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The Dietary Guidelines for Americans, 2020-2025 includes guidance for infants and toddlers aged birth to 24 months. To assess alignment with this new guidance, the Healthy Eating Index (HEI)-Toddlers-2020 was developed for toddlers 12 through 23 months old. This monograph focuses on the continuity, considerations, and future directions of this new index for toddlers in the context of evolving dietary guidance. There is considerable continuity between the HEI-Toddlers-2020 and previous versions of the HEI. The same process, guiding principles, and features (with caveats) are repeated in the new index. However, there are unique considerations for measurement, analysis, and interpretation for the HEI-Toddlers-2020 that this article addresses, while identifying future directions for the HEI-Toddlers-2020. The continued evolution of dietary guidance for infants, toddlers, and young children will provide additional opportunities for index-based metrics: considering inclusion of multidimensional layers in dietary patterns, defining a healthy eating trajectory, bridging healthy eating across different life stages, and communicating the constructs of balance among dietary constituents., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

The Healthy Eating Index-Toddlers-2020 (HEI-Toddlers-2020) is a measure for assessing how well a set of foods aligns with new guidance in the Dietary Guidelines for Americans, 2020-2025 (DGA) for toddlers aged 12 through 23 months. This new tool was developed using consistent features and the guiding principles of the HEI. The HEI-Toddlers-2020, like HEI-2020, has 13 components reflecting all constituents of dietary intake, except for human milk or infant formula. These components include the following: Total Fruits, Whole Fruits, Total Vegetables, Greens and Beans, Whole Grains, Dairy, Total Protein Foods, Seafood and Plant Proteins, Fatty Acids, Refined Grains, Sodium, Added Sugars, and Saturated Fats. Healthy dietary patterns for toddlers have unique considerations reflected in the scoring standards for Added Sugars and Saturated Fats. Toddlers have lower energy intake relative to high nutrient needs and added sugars should be avoided. Another distinctive difference is that there is no recommendation to limit saturated fats to <10% of energy intake in this age group; however, saturated fats cannot be unlimited without displacing the energy available to achieve other food group and subgroup goals. Calculations using the HEI-Toddlers-2020, like the HEI-2020, result in a total score and a set of individual component scores that reveal a dietary pattern. The release of a HEI-Toddlers-2020 will enable assessment of diet quality that aligns with the DGA and support additional methodological research to examine needs specific to each life stage and how to model trajectories of healthy dietary patterns., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: With the addition of new guidance for children from birth to 24 months in the Dietary Guidelines for Americans, 2020-2025 (DGA), a Healthy Eating Index (HEI) was developed for toddlers., Objective: To evaluate the psychometric properties of the HEI-Toddlers-2020, 5 analyses relevant to construct and concurrent validity and 2 related to reliability were examined., Design: Twenty-four-hour diet recall data from the cross-sectional National Health and Nutrition Examination Survey (2011-2018) were used. In addition, exemplary menus were analyzed., Participants/setting: The main analytic sample included toddlers aged 12 through 23 months (n = 838), with additional analyses of toddlers aged 12 through 35 months (n = 1,717) from the United States. Included participants had valid diet recalls and available weight-for-age data., Main Outcome Measures: Outcomes measures included HEI-Toddlers-2020 total and component scores on menus, population distributions, and correlations., Statistical Analyses: HEI total and component scores were calculated using menus from the American Academy of Pediatrics and Healthy Eating Research. Score means and distributions were estimated using a Markov Chain Monte Carlo approach with National Health and Nutrition Examination Survey data (2011-2018). Principal component analysis explored dimensions and Pearson correlations examined components, energy, and Cronbach α. In addition, HEI-Toddlers-2020 and HEI-2020 scores were compared for identical intakes at age 24 months., Results: For validity, exemplary menus received high scores with the HEI-Toddlers-2020. The mean ± SE total HEI-Toddlers-2020 score for toddlers aged 12 through 23 months was 62.9 ± 0.78 and ranged from 40.1 to 84.4 (1 st to 99 th percentile). Correlation between diet quality and diet quantity was low (-0.15); the scree plot revealed multiple factors. In addition, total scores for identical intakes were approximately 1.5 points higher for HEI-Toddlers-2020 compared with HEI-2020 (difference range for component scores, -4.97 to 4.89). For reliability, most of the intercorrelations among components were low to moderate (0 to 0.49), with a few exceptions among related components. Cronbach α was .48. These results indicate that the index is multidimensional, with no single component driving the total score, and no unnecessary components that are highly correlated with another component., Conclusions: The results demonstrated evidence supportive of validity and reliability. The HEI-Toddlers-2020 can be used to assess alignment with the DGA for toddlers., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: High intake of ultra-processed foods (UPFs) is associated with increased risk of chronic disease; thus, it is important to understand how UPFs influence diet quality early in life., Objectives: We describe complementary foods and beverages (CFBs) according to the Nova Classification System of Food Processing for infants and toddlers in the United States and estimate how Nova groups and subgroups contribute to energy and select nutrients and food groups., Methods: We used day 1 24-h recall from infants and toddlers aged 6-23 mo from the cross-sectional, nationally representative 2013-18 National Health and Nutrition Examination Survey (n = 1140). We estimated contributions of Nova groups and subgroups to energy and select nutrients and food groups consumed as CFBs (excluding human milk and formula) using the population ratio with weighted survey commands in SAS., Results: For infants and toddlers in the United States, 42 ± 0.9% (mean ± standard error of the mean) of energy intake from CFBs came from unprocessed/minimally processed foods (U/MPFs) and 45 ± 0.8% from UPFs. U/MPFs contributed most to nutrient intakes (except iron, zinc, and sodium); ≥20% of all selected nutrients was from UPFs. UPFs contributed most to iron (75 ± 1.0%) and zinc (48 ± 1.3%); breakfast cereals were the top source. Most fruit, vegetables, and dairy were from U/MPFs. More than 80% of total grains, whole grains, refined grains, and added sugars were UPFs., Conclusions: U/MPFs support healthy dietary intake of infants and toddlers in the United States, whereas UPFs contribute meaningfully to nutrients and food groups to be encouraged (iron, zinc, and whole grains), as well as some that should be limited (added sugars and sodium). More research is needed to better understand the utility and sensitivities of using Nova for providing dietary guidance for infants and toddlers in the United States., (Published by Elsevier Inc.)

