Prevalence, Trends, and Disparities in Beverage Consumption Among Young Children aged 0 to 4y: Findings From FITS 2016

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1 Prevalence, Trends, and Disparities in Beverage Consumption Among Young Children aged to 4y: Findings From FITS 216 Mary Story, PhD, RD Duke University Emily Welker MPH, RD Duke University Emma Jacquier, PhD, MSc Nestlé Research Center

2 Overview of the presentation Feeding Infants and Toddlers Study (FITS) 216 overview Food group classification of beverages Which beverages are young children consuming? Trends in beverage consumption versus previous FITS surveys Race and ethnic differences in beverage consumption Conclusions - major findings Evidence gaps

3 FITS 216 Study Overview Cross-sectional survey of caregivers of U.S. infants, toddlers, and preschool aged children from birth up to 47.9 months The study & participants Lifestyle behaviors and feeding practices 24-h dietary recall of all foods, beverages, and dietary supplements 2 nd recall on a random subsample Instruments Collect data on: Infant feeding practices Nutrient intakes Food intakes Dietary patterns Lifestyle behaviors Study Aims

4 Study design 6 months instrument design and pilot test phase National sampling via landline, cell-phone, home address and on-line Recruitment questionnaire (n=4866) followed by CATI 24h recall dietary (n=3249) 25% sample 2 nd recall (n=81)

5 Characteristics of the children in the FITS 216 sample 67% Non-Hispanic White 14% Non-Hispanic Black 14% Hispanic 5% Other Household income 12 % <$1, 12% $1-19,999 17% $2-34,999 26% $35-74,999 27% $75,+ 36% of children WIC benefits 34% of children were firstborn

6 Sample size by age-group and recall, FITS 216 Age group Day 1 24-Hour Recall Day 2 24-Hour Recall Day 1 and 2 24-Hour Recall -5.9 months months months months months months TOTAL *36% of the children receive benefits from WIC

7 Strengths FITS 216 Largest and most comprehensive sample of its kind, specifically for B-24 mo Consistent methodology for collection, QA/QC, analysis of 24-h recall data, ability to assess trends Sample reflects geographic and sociodemographic diversity of U.S. households with 1 or more children under 4 yrs Allows for comparisons by race and ethnicity and by WIC recipients Limitations Cannot determine ways selection bias may have affected our study sample - - calibrated data to remove known biases Self-reported data may over- or under-report intakes and consumption of healthy or unhealthy foods/beverages

8 Food group classifications of beverages: FITS 216 FITS 216 Food groups were updated to mirror, as closely as possible, WWEIA Baby: 1% Juice Apple/Apple Blend Citrus/Citrus Blend Vegetable And Fruit Blends Grape/Grape Blend Other 1% Juice Punch/Blend 1% Juice Apple/Apple Blend Berry/berry blend Citrus/Citrus Blend Vegetable And Fruit Blends Grape/Grape Blend Other 1% Juice Punch/Blend Sweetened beverages Soft drinks Fruit-flavored drinks Tea and coffee Sports drinks Other WATER Tap or bottled water Baby Flavored water Baby MILK AND MILK PRODUCTS Milk Flavored Cows milk Nonfat Lowfat Reduced fat Whole Goat's milk Plant milks/dairy substitutes Baby milks Human milk Infant formula Toddler milk drink

9 Early toddler and preschooler diet transitions quickly to more meats/proteins, sweets and grains Percent of total kcal consumed across all participants 1% 9% 8% 7% 6% 5% 4% 3% 2% 1% 97% 3% 2% 5% 88% 2% 2% 2% 7% 5% 3% 8% 72% 6% 4% 3% 8% 4% 6% 12% 56% 1% 12% 13% 11% 9% 3% 12% 12% 13% 7% 4% 5% 5% 4% 7% 7% 8% 5% 12% 4% 4% 14% 15% 14% 16% 15% 17% 18% 36% 31% 26% 24% 15% 14% 18% 19% 4% 3% 7% 6% 4% 4% 14% 16% 16% 19% 2% 17% FATS/OTHER MIXED DISHES SWEETS/SNACKS 1% JUICE FRUIT VEGETABLES MEATS/PROTEIN GRAINS/GRAIN PRODUCTS MILK & MILK PRODUCTS % -3.9mo 4-5.9mo 6-8.9mo mo mo mo mo mo mo mo Age Source: FITS 216, unpublished

10 As energy intake increases; kcal from fruit and veg stable; energy from sweets increases x Energy consumed (kcal) per capita, by major food group: FITS 216 kcal per capita FATS/OTHER MIXED DISHES SWEETS 1% JUICE FRUIT VEGETABLES MEATS/PROTEIN GRAINS/GRAIN PRODUCTS MILK & MILK PRODUCTS -3.9mo 4-5.9mo 6-8.9mo mo mo mo mo mo mo mo Age Source: FITS 216, unpublished

