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The objective of this study was to analyze the concentrations of polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) in infant food (infant formulas and human milk) collected in Serbia and to assess their exposure and associated health risks. A total of 101 PCB congeners and 26 PBDE congeners were analyzed. In infant formulas (IF), the total PCB levels averaged 63.17 ± 46.67 ng/g fat, with PentaCBs being the most abundant. The highest concentration was observed for PCB #101, at 3.69 ± 2.72 ng/g fat. Total PBDE levels in IF averaged 4.71 ± 2.96 ng/g fat, with DecaBDEs dominating. The highest concentration was determined for BDE #209, at 3.90 ± 2.38 ng/g fat. In human milk (HM), the total PCB levels averaged 82.27 ± 46.70 ng/g fat, with HexaCBs as the predominant group. PCB #153 had the highest concentration, at 12.98 ± 7.91 ng/g fat. Total PBDE levels averaged 4.17 ± 4.55 ng/g fat, with DecaBDEs being most abundant. BDE #209 had the highest concentration, at 3.17 ± 4.01 ng/g fat. The estimated daily intake of dl-PCBs for breastfed and formula-fed infants ranged from 11.79-13.96 to 0.37-0.44 pg WHO2005-PCB-TEQ/kg-bw/day, respectively. Hazard quotients for PBDEs ranged from 1.37-6.50 for breastfed infants to 0.65-5.90 for formula-fed infants, highlighting potential health concerns for breastfed infants. The pollutant levels in HM were comparable to those reported in other Central and Eastern European countries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Humans, including infants are exposed to complex mixtures of anthropogenic chemicals, and food is a major exposure route. Current risk assessment, however, typically does not evaluate mixture toxicity but rather focuses on single chemical exposure scenarios. Nevertheless, there is ample evidence that combined exposures to chemicals is involved in the etiology of major human diseases, and that infants are often more vulnerable than adults. Surprisingly hardly any efficient practical tools and guidelines have been defined to adequately assess mixture effects of food. Evaluation of levels of mixtures of dioxins and related compounds are a notable exception, although also in that area novel insights warrant reevaluation of the relevant compounds to be included in evaluation. Novel approaches are needed, since our knowledge on the toxicity of chemicals is lagging behind and even most of the industrial chemicals that are in common use have undergone no or limited safety testing, while the situation with natural compounds in food is even more challenging. Novel untargeted chemical analytical techniques and quantitative bioanalytical techniques that respond to toxic chemicals independent of prior knowledge on their structure or toxicity can be used to increase the knowledge on chemical mixtures. We discuss the complementarities between these bio- and chemical analytical methods that can be used in an integrated system to improve infant food safety by avoiding hazards of chemical mixture effects.

Background: We previously reported that delayed allergenic food introduction in infancy did not increase food allergy risk until age 4 y within our prospective cohort. However, it remains unclear whether other aspects of maternal or infant diet play roles in the development of childhood food allergy., Objectives: We examined the relationship between maternal pregnancy and infant dietary patterns and the development of food allergies until age 8 y., Methods: Among 1152 Singapore Growing Up in Singapore Towards healthy Outcomes study mother-infant dyads, the infant's diet was ascertained using food frequency questionnaires at 18 mo. Maternal dietary patterns during pregnancy were derived from 24-h diet recalls. Food allergy was determined through interviewer-administered questionnaires at regular time points from infancy to age 8 y and defined as a positive history of allergic reactions, alongside skin prick tests at 18 mo, 3, 5, and 8 y., Results: Food allergy prevalence was 2.5% (22/883) at 12 mo and generally decreased over time by 8 y (1.9%; 14/736). Higher maternal dietary quality was associated with increased risk of food allergy (P ≤ 0.016); however, odds ratios were modest. Offspring food allergy risk ≤8 y showed no associations with measures of infant diet including timing of solids/food introduction (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.42, 1.92), infant's diet quality (aOR: 0.93; 95% CI: 0.88, 0.99) or diet diversity (aOR: 0.84; 95% CI: 0.6, 1.19). Most infants (89%) were first introduced to cow milk protein within the first month of life, while egg and peanut introduction were delayed (58.3% introduced by mean age 8.8 mo and 59.8% by mean age 18.1 mo, respectively)., Conclusions: Apart from maternal diet quality showing a modest association, infant's allergenic food introduction, diet quality, and dietary diversity were not associated with food allergy development in this Asian pediatric population. Interventional studies are needed to evaluate the efficacy of these approaches to food allergy prevention across different populations., (Copyright © 2024 American Society for Nutrition. Published by Elsevier Inc. All rights reserved.)

