Family Economics and Nutrition Review [Volume 12, Number 3-4]

              Special Issue
Food Guide Pyramid for Young Children
3 Adapting the Food Guide Pyramid for Children: Defining the Target Audience
Etta Saltos
18 Technical Research for the Food Guide Pyramid for Young Children
Kristin L. Marcoe
33 Consumer Research: Food Guide Pyramid for Young Children
Catherine Tarone
45 Factors Influencing Children's Dietary Practices: A Review
Alyson Escobar
56 Expenditures on Children by Families, 1999
MarkLino
Research Briefs
75 Are All Food Pyramids Created Equal?
Alyson Escobar
78 Report Card on the Diet Quality of Children
Mark Lino, Shirley A. Gerrior, P. Peter Basiotis, and Rajen S. Anand
81 Eating Breakfast Greatly Improves Schoolchildren's Diet Quality
P. Peter Basiotis, Mark Lino, and Raj enS. Anand
Research Summaries
85
90
93
96
101
104
Regular Items
108
110 Research and Evaluation Activities in USDA
113 Journal Abstracts
115 USDA Food Plans: Cost of Food at Home
116 Consumer Prices
117 U.S. Poverty Thresholds
Volume 12, Numbers 3&4
1999
Dan Glickman, Secretary
U.S. Department of Agriculture
Shirley R. Watkins, Under Secretary
Food, Nutrition, and Consumer Services
Rajen Anand, Executive Director
Center for Nutrition Policy and Promotion
P. Peter Basiotis, Director
Nutrition Policy and Analysis Staff
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~ditor
Julia M. Dinkins
Features Editor
Mark Lino
Managing Editor
Jane W. Fleming
Contributor
Joan C. Courtless
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3
18
33
45
56
Special Issue
Food Guide Pyramid for Young Children
Adapting the Food Guide Pyramid for Children;
Defining the Target Audience
Etta Saltos
Technical Research for the Food Guide Pyramid for Young Children
Kristin L. Marcoe
Consumer Research: Food Guide Pyramid for Young Children
Catherine Tarone
Factors Influencing Children's Dietary Practices: A Review
Alyson Escobar
Expenditures on Children by Families, 1999
MarkLino
Research Briefs
75 Are All Food Pyramids Created Equal?
Alyson Escobar
78 Report Card on the Diet Quality of Children
Mark Lino, Shirley A. Gerrior, P. Peter Basiotis, and Rajen S. Anand
81 Eating Breakfast Greatly Improves Schoolchildren's Diet Quality
P. Peter Basiotis, Mark Lino, and Rajen S. Anand
Research Summaries
85 Contribution of Away-From-Home Foods to American Diet Quality
90 The Rural Poor's Access to Supermarkets and Large Grocery Stores
93 Poverty and Well-Being in Rural America
96 Alternative Employment Arrangements
101 Factors Affecting Nutrient Intake of the Elderly
104 The Food Stamp Program After Welfare Reform
Regular Items
108 Federal Statistics: Children's Health
110
113
115
Research and Evaluation Activities in USDA
Journal Abstracts
USDA Food Plans: Cost of Food at Home
116 Consumer Prices
117 U.S. Poverty Thresholds
118 Index of Articles in 1999 Issues
119 Index of Authors in 19991ssues
120 Reviewers for 1999 Articles
Volume 12, Numbers 3&4
1999
2
Would you like to publish in Family Economics and Nutrition Review?
Family Economics and Nutrition Review will consider for publication articles concerning economic and
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about U.S. population groups at risk-from either an economic or nutritional perspective. Research
may be based on primary or secondary data as long as it is national or regional in scope or of national
policy interest. Articles may use descriptive or econometric techniques.
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Briefs as short research articles. Our guidelines are found on the back inside cover of each issue.
We invite submission of Research Briefs; manuscripts may contain findings previously presented at
poster sessions if not published in proceedings (except for abstract).
Manuscripts may be mailed to Julia M. Dinkins, Editor, Family Economics and Nutrition Review,
Center for Nutrition Policy and Promotion. See guidelines on back inside cover for complete address.
Family Economics and Nutrition Review
Etta Saltos
USDA Cooperative State Research,
Education and Extension Service
1999 Vol. 12 Nos. 3&4
Research Articles
Adapting the Food Guide
Pyramid for Children:
Defining the Target Audience
Nutrition educators, as well as the 1995 Dietary Guidelines Advirory Committee,
have identified a need for nutrition guidance specifically for children. Because
of the variation in children's nutrient needs and eating practices, it is impractical
to adapt one food guide for all children. The purpose of the present study,
therefore, was to identify the best age group to target for an adapted Food
Guide Pyramid for Children. Three potential subgroups between the ages
of 2 and 18 were identified: preschool-age (2 through 6 years), school-age
(7 through 11 years), and adolescents (12 to 18 years). Subgroups were
ranked by reviewing the literature to determine whether the Food Guide
Pyramid meets each subgroup's dietary needs, to consider each subgroup's
specific nutritional or health problems that an adapted food guide could help
address, and to examine user demand for a new food guide. A food guide
adapted for use with parents and caregivers of preschool-age children was
identified as the greatest need based on children's specific dietary require­ments
(higher fat intakes as recommended by the 1995 Dietary Guidelines
and their need for smaller serving sizes) and user demand (requests from
parents, caregivers, and nutrition educators).
IT] he USDA's Food Guide,
designed to help all healthy
Americans 2 years old and
over use the Dietary Guide­lines
for Americans (38), and its graphic
representation, the Food Guide Pyramid
(Pyramid), have been distributed widely
since the Food Guide was first introduced
in the mid-1980's. The Pyramid has been
used widely in a variety of materials
(including posters, textbooks, school
curricula, and computer software) by
nutrition educators and has also been used
by industry on food labels. In materials
accompanying the Pyramid, USDA
recommends that preschool-age children
obtain at least the minimal number of
servings from the five major food
groups, but this age group can have
smaller servings from all food groups
except the milk group (38). Neverthe­less,
nutrition educators have identified
a need for nutrition guidance regarding
the dietary needs of children,1 and the
1995 Dietary Guidelines Advisory
Committee has recommended that the
development of separate dietary guide­lines
for children be considered (7).
Adaptation of the Pyramid and its
accompanying nutrition guidance
materials specifically for children is
an important component of the effort
to help children apply the Dietary
Guidelines for Americans.
1The term "children," in this article, refers to
children and adolescents ages 2 through 18 years.
3
The purpose of this study was to define
the target audience for a food guide that
would be adapted for children by recom­mending
subgroups within the 2- to 18-
year age range and ranking the subgroups
in order of greatest need based on dietary
requirements and user demand for nutri­tion
education materials. Materials
reviewed for this study included journal
articles, reference materials (including
the Recommended Dietary Allowances
and nutrition textbooks), and published
and unpublished reports from government
agencies. Criteria used to define and rank
the subgroups included the following:
• nutrient needs of children,
• nutrition recommendations for
children by authoritative bodies,
;;uch as the Dietary Guidelines
Advisory Committee,
• nutritional status of children,
including macronutrient and micro­nutrient
intake and anthropometric
measurements, and
• children's knowledge and attitudes
regarding nutrition.
These criteria were used to define sub­groups
and to list facts in favor of and
against adapting a food guide for each
subgroup.
Nutrient Needs of Children
The Recommended Dietary Allowances
(RDA) provide information concerning
children's nutrient needs, as well as the
nutritional needs of the rest of the popu­lation
(23). The 1989 RDA are expressed
for the following age-gender groups:
children, ages 1 to 3 years; children,
ages 4 to 6 years; children, ages 7 to 10
years; males, ages 11 to 14 years; females,
ages 11 to 14 years; males, ages 15 to
18 years; and females, ages 15 to 18
years.
4
The National Academy of Sciences'
Food and Nutrition Board, however, is
in the process of replacing these RDA
with new dietary recommendations:
Dietary Reference Intakes (DRI)?
DRI were released recently for calcium,
phosphorus, magnesium, fluoride,
vitamin D, thiamin, riboflavin, niacin,
vitamin B6, folate, vitamin B12, panto­thenic
acid, biotin, and choline (31,32).
Reference intake values were published
for the following age groups: 1 to 3 years,
4 through 8 years, 9 through 13 years,
and 14 through 18 years.
The current RDA (or AI for calcium,
fluoride, vitamin D, pantothenic acid,
biotin, and choline) for children were
(a) extrapolated from infant or adult
research results (vitamins A, K, C,
B6, B12, riboflavin, niacin, folate,
biotin, choline, pantothenic acid,
selenium, iodine, and manganese),
(b) based on growth and consumption
data (energy, protein, iron, phos­phorus,
and potassium),
(c) estimated based on weight (fluoride
and vitamin E),
1-he DRI, a set of up to four nutrient-based refer­ence
values, consist of the Estimated Average
Requirement (EAR), Recommended Dietary
Allowances (RDA), Adequate Intake (AI), and
Tolerable Upper Intake Level (UL). The EAR
refers to the daily intake value that is estimated
to meet the nutrient requirement in half of the
individuals in a given age-gender group. The RDA
consist of the average daily intake level that is
sufficient to meet the nutrient requirement of
nearly all healthy individuals in the age-gender
group, based on the EAR. The AI is the daily
intake value that is estimated to meet the nutrient
requirement of nearly all healthy individuals in the
age-gender group and is used when an EAR is not
available to calculate the RDA. The UL defines
the highest level of nutrient intake that is likely to
pose no risks of adverse health effects in almost
all individuals in the general population.
(d) based on studies on balance in
children, but not necessarily with
all the above age groups (thiamin,
zinc, copper, sodium, calcium, and
magnesium), or
(e) estimated based on biochemical
markers (vitamin D) (23,31,32).
Because the RDNAI for children were
largely extrapolated or calculated rather
than determined directly from studies of
children, there is no overriding reason
for using the RDA age-gender cutoffs
for a children's food guide. Information
on children's dietary intakes, nutritional
status, and dietary recommendations­as
well as information on their attitudes,
knowledge, and behavior-must also be
considered when determining which
groups of children are most in need of
nutritjon guidance.
Nutrition Recommendations
for Children
Reconunendationsofthe
U.S. Government
A number of recommendations indicate
what constitutes a healthful diet for
children. The Dietary Guidelines for
Americans, the basis of Federal nutrition
policy ( 39 ), provide advice about food
choices that promote health and prevent
disease among healthy Americans 2 years
old and older. The Guidelines advise
Americans to eat a varied diet with plenty
of grain products, vegetables, and fruits,
while moderating their intakes of fat,
saturated fat, cholesterol, sugars, salt
and sodium, and alcoholic beverages. In
addition to emphasizing the benefits of
physical activity, the Guidelines provide
some specific advice for children: they
should be taught to eat grain products;
vegetables and fruits; lowfat milk
products or other calcium-rich foods;
beans, lean meat, poultry, fish or other
Family Economics and Nutrition Review
protein-rich foods; and to participate in
vigorous physical activity. The Guidelines
caution that fat should not be restricted
for children younger than age3 2, that
major efforts to change a child's diet
should be accompanied by monitoring
of growth at regular intervals by a health
professional, and that children should
IlQ! consume alcoholic beverages. The
Guidelines also recommend that children
between the ages of 2 and 5 should
gradually adopt a diet so that it contains
no more than 30 percent of calories from
fat by the time children are about 5 years
old(39).
