23.9 months using data from the FITS conducted in 2002, 2008, and 2016. A total of 5963 infants and young children ages 6–23.9 months were included in these analyses. Food consumption data were collected using a multiple-pass 24-h recall by telephone using the Nutrition Data System for Research. Linear trends were assessed using the Wald’s test in a multivariable linear regression model. Positive significant findings include increases in breast milk consumption and decreases in the consumption of sweets, sugar-sweetened beverages, and 100% fruit juice. More troubling findings include decreasing infant cereal consumption, stagnant or decreasing whole grain consumption, and stagnant consumption of vegetables. Our findings suggest some promising improvements in dietary intake among infants and toddlers in the United States over the past 15 years, but further policy, programmatic, and industry efforts are still needed.

A qualitative study to understand parent and physician perspectives about cow's milk fat for children

OBJECTIVE

Consensus guidelines recommend that children consume reduced-fat (0·1-2 %) cow's milk at age 2 years to reduce the risk of obesity. Behaviours and perspectives of parents and physicians about cow's milk fat for children are unknown. Objectives were to: (i) understand what cow's milk fat recommendations physicians provide to 2-year-old children; (ii) assess the acceptability of reduced-fat v. whole cow's milk in children's diets by parents and physicians; and (iii) explore attitudes and perceptions about cow's milk fat for children.

DESIGN

Online questionnaires and individual interviews were conducted. Questionnaire data were analysed using descriptive statistics. Interview transcripts were analysed using a general inductive approach and thematic analysis.

SETTING

The TARGet Kids! practice-based research network in Toronto, Canada.

PARTICIPANTS

Questionnaire respondents included fifty parents and fifteen physicians; individual interviews were conducted with with fourteen parents and twelve physicians.

RESULTS

Physicians provided various milk fat recommendations for 2-year-old children. Parents also provided different cow's milks: eighteen (36 %) provided whole milk and twenty-nine (58 %) provided reduced-fat milk. Analysis of qualitative interviews revealed three themes: (i) healthy eating behaviours, (ii) trustworthy nutrition information and (iii) importance of dietary fat for children.

CONCLUSIONS

Parents provide, and physicians recommend, a variety of cow's milks for children and hold mixed interpretations of the role of cow's milk fat in children's diets. Clarity about its effect on child adiposity is needed to help make informed decisions about cow's milk fat for children.

Child and Adolescent Sugar-Sweetened Beverage Intakes Are Longitudinally Associated with Higher Body Mass Index z Scores in a Birth Cohort Followed 17 Years

BACKGROUND

Sugar-sweetened beverages (SSB) are considered a risk factor for obesity.

OBJECTIVE

The objective of the current study was to investigate associations between the predictors of beverage and energy intakes and mean adequacy ratios (MARs), and the outcome of body mass index (BMI) z scores, in a birth cohort using longitudinal models.

DESIGN

This was a longitudinal analysis of secondary data.

PARTICIPANTS/SETTING

Participants in the Iowa Fluoride and Iowa Bone Development Studies with two beverage intake questionnaires completed between ages 2 and 4.7 years or 5 and 8.5 years or one questionnaire between ages 9 and 10.5, 11 and 12.5, 13 and 14.5, or 15 and 17 years (n=720); two food and beverage diaries completed between ages 2 and 4.7 years or 5 and 8.5 years or completion of the Block's Kids' Food Frequency Questionnaires at age 11, 13, 15, or 17 years (n=623); and anthropometric measures at the corresponding age 5-, 9-, 11-, 13-, 15-, or 17-year examination(s).

PREDICTORS

Mean daily 100% juice, milk, SSB, water/sugar-free beverage, and energy intakes and MARs averaged over ages 2 to 4.7, 5 to 8.5, 9 to 10.5, 11 to 12.5, 13 to 14.5, or 15 to 17 years were predictors.

OUTCOME

BMI z score was the outcome.

STATISTICAL ANALYSES

Linear mixed models were fit for each beverage, energy, and MAR variable, with the beverage, energy, or MAR variable as the predictor and BMI z score as the outcome. Beverage models were adjusted for energy and MAR and baseline socioeconomic status.

RESULTS

SSB intake adjusted for energy intake, MAR, and baseline socioeconomic status was associated with BMI z score; each additional 8 oz SSB consumed/day throughout childhood and adolescence increased the BMI z score an average 0.050 units (95% CI 0.022 to 0.079; P=0.001). Adjusted water/sugar-free beverage intake (0.026 units; 95% CI 0.006 to 0.046; P=0.013) was modestly associated with BMI z score, while 100% juice (-0.001 units; 95% CI -0.059 to 0.057; P=0.97) and milk (0.022 units; 95% CI -0.007 to 0.052; P=0.13) intakes were not associated with BMI z scores.

