Longitudinal Diet Quality Trajectories Suggest Targets for Diet Improvement in Early Childhood

Background There is little information about how diet quality evolves in early child-hood, whether children exhibit varying diet quality trajectories, or which components of diet quality should be targeted for intervention. Objective The goal of this study was to identify and evaluate trajectories of dietary quality in young children. Design This was a secondary analysis of an observational, longitudinal cohort study of non-Hispanic African American or White children and their parents from racially concordant households with 4 years of follow-up (up to 13 study visits). Data on mother, infant feeding, and body mass index were assessed at baseline. Diet was evaluated using 3-day diaries at each visit. Participants/setting Of 372 children enrolled, 349 children had at least 3 study visits with dietary data for this analysis. Participants were enrolled at age 3 years between March 2001 and August 2002 in Cincinnati, OH. Final study visits were conducted be-tween February 2005 and June 2006. Main outcome measure The main outcome measure was the total Healthy Eating Index 2005 (HEI-20 05) score and HEI-20 05 component scores. Statistical analyses Diet quality trajectories were modeled using group-based modeling techniques. Results The total HEI-20 05 score was low at age 3 years (mean +/- standard error = 55.1 +/- 0.4 of maximum 100 points) and remained stable to age 7 years (mean +/- standard error = 54.0 +/- 0.6; P = 0.08 for trend). Five HEI-20 05 trajectory groups were identified, of which 1 declined and 1 improved over time. HEI-20 05 component scores, except milk intake and meat/beans scores, differed significantly (all, P < 0.02) among trajectory groups at age 3 years, and most differences were maintained at age 7 years. Total vegetables, dark green and orange vegetables and legumes, and whole grains compo-nent scores were low for all trajectory groups. Whole fruit; total fruit; saturated fat; and calories from solid fats, alcoholic beverages, and added sugars (SoFAAS) were highly variable among trajectory groups. Children in the lowest diet quality trajectory group were less likely to be breastfed and more likely to have been regular consumers of soft drinks (e.g., powdered drink mixes, sport drinks, or soda pop) before age 3 years. Conclusions Young childhood diet quality was low at age 3 years and remained stable to age 7 years. Improving intake of vegetables and whole grains is needed for all chil-dren. Focused attention regarding increasing fruit intake and reducing SoFAAS may be needed for families at increased risk for low overall diet quality. J Acad Nutr Diet. 2021;121(7):1273-1283.

Automated summary

The study revealed that the dietary quality of young children was low at age 3 and remained stable until age 7. Improving vegetable and whole grain intake is necessary for all children, with additional focus needed for families at increased risk of low overall diet quality.