Advertisement

Feeding Infants and Toddlers Study: Do Vitamin and Mineral Supplements Contribute to Nutrient Adequacy or Excess among US Infants and Toddlers?

      Abstract

      Objective

      To report the prevalence of dietary supplement use in a random sample of US infants 4 to 24 months of age, and to compare demographic characteristics, usual nutrient intakes, and food patterns of supplement users and nonusers.

      Design

      Data from 24-hour recalls collected for the 2002 Feeding Infants and Toddlers Study were analyzed. Recalls included nutrient contributions from dietary supplements as well as all foods and beverages. We estimated usual energy and nutrient intakes of supplement users and nonusers, as well as the prevalence of nutrient adequacy and excess in the two groups. We also compared demographic characteristics and food patterns of supplement users and nonusers and, for supplement users, estimated the proportion of total intake provided by foods and the proportion provided by supplements.

      Subjects

      A national random sample of 3,022 infants and toddlers age 4 to 24 months, including 430 vitamin and/or mineral supplement users and 2,592 nonusers.

      Statistical Analysis

      We compared means, percentile distributions, and proportions by age and supplement subgroup, and applied the Dietary Reference Intakes to assess usual nutrient intakes. We conducted regression analysis to determine which population characteristics predict the use of dietary supplements in this population.

      Results

      Overall, 8% of infants age 4 to 5 months received some type of dietary supplement. The prevalence of supplement use increased with age, to 19% among infants 6 to 11 months and 31% among toddlers 12 to 24 months. The vast majority of supplement users (97%) received only one type of supplement, most commonly a multivitamin and/or mineral supplement. Vitamin/mineral supplement use among infants and toddlers was associated with being a first-born child and being reported by the primary caretaker as being a picky eater. Characteristics that were independent predictors of supplement use were living in the Northeast, being male, and living in a household with fewer children. We found no significant differences between supplement users and nonusers in mean daily intakes of nutrients or nutrient density from foods alone, and few differences in food consumption. Overall, the prevalence of inadequate intakes was low (<1% to 2%). However, 65% of supplement nonusers and 9% of supplement users had vitamin E intakes less than the Estimated Average Requirement. Excessive intakes (ie, intakes above the Tolerable Upper Intake Level) were noted for both supplement users and nonusers for vitamin A (97% and 15% of toddlers) and zinc (60% and 59% of older infants and 68% and 38% of toddlers) as well as for folate among supplement users (18% of toddlers).

