Complementary Feeding: Summary of Information Reviewed

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review WIC Food Packages

Appendix IComplementary Feeding: Summary of Information Reviewed

To evaluate complementary feeding of infants in this report, the committee relied on food intake data from three large contemporary datasets: (1) Infant Feeding Practices Study II (IFPS II) (Grummer-Strawn et al., 2008), (2) 2008 Feeding Infants and Toddlers Study (FITS 2008) (Deming et al., 2014), and (3) National Health and Nutrition Examination Survey (NHANES) (Grimes et al., 2015). The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Infant and Toddler Feeding Practices Study, (WIC ITFPS II) is currently under way, but only limited results were available in time for this report. A summary of the study designs is presented in Table I-1 and key results are outlined in Tables I-2 and I-3.

TABLE I-1

Study Designs and Characteristics of Selected Reports, IFPS II, FITS 2008, and NHANES 2005–2012.

TABLE I-2

Complementary Food Intake of Infants, Ages 0 to 2 Years, from IFPS II and FITS II.

TABLE I-3

Percent of Daily Energy Intake of Complementary Food Groups by Infants Ages 6 to 23.9 Months, NHANES 2005–2012.

REFERENCES

Briefel RR, Kalb LM, Condon E, Deming DM, Clusen NA, Fox MK, Harnack L, Gemmill E, Stevens M, Reidy KC. The Feeding Infants and Toddlers Study 2008: Study design and methods. Journal of the American Dietetic Association. 2010;110(12 Suppl):S16–S26. [PubMed: 21092765]
CDC (Centers for Disease Control and Prevention). Infant Feeding Practices Study II and its year six follow-up, chapter 2: Neonatal survey. 2014. [December 20, 2016]. http://www.cdc.gov/ifps/pdfs/data/ifps2_tables_ch2.pdf.
Deming DM, Briefel RR, Reidy KC. Infant feeding practices and food consumption patterns of children participating in WIC. Journal of Nutrition Education and Behavior. 2014;46(3 Suppl):S29–S37. [PubMed: 24809994]
Fein SB, Labiner-Wolfe J, Shealy KR, Li R, Chen J, Grummer-Strawn LM. Infant Feeding Practices Study II: Study methods. Pediatrics. 2008;122(Suppl 2):S28–S35. [PubMed: 18829828]
Fein SB, Li R, Chen J, Scanlon KS, Grummer-Strawn LM. Methods for the year 6 follow-up study of children in the Infant Feeding Practices Study II. Pediatrics. 2014;134(Suppl 1):S4–S12. [PMC free article: PMC4258852] [PubMed: 25183754]
Grimes CA, Szymlek-Gay EA, Campbell KJ, Nicklas TA. Food sources of total energy and nutrients among U.S. infants and toddlers: National Health and Nutrition Examination Survey 2005-2012. Nutrients. 2015;7(8):6797–6836. [PMC free article: PMC4555149] [PubMed: 26287236]
Grummer-Strawn LM, Scanlon KS, Fein SB. Infant feeding and feeding transitions during the first year of life. Pediatrics. 2008;122(Suppl 2):S36–S42. [PubMed: 18829829]

Publication Details

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National Academies Press (US), Washington (DC)

NLM Citation

National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Food and Nutrition Board; Committee to Review WIC Food Packages. Review of WIC Food Packages: Improving Balance and Choice: Final Report. Washington (DC): National Academies Press (US); 2017 May 1. Appendix I, Complementary Feeding: Summary of Information Reviewed.

