Research finds “suboptimal” improvements in diet quality of US toddlers

01 Aug 2024 --- Total dietary quality scores among US children improved during 2005–2020, but researchers note that the “increase remained suboptimal.” They analyzed the dietary quality of 1,404 US toddlers no longer receiving breast milk or infant formula.

The research letter underscores: “Children’s transition from a liquid-based infant diet to typical omnivorous diets establishes eating behaviors and dietary patterns, which are key determinants of food preferences and diet quality contributing to lifelong nutritional habits and overall health.” 

Researchers assessed the diet score with the Healthy Eating Index for Toddlers, which matches consumed foods to the Dietary Guidelines for Americans for children aged 12 to 23 months based on 13 components that reflect major constituents of dietary intake. 

Scores improved from a mean of 53 points out of a maximum of 100 points in 2005–2006 to an average of 56.6 points in 2017–2020. The trend was more consistent and robust among non-Hispanic Black children, showing an increase of 7.8 points in the same period. 

The researchers caution that the improved scores were under five points, a “significant threshold for children.” 

Healthy diet 
The Healthy Eating Index for toddlers assesses diet in adequacy components — total fruits, whole fruits, total vegetables, greens and beans, whole grains, dairy, total protein foods, seafood and plant proteins and fatty acids — and components that kids should consume in moderation — refined grains, sodium, added sugars and saturated fats. 

The research letter, published in JAMA Pediatrics, notes that individual scores increased among most components, while the mean score of dairy decreased slightly. The authors note that this may reduce diet quality. 

Moreover, the scores of all moderation components remained stable, with a slight increase in the consumption of foods with added sugars. The researchers note this “warrants further studies.” 

The Healthy Eating Index assesses beneficial components like fruits and things kids should eat in moderation, such as added sugars.Earlier this year, the USDA announced new nutrition standards for school meals, aiming to reduce the sugar levels in these meals. 

Scientific research underscores the importance of healthy diets in kids. For example, a study from the University of Eastern Finland determined that children can develop heightened reasoning skills if they have a quality diet and minimize red meat consumption. 

Study set up 
The study used data from the National Health and Nutrition Examination Survey and the USDA Food Patterns Equivalents Database between 2005–2006 and 2017–2020. The toddlers’ parents or caretakers reported all foods and beverages consumed by the children in the preceding 24 hours in a dietary recall interview. 

The researchers assessed diet scores for groups of 150–230 toddlers across six time frames: 2005–2006, 2007–2008, 2009–2010, 2011–2012, 2013–2014, 2015–2016 and 2017–2020. Diet scores varied considerably throughout these years, with the highest average score in 2011-2012 at 58.2 points out of 100. 

Although the researchers found an association between lower socioeconomic status and poorer dietary quality, diets of almost all subgroups increased. Last month, a survey from the British Nutrition Foundation indicated that the high price of healthy foods demotivates parents to create more nutritious diets for their kids. 

The authors note previous studies have focused on youth diets or used older data and diet quality measures for infants and toddlers. 

The study’s main limitations are its small sample size and potential measurement errors in dietary recalls. 

By Jolanda van Hal