Development of a diet quality and variety index for Norwegian children at 12 months of age - The relationship between diet quality and variety and age of introduction to solid foods

Abstract

Introduction Sufficient dietary intake in early childhood is essential for an adequate supply of important nutrients for development and growth, and for establishing healthy dietary habits at an early stage of life. Recommendations regarding the appropriate age of introduction to solid foods have changed over the past 20 years, and both internationally and nationally, has this been a topic of much debate. The third nationally representative Spedkost survey was conducted in 2018/2019, providing updated information about the dietary habits of infants aged 6 and 12 months.Dietary intake in early childhoodconsists of a wide range of different foods and nutrients. Dietary indices offer the possibility to evaluate dietary quality by comparing guidelines and nutrient recommendations.Due to limited knowledge about diet quality and variety in Norwegian children, this master thesis aimed to develop a diet quality and variety index for Norwegian children at 12 months of age, andto explore possible differences in the diet quality and variety index score according to age of introduction to solid foods and selected parental and child characteristics. Methods A sample of 3000 mother and infant pairs was invited to the Spedkost survey at 6 and 12 months of age. The study had a longitudinal design where the same infantswere invited to participate in the study when they were 6 months and12months of age. Dietary data were collected through a semi-quantitative food frequency questionnaire at 6 and 12 months of age, and a diet quality and variety index was developed for children aged 12 months. The diet quality and variety index was mainly based on the Norwegian dietary guidelines for adults and infants. The difference in index score at 12 months of age between groups introduced to solid foods at 4.5 months of age or earlier and at 5.0 months of age or later was assessed. Differences in index scores between different groups according to parental and child characteristics were also evaluated. Results The mean diet quality and variety index score in the total sample was 7.6 (SD 0.8) out of 10.0 possible points. There was no difference in the diet quality and variety index score between the group of childrenintroduced to solid foods at 4.5 months of age or earlier, and the group introduced to solid foods at 5.0months of age or later (p=0.838). Multivariate analysis showed that the diet quality andvariety indexscorewas significantly associatedwith birth weight, infant eating-related problems, parental education, maternal family situation, maternalwork situation, and parity in the total sample. Conclusion To our knowledge, a diet quality and variety index score made for children at 12 months of age has notpreviously been done in Norway. Such diet indices are a novel way of presenting a holistic view of the dietary intake and the dietary variety among children at this age. The mean diet quality and variety index was overall high, and no difference in the score was seen according to age of introduction to solid foods. Results indicated that the score was significantly associated with some parentaland child background characteristics. Due to possible challenges in the diet with increasing ageand that early food habits create a foundation for healthy food habits later in life, the average diet quality and variety index score could have the potential to be improved to prevent a falling diet quality and variety with increasing age. Further research on diet quality and variety in children is required to assess how the diet is affected by factors such as age of introduction to solid foods and parentaland child characteristics.