Objective: To assess how Australian infant and toddler foods compare to a nutrient and promotion profile model (NPPM) developed by the World Health Organization to support the appropriate promotion of commercial food products for children aged 6-36 months., Methods: A cross-sectional audit of infant and toddler foods found at three major Australian supermarkets was conducted in September/October 2022. Using nutrition and promotional data extracted from the packaging, products were classified according to NPPM categories and assessed against relevant compositional, front-of-pack labelling and promotional requirements., Results: Of 330 eligible products identified, just 28% met all NPPM compositional requirements. Toddler foods were less compliant than infant foods overall (18% vs. 31%; p=0.021), and for specific nutrients such as sodium (75% vs. 89%; p=0.003). No products met all NPPM front-of-pack labelling/promotional requirements. Only two-thirds and two-fifths of products were compliant with product name and ingredient list requirements, respectively., Conclusion: Australian infant and toddler foods do not fully comply with the NPPM requirements. While toddler foods performed comparatively worse in terms of their nutritional adequacy, there is considerable scope to improve the nutrient profile of both infant and toddler foods., Implications for Public Health: To better support young children's health and development, the introduction of mandatory nutrition standards for Australian toddler foods, and the improvement of nutrition standards for Australian infant foods, in line with the NPPM, is needed. To be most effective, these should be combined with regulations for the labelling and promotion of these foods in line with the NPPM., Competing Interests: Conflicts of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this articles., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objective: To understand the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) counselor experiences discussing responsive bottle feeding during counseling and WIC participants' knowledge, understanding, and use of responsive bottle feeding., Methods: Qualitative descriptive, semistructured interviews with 23 participants (8 WIC counselors and 15 WIC participants) were conducted online via Zoom. The WIC counselors and mothers of WIC-enrolled bottle-fed infants were recruited through a network of WIC clinics in North Carolina. Interviews were recorded, transcribed, and collaboratively analyzed using content analysis., Results: The WIC participants received responsive infant feeding support from WIC counselors but often in the context of breastfeeding. WIC counselors provided valuable support for families but were challenged by limited training on responsive bottle feeding, balancing promoting breastfeeding with supporting mothers' feeding decisions, and time constraints., Conclusions and Implications: Findings provide preliminary support for the need to develop and pilot an intervention focused on promoting responsive feeding for parents of bottle-fed infants., (Copyright © 2024 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Background: For the first time, the 2020-2025 Dietary Guidelines for Americans provide specific guidance regarding the types of foods and beverages that should be offered in the first 2 years of life. Milk, in various forms (eg, human milk, infant formula, and cow's milk) contributes a large proportion of key nutrients to the diets of infants and toddlers in the United States., Objective: The aim of this study was to determine the types of milk (human milk, infant formula, and other milk) fed to US infants and toddlers in the past 12 years and to describe trends over time., Design: This was a cross-sectional analysis of 2-day, 24-hour dietary recalls., Participants/setting: Data from the 2007-2018 National Health and Nutrition Examination Survey were used for these analyses. Infants and toddlers aged 0 through 23.9 months with 2 days of dietary recall data (n = 3,079) were included., Main Outcome Measures: The main outcome was proportion of infants and toddlers fed different milk types., Statistical Analyses Performed: Survey-adjusted weighted percentages were used to report sociodemographic characteristics and the proportion of subjects fed each milk type category by age group and survey cycles. Binary and multinomial logistic regressions were used to assess differences in subject characteristics by age groups., Results: Sociodemographic characteristics did not differ by age group. The proportion of infants aged 0 to <6 months fed infant formula only was 60.2% in 2007-2012 and 44.8% in 2013-2018. The proportion of infants aged 6 to <12 months fed partially hydrolyzed infant formula only was 7.3% in 2007-2012 and 13.1% in 2013-2018. In toddlers (>12 months old), cow's milk was the predominant milk type in both 2007-2012 and 2013-2018., Conclusions: The percentage of infants fed any human milk increased over the past decade. Unsweetened cow's milk was the most predominate milk type consumed among toddlers., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Abstract Objective : This study addresses the issue of whether voluntary industry regulation has altered companies’ marketing of breast‐milk substitutes in Australia since the adoption of the World Health Organization (WHO) International Code on the Marketing of Breast‐milk Substitutes 1981. Methods : Print advertisements marketing breast‐milk substitutes were systematically sampled from the Australian Women's Weekly (AWW) magazine and the Medical Journal of Australia (MJA) for the 61 years from 1950 to 2010. Results : Breast‐milk substitute advertising in both the MJA and the AWW peaked and began declining before the introduction of the WHO Code in 1981. Although there was almost no infant formula advertising in AWW after 1975–79, other breast‐milk substitute advertising has been increasing since 1992, in particular for baby food, toddler formula and food and brand promotion. Conclusions : Companies have adopted strategies to minimise the effects of the Code on sales and profit in Australia, including increasing toddler formula and food advertisements, increasing brand promotion to the public, and complying with more limited voluntary regulatory arrangements. Implications : Comprehensive regulation is urgently required to address changed marketing practices if it is to protect breastfeeding in Australia.

Background: Food additives have been used mainly in the past century to perform specific functions in foods. Some types of food additives have been linked to adverse health outcomes, yet there is little research examining food additives in the US food supply., Objective: To examine the proportion of products purchased by US households containing four common technical food additives using time-specific food composition data and examine whether purchases have changed over time., Participants/setting: Nielsen Homescan Consumer Panels, 2001 and 2019., Main Outcome Measures: The proportion of packaged food products containing common types of food additives purchased by US households was determined overall and by food category., Statistical Analysis Performed: Differences were examined using Student t test; P value < 0.001 was considered significant., Results: Between 2001 and 2019, the proportion of food products purchased by US households that contained additives increased from 49.6% to 59.5% (P < 0.001). The proportion of carbonated soft drinks purchased containing flavors decreased, with a subsequent increase in purchases containing nonnutritive sweeteners. Baby foods showed a 20% increase in the proportion of purchases containing additives and >15% increase in the proportion of purchases containing three or more additives., Conclusions: There is convincing evidence that US household purchases of common types of technical food additives are increasing. Despite some positive changes such as a decrease in the use of added flavors in carbonated soft drinks, across most food categories an increase in purchases of all types of products containing additives was observed. In particular the finding that purchases of baby food products containing additives have increased substantially is crucial in informing future research in this area and warrants further investigation., (Copyright © 2023 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Research is needed to identify pathways by which household food insecurity (FI) contributes to parental controlling feeding styles and infant food responsiveness, 2 factors that play a role in shaping obesity risk across infancy and early childhood., Objectives: This longitudinal study tested the hypothesis that prenatal FI would be positively associated with higher infant food responsiveness via greater parental mental health symptomatology and controlling feeding styles (pressuring, restrictive)., Methods: Participants included a community sample of 170 birth parents and their infants participating in an ongoing longitudinal study. Parents self-reported household FI and mental health symptoms (depression and anxiety) during pregnancy. Postnatally, parents reported their mental health symptoms, their use of controlling feeding styles, and infant food responsiveness. Path analyses with bias-corrected 95% bootstrapped CIs tested direct and indirect associations between prenatal FI and infant food responsiveness., Results: Prenatal FI was indirectly associated with higher infant food responsiveness via greater parental mental health symptomatology and pressuring to finish (b = 0.01; 95% CI: 0.001, 0.025). Prenatal FI was associated with greater parental mental health symptomatology across the peripartum period (β = 0.54; P < 0.001), which in turn was associated with more pressuring to finish at 2 months pospartum (β = 0.29; P = 0.01) and higher infant food responsiveness at 6 months (β = 0.17; P = 0.04). There were no direct effects of prenatal FI on controlling feedings styles or infant food responsiveness., Conclusions: Our findings point to parental mental health as a potential pathway by which FI may be associated with obesity-promoting parental feeding styles and infant appetitive behaviors. In addition to ensuring reliable access to enough quality food during pregnancy, multipronged assistance that promotes emotional well-being during the peripartum period and clinical guidance on noncontrolling feeding styles could benefit parent and infant health and well-being., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Baby-led weaning (BLW), proposed as a new form of complementary feeding, has emerged as a real trend phenomenon in the media. Infants are seated at the family table from the age of 6 months, facing the foods they grab and bring to their mouth: they decide which foods they want to eat and what amount. The consumption of mashed foods and the use of a spoon are totally discouraged. BLW is increasingly used in nurseries and centers of young children. A bibliographic search carried out between 2000 and 2021 found 423 articles, of which 38 were selected. The clinical studies selected are 11 cross-sectional observational studies and two randomized controlled studies. BLW promotes breastfeeding, the early introduction of morsels, the respect of the child's appetite, the use of unprocessed foods, and the choice of "homemade" and friendliness. These benefits can nonetheless be reached with usual complementary feeding (SCF), according to current recommendations. Other benefits are claimed without scientific evidence such as easier achievement of dietary complementary feeding and an optimal growth with prevention of excess weight gain. BLW has some obvious downsides. The infant may not get enough energy, iron, zinc, vitamins, and other nutrients, or too much protein, saturated fat, salt, or sugar. The risk of choking, which must be distinguished from the physiological gagging reflex, has not been ruled out by scientific studies. Currently, the Nutrition Committee of the French Pediatric Society considers that the data published to date in terms of benefits and risks of BLW do not lend themselves to advice for this practice in preference over SCF carried out according to current recommendations., Competing Interests: Conflicts of interest None., (Copyright © 2022 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.)

