Food consumption patterns and nutrient intakes of infants and young children amidst the nutrition transition: the case of Lebanon

Abstract

Background: This is the first study on dietary intakes of infants and young children in the Eastern Mediterranean Region, a region that is currently witnessing the nutrition transition. It aims at characterizing food consumption patterns amongst 0-4 year old children in Lebanon, evaluating their macro- and micronutrient intakes and assessing adherence to dietary recommendations.

Methods: Based on a national cross-sectional survey in 2012 (n = 866), the study collected data on sociodemographic and anthropometric characteristics, and one 24-hour dietary recall was administered. Nutrient intakes were compared with reference values: Estimated Average Requirement (EAR), Adequate Intake (AI) and Acceptable Macronutrient Distribution Range (AMDR).

Results: Milk was the highest contributor to energy intake (EI) in infants (95.8 and 56.5% in 0-5.9 months and 6-11.9 months old infants, respectively), while its intake was lower among toddlers and preschoolers (35.4 and 15.1%, respectively). In contrast, intakes of sweets and sweetened beverages were the highest in preschoolers compared to younger children, contributing 18.5% EI in preschoolers. Compared to dietary guidelines, the lowest dietary adherence was found for vegetables (17.8-20.7%) and fruits (14.4-34.3%). Protein intake was within the recommendations for the vast majority of children. Although total fat intake was lower in toddlers and preschoolers compared to infants, more than 40% of toddlers and preschoolers exceeded the AMDR for fat and 87.3% of preschoolers exceeded the upper limit for saturated fat. Only 3.6% of toddlers and 11.5% of preschoolers exceeded the AI level for dietary fiber. Micronutrient intake assessment showed that mean intakes in infants exceeded the AI for all micronutrients, except for vitamin D and magnesium. In toddlers, vitamin D and calcium were below the EAR among 84.7, and 44.6%, respectively. In preschoolers, most of the children (91.9%) had inadequate intakes of vitamin D, and a third had inadequate intakes of folate, calcium and vitamin A.

Conclusions: This study identified priority issues for nutrition intervention in infants and young children in Lebanon. Concerted multi-stakeholder efforts are needed to instill heathier food consumption and nutrient intake patterns early in life.

Keywords: Adherence; Food consumption patterns; Food groups; Intakes; Lebanon; Macronutrients; Micronutrients; Nutrients; Under-five children.

Fig. 1

Percent of energy from major food groups, as consumed, in 0–48 months Lebanese children. Legend: ¹ Includes any milk (breast milk, infant formula, cow’s milk, and goat’s milk) as well as dairy foods, cheeses, and yogurt. ² Includes bread, rolls, pita, saj, baby food cereals/grains, baby food finger food, cereals, crackers, pretzels, kaak, pancakes, French toast, pasta, rice, and other grains. ³ Includes all yogurt, grain, and meat based mixed dishes such as sandwiches, macaroni and cheese, spaghetti and lasagna, sandwiches, beans and rice, pizzas, Mahashi, and soups. ⁴ Includes any baby food and non-baby food meats, dried beans, peas and legumes, eggs, peanut butter, nuts and seeds. ⁵Includes baby food vegetables, canned, cooked and raw vegetables, white potatoes, and 100% vegetable juice. ⁶ Includes baby food fruits, canned, dried, and raw fruits, 100% baby food juices, and other 100% fruit juices. ⁷ Includes popcorn, potato chips, and corn chips. ⁸ Includes baby food desserts and cookies, non-baby food dessert items (cakes, pies, cookies, bars, brownies, biscuits, pastries, muffins, and traditional desserts), ice cream and dairy desserts, puddings, candy, cereal and nutrition bars, gelatins, ices, and sorbets, sugars, syrups, preserves, and jelly, fruit drinks and other sugar sweetened beverages. ⁹Includes butter, margarine, animal fats, dressings, oils, and olives. ¹⁰Includes condiments, herbs, seasonings, gravies, and sauces

Fig. 2

Adherence to dietary recommendations pertinent to food group intake^#, in children aged above 1 year. Legend: Adherence assessment was based on the recommended servings for the various food groups by age and gender based on the AHA/AAP Dietary Recommendations for Children [24, 25]. ^# Recipes of composite foods were disaggregated prior to the assessment of adherence to dietary recommendations. * Indicates significant difference between the age groups in the proportion of children adhering to food group recommendations. Abbreviations: AHA/AAP: American Heart Association/American Academy of Pediatrics