Usual nutrient intakes of U.S. infants and toddlers generally meet or exceed Dietary Reference Intakes: Findings from NHANES 2009-2012

Authors: AHLUWALIA, NAMANJEET - Centers For Disease Control And Prevention (CDC) - United States; HERRICK, KIRSTEN - Centers For Disease Control And Prevention (CDC) - United States; ROSSEN, LAUREN - Centers For Disease Control And Prevention (CDC) - United States; Rhodes, Donna; KIT, BRIAN - Centers For Disease Control And Prevention (CDC) - United States; Moshfegh, Alanna; DODD, KEVIN - National Cancer Institute (NCI, NIH)

Submitted to: The American Journal of Clinical Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/10/2016
Publication Date: 10/1/2016
Citation: Ahluwalia, N., Herrick, K.A., Rossen, L.M., Rhodes, D.G., Kit, B., Moshfegh, A.J., Dodd, K.W. 2016. Usual nutrient intakes of U.S. infants and toddlers generally meet or exceed Dietary Reference Intakes: Findings from NHANES 2009-2012. American Journal of Clinical Nutrition. 104(4):1167-1174. https://doi.org/10.3945/ajcn.116.137752.
DOI: https://doi.org/10.3945/ajcn.116.137752

Interpretive Summary: The first 2 years of life are critical in human development, and nutrition practices during this developmental period can influence short- and long-term health. This period is marked by high nutrient needs, and includes critical dietary changes involving complementary feeding around 4-6 months of age and transition to family foods in the first year of life, as well as the development of food preferences that affect food choices and intake long-term. Recognizing these and the need for specific dietary guidance for children under 2 years of age, the recent Agricultural Act of 2014 mandated that the birth to 24 month age group be included in the Federal 2020 Dietary Guidelines for Americans and there onwards. The dietary (food and nutrient) intakes of U.S. infants and toddlers are less well-characterized compared with older children and adults. This study shows that for the most part usual nutrient intakes were adequate for a majority of U.S. infants and toddlers compared to the recommendations with a few exceptions. An important proportion of infants (10%) were estimated to have inadequate iron intake. For at least 25% of toddlers, the macronutrient composition of their diets provided less than the recommended energy from fat, and for at least 7 of 10 toddlers estimated intakes of vitamins D and E were inadequate. A large proportion of children 6-23 months of age had excessive intakes of vitamin A and zinc, and an estimated 50% toddlers consumed too much sodium. The dietary sources associated with inadequate or excessive intakes may need further examination.

Technical Abstract: To our knowledge, few studies have described the usual nutrient intakes of U.S. children aged <2 y or assessed the nutrient adequacy of their diets relative to the recommended Dietary Reference Intakes (DRIs). We estimated the usual nutrient intake of U.S. children aged 6-23 months examined in NHANES 2009-2012 and compared them to age-specific DRIs as applicable. Dietary intake was assessed with two 24-h recalls for infants aged 6-11 months (n = 381) and toddlers aged 12-23 months (n = 516) with the use of the USDA's Automated Multiple-Pass Method. Estimates of usual nutrient intakes from food and beverages were obtained with the use of the National Cancer Institute method. The proportions of children with intakes below and above the DRI were also estimated. The estimated usual intakes of infants were adequate for most nutrients; however, 10% had an iron intake below the Estimated Average Requirement (EAR), and only 21% had a vitamin D intake that met or exceeded the recommended Adequate Intake (AI). More nutrient inadequacies were noted among toddlers; 1 in 4 had a lower-than-recommended fat intake (percentage of energy), and most had intakes that were below the EAR for vitamins E (82%) and D (74%). Few toddlers (<1%) met or exceeded the AI for fiber and potassium. In contrast, 1 in 2 had sodium intakes that exceeded the Tolerable Upper Intake Level (UL); >=16% and 41% of the children had excessive intakes (greater than the ULs) of vitamin A and zinc, respectively. The estimated usual intakes of infants were adequate for most nutrients. Most toddlers were at risk for inadequate intakes of vitamins D and E and had diets low in fiber and potassium. The sources contributing to excessive intakes of vitamin A and zinc among infants and toddlers may need further evaluation.