CONCLUSIONS

Higher SSB intakes were associated with increased BMI z scores throughout childhood and adolescence in Iowa Fluoride Study participants. Public health initiatives targeting SSB consumption during childhood and adolescence remain relevant.

The use of fluoride for the prevention of dental erosion and erosive tooth wear in children and adolescents

BACKGROUND

Erosive tooth wear (ETW) has gained increasing clinical relevance. It is estimated that worldwide 30-50% of deciduous and 20-45% of permanent teeth are affected. One of the most important nutritional factors causing ETW is the overconsumption of soft drinks, but also patient-related factors like reflux or eating disorders can lead to erosive lesions. Whether acids lead to erosive demineralisation depends on their degree of saturation with respect to tooth mineral at their actual pH.

REVIEW

Fluoride compounds like sodium or amine fluoride seem to be of limited efficacy against erosion, the main reason for this is the missing biofilm in the erosive process as well as the lower pH of the acids compared to bacterial acids. This means that to achieve some kind of preventive effect it would be necessary to use products with higher fluoride concentration, which is not an appropriate option for small children, and/or to increase the frequency of application. In addition, the fluoride compound plays a role as promising effects were found when fluoride is combined with titanium or stannous ions. TiF₄ can cause acid-resistant surface coatings and when Sn²⁺/F^- formulations are applied, Sn is not only found on the surface but is also incorporated into enamel and dentine. Both effects make the tooth surface more resistant against acid demineralisation. Different fluoride-containing vehicles have been tested to prevent erosion/ETW, such as toothpastes, rinses, gels and varnishes. Toothpastes offer some degree of protection, especially Sn²⁺-containing formulations, but effects of the active ingredients are sometimes counteracted by the presence of abrasives.

CONCLUSION

Detecting associated factors and influencing them is the main instrument in arresting erosive tooth wear. Additionally, patients at risk for dental erosion should always use an additional fluoride source preferably containing Sn²⁺.

Ethnic disparities of beverage consumption in infants and children 0-5 years of age; National Health and Nutrition Examination Survey 2011 to 2014

BACKGROUND

Dietary patterns, including beverage consumption, that are developed during a child's first few years of life have been shown to impact dietary choices made later in life. Authoritative sources provide beverage recommendations for infants and children; however, it is unclear if these guidelines are followed and what, if any, the differences are among races/ethnicities. The objective of this study was to examine beverage consumption to recommendations among children 0-5 months, 6-11 months, 12-23 months, 2-3 years, and 4-5 years. Additionally, examine how these beverage patterns associate with nutrient intake and to determine if differences exist in beverage consumption among race/ethnic groups (Non-Hispanic White, Non-Hispanic Black, Hispanic, and Asian) in children aged 0-23 months, 2-3 years, and 4-5 years.

METHODS

Data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) for children 0-5 years were analyzed (n = 2445). Beverages were classified as follows; milk, 100% juice, diet beverages, sugar sweetened beverages (SSB), and water.

RESULTS

Our results show that regardless of race/ethnicity, dietary recommendation were not always followed. Prior to 6 months, 10% of infants consumed any amount of 100% juice; from 6 to 11 months, 17% of young children were drinking any amount of milk. SSB consumption rapidly increased with age, whereas intake of milk and 100% juice declined after 2 to 3 years of age. Non-Hispanic Black young children consumed the most 100% juice from 2 to 3 years and up, exceeding recommended amounts, and throughout all age groups they consumed the least milk and most SSBs. The decreased intake of nutrient-rich beverages with age was associated with lower intakes of under-consumed nutrients of public health concern. By 4-5 years, 32.7% and 93.8% of children were consuming

CONCLUSIONS

Dietary recommendations for both the introduction of beverages and amounts consumed were not consistently followed for American infants and children 0-5 years. Race/ethnic disparities exist in beverage consumption with Non-Hispanic Black children consuming the least amount of milk and most SSBs. Improving beverage consumption patterns could help improve overall diet quality which directly contributes to overall childhood health.

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Key Words

• 100% juice
• Beverage
• Children
• Ethnic disparities
• Infants
• Milk
• Nutrient intake
• Recommendations
• Sugar sweetened beverage

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MESH Headings

• Black or African American/statistics & numerical data
• Animals
• Beverages/statistics & numerical data
• Child, Preschool
• Diet/methods
• Ethnicity/statistics & numerical data
• Female
• Fruit and Vegetable Juices/statistics & numerical data
• Humans
• Infant
• Infant, Newborn
• Male
• Milk/statistics & numerical data
• Nutrition Surveys/statistics & numerical data
• United States
• White People/statistics & numerical data

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Grants

• National Dairy Council

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Affiliation(s)

Elieke Demmer National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
Christopher J. Cifelli National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
Jenny A. Houchins National Dairy Council, 10255 West Higgins Road, Suite 900, Rosemont, IL 60018-5616 USA
Victor L. Fulgoni Nutrition Impact, LLC, Battle Creek, MI 49014 USA

