Contribution of snacks to dietary intakes of young children in the United States

Nutritional quality of children's diets is a public health priority in the fight against childhood obesity and chronic diseases. The main purpose of this study was to determine contribution of snacks to energy and nutrient intakes and to identify leading snack food sources of energy, total fat, and added sugars amongst young children in the United States. Using the 2005–2012 NHANES data, dietary intakes of 2‐ to 5‐year‐old children were analysed from a parent‐reported 24‐hour dietary recall (n = 3,429). Snacking occasions were aggregated to determine the proportion of total food/beverage intake obtained from snacks, estimate energy, and nutrient intakes, and identify the leading snack food sources of energy, added sugars, and total fat. Nearly all children consumed a snack on the reported day (62% morning, 84% afternoon, and 72% evening). Snacks accounted for 28% of total energy intake, 32% of carbohydrates, 39% of added sugars, and 26% of total fat and dietary fiber intakes for the day. Snacking occasions accounted for 46.6% of all beverages consumed on the reported day. Snacks and sweets food category (i.e., cookies and pastries) were the leading sources of energy (44%), total fat (52%), and added sugars (53%) consumed during snacking occasions. Sweetened beverages (e.g., fruit and sport drinks) contributed 1‐quarter of all added sugars obtained from snacks. Snacks contribute considerable amount of energy and nutrients to young children's diets, with a heavy reliance on energy‐dense foods and beverages. Targeted interventions are needed to improve the nutritional quality of snacks consumed by young children.     

Children's consumption of beverages in Singapore: knowledge, attitudes and practice

Aim: To examine the beverage consumption habits of Singaporean children and to investigate knowledge and attitudes of parents and children with regard to beverage consumption. Methods: A total of 800 respondents were randomly surveyed using face‐to‐face household interviews conducted between 10 March and 23 April 2009. The survey included mothers aged 25 to 44 years, of 400 children aged three to six years and 400 children aged seven to 10 years. Results: Children aged three to six and seven to 10 years typically consume milk on a daily basis. Younger children consume a greater number of servings of milk, whereas a significantly greater proportion of children aged seven to 10 years consume malted energy drinks and non‐gassy and gassy soft drinks (P ≤ 0.005 for all). In older children, a decline in the proportion consuming milk on a typical weekday (69% vs. 92% for three‐ to six‐year‐olds) is accompanied by a reduction in mean calcium intake (733 mg vs. 1032 mg for three‐ to six‐year‐olds). On a typical weekday, 26% of children aged three to six years did not meet the recommended daily dietary allowance (RDDA) of 600 mg of calcium. Of children aged seven to 10 years, 61% also did not meet the age‐appropriate RDDA of 700 g mg of calcium. Conclusions: Milk consumption decreases with age while the consumption of beverages such as malted energy drinks, gassy and non‐gassy soft drinks and syrups increases markedly. Educational programmes may aid in the selection of appropriate nutrient‐dense beverages and other calcium‐rich foods to ensure that children achieve the recommended daily dietary nutrient intake.     

Nearly half of the adolescents in an Italian school‐based study exceeded the recommended upper limits for daily caffeine consumption

Aim

No data are available on caffeine consumption among Italian adolescents. We investigated caffeine intake from coffee, soft drinks and energy drinks in a sample of Italian adolescents and determined if they exceeded the recommended limits.

Methods

The study comprised 1213 adolescents with a mean age of 15.1 years (range 12–19) from four schools in Foggia, southern Italy. Caffeine intake was assessed using an anonymous self‐reported questionnaire during the 2013/2014 school year. We calculated the percentage of daily caffeine consumers, their mean intake of caffeine from beverages and the contribution of each beverage category to the total caffeine intake.

Results

Approximately 76% of the sample consumed caffeine every day, amounting to 125.5 ± 69.2 mg/day and 2.1 ± 1.2 mg/kg/day. When we applied the reference values from the Academy of Pediatrics, we found that 46% of the adolescents exceeded the recommended upper limits. Coffee was the most frequently consumed caffeinated drink and the main contributor to daily caffeine intake.

Conclusion

More than three quarters (76%) of the Italian adolescents in our study drank coffee on a daily basis and nearly half (46%) exceeded the recommended upper limits. Strategies are needed to reduce caffeine consumption by adolescents.     