The report Healthy People 2010 outlines
a national strategy for improving signifi­cantly
the health of Americans during
the 2001 to 2010 decade (42). Included
in the 2010 report is a recommendation
to reduce fat intake to an average of 30
percent of calories or less and saturated
fat intake to an average of less than 10
percent of calories among people 2 years
old and older. The National Cholesterol
Education Program recommends that
total fat intake averages no more than
30 percent of calories (24). These
recommendations are consistent with
the advice given in the 1990 Dietary
Guidelines; the 1995 Dietary Guidelines
amended this advice, stating that children
between the ages of 2 and 5 should
gradually reduce their total fat intake
so that by age 5, they are consuming
no more than 30 percent of calories
from fat.
Recommendations of
Other Organizations
Several organizations provide dietary
advice for children that is consistent
with the basic principles of the Dietary
Guidelines for Americans. The American
3In this paper, the use of the terms "age" and
"ages" refers to age in years, unless stated
otherwise.
1999 Vol. 12 Nos. 3&4
Academy of Pediatrics, for example,
recommends that children eat a wide
variety of foods and consume enough
calories to support growth and develop­ment
and to reach or maintain advisable
body weight. The Academy also recom­mends
that children over the age of 2
consume, on average, 30 percent of total
calories from fat, less than 10 percent of
calories from saturated fat, and less than
300 mg of cholesterol per day. However,
the Academy cautions that "recommen­dations
that call for 'less than' 30 percent
of calories from fat may lead to the
inappropriate use of more restrictive
diets" (3).
The American Heart Association (AHA)
concurs with the recommendation of the
Dietary Guidelines that children between
the ages of 2 and 5 gradually adopt a
diet containing 30 percent or less of
calories from fat. The AHA also agrees
with the Dietary Guidelines' recommen­dation
that diets of young children should
maintain the primary emphasis on pro­viding
adequate calories and nutrients
for normal physical activity, growth,
and development ( 17).
Some disagree about the age at which
children should adopt a lower fat diet.
A joint working group of the Canadian
Paediatric Society and Health Canada
recommended a longer transition period
to a diet lower in fat, compared with
that recommended by the Dietary Guide­lines.
The joint working group advised
that the transition from the high-fat diet
during infancy (about 50 percent of
calories from fat) to a diet that includes
no more than 30 percent of calories as
fat and 10 percent of calories as saturated
fat take place between the age of 2 and
the end of linear growth (about age 14
for females and 15 for males) ( 14). The
rationale for the working group's recom­mendation
was based on ( 1) lack of
Other studies have
also concluded
that it is safe to ·
recommend that fat
intake be limited to
30 percent of calories
and saturated fat
intake to less than
1 0 percent of calories
for children 5 years
old and older ....
5
evidence that consuming a diet provid­ing
30 percent of calories as fat and
I 0 percent of calories as saturated fat
would either reduce illness in later life
or provide short-term health benefits
and (2) concerns that some children
consuming a diet with low fat intakes
have lower energy intakes and low
intakes of some nutrients.
To support their position, the Canadian
Paediatric Society and Health Canada
cited a publication from the Bogalusa
Heart Study in which 24-hour recalls
were obtained from about 870 10-year­olds
whose diets were stratified by fat
intake: those with less than 30 percent
of calories from fat had lower intakes
of many nutrients than did children with
higher fat intakes. The children with the
lower percentage of calories from fat
also had higher intakes of simple carbo­hydrates
(25). The children enrolled in
the Bogalusa Study had not been exposed
previously to any dietary intervention
programs. Therefore, it cannot be con­cluded,
on the basis of the Bogalusa
Study, that children-whose parents
and caregivers have been instructed on
how to moderate dietary fat intake­will
be unable to meet their nutrient
requirements on a diet containing 30
percent of calories from fat.
Other researchers have concluded that
children can safely follow diets contain­ing
30 percent of calories from fat. The
Dietary Intervention Study in Children
(DISC) is an ongoing, randomized study
that is a controlled clinical trial of diets
containing lowered fat, saturated fat,
and cholesterol. About 660 children
ages 8 to 10 who were enrolled in 6
centers, located around the country, were
assigned randomly to either control
groups or groups receiving behavioral
intervention to promote their following
a diet prov:ding 28 percent of calories
6
from total fat, less than 8 percent of
calories from saturated fat, and less than
150 mg of cholesterol (less than 75 mg/
1,000 calories) per day. After 3 years,
dietary levels of total fat, saturated fat,
and cholesterol and blood levels of low­density
lipoprotein cholesterol (LDL-C)
decreased significantly in the interven­tion
group, compared with the control
group. The two groups, however, did
not differ significantly on measures of
growth and development: Height, red­blood-
cell folate values, serum zinc,
retinol and albumin levels, sexual
maturation, and psychosocial health.
The DISC study found that children
grew and developed normally after
being instructed on consuming a lower
fat diet. The children in the intervention
group also had lower LDL-C levels than
the controls. The researchers concluded,
therefore, that the diet was effective as
well as safe (19). Other studies have also
concluded that it is safe to recommend
that fat intake be limited to 30 percent
of calories and saturated fat intake to
less than 10 percent of calories for
children 5 years old and older
(26,29,35).
Another recommendation regarding
children's diets addresses their require­ments
for dietary fiber. The Dietary
Guidelines recommend that individuals
2 years and older choose a diet with
plenty of grain products, vegetables,
and fruits to provide adequate fiber.
But the Guidelines do not set specific
numerical goals for fiber intake. The
American Health Foundation published
a recommendation that a child's fiber
intake be equivalent to his or her age
plus 5 grams (g) a day ("age+ 5"),
with the recommendation ranging from
8 g a day for a child age 3 to 25 g a day
for a person age 20 (44).
Nutritional Status of Children
Dietary Intake-Energy
Data on children's food consumption
are provided by several national surveys:
DHHS's National Health and Nutrition
Examination Survey (NHANES III),
USDA's Continuing Survey of Food
Intakes by Individuals (CSFII), and the
Market Research Corporation of America
(MRCA) ( 1,10,16,37). Median energy
intakes below 100 percent of the RDA
for several age-gender groups were
reported in NHANES III results ( 1 0).
The CSFII 1994-96 reported that over
half of the children 5 years old and
younger had energy intakes below the
RDA, and about 20 percent had energy
intakes below 75 percent of the RDA.
About 60 percent of males and 75 per­cent
of females 6 to 19 years old had
energy intakes below the RDA (37).
Rather than a reflection of actual low
intakes of energy by children, these low
intakes of energy could be the result of
underreporting the foods eaten or of
low energy expenditures by children.
Several studies have reported that
preschool-age children have energy
expenditures lower than the RDA
(6,11,12). In contrast, the prevalence
of overweight among children has been
increasing ( 36). According to CSFII
1994-96, about 5 to 10 percent of all
children have energy intakes at or above
150 percent of the RDA ( 37).
Dietary Intake-Macronutrients
and Fiber
Food consumption surveys report that,
on average, children are consuming
more than 30 percent of calories from
total fat and more than 10 percent of
calories from saturated fat (fig. 1) ( 1,10,
16,37). Kennedy and Goldberg, using
CSFII 1989-91 data, reported that over
three-fourths of all children exceeded
Family Economics and Nutrition Review
Figure 1. Percent of calories from total fat and saturated fat in children's diets exceeds
recommendations
Percent
45
40
35
30
25
20
15
10
5
0
Age and 1-2 years 3-5 years 6-11 years
males
6-11 years
females
12-19 years
males
12-19 years
gender females
• o/o Calories from total fat
D o/o Calories from saturated fat
••••••• Dietary Guidelines recommendation for o/o calories from total fat
- • • - • Dietary Guidelines recommendation for o/o calories from saturated fat
recommendations for total fat and
saturated fat ( 15). Improvement was
slight by 1994, when roughly two-thirds
of all children exceeded the recommen­dation
for total fat and saturated fat
(16). Because of the Guidelines' recom­mendation
for gradual adoption of a diet
low in fat, concern is greater for children
5 years and older than it is for children
2 to 5 years old. The CSFTI 1994-96
also reported that adolescent males are
consuming more than 300 mg/day of
cholesterol, the upper limit of cholesterol
intake listed on the Nutrition Facts label
(37).
Other studies have confirmed the findings
regarding children's fat intake: most are
consuming more than the recommended
levels. About ninety 3- to 5-year-old
children enrolled in the Framingham
1999 Vol. 12 Nos. 3&4
Children's Study4 consumed an average
of 33 percent of calories from fat (28 ).
Albertson and Tobelmann, analyzing
1986-88 MRCA data, reported that
among 825 children ages 7 to 12, those
who frequently ate ready-to-eat cereal
(7 or more times in 14 days) consumed
a lower percentage of calories from fat,
compared with others who consumed
ready-to-eat cereals less frequently: 2 to
6 times in 14 days or less than 2 times
in 14 days. However, all three groups
consumed more than 30 percent of
calories from fat (2).
Data from the CSFTI 1994-96 showed
that young children's mean intakes of
"The longitudinal Framingham Children's Study
examined factors related to the development of
dietary habits and patterns of physical activity
during childhood.
dietary fiber met the "age+ 5" recom­mendation
of the American Health
Foundation. Children 5 years old and
younger had mean fiber intakes of
about 11 g a day. However, older children
began to fall short of the fiber recom­mendations:
males and females 6 to 11
years old consumed about 14 g and 12 g
of fiber per day, respectively; their counter­parts
12 to 19 years old consumed about
17 g (males) and 13 g (females) per day
(37).
Dietary Intake-Micronutrients
American children are more likely to
get adequate amounts of vitamins and
minerals than they are to meet Dietary
Guideline recommendations for total fat
and saturated fat intake. However, some
nutrients are consumed at levels below
recommended amounts by some groups
7
in the U.S. population. For example,
vitamin E and zinc are consumed at
levels below 100 percent of the RDA
by most children 2 to 19 years old (37).
According to CSFII 1994-96, on the
days surveyed, only about 60 percent
of children 5 years and younger, 60 per­cent
of females 6 to 11 years old, and
only 28 percent of females 12 to 19 years
old consumed 100 percent or more of
the RDA for iron. Only about one-third
each of males and females 12 to 19
years old consumed 100 percent or
more of the RDA for vitamin A ( 37).
