Ultra-processed foods dominate children's diets from toddlerhood to middle childhood

By Pooja Toshniwal PahariaReviewed by Benedette Cuffari, M.Sc.Oct 9 2024

Children's intake of ultra-processed foods spikes significantly between toddlerhood and middle childhood, raising concerns over long-term health impacts like higher sodium and sugar consumption and reduced fiber intake.

Study: Ultra-processed food intake in toddlerhood and mid-childhood in the UK: cross-sectional and longitudinal perspectives. Image Credit: Oksana Kumina / Shutterstock.com

A recent European Journal of Nutrition study examines ultra-processed (UPF) food consumption trends between toddlerhood and middle childhood.

Shaping healthy eating habits from toddlerhood

Early meal experiences influence meal choices and eating habits later in life. Repeated exposure to various vegetables in infancy and toddlerhood increases the acceptance of these healthy foods into childhood and promotes good eating habits.

Meta-analyses have reported associations between high UPF intake and increased fat, saturated fat, and free sugar intake. Comparatively, excessive consumption of UPF foods is associated with low protein, fiber, vitamin C, and potassium intake.

The hyper-palatability of UPFs contributes to their increased consumption. Many children are overweight or obese when they enter school, with the prevalence of obesity increasing by the time these children complete primary school. However, limited studies have evaluated UPF consumption in toddlerhood and changes in their intake during childhood.

About the study

Between 2007 and 2008, the Office for National Statistics contacted 6,754 families in Wales and England who had live twin births from March to December 2007. Taken together, 2,402 families, which included 4,804 children, completed baseline questionnaires on the birth date, weight, gestational age, and sex of their children, as well as maternal ethnicity and socioeconomic status.

The study included children from the Gemini birth cohort of twin families. Among the participants, 2,591 were 21 months old, and 592 were seven years old, with boys and girls similarly represented. However, most children were white.

The researchers used three-day diet diaries to estimate UPF consumption. Study participants completed diet diaries between November 2008 and August 2009 and between April and December 2014.

Four independent researchers classified foods in the Diet In, Nutrients Out (DINO) database as unprocessed or minimally processed, culinary ingredients, processed foods, and UPFs. Cow milk formula (CMF) was considered a distinct non-UPF category, as it is consumed in large quantities by toddlers. Fish oils and mineral and vitamin supplements were excluded from the analysis.

Logistic regression analysis was used to determine odds ratios (ORs), whereas complex samples general linear modeling (CSGLM) accounted for twin data clustering.

Study findings

Mean daily calorie intakes of 1,033 and 1,500 kcal were observed in toddlerhood and mid-childhood, respectively. UPFs contributed 47% to the total calorie intake at 21 months and 59% at seven years.

The primary UPF subgroups among toddlers were high-fiber cereals, whole-grain bread, and flavored yogurts. White breads, sweet cereal products, and puddings were the most common UPFs at mid-childhood. Mean sodium and free sugar intakes exceeded the recommended maximum allowances at both ages.

Negative correlations were observed between UPFs and toddlers' fat, saturated fatty acids, and protein consumption. UPF consumption was inversely related to fiber intake during middle childhood. Repeating the analysis for CMF non-consumers yielded similar results.

Individuals who maintained food records at the two intervals reported increased UPF consumption by 16% from toddlerhood to middle childhood.

The study of 467 participants who were not CMF consumers during toddlerhood revealed an 18% rise in UPF consumption between toddlerhood and mid-childhood. Moreover, belonging to the quintile with the highest UPF intake during toddlerhood was predicted to be in the same top quintile in mid-childhood with an OR of 9.4.

UPF consumption in toddlerhood explained 19% of the variation during middle childhood UPF consumption in the study sample and 22% after excluding CMF-consuming toddlers. In mid-childhood, CMF drinkers increased their UPF consumption by 7%.

CMF consumption varied greatly, with toddlers in the lowest quintile (Q1) reporting 0.3% UPF consumption, whereas 9.2% of those in the uppermost quintile (Q5) consumed UPFs. About 29% of toddlers in Q1 consumed whole milk compared to 9.2% in Q5.

Conclusions

UPFs accounted for approximately 50% of toddlers' energy, which rose to 59% by middle childhood. Higher UPF intake was associated with increased salt and free sugar intake but lower fiber intake.

During toddlerhood, the most commonly consumed UPFs included those advertised as healthy, such as flavoring yogurts and higher-fiber morning cereals. Comparatively, puddings, sweet cereal, and white bread were more commonly consumed during mid-childhood.
Integrated strategies are needed to provide children with meals containing fewer ultra-processed items, ultimately providing the foundation for consuming a healthy diet as the child continues to develop. Future studies could investigate the obesogenic effects of UPF foods and elucidate underlying mechanisms linking UPF intake to obesity.