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DIET QUALITY BY FOOD INTAKE AND MEALS IN LIMITED INCOME MOTHER-INFANT PAIRS IN JACKSON, MICHIGAN
Seung-yeon Lee, Sharon Hoerr, and Rachel Schiffman
Michigan State University
Background
Low-income families are at high risk for poor nutritional status and health. Low socioeconomic status (SES) groups show higher incidence than high SES groups of premature and low birth weight babies, growth and developmental retardation in infants/toddlers, and chronic diseases such as heart disease, stroke, and some cancers. Poor diet is a factor in these conditions that is sometimes overlooked by child development specialists. Furthermore, despite the importance of diet to growth, limited research exists on the dietary quality of infants and toddlers.
Objective
To investigate the dietary quality of mothers and infants in low-income families at risk for poor dietary quality.
Methods
Participants for this study were 181 mother-infant pairs eligible for Early Head Start who were participating in the longitudinal evaluation of Early Head Start. Mothers were interviewed in their homes about many aspects of parenting, service use, and family health habits. Interviewers obtained 24-hour dietary recalls of both the mothers (average age 23.3 years, SD = 5.2) and their infants at or near the time of enrollment (average age of infants was 6.4 months, SD = 3.3) and again when the infants were about 14 months old. The interviews lasted about two hours, and mothers were given $20 for each interview. Questions were asked at the first interview about consumption of nutritional supplements and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Food Stamp, and Medicaid programs. Food and meal analysis, not nutrient analysis, was considered appropriate because detailed probing was not done. Food recall data were analyzed by subject-identified eating times such as "breakfast," "morning snack," "lunch," "afternoon snack," "dinner," and "evening snack" using SPSS (Statistical Package for the Social Sciences 1996, version 7.5). Foods were entered by type of food and subdivided by the major food groups. The dietary quality of infants at the first data collection was classified according to the U.S. Department of Agriculture's (USDA's) guideline for WIC (Table 1). Six factors comprised "appropriate infant feeding," including the age-/amount-appropriate intake of formula, juice, milk, grains, vegetables, and fruits (Table 2). The dietary quality of mothers and 14-month-old children was examined by food group and skipping breakfast (Table 2). Consumption of less than at least one serving from each of the five food groups from the USDA Food Guide Pyramid (fruit, vegetable, dairy, meat, and grain) has been shown to be nutritionally inadequate. Many studies have reported poor dietary quality to be associated with skipping breakfast.
Results
At the 14-month interview, data were collected for 158 pairs; however, data from only 123 pairs could be analyzed, because some mothers provided incomplete data on their children's food intake. For the two time points, 119 cases could be matched. The percentage of mothers using WIC and Medicaid was 87.5 and 88.7, respectively. Only 58.3 percent of mothers reported receiving food stamps, although all were eligible (13 mothers did not answer this item). Most (91.5 percent) of the mothers had inappropriate diets. Grain and meat were the most frequently consumed food groups; about two-thirds of mothers consumed a vegetable or dairy food, but fruit consumption was very low at both time points (Table 3). Mothers' diets were also fairly consistent from the first to the second time point, with only about half of mothers consuming foods from four or five of the food groups (Table 4). Most (82.5 percent) infants were not fed according to the WIC guidelines. Infants consumed formula (only 11 infants were reported to have been breast-fed) in inappropriate amounts and were fed juice, fruit, grains, and vegetables at younger ages than recommended. Fruit juice is recommended after 6 months of age, but 18 infants were fed juice before 6 months of age, including 7 infants who were fed high amounts of juice (>12 oz.). No soda drinks were reported for infants at breakfast at the first time point. Fruit and vegetable consumption were the least frequently consumed food groups for toddlers (Table 3), but by 14 months more than 50 percent of children consumed from the five food groups and another 30 percent from at least four food groups (Table 4).
The percent of skipped meals was higher for mothers than for toddlers. At baseline, 41 percent of mothers skipped breakfast; 23.8 percent, lunch; and 5.5 percent, dinner. Toddlers rarely missed a meal. Few mothers or infants reported taking nutrient or dietary supplements. At the first interview, supplements were reported for 20.4 percent of mothers and 19.3 percent of infants. This changed to 23.6 percent of mothers and 9.8 percent infants at 14 months. To examine the relationship between the diet quality of mothers and that of their infants, we compared the dietary quality of mother and infants (Table 5). At the first interview (6 months), a poor diet for the mother was highly predictive of her infant's having a poor diet. A poor-quality mother's diet had a sensitivity of 93 percent, specificity of 29 percent, and predictive value of 76.8 percent at 6 months of age for her infant's diet quality. At 14 months, a poor-diet quality for mothers remained a good predictor for poor diet quality of her infant but not as good as at the first time point. Sensitivity was 84 percent, specificity was 53 percent, and predictive value was 48 percent. There was no relationship between services received and dietary quality.
