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Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study.

ABSTRACT: Diet in the first years of life is an important factor in growth and development. Dietary protein is a critical macronutrient that provides both essential and nonessential amino acids required for sustaining all body functions and procedures, providing the structural basis to maintain life and healthy development and growth in children. In this study, our aim was to describe the total protein intake, type and food sources of protein, the adequacy to the Population Reference Intake (PRI) for protein by the European Food Safety Authority (EFSA), and the Recommended Dietary Allowance (RDA) by the Institute of Medicine (IoM). Furthermore, we analyzed whether the consumption of dairy products (including regular milk, dairy products, or adapted milk formulas) is associated with nutrient adequacy and the contribution of protein to diet and whole dietary profile in the two cohorts of the EsNuPI (in English, Nutritional Study in the Spanish Pediatric Population) study; one cohort was representative of the Spanish population from one to <10 years old (n = 707) (Spanish reference cohort, SRS) who reported consuming all kinds of milk and one was a cohort of the same age who reported consuming adapted milk over the last year (including follow-on formula, growing up milk, toddler's milk, and enriched and fortified milks) (n = 741) (adapted milk consumers cohort, AMS). The children of both cohorts had a high contribution from protein to total energy intake (16.79% SRS and 15.63% AMS) and a high total protein intake (60.89 g/day SRS and 53.43 g/day AMS). We observed that protein intake in Spanish children aged one to <10 years old was above the European and international recommendations, as well as the recommended percentages for energy intakes. The main protein sources were milk and dairy products (28% SRS and 29% AMS) and meat and meat products (27% SRS and 26% AMS), followed by cereals (16% SRS and 15% AMS), fish and shellfish (8% in both cohorts), eggs (5% SRS and 6% AMS), and legumes (4% in both cohorts). In our study population, protein intake was mainly from an animal origin (meat and meat products, milk and dairy products, fish and shellfish, and eggs) rather than from a plant origin (cereals and legumes). Future studies should investigate the long-term effect of dietary protein in early childhood on growth and body composition, and whether high protein intake affects health later in life.

SUBMITTER: Madrigal C

PROVIDER: S-EPMC8064310 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Bone problems in the population begin to be establish in childhood. The present study aims to assess the usual calcium, phosphorus, magnesium, and vitamin D intakes, along with the food sources of these nutrients, in Spanish children participating in the EsNuPI (Estudio Nutricional en Población Infantil Española) study. Two 24 h dietary recalls were applied to 1448 children (1 to <10 years) divided into two sub-samples: one reference sample (RS) of the general population [n = 707] and another sample which exclusively included children consuming enriched or fortified milks, here called "adapted milks" (AMS) [n = 741]. Estimation of the usual intake shows that nutrient intake increased with age for all nutrients except vitamin D. Using as reference the Dietary Reference Values from the European Food Safety Authority (EFSA), calcium and magnesium intakes were found to be below the average requirement (AR) and adequate intake (AI), respectively, in a considerable percentage of children. Furthermore, phosphorus exceeded the AI in 100% of individuals and vitamin D was lower than the AI in almost all children studied. The results were very similar when considering only plausible reporters. When analyzing the food sources of the nutrients studied, milk and dairy products contributed the most to calcium, phosphorus, magnesium, and vitamin D. Other sources of calcium were cereals and vegetables; for phosphorus: meat, meat products, and cereals; for magnesium: cereals and fruits; and, for vitamin D: fish and eggs. These results highlight the desirability of improving the intake concerning these nutrients, which are involved in bone and metabolic health in children. The AMS group appeared to contribute better to the adequacy of those nutrients than the RS group, but both still need further improvement. Of special interest are the results of vitamin D intakes, which were significantly higher in the AMS group (although still below the AI), independent of age.

