Predictors of free sugars intake trajectories across early childhood – results from the SMILE birth cohort study

Foods and beverages high in free sugars can displace healthier choices and increase the risk of weight gain, dental caries, and noncommunicable diseases. Little is known about the intake of free sugars across early childhood. This study aimed to examine the longitudinal intake from 1 to 5 years of free sugars and identify the independent maternal and child-related predictors of intake in a cohort of Australian children participating in the Study of Mothers’ and Infants’ Life Events Affecting Oral Health (SMILE). Free sugars intake (FSI) was previously estimated at 1, 2, and 5 years of age, and three distinct FSI trajectories were determined using group-based trajectory modelling analysis. This study utilized multinomial logistic regression to identify the maternal and child-related predictors of the trajectories. The risk of following the ‘high and increasing’ trajectory of FSI compared to the ‘low and fast increasing’ trajectory was inversely associated with socio-economic disadvantage (aRRR 0.83; 95% CI 0.75–0.92; p < 0.001), lower for females (aRRR 0.56; 95% CI 0.32–0.98; p = 0.042), and higher in children with two or more older siblings at birth (aRRR 2.32; 95% CI 0.99–5.42; p = 0.052). Differences in trajectories of FSI were evident from an early age and a high trajectory of FSI was associated primarily with socio-economic disadvantage, providing another example of diet quality following a social gradient

Pairwise approach for analysis and reporting of child’s free sugars intake from a birth cohort study

Objectives: The prospective cohort design is an important research design, but a common challenge is missing data. The purpose of this study is to compare three approaches to managing missing data, the pairwise (n = 1386 children), the partial or modified pairwise (n = 1019) and the listwise (n = 546), to characterize the trajectories of children's free sugars intake (FSI) across early childhood. Methods: By applying the Group-based Trajectory Model Technique to three waves of data collected from a prospective cohort study of South Australian children, this study examined the three approaches in managing missing data to validate and discuss children's FSI trajectories. Results: Each approach identified three distinct trajectories of child's FSI from 1 to 5 years of age: (1) ‘low and fast increasing’, (2) ‘moderate and increasing’ and (3) ‘high and increasing’. The trajectory memberships were consistent across the three approaches, and were for the pairwise scenario (1) 15.1%, (2) 68.3% and (3) 16.6%; the partial or modified pairwise (1) 15.9%, (2) 64.1% and (3) 20.0%; and the listwise (1) 14.9%, (2) 64.9% and (3) 20.2% of children. Conclusions: Given the comparability of the findings across the analytical approaches and the samples' characteristics between baseline and across different data collection waves, it is recommended that the pairwise approach be used in future analyses to optimize the sample size and statistical power when examining the relationship between FSI in the first years of life and health outcome such as dental caries

Are the nutrient and textural properties of Australian commercial infant and toddler foods consistent with infant feeding advice?

Infant Feeding Guidelines worldwide recommend first foods be iron rich with no added sugars and that nutrient poor discretionary foods be avoided. Feeding guidelines also recommend exposing infants to a variety of foods and flavours with increasingly complex textures. Here, we compare nutritional and textural properties of commercial infant and toddler foods available in Australia with established infant feeding guidelines. Nutrition information and ingredient lists were obtained from food labels, manufacturer and/or retailer websites. In total, 414 foods were identified, comprising mostly mixed main dishes, fruit and vegetable first foods, and snacks. Most products were poor sources of iron, and 80% of first foods were fruit-based. Half of all products were purees in squeeze pouches and one third of all products were discretionary foods. The nutritional content of many products was inconsistent with guidelines, being low in iron, sweet, smooth in consistency, or classified as discretionary. Reformulation of products is warranted to improve iron content, particularly in mixed main dishes, expand the range of vegetable only foods, and textural variety. Greater regulatory oversight may be needed to better inform parents and caregivers. Frequent consumption of commercial baby foods low in iron may increase risk of iron deficiency. Excessive consumption of purees via squeeze pouches may also have implications for overweight and obesity risk.Najma A. Moumin, Tim J. Green, Rebecca K. Golley and Merryn J. Nettin

Evaluation of simulation models that estimate the effect of dietary strategies on nutritional intake: a systematic review

Background: Dietary simulation modeling can predict dietary strategies that may improve nutritional or health outcomes. Objectives: The study aims were to undertake a systematic review of simulation studies that model dietary strategies aiming to improve nutritional intake, body weight, and related chronic disease, and to assess the methodologic and reporting quality of these models. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guided the search strategy with studies located through electronic searches [Cochrane Library, Ovid (MEDLINE and Embase), EBSCOhost (CINAHL), and Scopus]. Study findings were described and dietary modeling methodology and reporting quality were critiqued by using a set of quality criteria adapted for dietary modeling from general modeling guidelines. Results: Forty-five studies were included and categorized as modeling moderation, substitution, reformulation, or promotion dietary strategies. Moderation and reformulation strategies targeted individual nutrients or foods to theoretically improve one particular nutrient or health outcome, estimating small to modest improvements. Substituting unhealthy foods with healthier choices was estimated to be effective across a range of nutrients, including an estimated reduction in intake of saturated fatty acids, sodium, and added sugar. Promotion of fruits and vegetables predicted marginal changes in intake. Overall, the quality of the studies was moderate to high, with certain features of the quality criteria consistently reported. Conclusions: Based on the results of reviewed simulation dietary modeling studies, targeting a variety of foods rather than individual foods or nutrients theoretically appears most effective in estimating improvements in nutritional intake, particularly reducing intake of nutrients commonly consumed in excess. A combination of strategies could theoretically be used to deliver the best improvement in outcomes. Study quality was moderate to high. However, given the lack of dietary simulation reporting guidelines, future work could refine the quality tool to harmonize consistency in the reporting of subsequent dietary modeling studies.Jessica A Grieger, Brittany J Johnson, Thomas P Wycherley and Rebecca K Golle