Background: Objective markers of ultraprocessed foods (UPF) may improve the assessment of UPF intake and provide insight into how UPF influences health., Objectives: To identify metabolites that differed between dietary patterns (DPs) high in or void of UPF according to Nova classification., Methods: In a randomized, crossover, controlled-feeding trial (clinicaltrials.govNCT03407053), 20 domiciled healthy participants (mean ± standard deviation: age 31 ± 7 y, body mass index [kg/m 2 ] 22 ± 11.6) consumed ad libitum a UPF-DP (80% UPF) and an unprocessed DP (UN-DP; 0% UPF) for 2 wk each. Metabolites were measured using liquid chromatography with tandem mass spectrometry in ethylenediaminetetraacetic acid plasma, collected at week 2 and 24-h, and spot urine, collected at weeks 1 and 2, of each DP. Linear mixed models, adjusted for energy intake, were used to identify metabolites that differed between DPs., Results: After multiple comparisons correction, 257 out of 993 plasma and 606 out of 1279 24-h urine metabolites differed between UPF-DP and UN-DP. Overall, 21 known and 9 unknown metabolites differed between DPs across all time points and biospecimen types. Six metabolites were higher (4-hydroxy-L-glutamic acid, N-acetylaminooctanoic acid, 2-methoxyhydroquinone sulfate, 4-ethylphenylsulfate, 4-vinylphenol sulfate, and acesulfame) and 14 were lower following the UPF-DP; pimelic acid, was lower in plasma but higher in urine following the UPF-DP., Conclusions: Consuming a DP high in, compared with 1 void of, UPF has a measurable impact on the short-term human metabolome. Observed differential metabolites could serve as candidate biomarkers of UPF intake or metabolic response in larger samples with varying UPF-DPs. This trial was registered at clinicaltrials.gov as NCT03407053 and NCT03878108., (Published by Elsevier Inc.)

Background: The degree of food processing may be an important dimension of diet in how it relates to health outcomes. A major challenge is standardizing food processing classification systems for commonly used datasets., Objectives: To standardize and increase transparency in its application, we describe the approach used to classify foods and beverages according to the Nova food processing classification in the 24-h dietary recalls from the 2001-2018 cycles of What We Eat in America (WWEIA), NHANES, and investigate variability and potential for Nova misclassification within WWEIA, NHANES 2017-2018 data via various sensitivity analyses., Methods: First, we described how the Nova classification system was applied to the 2001-2018 WWEIA, NHANES data using the reference approach. Second, we calculated the percentage energy from Nova groups [1: unprocessed or minimally processed foods, 2: processed culinary ingredients, 3: processed foods, and 4: ultraprocessed foods (UPFs)] for the reference approach using day 1 dietary recall data from non-breastfed participants aged ≥1 y from the 2017-2018 WWEIA, NHANES. We then conducted 4 sensitivity analyses comparing potential alternative approaches (e.g., opting for more vs. less degree of processing for ambiguous items) to the reference approach, to assess how estimates differed., Results: The energy contribution of UPFs using the reference approach was 58.2% ± 0.9% of the total energy; unprocessed or minimally processed foods contributed 27.6% ± 0.7%, processed culinary ingredients contributed 5.2% ± 0.1%, and processed foods contributed 9.0% ± 0.3%. In sensitivity analyses, the dietary energy contribution of UPFs ranged from 53.4% ± 0.8% to 60.1% ± 0.8% across alternative approaches., Conclusions: We present a reference approach for applying the Nova classification system to WWEIA, NHANES 2001-2018 data to promote standardization and comparability of future research. Alternative approaches are also described, with total energy from UPFs differing by ∼6% between approaches for 2017-2018 WWEIA, NHANES., (Copyright © 2022 American Society for Nutrition. All rights reserved.)

