Dietary intakes and contemporary feeding patterns in Australian infants and toddlers 0-24 months

Abstract

Caregiver feeding practices during the first two years of a child’s life influence nutrition, growth, and development, as well as long term taste preferences and dietary patterns. Suboptimal feeding practices have been associated with poorer short- and long-term health outcomes. Although the importance of early life nutrition is well-established, there is no Australia-wide survey of contemporary caregiver feeding practices and dietary intakes of children under two years of age. To inform the Australian Feeding Infants and Toddlers Study (OzFITS 2021), I first conducted an audit of commercial infant and toddler foods sold in Australia. In this audit, I reviewed the nutritional and textural properties of >400 products and found the majority were inconsistent with National Health and Medical Research Council (NHMRC) Infant Feeding Guidelines, being low in iron, sweet tasting and smooth in consistency. From here, I describe the methods we used to conduct OzFITS 2021. OzFITS 2021 was a crosssectional survey with caregivers and their children 0-24m across Australia. Using a telephonebased survey, we collected information on early life feeding practices including breastfeeding history, breastmilk substitute use, and the timing of introduction to complementary foods. In addition, we collected dietary intake data using a one-day food record, with repeats in a randomly selected subset of the population. We enrolled 1140 caregiver-child dyads and 850 caregivers completed at least one food record for their child. Dietary data were entered into FoodWorks Professional™ which used composition data from the Australian Food, Supplement and Nutrient Database to assign nutrient values to foods. Due to the lack of composition data on commercial infant and toddler foods, the database created in the audit (Chapter 3) was used. In the subsequent chapters (4-7), I discuss the results from the child feeding questionnaire and dietary intake survey. Breastfeeding rates were high with nearly all mothers initiating breastfeeding soon after birth, and 40% of toddlers continued to receive breastmilk in the second year. Less than 1% of infants were exclusively breastfed to six months. Most infants started complementary feeding between the fifth and sixth month of life and most were introduced to common food allergens in the first year. Compared to the Australian Dietary Guidelines, most toddlers consumed foods from all five food groups; however, few met the recommended daily serves for all food groups. Discretionary foods and milks, including breastmilk, contributed 10% and 25% of daily energy, respectively, and may have displaced consumption of other foods. Compared to the Nutrient Reference Values for Australia and New Zealand, diets were nutritionally adequate for most nutrients; however, we found a high prevalence of inadequacy for iron in older infants and toddlers, and excessive sodium intake in toddlers. Although breastmilk provides a significant proportion of daily energy, the recommended dietary pattern for toddlers does not include breastmilk. The dietary modelling used to inform the Australian Dietary Guidelines needs revision. While the high prevalence of inadequacy for iron is concerning, it is unclear if our data reflects biochemical deficiency as there is no information on nutritional status for this age group to compare to. A nationally representative survey with biomarkers for key nutrients is urgently needed.