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The role and requirements of digestible dietary carbohydrates in infants and toddlers

By A Stephen, M Alles, C de Graaf, M Fleith, E Hadjilucas, E Isaacs, C Maffeis, G Zeinstra, C Matthys and A Gil


Digestible carbohydrates are one of the main sources of dietary energy in infancy and childhood and are essential for growth and development. The aim of this narrative review is to outline the intakes of digestible carbohydrates and their role in health and disease, including the development of food preferences, as well the consequences of excess carbohydrate. Key experts in these fields provided up-to-date reviews of the literature. A search of available information on dietary intakes of children below the age of 4 years was conducted from 1985 up to 2010. Articles and reports including information about sugars and/or starch intakes were selected. A number of factors limit the ability to obtain an overall picture of carbohydrate intakes and food sources in this age group. These include small numbers of intake studies, differing approaches to analysing carbohydrate, a variety of terms used to describe sugars intakes and a dearth of information about starch intakes. Data suggest that sweet taste is preferred in infancy and later food choices. There are few established adverse consequences of high intakes of digestible carbohydrate for young children. The greatest evidence is for dental caries, although this is influenced by high intake frequency and poor oral hygiene. Evidence for detrimental effects on nutrient dilution, obesity, diabetes or cognition is limited. In infants, minimum carbohydrate (mainly lactose) intake should be 40% of total energy, gradually increasing to 55% energy by the age of 2 years

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Publisher: Nature Publishing Group
OAI identifier: oai:pubmedcentral.nih.gov:3390559
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    1. (2007). A critical examination of the evidence relating high fructose corn syrup and weight gain. Crit Rev Food Sci Nutr
    2. (1998). A critical period of brain development: studies of cerebral glucose utilization with PET. Prev Med
    3. (2001). A prospective study on sucrose consumption, visible plaque and caries in children from 3 to 6 years of age. Community Dent Oral Epidemiol
    4. (1984). Acceptance of sweet and salty tastes in 2-year-old children. Appetite
    5. (2009). Adolescent beverage habits and changes in weight over time: findings from Project EAT.
    6. (2003). Agence Franc¸aise de la Se ´curite ´ Sanitaire. Enque ˆte individuelle et nationale sur les consommations alimentaires Enque ˆte INCA 1999. Principaux Re ´sultats.
    7. (2009). American heart association childhood obesity research summit report. Circulation
    8. (2005). Application of prebiotics in infant foods.
    9. (2008). Apports nutritionnels en France en 2005 chez les enfants non allaite ´sa ˆge ´s de moins de 36 mois. Arch Pe ´diatr
    10. (1994). Assessment of nutritional status in The Netherlands (Dutch Nutrition Surveillance System). Bibl Nutr Dieta
    11. (2009). Associations between added sugars and micronutrient intakes and status: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years.
    12. (2003). Associations between intake of added sugars and intakes of nutrients and food groups in the diets of German children and adolescents.
    13. (2008). Beverage consumption patterns of children born at different risk of obesity. Obesity (Silver Spring)
    14. (2006). Beverage intake among preschool children and its effect on weight status. Pediatrics
    15. (2000). Breakfast cereal consumption in young children: associations with non-milk extrinsic sugars and caries experience: further analysis of data from the UK National Diet and Nutrition Survey of children aged 1.5- -4.5 years. Public Health Nutr
    16. (2005). Breastfeeding and introduction of solid foods in Swedish infants: the All Babies in Southeast Sweden study.
    17. (1997). Carbohydrate absorption from one serving of fruit juice in young children: age and carbohydrate composition effects.
    18. (2006). Carbonated soft drinks and dental caries in the primary dentition.
    19. (1987). Changes in the diet in the Netherlands:
    20. (2002). Children’s food preferences: a longitudinal analysis.
    21. (2001). Children’s nutrient intake at preschool and at home. Acta Paediatr
    22. (2001). Comparative expression of hedonic impact: affective reactions to taste by human infants and other primates. Neurosci Biobehav Rev
    23. (2007). Comparison of the intakes of sugars by young children with and without dental caries experience. J Am Dent Assoc
    24. (2008). Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition.
    25. (1996). Composition of diet in relation to fat intake of children aged 1- -7 years.
    26. (1990). Conditioned flavor preferences in young children. Physiol Behav
    27. (1991). Conditioned preferences: young children prefer flavors associated with high dietary fat. Physiol Behav
    28. (1997). Consommation alimentaire des nourrissons et des enfants en bas a ˆge en France en 1997. Arch Pe ´diatr
    29. (2009). Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/ obese humans.
    30. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity.
    31. (1995). Consumption of sugars.
    32. (2003). Defining and interpreting intakes of sugars.