Energy intake from unhealthy snack food/beverage among 12‐23‐month‐old children in urban Nepal

Unhealthy snack food and beverage (USFB) consumption among young children has been noted in many low‐income and middle‐income countries (LMIC), however, there is a lack of information on the contribution of these foods to children's diets in these contexts. This study describes the nutrient profiles and costs of snacks consumed by young children in Kathmandu Valley, Nepal, and assesses the proportion of total energy intake from nonbreastmilk foods (%TEI‐NBF) contributed by USFB and factors associated with high USFB consumption. A cross‐sectional survey was conducted among 745 randomly sampled primary caregivers of children aged 12–23 months. Of 239 unique snack foods and beverages consumed, 180 (75.3%) were classified as unhealthy based on nutrient profiling, with 158 of these being commercially branded. Median cost/100 kcal of USFB was lower as compared with healthy snacks. Ninety‐one percent of children had consumed a USFB in the previous 24 hr, with these foods contributing a mean %TEI‐NBF of 24.5 ± 0.7 among all children. Biscuits (10.8%), candy/chocolate (3.5%), and savoury snacks (3.4%) provided the largest %TEI‐NBF. Children who were older, female, or from the poorest households had significantly higher odds of high USFB consumption, whereas children whose caregivers were of upper caste/ethnicity or had achieved tertiary education had lower odds of consumption than other children. To reduce USFB consumption, interventions should seek to further understand social/cultural drivers of feeding practices, target disadvantaged populations, and ensure caregivers are fully aware of the nutritional quality of food products they choose for their children.     

The health of HIV‐exposed children after early weaning

There are potential health risks associated with the use of early weaning to prevent mother‐to‐child transmission of human immunodeficiency virus (HIV) in resource‐poor settings. Our objective was to examine growth and nutrient inadequacies among a cohort of children weaned early. Children participating in the Breastfeeding Antiretrovirals and Nutrition (BAN) Study in Lilongwe, Malawi, had HIV‐infected mothers, were weaned at 6 months and fed LNS until 12 months. 40 HIV‐negative, BAN‐exited children were compared with 40 HIV‐negative, community children matched on age, gender and local health clinic. Nutrient intake was calculated from 24‐h dietary recalls collected from BAN‐exited children. Anthropometric measurements were collected from BAN‐exited and matched community children at 15–16 months, and 2 months later. Longitudinal random effects sex‐stratified models were used to evaluate anthropometric differences between the two groups. BAN‐exited children consumed adequate energy, protein and carbohydrates but inadequate amounts of fat. The prevalence of inadequate micronutrient intakes were: 46% for vitamin A; 20% for vitamin B6; 69% for folate; 13% for vitamin C; 19% for iron; 23% for zinc. Regarding growth, BAN‐exited girls gained weight at a significantly lower rate {0.02 g kg^?1 per day [95% confidence interval (CI): 0.01, 0.03]} than their matched comparison [0.05 g kg^?1 per day (95% CI: 0.03, 0.07)]; BAN girls grew significantly slower [0.73 cm month^?1 (95% CI: 0.40,1.06)] than their matched comparison (1.55 cm month^?1[95% CI: 0.98, 2.12]). Among this sample of BAN‐exited children, early weaning was associated with dietary deficiencies and girls experienced reduced growth velocity. In resource‐poor settings, HIV prevention programmes must ensure that breastfeeding stop only once a nutritionally adequate and safe diet without breast milk can be provided.     

Availability of,access to and consumption of fruits and vegetables in a peri‐urban area in KwaZulu‐Natal,South Africa

Availability and consumption of fruits and vegetables were assessed in peri‐urban households in KwaZulu‐Natal Province, South Africa. Caregivers of 400 randomly selected grade 6 and 7 learners were interviewed using a questionnaire that included unquantified food frequency questions. Using a repeated 24‐h dietary recall, dietary intake was quantified for learners, caregivers and 2‐ to 5‐year‐old children in the household. Usual household fruit and vegetable consumption was expressed over three Living Standard Measure (LSM) categories. Average per capita intake of fruit and/or vegetables was 99 g for 2‐ to 5‐year‐old children and 124 g for caregivers. For consumers, fruits and/or vegetables contributed towards total dietary intake of fibre (16–21%), calcium (13–21%), vitamin A (27–31%) and vitamin C (47–62%). For households not consuming fruits (n = 297) and vegetables (n = 178) daily, cost was the major constraint (≥75%). Of all households, 52% had fruit trees and 25% had a vegetable garden. Animals destroying vegetables was the major constraint to 59% of vegetable growers. Household consumption of fruits and vegetables increased over the LSM categories. Caregivers in the higher LSM group more likely used printed material for information on healthy eating, had fruit trees, were confident about vegetable gardening and sold some of their produce. To enable peri‐urban populations of low socio‐economic status to consume more frequently a bigger variety of fruits and vegetables, the cost of purchasing these food items needs to be addressed by government and business sector. Households should further receive support to overcome constraints which hamper the success of home gardens.     