Calcium is another nutrient that children
consume at levels below recommenda­tions.
Average calcium consumption is
below the 1989 RDA for children 12 to
19 years old (fig. 2). In 1994-96, about
half of the children 11 years old and
younger consumed 100 percent or more
of the 1989 RDA for calcium; just over
one-third of males 12 to 19 years old
and about 15 percent of females 12 to
19 years old consumed 100 percent or
more of the calcium RDA (37). Even
fewer children ages 9 and older would
meet the new Adequate Intake for calcium,
which increased to 1,300 mg (31).
Compared with other children, adoles­cents,
particularly adolescent females,
had the greatest problems in meeting
their nutrient requirements. Adolescent
females reported the lowest energy
intakes in proportion to their energy
requirement ( 37). Findings of MRCA
data from 1991-94 show that most
adolescents ages 11 to 17 consumed
less than 2 servings (the minimal
number recommended) of fruits a day.
Twelve percent of adolescents con­sumed
no fruits in a given day (45).
Krebs-Smith et al. examined 3-day data
from CSFII 1989-91 for children and
adolescents 2 to 18 years old. Even
after foods were separated into their
8
component ingredients (e.g., credit is
given for vegetables in mixed dishes,
such as on pizza or in sandwiches),
only one in five children consumed the
recommended 5 servings of fruits and
vegetables a day. One-quarter of all
vegetables that were consumed were
French fries. Children from families
with higher income consumed more
servings of fruits and vegetables,
compared with children from families
with lower income (18).
Data from the CSFII 1994-96 also
showed that children's intake of fruits
and vegetables was low. Only about
one-fourth of children 2 to 11 years old
consumed the minimal 3 servings of
vegetables a day that are recommended
by the Pyramid, and only about 40 per­cent
of females and 55 percent of males
12 to 19 years old met the minimal number
of servings. About half of all 2- to 5-year­olds
consumed the minimal 2 servings
of fruit a day recommended by the
Pyramid, but this dropped to about one­fourth
for males and females 11 to 19
years old ( 37). Low intakes from one
food group could explain some of the
low nutrient intakes, particularly for
vitamins A and C and folate.
Sodium intakes for many children are
higher than 2,400 mg a day, its upper
limit (listed on the Nutrition Facts label).
Children 6 years old and older had
median sodium intakes greater than
2,400 mg a day according to NHANES
data (which includes allowances for salt
added at the table and sodium in water
and medications) ( 10). In the CSFII
1994-96 (which reports only sodium
intake from food), the mean sodium
consumption for all children 3 years old
and older exceeded 2,400 mg a day.
Mean sodium consumption for males ages
12 to 19 years was 4,407 mg a day (37).
Anthropometric Indices
Weight and height indicators from
NHANES III show that underweight is
a concern for about 5 percent of 2- to
17-year-olds (only 2 percent of 12- to
17-year-old females) ( 10). Overweight,
when defined as a weight for height
greater than the 95th percentile, occurred
in 10.9 percent of children ages 6 through
17 (36). When overweight was defined
as a weight for height greater than the
85th percentile, the incidence of over­weight
increased to 22 percent ( 36).
The prevalence of overweight increased
between 1963-65 and 1988-91 among
all age-gender groups, with the greatest
increase occurring between 1976-80 and
1988-91 (36).
A study of the prevalence of overweight
among preschool-age children 2 months
through 5 years old found that overweight
among 4- and 5-year-old females in­creased
from 5.8 percent in 1971-74 to
10 percent in 1988-94. Overweight was
defined, in this study ofNHANES data,
as being above the 95th percentile of the
appropriate measures of the National
Center for Health Statistics: weight­for-
length or weight-for-stature growth
curve. The prevalence of overweight did
not increase among younger children.
However, the increase in prevalence of
overweight in children as young as 4 years
old suggests that efforts to prevent over­weight
should begin in early childhood
(27).
The increase in obesity is surprising,
because many children are reporting
energy intakes below the RDA. Lack
of physical activity may be responsible
for the increase, and the number of hours
children watch television has been linked
to obesity in this age group (8).
Family Economics and Nutrition Review
Figure 2. Mean calcium· intakes of older American children below recommended levels
Milligrams
1400
1200
1000
800
600
400
200
0
Age and
gender
1-2 years 3-5 years 6-11 years
males
6-11 years
females
12-19 years
males
12-19 years
females
• Calcium intake, mg • 1989 RDA, mg [2J 1997 AI, mg
Consumer Research­Children's
Knowledge and
Attitudes About Nutrition
When adapting a food guide for children,
USDA staff believe it is useful to find
out what children know about nutrition,
what their attitudes are about foods and
nutrition, and what nutrition education
programs have been successful. Children
have been the target audience for some
qualitative and quantitative studies;
however, information about their knowl­edge
and attitudes regarding nutrition is
far more scarce than information about
adult's knowledge and attitudes.
Qualitative Studies
In late 1991, in preparation for developing
nutrition labeling materials for children,
1999 Vol. 12 Nos. 3&4
KIDSNET, Inc., an organization working
on children's educational issues (in coop­eration
with the U.S. Food and Drug
Administration [FDA]), sponsored mini­focus
groups (3 children in each group)
with children 6, 8, and 12 years old. The
focus groups were designed to examine
children's attitudes and behavior regard­ing
food, as well as their awareness and
knowledge of the relationship between
nutrition and food. Six focus groups (with
a mixture of racial and income groups)
were conducted in the Washington, DC,
area. The children reported having some
influence over the foods they eat, par­ticularly
breakfast cereals, snack foods,
and lunches. Some 6-year-olds even
reported making their own lunches.
Results from the mini-focus group showed
that the children's age influenced their
knowledge of nutrition. Twelve-year-old
children could name food groups and
were aware that carbohydrate, protein,
fat, vitamins, and minerals are found in
food. Younger children did not have a
clear understanding of food groups, and
many children thought of vitamins as
products that come in a bottle from the
drugstore. However, even though the
12-year-old children were fairly knowl­edgeable
about nutrition, their knowledge
did not carry over to their own dietary
patterns. Taste, instead, was their primary
consideration in making food choices.
In the words of one 12-year-old partici­pant:
"We hear 'Eat right. Don't do
drugs.' It's getting boring, like a broken
record, so we just tune it out" (30).
9
10
... the increase in
prevalence of over­weight
in children as
young as 4 years old
suggests that efforts
to prevent overweight
should begin in early
childhood ....
The FDA sponsored two focus groups,
each consisting of six to eight females
13 to 15 years old from various racial
and ethnic groups. The purpose of the
focus groups was to determine the types
of nutrition messages the participants
would find compelling and to determine
which format(s)-for messages about
calcium-the participants would most
likely pay attention to. These focus
groups were held in the Washington,
DC/Baltimore, MD, metropolitan area.
The results revealed that the participants
had a fairly good knowledge of nutrition;
they could name nutrients and make
associations between a nutrient and its
function, for example, "calcium makes
your bones strong." Participants said
they tended to pay more attention to
eating a healthful diet when they were
actively involved in a sport. (Most were
active in at least one sport.) A frequently
mentioned barrier to healthful eating
was related to school lunches: lunch
periods were often rushed and at odd
hours of the day. Participants expressed
a preference for educational materials
that contained bold, bright colors and
little or no text (21 ).
The International Food Information
Council sponsored one focus group with
9- to 12-year-old children and another
with 13- and 14-year-olds to evaluate a
prototype nutrition brochure. All of the
participants had seen the Food Guide
Pyramid, and all said they already knew
about the importance of eating vegetables,
fruits, and grain products. The partici­pants,
however, believed these concepts
were "boring, because everyone knows
that," and they believed that information
about eating breakfast, smart snacking,
and balance was important. They also
thought information about physical
activity was important but believed that
activities portrayed should be relevant
to their age group. Activities such as
golf and racquetball were perceived
as "adult" sports (9).
Because these studies were conducted
using locally available samples and
were conducted in urban areas, the
results must be interpreted cautiously
and cannot be generalized to all children.
Quantitative Studies
The Kellogg Company surveyed children
about their nutrition knowledge, attitudes,
and behavior. A nationally representative
school-based survey was conducted in
1988-89 with 5,000 students in Grades
3 through 12. Over half of the respondents
in this survey believed nutrition is
"very important"; however, nutrition
was considered less important by older
children than by younger ones. Almost
three-quarters of elementary school
students considered nutrition "very
important," compared with about half
of junior high school students and only
about one-third of high school students
(13).
The Kellogg survey also found that the
positive attitudes of many children did
not always translate into appropriate
behavior, confirming the results of the
qualitative studies referred to earlier in
this paper. Only about one-third of all
school-age children responded "often"
(rather than "sometimes" or "rarely")
to the statement "I eat the right foods."
Children who agreed strongly with the
statement that too much cholesterol and
saturated fat are bad for health reported
eating foods high in these components
as often as did other children, thus dem­onstrating
that their knowledge did not
change their behavior. The authors of
the Kellogg survey suggested that lack
of sufficient knowledge could be par­tially
responsible for this disconnect­the
children might know that excessive
Family Economics and Nutrition Review
dietary cholesterol and saturated fat are
unhealthful, but they may not know
which foods are rich sources of these
components ( 13 ).
Lack of adult supervision could also
account for some of the poor eating
habits reported by the participants of
the Kellogg survey. About 60 percent
of children reported coming home to an
empty house at least once a week, with
more than one-third coming home alone
three or more times a week. These
"latchkey" children were more likely
to report that they, rather than their
parents, have more control over what
they eat (60 percent of "latchkey"
children; 35 percent of all elementary
schoolchildren).
Eating away from home frequently could
influence children's diets. According to
USDA's CSFII 1994-96, about 40 per­cent
of children 5 years old and younger
and over two-thirds of children 6 to 19
years old reported eating at least one
food item away from home on the day
of the survey. The most frequently
mentioned sources of food away from
home were fast-food restaurants, school
or day care, someone else or gift, and
stores (37).
The Kellogg Survey also found that
almost one-third of school-age children
believed they were overweight ( 13 ).
This figure is somewhat higher than the
22 percent of children 6 to 17 years old
who were found to be overweight by
NHANES III. This difference raises a
possibility: some children whose weight
is normal think they are overweight.
Thus dieting is a common behavior
among children; about 40 percent of
all school-age children participating
in the Kellogg Survey reported having
been on a diet. More females than males
reported dieting, and most of the children
1999 Vol. 12 Nos. 3&4
who reported dieting did so for cosmetic
reasons rather than for health ( 13 ).
