Developing food-based dietary guidelines for 1–5 year old children: a protocol for use in population health globally

Abstract

Early childhood is a well-established critical period for growth and development, potentially impacting on life-long health. Healthy dietary habits formed during the transition from a predominantly milk-based to a food-based diet track into later life. Globally, there is no established process for developing food-based dietary guidelines (FBDG) for 1–5 year old children. This study aims to establish a protocol for developing FBDG for 1–5 year old children for use in population health globally.

Foods consumed by > 10% of consumers aged 1–5 years (at each eating occasion) were identified by secondary analysis of the Irish National Pre-School Nutrition Survey (NPNS; 2012). Consultations were held with registered dietitians to update the NPNS data and reflect current dietary habits. Dietary modelling, based on healthy eating principles, was conducted on boys (n30) and girls (n30) at five percentiles on the World Health Organisation (WHO) growth charts (0.4^th; 25^th; 50^th; 75^th; 99.6^th) and at six age time-points (1y; 1.5y; 2y; 3y; 4y and 5y). Intake targets were identified for energy, macronutrients and 6 key micronutrients. For those with inadequate nutrient intakes, key contributing foods were identified and used in the modelling.

Dietary modelling yielded 640 four-day food intake patterns. For 1–3 year olds, especially those < 25th growth percentile, iron was identified as an at-risk nutrient as the intake target was not achieved. For all 1–5 year olds, vitamin D was identified as an at-risk nutrient. Red meat and iron-fortified cereal (> 12mg/100g) were identified as key contributors to iron intake. A combination of red meat (30 g, 3 days/week) and iron-fortified cereal (30 g, 5 days/week) resolved inadequate iron intakes for 1–3 year olds, except those < 25th growth percentile. For those children, the additional inclusion of 4 mg iron from use of iron-fortified milk (1.2mg/100mL) or a low-dose iron supplement (7 mg, 4 days/week) resulted in adequate iron intakes. For all children aged 1–5 years, vitamin D intakes improved by including a daily 5μg vitamin D supplement, but still did not reach the intake target.

Worldwide, significant resources are invested in assessing growth and development of 1–5 year olds. This study provides a protocol for developing FBDG to meet nutritional needs of 1–5 year olds at various growth parameters (age and percentiles), using WHO charts. This enables the provision of practical food-based interventions to nutritionally vulnerable children. Using national dietary data, this approach can be applied for developing FBDG specific to a country's needs.