An acute shortage of infant formulas in the United States occurred in early 2022, exacerbating a longer-standing, less severe shortage that has occurred over the last several years. The shortage has been particularly problematic for specialized formulas such as those needed for infants and children with food allergies, intestinal failure, kidney disease, and metabolic disorders. Although undoubtedly the magnitude of the current shortage will abate over time, it has affected many children and caused tremendous distress for thousands of families. We propose a series of interventions to be undertaken as soon as feasible to help ensure that the conditions that led to this problem do not recur and families regain confidence in the safety and supply reliability of formulas for infants and young children regardless of their medical needs., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Society for Nutrition.)

This study was performed to evaluate the presence of chlorinated paraffins (CPs) in complementary baby food from different European countries, to assess portion-based dietary intake of CPs, and to characterize possible risks to children arising from CPs uptake. In total, 86 baby food samples from 22 countries were grouped into eight food-type categories considering the WHO classification. In six out of eight sample categories, predominance of medium-chain CPs (MCCPs) concentrations over short-chain CPs (SCCPs) was observed and, contrary to expectations, samples that contained ingredients of animal origin (e.g., meat or fish) did not display elevated CPs levels. The median ∑ CPs concentrations for selected sample categories ranged from 0.8 ng g -1 for desert to 2.8 ng g -1 found in dry cereal and porridge subgroups, while the highest CPs concentration of 387 ng g -1 was observed in dry porridge. Among the selected groups of baby foods, portion-based intake of ∑ CPs varied from 1.0 to 43.6 ng kg -1 body weight (b.w.) while exposure estimations indicated that portion-based dietary exposure through consumption of complementary baby food was the highest for infants aged 3-12 months due to the lower body weight. The risk characterization according to the European Food Safety Authority (EFSA) approach showed that the margin of exposure (MOE) figures higher than the critical value for ∑ CPs , indicating that the dietary exposures through consumption of complementary baby food are unlikely to be of significant health concern for children. However, it should be pointed out that the performed risk assessment covered only SCCPs and MCCPs, while the occurrence of other groups from CPs and CPs related compounds (e.g., very short-chain CPs, chlorinated alkenes, or long-chain CPs (LCCPs)) was not addressed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objective: To examine infant food preparation practices at age 7, 9, 11, and 13 months overall and by sociodemographic characteristics., Design: Data from a longitudinal study from the US Department of Agriculture's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study-2 (ITFPS-2) were used., Participants: A sample of 1,904 infants (970 males and 934 females) enrolled in WIC who had been introduced to solid foods and were consuming food prepared at home., Main Outcome Measures: Food preparation practices included pureeing, mashing, chopping/dicing, and prechewing. Estimates were provided overall and by sociodemographics., Analysis: Prevalence estimates were calculated for each survey month overall and by sociodemographics. Chi-square tests for independence were used to test for differences., Results: Food preparation practices changed as infants aged. Pureeing and mashing were common in month 7 (57.8% and 59.6%, respectively), but chopping/dicing were the most prevalent by month 13 (85.4%). Food preparation practices did not vary by education status, but statistical differences were consistently observed by race and ethnicity and inconsistently observed by maternal age at birth., Conclusions and Implications: Exposing children to a range of food textures at an appropriate age is important for developmental progress. Continued culturally relevant efforts by WIC educators and health care providers can emphasize the importance of early experiences with food textures., (Published by Elsevier Inc.)

Because of their extremely low amount in complex samples, it is quite challenging to accurate determine residues of phosphorus-containing amino-acid-like herbicides (PAAHs) in food products. Here we develop novel core-shell mesoporous silica (CSMS) microspheres coated by titanium dioxide (CSMS@TiO 2 ) for extraction and enrichment of PAAHs in baby foods. After the dispersive solid phase extraction (d-SPE), sheathless capillary electrophoresis-mass spectrometry (sheathless CE-MS) is utilized to achieve efficient separation and sensitive detection. The synthesized CSMS@TiO 2 composites are characterized by various spectroscopic techniques, proving TiO 2 is uniformly distributed onto the channel surface of CSMS. The composites have essential features that are favorable for adsorption of the analytes on the material for d-SPE, including uniform diameter (1.0 μm with a shell thickness of 133 nm), large perpendicular mesopores (15.6 nm), high surface area (101.1 m 2 /g) and large pore volume (0.4 cm 3 /g). Taking glyphosate, glufosinate and their main metabolites (aminomethylphosphonic acid and 3-methylphosphinicopropionic acid) as analytes, selective and efficient enrichment is achieved by CSMS@TiO 2 -based d-SPE through the affinity interaction between titanium dioxide and phosphate groups. Sensitive detection of target compounds is achieved with low limits of quantitation (LOQs) between 0.3-1.6 ng/mL and excellent inter/intra-day repeatability. The compounds in nine different commercial baby foods from local markets are analyzed using the proposed method. Good recoveries of 82.3-102.6% are achieved with low RSDs (n = 5) of 2.1-8.3%. Our study indicates that the proposed CSMS@TiO 2 -based d-SPE combined with sheathless CE-MS is an accurate and reliable approach for sensitive determination of trace-amount PAAHs and their metabolites in complex samples., Competing Interests: Declaration of Competing Interest We declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier B.V.)

