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Birth - 24 Work Group 3 – Period of Transitional Feeding (12-24 Months)

Each work group developed a set of topics and questions that might be the focus of future NEL systematic reviews, identified priority data needs (to be derived either from existing data sets, e.g., NHANES, or met with new data/surveillance) and described research priorities. Work Group 3 discussed development and measurement of physical activity.  Below is the list of topics and systematic review questions identified by Work Group 3. The full topic brief for Work Group includes the data needs and research priorities for the topics as well as a reference list for each topic.
  • What are the specific energy needs of infants and children 12-24 to promote health and prevent disease?
    • What are the energy requirements for toddlers, ages 12-24 months, to promote optimal growth and physical development?
  • What is the optimal type and amount of physical activity to promote health of infants and toddlers 6-24 months of age?
    • What types of physical activity during ages 6-24 months are associated with 1) optimal growth and physical development, 2) optimal bone development and 3) reduced risk of overweight/obesity?
    • What amount (i.e., duration, frequency and number of daily occasions) of physical activity from ages 6-24 months is associated with 1) optimal growth and physical development, 2) optimal bone development and 3) reduced risk of overweight/obesity?
  • Micronutrients and other dietary constituents of concern for infants/toddlers 12-24 months of age
    • What is the relationship between observed intakes of fiber, vitamin A and folate and the EARs and ULs for toddlers 12-24 months of age?
    • What is the relationship between fiber, vitamin A and folate and 1) markers of growth in relation to WHO reference growth standards, or 2) biomarkers of adequacy?
  • Impact of different approaches weaning off the breast or bottle on infant/toddler health
    • What is the relationship between delayed weaning from the breast on toddler 1) dietary intake (including energy and iron intake), 2) eating behaviors, 3) growth and development, including risk of overweight/obesity, 4) oral health and 5) anemia?
    • What is the relationship between delayed weaning from the bottle and/or inappropriate use (including formula, human milk, and juice) of a bottle on toddler: 1) dietary intake (including energy and iron intake), 2) eating behaviors, 3) growth and development, including risk of overweight/obesity, 4) oral health and 5) anemia? An example of  “inappropriate” use might include either use that is inconsistent with current guidance (e.g., off the bottle by 18 mo)  or use of food to manage behavior: soothe, quiet, redirect or control  a non-hungry infant/toddler.
  • Implication of consumption of different types of post-weaning beverages in infant/toddler growth, development and health
    • Is there a level (minimum and maximum) of cow’s milk consumption that is ideal for infants/toddlers 12-24 to support:
    • Physical growth and development.
    • Cognitive/behavioral development.
    • Prevent increased risk for such non-communicable conditions as: anemia, obesity, cardiovascular disease.
    • What is the effect of different percent milk fat (e.g., whole, reduced, and skim) on 12-24 month old’s: 1) energy intake, 2) neurological development, 3) obesity and 4) cardiovascular disease risk?
    • What are the effects “milk” alternative beverages (e.g., soy, rice, almond and coconut beverages) as compared to human or cow’s milk on children’s:1) nutritional status, 2) nutrient intake (e.g., effect on vitamin D and calcium status), 3) risk of allergy and 4) cardiovascular disease risk?
    • What is the effect of juice consumption in this age-group on: 1) risk of diarrhea, 2)  growth and development (decreased risk of obesity or poor weight gain) and 3) diet quality (i.e., displacement of other foods in diet)?
    • What amount of free water is recommended for children ages 12-24 months to promote optimal growth and development, adequate hydration, and limits displacement of other foods in the diet?
  • Implications of sleep patterns for infant/toddler nutrition, growth and health
    • What is the effect of short sleep duration on obesity risk among infants aged 0 to 24 months?
    • What is the effect of short sleep duration on appetite and dietary quality among children consuming complementary foods?
  • “Micro-environmental” effects on the transition to the adult diet.  How do inborn responses to basic tastes and learning and experience with food and eating influence the transition to the adult diet during the period of 6-24 months of age?
    • How do children’s A) inborn ability to learn food likes and dislikes (i.e., the ability to learn to like, dislike foods and other things via familiarization, and associative learning processes), B) predispositions for basic tastes (i.e., the species general  unlearned liking to sweet, salty, umami, rejection of sour, bitter tastes) and C) individual differences contribute to: 1) making the transition to consuming the foods of the adult diet (food preferences and dietary intake), 2) growth and development, and 3) risk of overweight/obesity?
    • How do parent/caregiver feeding practices impact the transition to the adult diet (food preferences and dietary intake; development of reactivity, self-regulation of food intake), 2) growth and development and 3) risk of overweight/obesity?
    • What food characteristics (e.g., taste/flavor characteristics; portion size, energy, nutrient density, novel or familiar) impact the development of food preferences and dietary intake?
    • What factors (either from the child or the parent/caregiver) precipitate or exacerbate “picky eating”?
    • What is the relationship between picky eating and dietary intake, long-term eating behaviors and other health outcomes, such as growth and development and risk of overweight/obesity?
    • What factors contribute to the ability to self-regulate energy intake?
    • Can changes in infant/toddler feeding patterns and/or environmental characteristics impact the ability to self-regulate energy intake?
  • Factors affecting exposure to and impact of media in infants/toddlers
    • What are the impacts of exposure to advertising on food choice, food intake and weight status?
    • What is the relationship between screen time and 1) growth and physical development, 2) overweight/obesity and 3) cognitive, behavioral, or neuromuscular development in infants and toddlers?
  • Impact of food insecurity on infant/toddler health and development
    • What is the relationship between food insecurity in infants/toddlers and: 1) cognitive, behavioral or neuromotor development, 2) dietary intake/diet quality, 3) poor perceived health, 4) risk of iron deficiency/anemia and 5) weight status?
  • Specific food safety concerns for this population, such as exposure to lead and mercury and potential choking risks associated with food (e.g., texture, shape, etc.)
    • What dietary behaviors increase the risk of lead poisoning among infants and toddlers?
    • What dietary behaviors increase a toddler’s risk of exposure to mercury among infants and toddlers?
    • What food characteristics (i.e., texture, shape) are associated with increased risk of choking among infants and toddlers?