Lack of physical activity has been cited
as a possible reason for the increase in
the percentage of children who are over­weight
(6,8,11,12). The Kellogg Survey,
on the other hand, found that school­children
do consider exercise to be
important. Elementary schoolchildren
reported taking part in physical activity
over five times a week; high school
students reported being involved in
physical activity about four times a
week(13).
The Youth Risk Behavior Survey, a
component of the Youth Risk Behavior
Surveillance System (Centers for Disease
Control and Prevention), is a national
school-based survey of students in
Grades 9 through 12. It contains a series
of questions, parts of which are nutrition­or
diet-related. Male students responding
to this survey were significantly more
likely than female students to consider
themselves the "right weight" or
"underweight" (86 vs. 66 percent).
Female students were significantly more
likely than male students to report trying
to lose weight at the time of the survey
(44 vs. 15 percent). Over one-fourth of
female students who considered them­selves
the "right weight" reported trying
to lose weight. And female students
were significantly more likely than
their male counterparts to report either
currently or ever having used inappro­priate
practices to lose weight: such as,
skipping meals, taking diet pills, or
inducing vomiting (40).
The Youth Risk Behavior Survey asked
students in Grades 9 through 12 how often
they participated in vigorous activity in
the 2 weeks preceding the survey. Vigor­ous
activity was defined as "at least 20
minutes of hard exercise that made you
breathe heavily and made your heart
beat fast" ( 41 ). About one-third of all
students reported being vigorously
active three or more times a week, but
female students were half as likely than
male students to report regular vigorous
activity (25 vs. 50 percent), and African
American students were less likely than
White or Hispanic students to report
regular vigorous activity (30 vs. 40 and
35 percent, respectively) (41).
Studies of Nutrition Education
Prograrns--VVhatVVorks
USDA conducted research to evaluate
adults' comprehension and perceived
usefulness of its food guide and to
develop a graphic presentation of the
food guide ( 43 ). USDA also conducted
research to determine the effectiveness
of the resulting graphic of the Food
Guide Pyramid with three target audi­ences:
children, consumers with less
than a high school education, and low­income
consumers. USDA, in 1991,
collaborated with DHHS and contracted
with private industry (4) to develop and
test graphic alternatives (including a
bowl, shopping cart, and dinner plate) to
the Food Guide Pyramid for conveying
the key concepts of variety, proportion­ality,
and moderation.
Qualitative findings indicated that
children preferred the Pyramid graphic
to the alternatives tested. They, as well,
learned the most information from the
Pyramid. Teachers also preferred the
Pyramid as a teaching tool, compared
with the alternatives (4). For the quanti­tative
phase of the research, interviewers
questioned 3,017 individuals, including
1,523 children in Grades 2 through 10.
The children's responses to the 60-item
questionnaire indicated that the Pyramid
graphic conveyed the concepts of variety,
proportionality, and moderation.
Younger children (Grades 2 to 3),
11
12
The Center selected
the preschool-age
group (2 to 6 years)
as the target audience
for an adapted food
guide . ...
however, understood variety more so
than proportionality and moderation (4).
Effectiveness of Nutrition
Education Programs
The Food Guide Pyramid adapted for
children needed to integrate relevant
findings from a recent comprehensive
review on the effectiveness of methods
used in nutrition education. This review
revealed that programs using educa­tional
methods directed at behavioral
change as a goal were more likely than
other programs to be successful-that
is, they were more likely to result in some
behavioral change than were programs
that focused on only distributing
information (5).
Contento et al. recommended that pro­grams
be behaviorally based and appro­priately
designed for the child's stage
of cognitive development ( 5 ). Preschool
and early elementary school-age children
(4 to 7 years) need activities that allow
them to modify their environment. Pro­viding
food-based activities and having
adults model eating behavior are appro­priate
for this age group. Also, parents'
or other caregivers' involvement with
children in this age group is an important
factor contributing to success. Older
elementary school-age children (8 through
about 11 years) still need to have infor­mation
presented in concrete terms.
Food-classification activities and model­ing
by adults are appropriate for this age
group, and involvement with parents
and the community is still important for
programs targeted for this age group.
Adolescents (second decade oflife)
move from concrete to abstract thinking
and are able to comprehend more abstract
information, such as the relationship
between diet and health-present and
future. They need activities that encour­age
critical thinking, such as exploring
the influence of diet on health and the
environment. With this age group, parents'
involvement becomes less important,
because adolescents are more likely to
be influenced by their peers than by
their parents or caregivers (5).
The quantity and quality of existing
nutrition education materials for spe­cific
age groups of children must also
be considered when selecting a target
audience. Recently, Swadener reviewed
research related to nutrition education
for preschool-age children ( 33 ), and
Lytle reviewed research related to nutri­tion
education for school-age children
(20). Both found that while many nutri­tion
education materials are directed
toward children, improvements and
follow-up are needed to determine
whether the materials are really effective.
Swadener found that many nutrition
education materials developed for pre­schoolchildren
did not include an evalu­ation
component, many programs were
not conducted for a sufficient time to
result in changes in attitudes or behavior,
and few programs were designed for
use with children from dysfunctional or
marginally functional families. Lytle
concluded that more tools are needed
for assessment of change in children's
and adolescents' eating behavior and
that adolescents, in particular, could
benefit from exposure to strategies that
modify behavior. Lytle also found that
more programs are needed: ones that
target multi-ethnic groups as well as
involve families of school-age children.
Family Economics and Nutrition Review
Pros and cons of adapting the Food Guide Pyramid for use with three groups of children
Pros Cons
Preschool age (2 through 6 years)
Have special needs, re: fat, smaller serving sizes
Peer pressure not a problem
Can reach them through the Special Supplemental Feeding Program
for Women, Infants, and Children and the Child and Adult Care
Feeding Program
Developmentally a good time to reach (e.g., when food habits are still
being formed)
Can counteract exposure to television advertising of high-calorie
foods
Not as many materials targeting this age group as for older children
Educational materials must target parents and caregivers, not child
directly
Fat message (children this age need more fat) may confuse parents,
because this need is temporary
Elementary school age (7 through 11 years)
Think nutrition is important but don't act on it; they are "reachable" Already a large amount of nutrition education material available for
this audience (however, not all of it is relevant or appropriate)
Beginning to take more responsibility for their own food choices Current food guide already meets nutrient needs
Easier to reach (through a single classroom teacher) than younger
or older children (where nutrition education may be provided by a
diverse group of individuals)
Adolescents ( 12 to 18 years)
More problems meeting nutrient needs
Not many materials targeting this audience
Current food guide already meets nutrient needs
Difficult audience to reach-need different ways to communicate
food guide, not necessarily different food guide
Make many of own food choices Need more individualized messages-e.g., for athletes vs. nonathletes
Perhaps can tum weight concerns into motivation for change
1999 Vol. 12 Nos. 3&4 13
Decision Point-Target
Audience for the Food Guide
Pyramid for Children
Because of differences in nutrient needs
(23,31,32), current food consumption
patterns ( 10,16,37), and stages of educa­tional
development ( 5 ), a single food
guide cannot meet the needs of all children
2 to 18 years old. Based on children's
nutrient needs and developmental level,
staff of the Center for Nutrition Policy
and Promotion identified three age groups
for which a Pyramid could be developed:
• Preschool and early elementary age
(2 through 6 years)
• Elementary school age (7 through
11 years)
• Middle and high school age (12 to
18 years)
The Center staff considered several
factors when deciding which age group
should be targeted for an adapted food
guide:
• Does the existing food guide meet
this group's dietary needs, or does
this group have specific nutritional
and health problems that an adapted
food guide could help to address?
• If the existing food guide meets the
group's dietary needs, has it been
successful in influencing the group's
behavior? Is there a need for an
alternate presentation of the existing
food guide to better reach this group?
• What nutrition education materials
exist for this audience?
• What are the educational considera­tions
for this group? Will children
be able to use the new food guide
directly? Will they use the materials
with guidance from a parent or
caregiver? Or will the materials
14
be developed for the parent or
caregiver?
• Is there user demand for a new food
guide for this group?
• What is the social effect of the
decision? Will different food guides
for different ages create confusion?
Based on these factors, Center staff
listed pros and cons for developing an
adapted food guide for each age group
(table) and considered these issues
when making the decision regarding the
target audience.
Implications and
Recommendations for a
Food Guide for Preschool-Age
Children (2 to 6 Years)
The Center selected the preschool-age
group (2 to 6 years) as the target audience
for an adapted food guide because there
is a greater need for verifying the scien­tific
basis of the food guide, both from
a physiological and developmental view­point
for 2- to 6-year-olds than for older
children. The rationale for this conclu­sion
follows:
• Nutrient needs of preschool-age
children differ from those of older
children. The Dietary Guidelines for
Americans recommend that the level
of dietary fat be gradually decreased
from current levels (about 34 percent
of calories from fat) to 30 percent
of calories by the time the child is
about 5 years old (39). Concerns
about undue food and fat restrictions
for children in this age group, leading
to "failure to thrive," have been
expressed by the American Academy
of Pediatrics ( 3 ). Because the current
Food Guide Pyramid assumes a
dietary fat intake of 30 percent of
calories, Center staff concluded that
additional guidance is needed for
parents and caregivers of children
less than 5 years old.
• Following the release of the Food
Guide Pyramid, USDA received
numerous questions from the Exten­sion
Service; the Dairy Council; the
Special Supplemental Food Program
for Women, Infants, and Children
(WI C); the Child and Adult Care
Food Program; and the media. The
concern: how to use the food guide
with young children, particularly
regarding children's need for
smaller serving sizes.
• Developmental concerns regarding
food activities at the preschool level
include determining what young
children can or should "learn" and
addressing the physiological and
emotional issues related to food.
Because parents and caregivers have
a major role in food selection for
this age group, Center staff believed
these children's attitudes and behavior
must also be considered.
Adaptation of the food guide for this
age group uses the same framework of
food groups as the original food guide.
Thus the framework blends into later
learning activities in school where
concepts are added, for example, nutrient
content of different types of foods;
how foods are grown, processed, and
delivered; how different food items
are used in different cultures; and how
"new" foods have been historically
introduced into the American diet.
Using the same framework of food
groups also makes the new food guide
more practical for family food managers
to use. The process used to adapt the
food guide for the preschool and early
elementary-age audience is described
elsewhere in this issue (22,34).
Family Economics and Nutrition Review
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43. Welsh, S.O., Davis, C., and Shaw, A. 1993. USDA's Food Guide: Background and
Development. U.S. Department of Agriculture. HNIS Miscellaneous Publication No. 1514.
44. Williams, C.L. 1995. Importance of dietary fiber in childhood. Journal of the American
Dietetic Association 95:1140-1146, 1149.
45. Zizza, C. A. and Powell, R. 1996. Characteristics distinguishing adolescents by fruit
consumption. Journal of the American Dietetic Association 96:A-91 .
