Lessons from the feeding infants and toddlers study in North America: what children eat, and implications for obesity prevention.

The latest exhaustive survey of dietary patterns in infants from the Feeding Infants and Toddlers Study (FITS) in North America documents and quantifies current trends in infant feeding. These include higher than generally recommended energy, protein, and saturated fat intakes. The majority of infants are bottle fed at some point in their first year of life, and their weaning diet often includes low intakes of fruits and vegetables, with high starchy, rather than green or yellow, vegetables. Early introduction of solids, use of cow's milk prior to 1 year of age, and high juice intake in the first 2 years - all less desirable diet practices - are improving, but are still prevalent. More preschoolers are likely to get sweets or sweetened beverages than a serving of fruit or a vegetable on a given day. These food intake patterns mimic the adult American diet and are associated with an increased risk of obesity in childhood and later life. But more importantly, these patterns appear to be set as early as 18 months of age, and by 20 months of age, they mimic the adult diet. Despite increase in total energy intake, and greater variety of foods, the basic characteristics of macronutrient intake distribution and food group contribution of energy to the diet before 2 years of age remain remarkably stable and similar to the family table. Obesity prevention needs to include specific targets in terms of breastfeeding and adequate formula feeding, as well as appropriate introduction of weaning foods with goals of changing the inadequate patterns documented in the FITS. These interventions will also require addressing parent and caregiver behaviors, including attending to hunger satiety cues (responsive feeding), and shaping early food preferences. This needs to be done starting at birth, in the first months of life. Early intervention offers a unique and potentially efficacious opportunity to shape the future dietary patterns of the next generation.