Dietary Intake in Child Age One To Three

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SUPPLEMENT

Nutrient Intakes and Vegetable and White Potato


Consumption by Children Aged 1 to 3 Years1,2

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Maureen L Storey* and Patricia A Anderson
Alliance for Potato Research and Education, McLean, VA

ABSTRACT

In 2020, for the first time, the Dietary Guidelines for Americans will include recommendations for children from birth to age 24 mo. We examined
average nutrient intakes as well as total vegetable and white potato (WP) consumption among children aged 1–3 y using day 1 dietary data from
the NHANES 2009–2012 and the Food Patterns Equivalents Database 2009–2012. Appropriate survey weights were used to calculate average
daily consumption of total vegetables and WPs, which included French-fried potatoes and chips, for boys and girls aged 1–3 y. We calculated
mean intakes of selected nutrients of concern, including vitamin D, potassium, dietary fiber (DF), and calcium. We also examined intakes of
selected nutrients by major food group. Average intakes of most nutrients, including calcium, by children aged 1–3 y exceeded Dietary Reference
Intakes (DRIs). However, average intakes of potassium, DF, and vitamin D were 67%, 55%, and 49% of DRIs, respectively. Mean total vegetable
intake was less than the recommendation of 1 cup/d. Boys and girls aged 1–3 y consumed an average of 0.58 cup equivalents of total vegetables
on the day of the survey, which included 0.16 cups of WPs. Average vegetable consumption and mean intakes of potassium, DF, and vitamin D
were far below recommendations. The consumption of all vegetables, particularly those that are excellent sources of potassium and DF, such as
potatoes, should be encouraged. Adv Nutr 2016;7(Suppl):241S–6S.

Keywords: vegetables, potatoes, toddlers, potassium, dietary fiber, nutrient intake

Introduction Key recommendations in the 2010 DGA included increas-


The Dietary Guidelines for Americans (DGA)3 were first ing vegetable and fruit intake and choosing foods that provide
published in 1980 by the USDA and the US Department more potassium, dietary fiber (DF), calcium, and vitamin D,
of Health and Human Services. By law, the guidelines are which are nutrients of concern in the American diet (1).
updated every 5 y and are intended for healthy individuals Moreover, the 2010 DGA recommend that children 2–3 y
over the age of 2. In 2020, and for the first time since of age consume at least 1 cup of vegetables each day—and
1980, the DGA will include recommendations for infants and more for physically active children. There are no guidelines
toddlers from birth to 24 mo of age. Little is known, however, for vegetable consumption by infants and toddlers aged 1–3 y.
about the nutrient requirements for this age group, with most The DGA affect 15 federal food assistance programs,
recommendations being extrapolated from studies conducted which are used by 1 in 4 Americans every day (2). The Spe-
in older children or adults. cial Supplemental Nutrition Program for Women, Infants,
and Children (WIC) serves at-risk, low-income pregnant,
1
Published in a supplement to Advances in Nutrition. Presented at the Roundtable on Science breastfeeding, and postpartum women, infants, and young
and Policy: Adopting a Fruitful Vegetable Encounter for Our Children. The roundtable was
sponsored by the USDA/Agricultural Research Service Children’s Nutrition Research Center, children under age 5. More than half of newborn infants
Baylor College of Medicine, and was held in Chicago, IL, 10–11 November 2014. The in the United States are served by WIC. In 2012, more
roundtable and supplement publication were supported by an unrestricted grant from the than half of WIC participants were 1- to 4-y-old children
Alliance for Potato Research and Education. The roundtable speakers received travel funding
and an honorarium for participation in the meeting and manuscript preparation. (3). Certain foods that are rich sources of selected nutrients
2
Author disclosures: ML Storey is a paid employee of the Alliance for Potato Research and are specified to supplement the diets of WIC participants.
Education; PA Anderson is a paid consultant for the Alliance for Potato Research and The National Academies’ Institute of Medicine (IOM) af-
Education.
3
Abbreviations used: AI, Adequate Intake; CVV, cash value voucher; DF, dietary fiber; DGA, fects dietary guidance as it convenes expert committees that
Dietary Guidelines for Americans; FFP, French-fried potato; FPED, Food Patterns Equivalents examine various health issues. In 2007, the IOM published a
Database; IOM, Institute of Medicine; MA, Mexican American; NHB, non-Hispanic black; report that recommended that the USDA encourage greater
NHW, non-Hispanic white; ORE, other race/ethnicity; WIC, Special Supplemental Nutrition
Program for Women, Infants, and Children; WP, white potato; 24HR, 24-h dietary recall. fruit and vegetable consumption by issuing a cash value
*To whom correspondence should be addressed. E-mail: mstorey@apre.org. voucher (CVV). USDA regulation allowed WIC participants

