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The Australian Feeding Infants and Toddlers Study (OZFITS), 2021

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Pediatric Nutrition".

Deadline for manuscript submissions: closed (25 January 2022) | Viewed by 20329

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Prof. Dr. Susan J. Whiting

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College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
Interests: nutrient requirements for bone health; dietary assessment and population health
Special Issues, Collections and Topics in MDPI journals

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Dear colleagues,

Despite the recognition of the importance of nutrition during the early years, there are scant data on the dietary intake and contemporary feeding practices of children under two years old in Australia.

To address this gap, in 2020–2021, we conducted the Australian Feeding Infant and Toddler Survey (OzFITS). We surveyed parents or caregivers of children under 2 years of age from across Australia. Over 1000 parents or caregivers were surveyed. Parents completed a telephone survey which asked about demographic characteristics, breastfeeding practices, timing, and types of introductory foods introduced, as well as exposure to potential allergens and more. A 24-hour record/recall was collected on each child. This allowed us to determine food groups consumed, the use of ‘discretionary foods’, and usual nutrient intake distributions along with the prevalence of nutrient inadequacy. In the following series of papers, we will present the findings from this survey.

Prof. Dr. Susan Whiting
Guest Editor

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Keywords

infant and young child feeding practices
dietary intake
breastfeeding
complementary foods
food groups
Australia

Published Papers (7 papers)

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Editorial

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5 pages, 232 KiB

Open AccessEditorial

Feeding Infants and Toddlers Studies (FITS) Provide Valuable Information for Setting Dietary Guidelines

by Susan J. Whiting and Tolassa W. Ushula

Nutrients 2022, 14(19), 4073; https://doi.org/10.3390/nu14194073 - 30 Sep 2022

Viewed by 1407

Abstract

Adequate nutrition is essential from the early stages of life onward, to ensure proper growth and development as well as long-term health [...] Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

Research

Jump to: Editorial, Other

10 pages, 272 KiB

Open AccessArticle

Does Food Intake of Australian Toddlers 12–24 Months Align with Recommendations: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

by Najma A. Moumin, Merryn J. Netting, Rebecca K. Golley, Chelsea E. Mauch, Maria Makrides and Tim J. Green

Nutrients 2022, 14(14), 2890; https://doi.org/10.3390/nu14142890 - 14 Jul 2022

Cited by 6 | Viewed by 2086

Abstract

(1) Background: Food-based dietary guidelines promote population health and well-being through dietary patterns that reduce chronic disease risk while providing adequate energy and nutrients. In Australia, recommended dietary patterns based on servings per day from the five food groups—fruits, vegetables, cereals and grains, meats and alternatives, and dairy—have been developed for toddlers 1–2 years of age. However, no study has assessed the intake of the five food groups in this age group nationally. (2) Aim: To compare daily servings and the percentage of energy from the five food groups and discretionary foods in toddlers 1–2 years old to the Australian Dietary Guidelines. (3) Methods: Dietary intake was assessed using a one-day food record for 475 toddlers. (4) Results: Apart from fruit and dairy, servings of the five food groups were below the recommendations. Two-thirds of toddlers did not consume enough vegetables, and only 10% consumed the recommended number of servings for cereals and grains. On average, toddlers consumed only half the recommended servings of meat and alternatives. Nearly all toddlers (89%) consumed discretionary foods, which accounted for ~12% of total energy. Forty-five percent of toddlers received breastmilk. On average, breastfed toddlers consumed fewer servings from the five food groups than non-breastfed toddlers. Dairy contributed 20% of daily energy in all toddlers; however, this food group accounted for 13% in breastfed and 32% in non-breastfed toddlers on the day of the food record. (4) Conclusions: Compared to the recommendations, alignment with the servings of the five food group foods was not achieved by most toddlers, except for fruit and dairy. Discretionary foods may have displaced nutritious family foods. Consistent with Australian Infant Feeding Guidelines, many toddlers in this study continued to receive breastmilk but the recommended dietary patterns do not include breastmilk. Dietary modeling, including breastmilk as the primary milk source, is urgently needed, along with practical advice on incorporating breastmilk in a toddler’s diet while optimizing food consumption. Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

