Top sources of dietary sodium from birth to age 24 mo, United States, 2003-2010

Avoidance of added salt for 6-12-month-old infants: A narrative review

Most nutrition guidelines recommend avoiding foods with added salt for infants aged 6-12 months. However, the reason for no added salt lacks enough and reliable evidence. We re-searched and re-studied the relevant evidence. We searched PubMed and the Cochrane database for English-language studies published from 1904 through 2021. We also searched the databases of the websites of different national institutions. Randomized clinical trials (RCTs), systematic reviews, observational studies, and dietary guidelines were included in this review. The kidneys of infants aged 6-12 months have adequate sodium excretion capacity. There is insufficient evidence that high salt (sodium) intake early in life might lead to hypertension or salty diet preference in adults. Infants aged 6-12 months might be at risk of low sodium intake of only 150-300 mg of sodium/day, which may not meet the body's needs, if their supplementary food is not adequately salted.

Food consumption patterns and nutrient intakes of infants and young children amidst the nutrition transition: the case of Lebanon

Background

This is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0–4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations.

Methods

Based on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR).

Results

Milk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0–5.9 months and 6–11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8–20.7%) and fruits (14.4–34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A.

Conclusions

This study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12937-022-00779-9.

Effects of Early Weight Gain Velocity, Diet Quality, and Snack Food Access on Toddler Weight Status at 1.5 Years: Follow-Up of a Randomized Controlled Infant Formula Trial

This study followed children who participated in a feeding trial in which the type of randomized infant formula fed from 2 weeks significantly affected weight gain velocity during the first 4 months and weight-for-length Z (WLZ) scores up to 11.5 months. We focused on measures of anthropometry, dietary intakes, and parenting related to the provision of snack foods that were collected at the end of the trial (1 year) and the 1.5 years follow-up visit. We not only describe what toddlers are eating, but we also determined the independent and/or interactive effects of randomized formula group, early weight gain velocity, the nutrient content of the post-formula diet, and maternal snack food practices, on toddlers’ weight status. Diet quality underwent drastic changes during this 6-month period. As infant formula disappeared from the diet, fruit and 100% fruit juice intake increased slightly, while intake of “What We Eat in America” food categories sweetened beverages and snacks and sweets more than doubled. Added sugars accounted for 5% of energy needs at 1 year and 9% at 1.5 years. Generalized linear mixed models revealed that, independent of the randomized formula group, greater velocities of weight gain during early infancy and lower access to snacks as toddlers predicted higher WLZ and a greater proportion of toddlers with overweight at 1.5 years. Energy and added sugar intake had no significant effects. These findings add to the growing body of evidence that unhealthy dietary habits are formed even before formula weaning and that, along with improving early diet, transient rapid weight gain and parental feeding practices are modifiable determinants that may reduce risks for obesity.

Dietary intake of sodium by children: Why it matters

Dietary sodium is required in very small amounts to support circulating blood volume and blood pressure (BP). Available nutritional surveillance data suggest that most Canadian children consume sodium in excess of their dietary requirements. Approximately 80% of the sodium Canadians consume comes from processed and packaged foods. High sodium intakes in children may be an indicator of poor diet quality. Results from systematic reviews and meta-analyses have demonstrated that decreasing dietary sodium in children leads to small but clinically insignificant decreases in BP. However, population-level strategies to reduce sodium consumption, such as food product reformulation, modifying food procurement processes, and federal healthy eating policies, are important public health initiatives that can produce meaningful reductions in sodium consumption and help to prevent chronic disease in adulthood.

L’importance de l’apport alimentaire en sodium chez les enfants

L’organisme a besoin de très petites quantités de sodium alimentaire pour soutenir le volume sanguin et la tension artérielle. Selon les données de surveillance nutritionnelle disponibles, la plupart des enfants canadiens consomment une quantité de sodium supérieure à leurs besoins nutritionnels. Environ 80 % du sodium que consomment les Canadiens proviennent d’aliments transformés et emballés. Chez les enfants, un fort apport en sodium peut être indicateur d’un régime alimentaire de piètre qualité. Les résultats d’analyses systématiques et de méta-analyses démontrent que la diminution du sodium alimentaire chez les enfants entraîne une réduction modeste, mais cliniquement non significative, de la tension artérielle. Les stratégies en population pour limiter la consommation de sodium, telles que la reformulation des produits alimentaires, la modification des processus d’approvisionnement alimentaire et les politiques fédérales de saine alimentation, sont d’importantes initiatives en santé publique qui peuvent réduire considérablement la consommation de sodium et contribuer à prévenir des maladies chroniques à l’âge adulte.