TABLE I-1Study Designs and Characteristics of Selected Reports, IFPS II, FITS 2008, and NHANES 2005–2012

	IFPS II^a	FITS 2008^b	NHANES, 2005–2012^c
Design	Longitudinal data collected from the last trimester of pregnancy through infant's first year of life^d	Cross-sectional evaluation of dietary intake of U.S. children, 0–4 years	Cross-sectional
Data Collection Dates	May 2005–June 2007; 6-year follow-up in 2012^d	June 2008–January 2009	2005–2012
Recruitment	Pregnant women who were part of a nationally distributed consumer opinion panel	Sample frame came from the New Parent Database and the Consumer Database and the Consumer Database from the Experian, Inc.	Complex, multistage, probability sampling
Eligibility	Women at least 18 years of age Delivered a singleton infant who was at least 35 weeks gestation and weighed at least 5 pounds at birth Both mother and child were free from conditions that could affect feeding	Household had child 0–47 months	Non-institutionalized U.S. population
Sample Size	4,902 qualified in prenatal period 3,033 qualified in neonatal period 1,807 remained by end of study	3,273 infants and children	2,857 children enrolled^e 2,791 completed the first 24-hour dietary recall 2,740 had reliable dietary recall data 765 infants, 0–5.9 months 854 infants, 6–11.9 months 1,121 toddlers, 12–23.9 months
WIC Participants in Sample	1,112 (36.7%) of enrolled households (mother and/or infant) participated in WIC in the neonatal period 912 (30.1%) of enrolled households (mother and/or infants) participated in WIC any time from month 1 to 12	794 WIC infants and children 117 infants, 0–5.9 months 84 infants, 6–8.9 months 76 infants 9–11.9 months 238 toddlers, 12–23.9 months 279 preschoolers, 24–47.9 months	Not identified in this analysis
Data Collection	Mail-based survey Sent monthly approximately 2–7 months postpartum, then approximately every 7 weeks thereafter through 12 months postpartum	Phone-based	Face-to-face interview
Dietary Assessment^f	Food frequency table of liquids and solids the infant consumed in previous 7 days Quantities consumed not captured	24-hour recall and brief questionnaire Second 24-hour recall performed in a subsample, 7–10 days after first (n = 701)^h Descriptive findings of unadjusted prevalence are presented for WIC vs. non-WIC participants; analyses used sample weights and groups were compared using t-tests^g	24-hour proxy-recallⁱ Evaluated contributions of foods to energy and nutrient intake

: NOTES: FITS = 2008 Feeding Infants and Toddlers Study; IFPS II = Infant Feeding Practices Study II; NHANES = National Health and Nutrition Examination Survey.

a: Overall study design, Fein et al., 2008; CDC, 2014.

b: Overall study design, Briefel et al., 2010.

c: Grimes et al., 2015.

d: A year 6 follow-up study of children initially assessed in the IFPS II has been conducted, evaluating links between early feeding practices and various health outcomes (Fein et al., 2014).

e: Number represents sample included in the analysis, not entire NHANES sample.

f: Information about dietary supplement use was collected in each of the overall study designs, but the three reports on food group intakes did not evaluate supplement use.

g: Report-specific analysis, Deming et al., 2014.

h: Two days of dietary intake per sampled child was used to calculate usual nutrient intake distributions, Briefel et al., 2010.

i: While two 24-hour recalls are part of the NHANES procedures, Grimes et al. (2015) only evaluated intake reported on the first day of recall.

: SOURCES: CDC, 2014; Fein et al., 2008, 2014; Grimes et al., 2015.

TABLE I-2Complementary Food Intake of Infants, Ages 0 to 2 Years, from IFPS II and FITS II