    33. (2007). Design effects associated with dietary nutrient intakes from a clustered design of 1 to 14-year-old children.
    34. (1999). Development of food preferences. Annu Rev Nutr
    35. (2007). Development of insulin resistance and its relation to diet in the obese child.
    36. (1981). Development of taste perception in humans: sensitivity and preference throughout the life span. Psychol Bull
    37. (2009). Developmental changes in the acceptance of the five basic tastes in the first year of life.
    38. (2001). Diet and risk of Type II diabetes: the role of types of fat and carbohydrate. Diabetologia
    39. Diet in a group of 18-month-old children in South West England, and comparison with the results of a national survey.
    40. Diet quality in young children is influenced by beverage consumption.
    41. (2001). Dietary and developmental regulation of intestinal sugar transport.
    42. (1998). Dietary and Nutritional Status Survey of the Population in Bulgaria.
    43. (1980). Dietary correlates of hyperactive behavior in children.
    44. (1982). Dietary experience and sweet taste preference in human infants. Appetite
    45. (2004). Dietary factors are not associated with high levels of obesity in New Zealand Pacific preschool children.
    46. (2012). Dietary fat is not a major determinant of body fat. Am J Med 2002; 113 (Suppl 9B), 47S- -59S. Digestible carbohydrates in infants and toddlers A Stephen et al
    47. (1987). Dietary fiber and resistant starch.
    48. (2009). Dietary fructose and glucose differentially affect lipid and glucose homeostasis.
    49. (2009). Dietary fructose and metabolic syndrome and diabetes.
    50. (2004). Dietary fructose reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and increases triglycerides in women.
    51. (2002). Dietary intake of macronutrients, micronutrients, and other dietary constituents: United States 1988- -94. Vital Health Stat
    52. (1988). Differential facial responses to four basic tastes in newborns. Child Dev
    53. (2012). Digestible carbohydrates in infants and toddlers A Stephen et al
    54. Dutch National Food Consumption Survey Young Children 2005/2006.
    55. (2009). Early flavor learning and its impact on later feeding behavior.
    56. (2003). Effect of glycemic carbohydrates on short-term satiety and food intake. Nutr Rev
    57. (2004). Effects of diet on behaviour and cognition in children.
    58. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children.
    59. (1994). Effects of sugar ingestion expectancies on mother-child interactions.
    60. (2010). EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific opinion on dietary reference values for carbohydrates and dietary fibre.
    61. (2003). Energy density predicts preferences for fruit and vegetables in 4-year-old children. Appetite
    62. Exploring the relationship between sugars and obesity. Public Health Nutr
    63. (1992). Facial expressions and genetic sensitivity to 6-npropylthiouracil predict hedonic response to sweet. Physiol Behav
    64. (2005). Factors contributing to individual differences in sucrose preference. Chem Senses
    65. (2007). FAO/WHO scientific update on carbohydrates in human nutrition: conclusions.
    66. (2007). FAO/WHO scientific update on carbohydrates in human nutrition: introduction.
    67. (2006). Feeding Infants and Toddlers Study (FITS): development of the FITS survey in comparison to other dietary survey methods.
    68. (2006). Feeding Infants and Toddlers Study: do vitamin and mineral supplements contribute to nutrient adequacy or excess among US infants and toddlers? J Am Diet Assoc
    69. (2004). Feeding practices of infants through the first year of life in Italy. Acta Paediatr
    70. (1987). Field studies in early nutrition and later achievement. Early Nutrition and Later Achievement
    71. (1998). Food Agriculture Organisation. Carbohydrates in human nutrition. Report of a Joint FAO/ WHO Expert Consultation. Food and Agriculture Organisation of the United Nations:
    72. (1993). Food and nutrient intake in a cohort of 8-month-old infants in the south-west of England in
    73. Food and nutrient intakes of
    74. (1996). Food and nutrient intakes of a population sample of 3-year-old children in the south west of England in
    75. (1992). Food and Nutrient Intakes of British Infants Aged 6- -12 Months.
    76. (2005). Food choices at lunch during the third year of life: high selection of animal and starchy foods but avoidance of vegetables. Acta Paediatr
    77. (1992). Food consumption and nutrient intake of one- to two-yearold Finnish children. Acta Paediatr
    78. (1980). Food habits and nutrient intake in childhood in relation to health and socio-economic conditions.
    79. (1997). Food intake and meal patterns of one year old infants. Appetite
    80. (1986). Food likes and dislikes. Annu Rev Nutr
    81. (2001). Food likes and their relative importance in human eating behavior: review and preliminary suggestions for health promotion. Health Educ Res
    82. (2008). Fructose consumption and consequences for glycation, plasma triacylglycerol, and body weight: meta-analyses and meta-regression models of intervention studies.
