Infant and Toddler Populations Studies - NCS Dietary Assessment Literature Review

See Infants and Toddlers tables

Table 3.3 presents summary data from several epidemiologic surveys collecting food and supplement intake data from infant and/or toddler populations. More information on the specific surveys is included in Table 3.4. The two most recent US nutrition monitoring surveys, the 1999-2000 National Health and Nutrition Examination Survey (NHANES) and the 1994-96 Continuing Survey of Food Intake of Individuals (CSFII), each included 24HR (24-Hour Recall) interviews to assess food and beverage intake. Information on the milk intake of breastfed infant was limited to the time each breastfeeding began. Standardized probes solicited detail on type of formula, preparation method, and amount consumed as well as amount and type of complementary food consumed by the infant or toddler. Interviews were conducted with the child's parent or a parent-designated proxy. If intake of food or amount was not known, data retrieval was conducted with the caretaker or day care center. Table 2.5 presents the diet-related questions in each of these surveys as well as in the integrated What We Eat in America-NHANES survey, which is currently in the field. The rationale for selecting the instrument for the integrated survey as well as the history of past CSFII and NHANES surveys was recently reviewed (9). The integrated What We Eat in America-NHANES includes two 24HR interviews, one in-person and one by telephone for children under 2 years. Supplement use is queried in a separate questionnaire on frequency, dosage, and duration of use of specific products.

The 1994 (106) and 2003 (107) surveys of US infants sponsored by Gerber Products Company also used a cross-sectional approach, but differed in dietary assessment method. The earlier survey collected 4-day estimated FR (Food Record) from 1,658 mothers of infants and toddlers, while the recent Feeding Infants and Toddler Study collected a telephone-administered, 24HR interview with the mothers of 2,025 children and a second 24HR in a 23 percent sub-sample.

Most of the other large studies used a longitudinal approach to dietary assessment during the first 12 months of life, with many continuing data collection through 2 years or longer. Three large European studies collected weighed or estimated food records at various time intervals (109;112;113;116;117;124). The most rigorous are the German DONALD study which collected 3-day weighed FRs at 3, 6, 9, and 12 months and then annually (124;125), and the Adelaide Nutrition Study (117) in South Australia, in which parents completed 7-day weighed FRs four times between 3 and 24 months. A number of studies paired other assessment measures with infant feeding practices questionnaires that parents completed periodically and returned by mail. For example, the Bogalusa Newborn-Infant Cohort Study (118) mailed monthly infant feeding practices questionnaires with food checklists to parents for the first four months and then had interviewers administer a questionnaire at 6 and 12 months. This was paired with a 24HR recall interview in a subset of participants at 6 and 12 months and then annually.

Maternal test weighing of breastfed infants and 24-hour breast milk sample collection was successful in a longitudinal study of 73 breastfed and 43 formula-fed infants from middle- and upper-income households participating in The DARLING Study (119), conducted by the University of California at Davis. This cohort was followed longitudinally 18 months. Carruth and colleagues (120) have been successful in following a cohort of infants from middle and upper socioeconomic status households for the completion of ten 4HR and usual intake interviews in the home over a 22 month period.

As is evident from the Table 3.3 and Table 3.4, most literature reviewed did not discuss supplement intake assessment methods.