Does Food Intake of Australian Toddlers 12–24 Months Align with Recommendations: Findings from the Australian Feeding Infants and Toddlers Study (OzFITS) 2021

(1) Background: Food-based dietary guidelines promote population health and well-being through dietary patterns that reduce chronic disease risk while providing adequate energy and nutrients. In Australia, recommended dietary patterns based on servings per day from the five food groups—fruits, vegetables, cereals and grains, meats and alternatives, and dairy—have been developed for toddlers 1–2 years of age. However, no study has assessed the intake of the five food groups in this age group nationally. (2) Aim: To compare daily servings and the percentage of energy from the five food groups and discretionary foods in toddlers 1–2 years old to the Australian Dietary Guidelines. (3) Methods: Dietary intake was assessed using a one-day food record for 475 toddlers. (4) Results: Apart from fruit and dairy, servings of the five food groups were below the recommendations. Two-thirds of toddlers did not consume enough vegetables, and only 10% consumed the recommended number of servings for cereals and grains. On average, toddlers consumed only half the recommended servings of meat and alternatives. Nearly all toddlers (89%) consumed discretionary foods, which accounted for ~12% of total energy. Forty-five percent of toddlers received breastmilk. On average, breastfed toddlers consumed fewer servings from the five food groups than non-breastfed toddlers. Dairy contributed 20% of daily energy in all toddlers; however, this food group accounted for 13% in breastfed and 32% in non-breastfed toddlers on the day of the food record. (4) Conclusions: Compared to the recommendations, alignment with the servings of the five food group foods was not achieved by most toddlers, except for fruit and dairy. Discretionary foods may have displaced nutritious family foods. Consistent with Australian Infant Feeding Guidelines, many toddlers in this study continued to receive breastmilk but the recommended dietary patterns do not include breastmilk. Dietary modeling, including breastmilk as the primary milk source, is urgently needed, along with practical advice on incorporating breastmilk in a toddler’s diet while optimizing food consumption.Najma A. Moumin, Merryn J. Netting, Rebecca K. Golley, Chelsea E. Mauch, Maria Makrides, and Tim J. Gree

Group-based trajectories of maternal intake of sugar-sweetened beverage and offspring oral health from a prospective birth cohort study

Objectives: To investigate the trajectory of maternal intake of sugar-sweetened beverages (SSB) during the first five years of their child’s life and its effect on the child’s dental caries at five years-of-age. Methods: This is an ongoing prospective population-based birth cohort study in Adelaide, Australia. Mothers completed questionnaires on their SSB intake, socioeconomic factors and health behaviors at the birth of their child and at the ages of one, two and five years. Child dental caries measured as decayed, missing, or filled tooth surfaces was collected by oral examination. Maternal SSB intake was used to estimate the trajectory of SSB intake. The trajectories then became the main exposure of the study. Dental caries at age five years were the primary outcomes. Adjusted mean- and prevalence-ratios were estimated for dental caries, controlling for confounders. Results: 879 children had dental examinations at five years-of-age. Group-based trajectory modeling identified three trajectories of maternal SSB intake: ‘Stable low’ (40.8%), ‘Moderate but increasing’ (13.6%), and ‘High early’ trajectory (45.6%). Multivariable regression analysis found children of mothers in the ‘High early’ and ‘Moderate but increasing’ groups to have greater experience of dental caries (MR: 1.37 (95%CI 1.01-1.67), and 1.24 (95%CI 0.96-1.60) than those in the ‘Stable low’ trajectory, respectively. Conclusion: Maternal consumption of SSB during pregnancy and in the early postnatal period influenced their offspring’s oral health. It is important to create a low-sugar environment from early childhood. The results suggest that health promotion activities need to be delivered to expecting women or soon after childbirth

Trajectories of child free sugars intake and dental caries - a population-based birth cohort study

Objectives: To investigate the association between trajectories of free sugars intake during the first five years of life and dental caries experience at five years. Methods: Data from the SMILE population-based prospective birth cohort study, collected at one, two and five years old, were used. A 3-days dietary diary and food frequency questionnaire were used to estimate free sugars intake (FSI) in grams. The primary outcomes were dental caries prevalence and experience (dmfs). The Group Based Trajectory Modelling method was used to characterize three FSI trajectories (‘Low and increasing’; ‘Mod erate and increasing’; and ‘High and increasing’), which were the main exposures. Multivariable regression models were generated to compute adjusted prevalence ratios (APR) and rate ratios (ARR) for the exposure, controlling for socioeconomic factors. Results: The prevalence of caries was 23.3%, with a mean dmfs of 1.4, and a median of 3.0 among those who had caries. There were clear gradients of caries prevalence and experience by the FSI trajectories. The ‘High and increasing’ had an APR of 2.13 (95%CI 1.23-3.70) and ARR of 2.77 (95%CI 1.45-5.32) against the ‘Low and increasing’. The ‘Moderate and increasing’ group had intermediate estimates. A quarter of the caries cases could have been prevented if the whole study sample had been in the ‘Low and increasing’ FSI trajectory. Conclusion: A sustained, high trajectory of FSI from a young age was positively associated with child dental caries. Measures to minimise consumption of free sugars must commence early in life. Clinical significance: The study has provided high level evidence to inform clinicians’ decisions in promoting a healthy dietary pattern for young children