    83. (2008). Fruit and vegetable intake correlates during the transition to young adulthood.
    84. (2005). Genetic and environmental determinants of bitter perception and sweet preferences. Pediatrics
    85. (2005). Ghrelin levels before and after reduction of overweight due to a low-fat high-carbohydrate diet in obese children and adolescents. Int J Obes (Lond)
    86. (2010). Girls’ early sweetened carbonated beverage intake predicts different patterns of beverage and nutrient intake across childhood and adolescence.
    87. (2004). Glucoamylase activity in infants and children: normal values and relationship to symptoms and histological findings.
    88. (2006). Glucose enhances newborn memory for spoken words. Dev Psychobiol
    89. (2004). Glucose improvement of memory: a review.
    90. (1987). Glucose improves attention and reaction to frustration in children.
    91. (2006). Glycaemic index and metabolic disease risk. Proc Nutr Soc
    92. (2003). Glycemic load and chronic disease. Nutr Rev
    93. (2008). Glycemic response and health: summary of a workshop.
    94. (1989). Health. Dietary Sugars and Human Disease.
    95. (2004). High intake of added sugar among Norwegian children and adolescents. Public Health Nutr
    96. (2007). Human hedonic responses to sweetness: role of taste genetics and anatomy. Physiol Behav
    97. (2002). Hyperinsulinemia in AfricanAmerican children: decreased insulin clearance and increased insulin secretion and its relationship to insulin sensitivity. Diabetes
    98. (2007). Increasing children’s liking of vegetables through flavour-flavour learning. Appetite
    99. Infant feeding practices and associated factors through the first 9 months of life in
    100. (1999). Influence of dietary fat on the nutrient intake and growth of children from 1 to 5 y of age: the Special Turku Coronary Risk Factor Intervention Project.
    101. (1995). Intake of carbohydrate and its components--international comparisons, trends over time, and effects of changing to low-fat diets.
    102. (2006). Intake of sugar-sweetened beverages and weight gain: a systematic review.
    103. (1993). Intakes and food sources of fructose in the United States.
    104. (1999). Intestinal fructose absorption: clinical and molecular aspects.
    105. (2005). Lancet
    106. (1974). Letter: an alternate method of managing the hyperactive child. Pediatrics
    107. (2008). Longchain polyunsaturated fatty acid supplementation in infants born at term. Cochrane Database Syst Rev
    108. (2009). Macronutrient analysis of a nationwide sample of donor breast milk.
    109. (1979). McCance and Widdowson’s ‘The composition of foods’: dietary fibre in egg, meat and fish dishes.
    110. (1991). McCance and Widdowson’s Composition of Foods. Her Majesty’s Stationery Office: London,
    111. (2010). Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev
    112. (2006). Metabolic markers in relation to nutrition and growth in healthy 4-y-old children in Sweden.
    113. (2002). Modeling 13C breath curves to determine site and extent of starch digestion and fermentation in infants.
    114. (2009). month-old infants in Adelaide, Australia. Public Health Nutr
    115. (1995). National Diet and Nutrition Survey:
    116. (1995). National Diet and Nutrition Survey: children aged 1.5 to 4.5 years,
    117. (2009). National diet and nutrition survey. Headline Results from Year 1 of the Rolling Programme (2008/2009). Food Standards Agency: London,
    118. (1977). National estimates of dietary fructose intake increased from
    119. (1983). Neonatal facial expressions in response to different qualities and intensities of gustatory stimuli. Infant Behav Dev
    120. (1997). Non-milk extrinsic sugars in the diets of pre-school children: association with intakes of micronutrients, energy, fat and NSP.
    121. (2012). Nutrient intake and growth in preschool children. I, Comparison of energy intake and sources of energy with growth. J Human Nutr Diet 1992; 5, 287- -298. Digestible carbohydrates in infants and toddlers A Stephen et al
    122. Nutrient intakes and food patterns of toddlers’ lunches and snacks: influence of location.
    123. (1997). Nutritional survey in Greek children: nutrient intake.
    124. (1991). Nutritional survey on a sample of one-year-old infants in Milan: intake of macronutrients. Nutr Res
    125. (2010). Nutritively sweetened beverage consumption and body weight: a systematic review and meta-analysis of randomized experiments. Obes Rev
    126. (2009). Obesity and sugar-sweetened beverages in African-American preschool children: a longitudinal study. Obesity (Silver Spring)
    127. (2002). of the National Academies. Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol,
    128. (2009). Oral and dental health. Prevention of Dental Caries, Erosion, Gingivitis and Periodontitis. ILSI Europe:
    129. (1999). Oral glucose and venepuncture reduce blood sampling pain in newborns. Early Hum Dev
    130. (2003). Organisation. Diet, nutrition and the prevention of chronic diseases. Report of a Joint WHO/FAO Expert Consultation. World health Organisation:
    131. (2001). Organisation. The Optimal Duration of Exclusive Breastfeeding.