1999 Vol. 12 Nos. 3&4 17
Kristin L. Marcoe
Center for Nutrition Policy
and Promotion
18
Technical Research for the
Food Guide Pyramid for
Young Children
This article describes the technical research for the Food Guide Pyramid for
Young Children. Composites for food groups and subgroups were developed
using food intake data for children 2 to 6 years old. Data were from the
Continuing Survey of Food Intakes by Individuals 1989-91. The composites
were used in creating 1 ,300- and 1 ,600-calorie Food Guide Pyramid diet
patterns. For children 4 to 6 years old, the 1 ,600-calorie pattern met all
nutrient requirements, except for vitamin E. The 1 ,300-calorie pattern pro­vided
the ADA for most nutrients for 2- to 3-year-olds and 4- to 6-year-olds.
The major exceptions were iron and zinc for both age groups and copper
and vitamin E for the 4- to 6-year-olds. When breakfast cereals fortified
with iron and zinc were used in the grain composites, the patterns provided
recommended levels of these nutrients. Children could improve their diet by
making different food choices, in particular, by eating more dark-green and
deep-yellow vegetables; legumes; whole grains; and lean meat, poultry, or
fish.
he Food Guide Pyramid
for Young Children ages
2 to 6 years is a nutrition
education tool to help
teach healthful eating concepts to young
children. The technical research con­ducted
in developing and documenting
the research base for this food guide
followed procedures similar to those
described in the development and
documentation of the original food
guide (1,9). Food selections and serving
sizes reported for young children, in
a national food consumption survey,
were incorporated into diet patterns
based on the Food Guide Pyramid to
determine whether such patterns would
meet nutritional goals.
A composite was developed for each
Pyramid food group (e.g., meat, poultry,
fish) or subgroup (e.g., whole grain).
Composites were based on children's
actual food choices and reflected the
relative use of individual foods within
the group or subgroup. An example: the
composite for deep-yellow vegetables
reflected children's consumption of
89 percent as carrots and 11 percent as
other deep-yellow vegetables. A nutrient
profile was then calculated for each
composite, after which composites
and their nutrient profiles were used
to calculate expected nutrient levels in
1 ,300- and 1 ,600-calorie diet patterns
based on the Food Guide Pyramid.
The nutrient totals were then analyzed
to determine whether children's nutrient
requirements could be met by diet
patterns that conform to Pyramid rec­ommendations
and that consist of the
foods most commonly eaten by children.
Family Economics and Nutrition Review
Methods
Data Sources
Data on 3-day food and nutrient intakes
reported in the Continuing Survey of
Food Intakes by Individuals (CSFII)
1989-91 for 1,053 children 2 to 6 years
old were used in this study. This data
set was used because when work was
started, the data set offered the largest
number of individuals and days for
analysis. Sample weights were applied
to provide estimates that were repre­sentative
of the population. The data
that were used to calculate the nutrient
profiles of the composites for the food
groups and subgroups came from the
U.S. Department of Agriculture's
(USDA) Nutrient Data Base for
Individual Intake Surveys, Release 7
(1991).
The Food Guide Servings Data Base
was used to report the amounts of food
consumed as numbers of food guide
servings. USDA's Center for Nutrition
Policy and Promotion (CNPP) devel­oped
this data base by using the foods
reported in the CSFII 1989-91. The
Food Guide Servings Data Base con­sists
of food-item descriptions and the
number of Pyramid servings per 100
grams of food. Servings data are pro­vided
for the 5 major food groups and
21 subgroups identified in the Food
Guide Pyramid.
Most foods, including mixed dishes,
were broken down into ingredient com­ponents,
and their food group servings
were calculated for more than one food
group. When a food code's typical
serving size, defined in the Survey
Code Book for CSFII 1989-91 and
based generally on median serving
sizes reported in USDA food consump­tion
surveys, provided less than one­fourth
of a serving of a Pyramid food
group or subgroup, it was usually not
1999 Vol. 12 Nos. 3&4
counted. For example, a serving of
oatmeal raisin cookies provided less
than one-fourth of a Pyramid serving
of raisins, so those raisins were not
counted toward fruit servings. These
small amounts were not counted
because one objective of the original
food guidance system was "usability."
It is unrealistic to expect Americans to
"count" small amounts of some foods
toward food group servings. However,
if several "other vegetables" like
tomatoes and onions were in small
amounts in a mixture, and these amounts
together added up to at least one-fourth
serving, these "other vegetables" were
counted toward vegetable servings.
Procedures
CNPP began the research process by
breaking down the foods that were
consumed by children 2 to 6 years old,
as reported in the CSFII 1989-91, into
numbers of food group and subgroup
servings. The Food Guide Servings
Data Base was used for this process.
To identify specific food components,
CNPP staff reviewed food codes that
contributed food guide servings.
All food items with similar food
components were grouped in the same
item-group. For example, broccoli soup
and broccoli casserole both contained
cooked broccoli and so were placed
in the item-group for cooked broccoli
within the subgroup for dark-green
vegetables. A composite was then
constructed by summing intakes from
all the item-groups within a food group,
with each item-group being weighted
by the numbers of servings reported
for children 2 to 6 years old. Then the
percentage contributed by each item­group
in the food group or subgroup
was calculated. The total number of
servings of cooked broccoli consumed,
for example, was divided by the total
number of servings of dark-green
vegetables consumed. This calculation
produced the percentage of the composite
for dark-green vegetables that was
cooked broccoli. Any item-group total­ing
less than 1 percent of the composite
was combined with another item-group,
based on the similarity in nutrient
composition or its use in meals.
A food code most representative of an
item-group was then selected to repre­sent
each food-item group in each of
the composites. The nutrient values of
these food codes were used to calculate
the nutrient profiles of the composites.
In developing the original nutrient
profiles for the food groups and sub­groups,
researchers included foods
with the least amount of fat and with­out
added sugars; thus, the original
philosophical goal of flexibility for the
food guide was met. The food guide
was used to show consumers how to
obtain nutrients while allowing them
flexibility to choose sources of fat and
added sugars within the fat and calorie
limits specified (9). In addition, the
Food Guide Pyramid is an educational
tool to help put the Dietary Guidelines
into practice (8).
To minimize fat, added sugars, and
sodium, CNPP staff used the form of
the food item that was lowest in these
components. For example, the deep­yellow
vegetable subgroup contained
the item-group for sweet potatoes. To
represent the latter in the composite,
CNPP used the code for a baked sweet
potato without added fat-despite the
fact that children usually eat candied
sweet potatoes. For most vegetable and
cooked-grain item-groups, CNPP used
food codes that specified "no salt
added in preparation." In a few cases,
CNPP used the salted form to represent
popular vegetables that are canned.
Estimates of the percentage selected
19
20
... young children ate
somewhat different
types and amounts
of food items within
each food group and
subgroup than did
the total population.
in canned form were calculated from
data of the food supply ( 4).
Non-fortified ready-to-eat and cooked
breakfast cereals were used in both
the composites for whole grains and
enriched grains. Hence nutrient profiles
of the composites do not overestimate
the nutrients for children who do not
eat fortified breakfast cereals. Nutrients
added at standard enrichment levels,
as in enriched bread, were included in
the nutrient profiles for the composites.
Folate fortification was not mandated
by the Government at the time the
CSFII 1989-91 was conducted, so it
was not reflected in any of the nutrient
profiles for grain products.
Once CNPP chose the food code to
represent each item-group, we calcu­lated
grams of the food code and corre­sponding
nutrient values for its portion
of the composite serving. Nutrient values
were then summed across all items in
the food group or subgroup to deter­mine
the composite's nutrient profile
per serving.
Composites were not developed for the
meat alternates (eggs, nuts and seeds)
or for the milk, yogurt, and cheese
group. The nutrient profiles of a food
group or subgroup reflect proportion­ately
the nutrient content of the foods
within them; consequently, the nutrient
profile of a food group or subgroup
most reflects the nutrient content of
the most frequently consumed foods
within that group.
Nutrient profiles for the meat alternates
were represented by the nutrients in
one large boiled egg and 2 tablespoons
of peanut butter, each of which counts
as 1 ounce from the meat, poultry, fish
group. Peanut butter was 90 percent of
young children's servings of nuts and
seeds in the CSFII 1989-91 ; thus, peanut
butter's nutrient profile was used in­stead
of calculating a composite of all
the different nuts and seeds that were
consumed in small quantities by young
children.
All legumes were counted as vegetables
in the earlier research on Pyramid food
patterns (J) and so were counted simi­larly
in this research project. One-half
cup of cooked legumes may be counted
as 1 ounce of meat, poultry, or fish
rather than 1 serving of vegetables.
The nutrient profile for the milk, yogurt,
and cheese group was represented by
1 cup of nonfat milk, except for vitamin
A. The amount of vitamin A used was
the 76 RE per cup found in whole milk,
instead of the 149 RE per cup found
in fortified nonfat milk. Thus over­estimation
of vitamin A was avoided
for those who consumed non-fortified
whole milk products.
The data on food intake, which were
used to develop the composites, were
examined to identify the most popular
foods (at the food code level) and
preparation styles in each item-group.
Amounts reported eaten were also
analyzed. For each item-group, the
average number of servings per report
was calculated. This was the average
quantity of a specified food that was
eaten by consumers during an eating
occasion (at a single time). Then, the
average number of servings per report
was calculated for each food group or
subgroup.
The food-group composites and nutrient
profiles for young children were com­pared
with another set of composites
that were developed for all individuals
ages 2 years and older who provided
3 days of data in the CSFII 1989-91
(N=11 ,488).
Family Economics and Nutrition Review
Methods
Data Sources
Data on 3-day food and nutrient intakes
reported in the Continuing Survey of
Food Intakes by Individuals (CSFII)
1989-91 for 1,053 children 2 to 6 years
old were used in this study. This data
set was used because when work was
started, the data set offered the largest
number of individuals and days for
analysis. Sample weights were applied
to provide estimates that were repre­sentative
of the population. The data
that were used to calculate the nutrient
profiles of the composites for the food
groups and subgroups came from the
U.S. Department of Agriculture's
(USDA) Nutrient Data Base for
Individual Intake Surveys, Release 7
(1991).
The Food Guide Servings Data Base
was used to report the amounts of food
consumed as numbers of food guide
servings. USDA's Center for Nutrition
Policy and Promotion (CNPP) devel­oped
this data base by using the foods
reported in the CSFII 1989-91. The
Food Guide Servings Data Base con­sists
of food-item descriptions and the
number of Pyramid servings per 100
grams of food. Servings data are pro­vided
for the 5 major food groups and
21 subgroups identified in the Food
Guide Pyramid.
