The latest exhaustive survey of dietary patterns in infants from the Feeding Infants and Toddlers Study (FITS) in North America documents and quantifies current trends in infant feeding. These include higher than generally recommended energy, protein, and saturated fat intakes. The majority of infants are bottle fed at some point in their first year of life, and their weaning diet often includes low intakes of fruits and vegetables, with high starchy, rather than green or yellow, vegetables. Early introduction of solids, use of cow's milk prior to 1 year of age, and high juice intake in the first 2 years - all less desirable diet practices - are improving, but are still prevalent. More preschoolers are likely to get sweets or sweetened beverages than a serving of fruit or a vegetable on a given day. These food intake patterns mimic the adult American diet and are associated with an increased risk of obesity in childhood and later life. But more importantly, these patterns appear to be set as early as 18 months of age, and by 20 months of age, they mimic the adult diet. Despite increase in total energy intake, and greater variety of foods, the basic characteristics of macronutrient intake distribution and food group contribution of energy to the diet before 2 years of age remain remarkably stable and similar to the family table. Obesity prevention needs to include specific targets in terms of breastfeeding and adequate formula feeding, as well as appropriate introduction of weaning foods with goals of changing the inadequate patterns documented in the FITS. These interventions will also require addressing parent and caregiver behaviors, including attending to hunger satiety cues (responsive feeding), and shaping early food preferences. This needs to be done starting at birth, in the first months of life. Early intervention offers a unique and potentially efficacious opportunity to shape the future dietary patterns of the next generation.

Keywords:
Infant, Diet, Dietary intake, Overweight, Obesity, Breastfeeding
1.
International Obesity Task Force: Global childhood overweight. http://www.oecd.org/ (accessed February 15, 2013).
2.
Hammond RA, Levine R: The economic impact of obesity in the United States. Diabetes Metab Syndr Obes 2010;3:285-295.
3.
Ogden CL, Carroll MD, Kit BK, Flegal KM: Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012;307:483-490.
4.
Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM: Prevalence of high body mass index in US children and adolescents, 2007-2008. JAMA 2010;303:242-249.
5.
Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH: Predicting obesity in young adulthood from childhood and parental obesity. N Engl J Med 1997;337:869-873.
6.
Winter JD, Langenberg P, Krugman SD: Newborn adiposity by body mass index predicts childhood overweight. Clin Pediatr (Phila) 2010;49:866-870.
7.
Moss BG, Yeaton WH: US children's preschool weight status trajectories: patterns from 9-month, 2-year, and 4-year Early Childhood Longitudinal Study-birth cohort data. Am J Health Promot 2012;26:172-175.
8.
Stettler N, Iotova V: Early growth patterns and long-term obesity risk. Curr Opin Clin Nutr Metab Care 2010;13:294-299.
9.
Taveras EM, Rifas-Shiman SL, Belfort MB, Kleinman KP, Oken E, Gillman MW: Weight status in the first 6 months of life and obesity at 3 years of age. Pediatrics 2009;123:1177-1183.
10.
Dattilo AM, Birch L, Krebs NF, Lake A, Taveras EM, Saavedra J: Need for early interventions in the prevention of pediatric overweight: a review and upcoming directions. J Obes 2012;2012:1-18.
11.
Briefel RR, Kalb LM, Condon E, et al: The Feeding Infants and Toddlers Study 2008: study design and methods. J Am Diet Assoc 2010;110:S16-S26.
12.
Devaney B, Kalb L, Briefel R, Zavitsky-Novak T, Clusen N, Ziegler P: Feeding Infants and Toddlers Study: overview of the study design. J Am Diet Assoc 2004;104:s8-s13.
13.
Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, et al: CDC growth charts: United States. Adv Data 2000;1-27.
14.
Butte NF, Fox MK, Briefel RR, et al: Nutrient intakes of US infants, toddlers, and preschoolers meet or exceed dietary reference intakes. J Am Diet Assoc 2010;110:S27-S37.
15.
