Measuring dietary quality among toddlers in the Feeding Infants and Toddlers Study, 2016, using the New Healthy Eating Index-Toddlers-2020

Abstract

Background: Child diet can influence risk for obesity and other related noncommunicable diseases. Few studies have used the Healthy Eating Index (HEI)-Toddlers-2020 to assess diet quality among toddlers (children aged 12 to 23.9 months). Objective: The aim of this study was to examine diet quality among toddlers participating in the Feeding Infants and Toddlers Study, 2016, and determine differences by sociodemographic characteristics. Caregiver perception of how their toddler's diet aligns with HEI-Toddlers-2020 diet quality scores was also assessed. Design: This cross-sectional study used 24-hour dietary records collected in 2016. Participants and setting: Data were collected on toddlers ages 12 to 23.9 months (N = 1133) participating in the Feeding Infants and Toddlers Study, 2016. Main outcome measures: Diet quality was assessed using the HEI-Toddlers-2020. Statistical analyses performed: The population ratio method was used for all analyses using weighted data to estimate HEI-Toddlers-2020 scores overall and within subgroups. To determine significant differences of the HEI-Toddlers-2020 score between subgroups, pairwise t tests were used. Statistical significance at P < .05 was used as a cutoff for all 2-sided P values. Results: Average HEI-Toddlers-2020 score among toddlers ages 12 to 23.9 months participating in the Feeding Infants and Toddlers Study, 2016, was 71.2 out of a possible 100. Total scores (mean, standard error) varied by race and ethnicity with Hispanic toddlers having higher scores compared with non-Hispanic White toddlers (76.4 +/- 2.5 vs 69.0 +/- 1.2; P = .03) and by federal poverty level with those >200% of the poverty level having higher scores compared with those <100% of the poverty level (74.7 +/- 1.5 vs 67.0 +/- 2.6; P = .01). Conclusions: Opportunities for improvement in dietary intake were identified using the new HEI-Toddlers-2020 to assess diet quality among children ages 12 to 23.9 months. Scores were indicative of toddlers consuming excess added sugars and lower-than-recommended amounts of seafood and plant proteins, greens and beans, whole grains, and vegetables. Interventions to improve diet quality in toddlers may benefit from focusing on foods children should eat more of along with foods to consume in moderation.