ã2016 American Society for Nutrition. Adv Nutr 2016;7(Suppl):241S–6S; doi:10.3945/an.115.008656. 241S
to use the CVV for purchasing any fruit or vegetable, except added sugars; gram equivalents of solid fats and oils; and number of alco-
for white potatoes (WPs) (4). holic drinks (7, 8). For coding purposes, the FPED groups foods and bev-
erages into the following categories: milk and milk products (dairy);
In 2014, the USDA sponsored another IOM review of meat, poultry, fish, and mixtures (meats); eggs; legumes, nuts, and seeds
the WIC food package with an expedited review of the exclu- (beans and seeds); grain products including whole grains and refined grains
sion of WPs in the WIC program. After its review, the IOM (carbohydrates); fruit; vegetables; fats, oils, and salad dressings (fats); and
committee published a letter report to the USDA on 3 February sugars, sweets, and sugar-sweetened beverages (sweets). The sweets category
2015, recommending that WPs be included in the WIC pro- includes added sugars, which were defined as sugars that were added to
foods as an ingredient during preparation, processing, or at the table. In
gram like any other vegetable (5). The report concluded that, the fruit and vegetable groups, a cup equivalent is the amount of a food con-
“The nutrient profile of white potatoes does not support their sidered to be equivalent to 1 cup of a cut-up fruit or vegetable (7, 8).
exclusion from the CVV because their nutrient content is Appropriate survey weights were used to calculate average daily nutrient
similar to that of other starchy vegetables included in the intakes and consumption of total vegetables, WPs, FFPs, and other starchy veg-
CVV. Increased consumption of white potatoes could im- etables (sweet corn, green peas, and lima beans) for boys and girls aged 1–3 y.
For purposes of this study, WPs included the following: baked, boiled, fried,
prove potassium intake for both women and children.” hash-browned, home-fried, mashed, roasted, salad, scalloped, stuffed, with