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Description of Child and Adolescent Beverage and Anthropometric Measures According to Adolescent Beverage Patterns

Our objective is to retrospectively describe longitudinal beverage intakes and anthropometric measures according to adolescent beverage patterns. Data were collected from Iowa Fluoride Study participants (n = 369) using beverage questionnaires at ages 2⁻17 years. Weight and height were measured at ages 5, 9, 13 and 17 years. Cluster analyses were used to identify age 13- to 17-year beverage patterns. Treating age and beverage cluster as explanatory factors, sex-specific generalized linear mixed models were used to identify when differences in beverage intakes and anthropometric measures began. Predominant beverage intakes were higher in each of the corresponding clusters by 9⁻12.5 years; females with high milk intakes during adolescence and males with high 100% juice or sugar-sweetened beverage intakes during adolescence reported higher intakes of that beverage beginning at 2⁻4.7 years. Females and males in the 100% juice cluster had lower weights than other clusters beginning at 13 years, while females and males in the neutral cluster were shorter beginning at 13 years. Females in the water/sugar-free beverage cluster had higher body mass indices (BMIs) beginning at 9 years. Females and males in the 100% juice cluster had lower BMIs beginning at 5 and 9 years, respectively. Childhood beverage intakes and growth patterns differ according to adolescent beverage patterns.

The association of flavored milk consumption with milk and energy intake, and obesity: A systematic review

Taxes on sugary drinks are being implemented to prevent chronic diseases. Sugar-sweetened milk has been exempt from such policies because of its nutritional value. This systematic review sought to examine whether flavored milk consumption was associated with milk and energy intake, and obesity among children. A search of PubMed, EMBASE, Cochrane, CINAHL, Web of Science, Cochrane Central Register of Controlled Trials and the grey literature was conducted for peer-reviewed publications published before June 6, 2016 that met the following criteria: 1) English-language publications 2) studies of children ages 1 to 18 years, 3) controlled experimental, cohort, case-control, systematic reviews, or meta-analysis studies 4) dependent variable: flavored milk consumption 5) independent variable: weight, weight gain, weight change, body mass index, metabolic syndrome, waist circumference, cholesterol, triglycerides, blood pressure, serum glucose, calories, sugar, or milk consumed. Of 3978 studies identified, 13 met inclusion criteria. Ten studies were experimental and three were longitudinal cohort studies. Eleven studies found that flavored milk increased overall milk intake, five of seven studies that examined energy intake showed that flavored milk increased energy intake, and one of three studies that assessed obesity outcomes demonstrated an increase in weight gain with flavored milk consumption. Only one study was a randomized controlled trial, most studies had high bias, and over half were industry-funded or did not disclose funding. Although flavoring milk may increase milk intake, added sugars may promote increased energy intake. More data regarding flavored milk's impact on health is needed to inform its role in sugary drink policies.

Attainment of '5-2-1-0' obesity recommendations in preschool-aged children

Obesity prevention guidelines recommend children eat ≥ 5 servings of fruits and vegetables, view ≤ 2 h of screen time, participate in 1 h of physical activity, and consume 0 sugar-sweetened beverages daily, commonly known as '5-2-1-0'. We sought to determine: the extent to which preschool-aged children attending child care meet these guidelines, predictors of attainment, and associations of attainment with weight status. We analyzed in 2016, 24-hour dietary, physical activity, and screen time data collected in 2009-10 from 398 preschool-aged children in 30 child-care centers in Cincinnati, OH. Dietary intake, screen time and body-mass index (BMI) were obtained by research staff during child care and from parents when at home. Accelerometers measured physical activity. Mixed-effects models and generalized estimating equations were used to determine associations between '5-2-1-0' recommendations, demographic variables, and BMI z-scores. Average child age was 4.3 ± 0.7 years; 26% had a BMI ≥ 85th percentile. Seventeen percent of children with complete dietary data (n = 307) consumed ≥ 5 servings of fruits and vegetables and 50% consumed 0 sugar-sweetened beverages. < 1% with complete physical activity data (n = 386) met the activity recommendation; 81% of children (n = 379) had ≤ 2 h of screen time. Only 1 child met all of the '5-2-1-0' recommendations. There were no consistent demographic predictors of attaining individual recommendations. An additional hour of screen time was associated with a 0.11 (SD 0.06) increase in BMI z-score. Our data suggests there is ample room to increase fruit and vegetable intake and physical activity in preschool-aged children.