Many research questions focused on characterizing usual, or long-term average, dietary intake of populations and subpopulations rely on short-term intake data. The objective of this paper is to review key assumptions, statistical techniques, and considerations underpinning the use of short-term dietary intake data to make inference about usual dietary intake. The focus is on measurement error and strategies to mitigate its effects on estimated characteristics of population-level usual intake, with attention to relevant analytic issues such as accounting for survey design. Key assumptions are that short-term assessments are subject to random error only (i.e., unbiased for individual usual intake) and that some aspects of the error structure apply to all respondents, allowing estimation of this error structure in data sets with only a few repeat measures per person. Under these assumptions, a single 24-hour dietary recall per person can be used to estimate group mean intake; and with as little as one repeat on a subsample and with more complex statistical techniques, other characteristics of distributions of usual intake, such as percentiles, can be estimated. Related considerations include the number of days of data available, skewness of intake distributions, whether the dietary components of interest are consumed nearly daily by nearly everyone or episodically, the number of correlated dietary components of interest, time-varying nuisance effects related to day of week and season, and variance estimation and inference. Appropriate application of assumptions and recommended statistical techniques allows researchers to address a range of research questions, though it is imperative to acknowledge systematic error (bias) in short-term data and its implications for conclusions., (Copyright © 2022 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Importance: The childhood obesity rate has been steadily rising among US youths during the past 2 decades. Increasing evidence links consumption of ultraprocessed foods to excessive calorie consumption and weight gain, but trends in the consumption of ultraprocessed foods among US youths have not been well characterized., Objective: To characterize trends in the consumption of ultraprocessed foods among US youths., Design, Setting, and Participants: Serial cross-sectional analysis using 24-hour dietary recall data from a nationally representative sample of US youths aged 2-19 years (n = 33 795) from 10 cycles of the National Health and Nutrition Examination Survey (NHANES) from 1999-2000 to 2017-2018., Exposures: Secular time., Main Outcomes and Measures: Percentage of total energy consumed from ultraprocessed foods as defined by NOVA, an established food classification system that categorizes food according to the degree of food processing., Results: Dietary intake from youths were analyzed (weighted mean age, 10.7 years; 49.1% were girls). From 1999 to 2018, the estimated percentage of total energy from consumption of ultraprocessed foods increased from 61.4% to 67.0% (difference, 5.6% [95% CI, 3.5% to 7.7%]; P < .001 for trend), whereas the percentage of total energy from consumption of unprocessed or minimally processed foods decreased from 28.8% to 23.5% (difference, -5.3% [95% CI, -7.5% to -3.2%]; P < .001 for trend). Among the subgroups of ultraprocessed foods, the estimated percentage of energy from consumption of ready-to-heat and -eat mixed dishes increased from 2.2% to 11.2% (difference, 8.9% [95% CI, 7.7% to 10.2%]) and from consumption of sweet snacks and sweets increased from 10.7% to 12.9% (difference, 2.3% [95% CI, 1.0% to 3.6%]), but the estimated percentage of energy decreased for sugar-sweetened beverages from 10.8% to 5.3% (difference, -5.5% [95% CI, -6.5% to -4.5%]) and for processed fats and oils, condiments, and sauces from 7.1% to 4.0% (difference, -3.1% [95% CI, -3.7% to -2.6%]) (all P < .05 for trend). There was a significantly larger increase in the estimated percentage of energy from consumption of ultraprocessed foods among non-Hispanic Black youths (from 62.2% to 72.5%; difference, 10.3% [95% CI, 6.8% to 13.8%]) and Mexican American youths (from 55.8% to 63.5%; difference, 7.6% [95% CI, 4.4% to 10.9%]) than the increase among non-Hispanic White youths (from 63.4% to 68.6%; difference, 5.2% [95% CI, 2.1% to 8.3%]) (P = .04 for trends)., Conclusions and Relevance: Based on the NHANES cycles from 1999 to 2018, the estimated proportion of energy intake from consumption of ultraprocessed foods has increased among youths in the US and has consistently comprised the majority of their total energy intake.

