Poor Quality Diets Characterized by Low-Nutrient Density Foods Observed in One-Quarter of 2-Year-Olds in a High Resource Setting

Abstract

Background: Young children have high nutritional requirements relative to their body size, making healthy diets critical for normal growth and development.

Objective: We aimed to integrate analysis of dietary patterns among 2-y-old children with indicators of dietary quality, micronutrient status, and body weight status.

Methods: Data from the 2-y follow-up of the Cork BASELINE Birth Cohort included dietary assessment using a 2-d weighed food diary, vitamin D and iron status biomarkers, and anthropometry (n = 468). K-means cluster analysis identified predominant dietary patterns based on energy contributions and associations with nutrient intakes and status and body weight were investigated.

Results: Four dietary patterns emerged: "Cows' milk" (unmodified cows' milk: 32% of total energy (TE)); "Traditional" (wholemeal breads, butter, fresh meat, fruit); "Low Nutrient Density (LND) foods" (confectionary, processed meat, convenience foods) and "Formula" (young child formula: 23%TE). The LND pattern was associated with excessive free sugar intake (14%TE) and salt intake (153% of daily limit). No differences in patterns of overweight were observed between the 4 groups; however, the LND group had 3-fold higher odds of being underweight [aOR (95% CI): 3.2 (1.2, 8.5)]. Children consuming >400ml/d of cows' milk or formula exhibited lower dietary variety, fewer family-type meals, and continued use of feeding bottles (75% and 81%, respectively, vs. 35-37% in the other groups).

Conclusions: Unhealthy eating habits are common among young children. Dietary guidance to support families to provide healthy diets needs to maintain currency with eating habits and focus on food choices for meals, snacks, and beverages.

Keywords: body weight; diet quality; dietary patterns; iron; preschool children; vitamin D.