11 pages, 280 KiB

Open AccessArticle

Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

by Najma A. Moumin, Merryn J. Netting, Rebecca K. Golley, Chelsea E. Mauch, Maria Makrides and Tim J. Green

Nutrients 2022, 14(7), 1381; https://doi.org/10.3390/nu14071381 - 25 Mar 2022

Cited by 6 | Viewed by 4050 | Correction

Abstract

(1) Background: Breastmilk provides all the nutrition an infant requires between 0–6 months. After that, complementary foods are needed to meet the child’s increasing energy and nutrient requirements. Inadequate energy and nutrient intake may lead to growth faltering, impaired neurodevelopment, and increased disease risk. While the importance of early life nutrition is well recognized, there are few investigations assessing the nutritional adequacy of Australian children <24 months. Here, we describe usual energy and nutrient intake distributions, including the prevalence of inadequate intakes and exceeding the upper limit (UL), in a national sample of Australian children 6– 24 months and infants < six months who had commenced solids and/or formula. (2) Methods: Dietary intakes were assessed using a one-day food record for 976 children with a repeat one-day record in a random subset. (3) Results: Based on the Nutrient Reference Values for Australia and New Zealand, children’s intakes were above the Adequate Intake or Estimated Average Requirement for most nutrients. Exceptions were iron and zinc where the prevalence of inadequacy was estimated to be 90% and 20%, respectively, for infants aged 6–11.9 months. Low iron intake was also observed in one quarter of toddlers 12–24 months. On average, children consumed 10% more energy than predicted based on Estimated Energy Requirements, and ~10% were classified as overweight based on their weight for length. One third of toddlers exceeded the tolerable upper limit for sodium and consumed > 1000 mg/day. Of the children under six months, 18% and 43% exceeded the UL for vitamin A (retinol) and zinc. (4) Conclusions: Compared to nutrient reference values, diets were sufficient for most nutrients; however, iron was a limiting nutrient for infants aged 6–11.9 months and toddlers 12–24 months potentially putting them at risk for iron deficiency. Excessive sodium intake among toddlers is a concern as this may increase the risk for hypertension. Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

8 pages, 228 KiB

Open AccessFeature PaperArticle

The Australian Feeding Infants and Toddler Study (OzFITS 2021): Breastfeeding and Early Feeding Practices

by Merryn J. Netting, Najma A. Moumin, Emma J. Knight, Rebecca K. Golley, Maria Makrides and Tim J. Green

Nutrients 2022, 14(1), 206; https://doi.org/10.3390/nu14010206 - 03 Jan 2022

Cited by 16 | Viewed by 3968

Abstract

The Australian Feeding Infants and Toddler Study 2021 (OzFITS 2021) is a nationwide survey of Australian caregivers’ infant and toddler feeding practices. Here, we describe breastfeeding rates and duration, use of breastmilk substitutes, and introduction of complementary (solid) foods, including common food allergens. Caregivers (n = 1140) were recruited by a digital marketing company and were interviewed using a structured telephone questionnaire to obtain information. Breastfeeding was initiated in 98% of infants, but the duration of exclusive breastfeeding to six months was less than 1%. Nearly 40% of children continued to receive breastmilk beyond one year, with 10% of toddlers receiving breastmilk at two years. One-quarter of infants were introduced to solid foods between 4 to 5 months, and nearly all infants had received solid foods by 7 months. New guidelines encourage the early introduction of potential food allergens to reduce the risk of allergy, and by 12 months, over 90% of children had been given eggs and peanuts. One-third of children received no breastmilk substitutes during their first year. One-third of infants first received breastmilk substitutes following birth and before discharge from the hospital. Of these infants, 30% ceased breastmilk substitute use after discharge. Our findings suggest a high rate of continued breastfeeding with 44% receiving breastmilk beyond 1 year. One approach to increase the duration of exclusive breastfeeding is to reduce breastmilk substitute use while in hospital. Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

11 pages, 402 KiB

Open AccessArticle

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Study Design, Methods and Sample Description

by Najma A. Moumin, Rebecca K. Golley, Chelsea E. Mauch, Maria Makrides, Tim J. Green and Merryn J. Netting

