Babies in rural areas often fed high-salt and sugary foods, at odds with guidelines

Key takeaways:

• Researchers surveyed parents of over 10,000 infants in rural Pennsylvania on eating habits prior to age 2.
• Fewer than half exclusively consumed human milk and/or formula for the first 6 months, against guidelines.

BOSTON — A large proportion of rural children were fed high-sugar and high-salt foods within the first 2 years of life, according to a study presented at NUTRITION.

“For the first time since the 1985 edition of the Dietary Guidelines for Americans (DGA), the 2020-2025 publication includes recommendations for infants and toddlers,” Carolyn F. McCabe, PhD, MS, a staff scientist at Geisinger, Pennsylvania, told Healio. “These recommendations are evidence-based to support nutritional adequacy as well as promote health across the life course, but we know that, on average, most people are not meeting recommendations.”

Current U.S. dietary guidelines recommend waiting until after 1 year of age to introduce 100% fruit or vegetable juices — but even then in limited amounts, and most fruit intake should come from eating whole fruit. Families should also avoid foods and beverages with added sugars and limit those high in sodium for children aged younger than 2 years.

Early life is a “critical period” for establishing healthy eating habits and food preferences, McCabe said, because it is associated with lowering risks for overweight and obesity, lower risk of type 1 diabetes and lowering asthma risk.

“It is important to evaluate how well infants are meeting dietary recommendations because these recommendations are ‘new’ for this age group, and there few data describing if they are indeed being fed in an age-appropriate manner, and rural infants and children face disparities compared to nonurban and rural children including but not limited to higher odds of experiencing obesity,” McCabe said. “To address gaps for this population broadly, and for rural infants and children in particular, the DGA provides a useful way to determine just what those gaps and needs are.”

McCabe and colleagues analyzed responses to Early Healthy Lifestyles (EHL) questionnaires that were given at well-child visits for 10,614 children up to 26 months of age who visited Geisinger, a rural-serving health system in Pennsylvania, between 2016 and 2020.

“The EHL tool asks parents or caregivers about foods that their child ate in the past week, and we specifically looked at age at first report (eg, first ‘yes’ to water) to calculate the prevalence of infants receiving age-inappropriate foods,” McCabe said. “It was important to focus on rural children because in addition to experiencing 25% higher odds of obesity compared to nonrural children, rural children face numerous health disparities, including lower household income — more than one in five rural children live in poverty and may experience greater community socioeconomic depravation.”

The researchers found that 53% of the children in the study received high-sodium meats such as hot dogs, 37% received salty snacks such as potato chips, and 34% received cakes, cookies or pudding before age 2 years. In addition, 27% of babies received 100% juice before their first birthday, 29% of children received sweetened cereal and one in 10 received sugar-sweetened beverages before age 2 years.

“It was quite surprising,” McCabe said of the results.

Additionally, the authors said 46% of babies exclusively consumed human milk and/or formula for the first 6 months of life, as the dietary guidelines recommend.

“Additional studies should continue to explore the patterns of dietary intake among infants in both rural and urban populations,” McCabe said. “Furthermore, studies are needed that more closely examine frequency and quantity of intake of both foods that are recommended and those that are not.”

She added that messaging ought to be focused on caregivers.

“Certainly, infants and children have very little say in the food they are provided; it is in fact their parent or caregiver who decides what, when, and perhaps even how much they eat,” McCabe said. “So, an important part of these findings and this work is to improve our messaging to parents and caregivers.”

References:

• Dietary Guidelines for Americans, 2020-2025. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf. Accessed July 20, 2023.
• Many children in rural areas receive high salt and sugar foods before age 2. https://www.eurekalert.org/news-releases/995508?. Published July 23, 2023. Accessed July 23, 2023.
• McCabe CF, et al. Misalignment with 2020-2025 dietary guidelines for Americans among a rural population under 2 years of age. Presented at: NUTRITION; July 22-25, 2023.