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Serve sizes and frequency of food consumption in Australian children aged 14 and 24 months

Serve sizes and frequency of food consumption in Australian children aged 14 and 24 months life determines growth trajectory and D Objective: To describe the dietary intake of a sample of Australian children. health in childhood, adolescence In particular, it is hypothesised and adult life. Methods: Three days (1x24 hour recall, 2x24 hour records) of dietary intake data were collected that early exposure to a variety of healthy from 409 and 363 mother-child dyads (resident in Brisbane and South Australia) at 14 (T2) and foods facilitates the development of life-long 24 (T3) months of age respectively as part of the NOURISH and SAIDI studies. Data presented However, there is healthy food preferences. include foods consumed by ≥10% of children, number of consumers and median serve size. still much to learn about the dietary intake Results: Thirteen of 25 vegetables consumed by more than 10% of children at T2 were of Australian infants and toddlers. Australian consumed by a lower proportion at T3 (9:1-5% less consumers; 4: 10-16% less). Eleven population-based studies focus on children discretionary foods were consumed by greater than 10% of children at T2, and by T3, this 2,3 while nationally older than two years of age, number had almost doubled. representative studies in other countries have Conclusions: Increased exposure to discretionary food and decreased exposure to vegetables 4,5 reported on intakes of infants and toddlers. is occurring in the transition toward family food, during a time of increasing independence and Data have been published in an attempt to emerging neophobia. fill this gap, describing the total daily intake Implications for Public Health: The age-related decline in dietary quality is of concern, with of core food groups and discretionary choices 6 7,8 and 18 months. More potential concurrent impact on nutritional adequacy, development of food preferences and of children at age 14 detailed reporting may help researchers and later eating patterns. Serve size data could be used to inform serve sizes for toddlers in future editions of the Australian Guide to Healthy Eating. practitioners understand the development of children’s food preferences. Key words: dietary intake, serve sizes, children Data describing the types and amounts of foods consumed can offer insight into the should provide an increasing proportion of in very young children , and the prospective variety (or lack of ) to which children are being energy intake after 12 months”. South Australian Infants Dietary Intake (SAIDI) exposed, and inform guidance for parents study. SAIDI participants were recruited This analysis describes the dietary intake of with respect to realistic portion sizes for simultaneously using the same protocol as a sample of Australian children aged 14 and young children. A sample daily food pattern NOURISH. Recruitment has been described 24 months, in terms of the most frequently for children aged 1-2 years is included within 12,13 in detail. Briefly, a consecutive sample consumed foods (including the change the Australian Guide to Healthy Eating. This of mothers (aged ≥18 years) delivering between 14 and 24 months), the median provides serve sizes and recommended healthy term infants (≥37 weeks gestation (and interquartile range) serve size and the number of serves per day for vegetables, and birthweight ≥2,500g) at maternity number of children consuming the food at fruit, grain foods, lean meat/alternatives, hospitals in Brisbane, Queensland, (n=3) least once in a three-day period. dairy/alternatives and an allowance for (first-time mothers only) and metropolitan unsaturated spreads/oils such that children (n=5) and regional (n=7) South Australia were meet their recommended nutrient intakes. Methods approached within 72 hours post-delivery. However these were derived from the food Eligible mothers were asked to provide This is secondary analysis of data collected intake patterns of children aged between consent to be contacted when infants were at the second and third assessments of 2 and 3 years, due to lack of data available 4–7 months-of-age, for full enrolment in 10 mother-child dyads in the control group for younger children. Younger children are the studies. Approval was gained from 11 of NOURISH, a randomised controlled trial likely to have different dietary patterns as human research ethics committees including evaluating an intervention commencing in they transition from the milk–based diet of Queensland University of Technology and infancy, promoting positive feeding practices infancy to family foods given “solid foods 1. Nutrition and Dietetics, School of Health Sciences, Flinders University, South Australia 2. School of Exercise and Nutritional Sciences, Institute Health Biomedical Innovation, Queensland University of Technology Correspondence to: Professor Anthea Magarey, Nutrition and Dietetics, Flinders University, GPO Box 2100, Adelaide, SA 5001; e-mail: anthea.magarey@flinders.edu.au Submitted: March 2016; Revision requested: June 2016; Accepted: September 2016 The authors have stated they have no conflict of interest. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Aust NZ J Public Health. 2017; 41:38-44; doi: 10.1111/1753-6405.12622 38 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors Food Food consumption at 14 and 24 months Flinders University (Australasian Clinical Trials two weekdays and one weekend day were according to the Australian Guide to Healthy Registration ACTRN 1260800056392; QUT included in the three-day intake data for each Eating (AGHE). For the present analyses, HREC 00171 Protocol 0700000752). child. Quantities were estimated as per the those recipes that were considered ‘core’ recall. Completed records were returned via foods were separated into individual Data collection reply-paid envelope. ingredients for inclusion in the final analyses. Demographic data were collected at Time Food items from the recall and records Analysis 1 when infants were 4–6 months old. Three were entered into FoodWorks Professional 15 For each time point, the five-digit (or eight- days of dietary intake data were collected version 9 by trained staff using the AUSNUT digit where more detail was necessary) using one 24-hour recall and two days of 2007 database from the 2007 Australian food code was used to group individual food record when children were aged 12-16 National Children’s Nutrition and Physical 16 foods and identify those most frequently months (T2 n=409) and 24 months (T3 Activity Survey and an additional study- consumed. The three days of intake were n=363). Only children providing intake data specific database containing commercial combined and a participant was considered on all three days for at least one point are infant products. A coding decisions file was a consumer if they ate the food at least included. maintained to ensure consistency of data once in the three days. Foods consumed by entry. Mixed dishes prepared at home with A dietitian contacted the mother by at least 10% of the sample are discussed, more than four ingredients were added to telephone, unannounced, to conduct the 24- 15 however only foods from the five core food 14 FoodWorks as a recipe; individual ingredients hour recall using a three-pass methodology. groups, and discretionary foods, consumed were entered as separate food items. She was asked to recall everything her by at least 20% are presented in tables. child ate or drank in the previous 24 hours, Data cleaning occurred using a standard Foods were grouped into 10 categories, starting from midnight on the previous day, protocol. Each FoodWorks recall and record based on the AGHE, but including further with quantities estimated using household file was checked to ensure accurate subject groupings of beverages, discretionary foods, measures (metric cup, tablespoon and ID, date and plausible meal times, food and commercial infant foods and fats and oils. teaspoon). A visual aid showing actual size drink quantities consumed, and total energy Some differences in groupings compared illustrations of these measures designed and macronutrient intakes. Implausible with the AGHE were inclusion of legumes in to improve estimation was provided to records were checked with the hard copy the vegetable group only, butter included in participants before the phone call along with and assumptions made in the absence of the fats and oils group (primarily for ease of a food record booklet. Breast milk intake was sufficient detail were checked for consistency comparison with other fats) and 100% fruit estimated from the number of minutes up with protocol. juice included with beverages. Beverages to a maximum of 10 that a child was actively Data were exported into an Access database included all drinks other than water, plain feeding. A second feed starting within 30 and merged with an eight digit food group milks (included with dairy) and infant/ minutes of the start of the previous feed was code that allowed identification of each toddler formula (included with commercial not considered a second feed and the time 16 unique food in the AUSNUT 2007 database. infant foods). Commercial infant foods were added to the previous feed to a maximum of Staff allocated additional eight digit codes considered those foods that are marketed 10 minutes. Ten grams of milk were assumed to infant foods and recipes. This database specifically towards infants, including infant to be consumed per minute with an energy was imported into IBM SPSS Version 22 and toddler formula (but excluding infant and content of 2.77 kJ /g. Mothers were allocated for analysis. Foods, including recipes, children’s yoghurt). For all identified foods, a two days to record their child’s intake within were categorised as ‘core’ or ‘discretionary’ single consumption was