Most foods, including mixed dishes,
were broken down into ingredient com­ponents,
and their food group servings
were calculated for more than one food
group. When a food code's typical
serving size, defined in the Survey
Code Book for CSFII 1989-91 and
based generally on median serving
sizes reported in USDA food consump­tion
surveys, provided less than one­fourth
of a serving of a Pyramid food
group or subgroup, it was usually not
1999 Vol. 12 Nos. 3&4
counted. For example, a serving of
oatmeal raisin cookies provided less
than one-fourth of a Pyramid serving
of raisins, so those raisins were not
counted toward fruit servings. These
small amounts were not counted
because one objective of the original
food guidance system was "usability."
It is unrealistic to expect Americans to
"count" small amounts of some foods
toward food group servings. However,
if several "other vegetables" like
tomatoes and onions were in small
amounts in a mixture, and these amounts
together added up to at least one-fourth
serving, these "other vegetables" were
counted toward vegetable servings.
Procedures
CNPP began the research process by
breaking down the foods that were
consumed by children 2 to 6 years old,
as reported in the CSFII 1989-91, into
numbers of food group and subgroup
servings. The Food Guide Servings
Data Base was used for this process.
To identify specific food components,
CNPP staff reviewed food codes that
contributed food guide servings.
All food items with similar food
components were grouped in the same
item-group. For example, broccoli soup
and broccoli casserole both contained
cooked broccoli and so were placed
in the item-group for cooked broccoli
within the subgroup for dark-green
vegetables. A composite was then
constructed by summing intakes from
all the item-groups within a food group,
with each item-group being weighted
by the numbers of servings reported
for children 2 to 6 years old. Then the
percentage contributed by each item­group
in the food group or subgroup
was calculated. The total number of
servings of cooked broccoli consumed,
for example, was divided by the total
number of servings of dark-green
vegetables consumed. This calculation
produced the percentage of the composite
for dark-green vegetables that was
cooked broccoli. Any item-group total­ing
less than 1 percent of the composite
was combined with another item-group,
based on the similarity in nutrient
composition or its use in meals.
A food code most representative of an
item-group was then selected to repre­sent
each food-item group in each of
the composites. The nutrient values of
these food codes were used to calculate
the nutrient profiles of the composites.
In developing the original nutrient
profiles for the food groups and sub­groups,
researchers included foods
with the least amount of fat and with­out
added sugars; thus, the original
philosophical goal of flexibility for the
food guide was met. The food guide
was used to show consumers how to
obtain nutrients while allowing them
flexibility to choose sources of fat and
added sugars within the fat and calorie
limits specified (9). In addition, the
Food Guide Pyramid is an educational
tool to help put the Dietary Guidelines
into practice (8).
To minimize fat, added sugars, and
sodium, CNPP staff used the form of
the food item that was lowest in these
components. For example, the deep­yellow
vegetable subgroup contained
the item-group for sweet potatoes. To
represent the latter in the composite,
CNPP used the code for a baked sweet
potato without added fat-despite the
fact that children usually eat candied
sweet potatoes. For most vegetable and
cooked-grain item-groups, CNPP used
food codes that specified "no salt
added in preparation." In a few cases,
CNPP used the salted form to represent
popular vegetables that are canned.
Estimates of the percentage selected
19
22 Family Economics and Nutrition Review
Table 1. Continued
Percent Percent
Whole grain
Enriched
grain
WW* bread
Rye bread
Oatmeal bread
WW quick bread
Total breads
WW crackers
Corn tortilla
Popcorn
Brown rice
Total snacks/other
WW cereal, RTE* & ck
Oatmeal, ck
Oat RTE cereals
Total cereals
Whitebread
French bread
English muffins
Flour tortilla
Enr* crackers
Total breadlcrx*
Enr quick breads
Biscuit
Cornbread
Total quick breads
Pasta, noodles
White rice
Grits
Total pasta, rice
Enr flour desserts
Corn RTE cereals
Rice RTE cereals
Total cereals
33.2 35.6
4.2
2.5 3.3
2.1 2.4
37.8 45.5
4.2 2.8
9.5 11.6
3.6 5.2
.LQ
17.3 21.2
11.5 16.9
15.9 ' 8.4
17.5 8.0
44.9 33.3
35.1 35.4
1.4 4.0
1.1 2.4
1.4 2.3
4.2 2.8
43.2 46.9
7.1 5.9
1.6 2.7
2.4 3.3
11.1 11.9
13.6 11.5
5.3 6.1
u 1.0
20.4 18.6
14.4 17.8
8.2 3.7
2.7 u
10.9 4.8
1Children 2 to 6 years old and all individuals ages 2 years and older.
-Item-group had <1 percent representation in the composite.
Meat,
poultry, Beef, fresh 18.6
fish Pork, fresh 6.2
Pork, cured 2.9
Lamb 0.7
Total meat cuts 28.4
Ground beef 21.5
Beef lunchmeats 8.1
Pork lunchmeats 4.4
Totallunchmeat 12.5
Liver 0.3
Chicken 23.0
Turkey 3.9
Total poultry 26.9
Lean finfish 3.3
Fatty finfish 1.6
Finfish, end 4.5
Shellfish 1.0
Total rash 10.4
*Abbreviations: ck- cooked, end- canned, DY- deep-yellow, WW- whole wheat, RTE ·ready-to-eat, Enr- enriched, crx.- crackers.
Source: CSFII 1989-91, 3-day weighted samples.
1999 Vol. 12 Nos. 3&4
21.4
7.2
3.2
u
32.9
18.8
3.6
4.9
8.5
0.5
21.5
ll
26.6
4.3
1.7
4.2
2.8
13.0
23
Table 2. Nutrient profiles for food proup composites and milk: Nutrient values per serving for
young children and all individuals
Calories, kcal 24
Sodium,mg 29
Potassium, mg 278
Protein, g 2.6
Fat, g 0.3
Saturated fat, g 0.0
Mono.* fat, g 0.0
Poly.* fat, g 0.1
Cholesterol, mg 0
Carbohydrate, g 4.4
Fiber, g 2.3
Vitamin A, RE 239
Vitamin C, mg 55
Folate, ug 57.9
Vitamin B12, ug 0.0
Calcium,mg 55
Magnesium, mg 29.3
Iron, mg 1.10
Zinc, 0.38
Dark-green vegetable. Broccoli was
the predominant vegetable in this
composite for children. Of all the
composites, the one for dark-green
vegetables had the highest vitamin-C
value per serving.
Cooked broccoli was the largest (74
percent) component and cooked spinach
was the second largest (14 percent)
component of the composite for dark­green
vegetables (table 1). Thus the
high percentage of broccoli helps to
explain the high value of vitamin C
per serving of this composite: 55 mg
24
0.1
0.0
(table 2). Children consumed much
less cooked greens, raw broccoli, and
romaine than did all individuals (table 1).
Deep-yellow vegetable. This composite
was mostly carrots, and it provided the
highest amount of vitamin A of any
composite.
Most (89 percent) of the children's
deep-yellow vegetable composite was
carrots (table 1). Children ate more raw
carrots than cooked carrots. Eaten pri­marily
in candied form, sweet potatoes
ranked a distant second in the composite.
One serving of the deep-yellow vegetable
composite provided 1,685 RE vitamin A
for children (table 2).
Legume. Pinto beans accounted for
the highest percentage of the children's
composite for legumes. Of all the
composites, this one contained the
most calories and fiber per serving.
Pinto beans ranked first (35 percent
for children) in the legume composite
(table 1). The top food codes in the
item-group for pinto beans were pinto
beans without fat and refried beans
Family Economics and Nutrition Review
Table 2. Continued
. '~: "i·:' i'Y ' Meat, poultry, fish
.l Fruit Whole grain Enriched grain (per ounce) MDk%
:; AU AU All All lcup
Nutrient
·,,.
Cblld indiv . Child indiv. Clnld indiv. Child indiv. nonfat
Calories, kcal 74 68 80 78 86 83 56 55 86
Sodium, mg 3 2 60 69 104 115 82 67 126
Potassium, mg 237 245 60 56 30 31 89 88 406
Protein, g 0.7 0.8 2.8 2.6 2.3 2.3 7.7 7.7 8.4
Fat, g 0.2 0.2 1.2 l.l 1.1 1.1 2.5 2.4 0.4
Saturated fat, g 0.1 0.1 0.2 0.2 0.2 0.3 0.9 0.9 0.3
Mono. fat, g 0.0 0.0 0.4 0.4 0.5 0.5 1.0 1.0 0.1
Poly. fat, g 0.1 0.1 0.4 0.4 0.3 0.3 0.2 0.2 ' 0.0
Cholesterol, mg 0 0 0 0 2 2 22 24 4
Carbohydrate, g 18.3 16.8 14.9 15.0 16.3 15.5 0.2 0.1 11.9
Fiber, g 1.1 1.2 2.1 2.0 0.6 0.6 0.0 0.0 0.0
Vitamin A, RE 12 28 2 2 2 2 9 18 76
Vitamin C, mg 24 30 0 0 0 0 1 1 2
Folate, ug 23.8 26.9 7.4 7.8 6.5 6.9 2.3 2.4 12.7
Vitamin B12, ug 0.0 0.0 0.0 0.0 0.0 0.0 0.5 0.6 0.9
Calcium, mg 13 13 19 20 23 26 4 4 302
Magnesium, mg 12.3 13.5 ' 24.6 23.0 7.4 7.4 6.8 7.0 27.8
Iron, mg 0.34 0.27 0.81 0.76 0.80 0.80 0.55 0.55 0.10
Zinc, mg 0.08 0.10 0.54 0.50 0.20 0.21 """' 1.11 1.10 0.98
1Children 2 to 6 years old and all individuals ages 2 years and older.
2 A composite was not developed for the milk group. The nutrient profile was based on nonfat fluid milk.
*Abbreviations: Mono. - monounsaturated; Poly.- polyunsaturated.
with added fat. White beans (eaten
mostly in pork and beans/baked beans)
and kidney beans (eaten mostly in chili
con carne with beans) were, respec­tively,
the second and third largest item­groups.
Legumes contributed the most
calories and dietary fiber per serving of
all the composites; for children, one
legume serving provided 108 calories
and 5.6 g fiber (table 2). Legumes also
provided the most copper per serving
of all the composites, 0.20 mg.
1999 Vol. 12 Nos. 3&4
Starchy vegetable. fried potatoes
were the starchy vegetable most
commonly eaten by young children.
White potatoes were the primary
constituent of the composite for starchy
vegetables (table 1); they were most
often eaten with added fat-as potato
chips and French fries. Because the
composite was created using the form
of the food lowest in fat, boiled potatoes
were chosen as a proxy for fried potatoes.
The smaller amount of baked potatoes
in the children's composite, compared
with that for all individuals, contributed
to a lower potassium value in children's
nutrient profile (table 2). The second
largest item-group in this composite
was com (table 1).
