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Looking at diets in early childhood

Contemporary PEDS JournalAugust 2021
Volume 38
Issue 8

A high-quality diet in early childhood can be just 1 way to combat childhood obesity. However, a recent report indicates that there’s room for improvement.

The diet in the first years of a child’s life has been seen as a key way to intervene and promote high high-quality nutrition. However, there is little data on the evolution of diet quality in early childhood as well as data on variation in diet quality trajectories. A report in the Journal of the Academy of Nutrition and Dietetics sought to identify and evaluate these paths.1

The investigators performed a secondary analysis of an observational, longitudinal cohort study that included non-Hispanic Black and White children as well as their parents from racially concordant homes along with 4 years of follow-up, which could mean as many as 13 study visits for the child, with at least 3 visits required for inclusion. At baseline, body mass index, infant feeding habits, and data on the mother were collected. A child’s diet was evaluated through a 3-day diary at each visit. The main outcome measures were the Healthy Eating Index 2005 (HEI-2005) component scores as well as the total HEI-2005 score.

They found that overall, the total HEI-score was low when a child was aged 3 years (mean ± standard error = 55.1 ± 0.4 of maximum 100 points) and remained stable up until (?) when the child was aged 7 years (mean ± standard error = 54.0 ± 0.6; P = 0.08 for trend). There were 5 HEI-2005 trajectory groups noted, with 1 declining over time and 1 improving over time. The HEI-2005 component scores, excluding meat/beans and milk intake, varied significantly (all, P ≤ 0.02) among the trajectory groups at age 3 years and these differences were maintained at age 7 years. All trajectory groups saw low component scores in total vegetables, whole grains, and dark green and orange vegetables and legumes. High variability was noted in whole fruit; total fruit; saturated fats; and calories from solid fats, alcoholic beverages, and added sugars. Children who were in the lowest diet trajectory group were more likely to have regularly consumed soft drinks before their third birthday and were also less likely to have been breastfed.

The investigators concluded that children had low diet quality at age 3 years, and this remained stable to age 7 years. All children’s diets could be improved with increased consumption of vegetables and whole grains. In families at increased risk of overall low diet quality, there should be a concentrated effort to increase fruit intake and reduce the consumption of solid fats, alcoholic beverages, and added sugars.


1. Woo J, Reynolds K, Summer S, Khoury P, Daniels S, Kalkwarf H. Longitudinal diet quality trajectories suggest targets for diet improvement in early childhood. J Acad Nutr Diet. 2021;121(7):1273-1283. doi:10.1016/j.jand.2020.08.084

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