Background: Limited information is available on added sugars consumption in US infants and toddlers., Objectives: To present national estimates of added sugars intake among US infants and toddlers by sociodemographic characteristics, to identify top sources of added sugars, and to examine trends in added sugars intake., Design: Cross-sectional analysis of 1 day of 24-hour dietary recall data., Participants/setting: A nationally representative sample of US infants aged 0 to 11 months and toddlers aged 12 to 23 months (n=1,211) during the period from 2011 through 2016 from the National Health and Nutrition Examination Survey. Trends were assessed from 2005-2006 through 2015-2016 (n=2,795)., Main Outcome Measures: Among infants and toddlers, the proportion consuming any added sugars, the average amount of added sugars consumed, percent of total energy from added sugars, and top sources of added sugars intake., Statistical Analysis: Paired t tests were used to compare differences by age, sex, race/Hispanic origin, family income level, and head of household education level. Trends were tested using orthogonal polynomials. Significance was set at P<0.05., Results: During 2011 to 2016, 84.4% of infants and toddlers consumed added sugars on a given day. A greater proportion of toddlers (98.3%) consumed added sugars than infants (60.6%). The mean amount of added sugars toddlers consumed was also more compared with infants (5.8 vs 0.9 tsp). Non-Hispanic black toddlers (8.2 tsp) consumed more added sugars than non-Hispanic Asian (3.7 tsp), non-Hispanic white (5.3 tsp), and Hispanic (5.9 tsp) toddlers. A similar pattern was observed for percent energy from added sugars. For infants, top sources of added sugars were yogurt, baby food snacks/sweets, and sweet bakery products; top sources among toddlers were fruit drinks, sugars/sweets, and sweet bakery products. The mean amount of added sugars decreased from 2005-2006 through 2015-2016 for both age groups; however, percent energy from added sugars only decreased among infants., Conclusion: Added sugars intake was observed among infants/toddlers and varied by age and race and Hispanic origin. Added sugars intake, as a percent of energy, decreased only among infants from 2005 to 2016., (Published by Elsevier Inc.)

The 2015-2020 Dietary Guidelines for Americans (1) recommend consuming two servings of seafood, including fish and shellfish, per week. Consuming approximately 8 ounces of a variety of seafood weekly is associated with reduced cardiac deaths (2). This report describes the percentage of U.S. adults and youth who reported consuming seafood at least two times per week by sex, age, and race and Hispanic origin during 2013-2016. Trends in the percentage of adults and youth who consumed seafood at least twice weekly, from 2005-2006 through 2015-2016, are also presented., (All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.)

We estimated iodine status (median urinary iodine concentration (mUIC (&micro;g/L))) for the US population (6 years and over; n = 4613) and women of reproductive age (WRA) (15⁻44 years; n = 901). We estimated mean intake of key iodine sources by race and Hispanic origin. We present the first national estimates of mUIC for non-Hispanic Asian persons and examine the intake of soy products, a potential source of goitrogens. One-third of National Health and Nutrition Examination Survey (NHANES) participants in 2011⁻2014 provided casual urine samples; UIC was measured in these samples. We assessed dietary intake with one 24-h recall and created food groups using the USDA&rsquo;s food/beverage coding scheme. For WRA, mUIC was 110 &micro;g/L. For both non-Hispanic white (106 &micro;g/L) and non-Hispanic Asian (81 &micro;g/L) WRA mUIC was significantly lower than mUIC among Hispanic WRA (133 &micro;g/L). Non-Hispanic black WRA had a mUIC of 124 &micro;g/L. Dairy consumption was significantly higher among non-Hispanic white (162 g) compared to non-Hispanic black WRA (113 g). Soy consumption was also higher among non-Hispanic Asian WRA (18 g compared to non-Hispanic black WRA (1 g). Differences in the consumption pattern of key sources of iodine and goitrogens may put subgroups of individuals at risk of mild iodine deficiency. Continued monitoring of iodine status and variations in consumption patterns is needed., Competing Interests: The authors declare no conflict of interest.

Objective: Differences in bottled v. tap water intake may provide insights into health disparities, like risk of dental caries and inadequate hydration. We examined differences in plain, tap and bottled water consumption among US adults by sociodemographic characteristics., Design: Cross-sectional analysis. We used 24 h dietary recall data to test differences in percentage consuming the water sources and mean intake between groups using Wald tests and multiple logistic and linear regression models., Setting: National Health and Nutrition Examination Survey (NHANES), 2007-2014., Subjects: A nationally representative sample of 20 676 adults aged ≥20 years., Results: In 2011-2014, 81·4 (se 0·6) % of adults drank plain water (sum of tap and bottled), 55·2 (se 1·4) % drank tap water and 33·4 (se 1·4) % drank bottled water on a given day. Adjusting for covariates, non-Hispanic (NH) Black and Hispanic adults had 0·44 (95 % CI 0·37, 0·53) and 0·55 (95 % CI 0·45, 0·66) times the odds of consuming tap water, and consumed B=-330 (se 45) ml and B=-180 (se 45) ml less tap water than NH White adults, respectively. NH Black, Hispanic and adults born outside the fifty US states or Washington, DC had 2·20 (95 % CI 1·79, 2·69), 2·37 (95 % CI 1·91, 2·94) and 1·46 (95 % CI 1·19, 1·79) times the odds of consuming bottled water than their NH White and US-born counterparts. In 2007-2010, water filtration was associated with higher odds of drinking plain and tap water., Conclusions: While most US adults consumed plain water, the source (i.e. tap or bottled) and amount differed by race/Hispanic origin, nativity status and education. Water filters may increase tap water consumption.