    132. (2003). Organisation. The World Oral Health Report. World Health Organisation:
    133. (1995). Organisation. World Health Organisation’s infant feeding recommendation. Weekly Epidemiological Record
    134. (2008). Overestimation of infant and toddler energy intake by 24-h recall compared with weighed food records.
    135. (1999). Overweight among low-income preschool children associated with the consumption of sweet drinks:
    136. (1983). Passage of carbohydrate into the colon. Direct measurements in humans. Gastroenterology
    137. Patterns of milk and food intake in infants from birth to age 36 months: the Euro-growth study.
    138. (1997). Physical activity and body composition in 10 year old French children: linkages with nutritional intake? Int J Obes Relat Metab Disord
    139. (2006). Prentice A (eds).
    140. (1998). Psychological influences on the childhood diet.
    141. (2008). Regulation of the fructose transporter GLUT5 in health and disease.
    142. (2010). Role of intestinal transporters in neonatal nutrition: carbohydrates, proteins, lipids, minerals, and vitamins.
    143. Routine sucrose analgesia during the first week of life in neonates younger than
    144. (1994). Small intestinal glucoamylase deficiency and starch malabsorption: a newly recognized alpha-glucosidase deficiency in children.
    145. (1999). Starch digestion in infancy.
    146. Stolarczyk A et al. Introduction of complementary feeding in 5 European countries.
    147. (2009). Sucrose in the diet of 3-year-old Finnish children: sources, determinants and impact on food and nutrient intake.
    148. (1989). Sugar consumption, locomotion, task orientation, and learning in preschool children.
    149. (2008). Sugar-sweetened soft drinks and obesity: a systematic review of the evidence from observational studies and interventions. Nutr Res Rev
    150. (2003). Sugars in the Australian diet: results from the 1995 National Nutrition Survey. Nutr Diet
    151. (2002). Sweet and sour preferences during childhood: role of early experiences. Dev Psychobiol
    152. (1999). Sweetness intensity and pleasantness in children, adolescents, and adults. Physiol Behav
    153. (1999). Taste and Smell. In: Swainan KF, Ashwall S (eds). Pediatric Neurology: Principles and Practice.
    154. (1996). The classification and measurement of dietary carbohydrate. Food Chem
    155. (1995). The effect of sugar on behavior or cognition in children. A meta-analysis. JAMA
    156. (2002). The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease.
    157. (1973). The gustofacial response: observation on normal and anencephalic newborn infants. Symp Oral Sens Percept
    158. (2004). The Nordic Council. Nordic Nutrition Recommendations 2004: Intergrating Nutrition and Physical Activity. The Nordic Food Policy Co-Operation:
    159. The ontogeny of face recognition: eye contact and sweet taste induce face preference in 9- and 12-week-old human infants. Dev Psychol
    160. (2004). The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol
    161. (1993). The postingestive consequences of fat condition preferences for flavors associated with high dietary fat. Physiol Behav
    162. (1985). The role of Pavlovian conditioning in the acquisition of food likes and dislikes.
    163. (2009). The state of the science on dietary sweeteners containing fructose: summary and issues to be resolved.
    164. (2012). This work is licensed under the Creative Commons AttributionNonCommercial-No Derivative Works 3.0 Unported License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/3.0/ Supplementary Information accompanies the paper on
    165. (1998). to 18 year old German children and adolescents. Z Ernahrungswiss
    166. (1999). to 36-month-old German infants and children: results of the DONALD Study. Dortmund Nutritional and Anthropometric Longitudinally Designed Study. Ann Nutr Metab
    167. (2003). Validation of a semi-quantitative foodfrequency questionnaire used among 12-month-old Norwegian infants.
    168. (2004). Validation of a semi-quantitative foodfrequency questionnaire used among 2-year-old Norwegian children. Public Health Nutr
    169. (2008). Variation in energy and nutrient intakes among pre-school children: implications for study design.
    170. (2002). Variation in fat, lactose and protein in human milk over 24h and throughout the first year of lactation.
    171. (1998). Weaning practice in the Glasgow Longitudinal Infant Growth Study. Arch Dis Child
    172. (2002). weeks’ postconceptional age. Pediatrics
    173. (2009). What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 12 months. Public Health Nutr
    174. (2008). What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 6 months. Public Health Nutr

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