Project description:Minerals and vitamins involved in the antioxidant defense system are essential for healthy growth and proper development during infancy. Milk and dairy products are of particular importance for improving the supply of these nutrients to children. Indeed, the present study aimed to evaluate the nutrient intake and food sources of zinc (Zn), selenium (Se), retinol and carotenoids (sources of vitamin A), and vitamins C and E, and to analyze their relationships with personal and familiar factors in Spanish children from the EsNuPI study. One subpopulation representative of the Spanish population from 1 to <10 years old (n = 707) (reference group, REF) who reported consuming all types of milk over the last year, and another subpopulation of the same age who reported consuming fortified milk formulas (FMFs) (including follow-on formula, young child formula, growing up milk, toddler's milk, and enriched and fortified milk) (n = 741) (fortified milk consumers, FMCs) completed two 24 h dietary recalls used to estimate their nutrient intakes and to compare them to the European Food Safety Authority (EFSA) Dietary Reference Values (DRVs). The REF reported higher median intakes than FMCs for Se (61 µg/kg vs. 51 µg/kg) and carotenoids (1079 µg/day vs. 998 µg/day). Oppositely, FMCs reported higher intakes than REF for Zn (7.9 mg/day vs. 6.9 mg/day), vitamin A (636 µg/day vs. 481 µg/day), vitamin E (8.9 mg/day vs. 4.5 mg/day), vitamin C (113 mg/day vs. 71 mg/day), and retinol (376 µg/day vs. 233 µg/day). In the REF group, more than 50% of the children met the EFSA recommendations for Zn (79.6%), Se (87.1%), vitamin A (71.3%), and vitamin C (96.7%), respectively. On the other hand, 92.2% were below the EFSA recommendations for vitamin E. In the FMC group, more than 50% of the children met the EFSA recommendations for Zn (55.2%), Se (90.8%), vitamin A (75.7%), vitamin E (66.7%), and vitamin C (100%). We found statistically significant differences between subpopulations for all cases except for Se. In both subpopulations, the main sources of all antioxidant nutrients were milk and dairy products. For carotenoids, the main sources were vegetables and fruits followed by milk and dairy products. A high percentage of children had vitamins A and E intakes below the recommendations, information of great importance to stakeholders. More studies using intakes and biomarkers are needed, however, to determine an association with diverse factors of oxidative damage.

Project description:Currently, in Spain there are no studies assessing the intakes and sources of intrinsic and added sugars by both children consuming standard milks and children regularly consuming adapted milk formulas. Our goal was to evaluate current sugar intake levels (intrinsic and added) and their major dietary sources within the EsNuPI study participants by applying two 24-h dietary recalls that were completed by 1448 children (1 to <10 years) divided into two subsamples: One "Spanish Reference Sample" (SRS) of the general population (n = 707) and another sample which included children consuming adapted milks including follow-on milk, toddler's or growing up milk and fortified and enriched milks, here called "Adapted Milk Consumers Sample" (AMS) (n = 741). Estimates of intrinsic and added sugar intakes from the Spanish EsNuPI population as well as the adherence to recommendations varied notably according to age segment, but no major differences between subsamples were found. Younger children (1 to <3 years) showed the highest added sugar contribution to total energy intake (TEI) (SRS: 12.5% for boys and 11.7% for girls; AMS: 12.2% for boys and 11.3% for girls) and the lowest adherence to recommendations set at <10% TEI (SRS: 27.4% for boys and 37.2% for girls; AMS: 31.3% for boys and 34.7% for girls). Adherence increased with age but remains inadequate, with approximately one in two children from the older age segment (6 to <10 years) exceeding the recommendations. Main food sources of intrinsic sugars for both subsamples were milk and dairy products, fruits, vegetables and cereals, while for added sugars, these were milk and dairy products (mainly yogurts), sugars and sweets (mainly sugary cocoa and nougat), bakery products (mainly cookies) and cereals (mainly bread and wheat flour). However, for the AMS, the groups milk and dairy products and cereals showed a significantly lower contribution to intrinsic sugar intake but a significantly higher contribution to that of added sugars. These results demonstrate that sugar intake and the adherence to recommendations in the studied population varied notably according to age but not to the type of milk consumed. In addition, our results highlight the need to monitor the consumption of added sugars by the infant population, as well as the need to make efforts to facilitate this task, such as harmonizing the recommendations regarding free/added sugars and the inclusion of information on their content on the nutritional labeling of products in order to incorporate them into food composition databases.

Project description:Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler's milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.

Dataset Information

Dietary Intake, Nutritional Adequacy, and Food Sources of Protein and Relationships with Personal and Family Factors in Spanish Children Aged One to <10 Years: Findings of the EsNuPI Study.

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