Background: To our knowledge, few studies have described the usual nutrient intakes of US children aged <2 y or assessed the nutrient adequacy of their diets relative to the recommended Dietary Reference Intakes (DRIs)., Objective: We estimated the usual nutrient intake of US children aged 6-23 mo examined in NHANES 2009-2012 and compared them to age-specific DRIs as applicable., Design: Dietary intake was assessed with two 24-h recalls for infants aged 6-11 mo (n = 381) and toddlers aged 12-23 mo (n = 516) with the use of the USDA's Automated Multiple-Pass Method. Estimates of usual nutrient intakes from food and beverages were obtained with the use of the National Cancer Institute method. The proportions of children with intakes below and above the DRI were also estimated., Results: The estimated usual intakes of infants were adequate for most nutrients; however, 10% had an iron intake below the Estimated Average Requirement (EAR), and only 21% had a vitamin D intake that met or exceeded the recommended Adequate Intake (AI). More nutrient inadequacies were noted among toddlers; 1 in 4 had a lower-than-recommended fat intake (percentage of energy), and most had intakes that were below the EAR for vitamins E (82%) and D (74%). Few toddlers (<1%) met or exceeded the AI for fiber and potassium. In contrast, 1 in 2 had sodium intakes that exceeded the Tolerable Upper Intake Level (UL); ≥16% and 41% of the children had excessive intakes (greater than the ULs) of vitamin A and zinc, respectively., Conclusions: The estimated usual intakes of infants were adequate for most nutrients. Most toddlers were at risk for inadequate intakes of vitamins D and E and had diets low in fiber and potassium. The sources contributing to excessive intakes of vitamin A and zinc among infants and toddlers may need further evaluation., (© 2016 American Society for Nutrition.)

Objectives: To describe the contribution of whole fruit, including discrete types of fruit, to total fruit consumption and to investigate differences in consumption by sociodemographic characteristics., Methods: We analyzed data from 3129 youth aged 2 to 19 years from the National Health and Nutrition Examination Survey, 2011 to 2012. Using the Food Patterns Equivalents Database and the What We Eat in America 150 food groups, we calculated the contribution of whole fruit, 100% fruit juices, mixed fruit dishes, and 12 discrete fruit and fruit juices to total fruit consumption. We examined differences by age, gender, race and Hispanic origin, and poverty status., Results: Nearly 90% of total fruit intake came from whole fruits (53%) and 100% fruit juices (34%) among youth aged 2 to 19 years. Apples, apple juice, citrus juice, and bananas were responsible for almost half of total fruit consumption. Apples accounted for 18.9% of fruit intake. Differences by age were predominately between youth aged 2 to 5 years and 6 to 11 years. For example, apples contributed a larger percentage of total fruit intake among youth 6 to 11 years old (22.4%) than among youth 2 to 5 years old (14.6%), but apple juice contributed a smaller percentage (8.8% vs 16.8%), P < .05. There were differences by race and Hispanic origin in intake of citrus fruits, berries, melons, dried fruit, and citrus juices and other fruit juices., Conclusions: These findings provide insight into what fruits US youth are consuming and sociodemographic factors that may influence consumption., (Copyright © 2015 by the American Academy of Pediatrics.)

There is increasing concern about potential adverse effects of caffeine in children. Our understanding of caffeine intake relies on studies dating to the late 1990s. This article synthesizes information from national studies since then to describe caffeine consumption, its association with sociodemographic factors, key dietary sources including caffeine-containing energy drinks (CCEDs), and trends in caffeine intake and sources among US children. Findings from the Kanter Worldpanel (KWP) Beverage Consumption Panel and the NHANES showed that caffeine consumption prevalence was generally consistent across studies and over time; more than one-half of 2- to 5-y-olds and ∼75% of older children (>5 y) consumed caffeine. The usual intakes of caffeine were 25 and 50 mg/d for children and adolescents aged 2-11 and 12-17 y, respectively (NHANES 2007-2010). Caffeine consumption correlated with age and was higher in non-Hispanic white children. The key sources of caffeine were soda and tea as well as flavored dairy (for children aged <12 y) and coffee (for those aged ≥12 y). The frequency of CCED use varied (2-30%) depending on study setting, methods, and demographic characteristics. A statistically significant but small decline in caffeine intake was noted in children overall during the 10- to 12-y period examined; intakes remained stable among older children (≥12 y). A significant increasing trend in CCED and coffee consumption and a decline in soda intake were noted (1999-2010). In 2009-2010, 10% of 12- to 19-y-olds and 10-25% of caffeine consumers (aged 12-19 y) had intakes exceeding Canadian maximal guidelines. Continued monitoring can help better understand changes in caffeine consumption patterns of youth., (© 2015 American Society for Nutrition.)

