Development of food pattern recommendations for infants and toddlers 6–24 months of age to support the Dietary Guidelines for Americans, 2020–2025

Authors: DEWEY, KATHRYN - University Of California, Davis; PANNUCCI, TUSAREBECCA - Center For Nutrition Policy & Promotion (CNPP); KELLIE, CASAVALE - Us Food & Drug Administration (FDA); DAVIS, TERESA - Children'S Nutrition Research Center (CNRC); DONOVAN, SHARON - University Of Illinois; KLEINMAN, RONALD - Massachusetts General Hospital; TAVERAS, ELSIE - Massachusetts General Hospital; BAILEY, REGAN - Purdue University; NOVOTNY, RACHEL - University Of Hawaii; SCHNEEMAN, BARBARA - University Of California, Davis; STANG, JAMIE - University Of Minnesota; DE JESUS, JANET - US Department Of Health And Human Services (HHS); STOODY, EVE - Center For Nutrition Policy & Promotion (CNPP)

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/28/2022
Publication Date: 6/30/2021
Citation: Dewey, K.G., Pannucci, T., Kellie, C.O., Davis, T.A., Donovan, S.M., Kleinman, R.E., Taveras, E.M., Bailey, R.L., Novotny, R., Schneeman, B.O., Stang, J., De Jesus, J., Stoody, E.E. 2021. Development of food pattern recommendations for infants and toddlers 6–24 months of age to support the Dietary Guidelines for Americans, 2020–2025. Journal of Nutrition. 151(10):3113-3124. https://doi.org/10.1093/jn/nxab201.
DOI: https://doi.org/10.1093/jn/nxab201

Interpretive Summary: The Dietary Guidelines for Americans provides a set of evidence-based nutrition recommendations for policymakers, educators, industry leaders, and the public. For the first time, the 2020 Dietary Guidelines Advisory Committee (DGAC) reviewed the scientific evidence for associations of dietary intake to healthy outcomes for infants and toddlers, ages 6-24 months, to enable inclusion of food-based dietary guidelines for this age group in the 2020-2025 Dietary Guidelines for Americans. The DGAC, a group of non-federal scientific experts in health and nutrition, conducted food pattern modeling to identify a pattern for infants and toddlers by 1) identifying energy intake targets, 2) establishing nutritional goals, 3) identifying food groupings and expected amounts, 4) estimating expected nutrient intakes for each scenario using nutrient-dense representative foods, and 5) evaluating the expected nutrient intake against nutritional goals. The committee found that if iron-fortified cereals were included in patterns for human-milk-fed and formula-fed infants ages 6 to 12 months, the combination of complementary foods and beverages was close to meeting almost all nutrient recommendations. The committee also created two patterns for toddlers fed no human milk, the Healthy US-Style Pattern and the Healthy Vegetarian Pattern (a lacto-ovo vegetarian pattern). The results of the food pattern modeling indicated that there is no energy remaining for added sugars in the diet of children ages 6-24 months. The committee recommended future work to further this area of research by establishing a reference human milk composition profile, updating and strengthen the dietary reference intake values for this age group, and using optimization modeling, along with the food pattern modeling, to identify combinations of foods that meet all nutritional goals.

Technical Abstract: Developing food-based dietary guidelines (FBDGs) for infants and toddlers is a complex task that few countries have attempted. Our objectives are to describe the process of food pattern modeling (FPM) conducted to develop FBDGs for the Dietary Guidelines for Americans, 2020–2025 for infants 6 to <12 mo and toddlers 12 to <24 mo of age, as well as the implications of the results and areas needing further work. The US 2020 Dietary Guidelines Advisory Committee, with the support of federal staff, conducted FPM analyses using 5 steps: 1) identified energy intake targets; 2) established nutritional goals; 3) identified food groupings and expected amounts, using 3 options for the amount of energy from human milk in each age interval; 4) estimated expected nutrient intakes for each scenario, based on nutrient-dense representative foods; and 5) evaluated expected nutrient intakes against nutritional goals. For human milk–fed infants (and toddlers), example combinations of complementary foods and beverages were developed that come close to meeting almost all nutrient recommendations if iron-fortified infant cereals are included at 6 to <12 mo of age. These combinations would also be suitable for formula-fed infants. For toddlers not fed human milk, 2 patterns were developed: the Healthy US-Style Pattern and the Healthy Vegetarian Pattern (a lacto-ovo vegetarian pattern). Achieving nutrient recommendations left virtually no remaining energy for added sugars. It is challenging to meet all nutrient needs during these age intervals. Added sugars should be avoided for infants and toddlers <2 y of age. Further work is needed to 1) establish a reference human milk composition profile, 2) update and strengthen the DRI values for these age groups, and 3) use optimization modeling, in combination with FPM, to identify combinations of foods that meet all nutritional goals.