Public Health Nutrition Editorial Highlight: ‘Infant feeding practices and dietary consumption of US infants and toddlers’ by Kathleen E Davis, Xilong Li, Beverley Adams-Huet and Lona Sandon.

The rise in childhood obesity in the US has increased rates of health problems such as type 2 diabetes, hypertension, fatty liver disease, anxiety, and depression in children. Early obesity also increases the risk for adult obesity and obesity-related disease. Factors associated with early childhood obesity include rapid weight gain in early infancy, Mexican-American ethnicity and being low income. However, not much has been reported on disparities in early feeding practices and nutrient intake by race/ethnicity and income.

Our study used ten years (2003-2012) of National Health and Nutrition Examination Survey (NHANES) data to compare infant and toddler measurements (weight, length, and weight for length—a measurement that estimates overweight), feeding practices, and nutrient intake according to race/ethnicity and income. The 3669 infants and toddlers aged birth to 24 months included in this data set are representative of the overall US population of infants and toddlers in that they are diverse and mostly lower income. Thus, this study is different from past studies of infants and toddlers, which were based on commercial databases that included a greater proportion of white and higher income children.

The overall rate of overweight in this sample was about 13%, but we found higher rates of overweight among the Mexican-American infants and toddlers (about 15%). Only 71% of the infants were ever breastfed in this sample. Breastfeeding stopped earlier, formula started earlier, and milk was fed earlier in Mexican-American and non-Hispanic, black infants compared to non-Hispanic, white infants. Solids (puréed foods and cereals) were fed earlier to white infants compared to other groups.

There were no differences in protein intake by race/ethnicity, but black and white infants had higher reported energy (calorie) intake compared to Mexican-American infants.

Parents in the lowest income groups stopped breastfeeding earlier than higher income groups. Other feeding practices such as stopping formula use, and introducing milk also occurred earlier in low income groups. The lower income groups had higher energy intake and higher intake of several vitamins.

Surprisingly, the group with the highest rate of early overweight (Mexican-American infants and toddlers) reported lower energy (calorie) intake than other groups. In black infants, who had high reported energy intake as well as increased rates of less desirable feeding practices, rates of overweight were no higher. The lower intake among Mexican-American children may be due to under-reporting among their parents, but a clear cause for the association between low reported intake and higher overweight wasn’t identified.

NHANES data needs continued monitoring for trends by race/ethnicity and income so that disparities in feeding practices can be tracked. More resources should be committed to improving feeding practices, particularly among low-income and racial/ethnic groups at high risk for early overweight and obesity. Strengthening national and local initiatives to improve feeding practices among at risk infants and toddlers may help reduce the overall burden of obesity and obesity-related disease among children.

The full article ‘Infant feeding practices and dietary consumption of US infants and toddlers’ in Public Health Nutrition is available to download for free until 11th January 2018.

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