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The IOM report also reiterated that WIC participants’ in- sauce, and potato chips. FFPs were included in the total WP means.
take of all fruit and vegetables could be improved, includ- We also calculated mean day 1 intakes of all nutrients of concern for this
ing that of starchy vegetables. Research has found that population, including vitamin D, calcium, potassium, DF, and iron and es-
most children and adolescents do not consume the recom- timated the average contribution of these nutrients from WPs. The FPED
was used to convert grams of vegetables and vegetable combinations, in-
mended daily servings of fruit and vegetables (6). cluding WPs, to cup equivalents.
The purpose of this study was to assess nutrient intakes We compared mean vegetable consumption and nutrient intake across
and vegetable and WP consumption across races/ethnicities genders and races/ethnicities, which included non-Hispanic blacks
among toddlers aged 1–3 y. We also identified food groups (NHBs), non-Hispanic whites (NHWs), Mexican Americans (MAs), and other
that contribute to the intake of selected nutrients: potas- races/ethnicities (OREs). The ORE group was diverse and included non-MA
Hispanics, Asian Americans, Pacific Islanders, and others; therefore, results
sium, DF, calcium, iron, and vitamins A and D. should be interpreted with caution. Group means for each data cycle of
NHANES were estimated in STATA 9.2 by using the “svyreg” procedure to ad-
Methods just for the complex design of the survey and the “subpop” option to calculate
We examined mean intakes of macro- and micronutrients of concern as well the group means for the age group (12). This procedure used a Taylor lineari-
as consumption of total vegetables, WPs, oven-baked and deep-fried French- zation approach to correct the estimated SEs for survey design effects. The sig-
fried potatoes (FFPs), and other starchy vegetables by children aged 1–3 y us- nificance of differences of intakes between gender and race/ethnicity means
ing dietary data from NHANES 2009–2010 and 2011–2012 and the Food (P < 0.05) was calculated by using the STATA “test” procedure, which
Patterns Equivalents Database (FPED) 2009–2010 and 2011–2012 (7–9). performed an adjusted Wald test when used after the “svyreg” procedure.
NHANES is conducted by the National Center for Health Statistics of the This test calculated the probability that any 2 estimated means were equal
CDC, and survey data are released in 2-y cycles. All NHANES data collections to one another. WP consumers were defined as individuals who reportedly
receive approval from the National Center for Health Statistics Research Ethics consumed any type of WP on the given survey day. Children who reportedly
Review Board. These data are publicly available and represent all noninstitu- consumed any breast milk were excluded from the analysis.
tionalized persons living in the United States.
Our analysis used data from the first day of the 24-h dietary recall
(24HR) and the total nutrient intake files. Dietary intake was measured Results
by using a multipass 24HR instrument that has been thoroughly tested Demographic characteristics. There were 370 NHW, 304
for accuracy. Methods of collecting these data are explained on the USDA’s NHB, 320 MA, and 319 ORE children in the combined
website (10). The 24HR data were provided by the children’s primary care-
givers. Only day 1 dietary recall data were used because, according to the NHANES 2009–2012 unweighted sample (Table 1). Approxi-
NHANES documentation, “the mean of the population’s distribution of mately 30% of households with children ages 1–3 y reported a
usual intake can be estimated from a sample of individuals’ 24-h recalls, total household income <$25,000, with ;39% of children living
without sophisticated statistical adjustment” (11). In addition, day 1 dietary at <130% of the federal poverty level. Approximately half of MA
recall data were collected in-person, whereas day 2 data were collected on a children and more than half of NHB children lived in house-
smaller subsample by phone interview.
The FPED converts foods and beverages in the Food and Nutrient Da- holds with an annual family income <$25,000, whereas approx-
tabase for Dietary Studies to cup equivalents of fruit, vegetables, and dairy; imately one-third of ORE children and 15% of NHW children
ounce equivalents of grains and protein foods; teaspoon equivalents of lived in households with an annual income <$25,000.

TABLE 1 Demographic characteristics by race/ethnicity among children aged 1–3 y: NHANES 2009–20121
All NHWs NHBs MAs OREs
(n = 1313) (n = 370) (n = 304) (n = 320) (n = 319)
Boys, % 52.8 6 2.0 55.4 6 3.3 51.9 6 3.7 52.1 6 3.4 46.4 6 4.1
Age, y 2.0 6 0.03 2.1 6 0.05 2.0 6 0.05 1.9 6 0.05 2.1 6 0.06
Families with annual 29.6 6 1.6 15.4 6 2.0 56.2 6 4.0 47.4 6 3.9 33.2 6 4.2
income ,$25,000, %
Families living in 39.0 6 1.8 23.1 6 2.5 64.0 6 4.1 63.9 6 4.1 42.6 6 4.3
poverty (,130% of PIR), %
1
Values are sample-weighted means or proportions 6 SEs calculated by using STATA, 2006. Children who consumed breast milk on the day of
the survey were excluded from the analysis. MA, Mexican American; NHB, non-Hispanic black; NHW, non-Hispanic white; ORE, other race/eth-
nicity; PIR, poverty-to-income ratio.

242S Supplement
TABLE 2 Mean daily intakes of energy and selected nutrients by gender and race/ethnicity among children aged 1–3 y: NHANES 2009–
20121
All Boys Girls NHWs NHBs MAs OREs
(n = 1313) (n = 693) (n = 620) (n = 370) (n = 304) (n = 320) (n = 319) DRI2
Energy, kcal/d 1400 6 14.3 1440 6 17.5 1370* 6 25.7 1410 6 29.1
b
1520 6 38.9
a
1340 6 35.8
b
1350 6 33.0
b

