By: Kellie O. Casavale, PhD, RD and David Woodwell, MPH
The relationship of early child nutrition to health throughout the lifespan is an important and growing area of public health interest. The stage from birth to 24 months (B-24 mo) is particularly important nutritionally because of increased demands to support growth and development and opportunities to positively influence the trajectory for building healthy dietary patterns.
Traditionally, the Dietary Guidelines for Americans has focused on ages 2 years and older. The Agricultural Act of 2014 (aka, Farm Bill) mandated that beginning with the 2020-2025 edition, the Dietary Guidelines will include recommendations for pregnancy and children B-24 months.
Nationally representative nutrition data are an important source of evidence for the Dietary Guidelines and Federal nutrition monitoring activities. However, current national data for children B-24 months are not sufficient.
Needs for Nationally Representative Data
Through the Federal Data Consortium on Pregnancy and B-24 Months, more than two dozen Federal agencies articulated their needs for data on these population groups to fill gaps in scientific knowledge to support evidence-based programs and policies. We are collaborating on new initiatives to begin to fill these gaps. The first two of these projects related to the B-24 months population are through the National Health and Nutrition Examination Survey (NHANES). This survey is a program of studies designed to assess the health and nutritional status of adults and children in the United States. The survey is unique in that it combines interviews and physical examinations of about 5,000 nationally representative persons of all ages each year. These persons are located in counties across the country, 15 of which are visited each year.
New NHANES Diet and Behavior Questions for Children B-24 Months
New questions in the Diet and Behavior Questionnaire will be asked for all NHANES participants from B-24 months for two NHANES cycles from 2019-2022 (4 years). This questionnaire, one of many during the NHANES interview, is asked of all survey participants.
The new questions address a number of topics. The topic of “mixed feeding” will include questions on the consumption of human milk and/or infant formula, mixing milk and formula in the same bottle, as well as adding other components such as sweeteners or vitamin supplements. Questions will ask about “modes of feeding;” that is, if human milk is consumed directly from the mother or if the child uses bottles or cups for human milk and/or formula. A series of questions will also inquire about the time frame for the first introduction of food groups and subgroups. And finally, new data will allow self-reported pre-pregnancy body mass index to be calculated for the mothers of the child participants.
NHANES Pilot of Infant Blood Draws
NHANES currently only collects blood samples from participants 1 year of age and older. A pilot of infant blood draws is planned to test the feasibility of collecting venous blood from infants (birth up to 12 months) as well. It will also evaluate the efficacy of analyzing the samples for priority nutrients and contaminants of public health interest. If the pilot is successful and funding support is available, NHANES may be able to collect and analyze blood from infants as a regular laboratory assessment within the survey.
Federal Support for New Data on Children B-24 Months
The opportunities to improve public health through these new data will support initiatives across the Federal government and in the scientific and public health community at large. Federally, funding support for one or both of these initiatives has or aims to be provided by:
- U.S. Department of Health and Human Services
- Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health
- Center for Food Safety and Applied Nutrition, Food and Drug Administration
- Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention
- National Institutes of Health
- National Cancer Institute
- National Heart, Lung, and Blood Institute
- National Institute of Environmental Health Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development
- National Institute of Diabetes and Digestive and Kidney Diseases
- Office of Behavioral and Social Sciences Research
- Office of Disease Prevention
- Office of Dietary Supplements
- U.S. Department of Agriculture
- Agricultural Research Service
- Economic Research Service
- Food and Nutrition Service
Looking Forward to New Knowledge
We know that early child nutrition impacts growth and development, taste preferences, dietary behaviors, and the development of dietary patterns. These new ventures to study infants and young children through our national nutrition survey will provide additional public data files for researchers to advance what we know about early child nutrition and health.
Want to learn more about the National Health and Nutrition Examination Survey?
- Check out the NHANES Homepage for an overview and resources
- Take an NHANES Tutorial to learn everything you want to know about analyzing NHANES data
Find information for health professionals on NHANES and why participation in NHANES is important for studying public health