National diet guidelines includes infants and toddlers, offers food allergy prevention guidance

For the first time ever, the Dietary Guidelines for America (DGA) will include recommendations for infants and toddlers up to 2 years of age. Although the official guidelines won’t be released until later this year, a scientific report published by the Dietary Guidelines Advisory Committee in July offers early glimpses to what could be included in the final draft.

The scientific report¹ by the Dietary Guidelines Advisory Committee informs the US Department of Agriculture (USDA) and US Department of Health and Human Services as those agencies work to develop the Dietary Guidelines of America (DGA). These national guidelines were first published in 1980 and are updated every 5 years. Barbara Schneeman, PhD, professor emerita at the University of California, Davis, serves of the DGA Committee and says this will be the first edition of the guidelines to include recommendations for infants and toddlers. Previous version of the guidelines focused only on children aged two years and older. The final guidelines are due to be released by December 2020.

The inclusion of younger children is important and far-reaching, because the guidelines are used to help create policies that impact children. For example, policymakers use guidelines like the DGA to inform programs like the Supplemental Nutrition Assistance Program, and the Special Supplemental Nutrition Program for Women, Infant & Children program, and the National School Lunch program. Doctors also use this information to help guide their advice to patients about nutrition and healthy eating.

The most significant recommendations in this report take into account years of recent evidence on the benefits of early introduction of solid foods and foods that are most often linked to food allergies. Food exposures in the first 1000 days of life set the stage for long-term nutrition, taste preferences, and food choices, the report notes. Early exposure to foods usually associated with food allergies can help prevent these allergies, and a variety of new foods in this age range can help children appreciated a wider range of foods later in childhood.

The timing of solid food initiation was addressed in the report, with the recommendation varying slightly from the current recommendation from the American Academy of Pediatrics (AAP) currently. The AAP supports initiating solid foods to complement breast milk or formula between 4 to 6 months of age. However, the committee compared outcomes related to food introduction at 4, 5, and 6 months of age, and found no advantages or disadvantages. What was impacted by timing, according to the report, was when to introduce foods that are linked to food allergies.

“The committee’s review indicated that introducing peanut and egg, in an age-appropriate form, in the first year of life—after age 4 months—may reduce the risk of food allergy to these foods,” the report notes. The evidence of the protective effect of earlier introduction was more evident with peanut and nuts than other food groups.

The report also stresses the important of pregnant women, infants, and toddlers getting enough choline and linoleic acid in their diets. These nutrients are found in foods like eggs, nuts, seeds, and meats—food types that are not often consumed in high enough volumes by these age groups.

To help meet these goals—and to possibly avoid the development of allergies later on—the report is recommending that parents choose eggs as the first food to offer their infants at around 6 months of age. Guidance in previous decades was to avoid foods that contained a high allergy risk early in life. However, there is increasing evidence that early introduction of foods that often cause allergic reactions—including nuts and eggs—can actually help prevent the development of food allergies later on.² The committee notes in the new report that introducing eggs into an infant’s diet in the first year—around 6 months of age—may be helpful in reducing the risk of food allergies. The report also stresses the important of egg consumption for pregnant women because of the choline content, which is beneficial for fetal brain development.

In regard to earlier infant feeding, the report does point out that while breastfed babies appear less likely to become obese, or develop diabetes or asthma, the nutritional benefits of breastfeeding really rely on the diet quality of the nursing mothers. Breast milk may contribute to infant fatty acid status, according to the report, and it’s important for breastfeeding mothers to consume quality foods rich in long-chain polyunsaturated fatty acids like fish. By age 2 years, diet patterns can generally conform to whatever the child’s family eats.

Feeding patterns beyond breastfeeding or formula were another focus of the report, with the committee recommending diet patterns that use the USDA Food Pattern for children aged 2 years and older as a blueprint.

“The committee modeled several scenarios that incorporated that potential contribution from human milk or infant formula and reflected the total energy needs at ages 6 to 12 months and 12 to 24 months,” the report states. “The committee was not able to establish a recommended food pattern for infants ages 6 to 12 months, but was able to develop potential combinations of complementary food and beverages that come close to meeting all nutritional needs.”

More work is needed to offer up additional options for meeting nutritional requirements in these age groups, the report notes. The current recommendation includes a variety of foods—meat, poultry, seafood, eggs, dairy products, nuts, seeds, fruits, vegetables, and grain products—that can be prepared in ways that appeal to young children. Choosing potassium-rich fruits and vegetables, seafood, whole grains, and oils over fats should be prioritized, the committee adds.

The committee also stressed the importance of avoiding sugar-sweetened beverages in children aged younger than 2 years, as this adds unnecessary sugar to their diets and takes up “room” in daily intake that leads to possible nutrition gaps. When there are gaps in nutrition, many people turn to supplements, but the report doesn’t encourage nutritional supplements for children in general beyond the consumption of iron-fortified foods or iron supplements in other forms.

Reference

1. US Department of Agriculture. Scientific report of the 2020 dietary guidelines advisory committee. Dietaryguidelines.gov. Published July 1, 2020. Accessed October 5, 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-07/ScientificReport_of_the_2020DietaryGuidelinesAdvisoryCommittee_first-print.pdf.

2. Sicherer S, Greer F. Dietary interventions to prevent atopic disease: updated recommendations. AAP News. Published March 18, 2019. Accessed October 5, 2020. https://www.aappublications.org/news/2019/03/18/atopy031819.