Protein, g/d 51.9 6 0.7 52.3 6 0.9 51.6 6 1.1 52.0 6 1.3 52.7 6 1.2 51.8 6 1.4 51.2 6 1.7 13
Total fat, g/d 50.5 6 0.7 51.4 6 1.0 49.6 6 1.1 50.5a,b 6 1.5 56.1a 6 2.2 49.9b 6 1.7 46.4b 6 1.5 30–40
SFAs, g/d 18.9 6 0.3 18.9 6 0.5 18.9 6 0.4 19.4a 6 0.7 19.0a,b 6 0.7 19.1a 6 0.7 17.2b 6 0.6 —
Cholesterol, mg/d 167 6 5.2 167 6 9.1 168 6 4.9 153c 6 7.8 184a,b 6 9.3 198a 6 8.1 163b,c 6 12.0 —
Dietary fiber, g/d 10.5 6 0.2 10.8 6 0.3 10.2 6 0.3 10.7 6 0.4 10.5 6 0.4 9.91 6 0.5 10.6 6 0.5 19
Vitamin C, mg/d 83.1 6 3.9 86.3 6 5.6 79.8 6 3.9 78.2b,c 6 6.0 102a 6 6.8 73.7c 6 4.7 89.6a,b 6 5.4 15
Vitamin A, μg/d 576 6 13.9 589 6 21.9 563 6 19.4 597 6 21.8 540 6 24.5 589 6 38.2 537 6 21.2 300
Vitamin D, μg/d 7.4 6 0.2 7.3 6 0.2 7.5 6 0.2 7.5a 6 0.3 6.3b 6 0.3 8.1a 6 0.4 7.5a 6 0.3 15
Vitamin E,3 mg/d 5.1 6 0.1 5.4 6 0.2 4.7* 6 0.1 5.1a,b 6 0.2 5.6a 6 0.3 4.7b 6 0.2 4.9b 6 0.2 6
Folate, μg/d 266 6 5.1 268 6 8.0 263 6 8.3 260a,b 6 7.3 278a,b 6 9.2 252b 6 8.1 283a 6 12.4 150
Calcium, mg/d 1020 6 22.6 1030 6 32.7 1010 6 26.9 1070a 6 43.2 885b 6 30.1 1030a 6 36.7 992a 6 30.6 700

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Iron, mg/d 10.2 6 0.2 10.4 6 0.3 10.1 6 0.3 10.0b 6 0.3 11.5a 6 0.3 9.67b 6 0.3 10.4b 6 0.4 7
Potassium, mg/d 2000 6 27.5 2040 6 33.4 1970 6 46.0 2000 6 51.3 2010 6 43.8 2010 6 59.6 2000 6 56.1 3000
Sodium, mg/d 1990 6 28.1 2010 6 37.4 1980 6 44.5 1990b 6 55.9 2220a 6 59.3 1860b 6 58.1 1930b 6 62.7 1000
1
Values are sample-weighted means 6 SEs based on day 1 24-h dietary recall data calculated by using STATA, 2006. Children who consumed breast milk on the day of the
survey were excluded from the analysis. *Different from boys, P , 0.05. Labeled race/ethnicity means in a row without a common superscript letter differ, P , 0.05. MA,
Mexican American; NHB, non-Hispanic black; NHW, non-Hispanic white; ORE, other race/ethnicity.
2
The DRIs for protein, vitamin C, vitamin A, vitamin D, vitamin E, folate, calcium, iron, and sodium are RDAs. The DRI for total fat is an Acceptable Macronutrient Distribution
Range. The DRIs for dietary fiber and potassium are Adequate Intakes (13–19).
3
Includes added a-tocopherol.

