Nearly two-thirds of infants (61%) and almost all toddlers (98%) consume added sugars in their average daily diets, according to researchers at the Centers for Disease Control and Prevention (CDC), primarily in the form of flavored yogurts for infants and fruit drinks for toddlers.
Though the study’s results show a decline in the percentage of infants and toddlers whose daily diets included added sugars from the 2005 to 2006 timeframe to 2015 to 2016, the researchers note that there is still a persistent problem in the early development of eating patterns that are associated with negative oral and systemic health conditions.
“Our study, which is the first to look at trends in added sugars consumption by infants and toddlers, documents that most infants and toddlers consume added sugars,” said lead investigator Kristen A. Herrick, PhD, MSc, who was with the Division of Health and Nutrition Examination Surveys, National Center for Health Statistics, CDC, at the time of the study.
“This has important public health implications since previous research has shown that eating patterns established early in life shape later eating patterns,” said Herrick, who is now at the Division of Cancer Control and Population Studies at the National Cancer Institute, National Institutes of Health.
An earlier study found that 6-year-olds who had consumed any sugar-sweetened beverage (SSB) before the age of one were more than twice as likely to consume an SSB at least once a day compared to 6-year-olds who had not consumed any before the age of one, Herrick said.
“Previous research into the diets of children over 2 years old associated sugar consumption with the development of cavities, asthma, obesity, elevated blood pressure, and altered lipid profiles,” Herrick said.
Health organizations in the United States support guidelines limiting daily sugar intake to 9 teaspoons or less for adult men and 6 teaspoons or less for adult women and children between the ages of 2 and 19. With no comparable research for infants and children prior to this study, only the American Heart Association offered any guidance for children under the age of 2.
“Our study’s findings about infant and toddler diets should raise awareness among health organizations and practitioners and inform future guidelines and recommendations,” Herrick said.
The investigators analyzed data for 1,211 infants and toddlers between the ages of 6 and 23 months from the National Health and Nutrition Examination Survey 2011-2016. They used the Food Patterns Equivalents Database and the US Department of Agriculture’s What We Eat In America’s list to categorize foods. Sugars in breast milk and formula were not included.
Infants consumed about 1 teaspoon of added sugars daily, or about 2% of their daily caloric intake, while toddlers consumed about 6 teaspoons of sugars, or about 8% of their daily caloric intake. No differences were detected in added sugars consumption by sex, family income, or head of household.
However, non-Hispanic Asian toddlers consumed the fewest added sugars at 3.7 teaspoons, and non-Hispanic black toddlers consumed the most at 8.2 teaspoons. The top food sources of added sugars for infants included yogurt, baby snacks and sweets, and sweet bakery products. For toddlers, top sources included fruit drinks, sweet baked products, and sugar and candy.
According to Herrick, parents should be mindful of added sugars levels in the foods chosen when weaning their infants.
“The transition from a milk-based diet (breast milk and formula) to table foods has an impact on nutrition, taste preference, and eating patterns. More work is needed to understand this critical period,” said Herrick.
Herrick recommends discussing which solid foods to introduce during weaning with a child’s healthcare provider and pointed to the Nutrition Facts label as another resource. While the federal requirement to include added sugars content on the Nutrition Facts label is not mandatory until January 2020, many labels already include this information.
In September 2019, the Academy of Nutrition and Dietetics joined the American Heart Association, the American Academy of Pediatric Dentistry, and the American Academy of Pediatrics to recommend breast milk, infant formula, water, and plain milk as part of a new set of comprehensive beverage recommendations for children age 5 and under.
The recommendations caution against beverages that are sources of added sugars including flavored milks such as chocolate and strawberry and sugar-sweetened and low-calorie sweetened beverages, in addition to a wide variety of beverages that are on the market and targeted to children that provide no unique nutritional value.