Estimating usual intakes mainly affects the micronutrient distribution among infants, toddlers and pre-schoolers from the 2012 Mexican National Health and Nutrition Survey

Abstract Objective To compare estimates from one day with usual intake estimates to evaluate how the adjustment for within-person variability affected nutrient intake and adequacy in Mexican children. Design In order to obtain usual nutrient intakes, the National Cancer Institute’s method was used to correct the first 24 h dietary recall collected in the entire sample ( n 2045) with a second 24 h recall collected in a sub-sample ( n 178). We computed estimates of one-day and usual intakes of total energy, fat, Fe, Zn and Na. Setting 2012 Mexican National Health and Nutrition Survey. Subjects A total of 2045 children were included: 0–5·9 months old ( n 182), 6–11·9 months old ( n 228), 12–23·9 months old ( n 537) and 24–47·9 months old ( n 1098). From these, 178 provided an additional dietary recall. Results Although we found small or no differences in energy intake (kJ/d and kcal/d) between one-day v . usual intake means, the prevalence of inadequate and excessive energy intake decreased somewhat when using measures of usual intake relative to one day. Mean fat intake (g/d) was not different between one-day and usual intake among children >6 months old, but the prevalence of inadequate and excessive fat intake was overestimated among toddlers and pre-schoolers when using one-day intake ( P< 0·05). Compared with usual intake, estimates from one day yielded overestimated prevalences of inadequate micronutrient intakes but underestimated prevalences of excessive intakes among children aged >6 months. Conclusions There was overall low variability in energy and fat intakes but higher for micronutrients. Because the usual intake distributions are narrower, the prevalence of inadequate/excessive intakes may be biased when estimating nutrient adequacy if one day of data is used

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Many Infants and Young Children Are Not Compliant with Mexican and International Complementary Feeding Recommendations for Milk and Other Beverages

Mexican and international authorities provide guidelines for milk and beverage consumption for young children. This study classifies beverages as appropriate or inappropriate by age (0–5.9, 6–11.9, and 12–23.9 months) and details consumption patterns, amounts consumed, and the associated socio-demographic characteristics. Analysis of the Mexican National Nutrition and Health Survey (ENSANUT 2012) was conducted (n = 949). Among 0–5.9 month olds, 66.7% consumed either breast milk, infant formula, or a combination with no other beverages, whereas 29.3% consumed breast milk and/or infant formula with water (mean = 58 g/day) and/or other beverages (mean = 115 g/day), such as 100% fruit juice, milk, and sugar-sweetened beverages (SSBs). For infants 6–11.9 months, appropriate beverages include breast milk, infant formula, and water; only 40.2% met these recommendations. Many 6–11.9 month olds consumed age-inappropriate beverages, including milk (31%) and SSBs (35%). After 12 months of age, appropriate beverages include water, milk, and a limited amount of 100% fruit juice and SSBs; 32.4% complied fully, 18.3% consumed appropriate and inappropriate beverages, and 49.3% consumed only inappropriate beverages. Among 12–23.9 month olds, 58% consumed milk, 18% juice, and 42% water while 63% consumed SSBs. Many infants and young children are not compliant with Mexican and international breastfeeding and complementary feeding guidelines for beverages. Communication and guidance about age-appropriate beverages should be improved

Usual food intakes of 2- and 3-year old U.S. children are not consistent with dietary guidelines

BACKGROUND: The primary purpose of this paper is to assess how well food consumption patterns of young children in the U.S. conform to the 2015 Dietary Guidelines for Americans. A secondary purpose is to gain insight into food choices that contribute to over- or under-consumption of key food groups and dietary constituents. METHODS: The analysis used data from the Feeding Infants and Toddlers Study 2008 (FITS 2008), and a national random sample of 1323 2- and 3-year old U.S. children. Children’s usual food intakes were estimated using the National Cancer Institute method and proportions of children whose usual diets did not include recommended amounts of food groups were assessed, as well as the proportions that consumed excess calories from solid fat and added sugars. Leading sources of vegetables, grains, oils, solid fat and added sugars were also examined. RESULTS: The prevalence of usual food group intakes that did not meet recommendations was highest for vegetables (91%), whole grains (94%), and oils (>99%). In addition, virtually all children (>99%) had usual intakes of calories from solid fat and added sugars that exceeded the maximum allowance. The mean intake of calories from solid fat and added sugars was almost three times the maximum allowance. CONCLUSIONS: Given that children’s food preferences and habits develop early in life, educating primary caregivers about recommended feeding patterns and how to promote them is critical. Infants and young children will readily accept sweet and salty foods, but the wider variety of foods associated with healthy eating patterns may only be accepted if children have repeated experience with them. There is evidence that some caregivers may overestimate the quality of their children’s diets, so specific, practical, and actionable guidance is needed. This advice should include education about children’s normal resistance to new foods, strategies for promoting acceptance and not using food to manage behavior. Given that one-third of children under the age of five attend regular child care outside the home, child care centers and family day care homes also have an important role to play in developing healthy food habits and preferences among young children

