Are one-year-olds in Australia eating right? New study reveals nutrient gaps

New research from the ORIGINS study shows that while toddlers in Australia meet many dietary targets, some, especially those who are breastfed, are falling short on critical nutrients like iodine.

Study: ORIGINS: Nutritional Profile of Children Aged One Year in a Longitudinal Birth Cohort. Image Credit: Evgeniia Primavera / Shutterstock

The diet consumed during the first year of life is vital to the child’s growth and development. A recent paper in the journal Nutrients, based on data from the ORIGINS study, assessed the dietary intake of children aged one year and compared it to the national reference values for Australia.

Introduction

It is essential that infants get enough to sustain the rapid pace of growth and development during the first year of life. The lack of one or more nutrients may seriously impact proper physical, mental, and psychological development, increase the child’s risk of infectious disease, and cause failure to thrive.

Breastmilk, or infant formula, is sufficient for the first six months of life, after which complementary foods must be introduced. This change, called weaning, is essential to providing very young children with the nutrients needed for growth.

Food habits, consumption patterns, and dietary trends vary enormously over the first few years of life. Several Australian studies suggest that children under the age of two are not getting enough iron and zinc and are consuming too much sodium. Population-level data is essential for a comprehensive picture of how young children are actually being fed and whether their intake meets national dietary guidelines.

The current study is a cross-sectional evaluation covering children aged one year in Western Australia who are part of the ORIGINS cohort. This is a birth cohort being followed over time. It includes over 10,000 families from the Joondalup and Wanneroo communities.

This study included 779 children, with a mean age of 12 months, though nutrient analysis was restricted to 538 children for technical reasons. The aim was to understand the nutritional picture and the status of breastfeeding compared to the intake of infant formula, cow’s milk, and solid foods. A short Food Frequency Questionnaire (FFQ) assessed the child’s dietary intake.

Study findings

In this group, most infants (94%) were breastfed, but 22% practiced exclusive breastfeeding for the first six months. This may be because of the high socioeconomic status of mothers in this cohort, which led to their earlier return to paid employment.

At 12 months, 42% continued to receive breast milk. On average, the duration of breastfeeding was five months, with three feeds a day being the median at one year.

Formula consumption was reported in 79% of children, but only 6% were exclusively formula fed for the first six months. At one year, 58% were still on formula, with three formula feeds per day being the median at one year.

Additionally, 43% drank cow’s milk at one year, the average being one daily feed. Nearly all children were given solid foods by one year, beginning at or after six months for the most part. At one year of age, 89.7% of children were eating all the food the caregiver was consuming, which indicates a broad exposure to family foods rather than necessarily finishing all food offered.

More than 90% of children were introduced to foods often associated with allergy, like peanuts, cow’s milk, eggs, wheat, fish, and peanuts, and 9% of the children were reported to be allergic to at least one food. However, exposure to cashew nuts was lower, with just over half of the children (52%) having been introduced to them by one year.

Energy intake

Breastfed children (both sexes) had energy intakes below the estimated energy requirements (EER), while their non-breastfed counterparts met the EER. Carbohydrate intake exceeded the adequate intake (AI) threshold of 95 g, irrespective of breastfeeding.

The average daily protein intake was three times higher than the estimated average requirement (EAR) in both breastfed and non-breastfed children. This may be due to an error in the data collection, leading to overestimation. Fat intake was somewhat less than the AI threshold, as was fiber consumption per day.

However, over 25% of breastfed and nearly 50% of non-breastfed children were reported to be consuming excess fat. The case was similar with fiber intake, with about 39% of breastfed and 24% of non-breastfed children consuming more than the AI for fiber daily.

Several micronutrients were more likely to be deficient among breastfed children, including iron, calcium, folate, and iodine. While 42% had too little calcium, 75% lacked adequate iodine intake. The lower energy intake and consumption of iodine, iron, and calcium in the breastfed vs. non-breastfed group are explained by the failure to account for the nutritional value of breastmilk in the food frequency questionnaire used here.

Food group recommendations were not met in either group. Breastfed children had a lower daily intake of dairy at <1 serving a day vs 2 servings a day among the non-breastfed. Of course, children getting their nutrition from breastmilk would not drink dairy products to the same extent as non-breastfed children.

Fruit consumption was excessive, and non-breastfed children consumed too much dairy foods. Poultry and lean meat were being given according to the national guidelines, but not grains and vegetables.

Both groups were given discretionary foods despite the recommendation to totally avoid them at this age. Discretionary foods are often snacks that are high in fat and sodium and may lead to hypertension and cardiovascular disease later in life. Reducing fruit intake may allow for the consumption of foods from other food groups.

It is important to note that the study cohort was predominantly of high socioeconomic status and Caucasian ethnicity, which may limit the generalizability of these findings to the broader population.

Conclusions

The study demonstrates that children aged one year are getting most micronutrients in adequate amounts, meeting the national recommendations. However, iodine consumption was inadequate in the breastfed cohort, and sodium consumption was high overall.

The diet was not concordant with food group recommendations, with too much fruit and discretionary foods consumed, and too few grains and vegetables.

The study also exposes the limitations of the short FFQ as it does not capture breastmilk's nutritional profile and all the types of infant formula available. This is an urgent research need, and image-based assessment may be one way to improve data collection.