Development of an estimated food record for 9-36-month-old toddlers

Empirically derived portion sizes from the DOrtmund Nutritional and Anthropometric Longitudinally Designed (DONALD) study for 4- to 18-year-old children and adolescents to simplify analysis of dietary data using FFQ

OBJECTIVE

To apply FFQ, knowledge about portion sizes is relevant. According to increased energy and nutrient requirements, average portion sizes of foods are supposed to increase during growth. We provide empirically derived portion sizes for 4- to 18-year-olds in different age groups to facilitate analyses of FFQ data in children and adolescents.

DESIGN

Using data from the dynamic DOrtmund Nutritional and Anthropometric Longitudinally Designed cohort study, quantile regression for smoothing percentiles was used to derive portion sizes as a function of age from which age- and food group-specific portion sizes were calculated as median food group intake (g).

SETTING

Dortmund, Germany.

PARTICIPANTS

Data from 3-day weighed dietary records (WDR) of 1,325 participants (♀: 653) were analysed. Participants provided in total 9,828 WDR (on average 7·5 per participant) between 1985 and 2022. WDR were grouped into five age groups, whereby each age group covered 3 years of age.

RESULTS

In total, 11 955 food items were reported and categorised into sixteen major food groups with seventy-one sub-groups. Portion sizes tended to increase with age, except for milk- and plant-based alternatives. Comparing 4- to 6-year-olds to 16- to 18-year-olds, portion size increased between 22·2 % (processed meat: 18 g v. 22 g) and 173·3 % (savoury snacks: 15 g v. 41 g).

CONCLUSION

We provide empirically derived portion sizes for children and adolescents. These data are useful to establish dietary assessment methods based on estimates of portion sizes, such as FFQ, for children and adolescents.

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0-24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

(1) Background: Breastmilk provides all the nutrition an infant requires between 0−6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6− 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6−11.9 months. Low iron intake was also observed in one quarter of toddlers 12−24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6−11.9 months and toddlers 12−24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension.

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Study Design, Methods and Sample Description

(1) Background: Caregiver feeding practices during the first two years of a child's life influence nutrition, growth, and development, as well as long term taste preferences and dietary patterns. Suboptimal feeding practices lead to poorer health outcomes, such as obesity, that persist into adulthood. Although the importance of early life nutrition is well-established, there are no Australia-wide surveys of dietary intakes of children under two years of age. The 2021 Australian Feeding Infants and Toddlers Study (OzFITS) aims to fill this gap. This paper describes the methods and study sample of OzFITS 2021. (2) Methods: OzFITS 2021 is a cross-sectional study of children aged 0 to 23.9 months of age and their caregiver across Australia. Data were collected between April 2020 and April 2021. A telephone-based survey was completed with a caregiver to obtain information on child and caregiver characteristics and feeding practices. For exclusively breastfed infants, the number of breastfeeds in a 24 h period was reported. Dietary intakes for mixed fed children were estimated using a one-day food record, with 30% of caregivers completing a second food record on a non-consecutive day. (3) Results: We enrolled 1140 caregiver and child dyads. Of those eligible to complete a food record, 853 (87%) completed the food record. Compared to the Australian population, caregivers were more likely to be university-educated (>75%), married or in a de facto relationship (94%), and have a household income >$100,000/y (60%). (4) Conclusions: OzFITS 2021 is the first national study to examine food and nutrient intake in Australian children aged under 2 years. The study will provide information on breastfeeding rates and duration, use of breast milk substitutes, and timing of solid food introduction. Dietary intake data will allow the comparison of core food groups and discretionary food intake to Australian guidelines and estimate the prevalence of inadequate intake of key nutrients, like iron. Healthcare practitioners and policymakers can use the study findings as a source of evidence to inform the next iteration of infant feeding guidelines.