Early Antibiotic Exposure and Risk of Childhood Obesity in Latinos

We investigated the relationship between early antibiotic exposure before 6 months age and risk for obesity at 2 years in a high-risk, low-income, urban Latino cohort (n = 97), with the hypothesis that antibiotic exposure would increase risk for obesity by 2 years. Data were collected through maternal report of infant 24-hour dietary intake at 4-6 weeks, 6 months, 1, and 2 years; and food frequency questionnaires at 4-6 weeks, 6 months, 1, and 2 years. Antibiotic use data, including type and frequency, were collected through maternal self-report at 6 months and 1 year. Cord blood levels of leptin and insulin were measured at birth. Chi-squared tests were used to assess the relationship between obesity and dichotomous predictors and Student's t-tests for continuous predictors. Multivariable logistic models were used to ascertain independent predictors of obesity at age 2. We found that early antibiotic exposure before 6 months was independently associated with increased risk for rapid infant weight gain [odds ratio (OR) 6.42, 95% confidence interval (CI, defined as the range in which sample will fall with 95% confidence: 1.17-35.06)] and obesity at age 2 [OR 6.15, 95% CI (1.03-36.70)]. These findings provide evidence promoting antibiotic stewardship in pediatric practices to minimize exposure in the first 6 months of life.

Trends in Food and Beverage Consumption Among Infants and Toddlers: 2005-2012

BACKGROUND

Nutritional guidance for infants and toddlers is lacking, and the diets of American children in the first 2 years of life are not well characterized.

METHODS

Cross-sectional data from the NHANES were used to describe the diets of 0- to 23-month-olds in the United States. Participants with complete dietary data were eligible for the analysis (N = 2359). Linear regression models were constructed to identify changes from 2005 to 2008 and from 2009 to 2012 in food and beverage consumption, both overall and within sociodemographic groups.

RESULTS

We observed several trends toward meeting early-feeding recommendations, such as a decline in the prevalence of complementary feeding among 0- to 5-month-olds. However, the prevalence of vegetable consumption was consistently lower than desired (∼25% of 6- to 11-month-olds and 20% of 12- to 23-month-olds had no reported vegetable consumption on dietary recall days in the 2009-2012 set). Subgroup analyses revealed that some trends were limited to certain populations (eg, a decline in juice consumption was observed among 6- to 11-month-old non-Hispanic whites and non-Hispanic blacks but not among Mexican Americans), and additional trends emerged within groups (eg, the prevalence of breast milk consumption declined among 0- to 5-month-old Mexican Americans).

CONCLUSIONS

Although there have been some improvements in the diets of 0- to 23-month-olds in recent years, there are areas in which this population continues to fall short of current recommendations. This underscores the need for additional policy guidance for providers and education for parents and caretakers on helping infants and toddlers achieve healthy diets.

Beverage Consumption among U.S. Children Aged 0-24 Months: National Health and Nutrition Examination Survey (NHANES)

Data on beverage consumption patterns in early life are limited. The aim of this study was to describe beverage consumption by sociodemographic characteristics, along with water intake and sources of water among U.S. children aged 0-24 months. Data from 2740 children in the 2005-2012 NHANES were analysed. Food intake was determined via one 24-h dietary recall. Beverages were categorised according to What We Eat In America groups. Poverty-Income ratio was used to define household income. During infancy (0-5.9 months and 6-11.9 months) infant formulas were the most commonly consumed beverage, 74.1% and 78.6% of children consuming, respectively. Comparatively fewer children, 41.6% and 24.3%, consumed breast milk. In toddlers (12-24 months), the most commonly consumed beverages were plain milk (83.6% of children consuming), water (68.6%), 100% fruit juice (51.8%) and sweetened beverages (31.2%). Non-Hispanic black and Mexican-American children were more likely to consume sweetened beverages, 100% fruit juice and infant formula than Non-Hispanic white children. Children from lower income households were more likely to consume sweetened beverages and 100% fruit juice and less likely to consume breast milk than children from higher income households. Total water intake increased with age and the contribution of water from food and beverage sources was ~20% and ~80% for all children, respectively. Disparities in beverage consumption by race/ethnicity and income level are apparent in early life.

Beverage Consumption Patterns at Age 13 to 17 Years Are Associated with Weight, Height, and Body Mass Index at Age 17 Years

BACKGROUND

Sugar-sweetened beverages (SSBs) have been associated with obesity in children and adults; however, associations between beverage patterns and obesity are not understood.

OBJECTIVE

Our aim was to describe beverage patterns during adolescence and associations between adolescent beverage patterns and anthropometric measures at age 17 years.

DESIGN

We conducted a cross-sectional analyses of longitudinally collected data.

PARTICIPANTS/SETTING

Data from participants in the longitudinal Iowa Fluoride Study having at least one beverage questionnaire completed between ages 13.0 and 14.0 years, having a second questionnaire completed between 16.0 and 17.0 years, and attending clinic examination for weight and height measurements at age 17 years (n=369) were included.