11 Water and milk are the most prevalently consumed beverage type by all ages 1 FITS 216: Percentage of children reporting consumption of beverage type on day of survey Percent consuming (%) % Juice Baby 1% Juice Sweetened beverages Water Milk Baby milk -5.9mo mo mo mo mo mo Milk = All cow s milk types, flavored milks, plant milks, goats milk Baby milk = breast milk, infant formula, toddler milk Sweetened beverages = soft drinks, fruit flavored drinks, sports drinks, sweetened tea/coffee, other sweetened drinks

12 The early introduction of cow s milk remains a concern; ~15-2% of toddlers did not consume any milk on day of survey 1 Percentage of children consuming milk, by type, on a given day 8 Percent consuming (%) Cows milk Infant formula Breastmilk Toddler milk Age in months

13 Percent of children consuming any SSB by age 6% FITS 216: Percentage of children reporting any SSB consumption on the day of the survey by age, ages -48mo 5% 5% Percent consuming 4% 3% 2% 27% 31% 42% 1% % 9%.9% -5.9mo mo mo mo mo mo Age in months

14 Kcal/consumer from any SSB by age 14 FITS 216: Kcal per consumer from any SSB on the day of the survey by age kcal/consumer mo mo mo mo mo mo Age in months

15 Among 2-3y olds; ~half of children reported consuming a SSB on day of survey. Fruit-flavored drinks were most prevalent SSB. 6% FITS 216: Percentage of children reporting consumption of SSB on the day of the survey Percent consuming (%) 4% 2% Any Sweetened beverage Soft drinks Fruit-flavored drink Tea and coffee Other Sports drink % -5.9mo mo mo mo mo mo Age in months

16 Percent consuming fruit-flavored drinks by age FITS 216: Percentage of children reporting fruit-flavored drink consumption on the day of the survey by age, ages -48mo 4% 37% 35% 32% Percent consuming 3% 25% 2% 15% 21% 26% 1% 5% %.8% 7% -5.9mo mo mo mo mo mo Age in months

17 Kcal/consumer from fruit-flavored drinks by age FITS: Kcal per consumer from fruit-flavored drinks on the day of the survey by age Kcal/consumer mo mo mo mo mo mo Age in months

18 Fruit flavored drinks contributed 3-4 kcal to the diets of 18mo-4yrs, on the day of the survey Mean per capita kcal from different types of SSBs on the day of the survey 7 Per capita kcal mo mo mo mo mo mo Age in months Sports drink Other Tea and coffee Fruit-flavored drink Soft drinks

19 Among SSBs, fruit flavored drinks make the largest contribution to the percentage of total energy intake 12 Percentage of total energy (per capita kcal) from SSBs Percentage of total energy (per capita kcal) % 1 1 7% 1 5%.5 4.5% % % mo mo mo mo mo mo Age in months Sports drink Other Tea and coffee Fruit-flavored drink Soft drinks

20 The prevalence of 1% Fruit Juice consumption has declined across all age groups, when comparing FITS 216 to previous FITS surveys 1 Percentage of children consuming 1% juice in FITS 22, FITS 28 and FITS 216 Percent consuming (%) Series1 FITS Series2 FITS Series3 FITS

21 Trends in SSB consumption between survey years require further investigation 5 Percentage of children reporting consuming SSB, on day of survey, in FITS 22, FITS 28 and FITS 216 Percent consuming (%) mo 6-8.9mo mo mo mo mo mo

22 SSB Consumption (% consuming) by Race/Ethnicity Group ( months) 7 FITS 216: Percentage of children reporting SSB consumption on the day of the survey, by racial/ethnic group, ages mos 6 Percent Consuming (%) Overall Hispanic NH White NH Black 1 Any SSB Carbonated Soda Fruit Flavored Drink Sweetened tea and coffee Other

23 SSB Consumption (kcal consumed) by Race/Ethnicity Group ( months) 16 FITS 216: Energy per consumer for different types of SSBs by race-ethnicity group in children aged months Kcal/consumer Overall Hispanic NH White NH Black 2 Any SSB Carbonated Soda Fruit Flavored Drink Sweetened tea and coffee Other

24 Major findings related to beverage consumption, esp SSBs- FITS % of toddlers did not consume any milk on the day of the survey Fruit juice (1%) consumption has declined among all age groups from Early introduction and substantial Kcal from fruit flavored drinks Fruit flavored drinks are the most commonly consumed SSB among all ages; For 2-3 yr olds Kcal per consumer/day Half of all 3 year olds consumed a SSB on the day of the survey and children and Kcal per consumer were 118/day. At age 3, 1% of total Kcal are from SSBs A higher percent of non-hispanic black children consumed SSBs (and fruitflavored drinks compared to non-hispanic white and Hispanic children.

25 Evidence gaps & research opportunities Beverage consumption patterns by meal/snack occasion and location Beverage patterns by income Beverage patterns in different child care settings vs. home Parent/caregiver attitudes and beliefs around beverages in the diets of toddlers and preschoolers, esp health beliefs about fruit flavored drinks Parent/caregiver attitudes and beliefs around serving sizes/quantities consumed of beverages Do children who consume few SSBs have higher intakes of fruit, vegetables, whole grains and lower energy intakes What happens after age 3, regarding SSB consumption?

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