Background: Type of infant feeding has been linked to later nutritional outcomes, including dietary diversity and obesity in childhood. Little is known about how introduction to complementary feeding and diet quality in early childhood vary by infant feeding type and sex., Objective: Our objective was to investigate whether early childhood dietary patterns vary by infant feeding type and sex., Methods: Data from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infants and Toddler Feeding Practices Study 2 (ITFPS-2) was used, including children with complete information on the WIC infant food package received at ages 1, 7, and 11 mo (N = 2839). Based on this information, children were grouped as fully breastfed, mostly breastfed, mostly formula fed, and fully formula fed. Outcomes include introduction of complementary foods; caloric intake aged between 1 and 36 mo; and Healthy Eating Index (HEI)-2015 between 13 and 36 mo. Mixed models were used adjusting for child's, mother's, and family's sociodemographic characteristics., Results: Across all infant feeding groups, the mean age of introduction to any solids was before the age of 6 mo; fully breastfed children were introduced to complementary foods closer to the recommended age (mean 5.1-5.2 mo) compared with other feeding groups (mean 4.6-4.8 mo). Fully formula fed infants consumed significantly more energy than fully breastfed infants at ages 1 mo (boys = 55 kcal/d, girls = 47 kcal/d), 12 mo (boys = 68 kcal/d, girls = 59 kcal/d), 24 mo (boys = 81 kcal/d, girls = 71 kcal/d), and 36 mo (boys = 95 kcal/d, girls = 83 kcal/d). No meaningful differences were observed for HEI-2015 between infant feeding groups or child sex, with average scores of HEI-2015 for all children being 61-63 out of 100., Conclusion: Early childhood dietary patterns were slightly better among children who were fully breastfed as infants, compared with children in other infant feeding groups. The diets of all WIC-participating children could be improved., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Food intake has been identified as a major route for infants to short- and medium-chain chlorinated paraffins (SCCPs and MCCPs, respectively), but evaluations of SCCPs and MCCPs exposure for infants via dietary sources are limited. Here, SCCPs and MCCPs were analyzed in three categories of commonly used infant foods from the Chinese market. The mean concentrations (range) of SCCPs in infant formulas, cereals, and purees were 7.95 (2.32-54.2), 4.26 (2.73-8.81), and 4.66 (1.33-8.43) ng g -1 fresh weight, respectively, and the mean (range) MCCP concentrations were 4.77 (1.67-20.9), 2.91 (1.21-8.24), and 1.89 (0.53-5.41) ng g -1 fresh weight, respectively. Chlorinated paraffins (CP) concentrations in whole milk samples were significantly higher than those detected in the other infant foods (p < 0.01). This study is the first to determine the occurrence of CPs in baby purees. The estimated margin of exposure (MOE) values (SCCPs-MOE and MCCPs-MOE) in this study were all greater than 1000, indicating that there were no health risks posed by CP contamination in infant foods. Principal component analysis indicated that foods of animal origin were more influenced by MCCPs than those of plant-origin, indicating different contamination patterns of CPs between food groups., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Infant feeding practices are thought to shape food acceptance and preferences. However, few studies have evaluated whether these affect child diet later in life., Objective: The study objective was to examine the association between infant feeding practices and dietary patterns (DPs) in school-aged children., Design: A secondary analysis of data from a diverse prospective birth cohort with 10 years of follow-up (WHEALS [Wayne County Health Environment Allergy and Asthma Longitudinal Study]) was conducted., Participants/setting: Children from the WHEALS (Detroit, MI, born 2003 through 2007) who completed a food screener at age 10 years were included (471 of 1,258 original participants)., Main Outcome Measures: The main outcome was DPs at age 10 years, identified using the Block Kids Food Screener., Statistical Analysis Performed: Latent class analysis was applied for DP identification. Breastfeeding and age at solid food introduction were associated with DPs using a 3-step approach for latent class modeling based on multinomial logistic regression models., Results: The following childhood DPs were identified: processed/energy-dense food (35%), variety plus high intake (41%), and healthy (24%). After weighting for loss to follow-up and covariate adjustment, compared with formula-fed children at 1 month, breastfed children had 0.41 times lower odds of the processed/energy-dense food DP vs the healthy DP (95% CI 0.14 to 1.25) and 0.53 times lower odds of the variety plus high intake DP (95% CI 0.17 to 1.61), neither of which were statistically significant. Results were similar, but more imprecise, for breastfeeding at 6 months. In addition, the association between age at solid food introduction and DP was nonsignificant, with each 1-month increase in age at solid food introduction associated with 0.81 times lower odds of the processed/energy-dense food DP relative to the healthy DP (95% CI 0.64 to 1.02)., Conclusions: A significant association between early life feeding practices and dietary patterns at school age was not detected. Large studies with follow-up beyond early childhood that can also adjust for the multitude of potential confounders associated with breastfeeding are needed., (Copyright © 2021 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: α-Tocopherol (αT) in its natural form [2'R, 4'R, 8'R αT (RRR-αT)] is more bioactive than synthetic α-tocopherol (all rac-αT). All rac-αT is widely used in infant formulas, but its accretion in formula-fed infant brain is unknown., Objective: We sought to compare αT and stereoisomer status in infant rhesus macaques (Macaca mulatta) fed infant formula (RRR-αT or all rac-αT) with a reference group fed a mixed diet of breast milk and maternal diet., Methods: From 1 d after birth until 6 mo of age, infants (n = 23) were either nursery reared and exclusively fed 1 of 2 formulas by staff personnel or were community housed with their mothers and consumed a mixed reference diet of breast milk (69 mL/d at 6 mo) transitioning to monkey diet at ∼2 mo (MF; n = 8). Formulas contained either 21 μmol RRR-αT/L (NAT-F; n = 8) or 30 μmol all rac-αT/L (SYN-F; n = 7). Total αT and αT stereoisomers were analyzed in breast milk at 2, 4, and 6 mo and in monkey plasma and liver and 6 brain regions at 6 mo of age. α-Tocopherol transfer protein (α-TTP), lipoprotein αT, and urinary α-carboxyethyl-hydroxychroman (α-CEHC) were measured. One-way ANOVA with Tukey's post-hoc test was used for analysis., Results: At study termination, plasma, liver, lipoprotein, and brain total αT did not differ between groups. However, the NAT-F-fed group had higher RRR-αT than the SYN-F-fed group (P < 0.01) and the MF group (P < 0.0001) in plasma (1.7- and 2.7-fold) and brain (1.5- and 2.5-fold). Synthetic αT 2R stereoisomers (SYNTH-2R) were generally 3- and 7-fold lower in brain regions of the NAT-F group compared with those of the SYN-F and MF groups (P < 0.05). SYNTH-2R stereoisomers were 2-fold higher in MF than SYN-F (P < 0.0001). The plasma percentage of SYNTH-2R was negatively correlated with the brain percentage of RRR-αT (r = -0.99, P < 0.0001). Brain αT profiles were not explained by α-TTP mRNA or protein expression. Urine α-CEHC was 3 times higher in the NAT-F than in the MF group (P < 0.01)., Conclusions: Consumption of infant formulas with natural (NAT-F) compared with synthetic (SYN-F) αT differentially impacted brain αT stereoisomer profiles in infant rhesus macaques. Future studies should assess the functional implications of αT stereoisomer profiles on brain health., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Background: Although previous work has shown that children with older siblings tend to have poorer diet quality, no study has directly compared diets of infant siblings., Objective: The goals of this analysis were to examine birth-order differences in dietary intake between firstborn (FB) and secondborn (SB) siblings, and to determine whether a responsive parenting (RP) intervention modified birth-order effects on diet., Methods: The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) study randomly assigned first-time mothers to an RP intervention, which included guidance on feeding, sleep, soothing, and interactive play, or control. INSIGHT mothers who delivered a second child enrolled in an observation-only study of their SB infant (SIBSIGHT). Mothers completed FFQs for both children at ages 6 (n = 97 sibling pairs) and 12 (n = 100) mo. FB compared with SB intake of food groups of interest were compared, and the moderating effect of the RP intervention on birth-order differences was tested using generalized linear mixed models., Results: Though FBs and SBs had similar diets, more FBs than SBs consumed 100% fruit juice at both 6 (13.8 compared with 3.2%, P = 0.006) and 12 mo (46.0 compared with 32.0%, P = 0.01). SBs consumed fruit more frequently (FB 2.8 compared with SB 3.2 times/d, P = 0.01), and were more likely to consume fried potatoes (FB 38.4 compared with SB 57.6%, P = 0.0009) and processed meats (FB 43.0 compared with SB 58.0%, P = 0.02) than FBs at 12 mo. There were no differences by birth order in intake of sweets, snacks, or sugar-sweetened beverages at 12 mo. At 12 mo, RP-group SBs ate vegetables more times per day (3.2) than control SBs (2.2, P = 0.01). RP-SBs also consumed a greater variety of vegetables (10.2) than control-SBs (7.9, P = 0.01)., Conclusions: Birth order is not consistently associated with healthy or unhealthy infant dietary intake. However, an RP intervention delivered to first-time mothers may benefit subsequent infants' vegetable intake. This trial was registered at clinicaltrials.gov as NCT01167270., (Copyright © The Author(s) on behalf of the American Society for Nutrition 2020.)