      Conclusions

      Generally, healthy infants and toddlers can achieve recommended levels of intake from food alone. Dietetics professionals should encourage caregivers to use foods rather than supplements as the primary source of nutrients in children’s diets. Vitamin and mineral supplements can help infants and toddlers with special nutrient needs or marginal intakes achieve adequate intakes, but care must be taken to ensure that supplements do not lead to excessive intakes. This is especially important for nutrients that are widely used as food fortificants, including vitamin A, zinc, and folate.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ferrier G.
        The Global Nutrition Industry in 2004.
        Presentation made at Expo Asia, 2004. 2005; (http://www.naturalproductsasia.com/naturalproductsasia/images/ppt/Day2/1000-1050_Grant_Ferrier.ppt Accessed August 17, 2005)
        • American Dietetic Association
        Position of the American Dietetic Association.
        J Am Diet Assoc. 2001; 101: 115-125
      1. Dietary Supplement Health and Education Act of 1994. 1994; (Pub L No. 103-417 (S.784); 1994. Codified at 4 USC 287C-11.)
        • American Academy of Pediatrics, Committee on Nutrition
        Pediatric Nutrition Handbook. 5th ed. American Academy of Pediatrics, Elk Grove Village, IL2004: 307-309 (349, 793)
        • Briefel R.R.
        • Johnson C.L.
        Secular trends in dietary intake in the United States.
        Annu Rev Nutr. 2004; 24: 401-431
        • Radimer K.
        Methodological issues in assessing dietary supplement use in children.
        J Am Diet Assoc. 2005; 105: 703-708
        • Centers for Disease Control and Prevention
        Recommendations to prevent and control iron deficiency in the United States.
        MMWR. 1998; 47: 1-36
        • Grivetti L.E.
        Dietary supplements in American children.
        Nutr Today. 2002; 37: 128-129
        • Carriquiry A.L.
        Estimation of usual intake distributions of nutrients and foods.
        J Nutr. 2003; 133: S601-S608
        • Dwyer J.
        • Picciano M.F.
        • Raiten D.
        • Members of the Steering Committee
        Estimation of usual intakes.
        J Nutr. 2003; 133: S609-S623
        • Murphy S.
        Collection and analysis of intake data from the integrated survey.
        J Nutr. 2003; 133: S585-S589
        • Sanjur D.
        • Garcia A.
        • Aguilar R.
        • Furumoto R.
        • Mort M.
        Dietary patterns and nutrient intakes of toddlers from low-income families in Denver, Colorado.
        J Am Diet Assoc. 1990; 90: 823-829
        • Eichenberger Gilmore J.M.
        • Hong L.
        • Broffitt B.
        • Levy S.M.
        Longitudinal patterns of vitamin and mineral supplement use in young white children.
        J Am Diet Assoc. 2005; 105: 763-772
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes. National Academy Press, Washington, DC2000
        • Devaney B.
        • Kalb L.
        • Briefel R.
        • Zavitsky-Novak T.
        • Clusen N.
        • Ziegler P.
        FITS: Feeding Infants and Toddlers Study. Overview of the study design.
        J Am Diet Assoc. 2004; 104: S8-S13
        • Ziegler P.
        • Briefel R.
        • Clusen N.
        • Devaney B.
        Feeding Infants and Toddlers Study (FITS).
        J Am Diet Assoc. 2006; 106: S12-S27
        • Radimer K.
        • Bindewald B.
        • Hughes J.
        • Ervin B.
        • Swanson C.
        • Picciano M.F.
        Dietary supplement use by US adults.
        Am J Epidemiol. 2004; 160: 339-349
        • Radimer K.L.
        • Subar A.F.
        • Thompson F.E.
        Nonvitamin, nonmineral dietary supplements.
        J Am Diet Assoc. 2000; 100: 447-454
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes. National Academy Press, Washington, DC1999
        • Heinig M.J.
        • Nommsen L.A.
        • Peerson J.M.
        • Lonnderal B.
        • Dewey K.G.
        Energy and protein intakes of breast-fed and formula-fed infants during the first year of life and their association with growth velocity.
        Am J Clin Nutr. 1993; 58: 152-161
        • Dewey K.G.
        • Finley D.A.
        • Lonnerdal B.
        Breast milk volume and composition during late lactation (7-20 months).
        J Pediatr Gastroenterol Nutr. 1984; 3: 713-720
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes. National Academy Press, Washington, DC2002
        • Nutrition Coordinating Center, University of Minnesota
        Revisiting vitamin A measurements.
        NDS Quarterly. 2001; 11: 2
        • Fox M.K.
        • Pac S.
        • Devaney B.
        • Jankowski L.
        Feeding Infants and Toddlers Study.
        J Am Diet Assoc. 2004; 104: S22-S30
        • Life Sciences Research Office, Federation of American Societies for Experimental Biology
        Third Report on Nutrition Monitoring in the United States. US Government Printing Office, Washington, DC1995
        • Ervin R.B.
        • Wright J.D.
        • Kennedy-Stephenson J.
        Use of dietary supplements in the United States, 1988-94.
        Vital Health Stat. 1999; series 11, no. 244: 1-14
        • Yu S.M.
        • Kogan M.D.
        • Gergen P.
        Vitamin-mineral supplement use among preschool children in the United States.
        Pediatrics. 1997; 100 (Available at: http://www.pediatrics.org/cgi/content/full/100/5/e4. Accessed August 2, 2005): 1-6
        • Birch L.L.
        • Lee Y.
        Family influences.
        Nutr Today. 2002; 37: 173-174
        • Devaney B.
        • Ziegler P.
        • Pac S.
        • Karwe V.
        • Barr S.
        Nutrient intakes of infants and toddlers.
        J Am Diet Assoc. 2004; 104: S14-S21
        • Institute of Medicine, Committee to Review the WIC Food Packages, Food and Nutrition Board
        WIC Food Packages. National Academy Press, Washington, DC2005
        • Institute of Medicine, Food and Nutrition Board
        Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids. National Academy Press, Washington, DC2000
        • Fox M.K.
        • Reidy K.
        • Novak T.
        • Ziegler P.
        Sources of energy and nutrients in the diets of infants and toddlers.
        J Am Diet Assoc. 2006; 106: S28-S42
        • US Department of Agriculture, Agricultural Research Service
        Food and Nutrient Intakes by Children 1994-96, 1998. 2005; (http://www.barc.usda.gov/bhnrc/foodsurvey/home.htm Accessed June 6, 2005)
        • Cole N.
        • Fox M.K.
        Nutrition and Health Characteristics of Low-Income Populations, Volume II.
        US Department of Agriculture, Economic Research Service, Electronic publication number E-FAN-04-010-2. 2004; (http://www.ers.usda.gov Accessed June 16, 2005)
        • Fox M.K.
        • Reidy K.
        • Karwe V.
        • Ziegler P.
        Average portions of foods commonly eaten by infants and toddlers in the United States.
        J Am Diet Assoc. 2006; 106: S66-S76
        • Kleinman R.E.
        Current approaches to standards of care for children.
        Nutr Today. 2002; 37: 177-179
        • Bothwell T.H.
        Overview and mechanisms of iron regulation.
        Nutr Rev. 1995; 53: 237-245
        • Siegenberg D.
        • Baynes R.D.
        • Bothwell T.H.
        • Macfarlane B.J.
        • Lamparelli R.D.
        • Car N.G.
        • MacPhail P.
        • Schmidt U.
        • Tal A.
        • Mayet F.
        Ascorbic acid prevents the dose-dependent inhibitory effects of polyphenols and phytates on nonheme-iron absorption.
        Am J Clin Nutr. 1994; 53: 537-541

      Biography

      R. Briefel is a senior fellow and C. Hanson is a nutri-tion research analyst, Mathematica Policy Research, Inc, Washington, DC

      Biography

      M. K. Fox is a senior researcher at Mathematica Policy Research, Inc, Cambridge, MA; at the time of the study, she was an independent consultant.

      Biography

      T. Novak is a systems analyst, Mathematica Policy Research, Princeton, NJ

      Biography

      P. Ziegler is an adjunct, assistant professor, Department of Foods and Nutrition, College of Saint Elizabeth, Morristown, NJ; at the time of the study, she was a principal scientist,Gerber Products Co, Parsippany, NJ