LAUSR

For only the second time since the first publication of Dietary Guidelines for Americans (DGA) in 1980, the DGA, 2020–2025 provide dietary recommendations specific to children younger than 2 years [1]. In its entirety, the DGA, 2020–2025 include four overarching guidelines applicable to every stage of life. Six chapters address these stages, including pregnancy and lactation. The second edition of the DGA, published in 1985, contained a lean three paragraphs relevant to infants and recommended (1) breastfeeding with no duration specified, (2) gradual introduction of solid foods between 4 and 6 months, and (3) avoidance of adding salt or sugar to infant foods. In comparison, this current ninth edition provides a chapter focused entirely on recommendations for food and nutrient intake from birth through 23 months. While an advance in public health guidance on its own, additional value stems from coupling this content with advice for pregnant and lactating women; these DGA stand as a single source of dietary recommendations spanning the first 1000 days [2]. Guidance stems from two data sources including the completed Pregnancy and Birth to 24 Months Project led by the US Department of Agriculture (USDA) and Department of Health and Human Services [3], as well as original systematic reviews utilizing the USDA’s rigorous Nutrition Evidence Systematic Review team [4]. Therefore, important context for digesting these guidelines comes from knowing the outcomes interrogated in those systematic reviews. For intake specifically during infant and toddler ages, topics evaluated included cardiovascular health, diabetes, and cancer prevention yet not neurodevelopmental outcomes. While neurodevelopmental outcomes associated with intake particularly during early childhood are of interest to stakeholders, the Dietary Guidelines Advisory Committee (DGAC) considered predetermined questions. Public input helped shape these questions. Separate from early childhood diet, reviews evaluated maternal diet during pregnancy and lactation and associated children’s developmental outcomes. The DGA divide focus within the first 2 years into three general time frames. Those three correspond with developmental maturation of feeding skills including the first 6 months of infancy, the latter 6 months, and 12–23 months of age. Guidelines stand consistent with global recommendations for exclusive breastfeeding during the first 6 months. Included is direction for infants nourished with iron-fortified formula during the 1st year. As data allow, the DGA provide considerations for total energy, macronutrient, micronutrient, and vitamin intake specific to each time frame. A peculiarity exists in the mention of pasteurized human donor milk, seemingly for routine feeding of infants born full term. Guidance only discusses how donor milk can be safely acquired should families choose. Yet there is no mention that donor milk for routine feedings brings risk of energy and protein malnutrition and micronutrient deficiencies, including zinc deficiency [5], which may occur without close monitoring and nutrient supplementation as happens primarily in neonatal intensive care units. Donor milk was not systematically reviewed nor part of the DGAC’s Scientific Report [4], the foundation of DGA, 2020–2025. Additional items addressed include introduction of potentially allergenic foods and which foods reduce diet quality during infancy and toddler ages. The DGAC appropriately emphasized the relevance of nutrient density as complementary foods are introduced. Since portions of complementary foods are relatively small, any substitution with lower quality nutrients (e.g., added sugars) will easily displace intake of required nutrients. This particular content is important for the public to understand. For ages 12–23 months, these DGA provide exceptional detail regarding estimated intake of multiple food groups based on * Daniel T. Robinson [email protected]