Food Group	IFPS II^a		FITS 2008^b
	Age in Months	Percent Consuming in the Previous Week	Age in Months	Percent Consuming on a Given Day
	Age in Months	Percent Consuming in the Previous Week	Age in Months	WIC	Non-WIC
Fruit (excluding juice)	3	2.8	0–5.9	8.6^c	6.4^c
	6	71.3	6–11.9	69.1	75.6
	9	97.0	12–23.9	62.3	83.6^d
	12	98.4
100% Juice	3	5.0	0–5.9	8.2^c	3.8^c
	6	33.4	6–11.9	46.1	28.3^e
	9	62.8	12–23.9	61.9	52.4
	12	76.9
Vegetables, total	3	1.4	0–5.9	11.2^c	8.4
	6	73.1	6–11.9	57.7	75.6^e
	9	97.2	12–23.9	73.5	69.5
	12	98.7
Grains and grain products, total	3	18.3	0–5.9	26.7	22.7
	6	86.1	6–11.9	91.5^c	90.3
	9	96.3	12–23.9	99.5^c	98.4^c
	12	97.0
Infant cereal	3	18.2	0–5.9	26.7	21.9
	6	83.7	6–11.9	61.8	66.9
	9	83.4	12–23.9	6.9^c	11.4
	12	46.6
Meats and meat substitutes^f	3	0.7	0–5.9	2.8^c	0.0^c
	6	22.0	6–11.9	64.1	53.6
	9	78.4	12–23.9	93.9^c	94.1
	12	96.6
Cow's milk, total	3	0.3	0–5.9	0.0	0.0
	6	1.2	6–11.9	13.3	9.4
	9	5.3	12–23.9	86.5	81.0
	12	81.2
Cow's milk, whole	NR		6–11.9	10.0^c	7.8
Cow's milk, whole	NR		12–23.9	59.2	64.2
Cow's milk, reduced- or low-fat	NR		6–11.9	2.7^c	1.1^c
Cow's milk, reduced- or low-fat	NR		12–23.9	31.8	19.7^e
Cow's milk, nonfat	NR		6–11.9	0.5	0.1^c
Cow's milk, nonfat	NR		12–23.9	1.0^c	1.0
Sweetened beverages	3	1.1	0–5.9	0.0^c	0.3^c
	6	3.1	6–11.9	12.3^c	4.5^c
	9	6.2	12–23.9	39.6	22.0
	12	14.6
Desserts and candy	3	0.2	0–5.9	1.7^c	1.1^c
	6	1.5	6–11.9	22.7	24.8
	9	12.3	12–23.9	63.6	55.5
	12	52.2

: NOTES: NR = not reported.

a: Grummer-Strawn et al., 2008.

b: Deming et al., 2014 (data reprinted with permission).

c: Point estimate imprecise due to small sample size and it being an uncommon or very common response.

d: Significantly different from WIC group at 0.01 level by t-test.

e: Significantly different from WIC group at 0.05 level by t-test.

f: FITS 2008 classified this category as “Meat and other protein sources” and included cheese and yogurt in this category while IFPS II has a separate “Other Dairy” category.

: SOURCES: Grummer-Strawn et al., 2008; Deming et al., 2014.

TABLE I-3 Percent of Daily Energy Intake of Complementary Food Groups by Infants Ages 6 to 23.9 Months, NHANES 2005–2012^a

Food Group	Percent of Daily Energy Intake
Food Group	6–11.9 months	12–23.9 months
Fruit (excluding juice)	2.3	4.8
100% Juice	1.5	5.9
Vegetables	NA^b	3.2^c
Grains and grain products
Mixed dishes—grain-based	2.3	5.5
Bread, rolls, tortillas	1.1	3.8
Crackers	NA	2.4
Ready-to-eat cereal	NA	2.3
Quick breads and bread products	NA	1.6
Cooked cereals	NA	1.4
Meats and meat substitutes
Poultry	NA	3.6
Cured meats and poultry	NA	2.5
Eggs	NA	2.2
Mixed dishes—meat, poultry, seafood	NA	2.0
Plant-based protein foods	NA	1.6
Dairy
Cow's milk, all fat levels	3.1	22.4
Cheese	NA	2.6
Yogurt	NA	1.7
Flavored milk	NA	1.3
Desserts, sweetened beverages, and savory snacks
Sweet bakery products	1.8	4.6
Sweetened beverages	NA	3.1
Savory snacks	NA	2.4
Candy	NA	1.3
Other desserts	NA	1.2

: NOTES: NA = data not available.

a: Intake of human milk and infant formulas not represented in this table.

b: All NA notations indicate that data were not presented in Grimes et al. (2015), as intake contributed to less than 1 percent of total energy intake.

c: Sum of “White Potatoes” group and “Vegetables, excluding potatoes” group.

: SOURCE: Grimes et al., 2015.