USA Case Study

The U.S. 2020-2025 Dietary Guidelines for Americans will expand to include recommendations for infants and toddlers (birth to 24 months, i.e. B-24) for the first time. Given the very specific nutritional needs of the B-24 age group to support rapid growth and development, understanding current trends in dietary intakes is critical to inform such policy and best tailor dietary advice for infants and children.

The Feeding Infants and Toddlers Study (FITS), a periodic national cross-sectional survey to collect extensive data on infants and young children that included breastfed infants and intake from dietary supplements, filling gaps in federally-funded nutrition surveys. FITS was conducted in 2002, 2008, and 2016. FITS 2016 collected dietary data on children <48 mo (n=3,235): younger infants (birth to 5.9 mo), older infants (6-11.9 mo), toddlers (12-23.9 mo), younger preschoolers (24-36.9 mo), and older preschoolers (36-47.9 mo) using a 24-h dietary recall.

A second 24-h recall was collected from a representative subsample (n=799). Energy, total nutrient intake distributions, and compliance with Dietary Reference Intakes were estimated using the National Cancer Institute method. Infant feeding practices and food group consumption was assessed by age group and by participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program.  

Initiation and duration of breastfeeding were higher in 2016 compared to previous FITS surveys.  Nutrient intakes of infants were largely adequate, except for vitamins D and E and iron. About 1 in 5 older infants did not meet the iron recommendations; however, WIC participants more likely to meet iron recommendations, potentially due to higher use of infant formula. More nutrient inadequacies were noted among toddlers and preschoolers including low intakes of vitamin D, fiber, and potassium.

High intakes of sodium and added sugars were of concern in all children >12 months, especially among WIC participants. These nutrient imbalances result from lower than recommended intakes of vegetables and whole grain foods, and higher than recommended intakes of sugar-sweetened beverages and savory snacks.

The dietary intakes of US infants are nutritionally adequate, except iron. However, starting at 12 months when infants transition to family foods, we observed high than recommended intakes of sodium and added sugars, combined with low intakes of potassium, fiber, vitamins D and E.