Intake of nutrients. The mean energy intake for this sample lower than the IOM’s DRIs. Mean potassium intake among
of 1- to 3-y-old children was ;1400 kcal/d—on the higher children aged 1–3 y was ;2000 mg/d—two-thirds of the AI.
end of the range established for 2- to 3-y-old children by Mean intake of vitamin D was 7.4 mg/d, whereas the RDA
the 2010 DGA (Table 2). Mean protein and total fat intakes for vitamin D is 15 mg/d.
were greater than the RDA and Acceptable Macronutrient Dis- Boys and girls in this age group had few significant differ-
tribution Range, whereas average DF intake, 10.5 g DF/d, was ences in intakes of most nutrients, including protein, total
lower than the recommended Adequate Intake (AI) (14). fat, saturated fat, cholesterol, folate, iron, DF, vitamin A, vi-
Mean intakes of most micronutrients by children aged 1–3 y tamin C, vitamin D, calcium, potassium, and sodium. On
exceeded the DRIs (13, 15–19) (Figure 1). For example, average, boys consumed more total energy and vitamin E
mean vitamin C intake was >500% of the RDA. Mean vitamin than did girls (Table 2).
A, calcium, and iron intakes were ;150–200% of RDAs. The Across race/ethnicity we found no significant differences
mean intake of vitamin E was 5.1 mg/d, lower than the RDA in mean intakes of the following nutrients: protein, DF, vi-
of 6 mg/d. Mean intakes of potassium and vitamin D were tamin A, and potassium (Table 2). MAs and OREs had

FIGURE 1 Mean daily intakes of selected


nutrients as a percentage of DRIs (RDA or
AI) among children aged 1–3 y: NHANES
2009–2012 (13–19). AI, Adequate Intake.

Nutrient and white potato intakes by toddlers 243S


TABLE 3 Mean daily intakes of total vegetables and selected starchy vegetables by race/ethnicity among children aged 1–3 y: NHANES
2009–2012 and FPED 2009–20121
All (n = 1313) NHWs (n = 370) NHBs (n = 304) MAs (n = 320) OREs (n = 319)
Total vegetables2 0.58 6 0.02 0.57 6 0.03 0.63 6 0.04 0.58 6 0.04 0.57 6 0.04
White potatoes3 0.16 6 0.01 0.14b 6 0.02 0.23a 6 0.02 0.16b 6 0.02 0.15b 6 0.02
French-fried potatoes4 0.05 6 0.01 0.06a,b 6 0.01 0.07a 6 0.01 0.05a,b 6 0.01 0.03b 6 0.01
Other starchy vegetables5 0.06 6 0.01 0.06a 6 0.01 0.06a 6 0.01 0.03b 6 0.01 0.06a,b 6 0.02
1
Values are sample-weighted cup equivalent means 6 SEs based on day 1 24-h dietary recall data calculated by using STATA, 2006. Children who consumed breast milk on the
day of the survey were excluded from the analysis. Labeled means in a row without a common superscript letter differ, P , 0.05. FPED, Food Patterns Equivalents Database;
MA, Mexican American; NHB, non-Hispanic black; NHW, non-Hispanic white; ORE, other race/ethnicity.
2
Includes white potatoes and other starchy vegetables.
3
Includes baked, boiled, fried, hash-browned, home-fried, mashed, roasted, scalloped, stuffed, with sauce, potato salad, and potato chips.
4
Includes oven-baked and deep-fried French fried potatoes.
5
Includes sweet corn, green peas, and lima beans.

significantly lower intakes of total fat than did NHB chil- ;1.5 cup equivalents of starchy vegetables/wk (Table 3). On