Background: In 2009, the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages were updated. WIC-participating children in Los Angeles County receiving the new food package, compared with the old, had lower obesity risk at age 4., Objective: To determine if the association between the new WIC food package and obesity varies by type of infant WIC food package received., Design: Longitudinal study using administrative data on children participating in WIC in Los Angeles County continuously from birth until age 4. Children were compared across periods: Before (period 1: born 2003-2004), straddling (period 2: born 2005-2008), and after (period 3: born 2009-2011) the food package change. Children were further grouped as Fully Breastfed, Mostly Breastfed, Mostly Formula Fed, and Fully Formula Fed based on the type of food packages received during the first year of life., Participants/setting: WIC-participating children in Los Angeles County between 2003 and 2016 (N=116,991)., Main Outcome Measures: Weight-for-height z-score growth trajectories from 0 to 4 years and obesity (body mass index-for-age≥95th percentile) at age 4., Statistical Analyses Performed: Children were matched across periods on infant feeding group; age, sex, race or ethnicity, and initial weight status; maternal education and language; and family poverty. Sex-stratified piecewise linear spline mixed models and Poisson regression models were fit to the data., Results: No differences across periods were observed for children in the Fully Breastfed group. Boys in the Mostly Breastfed (relative risk [RR]=1.27, 95% CI=1.17 to 1.38), Mostly Formula Fed (RR=1.07, 95% CI=1.02 to 1.13), and Fully Formula Fed (RR=1.13, 95% CI=1.06 to 1.20) groups in period 1 had higher obesity risk than their counterparts in period 3; girls in the Mostly Breastfed group in period 1 had a higher obesity risk than those in period 3 (RR=1.17, 95% CI=1.07 to 1.28)., Conclusions: The association between the WIC food package change and obesity varied by type of infant food package received, with the strongest associations observed for those who were mostly breastfed., (Copyright © 2020 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Background: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation., Objective: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status., Methods: Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We characterized gut inflammation and permeability by myeloperoxidase (MPO), neopterin (NEO), and α-1-antitrypsin (AAT) concentrations from asymptomatic fecal samples averaged from 9 to 15 mo, and averaged the lactulose:mannitol ratio z-score (LMZ) at 9 and 15 mo. Nutrient intakes from complementary foods were quantified monthly from 9 to 15 mo and densities were averaged for analyses. α-1-Acid glycoprotein at 15 mo characterized systemic inflammation. Relations between variables were modeled using a Bayesian network., Results: A greater risk of anemia was associated with LMZ [1.15 (95% CI: 1.01, 1.31)] and MPO [1.16 (1.01, 1.34)]. A greater risk of low ferritin was associated with AAT [1.19 (1.03, 1.37)] and NEO [1.22 (1.04, 1.44)]. A greater risk of low retinol was associated with LMZ [1.24 (1.08, 1.45)]. However, MPO was associated with a lower risk of high transferrin receptor [0.86 (0.74, 0.98)], NEO with a lower risk of low retinol [0.75 (0.62, 0.89)], and AAT with a lower risk of low plasma zinc [0.83 (0.70, 0.99)]. Greater nutrient intake densities (vitamins A and B6, calcium, protein, and zinc) were negatively associated with EED. Inverse associations between nutrient densities and micronutrient deficiency largely disappeared after adjustment for EED, suggesting that EED mediates these associations., Conclusions: EED is independently associated with an increased risk of low ferritin, low retinol, and anemia. Greater nutrient density from complementary foods may reduce EED, and the control of micronutrient deficiencies may require control of EED., (Copyright © American Society for Nutrition 2019.)

Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6-23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation. We describe these and the methodology for an impact evaluation that was conducted for this program. Two monitoring systems using traditional and electronic platforms were established to register and track program delivery and processes including number of eligible beneficiaries, worker performance, program participation, and to monitor input, output, and outcome indicators. The impact evaluation used comparative cross-sectional and longitudinal designs to assess impact on anthropometric and infant and young child feeding outcomes. Three cross-sectional surveys (base-, mid-, and end-line) and two longitudinal cohorts of children followed in 6-month intervals from 6 to 24 months of age, were conducted in sampled households in the program and a neighboring comparison district. Additional M&E included qualitative studies, a process evaluation, and a cost-effectiveness study. The current paper describes lessons from this program's M&E, and demonstrates how multiple implementation research activities can inform course-correction and program scale-up., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Proper nutrition during early life is critical for growth and development., Objectives: The aim was to describe systematic reviews conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following: What is the relation between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and micronutrient status (iron, zinc, vitamin D, vitamin B-12, folate, and fatty acid status)?, Methods: A literature search identified articles from developed countries published from January 1980 to July 2016 that met the inclusion criteria. Data were extracted and risk of bias assessed. Evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded., Results: Nine articles addressed the timing of CFB introduction and 31 addressed types or amounts or both of CFBs. Moderate evidence suggests that introducing CFBs at age 4 mo instead of 6 mo offers no advantages or disadvantages in iron status among healthy full-term infants. Evidence is insufficient on the timing of CFB introduction and other micronutrient status outcomes. Strong evidence suggests that CFBs containing iron (e.g., meat, fortified cereal) help maintain adequate iron status or prevent deficiency in the first year among infants at risk of insufficient iron stores or low intake. Benefits for infants with sufficient iron stores (e.g., infant formula consumers) are less clear. Moderate evidence suggests that CFBs containing zinc (e.g., meat, fortified cereal) support zinc status in the first year and CFB fatty acid composition influences fatty acid status. Evidence is insufficient with regard to types and amounts of CFBs and vitamin D, vitamin B-12, and folate status, or the relation between lower-iron-containing CFBs and micronutrient status., Conclusions: Several conclusions on CFBs and micronutrient status were drawn from these systematic reviews, but more research that addresses specific gaps and limitations is needed., (Published by Oxford University Press on behalf of the American Society for Nutrition 2019.)

Background: Systematic reviews (SRs) were conducted by the Nutrition Evidence Systematic Review (NESR) team for the USDA's and the Department of Health and Human Services' Pregnancy and Birth to 24 Months Project., Objectives: The aim was to describe the SRs examining the relationship between types and amounts of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes., Methods: The NESR team collaborated with subject matter experts to conduct this SR. The literature was searched and screened using predetermined criteria. For each included study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of evidence was graded., Results: This SR includes 49 articles that examined type, amount, or both of CFBs consumed and growth, size, and body-composition outcomes. Moderate evidence suggests that consuming either different amounts of meat, meat instead of iron-fortified cereal, or types of CFBs with different fats or fatty acids does not favorably or unfavorably influence growth, size, or body composition. In relation to overweight/obesity, insufficient evidence is available with regard to the intake of meat or CFBs with different fats or fatty acids. Limited evidence suggests that type and amount of fortified infant cereal does not favorably or unfavorably influence growth, size, body composition, or overweight/obesity. Limited evidence suggests that sugar-sweetened beverage consumption during the complementary feeding period is associated with increased obesity risk in childhood but is not associated with other measures of growth, size, or body composition. Limited evidence showed a positive association between juice intake and infant weight-for-length and child body mass index z scores. Insufficient evidence is available on other CFBs or dietary patterns in relation to outcomes., Conclusions: Although several conclusions were drawn, additional research is needed that includes randomized controlled trials, examines a wider range of CFBs, considers issues of reverse causality, and adjusts for potential confounders to address gaps and limitations in the evidence., (© American Society for Nutrition 2019.)

Background: Nutrition during infancy and toddlerhood may influence health and disease prevention across the life span. Complementary feeding (CF) starts when human milk or infant formula is complemented by other foods and beverages, beginning during infancy and continuing to age 24 mo., Objectives: The aim of this study was to describe systematic reviews conducted for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer the following question: What is the relationship between the timing of the introduction of complementary foods and beverages (CFBs), or types and amounts of CFBs consumed, and the development of food allergy, atopic dermatitis/eczema, asthma, and allergic rhinitis?, Methods: The literature was searched using 4 databases (CINAHL, Cochrane, Embase, PubMed) to identify articles published from January 1980 to February 2017 that met predetermined inclusion criteria. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded., Results: Thirty-one included articles addressed the timing of CFB introduction, and 47 articles addressed the types and amounts of CFBs consumed., Conclusions: Moderate evidence suggests that there is no relationship between the age at which CF first begins and the risk of developing food allergy, atopic dermatitis/eczema, or childhood asthma. Limited to strong evidence, depending on the specific food, suggests that introducing allergenic foods in the first year of life (after 4 mo) does not increase the risk of food allergy and atopic dermatitis/eczema but may prevent peanut and egg allergy. There is not enough evidence to determine a relationship between diet diversity or dietary patterns and atopic disease. Research is needed to address gaps and limitations in the evidence on CF and atopic disease, including research that uses valid and reliable diagnostic measures and accounts for key confounders and potential reverse causality., (Published by Oxford University Press on behalf of the American Society for Nutrition 2019.)