Background: Because of the increasing concern of the potential adverse effects of caffeine intake in children, recent estimates of caffeine consumption in a representative sample of children are needed., Objectives: We provide estimates of caffeine intake in children in absolute amounts (mg) and in relation to body weight (mg/kg) to examine the association of caffeine consumption with sociodemographic factors and describe trends in caffeine intake in children in the United States., Design: We analyzed caffeine intake in 3280 children aged 2-19 y who participated in a 24-h dietary recall as part of the NHANES, which is a nationally representative survey of the US population with a cross-sectional design, in 2009-2010. Trends over time between 2001 and 2010 were examined in 2-19-y-old children (n = 18,530). Analyses were conducted for all children and repeated for caffeine consumers., Results: In 2009-2010, 71% of US children consumed caffeine on a given day. Median caffeine intakes for 2-5-, 6-11-, and 12-19-y olds were 1.3, 4.5, and 13.6 mg, respectively, and 4.7, 9.1, and 40.6 mg, respectively, in caffeine consumers. Non-Hispanic black children had lower caffeine intake than that of non-Hispanic white counterparts. Caffeine intake correlated positively with age; this association was independent of body weight. On a given day, 10% of 12-19-y-olds exceeded the suggested maximum caffeine intake of 2.5 mg/kg by Health Canada. A significant linear trend of decline in caffeine intake (in mg or mg/kg) was noted overall for children aged 2-19 y during 2001-2010. Specifically, caffeine intake declined by 3.0 and 4.6 mg in 2-5- and 6-11-y-old caffeine consumers, respectively; no change was noted in 12-19-y-olds., Conclusion: A majority of US children including preschoolers consumed caffeine. Caffeine intake was highest in 12-19-y-olds and remained stable over the 10-y study period in this age group., (© 2014 American Society for Nutrition.)

Recent studies have linked maternal consumption of an unbalanced high-protein, low-carbohydrate diet in late pregnancy with raised adult blood pressure in the offspring. Because high-protein diets stimulate the hypothalamic-pituitary-adrenal axis, we hypothesized that an unbalanced maternal diet might increase maternal cortisol levels, exposing the fetus to excess cortisol and programming lifelong hypersecretion of cortisol. We therefore measured fasting plasma cortisol concentrations in 251 subjects, 28-30 yr old, whose mothers had been advised to eat 0.45 kg of red meat daily during pregnancy and avoid carbohydrate-rich foods. Cortisol concentrations were higher in subjects with lower body mass index (P < 0.0001) and in those who reported recent vigorous activity (P = 0.03) and greater alcohol consumption (P = 0.004). Allowing for gender, current body mass index, activity, and alcohol consumption, cortisol concentrations increased 5.4% per portion of maternal meat/fish consumption per day (P = 0.03), decreased 3.3% per portion of maternal green vegetable consumption per week (P = 0.14), and were 12.2% higher in those born into manual social class families (P = 0.03). The specific advice given to mothers in this study precludes direct application to other populations, but the findings provide the first human evidence that an unbalanced maternal diet during late pregnancy may program lifelong hypercortisolemia in the offspring.

Complementary foods and beverages (CFBs) are key components of an infants diet in the second 6 months of life. This article summarizes nutrition and feeding practices examined by the 2020 Dietary Guidelines Advisory Committees during the CFB life stage. Breastfeeding initiation is high (84%), but exclusive breastfeeding at 6 months (26%) is below the Healthy People 2030 goal (42%). Most infants (51%) are introduced to CFBs sometime before 6 months. The primary mode of feeding (ie, human milk fed [HMF]; infant formula or mixed formula and human milk fed [FMF]) at the initiation of CFBs is associated with the timing of introduction and types of CFBs reported. FMF infants (42%) are more likely to be introduced to CFBs before 4 months compared with HMF infants (19%). Different dietary patterns, such as higher prevalence of consumption and mean amounts, were observed, including fruit, grains, dairy, proteins, and solid fats. Compared with HMF infants of the same age, FMF infants consume more total energy (845 vs 631 kcal) and protein (22 vs 12 g) from all sources, and more energy (345 vs 204 kcal) and protein (11 vs 6 g) from CFBs alone. HMF infants have a higher prevalence of risk of inadequate intakes of iron (77% vs 7%), zinc (54% vs

