First dietary guidelines for young Irish children may spur reformulation

23 Jun 2020 --- The Food Safety Authority of Ireland (FSAI) has published its first Food-Based Dietary Guidelines (FBDG) for children aged one to five years old. The recommendations support the intake of cows’ milk but warn against some plant-based alternatives. Additionally, vitamin D supplements are recommended during winter for all children, and some should also receive iron. There may well also be a further push for reformulation as high fat, salt and sugar (HFSS) foods come under fire. The country’s Department of Health is now developing resources based on the report and will implement the recommendations nationally. 

“Clear guidance is now available demonstrating that HFSS foods are not recommended for this age group, which should limit the development of inappropriate food products targeting these children. There is simply no room for these foods due to high nutritional requirements of children aged one to five years. This is in addition to their small capacity for food intake and their low energy requirements,” Dr. Mary Flynn, Chief Specialist Public Health Nutrition at FSAI, tells NutritionInsight.

She continues that HFSS foods overwhelm any natural curiosity to try the extensive range of flavors and textures naturally found in the food these children need for healthy eating throughout life. Fostering a tolerance to try an expanding variety of vegetables, salads, fruits, meat, fish and wholemeal cereals helps children develop a taste for nutritious foods at this critical life stage. 

Meanwhile, all children aged one to five should be given a low-dose (5 µg) vitamin D-only supplement between Halloween and St. Patrick’s Day. This is to make up for a lack of skin synthesis of this vitamin from sunlight. Young children aged one to three years who are naturally small (25th percentile or less on growth charts) need extra iron, which can be taken as iron-fortified full-fat milk, or a low-dose iron supplement.

Other guidelines detailed in FSAI’s report include:

• Milk is a key food, with a daily intake of 550 ml of cow’s milk, or equivalent amounts of yogurt or cheese is recommended.
• Water and milk are the only drinks recommended for this age group. Sugar-containing and acidic drinks should be limited and, if consumed at all, should be kept to mealtimes.
• Parents and guardians are warned against using some beverages such as almond, coconut and rice “milks” as these are nutritionally inadequate. If a plant-based beverage is required to replace cow’s milk, a soy “milk” can be used, provided it is fortified with nutrients, particularly calcium.
• A portion of vegetables should always be included at the main meal, together with the number of small portions of salad, vegetables or fruit that match the age of the child.
• Lean red meat (around 30 g) is recommended three days a week for iron and other essential minerals in addition to protein. On other days, red meat can be replaced with poultry, fish, eggs, beans or lentils, which also provide iron, as well as protein and minerals. Smooth nut butters also provide protein.
• A combination of both white and wholemeal breads, cereals, potatoes, pastas and rice will provide adequate fiber and are important sources of calories.
• Fats, spreads and oils should be used minimally.
• If a key food group is excluded from a child’s diet because a food allergy is suspected without proper indication or appropriate professional advice being sought, the growth and development of a child can be compromised.

A critical age
The guidelines are detailed in a report from the Scientific Committee of FSAI, where members are appointed by the Minister for Health. Extensive modeling of food patterns was undertaken for children of different body sizes (using WHO Growth Standards) in six age groups between one- to five-years-old. Over 2,400 daily patterns were modeled until 120 four-day food intake patterns (including vegetarian) were finalized as being closest to nutrient targets. All foods used were aligned with international best practice, such as no added salt, minimal sugar and no processed meats.

Ita Saul, Chair of the FSAI Working Group, notes that the process of using children’s growth chart percentiles as a basis for these dietary recommendations now enables healthcare workers involved in assessing young children’s growth to identify those at nutritional risk and provide specific advice on fortified foods or supplements.

Speaking about the specific needs of Irish children, Dr. Flynn explains that the majority of this age group are of a healthy weight, there is more of a tendency towards being overweight, while very few tend toward being underweight. Inadequate intakes of vitamin D and DHA and EPA are universal among one- to five-year-olds, and some have inadequate intakes of iron. However, protein and calcium intakes are excellent associated with relatively high intakes of milk among this age group.

Although over 100 countries worldwide have FBDG in place, very few address the specific nutritional needs of one- to five-year-old children.A global context
Dr. Flynn explains that although over 100 countries worldwide have FBDG in place, very few address the specific nutritional needs of one- to five-year-old children. “Most countries combine this age group with older children, adolescents, and in some countries, adults. This does not allow for detailed FBDG to address the specific challenges of best practice for young child feeding.”

However, she does flag that the US is now also catching up, citing the 2020–2025 Dietary Guidelines for Americans that are currently being updated to include birth to 24 months and recognize the specific nutritional needs of that age group. In January, the Grain Foods Foundation had an eye on the new guidelines as it highlighted a study finding that infant grain consumption was generally associated with higher nutrient intakes. 

Dr. Flynn concludes that the period from one to five years is a big transitional stage in dietary terms as this is when the predominantly milk-based diet of infancy gradually becomes more diverse and food-based. Additionally, children in this age group are at a development stage where they increasingly wish to make their own decisions about what they eat, which can make healthy eating challenging. 

By Katherine Durrell