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dren; ORE children had significantly lower mean intakes average, young children consumed 0.16 cup equivalents of
of saturated fat than did NHW and MA children and signif- WPs/d (including FFPs and potato chips). The mean con-
icantly lower mean cholesterol intakes than did MA sumption of FFPs was ;0.05 cup equivalents/d or <2.5 tea-
children. spoons/d—and there were few significant differences in
Mean calcium intakes for all races/ethnicities were greater consumption across races/ethnicities. On average, NHB
than the Estimated Average Requirement (500 mg Ca/d) and children consumed more WPs than did NHW, MA, and
the RDA (700 mg Ca/d) (17, 18). Although average calcium ORE children and more FFPs than did ORE children.
intake by NHB children was greater than the RDA, NHB
children consumed significantly less calcium and vitamin Food groups and associated nutrients of concern. For
D than did all other children, which possibly reflects lower children aged 1–3 y, dairy and fruit were top sources of potas-
consumption of milk and other dairy products by NHBs sium (Table 4). All vegetables—including WPs—provided
(20). NHB children also had significantly higher mean in- 195 mg K/d, on average; WPs contributed ;38% of the
takes of vitamin E and iron than their MA and ORE coun- potassium from vegetables. In addition to potassium, dairy
terparts. Mean potassium intake was below the AI and was products were the top source of vitamin A and calcium.
not significantly different across races/ethnicities. Although Top sources of DF included the category of carbohydrates
mean sodium intakes of all children were higher than (i.e., breads, cereals, and other grain products), fruit, and
the AI, NHB children had a significantly higher intake of vegetables. WPs provided 29% of vegetable fiber to the
this nutrient than did children of all other races/ethnicities. diets of young children. Top food sources of vitamin D in-
The mean sodium-to-potassium ratio for this sample, there- cluded carbohydrates, dairy, and meats (Table 4).
fore, was higher for NHB children than it was for other
children. Discussion
In general, average nutrient intakes of children aged 1–3 y
Vegetable consumption. The 2010 DGA recommend 1–1.5 were greater than or equal to the recommended levels.
cups of vegetables/d and 2–3.5 cups of starchy vegetables/wk Our findings are similar to the FITS (Food Intake by Infants
for individuals consuming 1000–1400 kcal/d (1). Boys and and Toddlers) 2008, which showed that the majority of in-
girls aged 1–3 y across all races/ethnicities consumed an av- fants and toddlers met or exceeded requirements for most nu-
erage of 0.58 cup equivalents of total vegetables/d, which in- trients (21). Our study also showed that average intakes of
cluded 0.21 cup equivalents of total starchy vegetables/d, or potassium, DF, and vitamin D across all races were far below
TABLE 4 Mean daily intakes of selected nutrients by food source among children aged 1–3 y: NHANES 2009–20121
Potassium, Dietary fiber, Vitamin Vitamin C, Iron, Calcium, Vitamin D,
mg/d g/d A, mg/d mg/d mg/d mg/d mg/d
Dairy 725 6 16.9 0.4 6 0.03 272 6 8.0 2.3 6 0.3 0.6 6 0.04 683 6 21.2 0.6 6 0.05
Fruit 391 6 17.5 2.6 6 0.1 12.9 6 0.9 50.7 6 2.9 0.5 6 0.02 52.9 6 4.5 0.4 6 0.02
Carbohydrates 308 6 7.2 4.7 6 0.1 155 6 6.9 4.9 6 0.3 7.0 6 0.2 189 6 6.1 1.9 6 0.1
Meats 226 6 8.9 0.6 6 0.03 23.8 6 3.7 1.7 6 0.2 1.0 6 0.04 26.7 6 1.3 0.6 6 0.03
Total vegetables2 195 6 10.0 1.4 6 0.1 67.6 6 8.0 6.9 6 0.5 0.4 6 0.02 16.5 6 1.2 0.5 6 0.03
White potatoes3 73.5 6 7.6 0.4 6 0.05 2.2 6 0.3 1.1 6 0.1 0.1 6 0.01 3.9 6 0.6 0.1 6 0.02
Sweets 71.7 6 6.2 0.1 6 0.01 10.8 6 3.9 16.0 6 2.0 0.2 6 0.02 31.0 6 1.3 0.4 6 0.06
Beans 56.7 6 5.8 0.8 6 0.1 1.1 6 0.4 0.4 6 0.1 0.3 6 0.04 8.0 6 0.9 0.4 6 0.05
Eggs 28.4 6 3.7 0.02 6 0.01 25.5 6 2.7 0.2 6 0.1 0.2 6 0.03 15.7 6 1.8 0.2 6 0.03
Fats 0.6 6 0.1 0.003 6 0.001 0.2 6 0.03 0.01 6 0.004 0.005 6 0.001 0.3 6 0.04 0.04 6 0.006
1
Values are sample-weighted means 6 SEs based on day 1 24-h dietary recall data calculated by using STATA, 2006. Children who consumed breast milk on the day of the
survey were excluded from the analysis.
2
Includes white potatoes.
3
Includes baked, boiled, fried, hash-browned, home-fried, mashed, roasted, scalloped, stuffed, with sauce, potato salad, and potato chips.

244S Supplement
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