Other vegetable. Almost half of children's
servings of "other vegetables" were of
tomatoes. This composite had one of
the smallest servings per report (0.5),
because the foods in this subgroup
were used in small amounts in many
mixed dishes.
Tomatoes were the primary component
( 48 percent) of the composite for other
25
Across all the food
groups and sub­groups,
children
tended to have
smaller serving
sizes than did all
individuals.
"·
26
vegetables; a higher percentage of its
cooked form was consumed, compared
with its raw form (table 1). Most of the
servings of the cooked form were eaten
as ingredients in grain mixtures. The
main sources of raw tomatoes, other
than those eaten by themselves, were
Mexican mixtures (taco/tostada) and
hamburger sandwiches. The large amount
of cooked tomatoes, represented as
canned in the composite, was the
major contributor to the 100 mg sodium
and 205 mg potassium per composite
serving (table 2). The second largest
item-group in the other vegetable com­posite
for children was cooked green
beans (19 percent) (table 1). Lettuce
represented 12 percent of the children's
composite, and the most frequently
consumed food was plain lettuce. One
composite serving of other vegetables
provided 12 mg vitamin C, second to
the dark-green vegetable subgroup,
55 mg per serving (table 2).
Whole grain. About 45 percent of this
composite was ready-to-eat and
cooked cereals; most were fortified.
Whole-grain cereals were the largest
component of the composite for whole
grains (table 1). Both the ready-to-eat
and cooked forms of wheat and oat
cereals were eaten, and the instant
variety was the most consumed type
of all the cooked oatmeals. Many of
the cereals in the item-groups for
wheat and oat cereal were fortified.
Children obtained added nutrients by
eating these fortified cereals. Whole­wheat
bread was 33 percent of the
composite for whole grains, but cracked­wheat
bread was the predominant food
code in the item-group for whole-wheat
bread. Cracked-wheat bread was in this
item-group, because the wheat-based
breads were grouped together. Corn
tortilla had a fairly large representation
(10 percent) in the composite for whole
grains. Tortilla chips and corn chips
were the top food codes in the item­group
for corn tortilla. For children,
one serving from the composite for
whole grains provided 2.1 g dietary
fiber, 24.6 mg magnesium, and 0.5 mg
zinc (table 2).
Enriched grain. White bread was the
largest component of the children 's
composite for enriched grains.
White bread was the first (35 percent)
and "enriched flour desserts and other
sources of enriched flour" (shortened
to just "enriched flour desserts") was
the second largest component (14 per­cent)
of the enriched-grain composite
(table 1). The term "desserts" was
used to identify the latter item-group
because many of the food codes in it
were sweet foods like cookies, dough­nuts,
pastries, pies, and cakes. Enriched
flour in each of these foods was
counted toward servings of enriched
grains. The enriched flour in pizza
crust was also included in this item­group.
A low-sugar and low-fat food
was used to represent the item-group
for enriched flour desserts in the com­posite,
but children were consuming
added sugars and fat from these foods.
The third largest component of this
composite was enriched pasta and
noodles. The foods in this item-group
that were most commonly eaten by
children were macaroni and cheese
and spaghetti with or without tomato
sauce. Corn and rice ready-to-eat
cereals combined were 11 percent of
the children's composite; most were
fortified. Wheat-flour tortillas consti­tuted
a separate item-group in the
composite for enriched grains, because
they were consumed in large amounts.
Children ate more wheat-flour tortillas
than English muffins or bagels. (Bagels
were placed in the item-group for
English muffins.)
Family Economics and Nutrition Review
As expected, the amount of fiber,
magnesium, and zinc in the composite
for enriched grains was lower than in
the composite for whole grains.
Meat, poultry, fish. Beef was 48 percent
and poultry 27 percent of the children's
composite for meat, poultry, and fish.
Children ate most of their beef in ground
form: 22 percent of their composite for
meat, poultry, and fish (table 1). Fresh
beef, as in steak and roast beef, was
about 19 percent of the children's
composite for meat, poultry, and fish.
Children's composite also contained
about 8 percent beef lunch meats­mostly
frankfurters. About 12 percent
of the children's composite for meat,
poultry, and fish was frankfurters and
other lunch meats. Because of their
higher fat content or water content or
both, 2 ounces of sausages and lunch
meats were counted as 1 ounce of lean
meat in the Food Guide Servings Data
Base. For example, a child who ate a
2-ounce hot dog was credited 1 ounce
of lean meat.
Chicken, compared with turkey, was
the most commonly eaten poultry: 23
versus 4 percent of the children's com­posite.
And it was the roasted chicken
breast without skin and chicken nuggets
that accounted for 12 percent of all
chicken servings. Many of the 188 food
codes with poultry servings, which
were reported consumed by children,
were various fried chicken parts. Fried
chicken was not, however, represented
as such in the composite, because the
leanest form of a food was used. All
chicken was represented in the composite
by a food code described as "chicken,
boneless, not specified as to part,
roasted, light or dark meat, skin not
eaten."
Within the item-group for liver, children
ate more chicken liver than beef liver.
1999 Vol. 12 Nos. 3&4
Because children ate less beef liver
than did all individuals, the children's
composite contained less of vitamins A
and B12 (table 2).
Canned finfish, mostly tuna in water,
was the predominant fish item-group
(table 1). For both children and all indi­viduals,
the top foods consumed in the
item-group for lean finfish were fried.
Most servings of fatty finfish were
fried catfish for both children and all
individuals. Shrimp was the largest
component of the item-group for shell­fish
for children and all individuals,
both of whom ate more servings of
steamed or boiled shrimp than fried
shrimp.
The composite for meat, poultry, and
fish contributed the most fat and satu­rated
fat of all the composites (table 2).
For children, 1 serving of meat, poultry,
and fish provided 2.5 g fat, 0.9 g satu­rated
fat, 7.7 g protein, 22 mg choles­terol,
0.5 ug vitamin B12, 0.55 mg iron,
and 1.11 mg zinc.
Milk. Children consumed more whole
milk than did all individuals.
Although a composite was not devel­oped
for the milk group, because the
nutrient profile was to be based on
nonfat fluid milk, CNPP did analyze
how children consumed their servings
of the milk group. Findings showed
that about 84 percent of children's serv­ings
from the milk group were of fluid
milk, 15 percent were of cheese, and
1 percent were of yogurt.
Children obtained the bulk of their
servings of the milk group by drinking
milk: about 92 percent of children's
"milk as beverage" servings were
whole, 2-percent, 1-percent, or skim
milk. The remaining 8 percent of their
"milk as beverage" servings were
cocoa, milk shakes, chocolate milk,
and other flavored milks. Young chil­dren
consumed a larger percentage of
the category entitled "milk as beverage"
as whole milk (47 percent) than did all
individuals (35 percent). Children had
14 percent of servings from 1-percent
or skim milk; all individuals had 21
percent from these types of milk.
Ice cream and ice milk were also part
(about 4 percent) of children's servings
of fluid milk. Children ate less pudding
(1 percent of the servings of fluid milk)
than ice cream and ice milk. Children
also obtained fluid milk in mixtures
such as cream sauces and soups, but
in small amounts.
The milk group is represented by 1 cup
skim milk, which provides 8.4 g protein,
86 calories, 0.3 g saturated fat, and 302
mg calcium (table 2).
Serving Sizes
Across all the food groups and sub­groups,
children tended to have smaller
serving sizes than did all individuals.
Children's average intake was 1 serving
per report for fruits and juices. When
children ate cooked greens, raw broccoli,
and romaine (dark-green vegetables),
their serving sizes were much smaller
than those for all individuals. Children
had 0.9 servings, on average, per report.
Of all five vegetable subgroups (dark­green,
starchy, etc.), children's number
of servings per report (0.4) was the
smallest for the deep-yellow vegetable
subgroup.
Children averaged 0.7 servings per
report for legumes and 0.8 servings
for starchy vegetables. Among starchy
vegetables, children averaged 0.9 serv­ings
for potato chips and 0.7 servings
for French fries. Children's number of
servings per report of other vegetables
27
28
By selecting foods
somewhat differently
in the food groups
and subgroups,
children can improve
their nutrient intakes.
averaged 0.5. The number of servings
per report (0.2 for children) for individual
item-groups was particularly small for
cooked onions, raw celery, and cooked
mushrooms, used in small amounts in
many mixed dishes.
Children had an average of 1.2 servings
per report from the composite for
whole grains and 1.4 servings per
report from the item-group for whole­wheat
bread. Children averaged 1.2
servings per report across all foods in
the composite for enriched grains, 1.4
servings for white bread, and 1.3 serv­ings
(a little over V2 cup) for enriched
pasta and noodles. The halves of an
English muffin or bagel constitute 2
servings of grains; children averaged
1.4 servings per report.
For items in the composite for meat,
poultry, and fish, children averaged
1.4 ounces per report. For the milk
composite, children consumed about
3/4 cup of milk (0.8 servings) per
report and 2/3 cup of ice cream per
eating occasion. For pudding, the
average amount eaten per report was
0.5 servings Ch cup).
Generally, the amounts reported for
children 2 to 6 years old were about
60 to 80 percent of those for all indi­viduals.
This suggests that it is appro­priate
to continue to use two-thirds of
the serving size designated for adults
as a serving size for 2- to 3-year-olds
when assessing nutrient levels in Food
Guide Pyramid patterns for young
children ages 2 to 3 (1,9). Two- to
three-year-olds need two-thirds of the
serving size for adults, except for milk.
Two cups of milk are recommended
for 2- to 3-year-old children. Four- to
six-year-old children need the same
serving sizes designated for adults.
Food Guide Pyramid Diet
Patterns for Young Children
The REI for 1- to 3-year-old children
is 1,300 calories (2). A 1,600-calorie
pattern was considered an appropriate
objective for 4- to 6-year-old children.
Although the REI for 4- to 6-year-old
children is 1,800 calories, food con­sumption
data reported for this age
group in the CSFII 1989-91 averaged
1,533 calories.
Focus groups with parents, a consumer
research aspect of the development of
the Food Guide Pyramid for Young
Children, indicated that parents were
concerned that the amount of food their
children ate might not be adequate
to meet their nutrient needs.1 It was
important to determine whether a diet
pattern set at a calorie level close to
what children reportedly eat, and based
on their reported food choices within
food groups, could meet their nutrient
requirements. It is not wise to have
parents feed their children more food
than needed-considering the prevalence
of childhood obesity in the United
States.
CNPP created the diet patterns as
follows. For each food group and sub­group
composite, the nutrients per Food
Guide Pyramid serving were multiplied
by the number of servings in the pattern
and summed. Discretionary fat was
added to bring the level of total fat in .
the 1 ,600-calorie pattern to 30 percent
of calories and in the 1 ,300-calorie
pattern to 34 percent of calories, the
actual consumption level in the CSFII
1989-91 for 2- to 3-year-old children.