EXPOSURE

Beverages were collapsed into four categories (ie, 100% juice, milk, water and other sugar-free beverages, and SSBs) for the purpose of clustering. Five beverage clusters were identified from standardized age 13 to 17 years mean daily beverage intakes and named by the authors for the dominant beverage: juice, milk, water/sugar-free beverages, neutral, and SSB.

OUTCOMES

Weight, height, and body mass index (BMI; calculated as kg/m²) at age 17 years were analyzed.

STATISTICAL ANALYSES

We used Ward's method for clustering of beverage variables, one-way analysis of variance and χ² tests for bivariable associations, and γ-regression for associations of weight or BMI (outcomes) with beverage clusters and demographic variables. Linear regression was used for associations of height (outcome) with beverage clusters and demographic variables.

RESULTS

Participants with family incomes <$60,000 trended shorter (1.5±0.8 cm; P=0.070) and were heavier (2.0±0.7 BMI units; P=0.002) than participants with family incomes ≥$60,000/year. Adjusted mean weight, height, and BMI estimates differed by beverage cluster membership. For example, on average, male and female members of the neutral cluster were 4.5 cm (P=0.010) and 4.2 cm (P=0.034) shorter, respectively, than members of the milk cluster. For members of the juice cluster, mean BMI was lower than for members of the milk cluster (by 2.4 units), water/sugar-free beverage cluster (3.5 units), neutral cluster (2.2 units), and SSB cluster (3.2 units) (all P<0.05).

CONCLUSIONS

Beverage patterns at ages 13 to 17 years were associated with anthropometric measures and BMI at age 17 years in this sample. Beverage patterns might be characteristic of overall food choices and dietary behaviors that influence growth.

Water and Beverage Consumption among Children Aged 4-13 Years in Lebanon: Findings from a National Cross-Sectional Study

This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children (n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9–13-year-old children failed to meet the DRIs compared to 4–8 years old (92%–98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life.

Usual Intake of Key Minerals among Children in the Second Year of Life, NHANES 2003-2012

Iron, calcium, and zinc are important nutrients for the young, developing child. This study describes the usual intake of iron, calcium, and zinc among US children in the second year of life using two days of dietary intake data from the National Health and Nutrition Examination Survey 2003-2012. Estimates were calculated using PC-SIDE to account for within and between person variation. Mean usual iron, calcium, and zinc intakes were 9.5 mg/day, 1046 mg/day, and 7.1 mg/day, respectively. Over a quarter of children had usual iron intakes less than the Recommended Dietary Allowance (RDA) (26.1%). Eleven percent of children had usual calcium intakes below the RDA and over half of children had usual intakes of zinc that exceeded the tolerable upper intake level (UL). Two percent or less had usual intakes below the Estimated Average Requirement (EAR) for iron, calcium, and zinc. Our findings suggest that during 2003-2012, one in four children and one in ten children had usual intakes below the RDA for iron and calcium, respectively. Children who are not meeting their nutrient requirements could be at increased risk for developing deficiencies such as iron deficiency or could lead to a shortage in adequate nutrients required for growth and development. One in every two children is exceeding the UL for zinc, but the interpretation of these estimates should be done with caution given the limited data on adverse health outcomes. Continued monitoring of zinc intake and further assessment for the potential of adverse health outcomes associated with high zinc intakes may be needed.

Water and beverage consumption among children aged 4-13 years in France: analyses of INCA 2 (Étude Individuelle Nationale des Consommations Alimentaires 2006-2007) data

OBJECTIVE

To examine the consumption of plain water among children in France and compare total water intakes with guidelines issued by the European Food Safety Authority (EFSA).

DESIGN

Nationally representative data were used to assess food, beverage and water consumption by sex, age group (4-8 years, 9-13 years), income-to-poverty ratio, eating occasion and location. Beverages were classified into nine groups: water (tap or bottled), milk, 100 % fruit juice, sodas, fruit drinks, hot beverages, sports drinks and flavoured waters. Total water volume in relation to energy intake (litres/kcal) was also examined.

SETTING

INCA 2 study (Étude Individuelle Nationale des Consommations Alimentaires 2006-2007).

SUBJECTS

French children (n 835) aged 4-13 years.

RESULTS

Total water intakes were accounted for by plain water (34 %), beverages (26 %) and food moisture (40 %). Plain water could be tap (18 %) or bottled (16 %). Older children drank more plain water than did younger children and boys drank more plain water than did girls. No socio-economic gradient for plain water consumption was observed. About 90 % of children did not meet the EFSA water intake recommendations. The daily water shortfall ranged from 367 to 594 ml/d. Water-to-energy ratio was 0·75-0·77 litres/1000 kcal (4184 kJ). Children drank milk at breakfast and plain water during lunch and dinner. Caloric beverages provided 10 % of dietary energy; consumption patterns varied by eating location.

