Studies of Infant and Toddler Populations
Table 3.3 presents
summary data from several epidemiologic surveys collecting food and supplement
intake data from infant and/or toddler populations. More information on
the specific surveys is included in Table
3.4. The two most recent US nutrition monitoring surveys, the 1999-2000
National Health and Nutrition Examination Survey (NHANES) and the 1994-96
Continuing Survey of Food Intake of Individuals (CSFII), each included
24HR (24-Hour
Recall) interviews to assess food and beverage intake. Information
on the milk intake of breastfed infant was limited to the time each breastfeeding
began. Standardized probes solicited detail on type of formula, preparation
method, and amount consumed as well as amount and type of complementary
food consumed by the infant or toddler. Interviews were conducted with
the child's parent or a parent-designated proxy. If intake of food or
amount was not known, data retrieval was conducted with the caretaker
or day care center. Table
2.5 presents the diet-related questions in each of these surveys as
well as in the integrated What We Eat in America-NHANES survey, which
is currently in the field. The rationale for selecting the instrument
for the integrated survey as well as the history of past CSFII and NHANES
surveys was recently reviewed (9).
The integrated What We Eat in America-NHANES includes two 24HR interviews,
one in-person and one by telephone for children under 2 years. Supplement
use is queried in a separate questionnaire on frequency, dosage, and duration
of use of specific products.
The 1994 (106)
and 2003 (107)
surveys of US infants sponsored by Gerber Products Company also used a
cross-sectional approach, but differed in dietary assessment method. The
earlier survey collected 4-day estimated FR (Food
Record) from 1,658 mothers of infants and toddlers, while the recent
Feeding Infants and Toddler Study collected a telephone-administered,
24HR interview with the mothers of 2,025 children and a second 24HR in
a 23 percent sub-sample.
Most of the other large studies used a longitudinal approach to dietary
assessment during the first 12 months of life, with many continuing data
collection through 2 years or longer. Three large European studies collected
weighed or estimated food records at various time intervals (109;112;113;116;117;124).
The most rigorous are the German DONALD study which collected 3-day weighed
FRs at 3, 6, 9, and 12 months and then annually (124;125), and the Adelaide
Nutrition Study (117) in South Australia, in which parents completed 7-day
weighed FRs four times between 3 and 24 months. A number of studies paired
other assessment measures with infant feeding practices questionnaires
that parents completed periodically and returned by mail. For example,
the Bogalusa Newborn-Infant Cohort Study (118) mailed monthly infant feeding
practices questionnaires with food checklists to parents for the first
four months and then had interviewers administer a questionnaire at 6
and 12 months. This was paired with a 24HR recall interview in a subset
of participants at 6 and 12 months and then annually.
Maternal test weighing of breastfed infants and 24-hour breast milk
sample collection was successful in a longitudinal study of 73 breastfed
and 43 formula-fed infants from middle- and upper-income households participating
in The DARLING Study (119), conducted by the University of California
at Davis. This cohort was followed longitudinally 18 months. Carruth and
colleagues (120) have been successful in following a cohort of infants
from middle and upper socioeconomic status households for the completion
of ten 4HR and usual intake interviews in the home over a 22 month period.
As is evident from the Table 3.3 and Table 3.4, most literature reviewed
did not discuss supplement intake assessment methods.
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