Conclusions
Even though these limited-income families received health services and most were in WIC, diet quality of most mothers was poor and remained so from the first to the second time point. Fruits and vegetables were the food groups least likely to be consumed by mothers and toddlers. Infants were often fed inappropriately, although, by the age of 14 months, the quality of the children's diets had improved slightly.
| Age (Months) |
Breast Milk or Infant Formula | Grain Products | Juices | Vegetables | Fruits | Protein Food |
|---|---|---|---|---|---|---|
| 0 to 4 | Breast Formula |
None | None | None | None | None |
| 4 to 6 | Breast Formula |
Iron-fortified infant cereals (1 to 2 servings/day: 1 to 8 Tb.) |
Infant or regular 100% juice (avoid citrus, pineapple, and tomato juices) | None | None | None |
| 6 to 8 | Breast Formula |
Iron-fortified infant cereals (2 servings/day 4 to 8 Tb.) Can try cracker, small pieces of toast, zwieback at 8 months) |
Infant or regular 100% juice or vegetable juice (2 to 4 oz./day) only from a cup | Plain strained or pureed cooked vegetables (1 to 2 servings/day: 4 to 8+ Tb./day) | Plain strained or pureed fresh or cooked fruits (2 servings/ day: 4 to 8+ Tb./day) | Protein foods may be introduced. (Plain strained or pureed meats may be introduced if an additional food source of iron is needed.) |
| 8 to 10 | Breast Formula |
Iron-fortified infant cereals (4 to 8+ Tb./day) Other grain products (2 to 3 servings/day) |
Infant or regular 100% juice or vegetable juice (4 oz./day) only from a cup | Pureed or mashed fresh or cooked fruits or junior fruits (2 servings/day: 4 to 8+ Tb./day) | Pureed or mashed fresh or cooked fruits or junior fruits (2 servings/day: 4 to 8+ Tb./day) | Pureed, finely chopped, or plain strained lean meat, poultry, or fish, egg, yolk, cheese, yogurt, mashed beans or peas (1 to 6 Tb./day) |
| 10 to 12 | Breast Formula |
Iron-fortified infant cereals (4 to 8+ Tb./day) Other grain products (2 to 3 servings/day) |
Infant or regular 100% juice or vegetable juice (4 oz/day) only from a cup | Mashed or chopped fresh or cooked fruits or junior fruits (2 servings/day: 6 to 8+ Tb./day) | Mashed or chopped fresh or cooked fruits or junior fruits (2servings/day: 6 to 8+ Tb.) | Pureed or chopped lean meat, poultry, or fish, egg yolk, cheese, yogurt, mashed beans or peas (2 to 8 Tb. or 1 to 2 oz./day) |
| Infant Nutrition and Feeding-A Reference
Hand Book for Nutrition and Health Counselors in the WIC and CSF
Programs. Alexandria, VA: FSN, United States Department of Agriculture,
1993 Bibliography - Chicago Dietetic Association and the South Suburban Dietetic Association. The Manual of Clinical Dietetics. Chicago, IL: The American Dietetic Association, 1992. - National Research Council. "Recommended Dietary Allowances." Report of the subcommittee on the Tenth Edition of the RDAs, Food and Nutrition Board, Commission on Life Science. Washington, DC: National Academy Press, 1989. - Pemberton et al. Mayo Clinic Diet Manual: A Handbook of Dietary Practices. Philadelphia, PA: B.C. Decker Inc., 1988. |
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| Food Group | Mothers at Baseline (n=119) | Mothers at 14 Months (n=119) | Toddlers at 14 Months (n=119) |
|---|---|---|---|
| Grain | 93.3 | 95.0 | 100.0 |
| Vegetable | 62.2 | 70.6 | 72.3 |
| Fruit | 25.2 | 27.7 | 78.2 |
| Dairy | 71.4 | 73.9 | 96.6 |
| Meat | 92.4 | 87.4 | 93.3 |
| 0 Food Group | 1 Food Group | 2 Food Groups | 3 Food Groups | 4 Food Groups | 5 Food Groups | |
|---|---|---|---|---|---|---|
| Mothers at Baseline (n=119) | 0.0 | 1.7 | 13.4 | 32.8 | 42.9 | 9.2 |
| Mothers at 14 Months (n=119) | 0.8 | 2.5 | 10.9 | 31.1 | 36.1 | 18.5 |
| Mother's Dietary Quality | ||||
|---|---|---|---|---|
| Inappropriate | Appropriate | Total | ||
| Infant's Dietary Quality |
6 Months (n=119) | |||
| Inappropriate | 96 (80.7%) | 5 (4.2%) | 101 (84.9%) | |
| Appropriate | 12 (12.6%) | 3 (2.5%) | 18 (15.1%) | |
| Total | 111 (93.3%) | 86 (6.7%) | 119 (100%) | |
| 14 Months (n=119) | ||||
| Inappropriate | 47 (39.4%) | 9 (7.6%) | 56 (47.0%) | |
| Appropriate | 54 (45.4%) | 9 (7.6%) | 63 (53.0%) | |
| Total | 101 (84.8%) | 18 (15.2%) | 119 (100%) | |
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