Background High energy intake from non–nutrient-dense sources correlates with poorer diet quality. Objectives The aims were to 1) estimate total energy intake and energy from solid fats and added sugars combined (SoFAS) and identify their top food category sources for ages 2–18 y in 2015–2018 and 2) describe trends over time in 2009–2018. Methods Data were from the NHANES. Pairwise differences were examined using univariate t statistics (2015–2018, n  = 5038), and trends by age and over time (2009–2018, n  = 14,038) were examined using orthogonal polynomials. Results In 2015–2018, SoFAS contributed a mean (SE) of 30.0% (0.3%) of total energy. Solid fats [16.1% (0.2%)] and added sugars [13.8% (0.2%)] each contributed >10%. The contribution of added sugars increased with age from 11.1% (2–3 y) to 14.4% (14–18 y), and was higher for all other race/Hispanic origins than non-Hispanic Asians. The top 5 sources of energy were sweet bakery products, savory snacks, pizza, other mixed dishes, and unflavored milk, and for SoFAS also included soft drinks, other desserts, candy, and snack bars. Total energy did not change between 2009 and 2018, but energy from SoFAS, and servings of solid fats, and added sugars declined. The contribution of unflavored milk to total energy declined for all ages and most race/Hispanic origins. Fruit drinks (all ages) and soft drinks (9–18 y) remained among top added sugars sources despite declines. The contribution of sweet bakery products to energy from SoFAS increased for most ages and candy and snack bars to energy from added sugars. Conclusions In 2015–2018, SoFAS contributed >30% of total energy for ages 2–18 y, which doubled the Dietary Guidelines for Americans' recommended limit of 15%. The top 5 sources of total energy were similar to those of solid fats, and those of SoFAS similar to those of added sugars. These results may inform public health efforts for improving diet quality. [ABSTRACT FROM AUTHOR]

Background: Standardized methods are needed to investigate intake patterns of processed meat subtypes, considering health concerns surrounding processed meat intake.Objectives: The objectives of this study were to create a standardized method of disaggregating processed meat into processed red meat and processed poultry and describe intake patterns of the US population aged ≥2 y.Methods: Two researchers independently manually disaggregated processed meat from the Food Patterns Equivalents Database into processed red meat and processed poultry based on available information from the Foods and Nutrient Database for Dietary Studies. We created an SAS program (called Processed Meat Categories) to mimic the manual coding. We used the program to describe intake patterns and trends over time of processed red meat and processed poultry using 24-h recalls from 2007-2008 through 2017-2018 NHANES data with SAS survey-weighted procedures for complex surveys.Results: The SAS program had high agreement with the manual code (Pearson concordance correlation ≥0.95). Of the US population aged ≥2 y, 46.8% (95% CI: 45.3, 48.2%) reported consuming any processed meat, 42.5% (95% CI: 41.0, 43.9%) reported consuming processed red meat, and 11.3% (95% CI: 10.2, 12.4%) reported consuming processed poultry. Most [74.1 ± 0.13% (SEM)] processed meat reported was red meat compared with poultry, and 32.1 ± 0.01% of total red meat and 13.7 ± 0.01% of total poultry reported were processed. Prevalence of processed poultry intake increased from 9.5% (95% CI: 8.9, 10.1%) in 2007-2010 to 11.3% (95% CI: 10.2, 12.4%) in 2015-2018 (P < 0.0001), but mean intake amount did not change. Prevalence of processed red meat intake did not change over time, but mean intake decreased from 0.8 ± 0.03 ounce-equivalents in 2007-2010 to 0.7 ± 0.02 ounce-equivalents (P = 0.0058) in 2015-2018.Conclusions: The Processed Meat Categories SAS program is a tool available for researchers to standardize estimates of processed meat subtypes for future dietary patterns research. Intake of total processed meat did not change in the United States, but intake amount of processed red meat decreased and the prevalence of processed poultry consumers increased. [ABSTRACT FROM AUTHOR]

Background Vitamin D is important for bone health; in 2014 it was the fifth most commonly ordered laboratory test among Medicare Part B payments. Objectives The aim of this study was to describe vitamin D status in the US population in 2011–2014 and trends from 2003 to 2014. Methods We used serum 25-hydroxyvitamin D data from NHANES 2011–2014 (n  = 16,180), and estimated the prevalence at risk of deficiency (<30 nmol/L) or prevalence at risk of inadequacy (30–49 nmol/L) by age, sex, race and Hispanic origin, and dietary intake of vitamin D. We also present trends between 2003 and 2014. Results In 2011–2014, the percentage aged ≥1 y at risk of vitamin D deficiency or inadequacy was 5.0% (95% CI: 4.1%, 6.2%) and 18.3% (95% CI: 16.2%, 20.6%). The prevalence of at risk of deficiency was lowest among children aged 1–5 y (0.5%; 95% CI: 0.3%, 1.1%), peaked among adults aged 20–39 y (7.6%; 95% CI: 6.0%, 9.6%), and fell to 2.9% (95% CI: 2.0%, 4.0%) among adults aged ≥60 y; the prevalence of at risk of inadequacy was similar. The prevalence of at risk of deficiency was higher among non-Hispanic black (17.5%; 95% CI: 15.2%, 20.0%) than among non-Hispanic Asian (7.6%; 95% CI: 5.9%, 9.9%), non-Hispanic white (2.1%; 95% CI: 1.5%, 2.7%), and Hispanic (5.9%; 95% CI: 4.4%, 7.8%) persons; the prevalence of at risk of inadequacy was similar. Persons with higher vitamin D dietary intake or who used supplements had lower prevalences of at risk of deficiency or inadequacy. From 2003 to 2014 there was no change in the risk of vitamin D deficiency; the risk of inadequacy declined from 21.0% (95% CI: 17.9%, 24.5%) to 17.7% (95% CI: 16.0%, 19.7%). Conclusion The prevalence of at risk of vitamin D deficiency in the United States remained stable from 2003 to 2014; at risk of inadequacy declined. Differences in vitamin D status by race and Hispanic origin warrant additional investigation. [ABSTRACT FROM AUTHOR]

