The 2016 Feeding Infants and Toddlers Study: Dietary Intakes and Practices of Children in the United States from Birth to 48 Months

Regan Bailey, Shinyoung Jun, and Alison L. Eldridge

The Feeding Infants and Toddlers Study (FITS) is a periodic national cross-sectional survey to examine the diets and feeding practices of US infants and children, with ages categorized to represent important transition times in the diet: younger infants (birth to 5.9 months), older infants (6–11.9 months), toddlers (12–23.9 months), younger preschoolers (24–36.9 months), and older preschoolers (36–47.9 months). FITS 2016 collected dietary data using a 24-h dietary recall (n = 3,235), with a replicate in a representative subsample (n = 799) [1, 2]. Energy, nutrient intakes, and compliance with dietary reference intakes were estimated using the National Cancer Institute method. Infant feeding practices and food group consumption were also assessed by participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) that provides food packages to US children <5 years.

Infant Feeding Practices (Birth to 12 Months). Initiation and duration of breastfeeding were higher in 2016 compared to previous FITS surveys but remained below public health recommendations. Exclusive breastfeeding varied by race/ethnicity with non-Hispanic White (40%) and Hispanic (36%) (birth to 3.9 months) having significantly higher rates than non-Hispanic Black infants (20%). Transition to complementary foods tended to occur earlier in formula-fed than breastfed infants. 

Energy and Nutrients
. Energy intakes and dietary diversity increased with age; however, vitamins D and E were low in all age groups. Nutrient intakes of the younger infants were largely adequate except for iron among older infants, with 18% of those 6–11.9 months below the estimated average requirement. After 12 months, few exceed the adequate intake for fiber and potassium: 3 and 3% among toddlers; 9 and 6% among younger preschoolers; and 8 and 4% among older preschoolers, respectively. Concerns exist about excessive intakes of retinol and zinc with estimates ranging from 32 to 49% for retinol and from 41 to 69% for zinc above the upper intake level. Among preschoolers, more than 70% exceeded the upper intake level for sodium and >60% exceeded the saturated fat recommendations. 

Foods and Beverages. These nutrient imbalances noted in FITS 2016 are likely the result from lower-than-recommended intakes of vegetables and whole grain foods and higher-than-recommended intakes of sugar-sweetened beverages and savory snacks. Iron-rich infant cereal was consumed by about one-half of those 4–12 months old. Close to 20% of toddlers and preschoolers did not consume cow’s milk, an excellent source of vitamin D and calcium, while all in this age group consumed grains; 40% did not consume whole grains. Fruit consumption was adequate across all groups, but vegetable intakes were lower and comprised primarily fried potatoes. After 12 months, all children exceeded energy recommendations from added sugars, primarily coming from sweet bakery foods, sugar-sweetened beverages, and candy. High sodium intakes were associated with processed meats and savory snacks. 

Women, Infants, and Children. WIC reaches 51% of US infants and about 30% of children 1–5 years. WIC eligibility is based on income; foods provided are tailored to meet age-specific nutrient needs. WIC infants were less likely to be breastfed than higher-income children; however, mean micronutrient intakes were higher for WIC infants possibly due to consumption of fortified infant formula. WIC preschoolers had a lower risk of inadequate vitamin D than income-eligible nonparticipants. High intakes of sodium, added sugars, and sweetened beverages were especially of concern among WIC participants [3]. 

Conclusion. The dietary intakes of US infants (<12 months) were nutritionally adequate, with exceptions noted for iron (6–11.9 months). However, starting at 12 months, we observed higher-than-recommended intakes of sodium, added sugars, saturated fat, retinol, and zinc combined with low intakes of potassium, fiber, vitamin D, and vitamin E. Shifting dietary patterns to enhance whole grains, fruit, vegetables, and low-fat dairy while limiting processed meats, sources of added sugars, and savory snacks would help align nutrient intakes with guidelines.

References

  1. Anater AS, Catellier DJ, Levine BA, et al: The Feeding Infants and Toddlers Study (FITS) 2016: study design and methods. J Nutr 2018;148:1516S–1524S.
  2. Bailey RL, Catellier DJ, Jun S, et al: Total usual nutrient intakes of US children (under 48 months): findings from the Feeding Infants and Toddlers Study (FITS) 2016. J Nutr 2018;148:1557S–1566S.
  3. Jun S, Catellier DJ, Eldridge AL, et al: Usual nutrient intakes from the diets of US children by WIC participation and income: findings from the Feeding Infants and Toddlers Study (FITS) 2016. J Nutr 2018;148:1567S–1574S.