considered a ‘serve’ the booklet, with days chosen to ensure and all ‘serves’ were used to generate quartiles of serve size in grams. The serve size was Table 1. Characteristics of mother-infant dyads at 14 and 24 months. generally cooked or prepared weight, except Time 2: 14 months Time 3: 24 months where otherwise specified. Where foods may Variable (n=409) (n=363) have been entered as ‘dry’ or ‘cooked’ into n (%) or M (SD) FoodWorks (e.g. pasta), the cooked serve Mother sizes only were used to calculate values. Education (university degree) 215 (53) 206 (57) Serve size data are presented as median and Born in Australia (yes) 348 (85) 314 (87) interquartile range. In a relationship (yes) 396 (97) 351 (97) Age at delivery (years) 31.4 (5.1) 31.6 (4.8) Self-reported weight status (overweight) 76 (19) 70 (19) Results First child 270 (67) 237 (66) Demographics Infant Characteristics of participants at T2 and T3 Gender (female) 225 (55) 196 (54) are presented in Table 1. Demographic data Age (months) 13.9 (1.1) 23.9 (0.7) were provided by 447 participants at T1, Ever breastfed (yes) 393 (98) 352 (98) with intake data available for 409 at T2 (91% Energy intake (kJ per day, mean of 3 days) 4.13 (0.86) 4.84 (0.98) retention) and 363 at T3 (89%). Mothers either Count (% within group); a: Mean (standard deviation) reported for continuous variables; declined further participation, were lost to All data (except infant age) collected at baseline. follow-up, or remained in the study but did n = 402 to 409 due to missing data; n = 357 to 363 due to missing data not provide three days of dietary intake data. 2017 vol . 41 no . 1 Australian and New Zealand Journal of Public Health 39 © 2016 The Authors Mauch et al. Article due to oats being cooked with water and/ both regular fat and reduced fat cow’s milk Breads and cereals or milk (compared with other cereals, where increased from T2 to T3. The median serve The most popular cereal product at T2 dry weight only was reported). Pasta and rice size for regular fat milk was 129 g (125 mL, was whole wheat biscuits (e.g. Weetbix), were consumed in the next largest quantities half a cup) at both points, with reduced fat consumed by 65% of the population (Table per serve at both T2 and T3. By T3 the median milk at T3 being of a similar median serve size 2). By T3 this figure dropped markedly to serve sizes of pasta and rice were equivalent (130 g). The median serve size of children’s 52%, becoming the second most commonly to half a metric measuring cup (250 mL yoghurt remained steady at around 90 g and consumed cereal product after white capacity) and a quarter cup respectively. was slightly lower than the median serve size bread and rolls. Puffed rice cereals and of other yoghurts. The median serve size of sugar-sweetened cereals (included in the Dairy and dairy alternatives cheddar cheese increased by more than 40% ‘discretionary foods’ group) were consumed from 12 g at T2 to 1 7g at T3. Regular fat cow’s milk, regular fat cheddar by less than 10% of children at T2, but by cheese and yoghurt marketed for infants and 11.3 and 11.8% respectively at T3. Most other Fruit children were the most popular dairy foods at foods in this group were consumed by a each time (Table 2). Breastmilk was consumed Most (8 of 12 consumed by at least 10% of the greater proportion of children at T3 compared by a quarter of children at T2, but less than sample) fruits were consumed by a greater with T2. Oats (generally consumed as 10% at T3. The proportion of consumers of proportion of children at T3. While bananas porridge) had the largest median serve size, Table 2: Breads and cereals, dairy and dairy alternatives, and fruit consumed by greater than 20% of the sample, and serving size quartiles at child age 14 months and 24 months. Time 2: 14 months (N=409) T3: 24 months (N=363) Change in % Food (by food group) Consumers of consumers Serving size in grams (25th, Serving size in grams (25th, Food (by food group) Consumers c c (%) from 14 to 24 50th and 75th percentiles) 50th and 75th percentiles) (%) months Breads and cereals Wholewheat breakfast biscuits 267 (65.3) ↓↓ 15.0 17.5 26.3 White bread and rolls 199 (54.8) 15.0 28.8 38.8 (eg Weetbix/Vitabrits) Pasta 185 (45.2) ↑ 20.0 45.0 82.5 Wholewheat breakfast biscuits (eg 189 (52.1) 17.5 21.9 35.0 Weetbix/Vitabrits) White bread and rolls 191 (46.7) ↑ 12.5 25.0 30.0 Pasta 181 (49.9) 28.8 57.5 91.8 Wholemeal bread and rolls 163 (39.9) ~ 11.5 21.6 27.0 Savoury biscuits (plain) 157 (43.3) 6.5 9.8 14.0 Savoury biscuits (plain) 154 (37.7) ↑ 3.5 6.5 8.5 Wholemeal bread and rolls 143 (39.4) 18.3 27.0 35.1 Rice 120 (29.3) ↑ 21.4 39.5 55.5 Rice 132 (36.4) 30.3 52.1 95.0 Rice cakes and crackers 104 (25.4) 3.0 4.0 6.7 Wholegrain bread and rolls 115 (31.7) 21.0 33.0 48.0 Flour (wheat based) 101 (24.7) 2.2 4.8 8.2 Rice cakes and crackers 112 (30.9) 5.1 8.3 11.6 Wholegrain bread and rolls 92 (22.5) ↑ 14.0 24.8 33.0 Oats 77 (21.2) 87.1 162.5 203.4 Dairy and dairy alternatives Cow’s milk (regular fat) 336 (82.2) ↑ 61.8 128.8 206.0 Cow’s milk (regular fat) 322 (88.7) 77.3 128.8 206.0 Cheddar cheese (regular fat) 255 (62.3) ↑ 6.5 12.4 20.0 Cheddar cheese (regular fat) 236 (65.0) 9.00 16.5 24.0 Infant and children’s yoghurt (regular fat, 145 (35.5) 60.0 90.0 90.0 Infant and children’s yoghurt (regular fat, 120 (33.1) 70.00 90.0 95.0 flavoured) flavoured) Processed cheese slices, sticks and spreads 126 (30.8) ↑ 12.0 20.0 21.0 Processed cheese slices, sticks and spreads 118 (32.5) 15.8 20.0 21.0 Breastmilk 109 (26.7) X 50.0 100.0 100.0 Yoghurt (regular fat flavoured) 77 (21.2) 67.6 103.0 156.0 Yoghurt (regular fat flavoured) 108 (26.4) ↓ 71.3 100.0 130.0 Fruit Bananas 312 (76.3) ↓ 33.3 50.5 89.7 Bananas 255 (70.2) 40.0 50.5 101.0 Apple (cooked and raw) 155 (37.9) ↑↑ 19.8 34.2 64.4 Apples (cooked and raw) 178 (49.0) 35.0 66.0 106.0 Grapes 135 (33.0) ↑ 20.0 30.0 42.6 Sultanas 153 (42.1) 12.5 17.7 35.4 Sultanas 132 (32.3) 8.8 16.8 22.4 Grapes 139 (38.3) 24.0 36.0 52.1 Canned fruit (all varieties) 106 (25.9) 25.0 53.8 86.0 Watermelon 117 (32.2) 26.0 54.6 120.8 Pears 104 (25.4) ↓ 27.1 43.5 83.0 Strawberries 102 (28.1) 24.0 36.0 60.0 Watermelon 99 (24.2) ↑ 27.0 52.0 85.4 Dried fruit (excluding sultanas) 80 (22.0) 7.0 13.3 20.0 Strawberries 84 (20.5) ↑ 24.0 36.0 48.0 Pears 80 (22.0) 29.0 67.5 85.6 Canned fruit (all varieties) 77 (21.2) 28.0 68.6 120.0 a: Starting with the most popular (based on proportion of children consuming the food at least once in 3 days). ↑= increase in the proportion of children consuming the food from T2-T3; b: Symbols (as follows) refer to the change in popularity of the food from T2 to T3; ↑↑= large increase (10 percentage points or more) in the proportion of children consuming the food from T2-T3; c: Unless otherwise specified, serving weight refers to cooked food. ↓= decrease in the proportion of children consuming the food from T2-T3; d: Mostly consumed as porridge, with some used in baking. Serving weight represents cooked weight as porridge. ↓↓= large decrease (10 percentage points or more) in the proportion of children consuming the food from T2-T3); e: serving size per eating occasion ~ = minimal (less than 1 percentage point) or no change in the proportion of children consuming the food from T2-T3; X = the food is no longer consumed by at least 10% of toddlers at T3. 40 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors Food Food consumption at 14 and 24 months were consumed by a smaller proportion of food preferences are being formed and food Fats and oils children at T3, the proportion consuming neophobia is strengthening. Although butter was consumed by more apple increased from 38% to 49% (Table 2). The serve sizes for breads, whole wheat children at T2 than margarine (42.3 v 36.2%) Dried fruit and sultanas were consumed by breakfast biscuits, vegetables, fruit, and this pattern was reversed at T3 (38.6 v 50.7%). a larger proportion of children at T3, while dairy/alternatives in our sample appear In addition, at T3 butter and margarine blends canned fruit and pears were consumed by a remarkably consistent with the only other were included, being consumed by 17% of smaller proportion. Mandarins and canned Australian study reporting actual serve the sample but less than 10% at T2. Median fruit had the largest median serve sizes at T2 sizes consumed by toddlers. The Childhood serve sizes for all fats and oils presented were and 3 while sultanas and dried fruit had the 8 Asthma Prevention Study (CAPS) reported less than one teaspoon. smallest. The serving size of apple almost on the intake of 429 children aged 16–24 doubled from T2 to T3. months, using three-day weighed food Discretionary foods records. Reported serve size of pasta was There were 11 discretionary foods consumed Vegetables and legumes larger in our cohort, 45 g and 58 g at T2 and by greater than 10% of the sample at T2, Of 25 vegetables consumed by at least 10% T3 respectively, compared with 21 g in CAPS. and by T3, this number had almost doubled. at T2, more than half were consumed by a This may reflect a more general change in High salt yeast spreads (predominantly lower proportion at T3. Carrots, potatoes (not popularity or acceptability of pasta-based Vegemite) were consumed by more than as potato chips, wedges or gems) and onion dishes in the approximately eight-year 50% of participants at both T2 and T3, with were the most popular vegetables at both T2 interval between the two studies. the median serve size being slightly greater and T3, although carrots and potatoes were Vegetable serve sizes are lower than those at T3 (Table 3). Plain sweet biscuits were consumed by a lower proportion of children reported among 18-month-old children in consumed by around 50% of children at each at T3 (Table 3). The most marked changes the Avon Longitudinal Study of Parents and time. One quarter (27%) consumed cake at T3 from T2 to T3 were for pumpkin – decreased 18 Children (ALSPAC). For example, the median compared to 11% at T2, 24% consumed other from 41% to 25% consuming, sweet potato serve size range for carrots for 18-month-olds sweet biscuits (cream filled, choc coated, – decreased 25% to 14% consuming, and in the ALSPAC data was 20-40 g, compared etc) at T3 compared with 10% at T2, and 22% potato chips, wedges and gems – increased to 10 g at T2 and 11 g at T3 in our sample, consumed icecream at T3, compared with from 21% to 33% consuming. Baked beans, despite this vegetable being the most 11% at T2. Median serve sizes were generally tomato-based pasta sauces and potato chips, popular at both points. Similarly, broccoli small (with 16 of 19 under 20 g at T3) with wedges and gems respectively had the and cauliflower, which had a median serve custard, cake and icecream having the largest largest median serve sizes, with potato chips, size range of 26-28 g in ALSPAC, were only serve sizes at T2, while custard, savoury wedges and gems becoming larger than consumed in median serves of between 10 g pastries and cake, had the largest median tomato-based pasta sauces by T3. 