Early development of dietary patterns: transitions in the contribution of food groups to total energy—Feeding Infants and Toddlers Study, 2008

BACKGROUND: Early dietary patterns are critical to growth and development and play an important role in development of food preferences and habits. The objective of this paper is to describe when different foods enter the diet and how food consumption changes over the period of complementary feeding. METHODS: We analyzed cross-sectional 24-h dietary recall data from the Feeding Infants and Toddlers Study (FITS) 2008, a nationally representative sample of young children. Data are presented for 7 age groups: 6–8.9 months (n = 249), 9–11.9 months (n = 256), 12–14.9 months (n = 243), 15–17.9 months (n = 251), 18–20.9 months (n = 219), 21–23.9 months (n = 212) and 24–47.9 months (n = 1461). Per capita energy was calculated from major food groups and specific types of food within each food group. RESULTS: The predominant source of energy in the infant diet was milk (breast milk and infant formula), contributing 98% of energy at 0–3 months, and 91% at 4–5 months. At 6–8 months, when complementary feeding had begun for most infants, 69% of daily energy was coming from milk, 11% from grains, 6% from fruits, 5% from vegetables and 4% from mixed dishes. The diet then quickly transitioned until at 21–23.9 months, 26% of energy came from milk, with other key sources of energy being grains (17%), mixed dishes (14%), meats (12%) and sweets (12%). The period from 4 to 14 months was the most dynamic period of change regarding the introduction of complementary foods for all food groups, with a slower rate of change between 15 and 24 months. After 24 months, the diet stabilized and included less energy from milk (20%) and vegetables (4%) and more energy from mixed dishes (18%), grains (16%), and sweets (17%), and began to resemble adult diets. CONCLUSIONS: Feeding in the first 24 months shapes dietary patterns, and thus provides a critical window of opportunity to shape subsequent dietary patterns and eating habits. Findings from FITS identified high sweet and low vegetable consumption as key issues. Education is needed for health care professionals and parents on feeding during this important period. These findings can be used to support the development of specific and actionable feeding guidance for parents

Early development of dietary patterns: transitions in the contribution of food groups to total energy—Feeding Infants and Toddlers Study, 2008

BACKGROUND: Early dietary patterns are critical to growth and development and play an important role in development of food preferences and habits. The objective of this paper is to describe when different foods enter the diet and how food consumption changes over the period of complementary feeding. METHODS: We analyzed cross-sectional 24-h dietary recall data from the Feeding Infants and Toddlers Study (FITS) 2008, a nationally representative sample of young children. Data are presented for 7 age groups: 6–8.9 months (n = 249), 9–11.9 months (n = 256), 12–14.9 months (n = 243), 15–17.9 months (n = 251), 18–20.9 months (n = 219), 21–23.9 months (n = 212) and 24–47.9 months (n = 1461). Per capita energy was calculated from major food groups and specific types of food within each food group. RESULTS: The predominant source of energy in the infant diet was milk (breast milk and infant formula), contributing 98% of energy at 0–3 months, and 91% at 4–5 months. At 6–8 months, when complementary feeding had begun for most infants, 69% of daily energy was coming from milk, 11% from grains, 6% from fruits, 5% from vegetables and 4% from mixed dishes. The diet then quickly transitioned until at 21–23.9 months, 26% of energy came from milk, with other key sources of energy being grains (17%), mixed dishes (14%), meats (12%) and sweets (12%). The period from 4 to 14 months was the most dynamic period of change regarding the introduction of complementary foods for all food groups, with a slower rate of change between 15 and 24 months. After 24 months, the diet stabilized and included less energy from milk (20%) and vegetables (4%) and more energy from mixed dishes (18%), grains (16%), and sweets (17%), and began to resemble adult diets. CONCLUSIONS: Feeding in the first 24 months shapes dietary patterns, and thus provides a critical window of opportunity to shape subsequent dietary patterns and eating habits. Findings from FITS identified high sweet and low vegetable consumption as key issues. Education is needed for health care professionals and parents on feeding during this important period. These findings can be used to support the development of specific and actionable feeding guidance for parents

