Beverage consumption and infant Nutrition - Benefits of Milk vs Juice

Nutrition Research Newsletter, Nov, 2003 by T Marshall, S Levy, B Broffitt, J Eichenberger-Gilmore, P Stumbo

The transition stage of infant nutrition, loosely defined as the period from introduction of infant food to acceptance of table food, is a critical time for the development of healthy dietary habits and acceptance of novel foods. The impact of contemporary dietary trends, particularly the increased consumption of carbonated beverages and juice and decreased consumption of cows' milk, on transition-stage nutrition has not been thoroughly investigated. The researchers of the present study hypothesize that milk intakes are inversely associated with alternative beverage intakes beginning in early infancy. The purposes of the present study are to describe beverage intakes during the transition from liquid to solid food and to identify associations among beverage intakes in a cohort followed from birth.

Children in this study were participants from the Iowa Fluoride Study (IFS). Mothers of newborns (n=1, 882) were recruited, and questionnaires were sent to parents when their children were 6, 9, 12, 16, 20, and 24 months of age. Inclusion criteria were as follows: completion of a minimum of three questionnaires from six through 24 months of age. Seven hundred one children met the criteria. The questionnaires included detailed questions regarding infants' beverage intake, general health, and oral health. A beverage frequency questionnaire was used to assess the type and quantity of water, infant formula, cows' milk, human milk, juice and/or juice drinks, and non-juice beverages consumed at home, child-care centers, and elsewhere during the previous week.

On average, the parents were well educated and relatively affluent, with 47% of mothers and 43% of fathers reporting at least a bachelor's degree and 31% of households reporting annual family incomes of $50, 000 at the time of their child's birth. Ninety-eight percent of mothers were white. Essentially all children (97%) consumed human milk, formula, or cows' milk throughout the study period. The percentage of infants consuming human milk declined with age. Infant formula consumption decreased; cows' milk consumption peaked at 12 months, plateaued and decreased at 20 months; and combined formula and cows' milk consumption gradually decreased with age. Average daily consumption and percentage of children consuming juice and juice drinks, water, and other beverages gradually increased with age, although juice and juice drink intakes decreased at 24 months. The percentages of children who exceeded 6 oz of juice and juice drinks per day at 6, 9, 12, 16, 20 and 24 months were 8%, 17%, 34%, 51%, 59%, and 53% respectively. In general, lower family income and less maternal education were associated with less breastfeeding, increased intakes of juice and juice drinks at younger ages, and increased intakes of other beverages at all ages.

Introduction of cows' milk is not recommended until 12 months of age; however, it is often introduced earlier. In the present study, the percentage of infants with reported cows' milk consumption increased from 26% on the nine-month questionnaire, to 79% on the 12-month questionnaire. The American Academy of Pediatrics (AAP) recently issued guidelines recommending that 100% fruit juice be limited to 4 oz to 6 oz/day for children one to five years of age, and emphasized that juice drinks are not equivalent to 100% fruit juice. Mean combined juice and juice drink intakes in this study exceeded the AAP's 4 oz to 6 oz guideline. Total beverage consumption remained relatively stable for the ages studied. Consumption of formula and milk declined, whereas consumption of juice and juice drinks and other beverages increased, suggesting that the replacement of milk by competing beverages begins early in life. Children exceeding guidelines for 100% juice or consuming juice drinks and other alternative beverages could be reducing formula or cows' milk intakes, which could reduce dietary intake of nutrients critical for growth and development.

T Marshall, S Levy, B Broffitt, J Eichenberger-Gilmore, P Stumbo. Patterns of beverage consumption during the transition stage of infant nutrition. JADA 103(10):1350-1353 (October 2003) [Correspondence: Teresa A. Marshall PhD, RD, Assistant Professor, Department of Preventive and Community Dentistry, University of Iowa College of Dentistry, 3/335 Dental Science Building, Iowa City, IA 52242. E-mail: teresa-marshall@uiowa.edu]