Nutrients 2021, 13(12), 4524; https://doi.org/10.3390/nu13124524 - 17 Dec 2021

Cited by 7 | Viewed by 3874

Abstract

(1) Background: 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 lead to poorer health outcomes, such as obesity, that persist into adulthood. Although the importance of early life nutrition is well-established, there are no Australia-wide surveys of dietary intakes of children under two years of age. The 2021 Australian Feeding Infants and Toddlers Study (OzFITS) aims to fill this gap. This paper describes the methods and study sample of OzFITS 2021. (2) Methods: OzFITS 2021 is a cross-sectional study of children aged 0 to 23.9 months of age and their caregiver across Australia. Data were collected between April 2020 and April 2021. A telephone-based survey was completed with a caregiver to obtain information on child and caregiver characteristics and feeding practices. For exclusively breastfed infants, the number of breastfeeds in a 24 h period was reported. Dietary intakes for mixed fed children were estimated using a one-day food record, with 30% of caregivers completing a second food record on a non-consecutive day. (3) Results: We enrolled 1140 caregiver and child dyads. Of those eligible to complete a food record, 853 (87%) completed the food record. Compared to the Australian population, caregivers were more likely to be university-educated (>75%), married or in a de facto relationship (94%), and have a household income >$100,000/y (60%). (4) Conclusions: OzFITS 2021 is the first national study to examine food and nutrient intake in Australian children aged under 2 years. The study will provide information on breastfeeding rates and duration, use of breast milk substitutes, and timing of solid food introduction. Dietary intake data will allow the comparison of core food groups and discretionary food intake to Australian guidelines and estimate the prevalence of inadequate intake of key nutrients, like iron. Healthcare practitioners and policymakers can use the study findings as a source of evidence to inform the next iteration of infant feeding guidelines. Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

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2 pages, 180 KiB

Open AccessCorrection

Correction: Moumin et al. Usual Nutrient Intake Distribution and Prevalence of Inadequacy among Australian Children 0–24 Months: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021. Nutrients 2022, 14, 1381

by Najma A. Moumin, Merryn J. Netting, Rebecca K. Golley, Chelsea E. Mauch, Maria Makrides and Tim J. Green

Nutrients 2023, 15(5), 1144; https://doi.org/10.3390/nu15051144 - 24 Feb 2023

Viewed by 991

Abstract

The authors would like to correct an error in their recently published paper [...] Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

8 pages, 427 KiB

Open AccessCommentary

The Australian Feeding Infants and Toddlers Study (OzFITS) 2021: Highlights and Future Directions

by Merryn J. Netting, Najma A. Moumin, Maria Makrides and Tim J. Green

Nutrients 2022, 14(20), 4343; https://doi.org/10.3390/nu14204343 - 17 Oct 2022

Cited by 3 | Viewed by 1896

Abstract

The 2021 Australian Feeding Infants and Toddlers Study (OzFITS 2021) is the first nationwide survey of the feeding practices of children under 2 years. Key Findings: Nearly half of the infants were exclusively breastfed to 4 months, and breastfeeding duration was long, with 68% of infants breastfed to 6 months and 44% breastfed into their second year. Infants were introduced to complementary foods at the appropriate time, between 4 and 6 months. We found a mismatch between the number of recommended servings from each food group in the Australian Dietary Guidelines and the dietary intake of toddlers in our study. Toddlers consumed twice as many fruit servings as recommended, and nearly all consumed discretionary foods despite no allowance for these foods. While most toddlers consumed the recommended dairy serves, they consumed half the recommended servings for other food groups—meats and alternatives, grains, and vegetables. The modeling that informed the Australian Dietary Guidelines did not include an allowance for breastmilk; this needs to be addressed, as a quarter of toddlers in OzFITS 2021 received 30% or more energy from breastmilk. Infants and toddlers met their requirements for most nutrients. One exception was iron, where 90% of older infants and 25% of toddlers had inadequate intakes. Excessive sodium intake was also of concern, with 1 in 3 toddlers exceeding the upper limit of 1000 mg/day. Here, we discuss additional findings, study limitations, gaps in the evidence base, and future directions. Full article

(This article belongs to the Special Issue The Australian Feeding Infants and Toddlers Study (OZFITS), 2021)

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