Alexy U, Kersting M, Sichert-Hellert W, Manz F, Schoch G: Macronutrient intake of 3- to 36-month-old German infants and children: results of the DONALD Study. Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Ann Nutr Metab 1999;43:14-22.
16.
Axelsson I: Effects of high protein intakes. Nestle Nutr Workshop Ser Pediatr Program 2006;58:121-129.
17.
Grote V, von Kries R, Closa-Monasterolo R, et al: Protein intake and growth in the first 24 months of life. J Pediatr Gastroenterol Nutr 2010;51(suppl 3):S117-S118.
18.
Koletzko B, von Kries R, Closa R, et al: Lower protein in infant formula is associated with lower weight up to age 2 y: a randomized clinical trial. Am J Clin Nutr 2009;89:1836-1845.
19.
Kalhan SC: Optimal protein intake in healthy infants. Am J Clin Nutr 2009;89:1719-1720.
20.
Agostoni C, Scaglioni S, Ghisleni D, Verduci E, Giovannini M, Riva E: How much protein is safe? Int J Obes (Lond) 2005;29(suppl 2):S8-S13.
21.
Rolland-Cachera MF, Deheeger M, Akrout M, Bellisle F: Influence of macronutrients on adiposity development: a follow up study of nutrition and growth from 10 months to 8 years of age. Int J Obes Relat Metab Disord 1995;19:573-578.
22.
Scaglioni S, Agostoni C, Notaris RD, et al: Early macronutrient intake and overweight at five years of age. Int J Obes Relat Metab Disord 2000;24:777-781.
23.
Rolland-Cachera MF, Deheeger M, Bellisle F, Sempe M, Guilloud-Bataille M, Patois E: Adiposity rebound in children: a simple indicator for predicting obesity. Am J Clin Nutr 1984;39:129-135.
24.
Raiha NRC: Protein content of human milk, from colostrum to mature milk; in: Protein Metabolism during Infancy. NNI Workshop Series, vol 33. New York, Raven Press, 1994, pp 87-99.
25.
USDA Agriculture Research Service: National nutrient database for standard reference. http://ndb.nal.usda.gov/index.html (accessed March 5, 2013).
26.
USDA Center for Nutrition and Policy Promotion: Dietary guidelines for America 2010. http://www.cnpp.usda.gov/dietaryguidelines.htm (accessed March 8, 2013).
27.
Arenz S, Ruckerl R, Koletzko B, von Kries R: Breast-feeding and childhood obesity - a systematic review. Int J Obes Relat Metab Disord 2004;28:1247-1256.
28.
Harder T, Bergmann R, Kallischnigg G, Plagemann A: Duration of breastfeeding and risk of overweight: a meta-analysis. Am J Epidemiol 2005;162:397-403.
29.
Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG: Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics 2005;115:1367-1377.
30.
Durmus B, van Rossem L, Duijts L, et al: Breast-feeding and growth in children until the age of 3 years: the Generation R Study. Br J Nutr 2011;105:1704-1711.
31.
Griffiths LJ, Smeeth L, Hawkins SS, Cole TJ, Dezateux C: Effects of infant feeding practice on weight gain from birth to 3 years. Arch Dis Child 2009;94:577-582.
32.
Siega-Riz AM, Deming DM, Reidy KC, Fox MK, Condon E, Briefel RR: Food consumption patterns of infants and toddlers: where are we now? J Am Diet Assoc 2010;110:S38-S51.
33.
US Department of Health and Human Services: HealthyPeople.gov. http://www.healthypeople.gov/2020/default.aspx (accessed February 15, 2012).
34.
Li R, Magadia J, Fein SB, Grummer-Strawn LM: Risk of bottle-feeding for rapid weight gain during the first year of life. Arch Pediatr Adolesc Med 2012;166:431-436.
35.
Taveras EM, Rifas-Shiman SL, Scanlon KS, Grummer-Strawn LM, Sherry B, Gillman MW: To what extent is the protective effect of breastfeeding on future overweight explained by decreased maternal feeding restriction? Pediatrics 2006;118:2341-2348.
36.