Nutrition Monitoring of Children Aged Birth to 24 Mo (B-24): Data Collection and Findings from the NHANES

The first 2 y of life are characterized by several transitions that can affect growth, development, and eating patterns long term. These include a shift from a primarily milk-based eating pattern to introduction of complementary foods at ∼4-6 mo of age, and passage to family-meal patterns in toddler years. Recognizing the importance of this critical period, the Dietary Guidelines for Americans from 2020 onwards will include guidance for children aged birth to 24 mo (B-24). Few large-scale surveys provide comprehensive, nationally representative, quantitative, recent data on infant and toddler nutrition in the United States. The continuous NHANES has collected data relevant to this initiative since 1999 using standardized interview and examination protocols. These include data on infant feeding practices, dietary intakes (foods, beverages, and supplements), anthropometry, and blood-based nutritional status on nationally representative samples of infants and toddlers. NHANES data can be used to describe large group-level consumption patterns, as well as trends over time for B-24 children overall, and by demographic groups (e.g., race-ethnic and income groups). In addition, NHANES data can be analyzed to examine adherence to nutrition-related recommendations, such as those from the American Academy of Pediatrics (AAP), and to track Healthy People 2020 objectives. This paper provides an update on NHANES nutrition monitoring in B-24 children since our previous publication (which provided details through NHANES 2009-2010) and describes data collection since 2010 and plans for upcoming cycles. It also describes key NHANES-based findings published in the last 5 y on infant feeding practices, dietary intakes and supplement use, and nutritional status of US children aged <2 y. Findings related to existing recommendations, such as from the AAP, are presented when available. This information can inform researchers and policymakers on the state of nutrition in the US B-24 population and its subgroups of interest.

Mineral and vitamin intake of infants and young children: the Nutri-Bébé 2013 survey

PURPOSE

Minerals and vitamins are essential for optimal growth and development, particularly during the first years of life. Therefore, regularly evaluating their intake makes sense. For this purpose, we report the data from the Nutri-Bébé 2013 survey in comparison with the European Food Safety Authority Adequate Intake (AI), or Average Requirement, (AR) according to age.

METHODS

This observational, nationally representative, cross-sectional survey was conducted in 1035 non-breastfed French children aged 0.5-35 months. Dietary intake was recorded using a food diary on three non-consecutive days, framed by two face-to-face interviews.

RESULTS

The intake of zinc, magnesium and water-soluble vitamins most of the time met the recommendations. From the first weeks of life, sodium intake exceeded the AI, with a maximum median intake of 1137 mg/day after the age of 30 months. However, it has decreased since 2005. Calcium median intake often exceeded the AI or AR, reaching a maximum of 780 mg/day between 18 and 23 months. Median vitamin A intake always exceeded the AI or AR but exceeded the recommended upper limit in only a few cases. After 2 years, median iron intake was clearly below the AR, i.e. lower than 6.0 mg/day. Dietary vitamin D intake was below the AI, thereby justifying adequate supplementation. Vitamin E intake was below the AI in 50-75% of toddlers.

CONCLUSION

This survey highlights excessive sodium intake as well as a shortfall of iron, vitamin D, and vitamin E intakes. The potential consequences of these discrepancies with respect to health outcomes remain to be assessed.

Food Consumption Patterns and Micronutrient Density of Complementary Foods Consumed by Infants Fed Commercially Prepared Baby Foods

Nutrition is critically important in the first 1000 days, and while most American babies are fed commercial baby foods, there is little or no evidence from nationally representative data to understand the implications of such consumption. We used 24-hour dietary recall data for 505 infants from The Feeding Infants and Toddlers Study to describe food consumption patterns and micronutrient density of complementary foods consumed by infants fed commercially prepared baby food fruit, vegetables, and dinners and compared with those eaten by nonconsumers of these products. Results show that consumers were significantly more likely to report eating all vegetables (excluding white potatoes, 71% vs 51%), deep yellow vegetables (42% vs 18%), and fruits (79% vs 65%) and were less likely to report eating white potatoes (10% vs 24%), dark green vegetables (4% vs 20%), and sweets (23% vs 47%) than were nonconsumers. Nutrient density of the complementary foods of consumers was greater for fiber, potassium, vitamin A, vitamin C, vitamin E, and magnesium, but lower in sodium and vitamin D. We conclude that infants fed commercially prepared baby foods were more likely to eat vegetables and fruits, and their diets were higher in several micronutrients. These findings provide important insights on complementary feeding and are useful to support the development of evidence-based infant-feeding guidelines.

Sources of Sodium in US Adults From 3 Geographic Regions

Supplemental Digital Content is available in the text.

Background:

Most US adults consume excess sodium. Knowledge about the dietary sources of sodium intake is critical to the development of effective reduction strategies.