Dietary diversity and food intake of urban preschool children in North‐Western Sri Lanka

Childhood malnutrition, associated with poor diet, is a clear public health threat in Sri Lanka, with high rates of under‐nutrition and micronutrient deficiencies coupled with the growing risk of overweight/obesity in urban locations. This study explored the dietary diversity and food intake of urban living Sri Lankan preschool children. A cross‐sectional analysis of the baseline data from a cohort study was conducted with parents/caregivers of children aged 2–6 years, from 21 preschool centres in Kurunegala District, Sri Lanka. Demographic and socio‐economic factors, dietary diversity score (DDS) (n = 597) and food intake (n = 458) (using a food frequency questionnaire) were assessed. Children had a mean DDS of 4.56 ± 0·85 out of 9, with most (91.1%) in the medium DDS category (DDS of 3.1–6.0), consuming rice as most common food. Lentils were consumed more than any meat or alternative food groups at all DDS levels. Child DDS differs with parent/caregiver age and ethnicity. Mean daily intakes of fruit (1.02) and vegetables (0.84) servings align with approximately half of national recommendations, with less than 20% of children meeting daily recommendations. More than one‐third consumed sugary snacks and confectionaries daily and 1 in 10 had them twice a day. Around 40% reported watching television while eating the evening meal. Despite the majority having reasonable DDSs (medium category), findings highlighted inadequate intakes of fruits and vegetables, excessive intakes of sugary snacks and unhealthy dietary and social behaviours, suggests the need for population‐based interventions to promote healthier dietary habits.     

Combining food‐based dietary recommendations using Optifood with zinc‐fortified water potentially improves nutrient adequacy among 4‐ to 6‐year‐old children in Kisumu West district,Kenya

Children in developing countries often face multiple micronutrient deficiencies. Introduction of zinc‐fortified water can increase zinc intake, but additional recommendations are required to address overall diet nutrient adequacy. We developed and tested food‐based recommendations (FBRs) that included zinc‐fortified water for children aged between 4 and 6 years from rural Kenya to achieve the best possible nutrient adequacy. Dietary intakes of 60 children aged 4–6 years, from Kisumu West district, Kenya, were assessed using a quantitative multipass 24‐hr recall. Linear programming model parameters were derived, including a list of foods consumed, median serving sizes, and distribution of frequency of consumption. By using the Optifood linear programming tool, we developed FBRs for diets including zinc‐fortified water. FBRs with nutrient levels achieving ≥70% recommended nutrient intake (RNI) of the World Health Organization/Food and Agriculture Organization of the United Nations RNI for most of the 12 considered nutrients were selected as the final recommendations for the children. With no FBRs and no zinc‐fortified water, percent RNI coverage range was between 40% and 76% for zinc, improving to 66–101% after introduction of zinc‐fortified water. The final set of FBRs achieved nutrient adequacy for all nutrients except for vitamin A (25% RNI) and folate (68% RNI). Introduction of zinc‐fortified water combined with FBRs will likely improve the nutrient adequacy of diets consumed by children in Kenya but needs to be complemented with alternative interventions to ensure dietary adequacy.     