8 and 17 g by our sample and the CAPS cohort. serve sizes at T3. As previously mentioned, the AGHE includes Meat and meat alternatives Commercial infant foods a sample daily food pattern for toddlers aged All but two types of meats consumed by 1-2 years that was developed using data from Although there were nine commercial more than 10% of the population at T2, children aged 2-3 years. The serve sizes are infant foods consumed by more than 10% increased in popularity by T3. Beef, chicken based on the adult serves, such as 250 mL of participants at T2, none were consumed and eggs were consistently the most popular milk and 65 g of lean meat. Although we by more than 10% by T3 (data not included meat and meat alternatives (Table 3). The cannot describe the total quantity of food in tables). The most commonly consumed proportion of children consuming ham and consumed from one food group on one (26.4%) commercial infant food at T2 was sausages increased substantially from T2 to T3 eating occasion (e.g. the total quantity of meat and vegetable mixtures followed (21 to 30% and 19 to 30% respectively), and all vegetables consumed at dinner-time) or by infant biscuits excluding rusks (22.7%). the proportion of children consuming canned across one day, our data do provide some Median serve sizes were quite large (meat fish reduced by almost 6%. Crumbed chicken understanding of the typical serve sizes of the and vegetable: 85 g, cereal and fruit mixture: and nuggets had the greatest median serve most popular foods consumed by this age 99 g, custard 120g,) compared to most other weight at T2 (40 g, 10% consuming) and T3 group, which may be of use to practitioners food groups, with the median serve size of (53 g, 19.3% consuming), followed by chicken when both assessing diets and educating formula (infant: 185 g, toddler: 155 g) being at T2 and crumbed, battered and floured fish families, but also may be considered in larger than that of full cream cow’s milk. at T3 (50 g, 12.9% consuming). future revisions of the AGHE. For example, the AGHE recommends 1-1½ serves of dairy Discussion Beverages per day, with a serve equivalent to 250 mL The proportion of children consuming fruit of milk, 40 g of cheese or 200 g of yoghurt. This paper provides valuable information with juice doubled from 19.3% at T2 to 39.9% at Our data show that the typical serve size is respect to foods Australian children aged 14 T3 along with the median serve size (T2: 49 g, at the most, half this amount. It is therefore and 24 months are consuming, the serve size T3: 86 g). Fruit juice drink (a combination of more realistic to expect that a toddler might of those foods and the change in popularity fruit juice, sugar and water) was consumed by have two serves of 125 mL of milk in one over the second year of life. It provides 10.7% of the population at T3, and the serve day rather than one larger serve of 250 mL. insight into the transition toward family size was substantially larger than that of fruit Further the contribution of breastmilk in food and eating patterns, at a time when juice (130 g). meeting nutrient requirements was not 2017 vol . 41 no . 1 Australian and New Zealand Journal of Public Health 41 © 2016 The Authors Mauch et al. Article considered in the food pattern of any child serve size were small and some reduced, on a number of occasions to achieve the older than 12 months. With a quarter of a pattern not seen in the other core food daily 2-3 serves of 75 g recommended by children in this sample breastfeeding at T2 groups. The Australian InFANT study found the AGHE, a target particularly challenging and 18% of children 13-18 months of age in a that the proportion of vegetable consumers in the second year of life when neophobia nationally representative sample it would be was similar at nine and 18 months of age is emerging. Several studies have reported appropriate to model inclusion of breast milk but median daily intake decreased from 84 neophobia to be associated with a lower in the composite dairy food for children up to to 70 g/day. In our study the serve size of intake of vegetables, both in amount and 20,21 eighteen months. vegetables was generally small, with 17 of variety. Parents can be reassured that 25 vegetables listed at T3 having a median young children are unlikely to consume a 75 g Most vegetables were consumed by a smaller serve size less than 30g. Clearly children serve of one vegetable type in one eating proportion of children at T3 compared would need to consume several vegetables occasion. Instead, children should be offered with T2, and in addition, most increases in Table 3: Vegetables and legumes, meat and meat alternatives and discretionary foods consumed by greater than 20% of the sample, and serving size quartiles at child age 14 months and 24 months. Time 2: 14 months (n=409) T3: 24 months (n=363) Change in % Food (by food group) Consumers of consumers Serving size in grams (25th, Consumers Serving size in grams (25th, Food (by food group) c c (%) from 14 to 24 50th and 75th percentiles) (%) 50th and 75th percentiles) months Vegetables and legumes Carrot 285 (69.7) ↓ 5.0 10.0 18.2 Carrots (cooked and raw) 231 (63.6) 5.1 10.9 18.5 Potato (other) 247 (60.4) ↓ 16.6 29.9 61.0 Potato (other) 184 (50.7) 19.9 41.3 71.0 Onions 187 (45.7) ~ 2.8 5.3 9.2 Onions 165 (45.5) 2.5 5.0 9.1 Pumpkin 168 (41.1) ↓↓ 12.0 24.5 46.8 Tomatoes (mostly raw) 124 (34.2) 16.9 33.4 51.0 Broccoli 157 (38.4) ↓ 8.2 13.4 25.9 Broccoli 121 (33.3) 10.0 16.0 25.2 Peas (frozen, can, fresh) 141 (34.5) ↓ 4.7 10.4 18.2 Potato chips, wedges, gems 118 (32.5) 28.2 50.0 70.5 Zucchini 130 (31.8) 5.5 11.7 20.1 Sweetcorn (frozen, fresh, can) 113 (31.1) 7.1 18.0 36.4 Tomatoes (cooked and raw) 110 (26.9) 15.0 30.0 48.8 Cucumber 99 (27.3) 16.5 26.0 39.0 Sweetcorn (frozen, fresh, can) 109 (26.7) ↑ 5.6 15.1 23.9 Zucchini 96 (26.4) 5.1 10.1 19.9 Sweet potato 103 (25.2) ↓↓ 9.2 17.0 31.2 Peas (frozen, can, fresh) 92 (25.3) 6.3 13.3 22.0 Garlic 101 (24.7) ~ 0.1 0.3 0.5 Garlic 91 (25.1) 0.1 0.3 0.5 Can tomatoes (whole, diced) 96 (23.5) ↓ 16.8 31.7 54.3 Pumpkin 89 (24.5) 12.6 23.8 35.4 Potato chips, wedges, gems 87 (21.3) ↑↑ 22.8 35.0 58.5 Mushrooms 81 (22.3) 2.7 6.3 12.0 Capsicum (raw and cooked) 79 (21.8) 2.6 6.1 11.9 Can tomatoes (whole, diced) 78 (21.5) 17.2 32.5 55.8 Meat and meat alternatives Beef 197 (48.2) ↓ 14.9 26.8 39.6 Beef 169 (46.6) 16.2 31.2 52.6 Chicken 174 (42.5) 14.3 30.2 50.8 Chicken 157 (43.3) 22.0 35.9 62.4 Eggs (inc egg in baked goods) 158 (38.6) 3.9 13.0 37.0 Eggs (inc egg in baked goods) 148 (40.8) 4.6 17.9 46.7 Canned fish 86 (21.0) ↓ 10.1 20.0 32.9 Ham 110 (30.3) 15.0 21.0 42.0 Ham 84 (20.5) ↑ 10.5 21.0 31.7 Sausages (all meats) 107 (29.5) 29.5 44.0 58.0 Discretionary foods Yeast spread (eg Vegemite) 221 (54.0) ↑ 1.5 2.3 4.2 Yeast spread (eg Vegemite) 205 (56.5) 2.0 3.0 6.0 Plain sweet biscuits 211 (51.6) 8.0 10.0 12.6 Plain sweet biscuits 172 (47.4) 10.0 13.0 20.0 Stock 82 (20.0) 0.1 0.3 0.8 Cake (all types, iced/ uniced) 98 (27.0) 19.0 39.0 55.0 Honey 94 (25.9) 2.5 5.4 10.0 Added salt 93 (25.6) 0.1 0.2 0.6 Tomato sauce / ketchup 93 (25.6) 3.6 7.3 12.9 Added sugar (all varieties) 93 (25.6) 1.4 3.4 5.8 Other sweet biscuits (cream filled, 86 (23.7) 10.0 14.0 22.5 choc coated, iced etc) Icecream 81 (22.3) 18.5 35.0 47.4 Sugar based confectionary 78 (21.5) 3.8 7.0 12.9 Chocolate and chocolate bars 77 (21.1) 6.0 10.5 14.0 a: Starting with the most popular (based on proportion of children consuming the food at least once in 3 days). ↑= increase in the proportion of children consuming the food from T2-T3; b: Symbols (as follows) refer to the change in popularity of the food from T2 to T3; ↑↑= large increase (10 percentage points or more) in the proportion of children consuming the food from T2-T3; c: Unless otherwise specified, serving weight refers to cooked food. ↓= decrease in the proportion of children consuming the food from T2-T3; d: serving size per eating occasion ↓↓= large decrease (10 percentage points or more) in the proportion of children consuming the food from T2-T3); e: includes powdered and liquid stock but weight of stock powders only presented ~ = minimal (less than 1 percentage point) or no change in the proportion of children consuming the food from T2-T3; X = the food is no longer consumed by at least 10% of toddlers at T3. 