Methods:

A total of 450 adults were recruited from 3 geographic locations: Birmingham, AL (n=150); Palo Alto, CA (n=150); and the Minneapolis–St. Paul, MN (n=150), metropolitan areas. Equal numbers of women and men from each of 4 race/ethnic groups (blacks, Asians, Hispanics, and non-Hispanic whites) were targeted for recruitment. Four record-assisted 24-hour dietary recalls were collected from each participant with special procedures, which included the collection of duplicate samples of salt added to food at the table and in home food preparation.

Results:

Sodium added to food outside the home was the leading source of sodium, accounting for more than two thirds (70.9%) of total sodium intake in the sample. Although the proportion of sodium from this source was smaller in some subgroups, it was the leading contributor for all subgroups. Contribution ranged from 66.3% for those with a high school level of education or less to 75.0% for those 18 to 29 years of age. Sodium inherent to food was the next highest contributor (14.2%), followed by salt added in home food preparation (5.6%) and salt added to food at the table (4.9%). Home tap water consumed as a beverage and dietary supplement and nonprescription antacids contributed minimally to sodium intake (<0.5% each).

Conclusions:

Sodium added to food outside the home accounted for ≈70% of dietary sodium intake. This finding is consistent with the 2010 Institute of Medicine recommendation for reduction of sodium in commercially processed foods as the primary strategy to reduce sodium intake in the United States.

Clinical Trial Registration:

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02474693.

Sodium, sugar, and fat content of complementary infant and toddler foods sold in the United States, 2015

Background: As part of a healthy diet, limiting intakes of excess sodium, added sugars, saturated fat, and trans fat has been recommended. The American Heart Association recommends that children aged <2 y should avoid added sugars.Objective: We sought to determine commercial complementary infant-toddler food categories that were of potential concern because of the sodium, added sugar, saturated fat, or trans fat content.Design: Nutrition label information (e.g., serving size, sodium, saturated fat, trans fat) for 1032 infant and toddler foods was collected from manufacturers' websites and stores from May to July 2015 for 24 brands, which accounted for >95% of infant-toddler food sales. The presence of added sugars was determined from the ingredient list. Reference amount customarily consumed (RACC) categories were used to group foods and standardize serving sizes. A high sodium content was evaluated on the basis of the Upper Intake Level for children aged 1-3 y and the number of potential servings per day ([i.e., 1500 mg/7 servings (>210 mg/RACC)], a sodium amount >200 mg/100 g, or a mean sodium density >1000 mg/1000 kcal.Results: In 2015, most commercial infant-only vegetables, fruit, dinners, and cereals were low in sodium, contained no saturated fat, and did not contain added sugars. On average, toddler meals contained 2233 mg Na/1000 kcal, and 84% of the meals had >210 mg Na/RACC (170 g), whereas 69% of infant-toddler savory snacks had >200 mg Na/100 g. More than 70% of toddler meals, cereal bars and breakfast pastries, and infant-toddler grain- or dairy-based desserts contained ≥1 sources of added sugar. Approximately 70% of toddler meals contained saturated fat (mean: 1.9 g/RACC), and no commercial infant-toddler foods contained trans fats.Conclusion: Most commercial toddler meals, cereal bars and breakfast pastries, and infant-toddler snacks and desserts have high sodium contents or contain added sugars, suggesting a need for continued public health efforts to support parents in choosing complementary foods for their infants and toddlers.

Nutritional aspects of commercially prepared infant foods in developed countries: a narrative review

Nutritional intake during infancy is a critical aspect of child development and health that is of significant public health concern. Although there is extensive research on breast-feeding and timing of solid food introduction, there is less evidence on types of solid foods fed to infants, specifically commercially prepared infant foods. The consumption of commercially prepared infant foods is very prevalent in many developed countries, exceeding the consumption of homemade foods in some situations. Although these food products may have practical advantages, there are concerns about their nutritional composition, sweet taste, bioavailability of micronutrients, diversity of ingredients and long-term health effects. The extent that the manufacturing, fortification and promotion of these products are regulated by legislation varies between countries and regions. The aim of the present narrative review is to investigate, appraise and summarise these aspects. Overall there are very few studies directly comparing homemade and commercial infant foods and a lack of longitudinal studies to draw firm conclusions on whether commercial infant foods are mostly beneficial or unfavourable to infant health.