We examined consumption of different types of infant formula (eg, cow’s milk, soy, gentle/lactose-reduced, and specialty) and regular milk among a nationally representative sample of 1864 infants, 0 to 12 months old, from the National Health and Nutrition Examination Survey, 2003-2010. Among the 81% of infants who were fed formula or regular milk, 69% consumed cow’s milk formula, 12% consumed soy formula, 5% consumed gentle/ lactose-reduced formulas, 6% consumed specialty formulas, and 13% consumed regular milk products. There were differences by household education and income in the percentage of infants consuming cow’s milk formula and regular milk products. The majority of infants in the United States who were fed formula or regular milk consumed cow’s milk formula (69%), with lower percentages receiving soy, specialty, gentle/sensitive, or lactose-free/reduced formulas. Contrary to national recommendations, 13% of infants younger than 1 year consumed regular milk, and the percentage varied by household education and income levels. [ABSTRACT FROM AUTHOR]

The period from birth to 24 mo (B-24) is a critical phase in which nutrient requirements for growth and development are high and several transitions in food consumption practices occur. A few largescale national studies (eg, the Feeding Infants and Toddlers Study and Infant Feeding Practices Study) offer important insights into infant feeding practices and food consumption patterns in young children in the United States. The NHANES collects comprehensive cross-sectional data on the nutrition and health of Americans including infants and toddlers. This article describes the NHANES program and data from NHANES 1999-2010 on young children that are relevant for the B-24 Project. NHANES is a nationally representative survey of the noninstitutionalized US population that combines personal interviews with standardized physical examination and measurements via mobile examination centers. Data on infant feeding practices (breastfeeding and timing of introduction and nature of complementary foods), dietary intake (two 24-h recalls), and nutrient supplements are collected. Data on demographic characteristics, anthropometric measurements, biomarkers of nutrient status, food security, and participation in federal nutrition programs are also available. Data can be accessed online, downloaded, and pooled over several survey cycles, allowing examination of infant feeding practices, food and nutrient intakes, and nutritional status of Americans, 2 y old. Subgroup analyses by race-ethnicity and income status are also possible. NHANES responds to evolving data needs, as feasible, in the context of the survey design, research priorities, and funding. It offers a vehicle for potentially gathering additional data on children ,2 y to address the objectives of the B-24 Project in the future. [ABSTRACT FROM AUTHOR]

Accurately estimating portion sizes remains a challenge in dietary assessment. Digital images used in online 24-hour dietary recalls may be conducive to accuracy. The current analyses were conducted to examine the accuracy of portion size estimation by women with low incomes who completed 24-hour dietary recalls using the online Automated Self-Administered 24-hour Dietary Assessment Tool (ASA24) in the Food and Eating Assessment Study II. True dietary intake was observed for 3 meals on 1 day through a controlled feeding study conducted from May through July 2016. The following day, participants completed an unannounced 24-hour dietary recall using ASA24, independently or with assistance in a small-group setting. Participants included 302 women aged 18 to 82 years living in the Washington, DC, area who met the income thresholds for the Supplemental Nutrition Assistance Program. The accuracy of portion size estimation was assessed by comparing the weight truly consumed (observed) and the weight reported for predetermined categories of foods and beverages. The differences between observed and reported portions were examined and linear regression tested differences by recall condition. Analyses were conducted by condition and repeated with stratification by racial/ethnic identity, education, and body mass index. On average across foods and beverages, reported portion sizes were 7.4 g (95% CI, 4.3-10.5) and 6.4 g (95% CI, 2.8-10.0) higher than observed portion sizes in the independent and assisted conditions, respectively. Portion sizes were overestimated for small pieces and shaped foods in both conditions, as well as for amorphous/soft foods in the assisted condition and underestimated for single-unit foods in both conditions. Misestimation was fairly consistent by participants' race/ethnicity, education, and body mass index, to varying magnitudes. Women with low incomes overestimated the amounts of foods and beverages consumed across several categories using online 24-hour dietary recalls with digital images to support portion size estimation. Assistance with ASA24 had little impact on accuracy. [ABSTRACT FROM AUTHOR]