42 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors Food Food consumption at 14 and 24 months small portions of a variety of vegetables therefore food refusal which may result from regular yoghurt varieties (e.g. less throughout the day, at both meals and in modifications to the range of foods sugar, added calcium compared with regular snacks, to facilitate adequate intake. However that parents offer , increasing exposure varieties) the primary difference tends to as only 7% of Australian adults met the AGHE to discretionary foods with age which be in packaging and presentation (smaller guidelines for vegetable serves in 2014-15, it appeals to children’s innate predisposition portions in squeezy, freezable sachets, with is likely that many children are growing up in toward sweeter and saltier flavours, and the minimal lumps). The overall lower serve size households where availability of healthy food transition toward family food which tends to of ‘infant’ or ‘children’s’ yoghurt – compared and modelling of healthy eating is limited. be complete by the time children reach two with regular yoghurts – probably reflects the 1,26,27 years of age. The age-related decline in packaging size. Pre-packaged portions of There were a number of changes between dietary quality is of concern in terms of the infant and children’s yoghurt range from 70 T2 and T3 that demonstrate a shift potential concurrent impact on nutritional to 140 g, compared with regular yoghurts at toward sweeter, saltier, and more highly adequacy, as well as on development of 150 to 200 g, or in larger containers of 500 or processed products with age. The number food preferences and later eating patterns. 1,000 g to be portioned as desired. of discretionary foods consumed by at We have recently shown that the number least 10% almost doubled by two years Our data have some limitations, which have of vegetables, fruit and discretionary foods of age (the majority at both times being been documented previously, including tried at 14 months predicted corresponding sweet), suggesting increased exposure bias toward older and university-educated preferences and higher intakes at 3.7 29 to discretionary foods and deterioration parents and error inherent in the collection years. In addition, after adjusting for 30 of children’s eating habits with age. This of intake data of infants and toddlers. fussiness at 14 months, children who tried level of exposure is a concern given the In our sample more than 50% of mothers more vegetables at 14 months had lower AGHE recommends that for children up to were university educated; in the general fussiness at 3.7 years of age. Overall, these eight years of age, discretionary choices be population, around 40% of women aged data suggest that intake in this age group 31 avoided or limited to no more than half a between 25 and 34 are university educated. 9 has important longer-term impacts on serve (equivalent to 300 kj) per day. Of the However, it is likely that this would mean the eating patterns. They highlight the need for meats and meat alternatives, the greatest intake of the sample is of somewhat better interventions to support carers to understand increase in proportion of consumers from quality than a more representative sample. the potential impact of neophobia, growing T2 to T3 was observed for sausages, ham, Strengths include a large sample size, three autonomy and increased exposure to the crumbed chicken and nuggets, and devon/ days of intake data including weekdays and obesogenic food environment on the short fritz (processed meat). This could be due to weekends, and the inclusion of first and and long term quality of children’s diets. a combination of factors not limited to their subsequent children, all of which improve the convenience and availability, salt content The median serve sizes of infant and toddler generalisability of the data. Finally, as our data and softer texture (than pure cuts of meat). formula and cows milk were by far the largest were longitudinal (with only minor differences The aforementioned meats also tended to of any food at T2 or T3. This likely reflects in the sample between times) we were able be consumed in the largest quantities. There the use of these products as drinks. Previous to investigate change in intake of a group of were also marked increases in the proportion research using T2 data from NOURISH and children at a time of transition from an ‘infant’ of children consuming fruit juice and fruit SAIDI reported an inverse relationship to ‘toddler’ diet, for which there is currently drinks, and fried potatoes (as chips, wedges, between formula intake and the number little comparable data available. etc) from T2 to T3. Additionally, there was a of core food groups from which a child eats considerable reduction in consumption of in a day. The same relationship was not Conclusion commercial infant foods and of pumpkin found with cow’s milk. It is reassuring that and sweet potato, two foods consumed by less than 10% of the population at T3 was The study provides rich data regarding the infants as purees (and the most popular consuming infant or toddler formula (4 most commonly consumed foods, along in our sample at T1, unpublished data), and 7% respectively, data not presented). with the median serving size, for Australian demonstrating the transition away from Toddler formula tends to be a formula infants and toddlers aged 14 and 24 months. ‘infant’ foods. Vegemite (or similar spreads), a marketed as suitable from one year of age, This will be of great benefit to parents and high salt yeast spread commonly consumed and when these data were collected (2010- practitioners, assisting them to have realistic on bread, was consistently popular, with 11) toddler formula was generally the only expectations of their children and patients more than half the children at both times formula marketed towards this age group. respectively. It also provides data that could consuming it at least once in the three days However, in recent years, at least four of be used to inform serving sizes for toddlers (compared with our previous report of one the major Australian infant formula brands in future editions of the Australian Guide third of children at T2 based on recall data have developed formula marketed towards to Healthy Eating. It highlights the changes only). This consistency of use demonstrates 2+ years. This new marketing strategy may in dietary intake in the transition toward that consumption of this product begins early have affected the number of children now family food, during a time of increasing and persists with time, likely due to children’s consuming formula beyond two years of age. independence and emerging neophobia. innate preference for salt. Ideally, the milk-based diet of infancy Choice of yoghurt may also be influenced by transitions to one reliant on vegetables, fruit, There are several factors that may have marketing, with more children consuming wholegrains and lean meat. Instead, these contributed to these changes from T2 to ‘infant’ or ‘children’s’ yoghurt than regular data identify early development of eating T3 including heightening levels of food varieties at both points. Although ingredients patterns that fall short of recommendations. neophobia, increasing autonomy and and nutritional content may differ slightly 2017 vol . 41 no . 1 Australian and New Zealand Journal of Public Health 43 © 2016 The Authors Mauch et al. Article 12. Daniels LA, Magarey A, Battistutta D, Nicholson JM, 23. Birch L. Development of food preferences. Annu Rev Comparison of these data with AGHE core Farrell A, Davidson G, et al. The NOURISH randomised Nutr. 1999;19:41-62. food serve recommendations to identify control trial: Positive feeding practices and food 24. Chan L, Magarey AM, Daniels LA. Maternal feeding the food patterns of children who achieve preferences in early childhood – a primary prevention practices and feeding behaviors of Australian program for childhood obesity. BMC Public Health. children aged 12-36 months. Matern Child Health J. these recommendations will provide further 2009;9:387. 2011;15(8):1363-71. guidance for families and practitioners and 13. Daniels LA, Wilson JL, Mallan KM, Mihrshahi S, Perry 25. Mennella JA. Ontogeny of taste preferences: basic R, Nicholson JM, et al. Recruiting and engaging new biology and implications for health. Am J Clin Nutr. should be a priority for future research. mothers in nutrition research studies: Lessons from 2014;99(3):704S-11S. the Australian NOURISH randomised controlled trial. 26. Brazionis L, Golley RK, Mittinty MN, Smithers LG, Int J Behav Nutr Phys Act. 2012;9:129. Emmett P, Northstone K, et al. Characterization of References 14. Jonnalagadda SS, Mitchell DC, Smiciklas-Wright H, transition diets spanning infancy and toddlerhood: Meaker KB, Van Heel N, Karmally W, et al. Accuracy A novel, multiple-time-point application of principal 1. Birch LL, Doub AE. Learning to eat: Birth to age 2 y. Am of energy intake data estimated by a multiple-pass, components analysis. Am J Clin Nutr. 2012;95:1200-8. J Clin Nutr. 2014;99(3):723S-8S. 24-hour dietary recall technique. J Am Diet Assoc. 27. Anzman SL, Rollins BY, Birch LL. Parental influence on 2. Commonwealth Scientific and Industrial Research 2000;100(3):303-8; quiz 9-11. children’s early eating environments and obesity risk: Organisation. Australian National Children’s Nutrition 15. FoodWorks: Nutrient Analysis Software. Professional. Implications for prevention. Int J Obes. 2010;34(7):1116- and Physical Activity Survey – Main Findings. Canberra Version 9. Brisbane (AUST): Xyris Software; 2016. 24. (AUST): Government of Australia, 2007. 16. Food Standards Australia New Zealand. AUSNUT 2007 28. Mallan KM, Fildes A, Magarey AM, Daniels LA. The 3. Australian Bureau of Statistics. 4364.0.55.007 – Australian – Australian Food Supplement and Nutrient Database Relationship between Number of Fruits, Vegetables, Health Survey: Nutrition First Results – Food and Nutrients for Estimation of Population Nutrient Intakes. Canberra and Noncore Foods Tried at Age 14 Months and Food 2011-12. Canberra (AUST): ABS; 2014. (AUST): FSANZ; 2008. Preferences, Dietary Intake Patterns, Fussy Eating 4. Lennox A, Sommerville J, Ong K, Henderson H, Allen R. 17. Dovey TM, Staples PA, Gibson EL, Halford JC. Food Behavior, and Weight Status at Age 3.7 Years. J Acad Diet and Nutrition Survey of Infants and Young Children, neophobia and ‘picky/fussy’ eating in children: A review. Nutr Diet. 2016;116(4):630-7. 