Dietary and complementary feeding practices of U.S. infants, 6-12 months: A narrative review of the Federal nutrition monitoring data

Authors: BAILEY, REGAN - Purdue University; STANG, JAIME - University Of Minnesota; DAVIS, TERESA - Children'S Nutrition Research Center (CNRC); NAIMI, TIMOTHY - Food And Nutrition Service, USDA; SCHNEEMAN, BARBARA - University Of California, Davis; DEWEY, KATHRYN - University Of California, Davis; DONOVAN, SHARON - University Of Illinois; NOVOTNY, RACHEL - University Of Hawaii; KLEINMAN, RONALD - Harvard Medical School; TAVERAS, ELSIE - Harvard Medical School; BAZZANO, LYDIA - Tulane University; SNETSELAAR, LINDA - University Of Iowa; DE JESUS, JANET - US Department Of Health And Human Services (HHS); CASAVALE, KELLIE - Food And Drug Administration(FDA); STOODY, EVE - Center For Nutrition Policy & Promotion (CNPP); Goldman, Joseph; Moshfegh, Alanna; Rhodes, Donna; HERRICK, KIRSTEN - National Cancer Institute (NCI, NIH); KOEGEL, KRISTEN - Center For Nutrition Policy & Promotion (CNPP); PERRINE, CRIA - Centers For Disease Control And Prevention (CDC) - United States; PANNUCCI, TUSA REBECCA - Center For Nutrition Policy & Promotion (CNPP)

Submitted to: Journal of the Academy of Nutrition and Dietetics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 10/13/2021
Publication Date: 10/21/2021
Citation: Bailey, R.L., Stang, J.S., Davis, T., Naimi, T.S., Schneeman, B.O., Dewey, K.G., Donovan, S.M., Novotny, R., Kleinman, R.E., Taveras, E.M., Bazzano, L., Snetselaar, L.G., De Jesus, J., Casavale, K.O., Stoody, E.E., Goldman, J.D., Moshfegh, A.J., Rhodes, D.G., Herrick, K., Koegel, K., Perrine, C., Pannucci, T. 2021. Dietary and complementary feeding practices of U.S. infants, 6-12 months: A narrative review of the Federal nutrition monitoring data. Journal of the Academy of Nutrition and Dietetics. https://doi.org/10.1016/j.jand.2021.10.017.
DOI: https://doi.org/10.1016/j.jand.2021.10.017

Interpretive Summary: Nutritional exposures and feeding practices in infancy have been related to risk of overweight and obesity and associated cardiometabolic conditions in childhood and subsequently later in life. For the first time, the 2020 Dietary Guidelines Advisory Committee extensively reviewed data on dietary intakes of 6-12 month-old infants from What We Eat In America, NHANES 2007-2016 on the diet and introduction of complementary foods of infants in order to further inform the development of the Dietary Guidelines for Americans for infants and toddlers. This manuscript summarizes diet and feeding practices of 6-12 month-old infants, and describes how these compare with recommendations of the American Academy of Pediatrics and other relevant organizations. Considerable differences were found between human milk fed and formula/human milk fed infants, with formula/human milk fed infants more likely to be exposed to complementary foods/beverages at earlier-than-recommended ages, more likely to consume fruit juice and saturated fats by 1 year of age, and to consume substantially more total calories compared with human milk fed infants. Because food preferences and patterns are beginning to form during this developmental stage, it is important that healthcare practitioners encourage consumption of nutrient-rich foods and avoid consumption of energy-dense but nutrient-poor complementary foods and beverages.

Technical Abstract: Complementary foods and beverages (CFB) are key components of an infant’s diet in the second 6 months of life. This manuscript summarizes diet and feeding practices of 6-12 month-old U.S. infants, and describes how these compare with recommendations of the American Academy of Pediatrics and other relevant organizations. Breastfeeding initiation is high (84%), but the prevalence of exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). The primary mode of feeding (i.e., human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFB is associated with the timing of introduction and types of CFB reported. FMF infants (41%) are more likely to be introduced to CFB before 4 months when compared to HMF infants (18.5%). After 6 months, FMF infants are also more likely to be consuming grains (91% vs. 81%), protein foods (50% vs. 33%), fruit (86% vs. 75%), and solid fat (62% vs. 49%) than HMF infants. These patterns of dietary intake result in differences in nutrient intakes. Compared to HMF, FMF consumed more total energy (845 vs. 631 kcal), energy from CFB (345 vs. 204 kcal), total protein (22 vs. 12 g) and protein from CFB (11 vs. 6 g). In addition, HMF infants have a high prevalence of inadequacy of iron intake (77%). Healthcare practitioners should consider tailoring their advice to caregivers on CFB feeding, taking into account the primary mode of milk feeding during this life stage to support infants’ nutrient adequacy.