Addressing nutrient shortfalls in 1- to 5-year-old Irish children using diet modeling: development of a protocol for use in country-specific population health

Background: Dietary habits formed in early childhood can track into later life with important impacts on health. Food-based dietary guidelines (FBDG) may have a role in improving population health but are lacking for young children. Objective: To establish a protocol for addressing nutrient shortfalls in 1-5-y-old children (12- 60 months) using diet modeling in a population-based sample. Design: Secondary analysis of the 2010-2011 Irish National Pre-School Nutrition Survey data (n 500) was conducted to identify typical food consumption patterns in 1-5-y-olds. Nutrient intakes were assessed against dietary reference values (European Food Safety Authority [EFSA] and Institute of Medicine [IOM]). To address nutrient shortfalls using diet modeling, 4-day food patterns were developed to assess different milk-feeding scenarios (human milk, whole or low-fat cow’s milk and fortified milks) within energy requirement ranges aligned with World Health Organization (WHO) growth standards. FBDG to address nutrient shortfalls were established based on 120 food patterns. Results: Current mean dietary intakes for the majority of 1-5-y-olds failed to meet reference values (EFSA) for vitamin D (≤100%), vitamin E (≤88%), docosahexaenoic/eicosapentaenoic acid (DHA+EPA; IOM; ≤82%) and fiber (≤63%), while free sugars intakes exceeded recommendations of <10% energy (E) for 48% of 1-3-y-olds and 75% of 4-5-y-olds. ‘Human milk + Cow’s milk’ was the only milk-feeding scenario modeled that predicted sufficient DHA+EPA among 1-3-y-olds. Vitamin D shortfalls were not correctable in any milk-feeding scenario, even with supplementation (5 μg/d), apart from the ‘Follow-up Formula + Fortified drink’ scenario in 1-3-y-olds (albeit free sugars intakes were estimated at 12%E compared to ≤5%E provided by other scenarios). Iron and vitamin E shortfalls were most prevalent in scenarios for 1-3-y-olds at ≤25th growth percentile. Conclusions: Using WHO growth standards and international reference values, this study provides a protocol for addressing nutrient shortfalls among 1-5-y-olds, which could be applied in country-specific population health.