Swedish pre-school children eat too much junk food and sucrose

Aim: To analyze dietary intake in healthy 4‐year‐old children. Methods: Families from three Paediatric Health Care Centres in different socio‐economic areas in Göteborg completed 7‐day food records and questionnaires about socio‐economy. Results: One hundred thirty two/153 completed the study, 49% of parents were university educated. Eighteen percent of children were overweight/obese. Energy intake was high; 67% had sucrose intake exceeding Nordic Nutrition Recommendations (NNR) but 36% had n‐3 fatty acid intake <0.5 energy percent. Significant negative correlations were found between sucrose and fat and between BMI and fat intake. Junk food supplied 24% of energy. Ninety‐two percent had low vitamin D intake, 70% low iron and 21% low calcium intake. Gruel, which was consumed by 28%, had a positive impact on micronutrient intake. Child care and mother's origin seemed to influence dietary intake. Conclusion: In 4‐year olds from well‐educated urban families, 18% was overweight/obese. Total energy intake was above present NNR but lower than 20 years ago, when overweight was rare. Fat energy intake was negatively associated with BMI, and low n‐3 fatty acid intake was associated with higher body weight. In several aspects dietary intake was not optimal in the children.     

Consumption of highly processed snacks,sugar‐sweetened beverages and child feeding practices in a rural area of Nicaragua

Appropriate feeding behaviours are important for child growth and development. In societies undergoing nutrition transition, new food items are introduced that may be unfavourable for child health. Set in rural Nicaragua, the aim of this study was to describe the infant and young child feeding (IYCF) practices as well as the consumption of highly processed snack foods (HP snacks) and sugar‐sweetened beverages (SSBs). All households with at least one child 0‐ to 35‐month‐old (n = 1371) were visited to collect information on current IYCF practices in the youngest child as well as consumption of SSBs and HP snacks. Breastfeeding was dominant (98%) among 0‐ to 1‐month‐olds and continued to be prevalent (60%) in the second year, while only 34% of the 0‐ to 5‐month‐olds were exclusively breastfed. Complementary feeding practices were deemed acceptable for only 59% of the 6‐ to 11‐month‐old infants, with low dietary diversity reported for 50% and inadequate meal frequency reported for 30%. Consumption of HP snacks and SSBs was frequent and started early; among 6‐ to 8‐month‐olds, 42% and 32% had consumed HP snacks and SSBs, respectively. The difference between the observed IYCF behaviours and World Health Organization recommendations raises concern of increased risk of infections and insufficient intake of micronutrients that may impair linear growth. The concurrent high consumption of SSBs and HP snacks may increase the risk of displacing the recommended feeding behaviours. To promote immediate and long‐term health, growth and development, there is a need to both promote recommended IYCF practices as well as discourage unfavourable feeding behaviours.     

Intake,sources, and determinants of free sugars intake in Australian children aged 12–14 months

The consumption of free sugars is directly associated with adiposity and dental caries in early childhood; however, intake data in the first 2 years of life are limited. This cross‐sectional analysis aims to identify major food sources of free sugars for Australian children aged 12–14 months and investigate factors associated with meeting the World Health Organisation (WHO) Guideline for sugars intake. Three days of nonconsecutive dietary data were collected via a 24‐hr recall and 2‐day food record for 828 participants. Usual intake of energy, total sugars, and free sugars were estimated, along with food group contributions to free sugars. Multiple logistic regression analysis was used to investigate factors associated with exceeding the WHO conservative recommendation that <5% of energy should come from free sugars. Mean free sugars intake was 8.8 (SD 7.7, IQR 3.7–11.6) g/day, contributing 3.6% (SD 2.8, IQR 1.6–4.8) of energy. Only 2.4% of participants exceeded the WHO recommendation that <10% of energy should come from free sugars, with 22.8% of participants exceeding the <5% recommendation. Children from households with greater socio‐economic disadvantage (IRSAD <5, OR = 1.94) and in the lowest income bracket (OR = 2.10) were more likely to have intakes ≥5% of energy. Major food sources of free sugars were commercial infant foods (26.6%), cereal‐based products (19.7%), namely, sweet biscuits (8.3%) and cakes (7.6%), followed by yoghurt (9.6%), and fruit and vegetable beverages (7.4%). These findings highlight the substantial contribution of infant foods to free sugars intakes and provide further evidence that dietary intakes are influenced by social determinants.     