Food groups consumed by infants and toddlers in urban areas of China

Background: Food consumption patterns of young children in China are not well known. Objective: Characterised food groups consumed by infants and young children in urban China using data from the Maternal Infant Nutrition Growth (MING) study. Design: One 24-h dietary recall was completed for 1,350 infants and young children (436 infants aged 6–11 months and 914 young children aged 12–35 months), who were recruited from maternal and child care centres in eight cities via face-to-face interviews with the primary caregiver. All foods, beverages and supplements reported were assigned to one of 64 food groups categorised into the following: milk and milk products, grains, vegetables, fruits, protein foods and desserts/sweets. The percentage of infants and young children consuming foods from specific food groups was calculated, regardless of the amount consumed. Results: Less than half of infants consumed breast milk (47%), whereas 59% of infants consumed infant formula and 53–75% of young children consumed growing-up (fortified) milk. Rice was the number one grain food consumed after 6 months (up to 88%) and the consumption of infant cereal was low. About 50% of infants did not consume any fruits or vegetables, and 38% of young children did not consume any fruits on the day of the recall. Only 40% of all children consumed dark green leafy vegetables and even fewer consumed deep yellow vegetables. Eggs and pork were the most commonly consumed protein foods. Conclusions: The data provide important insight for developing detailed food consumption guidelines for this population group. Mothers of infants should be encouraged to continue breastfeeding after the first 6 months. Parents should be advised to offer a wide variety of vegetables and fruits daily, particularly dark green leafy and deep yellow vegetables and colourful fruits. The consumption of fortified infant cereal should be advocated to improve the iron intake of Chinese infants

Nutrient Intakes of Pregnant Women and their Associated Factors in Eight Cities of China: A Cross-sectional Study

Background: During the last 3 decades, China has dramatic changes of the dietary pattern among its citizens, particularly in urban cities. This study aimed to determine the nutrient intake status and factors associated with nutrient intakes of urban Chinese pregnant women now-a-day. Methods: The multistage stratified random sampling method was applied in the cross-sectional study. 479 women in three trimesters of pregnancy from eight cities of China were recruited. Nutrient intakes were evaluated with one 24 h dietary recall, and compared with the Chinese Dietary Reference Intakes (DRIs) 2013 for available nutrients. Results: Most pregnant women had imbalanced macronutrient distribution with excessive energy derived from fat. Intakes of Vitamin A, B 6, calcium, magnesium, and selenium were below Chinese Recommended Nutrient Intake (RNI) and Estimated Average Requirements (EARs) in all trimesters. Most pregnant women took more folic acid in the first trimester with a significant decrease in the second and third trimester (P < 0.05). Shortfall in iron intake was found in the third trimester whereas some women may be at the risk of excessive iron intake. Intakes of thiamin met RNI in the first trimester but were below EAR in all trimesters. Trimester phasing was positively associated with most nutrients (P < 0.05). Prepregnancy body mass index was inversely associated with energy, fat, Vitamin C, and calcium intake (P < 0.05). Educational level and household income were positively associated with folic acid intake (P < 0.05). Conclusions: Current prenatal dietary choices of urban pregnant women in China are imbalanced in the nutrient intake when compared with national DRIs 2013, particularly in intakes of energy derived from fat and micronutrients. Appropriate dietary advice to pregnant women should promote a balanced diet with emphasis on avoidance of foods of high fat content and incorporation of foods that are good sources of the key micronutrients that are usually lacking in a regular pregnancy diet. Further research is needed to understand the eating habits and food patterns that contribute to this imbalanced diet in order to be able to effectively improve prenatal women′s nutrient intake status