Much emphasis has been placed on understanding the dietary intakes and behaviors of infants and toddlers to set them on the pathway to optimal health and reduce the burden of… Click to show full abstract
Much emphasis has been placed on understanding the dietary intakes and behaviors of infants and toddlers to set them on the pathway to optimal health and reduce the burden of obesity, dietary risks of dental caries, and chronic degenerative diseases in adulthood. Indeed, early life nutritional exposures are also likely to be critical for modifying the dietrelated risks of chronic degenerative diseases later in life such as obesity, type 2 diabetes mellitus, and cardiovascular disease. For much of the 20th century, carbohydrates, and sugars in particular, received little attention from nutritionists. In part, this was because until 1990s, analytical values for sugars and starch were not available, and their content was calculated by difference rather than being chemically analyzed. In the 21st century, the story has been different. Sugar has been one of the most contentious nutrition topics in the past decade. Sugars consist of monosaccharides (glucose, galactose, and fructose) and disaccharides (common examples are sucrose, lactose, and maltose). For the most part, concern about sugars is focused on ‘‘added’’ or ‘‘free’’ sugars rather than ‘‘naturally occurring’’ sugars found in fruits, vegetables, and milk. The term ‘‘added sugars’’ refers to any sugars or caloric sweeteners added to food during processing, preparation, or at the time of consumption. Examples of added sugars include table sugar, syrups (eg, corn syrup, high-fructose corn syrup, maple syrup, and agave syrup), honey, and molasses. ‘‘Free sugars’’ are similar to added sugars but include sugars present in 100% fruit juice. Although the body does not differentiate between a sugar molecule added to a food and one that occurs in the food naturally, this distinction has been made based on epidemiological data showing adverse health outcomes associated with high intakes of foods and beverages containing added/free sugars. As Achterberg points out, food plays many roles in infants and children aside from its nutritional and health functions. In infancy, food is seen as a milestone at times and a stressor at others. Toddlers view food as play, may use it as a sense of autonomy, and begin to develop specific preferences about what foods agree or do not agree with them (ie, pickiness). Johnson and Hayes describe social, emotional, and physical aspects of food consumption in children. Very little consideration has been given to how foods actually taste to young children; Hayes and Johnson provide interesting insights on how multiple senses coordinate to tailor child taste preferences. Their article also raises the question of whether adding small amounts of sugar to bitter-tasting foods such as vegetables could facilitate toddlers’ acceptance of these foods, even when the sugar is subsequently reduced or removed. There is a sound theoretical rationale for this suggestion, because humans have an innate preference for sweetness and an aversion to bitterness. Nevertheless, much research is needed to establish whether this strategy would be effective over the long term, and if so, on how to effectively communicate it to caregivers. Parents often feel uninformedonhowmuchandwhat typesof foods to offer children. As children age, food often becomes a reward or part of a reward system, ‘‘eat this and you canhave dessert’’ and ‘‘do what I told you and then you can have some candy.’’ For parents and caregivers, food presents a simultaneous opportunity to improve health and set a course for a healthy relationship with food, but it can also create stress and anxiety because feeding occasions become a dreaded routine of the day. Thus, tailoring specific dietary guidance to the variation in ages, needs, goals, and acceptance of nutrition in the B24 life stage is of upmost importance, but it will also serve as a tremendous challenge to the researchers and policy makers who are tasked with developing such recommendations. The recent 2015Y2020 Dietary Guidelines for Americans recommends that no more than 10% of daily calories N T
               
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