2011. London (UK): United Kingdom Department of Appetite. 2008;50(2-3):181-93. 29. Daniels LA, Mallan KM, Battistutta D, Nicholson JM, Health; 2013. 18. More JA, Emmett PM. Evidenced-based, practical food Meedeniya JE, Bayer JK, et al. Child eating behavior 5. Skinner JD, Ziegler P, Pac S, Devaney B. Meal and portion sizes for preschool children and how they fit outcomes of an early feeding intervention to reduce snack patterns of infants and toddlers. J Am Diet Assoc. into a well balanced, nutritionally adequate diet. J Hum risk indicators for child obesity: The NOURISH RCT. 2004;104(1 Suppl 1):65-70. Nutr Diet. 2015;28(2):135-54. Obesity. 2014;22(5):E104-11. 6. Byrne R, Magarey A, Daniels L. Food and beverage 19. Australian Institute of Health and Welfare. 2010 30. Collins CE, Watson J, Burrows T. Measuring dietary intake in Australian children aged 12-16 months Australian National Infant Feeding Survey: Indicator intake in children and adolescents in the context of participating in the NOURISH and SAIDI studies. Aust Results. Canberra (AUST): AIHW; 2011. overweight and obesity. Int J Obes. 2010;34:1103-15. N Z J Public Health. 2014;38(4):326-31. 20. Cooke L, Carnell S, Wardle J. Food neophobia and 31. Australian Bureau of Statistics. 4125.0 – Gender 7. Lioret S, McNaughton SA, Spence AC, Crawford D, mealtime food consumption in 4-5 year old children. Indicators, Australia, August 2014. Canberra (AUST): ABS; Campbell KJ. Tracking of dietary intakes in early Int J Behav Nutr Phys Act. 2006;3:14. 2014. childhood: The Melbourne InFANT Program. Eur J Clin 21. Perry RA, Mallan KM, Koo J, Mauch CE, Daniels LA, Nutr. 2013;67(3):275-81. Magarey AM. Food neophobia and its association 8. Webb KL, Rutishauser I, Knezevia N. Foods, nutrients with diet quality and weight in children aged 24 and portions consumed by a sample of Australian months: A cross sectional study. Int J Behav Nutr Phys children aged 16-24 months. Nutr Diet. 2008;65(1):56- Act. 2015;12:13. 22. Australian Bureau of Statistics. 4364.0.55.001 – National 9. National Health and Medical Research Council. Eat for Health Survey: First Results, 2014-15. Canberra (AUST): Health: Educator Guide. Canberra (AUST): NHMRC; 2013. ABS; 2015. 10. National Health and Medical Research Council. A Modelling System to Inform the Revision of the Australian Guide to Healthy Eating. Canberra (AUST): NHMRC; 2011. 11. National Health and Medical Research Council. Infant Feeding Guidelines. Canberra (AUST): NHMRC; 2012. 44 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Australian and New Zealand Journal of Public Health Wiley

Serve sizes and frequency of food consumption in Australian children aged 14 and 24 months

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Wiley
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© 2017 Public Health Association of Australia
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1326-0200
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1753-6405
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10.1111/1753-6405.12622
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27960228
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Abstract

life determines growth trajectory and D Objective: To describe the dietary intake of a sample of Australian children. health in childhood, adolescence In particular, it is hypothesised and adult life. Methods: Three days (1x24 hour recall, 2x24 hour records) of dietary intake data were collected that early exposure to a variety of healthy from 409 and 363 mother-child dyads (resident in Brisbane and South Australia) at 14 (T2) and foods facilitates the development of life-long 24 (T3) months of age respectively as part of the NOURISH and SAIDI studies. Data presented However, there is healthy food preferences. include foods consumed by ≥10% of children, number of consumers and median serve size. still much to learn about the dietary intake Results: Thirteen of 25 vegetables consumed by more than 10% of children at T2 were of Australian infants and toddlers. Australian consumed by a lower proportion at T3 (9:1-5% less consumers; 4: 10-16% less). Eleven population-based studies focus on children discretionary foods were consumed by greater than 10% of children at T2, and by T3, this 2,3 while nationally older than two years of age, number had almost doubled. representative studies in other countries have Conclusions: Increased exposure to discretionary food and decreased exposure to vegetables 4,5 reported on intakes of infants and toddlers. is occurring in the transition toward family food, during a time of increasing independence and Data have been published in an attempt to emerging neophobia. fill this gap, describing the total daily intake Implications for Public Health: The age-related decline in dietary quality is of concern, with of core food groups and discretionary choices 6 7,8 and 18 months. More potential concurrent impact on nutritional adequacy, development of food preferences and of children at age 14 detailed reporting may help researchers and later eating patterns. Serve size data could be used to inform serve sizes for toddlers in future editions of the Australian Guide to Healthy Eating. practitioners understand the development of children’s food preferences. Key words: dietary intake, serve sizes, children Data describing the types and amounts of foods consumed can offer insight into the should provide an increasing proportion of in very young children , and the prospective variety (or lack of ) to which children are being energy intake after 12 months”. South Australian Infants Dietary Intake (SAIDI) exposed, and inform guidance for parents study. SAIDI participants were recruited This analysis describes the dietary intake of with respect to realistic portion sizes for simultaneously using the same protocol as a sample of Australian children aged 14 and young children. A sample daily food pattern NOURISH. Recruitment has been described 24 months, in terms of the most frequently for children aged 1-2 years is included within 12,13 in detail. Briefly, a consecutive sample consumed foods (including the change the Australian Guide to Healthy Eating. This of mothers (aged ≥18 years) delivering between 14 and 24 months), the median provides serve sizes and recommended healthy term infants (≥37 weeks gestation (and interquartile range) serve size and the number of serves per day for vegetables, and birthweight ≥2,500g) at maternity number of children consuming the food at fruit, grain foods, lean meat/alternatives, hospitals in Brisbane, Queensland, (n=3) least once in a three-day period. dairy/alternatives and an allowance for (first-time mothers only) and metropolitan unsaturated spreads/oils such that children (n=5) and regional (n=7) South Australia were meet their recommended nutrient intakes. Methods approached within 72 hours post-delivery. However these were derived from the food Eligible mothers were asked to provide This is secondary analysis of data collected intake patterns of children aged between consent to be contacted when infants were at the second and third assessments of 2 and 3 years, due to lack of data available 4–7 months-of-age, for full enrolment in 10 mother-child dyads in the control group for younger children. Younger children are the studies. Approval was gained from 11 of NOURISH, a randomised controlled trial likely to have different dietary patterns as human research ethics committees including evaluating an intervention commencing in they transition from the milk–based diet of Queensland University of Technology and infancy, promoting positive feeding practices infancy to family foods given “solid foods 1. Nutrition and Dietetics, School of Health Sciences, Flinders University, South Australia 2. School of Exercise and Nutritional Sciences, Institute Health Biomedical Innovation, Queensland University of Technology Correspondence to: Professor Anthea Magarey, Nutrition and Dietetics, Flinders University, GPO Box 2100, Adelaide, SA 5001; e-mail: anthea.magarey@flinders.edu.au Submitted: March 2016; Revision requested: June 2016; Accepted: September 2016 The authors have stated they have no conflict of interest. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Aust NZ J Public Health. 2017; 41:38-44; doi: 10.1111/1753-6405.12622 38 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors Food Food consumption at 14 and 24 months Flinders University (Australasian Clinical Trials two weekdays and one weekend day were according to the Australian Guide to Healthy Registration ACTRN 1260800056392; QUT included in the three-day intake data for each Eating (AGHE). For the present analyses, HREC 00171 Protocol 0700000752). child. Quantities were estimated as per the those recipes that were considered ‘core’ recall. Completed records were returned via foods were separated into individual Data collection reply-paid envelope. ingredients for inclusion in the final analyses. Demographic data were collected at Time Food items from the recall and records Analysis 1 when infants were 4–6 months old. Three were entered into FoodWorks Professional 15 For each time point, the five-digit (or eight- days of dietary intake data were collected version 9 by trained staff using the AUSNUT digit where more detail was necessary) using one 24-hour recall and two days of 2007 database from the 2007 Australian food code was used to group individual food record when children were aged 12-16 National Children’s Nutrition and Physical 16 foods and identify those most frequently months (T2 n=409) and 24 months (T3 Activity Survey and an additional study- consumed. The three days of intake were n=363). Only children providing intake data specific database containing commercial combined and a participant was considered on all three days for at least one point are infant products. A coding decisions file was a consumer if they ate the food at least included. maintained