Grummer-Strawn LM, Scanlon KS, Fein SB: Infant feeding and feeding transitions during the first year of life. Pediatrics 2008;122(suppl 2):S36-S42.
37.
Hendricks K, Briefel R, Novak T, Ziegler P: Maternal and child characteristics associated with infant and toddler feeding practices. J Am Diet Assoc 2006;106:S135-S148.
38.
Mennella JA, Jagnow CP, Beauchamp GK: Prenatal and postnatal flavor learning by human infants. Pediatrics 2001;107:E88-E93.
39.
Beauchamp GK, Mennella JA: Flavor perception in human infants: development and functional significance. Digestion 2011;83(suppl 1):1-6.
40.
Galloway AT, Lee Y, Birch LL: Predictors and consequences of food neophobia and pickiness in young girls. J Am Diet Assoc 2003;103:692-698.
41.
Sullivan SA, Birch LL: Infant dietary experience and acceptance of solid foods. Pediatrics 1994;93:271-277.
42.
American Academy of Pediatrics: Pediatric Nutrition Handbook. Elk Grove Village, IL, American Academy of Pediatrics, 2009.
43.
Gidding SS, Dennison BA, Birch LL, et al: Dietary recommendations for children and adolescents: a guide for practitioners. Pediatrics 2006;117:544-559.
44.
Fox MK, Condon E, Briefel RR, Reidy KC, Deming DM: Food consumption patterns of young preschoolers: are they starting off on the right path? J Am Diet Assoc 2010;110:S52-S59.
45.
Huh SY, Rifas-Shiman SL, Taveras EM, Oken E, Gillman MW: Timing of solid food introduction and risk of obesity in preschool-aged children. Pediatrics 2011;127:e544-e551.
46.
Schack-Nielsen L, Sorensen TI, Mortensen EL, Michaelsen KF: Late introduction of complementary feeding, rather than duration of breastfeeding, may protect against adult overweight. Am J Clin Nutr 2010;91:619-627.
47.
Butte N, Cobb K, Dwyer J, Graney L, Heird W, Rickard K: The Start Healthy Feeding Guidelines for infants and toddlers. J Am Diet Assoc 2004;104:442-454.
48.
Baker RD, Greer FR: Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010;126:1040-1050.
49.
USDA Agriculture Research Service: Economic research service food availability data system. http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system.aspx (accessed March 5, 2013).
50.
Hendy HM, Williams KE, Camise TS, Eckman N, Hedemann A: The Parent Mealtime Action Scale (PMAS). Development and association with children's diet and weight. Appetite 2009;52:328-339.
51.
Leahy KE, Birch LL, Rolls BJ: Reducing the energy density of multiple meals decreases the energy intake of preschool-age children. Am J Clin Nutr 2008;88:1459-1468.
52.
Fox MK, Pac S, Devaney B, Jankowski L: Feeding Infants and Toddlers Study: what foods are infants and toddlers eating? J Am Diet Assoc 2004;104:s22-s30.
53.
Guenther PM, Dodd KW, Reedy J, Krebs-Smith SM: Most Americans eat much less than recommended amounts of fruits and vegetables. J Am Diet Assoc 2006;106:1371-1379.
54.
Krebs-Smith SM, Guenther PM, Subar AF, Kirkpatrick SI, Dodd KW: Americans do not meet federal dietary recommendations. J Nutr 2010;140:1832-1838.
55.
American Academy of Pediatrics: Bright Futures Nutrition. Elk Grove Village, IL, The American Academy of Pediatrics, 2011.
56.
American Dietetic Association, Evidence Analysis Library: Evidence-based pediatric weight management nutrition practice guideline. http://www.adaevidencelibrary.com (accessed February, 2013).
57.
Barlow SE: Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(suppl 4):S164-S192.
58.
Dwyer JT, Butte NF, Deming DM, Siega-Riz AM, Reidy KC: Feeding Infants and Toddlers Study 2008: progress, continuing concerns, and implications. J Am Diet Assoc 2010;110:S60-S67.
© 2013 S. Karger AG, Basel
2013
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