Background: Systematic reviews were conducted as part of the USDA and the US Department of Health and Human Services Pregnancy and Birth to 24 Months Project to examine the relation between complementary feeding and developmental milestones., Objectives: The aim of this study was to describe systematic reviews examining the relationship between timing of introduction of complementary foods and beverages (CFB), and the types and amounts of CFB consumed, and developmental milestones., Methods: The literature was searched using 4 databases (PubMed, Cochrane, Embase, and CINAHL) to identify articles that met predetermined criteria for inclusion. Data extraction and risk of bias assessment were conducted for each included study. The body of evidence for each systematic review was qualitatively synthesized to develop a conclusion statement, and the strength of evidence was graded., Results: Three included articles (1 randomized controlled trial; 2 observational studies) examined timing of introduction of CFB. Eight included articles (3 randomized controlled trials; 5 observational studies) examined types and amounts of CFB. There was insufficient evidence to draw conclusions about the relation between either timing of CFB introduction or types and amounts of CFB, and developmental milestones., Conclusions: The ability to draw conclusions about the relationship between complementary feeding and developmental milestones was restricted by an inadequate amount of evidence with potential for issues with reverse causality and wide variation in design, type/age of outcome assessment, exposure assessment, and reported results. Additional research to address these gaps and limitations would be useful., (© American Society for Nutrition 2019.)

Background: The systematic review described in this article was conducted as part of the USDA and Department of Health and Human Services Pregnancy and Birth to 24 Months Project., Objectives: The aim was to describe the relationship between timing of introduction of complementary foods and beverages (CFBs) and growth, size, and body-composition outcomes across the life span., Methods: The literature was searched and selected using predetermined criteria. Data were extracted and risk of bias assessed for each included study. Evidence was qualitatively synthesized, conclusion statements were developed, and the strength of the evidence was graded., Results: Eighty-one articles were included in this systematic review that addressed timing of CFB introduction relative to growth, size, and body-composition outcomes from infancy through adulthood. Moderate evidence suggests that introduction of CFBs between the ages of 4 and 5 mo compared with ∼6 mo is not associated with weight status, body composition, body circumferences, weight, or length among generally healthy, full-term infants. Limited evidence suggests that introduction of CFBs before age 4 mo may be associated with higher odds of overweight/obesity. Insufficient evidence exists regarding introduction at age ≥7 mo., Conclusions: Although several conclusions were drawn in this systematic review, additional research is needed to address gaps and limitations in the evidence on timing of introduction of CFBs and growth, size, and body composition, such as randomized controlled trials that examine multiple outcomes and/or CFB introduction between the ages of 4 and 6 mo, and research that accounts for potential confounders such as feeding practices and baseline growth status and considers issues of reverse causality., (© American Society for Nutrition 2019.)

Background: Proper nutrition during infancy and toddlerhood is crucial for supporting healthy growth and development, including bone health. Complementary feeding is the process that starts when human milk or infant formula is complemented by other foods and beverages, beginning during late infancy and continuing to 24 mo of age., Objectives: This article aims to describe systematic reviews (SRs) conducted by the Nutrition Evidence Systematic Review team for the USDA and the Department of Health and Human Services Pregnancy and Birth to 24 Months Project to answer these questions: what is the relationship between 1) timing of introduction of complementary foods and beverages (CFBs) or 2) types and/or amounts of CFBs consumed and bone health? Methods: The literature was searched with the use of 4 databases (CINAHL, Cochrane, Embase, and PubMed) to identify articles published from January 1980 to July 2016 that addressed these topics and met predetermined criteria for inclusion. For each study, data were extracted and risk of bias was assessed. The evidence was qualitatively synthesized to develop a conclusion statement, and the strength of the evidence was graded., Results: Three articles addressed the timing of introduction of CFBs and bone health during childhood (through 18 y of age), and 2 addressed the types and/or amounts of CFBs consumed relative to bone health., Conclusions: Insufficient evidence was available to draw conclusions about the relationships between the timing of CFB introduction and types and/or amounts of CFBs consumed and bone health. Therefore, a grade was not assignable for these SRs. The ability to draw conclusions was limited by an overall lack of research, failure to adjust for several key confounding factors, and heterogeneity in studies with regard to methodology, subject populations, and results. Additional research is needed that addresses these gaps and limitations., (Published by Oxford University Press on behalf of the American Society for Nutrition 2019.)

This qualitative risk assessment (QRA) was conducted to estimate the microbiological risk associated with the consumption of Moringa oleifera leaf powder (MLP) by infants and children ages 6 to 23 months to prevent or treat undernutrition in Siem Reap, Cambodia, and Madhya Pradesh, India. This QRA follows the Codex Alimentarius Commission principles and guidelines for risk assessment and takes into account all known microbial hazards that are associated with MLP. A comprehensive literature search was carried out for foodborne pathogens isolated from MLP and other dried foods of similar consistency, such as dried herbs and spices and flour. From this literature search, the following pathogens were identified and considered for this microbiological QRA: Bacillus cereus, Escherichia coli, Campylobacter spp., Clostridium perfringens, Cronobacter spp., Listeria monocytogenes, Salmonella spp., and Staphylococcus aureus. Results suggest that when cereal slurry (porridge) fortified with MLP is boiled (a rolling boil for 5 min) prior to consumption, the food safety risk to undernourished infants and children of B. cereus, C. perfringens type A, Cronobacter, enterohemorrhagic E. coli, L. monocytogenes, Salmonella spp., and S. aureus is low to moderate, with only a moderate to serious risk posed by C. perfringens type C. However, when the fortified porridge is not boiled before consumption, the food safety risk is increased for all of the evaluated pathogens. Overall, the QRA suggests that MLP presents a risk to undernourished infants and children. However, this risk can be mitigated when the powder is stored under the appropriate conditions to ensure there is no ingress of moisture and then processed in a hygienic manner to reduce contamination and/or cross-contamination by following hazard analysis critical control point or similar procedures (even in a home setting) including a heat treatment, i.e., boiling, to further reduce microbial hazards.