to ensure consistency of data once in the three days. Foods consumed by entry. Mixed dishes prepared at home with A dietitian contacted the mother by at least 10% of the sample are discussed, more than four ingredients were added to telephone, unannounced, to conduct the 24- 15 however only foods from the five core food 14 FoodWorks as a recipe; individual ingredients hour recall using a three-pass methodology. groups, and discretionary foods, consumed were entered as separate food items. She was asked to recall everything her by at least 20% are presented in tables. child ate or drank in the previous 24 hours, Data cleaning occurred using a standard Foods were grouped into 10 categories, starting from midnight on the previous day, protocol. Each FoodWorks recall and record based on the AGHE, but including further with quantities estimated using household file was checked to ensure accurate subject groupings of beverages, discretionary foods, measures (metric cup, tablespoon and ID, date and plausible meal times, food and commercial infant foods and fats and oils. teaspoon). A visual aid showing actual size drink quantities consumed, and total energy Some differences in groupings compared illustrations of these measures designed and macronutrient intakes. Implausible with the AGHE were inclusion of legumes in to improve estimation was provided to records were checked with the hard copy the vegetable group only, butter included in participants before the phone call along with and assumptions made in the absence of the fats and oils group (primarily for ease of a food record booklet. Breast milk intake was sufficient detail were checked for consistency comparison with other fats) and 100% fruit estimated from the number of minutes up with protocol. juice included with beverages. Beverages to a maximum of 10 that a child was actively Data were exported into an Access database included all drinks other than water, plain feeding. A second feed starting within 30 and merged with an eight digit food group milks (included with dairy) and infant/ minutes of the start of the previous feed was code that allowed identification of each toddler formula (included with commercial not considered a second feed and the time 16 unique food in the AUSNUT 2007 database. infant foods). Commercial infant foods were added to the previous feed to a maximum of Staff allocated additional eight digit codes considered those foods that are marketed 10 minutes. Ten grams of milk were assumed to infant foods and recipes. This database specifically towards infants, including infant to be consumed per minute with an energy was imported into IBM SPSS Version 22 and toddler formula (but excluding infant and content of 2.77 kJ /g. Mothers were allocated for analysis. Foods, including recipes, children’s yoghurt). For all identified foods, a two days to record their child’s intake within were categorised as ‘core’ or ‘discretionary’ single consumption was considered a ‘serve’ the booklet, with days chosen to ensure and all ‘serves’ were used to generate quartiles of serve size in grams. The serve size was Table 1. Characteristics of mother-infant dyads at 14 and 24 months. generally cooked or prepared weight, except Time 2: 14 months Time 3: 24 months where otherwise specified. Where foods may Variable (n=409) (n=363) have been entered as ‘dry’ or ‘cooked’ into n (%) or M (SD) FoodWorks (e.g. pasta), the cooked serve Mother sizes only were used to calculate values. Education (university degree) 215 (53) 206 (57) Serve size data are presented as median and Born in Australia (yes) 348 (85) 314 (87) interquartile range. In a relationship (yes) 396 (97) 351 (97) Age at delivery (years) 31.4 (5.1) 31.6 (4.8) Self-reported weight status (overweight) 76 (19) 70 (19) Results First child 270 (67) 237 (66) Demographics Infant Characteristics of participants at T2 and T3 Gender (female) 225 (55) 196 (54) are presented in Table 1. Demographic data Age (months) 13.9 (1.1) 23.9 (0.7) were provided by 447 participants at T1, Ever breastfed (yes) 393 (98) 352 (98) with intake data available for 409 at T2 (91% Energy intake (kJ per day, mean of 3 days) 4.13 (0.86) 4.84 (0.98) retention) and 363 at T3 (89%). Mothers either Count (% within group); a: Mean (standard deviation) reported for continuous variables; declined further participation, were lost to All data (except infant age) collected at baseline. follow-up, or remained in the study but did n = 402 to 409 due to missing data; n = 357 to 363 due to missing data not provide three days of dietary intake data. 2017 vol . 41 no . 1 Australian and New Zealand Journal of Public Health 39 © 2016 The Authors Mauch et al. Article due to oats being cooked with water and/ both regular fat and reduced fat cow’s milk Breads and cereals or milk (compared with other cereals, where increased from T2 to T3. The median serve The most popular cereal product at T2 dry weight only was reported). Pasta and rice size for regular fat milk was 129 g (125 mL, was whole wheat biscuits (e.g. Weetbix), were consumed in the next largest quantities half a cup) at both points, with reduced fat consumed by 65% of the population (Table per serve at both T2 and T3. By T3 the median milk at T3 being of a similar median serve size 2). By T3 this figure dropped markedly to serve sizes of pasta and rice were equivalent (130 g). The median serve size of children’s 52%, becoming the second most commonly to half a metric measuring cup (250 mL yoghurt remained steady at around 90 g and consumed cereal product after white capacity) and a quarter cup respectively. was slightly lower than the median serve size bread and rolls. Puffed rice cereals and of other yoghurts. The median serve size of sugar-sweetened cereals (included in the Dairy and dairy alternatives cheddar cheese increased by more than 40% ‘discretionary foods’ group) were consumed from 12 g at T2 to 1 7g at T3. Regular fat cow’s milk, regular fat cheddar by less than 10% of children at T2, but by cheese and yoghurt marketed for infants and 11.3 and 11.8% respectively at T3. Most other Fruit children were the most popular dairy foods at foods in this group were consumed by a each time (Table 2). Breastmilk was consumed Most (8 of 12 consumed by at least 10% of the greater proportion of children at T3 compared by a quarter of children at T2, but less than sample) fruits were consumed by a greater with T2. Oats (generally consumed as 10% at T3. The proportion of consumers of proportion of children at T3. While bananas porridge) had the largest median serve size, Table 2: Breads and cereals, dairy and dairy alternatives, and fruit consumed by greater than 20% of the sample, and serving size quartiles at child age 14 months and 24 months. Time 2: 14 months (N=409) T3: 24 months (N=363) Change in % Food (by food group) Consumers of consumers Serving size in grams (25th, Serving size in grams (25th, Food (by food group) Consumers c c (%) from 14 to 24 50th and 75th percentiles) 50th and 75th percentiles) (%) months Breads and cereals Wholewheat breakfast biscuits 267 (65.3) ↓↓ 15.0 17.5 26.3 White bread and rolls 199 (54.8) 15.0 28.8 38.8 (eg Weetbix/Vitabrits) Pasta 185 (45.2) ↑ 20.0 45.0 82.5 Wholewheat breakfast biscuits (eg 189 (52.1) 17.5 21.9 35.0 Weetbix/Vitabrits) White bread and rolls 191 (46.7) ↑ 12.5 25.0 30.0 Pasta 181 (49.9) 28.8 57.5 91.8 Wholemeal bread and rolls 163 (39.9) ~ 11.5 21.6 27.0 Savoury biscuits (plain) 157 (43.3) 6.5 9.8 14.0 Savoury biscuits (plain) 154 (37.7) ↑ 3.5 6.5 8.5 Wholemeal bread and rolls 143 (39.4) 18.3 27.0 35.1 Rice 120 (29.3) ↑ 21.4 39.5 55.5 Rice 132 (36.4) 30.3 52.1 95.0 Rice cakes and crackers 104 (25.4) 3.0 4.0 6.7 Wholegrain bread and rolls 115 (31.7) 21.0 33.0 48.0 Flour (wheat based) 101 (24.7) 2.2 4.8 8.2 Rice cakes and crackers 112 (30.9) 5.1 8.3 11.6 Wholegrain bread and rolls 92 (22.5) ↑ 14.0 24.8 33.0 Oats 77 (21.2) 87.1 162.5 203.4 Dairy and dairy alternatives Cow’s milk (regular fat) 336 (82.2) ↑ 61.8 128.8 206.0 Cow’s milk (regular fat) 322 (88.7) 77.3 128.8 206.0 Cheddar cheese (regular fat) 255 (62.3) ↑ 6.5 12.4 20.0 Cheddar cheese (regular fat) 236 (65.0) 9.00 16.5 24.0 Infant and children’s yoghurt (regular fat, 145 (35.5) 60.0 90.0 90.0 Infant and children’s yoghurt (regular fat, 120 (33.1) 70.00 90.0 95.0 flavoured) flavoured) Processed cheese slices, sticks and spreads 126 (30.8) ↑ 12.0 20.0 21.0 Processed cheese slices, sticks and spreads 118 (32.5) 15.8 20.0 21.0 Breastmilk 109 (26.7) X 50.0 100.0 100.0 Yoghurt (regular fat flavoured) 77 (21.2) 67.6 103.0 156.0 Yoghurt (regular fat flavoured) 108 (26.4) ↓ 71.3 100.0 130.0 Fruit Bananas 312 (76.3) ↓ 33.3 50.5 89.7 Bananas 255 (70.2) 40.0 50.5 101.0 Apple (cooked and raw) 155 (37.9) ↑↑ 19.8 34.2 64.4 Apples (cooked and raw) 178 (49.0) 35.0 66.0 106.0 Grapes 135 (33.0) ↑ 20.0 30.0 42.6 Sultanas 153 (42.1) 12.5 17.7 35.4 Sultanas 132 (32.3) 8.8 16.8 22.4 Grapes 139 (38.3) 24.0 36.0 52.1 Canned fruit (all varieties) 106 (25.9) 25.0 53.8 86.0 Watermelon 117 (32.2) 26.0 54.6 120.8 Pears 104 (25.4) ↓ 27.1 43.5 83.0 Strawberries 102 (28.1) 24.0 36.0 60.0 Watermelon 99 (24.2) ↑ 27.0 52.0 85.4 Dried fruit (excluding sultanas) 80 (22.0) 7.0 13.3 20.0 Strawberries 84 (20.5) ↑ 24.0 36.0 48.0 Pears 80 (22.0) 29.0 67.5 85.6 Canned fruit (all varieties) 77 (21.2) 28.0 68.6 120.0 a: Starting with the most popular (based on proportion of children consuming the food at least once in 3 days). ↑= increase in the proportion of children consuming the food from T2-T3; b: Symbols (as follows) refer to the change in popularity of the food from T2 to T3; ↑↑= large increase (10 percentage points or more) in the proportion of children consuming the food from T2-T3; c: Unless otherwise specified, serving weight refers to cooked food. ↓= decrease in the proportion of children consuming the food from T2-T3; d: Mostly consumed as porridge, with some used in baking. Serving weight represents cooked weight as porridge. ↓↓= large decrease (10 percentage points or more) in the proportion of children consuming the food from T2-T3); e: serving size per eating occasion ~ = minimal (less than 1 percentage point) or no change in the proportion of children consuming the food from T2-T3; X = the food is no longer consumed by at least 10% of toddlers at T3. 