CONCLUSIONS

Total water intakes among young children in France were below EFSA-recommended levels. Analyses of beverage consumption patterns by eating occasion and location can help identify ways to increase water consumption among children.

Early sugar-sweetened beverage consumption frequency is associated with poor quality of later food and nutrient intake patterns among Japanese young children: the Osaka Maternal and Child Health Study

Evidence from Western countries shows that higher consumption of sugar-sweetened beverages (SSBs) is associated with lower quality of young children's diets, but little is known about these relations in non-Western countries with relatively low consumption levels of SSBs. We hypothesized that SSB consumption in infancy would be associated with poor quality of later food and nutrient intake patterns among Japanese young children. The study subjects were 493 Japanese mother-child pairs from a prospective birth cohort study. Dietary data on children were collected from the mothers using self-administered questionnaires when the children were aged 16-24 months and 41-49 months. Multiple linear regression analyses were used to examine the relationships between SSB consumption frequency in infancy and later intake of foods and nutrients. At 16-24 months of age, more than half of the children (56.4%) consumed SSBs less than once a week, whereas 11.6% consumed SSBs at least once daily. More frequent consumption of SSBs in infancy was associated with higher intake of confectionaries and SSBs and lower intake of fruits and vegetables at 41-49 months of age. These associations were still evident after adjustment for maternal SSB consumption and socioeconomic status. At the nutrient level, SSB consumption frequency was positively associated with energy intake and inversely associated with intake of many nutrients, such as protein, dietary fiber, and most of the micronutrients examined. In conclusion, higher consumption frequency of SSBs at an early age is associated with poor quality of overall dietary intake among young Japanese children 1.5-2.5 years later.

Bottle and sippy cup use is associated with diet and energy intake in toddlers

The second year of life incorporates a continued shift from a liquid- to solid-based diet. Little is known about the prevalence and dietary impact of bottle and sippy cup use. This paper describes associations between percent of energy consumed via drinking containers (bottles and sippy cups combined) and dietary outcomes, between 1 and 2 years of age. This observational study recruited n = 299 low-income, nutrition programme clients from the Bronx, NY, whose 12 month olds consumed ≥ 2 non-water bottles per day. The main exposure variable was percent of energy intake via drinking containers (PEDC), dichotomized at the median into low-percent-energy-from-drinking-containers (LOW-C) and high-percent-energy-from-drinking-containers (HIGH-C) groups, assessed quarterly, for 1 year. We report 24-hour dietary recall nutrient and food serving data by LOW-C vs. HIGH-C. We employed linear mixed models to study associations between PEDC and nutrient intake. PEDC decreased from 52% to 33% between 1 and 2 years of age in both groups. The LOW-C group had higher intake of energy, dietary fibre, iron and sodium, grains, protein-rich foods and sweets. Conversely, LOW-C group had lower intake of Vitamin D and calcium vs. the HIGH-C group. PEDC was inversely associated with total energy intake in a model controlling for baseline age, baseline-weight-for-length and gender (β = -5.8, P = 0.029, 95% confidence interval (-10.96, -0.6). Lower bottle and sippy cup use had significant, albeit mixed association with diet quality in the second year of life, and was associated with higher energy intake. Evidence-based guidelines are needed to determine the appropriate use of those feeding methods.

Beverage Consumption: Are Alcoholic and Sugary Drinks Tipping the Balance towards Overweight and Obesity?

The role that energy-containing beverages may play in the development of overweight and obesity remains highly controversial, in particular the alcoholic and sugar-sweetened beverages (SSB). Both of these beverage formats have been increasing as a percentage of the westernized diet over the past 20 years, and both have contributed significantly to an increase in energy consumed in liquid form. Data from epidemiology and intervention studies however have long been contradictory, despite mechanistic evidence pointing towards poor compensation for addition of "liquid" energy from these two sources into the diet providing a strong rational for the balance to be tipped towards weight gain. Regulatory and government intervention has been increasing globally, particularly with respect to intake of SSBs in children. This narrative review presents evidence which both supports and refutes the link between alcohol and carbohydrate-containing liquids and the regulation of body weight, and investigates mechanisms which may underpin any relationship between increased beverage consumption and increased energy intake, body weight and adiposity.

Need for specific sugar-sweetened beverage lessons for fourth- and fifth-graders

OBJECTIVE

Consumption of sugar-sweetened beverages (SSB) is linked to obesity. The authors hypothesized that school-based nutrition education would decrease SSB consumption.

DESIGN

Self-selected interventional cohort with random selection for pre and post measurements.

SETTING

Arizona Supplemental Nutrition Assistance Program-Education Program-eligible schools.

PARTICIPANTS

Randomly selected (9%) fourth- and fifth-grade classroom students.