Background: Repeated exposure has been found to be an effective strategy to increase acceptability of foods in older children and adults, but little is known about its effectiveness in the birth to 24-mo population., Objectives: This systematic review was conducted to examine the effects of repeated exposure to a single or multiple foods on acceptance of those or other foods among infants and toddlers., Methods: A search was conducted for peer-reviewed articles related to food acceptability, flavor, taste, and infants and toddlers in 12 databases (e.g., PubMed, Embase, Cochrane, and CINAHL) with a date range of January 1980 to July 2017. The Nutrition Evidence Library (NEL) Bias Assessment Tool was used to assess potential bias in the included studies, and the NESR grading rubric was used to grade evidence supporting the conclusion statement., Results: From the 10,844 references obtained, 21 studies (19 controlled trials and 2 longitudinal cohort studies) published from 1980 to 2015 were included in this review. Moderate evidence indicates that tasting a single vegetable or fruit or multiple vegetable(s) or fruit(s) 1 food per day for 8-10 or more days is likely to increase acceptability of an exposed food (indicated by an increase in intake or faster rate of feeding after comparison with before the exposure period) in infants and toddlers 4-24 mo old. The effect of repeated exposure on acceptability is likely to generalize to other foods within the same food category but not foods from a different food category. Findings are based on the effects of repeated exposure to mostly vegetables with some findings on repeated exposure to fruits., Conclusion: This review advances the understanding of early food experiences and the development of food acceptability. Additional research is needed using diverse foods and textures with a focus on the transition to table foods., (© American Society for Nutrition 2019.)

The purpose of this study was to investigate if the enhanced bioaccumulation of lutein in retina and brain of breastfed, compared to formula-fed, infant monkeys was associated with higher levels of serum total and HDL cholesterol, apolipoproteins, or mRNA/protein expression of carotenoid-related genes. Newborn rhesus macaques were either breastfed, fed a carotenoid-supplemented formula, or fed an unsupplemented formula for 6 months (n = 8, 8, 7). Real-time qPCR and western blotting were performed in two brain regions (occipital cortex and cerebellum) and two retina regions (macular and peripheral retina). Breastfed infants had higher serum total cholesterol, HDL cholesterol, apoA-I, and apoB-100 levels than the combined formula-fed groups (P < 0.05). Breast milk or infant formulas did not alter expression of the nine genes (CD36, SCARB1, SCARB2, LDLR, STARD3, GSTP1, BCO1, BCO2, RPE65) examined except for SCARB2 in the retina and brain regions. In conclusion, dietary regimen did not impact the expression of carotenoid-related genes except for SCARB2. However, carotenoid-related genes were differentially expressed across brain and retina regions. Breastfed infants had higher serum total and HDL cholesterol, and apolipoproteins, suggesting that lipoprotein levels might be important for delivering lutein to tissues, especially the macular retina, during infancy., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Background: USDA's Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides expert-chosen supplemental foods to improve the diets and health of low-income infants and children <5 y of age, but dietary behaviors of WIC participants are not well characterized., Objective: The purpose of this analysis was to examine differences in food consumption patterns between WIC participants and nonparticipants., Methods: FITS 2016 is a nationwide cross-sectional study of children <4 y (n = 3235). Data were weighted to provide US population-representative results. Children were categorized as WIC participants or nonparticipants, with the latter divided into lower- and higher-income nonparticipants. Group differences were assessed via the Wald test (demographics) and Rao-Scott modified chi-square test (breastfeeding prevalence). Differences in percentage consuming WIC-provided and selected other foods between WIC participants and nonparticipants were evaluated with the use of ORs and 95% CIs., Results: WIC infants were less likely to breastfeed than were higher-income nonparticipants at 0-5.9 mo (45% compared with 74%) and less likely than both nonparticipant groups at 6-11.9 mo (30% compared with 49-60%). WIC 6- to 11.9-mo-olds were more likely to consume infant cereals and vegetables than were lower-income nonparticipants. WIC 12 to 23.9-mo-olds were more likely to drink whole milk (which WIC provides at this age) than were nonparticipants (72% compared with 59-64%), whereas WIC participants 24-47.9 mo were more likely to drink low- and nonfat milks (which WIC provides at this age) than were nonparticipants (45% compared with 13-22%). WIC participants 6-47.9 mo were more likely to drink juice than were nonparticipants., Conclusions: Continued improvements in early dietary patterns are warranted for WIC and non-WIC children. Breastfeeding among WIC participants is a continuing challenge. Findings suggest that baby-food cereals, vegetables, and fruits (all provided by WIC) contribute importantly to WIC infants' diets, whereas WIC children are more likely to use lower-fat milks after 2 y of age than are non-WIC participants.

Background: The prevalence of obesity and type 2 diabetes continues to increase. These conditions disproportionately affect minorities and are associated with poor nutrition early in life. Current food-consumption patterns can inform pending dietary guidelines for infants and toddlers., Objective: The aim of this study was to describe infant feeding, complementary feeding, and food and beverage consumption patterns of 0- to 23.9-mo-olds in the general population., Methods: The Feeding Infants and Toddlers Study 2016 is a cross-sectional survey of caregivers of children aged <4 y. Dietary data were collected from a national random sample by using a 24-h dietary recall (n = 3235). The percentage of children consuming foods from >400 food groups was calculated. Differences in the percentage consuming between Hispanic, non-Hispanic white, and non-Hispanic black children aged 0-23.9 mo were evaluated with the use of ORs and 95% CIs., Results: Eighty-three percent of 0- to 23.9-mo-olds (n = 2635) were ever breastfed, 34% of 0- to 3.9-mo-olds (n = 305) and 15% of 4- to 5.9-mo-olds (n = 295) were exclusively breastfed, and 24% of 12- to 14.9-mo-olds (n = 412) consumed breast milk on the day of the recall. Complementary foods were more likely to be introduced before 4 mo in formula-fed infants (27%) than in infants who did not consume formula (5%). Half of 4- to 5.9-mo-olds consumed iron-fortified infant cereal, but few consumed iron-rich meats. Among toddlers (12-23.9 mo; n = 1133), >20% consumed no servings of fruit or vegetables on the day of the recall, approximately half consumed 100% fruit juice, and one-quarter to one-third consumed a sugar-sweetened beverage (SSB)., Conclusions: Breastfeeding initiation and duration have improved, but exclusivity remains low. Low consumption of iron-rich foods, fruit, and vegetables and lack of variety in vegetable consumption are problems. Efforts to reduce the consumption of SSBs and 100% fruit juice are warranted in early childhood.