US consumer attitudes toward sodium in baby and toddler foods

Dietary data from a nationally representative survey indicate about 80% of US toddlers aged 1-3 years consume too much dietary sodium, which can influence their preference for salty foods in later life. Information on consumer attitudes can inform strategies to reduce sodium in baby and toddler foods. Data were obtained from a 2012 online survey sent to a sample of 11636 US adults aged ≥18 years enrolled in a national probability-based consumer panel; 6378 completed the survey and had non-missing responses to the question of interest, "It is important for baby and toddler foods to be low in sodium." Prevalence of agreement was estimated. Logistic regression was used to describe associations of respondent characteristics with agreement. The majority of respondents were non-Hispanic white and had a household income ≥$60,000. About 7 in 10 (68%, 95% CI: 66%-70%) respondents agreed it is important for baby or toddler foods to be low in sodium. More than 6 of 10 respondents in most subgroups agreed. Among parents with a child currently aged <2 years (N = 390), 82% agreed (95% CI: 77%-87%); the highest agreement included parents who thought sodium was very harmful to their own health (92%, 95% CI: 85%-99%) or who were watching/reducing their own sodium intake (95%, 95% CI: 90%-100%). After adjusting for sex, age, race-ethnicity, agreement was most strongly associated with being a parent of a child <2 years, thinking sodium was harmful, and watching/reducing sodium intake (adjusted odds ratios ≥ 2.5, 95% CI's ≠1.0). The majority of respondents including most parents agreed it is important for baby and toddler foods to be low in sodium, suggesting wide consumer support for strategies to lower sodium in these foods.

Saturated and trans-fatty acids in UK takeaway food

The aim of the study was to analyze the saturated fatty acid (SFA) and trans-fatty acid (TFA) contents of popular takeaway foods in the UK (including English, pizza, Chinese, Indian and kebab cuisine). Samples of meals were analyzed by an accredited public analyst laboratory for SFA and TFA. The meals were highly variable for SFA and TFA. English and Pizza meals had the highest median amount of SFA with 35.7 g/meal; Kebab meals were high in TFA with up to 5.2 g/meal. When compared to UK dietary reference values, some meals exceeded SFA and TFA recommendations from just one meal. Takeaway food would be an obvious target to reduce SFA and TFA contents and increase the potential of meeting UK recommendations. Strategies such as reformulation and smaller takeaway portion sizes warrant investigation.

Got Milk? Breastfeeding and Milk Analysis of a Mother on Chronic Hemodialysis

PURPOSE

Women on dialysis rarely become pregnant. However, the overall rate of successful pregnancies is increasing in this patient population and breastfeeding becomes an option for mothers on dialysis. In this study we performed a systematic breast milk composition analysis of a mother on chronic hemodialysis (HD).

METHODS

Specimens of breast milk and blood were collected in regular intervals before and after HD from a 39-year old woman starting on day 10 postpartum. Samples were analyzed for electrolytes, retention solutes, nutrients and other laboratory measurements. Breast milk samples from low-risk mothers matched for postpartum age were used as controls.

RESULTS

Significantly higher levels of creatinine and urea were found in pre-HD breast milk when compared to post-HD. A similar post-dialytic decrease was only found for uric acid but not for any other investigated parameter. Conversely, sodium and chloride were significantly increased in post-HD samples. Compared to controls creatinine and urea were significantly higher in pre-HD samples while the difference remained only significant for post-HD creatinine. Phosphate was significantly lower in pre- and post-HD breast milk when compared to controls, whereas calcium showed no significant differences. In terms of nutrient components glucose levels showed a strong trend for a decrease, whereas protein, triglycerides and cholesterol did not differ. Similarly, no significant differences were found in iron, potassium and magnesium content.

CONCLUSION

To the best of our knowledge this is the first report on a breastfeeding mother on chronic dialysis. Although we found differences in creatinine, urea, sodium, chloride and phosphate, our general analysis showed high similarity of our patient's breast milk to samples from low-risk control mothers. Significant variations in breast milk composition between pre- and post-HD samples suggest that breastfeeding might be preferably performed after dialysis treatment. In summary, our findings indicate that breastfeeding can be considered a viable option for newborns of mothers on dialysis.

Food Sources of Total Energy and Nutrients among U.S. Infants and Toddlers: National Health and Nutrition Examination Survey 2005-2012

Understanding the dietary intakes of infants and toddlers is important because early life nutrition influences future health outcomes. The aim of this study was to determine the dietary sources of total energy and 16 nutrients in a nationally representative sample of U.S. infants and toddlers aged 0-24 months. Data from the 2005-2012 National Health and Nutrition Examination Survey were analyzed. Dietary intake was assessed in 2740 subjects using one 24-h dietary recall. The population proportion was used to determine the contribution of foods and beverages to nutrient intakes. Overall infant formulas and baby foods were the leading sources of total energy and nutrients in infants aged 0-11.9 months. In toddlers, the diversity of food groups contributing to nutrient intakes was much greater. Important sources of total energy included milk, 100% juice and grain based mixed dishes. A number of foods of low nutritional quality also contributed to energy intakes including sweet bakery products, sugar-sweetened beverages and savory snacks. Overall non-flavored milks and ready-to-eat cereals were the most important contributors to micronutrient intakes. In conclusion this information can be used to guide parents regarding appropriate food selection as well as inform targeted dietary strategies within public health initiatives to improve the diets of infants and toddlers.