INTERVENTION

The University of Arizona Nutrition Network provided general nutrition education training and materials to teachers, to be delivered to their students. The University of Arizona Nutrition Network administered behavioral questionnaires to students in both fall and spring.

MAIN OUTCOME MEASURE(S)

Change in SSB consumption.

ANALYSES

Descriptive statistics were computed for student demographics and beverage consumption on the day before testing. Paired t tests evaluated change in classroom averages. Linear regression assessed potential correlates of SSB consumption.

RESULTS

Fall mean SSB consumption was 1.1 (± 0.2) times; mean milk and water intake were 1.6 (± 0.2) and 5.2 (± 0.7) times, respectively. Beverage consumption increased (3.2%) in springtime, with increased SSBs (14.4%) accounting for the majority (P = .006). Change in SSB consumption was negatively associated with baseline SSB and water consumption but positively associated with baseline milk fat (P ≤ .05).

CONCLUSIONS AND IMPLICATIONS

The results suggest the need for beverage-specific education to encourage children to consume more healthful beverages in warmer weather.

The impact of conventional dietary intake data coding methods on foods typically consumed by low-income African-American and White urban populations

OBJECTIVE

Analysing dietary data to capture how individuals typically consume foods is dependent on the coding variables used. Individual foods consumed simultaneously, like coffee with milk, are given codes to identify these combinations. Our literature review revealed a lack of discussion about using combination codes in analysis. The present study identified foods consumed at mealtimes and by race when combination codes were or were not utilized.

DESIGN

Duplicate analysis methods were performed on separate data sets. The original data set consisted of all foods reported; each food was coded as if it was consumed individually. The revised data set was derived from the original data set by first isolating coded foods consumed as individual items from those foods consumed simultaneously and assigning a code to designate a combination. Foods assigned a combination code, like pancakes with syrup, were aggregated and associated with a food group, defined by the major food component (i.e. pancakes), and then appended to the isolated coded foods.

SETTING

Healthy Aging in Neighborhoods of Diversity across the Life Span study.

SUBJECTS

African-American and White adults with two dietary recalls (n 2177).

RESULTS

Differences existed in lists of foods most frequently consumed by mealtime and race when comparing results based on original and revised data sets. African Americans reported consumption of sausage/luncheon meat and poultry, while ready-to-eat cereals and cakes/doughnuts/pastries were reported by Whites on recalls.

CONCLUSIONS

Use of combination codes provided more accurate representation of how foods were consumed by populations. This information is beneficial when creating interventions and exploring diet-health relationships.

Position of the Academy of Nutrition and Dietetics: nutrition guidance for healthy children ages 2 to 11 years

It is the position of the Academy of Nutrition and Dietetics that children ages 2 to 11 years should achieve optimal physical and cognitive development, maintain healthy weights, enjoy food, and reduce the risk of chronic disease through appropriate eating habits and participation in regular physical activity. Rapid increases in the prevalence of childhood obesity during the 1980s and 1990s focused attention on young children's overconsumption of energy-dense, nutrient-poor foods and beverages and lack of physical activity. While recent data suggest a stabilization of obesity rates, several public health concerns remain. These include the most effective ways to promote healthy weights, the number of children living in food insecurity, the under-consumption of key nutrients, and the early development of diet-related risks for chronic diseases, such as cardiovascular disease, type 2 diabetes, cancer, obesity, and osteoporosis. This Position Paper reviews what children 2 to 11 years old in the United States are reportedly eating, explores trends in food and nutrient intakes, and examines the impact of federal nutrition programs on child nutrition. Current dietary recommendations and guidelines for physical activity are also discussed. The roles of parents and caregivers in influencing the development of life-long healthy eating behaviors are highlighted. The Academy of Nutrition and Dietetics works with other allied health and food industry professionals to translate dietary recommendations and guidelines into positive, practical health messages. Specific recommendations and sources of science-based nutrition messages to improve the nutritional well-being of children are provided for food and nutrition practitioners.

Fluid intake survey among schoolchildren in Belgium

Background

In childhood, inadequate fluid intakes can lead on the short term, to reduced physical and cognitive performances. However, few data are available on the fluid intake among schoolchildren in Belgium. The main aim of this study is to evaluate total fluid intake provided by different types of beverages in a sample of Belgian schoolchildren, in order to assess the percentage of individuals complying with the European Food Safety Authority recommendations for total fluid intake. A secondary aim was to characterize the study population in terms of determinants of the total fluid intake requirements.

Methods

A child friendly “fluids and liquid food” diary was used to prospectively record the volume and frequency of beverage consumption over 7 days from 1045 schoolchildren. This diary also recorded the practice of physical activity. An adequate fluid intake was defined as an intake ≥ 75% of the age-specific adequate intake recommended by the EFSA.