Beverage consumption and anthropometric outcomes among schoolchildren in Guatemala

This analysis explores the clustering of beverage patterns in a single day in private vs. public school children in urban Guatemala. This study is based on measurements taken from 356 third- and fourth-grade pupils from the highland city of Quetzaltenango. Height, weight and body mass index were assessed, and one day's intake of all foods and beverages using a pictorial workbook and dietician assisted recall. Mean differences in beverage consumption were compared for private vs. public school children and by anthropometric outcomes (stunting, overweight and obesity). Plain water was consumed by 30.9% of the children on the day intakes were measured, with higher proportions of water drinkers among private school children. Children having reported water intake on that day consumed 154 fewer kcal (-7.7%) compared with the energy intake of children not having reported water intake (P = 0.02). Significantly more children of high socio-economic status (SES) consumed dairy, fruit juice, commercial fruit juice, fruit drink and soda whereas low SES children consumed thin gruels and infusions. A key result from this study is the finding of a lower energy intake shown by children reporting water intake.     

Local foods can meet micronutrient needs for women in urban Burkina Faso,but only if rarely consumed micronutrient‐dense foods are included in daily diets: A linear programming exercise

Women of reproductive age are at nutritional risk due to their need for nutrient‐dense diets. Risk is further elevated in resource‐poor environments. In one such environment, we evaluated feasibility of meeting micronutrient needs of women of reproductive age using local foods alone or using local foods and supplements, while minimizing cost. Based on dietary recall data from Ouagadougou, we used linear programming to identify the lowest cost options for meeting 10 micronutrient intake recommendations, while also meeting energy needs and following an acceptable macronutrient intake pattern. We modeled scenarios with maximum intake per food item constrained at the 75th percentile of reported intake and also with more liberal maxima based on recommended portions per day, with and without the addition of supplements. Some scenarios allowed only commonly consumed foods (reported on at least 10% of recall days). We modeled separately for pregnant, lactating, and nonpregnant, nonlactating women. With maxima constrained to the 75th percentile, all micronutrient needs could be met with local foods but only when several nutrient‐dense but rarely consumed items were included in daily diets. When only commonly consumed foods were allowed, micronutrient needs could not be met without supplements. When larger amounts of common animal‐source foods were allowed, all needs could be met for nonpregnant, nonlactating women but not for pregnant or lactating women, without supplements. We conclude that locally available foods could meet micronutrient needs but that to achieve this, strategies would be needed to increase consistent availability in markets, consistent economic access, and demand.     

High cholesterol dietary intake during pregnancy is associated with large for gestational age in a sample of low‐income women of Rio de Janeiro,Brazil

The association between the quality of maternal dietary fat intake during pregnancy and the infant's birthweight (BW) remains controversial. Our goal was to investigate the association between maternal dietary fat intake during pregnancy and the rate of large for gestational age (LGA) newborns. This study employed a cross‐sectional analysis of 297 pairs of mothers/children attending a public maternity at Rio de Janeiro, Brazil. BW for gestational age according to the Intergrowth 21st was defined as follows: adequate for gestational age (AGA ≤ 90th percentile) and LGA (>90th percentile). The statistical analysis was a Poisson regression with robust estimations of the standard errors. Maternal dietary fat intake variables comprised lipids (% total energy); saturated (mg/1000 kcal), monounsaturated (mg/1000 kcal) and polyunsaturated (mg/1000 kcal) fats; and cholesterol (mg/1000 kcal), all of which were obtained with a Food Frequency Questionnaire. The mean BW was 3338 g (SD = 446.9), and the rate of LGA newborns was 13.1%. The mean maternal total energy intake was 2880 kcal (SD = 1074), cholesterol was 154.3 mg/1000 kcal (SD = 68.1) and monounsaturated fat was 6.9 mg/1000 kcal (SD = 2). Mothers of LGA newborns reported higher cholesterol dietary intake (195.8 vs. 148 mg/1000 kcal; P < 0.001), pre‐pregnancy body mass index (25.1 vs. 23.5 kg/m²; P = 0.026) when compared with mothers of AGA newborns. Women with cholesterol intake within the fourth quartile were 2.48 (95% confidence interval: 1.31–4.66) times more likely to have an LGA infant compared with those in the 1–3 quartiles. Dietary intake of cholesterol during pregnancy influences LGA even after adjusting for other confounders.     

