Complementary foods and beverages in the diet of U.S. infants and toddlers: Importance of unprocessed/minimally processed foods and ultra-processed foods
A new study published in The Journal of Nutrition reveals that foods classified as unprocessed/minimally processed are top sources of many nutrients and food groups that are encouraged for infants and toddlers but some ultra-processed foods, such as breakfast cereals and breads, were top sources of iron, zinc, and whole grains.
Food choices early in life, including ultra-processed foods, can influence dietary intake across the lifespan and are associated with health outcomes into adulthood. Because ultra-processed foods generally do not contribute substantiative amounts of nutrients and tend to be energy-dense, it is important to understand how ultra-processed foods influence diet quality in infants and toddlers. Because food processing and formulation has become increasingly more complex, characterizing foods in terms of nutritional quality can be challenging. NOVA is a commonly used system of food classification that assigns foods to one of four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods.
To better understand how NOVA groups and subgroups contribute to select nutrients and total energy intake from complementary foods and beverages among infants and toddlers aged 6-23 months, O’Connor (United States Department of Agriculture) and colleagues used data from the cross-sectional 2013-2014, 2015-2016, and 2017-2018 National Health and Nutrition Examination Survey, a nationally representative survey conducted to assess the health and nutritional status of Americans. Each food or beverage reported for infants and toddlers was classified according to the NOVA Classification System of food. An equation was used to estimate the percent of energy, nutrient or food group intake from complementary food and beverages for each main NOVA group and subgroup.
For infants and toddlers, 42% of energy intake from complementary foods and beverages came from unprocessed/minimally processed foods, compared to 45% from ultra-processed foods. Unprocessed/minimally processed foods contributed most to nutrients that should be encouraged (except for iron and zinc, which came primarily from ultra-processed foods) and least to sodium. The majority of vitamin D, vitamin B12, choline, potassium, vitamin A, vitamin C and calcium were from unprocessed/minimally processed foods. Breakfast cereals, which are largely considered ultra-processed foods, contributed more to iron and zinc than any other food source. Most fruit, vegetables, and dairy were from unprocessed/minimally processed foods. More than 80% of total grains, whole grains, refined grains, and added sugars were ultra-processed foods.
For infants and toddlers in the United States, unprocessed/minimally processed foods support healthy dietary intakes. Study results also indicate that some types of ultra-processed foods, such as breakfast cereals and breads may contribute meaningfully to nutrients and food groups to be encouraged (iron, zinc, and whole grains). However, other types of ultra-processed foods, such as sweet snacks, frozen meals, and sweetened beverages contribute nutrients that should be avoided (added sugars) or limited (sodium) for this age group. These results highlight that a balanced perspective is needed on this topic, particularly for infants and toddlers. Whereas some ultra-processed foods are high in sodium, added sugars, and solid fats, others can provide important sources of iron, zinc, and whole grains. More research is needed to better understand the utility and sensitivities of using NOVA for providing dietary guidance for infants and toddlers in the United States due to the variety of food types that are captured under this umbrella term.
O’Connor LE, Martinez-Steele E, Want L, Zhang FF, Herrick KA. Food Processing, According to the Nova Classification System, and Dietary intake of US Infants and Toddlers. The Journal of Nutrition, Volume 153, Issue 8, August 2023, Pages 2413-2420, doi.org/10.1016/j.tjnut.2023.06.020.
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