Results

The median (P25-P75) of habitual daily fluid intake was 864 (608–1104) ml/day, with 355 (194–579) coming from drinking water. This habitual daily fluid intake varied significantly among the three investigated EFSA groups (girls and boys aged from 8 years, girls from 9 to 13 and boys from 9 to 13), except for the drinking water (P = 0.906). The highest medians of fruit juice, sugar-sweetened beverages and milk and derivatives were found among boys of 9–13. Only 9.5% of the children had an adequate fluid intake, with a value of 19.2% among the 8 years old girls and boys, 7.0% among girls of 9–13 and 8.4% among boys of 9–13. In the whole sample, 27.7% of the children declared to drink less than 3-4x/day, 56% drunk water less than 2x/day and 7.7% drunk no water at all. Every day, 27.1% and 34.1% of the children drank respectively one fruit juice and one sugar-sweetened beverage.

Conclusion

Belgian schoolchildren have an inadequate total fluid intake. Given the potential health consequences, interventions involving parents and school environment to promote water consumption seem pertinent.

Fluid intake from beverages across age groups: a systematic review

BACKGROUND

Fluid intake, especially water, is essential for human life and also necessary for physical and mental function. The present study aimed to assess beverage consumption across age groups.

METHODS

A systematic review was conducted. Original research in English language publications and available studies (or abstracts in English) from 2000 to 2013 was searched for by using the medical subheading (MeSH) terms: ('beverage' OR 'fluid' [Major]) AND ('consumption' [Mesh] OR 'drinking' [Mesh] OR 'intake' [Mesh]) AND ('child' [Mesh] OR 'adolescent' [Mesh] OR 'adult' [Mesh]). Article selection was restricted to those papers covering healthy populations of all age groups in a nationwide sample, or from a representative sample of the population of a city or cities, which examined the trends or patterns of beverage intake and the determinants of beverage intake. Sixty-five studies were identified with respect to beverage consumption across age groups. The papers were screened by thoroughly reading titles or abstracts. Full-text articles were assessed by three investigators.

RESULTS

Total beverage intake varied between 0.6 and 3.5 L day(-1) among all age groups (males more than females). Plain water contributed up to 58%, 75% and 80% of the total beverage intake in children, adolescents and adults, respectively. Milk consumption was higher among children; consumption of soft drinks was higher among adolescents; and the consumption of tea, coffee and alcoholic beverages was higher among adults.

CONCLUSIONS

Plain water is the main water source for all age groups and the consumption of other beverages varies according to age.

A comparison of beverage intakes in US children based on WIC participation and eligibility

OBJECTIVE

To compare beverage intakes for 2- to 4-year-olds based on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation.

METHODS

Data from National Health and Nutrition Examination Survey, 2005-2010 were analyzed to assess beverage intakes for 2- to 4-year-olds. Children were classified as WIC participants, low-income nonparticipants, and higher-income nonparticipants. All beverages were manually coded into 6 categories: water, milk, 100% juice, fruit drinks, soda, and low-calorie/diet drinks. Grams, calories, and percent consumers of each beverage were compared across groups.

RESULTS

Special Supplemental Nutrition Program for Women, Infants, and Children participants had the highest 100% juice consumption (P = .001) and their milk consumption was similar to higher-income children. Higher-income nonparticipants drank significantly less fruit drink (P < .001) and soda (P = .001) than both the WIC participants and low-income nonparticipants.

CONCLUSIONS AND IMPLICATIONS

Participation in WIC was related to higher intakes of the beverages provided in food packages for 2- to 4-year-olds. Intakes of fruit juice and sugar-sweetened beverages should be addressed during the WIC nutrition education counseling sessions.

Complementary feeding and obesity risk

PURPOSE OF REVIEW

This article will summarize recent progress in research in the area of complementary feeding as it relates to childhood obesity. Newly emerged findings demonstrate how research on contributing factors has shifted. Examining nutrient and caloric intakes alone has failed to answer the critical question, 'Why are some children obese, whereas others are not?' Recent research explores parental attitudes, beliefs and parental feeding styles as contributing factors.

RECENT FINDINGS

Studies examining the impact of specific macronutrients on obesity risk may have partially uncovered a link between consistently high protein intakes during infancy and an elevated obesity risk, at least until the second year of life. However, this relationship was not evident in all studies evaluated in a systematic review this year. Childhood obesity is not linked to any specific types of foods or food groups during the complementary feeding period. Adherence to dietary guidelines is associated with increased lean body mass, but not BMI or fat mass. Complementary feeding practices, socioeconomic and other family dynamics at least partially explain obesity risk.

SUMMARY

As young infants are dependent on adults for nourishment, parental attitudes and beliefs about infant nutrition and actual feeding practices directly influence infant nutritional status. Early nutrition interventions to prevent obesity should take nutrition belief systems, parental feeding styles, socioeconomic and educational status, among other characteristics into consideration.