High proportions of children under 3 years of age consume commercially produced snack foods and sugar‐sweetened beverages in Bandung City,Indonesia

Child undernutrition continues to be a national concern in Indonesia, whereas childhood overweight/obesity rises. Economic development has led to wide availability of highly processed foods and beverages, with growing evidence that children are consuming commercial snack products during the critical complementary feeding period. This study assessed the prevalence and patterns of consumption of commercially produced snack foods and sugar‐sweetened beverages among Indonesian children. A cross‐sectional survey was conducted with 495 mothers of children aged 6–35 months living in Bandung City, Indonesia. Among all children, 81.6% consumed a commercial snack food and 40.0% consumed a sugar‐sweetened beverage in the day preceding the interview. At 6–11 months, 46.5% of children consumed a snack food and 2.0% consumed a sugar‐sweetened beverage. Snack foods were consumed 3 or more times a day by 60.0% of children 24–35 months of age. Sweet biscuits and savory snacks were the most commonly consumed snack foods; sweetened milks and sweetened teas were the most common beverages. Maternal education, child age, and consumption of a commercially produced complementary food were associated with snack food consumption. Factors associated with sugar‐sweetened beverage consumption were child age and consumption of a commercially produced complementary food or breastmilk substitute. These findings reflect a high presence of processed, high‐sugar/salt commercial snack products in the diets of children 6–35 months. National attention should focus on interventions to reduce reliance on processed snack products and increase consumption of nutrient‐rich, locally available foods during the complementary feeding period.     

Association between watching TV whilst eating and children's consumption of ultraprocessed foods in United Kingdom

This study aimed to assess the association between watching TV whilst eating and consumption of ultraprocessed foods amongst children aged 4–10 years old in the United Kingdom. Cross‐sectional data from the UK National Diet and Nutrition Survey (NDNS 2008–2012) were analysed. Dietary data were derived from 4‐day food diaries of 1,277 children, and the dietary contribution of ultraprocessed foods was assessed. Meals were classified based on time of day in which foods were consumed (lunch: 11 pm–3 pm and dinner: 6 pm–9 pm). Crude and adjusted linear regression models were employed to verify the effect of watching TV during meals on dietary contribution of ultraprocessed foods (% of total energy intake). More than 70% of the children watched TV during meals, and 31.4% presented the behaviour on both “lunch and dinner.” Children's mean total energy intake was 1,532.3 kcal/day, of which 65.8% came from ultraprocessed foods. Findings indicated that children who watched TV whilst having both meals (lunch and dinner) consumed on average 85.5 kcal/day and 6.1% more energy from ultraprocessed foods than those who did not. Children who watched TV only during dinner consumed on average 37.1 kcal/day and 3.4% more energy from ultraprocessed foods than those who did not. The behaviour of watching TV whilst eating meals was associated with higher total daily consumption of ultraprocessed foods by children in the United Kingdom. Therefore, interventions designed to promote healthy eating habits should include aspects related to the context of meals.     

Nutritional and energetic consequences of sweetened drink consumption in 6- to 13-year-old children

OBJECTIVE: To study the effects of excessive sweetened drink consumption on daily energy balance and nutrient intake in a longitudinal study of children. SUBJECTS AND METHODS: Daily dietary intakes of 30 children aged 6 to 13 years old were collected over 4 to 8 weeks. Weights and heights of children were measured at the beginning and end of the study in 21 children. Data were analyzed by analysis of variance (ANOVA) (PROC MIXED in SAS) and multiple regression. RESULTS: Excessive sweetened drink consumption (>12 oz/day) displaced milk from children's diets (122-147 g/day less milk drank, P <.0001) because caregivers served less milk and the children consumed smaller amounts of milk. The consequences were lower daily protein, calcium, magnesium, phosphorus, and vitamin A intakes. Because children failed to reduce consumption of solid foods to compensate for the caloric contribution of sweetened drinks, higher daily energy intakes were observed. Consequently, the greater the sweetened drink consumption the greater the weight gain (1.12 +/- 0.7 kg) compared with children who consumed <12 oz per day (0.32-0.48 +/- 0.4 kg). CONCLUSIONS: Excessive sweetened drink consumption is associated with the displacement of milk from children's diets, higher daily energy intake, and greater weight gain.     