40 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors Food Food consumption at 14 and 24 months were consumed by a smaller proportion of food preferences are being formed and food Fats and oils children at T3, the proportion consuming neophobia is strengthening. Although butter was consumed by more apple increased from 38% to 49% (Table 2). The serve sizes for breads, whole wheat children at T2 than margarine (42.3 v 36.2%) Dried fruit and sultanas were consumed by breakfast biscuits, vegetables, fruit, and this pattern was reversed at T3 (38.6 v 50.7%). a larger proportion of children at T3, while dairy/alternatives in our sample appear In addition, at T3 butter and margarine blends canned fruit and pears were consumed by a remarkably consistent with the only other were included, being consumed by 17% of smaller proportion. Mandarins and canned Australian study reporting actual serve the sample but less than 10% at T2. Median fruit had the largest median serve sizes at T2 sizes consumed by toddlers. The Childhood serve sizes for all fats and oils presented were and 3 while sultanas and dried fruit had the 8 Asthma Prevention Study (CAPS) reported less than one teaspoon. smallest. The serving size of apple almost on the intake of 429 children aged 16–24 doubled from T2 to T3. months, using three-day weighed food Discretionary foods records. Reported serve size of pasta was There were 11 discretionary foods consumed Vegetables and legumes larger in our cohort, 45 g and 58 g at T2 and by greater than 10% of the sample at T2, Of 25 vegetables consumed by at least 10% T3 respectively, compared with 21 g in CAPS. and by T3, this number had almost doubled. at T2, more than half were consumed by a This may reflect a more general change in High salt yeast spreads (predominantly lower proportion at T3. Carrots, potatoes (not popularity or acceptability of pasta-based Vegemite) were consumed by more than as potato chips, wedges or gems) and onion dishes in the approximately eight-year 50% of participants at both T2 and T3, with were the most popular vegetables at both T2 interval between the two studies. the median serve size being slightly greater and T3, although carrots and potatoes were Vegetable serve sizes are lower than those at T3 (Table 3). Plain sweet biscuits were consumed by a lower proportion of children reported among 18-month-old children in consumed by around 50% of children at each at T3 (Table 3). The most marked changes the Avon Longitudinal Study of Parents and time. One quarter (27%) consumed cake at T3 from T2 to T3 were for pumpkin – decreased 18 Children (ALSPAC). For example, the median compared to 11% at T2, 24% consumed other from 41% to 25% consuming, sweet potato serve size range for carrots for 18-month-olds sweet biscuits (cream filled, choc coated, – decreased 25% to 14% consuming, and in the ALSPAC data was 20-40 g, compared etc) at T3 compared with 10% at T2, and 22% potato chips, wedges and gems – increased to 10 g at T2 and 11 g at T3 in our sample, consumed icecream at T3, compared with from 21% to 33% consuming. Baked beans, despite this vegetable being the most 11% at T2. Median serve sizes were generally tomato-based pasta sauces and potato chips, popular at both points. Similarly, broccoli small (with 16 of 19 under 20 g at T3) with wedges and gems respectively had the and cauliflower, which had a median serve custard, cake and icecream having the largest largest median serve sizes, with potato chips, size range of 26-28 g in ALSPAC, were only serve sizes at T2, while custard, savoury wedges and gems becoming larger than consumed in median serves of between 10 g pastries and cake, had the largest median tomato-based pasta sauces by T3. 8 and 17 g by our sample and the CAPS cohort. serve sizes at T3. As previously mentioned, the AGHE includes Meat and meat alternatives Commercial infant foods a sample daily food pattern for toddlers aged All but two types of meats consumed by 1-2 years that was developed using data from Although there were nine commercial more than 10% of the population at T2, children aged 2-3 years. The serve sizes are infant foods consumed by more than 10% increased in popularity by T3. Beef, chicken based on the adult serves, such as 250 mL of participants at T2, none were consumed and eggs were consistently the most popular milk and 65 g of lean meat. Although we by more than 10% by T3 (data not included meat and meat alternatives (Table 3). The cannot describe the total quantity of food in tables). The most commonly consumed proportion of children consuming ham and consumed from one food group on one (26.4%) commercial infant food at T2 was sausages increased substantially from T2 to T3 eating occasion (e.g. the total quantity of meat and vegetable mixtures followed (21 to 30% and 19 to 30% respectively), and all vegetables consumed at dinner-time) or by infant biscuits excluding rusks (22.7%). the proportion of children consuming canned across one day, our data do provide some Median serve sizes were quite large (meat fish reduced by almost 6%. Crumbed chicken understanding of the typical serve sizes of the and vegetable: 85 g, cereal and fruit mixture: and nuggets had the greatest median serve most popular foods consumed by this age 99 g, custard 120g,) compared to most other weight at T2 (40 g, 10% consuming) and T3 group, which may be of use to practitioners food groups, with the median serve size of (53 g, 19.3% consuming), followed by chicken when both assessing diets and educating formula (infant: 185 g, toddler: 155 g) being at T2 and crumbed, battered and floured fish families, but also may be considered in larger than that of full cream cow’s milk. at T3 (50 g, 12.9% consuming). future revisions of the AGHE. For example, the AGHE recommends 1-1½ serves of dairy Discussion Beverages per day, with a serve equivalent to 250 mL The proportion of children consuming fruit of milk, 40 g of cheese or 200 g of yoghurt. This paper provides valuable information with juice doubled from 19.3% at T2 to 39.9% at Our data show that the typical serve size is respect to foods Australian children aged 14 T3 along with the median serve size (T2: 49 g, at the most, half this amount. It is therefore and 24 months are consuming, the serve size T3: 86 g). Fruit juice drink (a combination of more realistic to expect that a toddler might of those foods and the change in popularity fruit juice, sugar and water) was consumed by have two serves of 125 mL of milk in one over the second year of life. It provides 10.7% of the population at T3, and the serve day rather than one larger serve of 250 mL. insight into the transition toward family size was substantially larger than that of fruit Further the contribution of breastmilk in food and eating patterns, at a time when juice (130 g). meeting nutrient requirements was not 2017 vol . 41 no . 1 Australian and New Zealand Journal of Public Health 41 © 2016 The Authors Mauch et al. Article considered in the food pattern of any child serve size were small and some reduced, on a number of occasions to achieve the older than 12 months. With a quarter of a pattern not seen in the other core food daily 2-3 serves of 75 g recommended by children in this sample breastfeeding at T2 groups. The Australian InFANT study found the AGHE, a target particularly challenging and 18% of children 13-18 months of age in a that the proportion of vegetable consumers in the second year of life when neophobia nationally representative sample it would be was similar at nine and 18 months of age is emerging. Several studies have reported appropriate to model inclusion of breast milk but median daily intake decreased from 84 neophobia to be associated with a lower in the composite dairy food for children up to to 70 g/day. In our study the serve size of intake of vegetables, both in amount and 20,21 eighteen months. vegetables was generally small, with 17 of variety. Parents can be reassured that 25 vegetables listed at T3 having a median young children are unlikely to consume a 75 g Most vegetables were consumed by a smaller serve size less than 30g. Clearly children serve of one vegetable type in one eating proportion of children at T3 compared would need to consume several vegetables occasion. Instead, children should be offered with T2, and in addition, most increases in Table 3: Vegetables and legumes, meat and meat alternatives and discretionary foods consumed by greater than 20% of the sample, and serving size quartiles at child age 14 months and 24 months. Time 2: 14 months (n=409) T3: 24 months (n=363) Change in % Food (by food group) Consumers of consumers Serving size in grams (25th, Consumers Serving size in grams (25th, Food (by food group) c c (%) from 14 to 24 50th and 75th percentiles) (%) 50th and 75th percentiles) months Vegetables and legumes Carrot 285 (69.7) ↓ 5.0 10.0 18.2 Carrots (cooked and raw) 231 (63.6) 5.1 10.9 18.5 Potato (other) 247 (60.4) ↓ 16.6 29.9 61.0 Potato (other) 184 (50.7) 19.9 41.3 71.0 Onions 187 (45.7) ~ 2.8 5.3 9.2 Onions 165 (45.5) 2.5 5.0 9.1 Pumpkin 168 (41.1) ↓↓ 12.0 24.5 46.8 Tomatoes (mostly raw) 124 (34.2) 16.9 33.4 51.0 Broccoli 157 (38.4) ↓ 8.2 13.4 25.9 Broccoli 121 (33.3) 10.0 16.0 25.2 Peas (frozen, can, fresh) 141 (34.5) ↓ 4.7 10.4 18.2 Potato chips, wedges, gems 118 (32.5) 28.2 50.0 70.5 Zucchini 130 (31.8) 5.5 11.7 20.1 Sweetcorn (frozen, fresh, can) 113 (31.1) 7.1 18.0 36.4 Tomatoes (cooked and raw) 110 (26.9) 15.0 30.0 48.8 Cucumber 99 (27.3) 16.5 26.0 39.0 Sweetcorn (frozen, fresh, can) 109 (26.7) ↑ 5.6 15.1 23.9 Zucchini 96 (26.4) 5.1 10.1 19.9 Sweet potato 103 (25.2) ↓↓ 9.2 17.0 31.2 Peas (frozen, can, fresh) 92 (25.3) 6.3 13.3 22.0 Garlic 101 (24.7) ~ 0.1 0.3 0.5 Garlic 91 (25.1) 0.1 0.3 0.5 Can tomatoes (whole, diced) 96 (23.5) ↓ 16.8 31.7 54.3 Pumpkin 89 (24.5) 12.6 23.8 35.4 Potato chips, wedges, gems 87 (21.3) ↑↑ 22.8 35.0 58.5 Mushrooms 81 (22.3) 2.7 6.3 12.0 Capsicum (raw and cooked) 79 (21.8) 2.6 6.1 11.9 Can tomatoes (whole, diced) 78 (21.5) 17.2 32.5 55.8 Meat and meat alternatives Beef 197 (48.2) ↓ 14.9 26.8 39.6 Beef 169 (46.6) 16.2 31.2 52.6 Chicken 174 (42.5) 14.3 30.2 50.8 Chicken 157 (43.3) 22.0 35.9 62.4 Eggs (inc egg in baked goods) 158 (38.6) 3.9 13.0 37.0 Eggs (inc egg in baked goods) 148 (40.8) 4.6 17.9 46.7 Canned fish 86 (21.0) ↓ 10.1 20.0 32.9 Ham 110 (30.3) 15.0 21.0 42.0 Ham 84 (20.5) ↑ 10.5 21.0 31.7 Sausages (all meats) 107 (29.5) 29.5 44.0 58.0 Discretionary foods Yeast spread (eg Vegemite) 221 (54.0) ↑ 1.5 2.3 4.2 Yeast spread (eg Vegemite) 205 (56.5) 2.0 3.0 6.0 Plain sweet biscuits 211 (51.6) 8.0 10.0 12.6 Plain sweet biscuits 172 (47.4) 10.0 13.0 20.0 Stock 82 (20.0) 0.1 0.3 0.8 Cake (all types, iced/ uniced) 98 (27.0) 19.0 39.0 55.0 Honey 94 (25.9) 2.5 5.4 10.0 Added salt 93 (25.6) 0.1 0.2 0.6 Tomato sauce / ketchup 93 (25.6) 3.6 7.3 12.9 Added sugar (all varieties) 93 (25.6) 1.4 3.4 5.8 Other sweet biscuits (cream filled, 86 (23.7) 10.0 14.0 22.5 choc coated, iced etc) Icecream 81 (22.3) 18.5 35.0 47.4 Sugar based confectionary 78 (21.5) 3.8 7.0 12.9 Chocolate and chocolate bars 77 (21.1) 6.0 10.5 14.0 a: Starting with the most popular (based on proportion of children consuming the food at least once in 3 days). ↑= increase in the proportion of children consuming the food from T2-T3; b: Symbols (as follows) refer to the change in popularity of the food from T2 to T3; ↑↑= large increase (10 percentage points or more) in the proportion of children consuming the food from T2-T3; c: Unless otherwise specified, serving weight refers to cooked food. ↓= decrease in the proportion of children consuming the food from T2-T3; d: serving size per eating occasion ↓↓= large decrease (10 percentage points or more) in the proportion of children consuming the food from T2-T3); e: includes powdered and liquid stock but weight of stock powders only presented ~ = minimal (less than 1 percentage point) or no change in the proportion of children consuming the food from T2-T3; X = the food is no longer consumed by at least 10% of toddlers at T3. 42 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors Food Food consumption at 14 and 24 months small portions of a variety of vegetables therefore food refusal which may result from regular yoghurt varieties (e.g. less throughout the day, at both meals and in modifications to the range of foods sugar, added calcium compared with regular snacks, to facilitate adequate intake. However that parents offer , increasing exposure varieties) the primary difference tends to as only 7% of Australian adults met the AGHE to discretionary foods with age which be in packaging and presentation (smaller guidelines for vegetable serves in 2014-15, it appeals to children’s innate predisposition portions in squeezy, freezable sachets, with is likely that many children are growing up in toward sweeter and saltier flavours, and the minimal lumps). The overall lower serve size households where availability of healthy food transition toward family food which tends to of ‘infant’ or ‘children’s’ yoghurt – compared and modelling of healthy eating is limited. be complete by the time children reach two with regular yoghurts – probably reflects the 1,26,27 years of age. The age-related decline in packaging size. Pre-packaged portions of There were a number of changes between dietary quality is of concern in terms of the infant and children’s yoghurt range from 70 T2 and T3 that demonstrate a shift potential concurrent impact on nutritional to 140 g, compared with regular yoghurts at toward sweeter, saltier, and more highly adequacy, as well as on development of 150 to 200 g, or in larger containers of 500 or processed products with age. The number food preferences and later eating patterns. 1,000 g to be portioned as desired. of discretionary foods consumed by at We have recently shown that the number least 10% almost doubled by two years Our data have some limitations, which have of vegetables, fruit and discretionary foods of age (the majority at both times being been documented previously, including tried at 14 months predicted corresponding sweet), suggesting increased exposure bias toward older and university-educated preferences and higher intakes at 3.7 29 to discretionary foods and deterioration parents and error inherent in the collection years. In addition, after adjusting for 30 of children’s eating habits with age. This of intake data of infants and toddlers. fussiness at 14 months, children who tried level of exposure is a concern given the In our sample more than 50% of mothers more vegetables at 14 months had lower AGHE recommends that for children up to were university educated; in the general fussiness at 3.7 years of age. Overall, these eight years of age, discretionary choices be population, around 40% of women aged data suggest that intake in this age group 31 avoided or limited to no more than half a between 25 and 34 are university educated. 9 has important longer-term impacts on serve (equivalent to 300 kj) per day. Of the However, it is likely that this would mean the eating patterns. They highlight the need for meats and meat alternatives, the greatest intake of the sample is of somewhat better interventions to support carers to understand increase in proportion of consumers from quality than a more representative sample. the potential impact of neophobia, growing T2 to T3 was observed for sausages, ham, Strengths include a large sample size, three autonomy and increased exposure to the crumbed chicken and nuggets, and devon/ days of intake data including weekdays and obesogenic food environment on the short fritz (processed meat). This could be due to weekends, and the inclusion of first and and long term quality of children’s diets. a combination of factors not limited to their subsequent children, all of which improve the convenience and availability, salt content The median serve sizes of infant and toddler generalisability of the data. Finally, as our data and softer texture (than pure cuts of meat). formula and cows milk were by far the largest were longitudinal (with only minor differences The aforementioned meats also tended to of any food at T2 or T3. This likely reflects in the sample between times) we were able be consumed in the largest quantities. There the use of these products as drinks. Previous to investigate change in intake of a group of were also marked increases in the proportion research using T2 data from NOURISH and children at a time of transition from an ‘infant’ of children consuming fruit juice and fruit SAIDI reported an inverse relationship to ‘toddler’ diet, for which there is currently drinks, and fried potatoes (as chips, wedges, between formula intake and the number little comparable data available. etc) from T2 to T3. Additionally, there was a of core food groups from which a child eats considerable reduction in consumption of in a day. The same relationship was not Conclusion commercial infant foods and of pumpkin found with cow’s milk. It is reassuring that and sweet potato, two foods consumed by less than 10% of the population at T3 was The study provides rich data regarding the infants as purees (and the most popular consuming infant or toddler formula (4 most commonly consumed foods, along in our sample at T1, unpublished data), and 7% respectively, data not presented). with the median serving size, for Australian demonstrating the transition away from Toddler formula tends to be a formula infants and toddlers aged 14 and 24 months. ‘infant’ foods. Vegemite (or similar spreads), a marketed as suitable from one year of age, This will be of great benefit to parents and high salt yeast spread commonly consumed and when these data were collected (2010- practitioners, assisting them to have realistic on bread, was consistently popular, with 11) toddler formula was generally the only expectations of their children and patients more than half the children at both times formula marketed towards this age group. respectively. It also provides data that could consuming it at least once in the three days However, in recent years, at least four of be used to inform serving sizes for toddlers (compared with our previous report of one the major Australian infant formula brands in future editions of the Australian Guide third of children at T2 based on recall data have developed formula marketed towards to Healthy Eating. It highlights the changes only). This consistency of use demonstrates 2+ years. This new marketing strategy may in dietary intake in the transition toward that consumption of this product begins early have affected the number of children now family food, during a time of increasing and persists with time, likely due to children’s consuming formula beyond two years of age. independence and emerging neophobia. innate preference for salt. Ideally, the milk-based diet of infancy Choice of yoghurt may also be influenced by transitions to one reliant on vegetables, fruit, There are several factors that may have marketing, with more children consuming wholegrains and lean meat. Instead, these contributed to these changes from T2 to ‘infant’ or ‘children’s’ yoghurt than regular data identify early development of eating T3 including heightening levels of food varieties at both points. 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Canberra (AUST): NHMRC; 2012. 44 Australian and New Zealand Journal of Public Health 2017 vol . 41 no . 1 © 2016 The Authors

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Australian and New Zealand Journal of Public Health – Wiley

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