New dietary guidelines address infants, support healthy dietary patterns

For the first time, the Dietary Guidelines for Americans (DGA) include recommendations for children younger than 2 years and make it clear that a healthy diet for infants and toddlers is critical in setting a healthy pathway for later diet.

The U.S. Department of Agriculture and the Department of Health and Human Services published the 2020-2025 DGA in December, calling on Americans to “Make Every Bite Count” by choosing foods and beverages rich in nutrients and staying within calorie limits.

The guidelines are updated every five years and serve as the foundation for federal nutrition policy and healthy eating guidelines, including federal nutrition programs like school meals.

Findings specific to children younger than 2 years of age include support for the benefits of breastfeeding, especially in the prevention of childhood obesity and asthma. The guidelines emphasize that what children this age are fed has key implications for lifelong development, and caregivers should consider nutrients such as iron and calcium that are needed for optimal growth and development.

The guidelines also recommend introducing potentially allergenic foods at about 6 months of age along with other complementary foods. “There is no evidence that delaying introduction of allergic foods, beyond when other complementary foods are introduced, helps to prevent food allergy,” the guidelines state.

Of note, a specific recommendation calls for introducing peanut-containing foods to infants at high risk of peanut allergy at age 4 to 6 months to reduce the risk of developing peanut allergy. “Caregivers should check with the infant’s healthcare provider before feeding the infant peanut-containing foods,” the guideline advises.

The guidelines also focus on limiting the intake of added sugars during childhood. Specifically, families are advised to avoid giving children under 1 year any fruit juice or other sugar-sweetened beverages (SSB), which leave less room in the diet for more nutritious foods and beverages. Although the evidence is limited, concern is mounting that early consumption of SSB is a risk factor for childhood overweight and sets the stage for a pattern of dietary choices later in life.

The DGA is based on a scientific report from the Dietary Guidelines Advisory Committee (DGAC) published earlier in 2020 (http://bit.ly/2L3w1sC). While the DGA included most of the DGAC’s recommendations, the final guidance maintains the 2015 recommendation to limit added sugars to 10% of calories for those 2 and older instead of the 6% proposed in the scientific report.

The DGA recommends that people of all ages, including children, increase fruit and vegetable consumption.

The 2020-2025 DGA recognizes, as did the 2015-2020 DGA, that maintaining a healthy dietary pattern is important. These patterns might be a typical American diet, a Mediterranean style diet or a vegetarian diet that meets most nutrient intakes. In some cases, however, low intakes of nutrients, including iron, calcium and vitamin D, may be of concern.

Although the DGA does not provide recommendations on food systems and sustainability, the DGAC report recommended developing strategies to examine the connections between dietary guidelines and food systems. The report references a 2017 National Academies of Sciences, Engineering, and Medicine report that encourages adopting a “systems approach” to dietary guidelines. Such an approach could better account for social and environmental determinants of health as we look to improve both the diet and health outcomes for the population.

Dr. Abrams is chair of the AAP Committee on Nutrition. Dr. Patel is a member of the AAP Council on Environmental Health Executive Committee.