Snack food and beverage consumption and young child nutrition in low‐ and middle‐income countries: A systematic review

Although snacks can provide important nutrients for young children during the complementary feeding period, the increasing availability of snack foods and sugar‐sweetened beverages (SSB), often energy‐dense and nutrient‐poor, in low‐ and middle‐income countries (LMIC) is a concern. Such foods may displace consumption of nutritious foods in contexts where diets are often nutritionally inadequate and the burden of childhood malnutrition is high. This systematic review summarizes literature on the contribution of snack food/SSB consumption to total energy intakes (TEI) of children below 23 months of age in LMIC and associations between this consumption and nutritional outcomes. It also identifies areas where further research is needed. A systematic search of Embase, Global Health, and MEDLINE for literature published in January 1990–July 2018 was conducted. This search yielded 8,299 studies, 13 of which met inclusion criteria: Nine studies assessed % TEI from snack foods/SSB, and four studies assessed associations between snack food/SSB consumption and nutritional outcomes. Average % TEI from snack foods/SSB ranged from 13% to 38%. Findings regarding associations with growth were inconclusive, and no studies assessed associations with nutrient intakes. Variation in measurement of consumption and definitions of snack foods and SSB limited study comparisons. Further research is needed to understand how consumption of energy‐dense, nutrient‐poor snack foods and SSB influences undernutrition and overnutrition among young children during the complementary feeding period in settings that are experiencing dietary transitions and the double burden of malnutrition.     

Bottle and sippy cup use is associated with diet and energy intake in toddlers

The second year of life incorporates a continued shift from a liquid‐ to solid‐based diet. Little is known about the prevalence and dietary impact of bottle and sippy cup use. This paper describes associations between percent of energy consumed via drinking containers (bottles and sippy cups combined) and dietary outcomes, between 1 and 2 years of age. This observational study recruited n = 299 low‐income, nutrition programme clients from the Bronx, NY, whose 12 month olds consumed ≥ 2 non‐water bottles per day. The main exposure variable was percent of energy intake via drinking containers (PEDC), dichotomized at the median into low‐percent–energy‐from‐drinking‐containers (LOW‐C) and high‐percent–energy‐from‐drinking‐containers (HIGH‐C) groups, assessed quarterly, for 1 year. We report 24‐hour dietary recall nutrient and food serving data by LOW‐C vs. HIGH‐C. We employed linear mixed models to study associations between PEDC and nutrient intake. PEDC decreased from 52% to 33% between 1 and 2 years of age in both groups. The LOW‐C group had higher intake of energy, dietary fibre, iron and sodium, grains, protein‐rich foods and sweets. Conversely, LOW‐C group had lower intake of Vitamin D and calcium vs. the HIGH‐C group. PEDC was inversely associated with total energy intake in a model controlling for baseline age, baseline‐weight‐for‐length and gender (β = ?5.8, P = 0.029, 95% confidence interval (?10.96, ?0.6). Lower bottle and sippy cup use had significant, albeit mixed association with diet quality in the second year of life, and was associated with higher energy intake. Evidence‐based guidelines are needed to determine the appropriate use of those feeding methods.     

Agroforestry diversity,indigenous food consumption and nutritional outcomes in Sauria Paharia tribal women of Jharkhand,India

Like several indigenous populations, Sauria Paharias, a vulnerable indigenous tribal group residing in a biodiverse environment of Jharkhand, India, have high levels of undernutrition. We assessed agroforestry and dietary diversity, food consumption especially indigenous food (IF) intake and nutritional status of Sauria Paharia women through a cross‐sectional study conducted in 18 villages of Godda district, Jharkhand. Household level information was elicited through household surveys including a dietary survey and a food frequency questionnaire. Twenty‐four‐hour dietary recalls (24 HDR) and anthropometric assessments were taken on one randomly selected woman per household. An index, Food Accessed Diversity Index (FADI) created to measure agroforestry diversity, showed a low mean score of 0.21 ± 0.15 and range: 0, 0.85. Fifty‐nine percent of women consumed any IF during 24 HDR. Median minimum dietary diversity score for women (MDD‐W) was 3 (acceptable score ≥5). More than 96% of women had intakes below estimated average requirements for all nutrients studied (energy; vitamins A, C, thiamine, riboflavin, niacin, pyridoxine; folate; iron; calcium and zinc) except protein; 41% women were underweight. IF consumption was independently associated with calcium and vitamin A intake. Decision trees developed for micronutrient consumption at different levels of MDD‐W score and IF consumption scenarios revealed 1.3 to 2.9 times higher consumption of micronutrients among women with MDD‐W ≥ 3 or 4. Strategies like agricultural extension programmes promoting indigenous varieties and nutrition education for increasing dietary diversity with IFs have potential to address undernutrition in Sauria Paharia women.