Added sugars, represented as teaspoons
of sugar, were then included to bring
calories to the levels targeted for the
two diet patterns.
1See Tarone (5).
Family Economics and Nutrition Review
Table 3. Comparison of children's recommended intake with their consumption: Food group and
subgroup servings per day
All individuals
Fruit 1.33 2.00 1.19 1.12
Vegetable 2 servings 3 servings 1.41 servings 2.62 servings
Dark-Green 0.29 0.43 0.08 0.13
Deep-Yell ow 0.38 0.57 0.06 0.14
Legume 0.29 0.43 0.08 0.17
Starchy 0.38 0.57 0.61 0.94
Other 0.67 1.00 0.58 1.25
Grain 4 servings 6 servings 4.55 servings 5.50 servings
Whole Grain 2.00 3.00 0.96 1.27
Enriched Grain 2.00 3.00 3.59 4.22
Meat, poultry, fish 3.33 llUnces 5.00 ounces 2.55 ounces 4.37 ounces
Meat, Poultry, Fish 2.:36 4.57 2.17 3.95
Egg 0. :~9 0.43 0.24 0.32
Nuts and Seeds 0.18 0.0 0.14 0.10
Milk 2.00 2.00 1.94 1.48
Fat, total 49.5 grams 53.4 grams 54.5 grams 70.4 grams
Added sugars 7 tsp 6 tsp 13.2 tsp2 19.5 tsp2
Total calories 1,304 kcal 1,613 kcal 1,435 kcal 1,796 kcal
1Calculated by dividing the total weighted number of servings reported over 3 days by 3 and then dividing by the weighted number of people in the ~amples.
~timated extra calories from added sugars in foods and small amounts of foods not accounted for in Food Guide Servings Data Base.
The 1,600-calorie pattern contained the
minimal number of Food Guide Pyramid
servings at the serving size recom­mended
in the original Food Guide
Pyramid (table 3). There were 2 servings
of fruit, 3 of vegetables, 6 of grains,
5 ounces of meat, and 2 cups of nonfat
milk, along with added fat and sugars.
The 1 ,300-calorie pattern had the mini­mal
numbers of Food Guide Pyramid
food group servings reduced in size by
1999 Vol. 12 Nos. 3&4
one-third for all food groups and sub­groups
except milk, to represent the
one-third smaller serving size estimated
for 2- to 3-year-old children. For
example, 2 servings of fruit multiplied
by two-thirds equaled 1.33 Food Guide
Pyramid fruit servings in the 1,300-
calorie pattern.
A total of 2 cups of milk was included
in both diet patterns to meet calcium
recommendations. Because there is
more fat permitted in the younger
child's diet, CNPP substituted peanut
butter for a portion of the meat servings
in developing the 1 ,300-calorie pattern
for 2- to 3-year-old children. This meat
alternate, which is higher in fat content,
represented the percentage of the meat
group that young children consumed as
nuts.
29
Table 4. Nutrient levels in Food Guide Pyramid patterns for young children1
Nutrient
RDAl.or
reeoan.mend8tion
ChUd
1-3
1,300-calorle pattern
Child
1,600-calorle
pattern
Child
4-6rs 2-3
CSFI11989-91
consumption
Child
- - • - • - • - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Kcal - - - - - - - - - - - - - - - • - - - - - - - •• - - - - - - - - - -
Calories (avg) 1,300 1 ,800 -1,300 -1 ,300 -1,600 1 ,288 1,533
- - • - • - - - - - - - - - - - - - - Percent of RDA - - - - - - - - - - - - - • - - - - - - - -
Protein
Calcium
Magnesium
Iron
Zinc
Copper
Vitamin A
Vitamin E
VitaminC
Niacin
Vitamin B6
Folate
Vitamin B12
16 g
800mg
80mg
10mg
10mg
0.7mg
400RE
6mg
40mg
9mg
l.Omg
50ug
0.7ug
24g 361
800mg 98
120mg 259
lOmg 74
10mg 77
1.0 mg 100
500RE 267
7mg 98
45 mg 169
12mg 122
1.1 mg 104
75 ug 329
l.Oug 513
241 325 305 244
98 109 94 107
173 225 219 169
74 110 96 117
77 107 68 82
70 100 98 81
214 295 177 162
84 89 78 77
150 220 194 186
92 130 143 134
95 133 117 126
219 303 378 295
359 460 492 371
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Percent of Kcal- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Fat3
Saturated fat3
<34
<13.6 .
30 34.1
<10 10.5
34.1 29.8 34.4 34.0
10.5 9.3 13.6 13.3
- - - - • - - - - - - - - - - - - - - - - - - - - - - - - - - - - Milligrams - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Cho1estero14
Sodium4
300 300 161 161 230 182 210
<2,400 <2,400 1,127 1,127 1,485 2,122 2,534
- - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - Grams - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Fibe? 8 9-11 12.0 12.0 17.4 8.5 10.4
1Composite nutrient profiles based on children 2 to 6 years old.
2Recommended Dietary Allowances (RDA), 1989.
3U.S. Department of Agriculture and U.S. Department of Health and Human Services, 1995, Nutrition and Your Health: Dietary Guidelines for Americans.
4National Research Council. 1989. Diet and Health. National Academy Press, Washington, DC.
5 American Health Foundation for "age plus 5" per day (Williams et al ., 1995).
Source: CSFII 1989-91, 3-day weighted sample.
Total nutrient levels in the 1,300- and
1 ,600-calorie patterns were then com­pared
with the 1989 RDA for children
1 to 3 and 4 to 6 years old and with
other recommendations, as specified
earlier, for fat, saturated fat, cholesterol,
sodium, and dietary fiber (table 4).
30
Except for vitamin E (89 percent of the
RDA), the 1 ,600-calorie pattern met or
exceeded all nutrient requirements for
children ages 4 to 6. Vitamin E was
also less than the RDA in the 1,300-
calorie pattern. However, the levels of
vitamin E in the patterns exceeded the
amounts consumed by children, as
reported in theCSFII 1989-91, because
the composite for discretionary fat,
which was based on food supply data
for individuals of all ages, contained
more vegetable fat (rich in vitamin E)
than young children ate. The fat
Family Economics and Nutrition Review
composite had more polyunsaturated
fat and less saturated fat than the
amount consumed by children.
The 1 ,300-calorie pattern provided at
least 100 percent of the RDA for most
nutrients for both 2- to 3-year-olds and
4- to 6-year-olds. The major exceptions
were the trace minerals-iron and zinc
for both age groups and copper for the
4- to 6-year-olds. The amount of iron
provided by the 1 ,300-calorie pattern
was lower than the amount consumed
by children, according to the CSFII
1989-91. The reason for this difference:
composites for whole grains and
enriched grains contained non-fortified
breakfast cereals, but the cereals children
ate were fortified. Additional analysis
showed that when breakfast cereals
included in the grain composites were
changed to contain iron and zinc at
fortification levels, the Food Guide
Pyramid patterns provided recommended
levels of iron and zinc for children.
The 1,300- and 1,600-calorie patterns
met or nearly met objectives for fat,
saturated fat, cholesterol, sodium, and
dietary fiber. At 10.5 percent of calories
in the 1 ,300-calorie pattern, saturated
fat was somewhat lower than the actual
level of consumption targeted for the
2- to 3-year-old child: 13.6 percent.
Consumption of Food Groups
Table 3 shows the recommended
numbers of food group and subgroup
servings for the 1,300- and 1 ,600-calorie
Food Guide Pyramid patterns devel­oped
for young children. The numbers
of servings for vegetables, grains, and
meat and me~t alternates were derived
as follows. Originally when the food
guide was developed, the daily servings
of vegetables were divided equally
among dark-green/deep-yellow, legumes/
1999 Vol. 12 Nos. 3&4
starchy, and other vegetables (1). For
vegetables, "several" servings was
defined as 3, so several times a week
meant 3 times a week or 317 of 1 serving
per day. For the 1 ,600-calorie pattern,
3 vegetable servings were divided into
1 serving each from dark-green/deep­yellow,
legumes/starchy, and other
vegetables. Hence the 317 (0.43) dark­green
and 417 (0.57) deep-yellow
provided 1 serving per day, the 0.43
legumes and 0.57 starchy provided
another serving, and other vegetables
provided the third serving per day. The
numbers of grain servings were based
on the Food Guide Pyramid recommen­dation
to choose "several" servings a
day of foods made from whole grains
(6). For the meat and meat alternates,
the number of egg servings was based
on 3 eggs per week, and the meat,
poultry, fish servings were calculated
by difference (0.43 eggs subtracted
from 5.0 ounces total meat and meat
alternates).
The Food Guide Servings Data Base
used in this study did not quantify the
amount of added sugars in foods.
These values were estimated from the
calories in added sugars in foods and
from the calories in small amounts of
foods, such as raisins in oatmeal raisin
cookies and garnishes and condiments,
which were not counted by the Food
Guide Servings Data Base. Calories
were then expressed as average daily
servings of added sugars, in teaspoons.
Thus the average daily servings of
added sugars may somewhat over­estimate
actual intakes of sugar. How­ever,
these estimated consumption levels
of sugars were much higher than the
levels of 6 teaspoons and 7 teaspoons
(1 ,600- and 1 ,300-calorie patterns,
respectively) suggested in the Food
'Guide Pyramid patterns.
Conclusions
Children ate somewhat differently from
the rest of the population, as indicated
by composites of the food groups and
subgroups, which were based on
reported food consumption by young
children ages 2 to 6 and all individuals
ages 2 and older. However, the vari­ations
resulted in few substantial differ­ences
in the nutrient profiles of a
composite serving of any of the food
groups or subgroups.
Young children consumed smaller
servings of foods, typically 60 to 80
percent of the average amounts for
individuals of all ages. A serving that
is two-thirds of the original Food Guide
Pyramid serving is a reasonable esti­mate
for assessing nutrient levels in
patterns for 2- to 3-year-old children.
The 1 ,300-calorie Food Guide Pyramid
diet pattern, which used the children's
composites and nutrient profiles, met
or nearly met objectives for most nutri­ents
except for iron, zinc, and copper.
The 1 ,600-calorie pattern met all of the
objectives except for vitamin E. When
iron and zinc were included at regular
fortification levels in the ready-to-eat
cereals used in the grain composites,
diet-pattern levels of these nutrients met
the RDA. Breakfast cereals were popular
with young children, so ensuring that
these cereals are fortified with iron
and zinc can contribute substantially
to meeting targeted intakes of these
nutrients.
Copper was less than the RDA in the
1,300-calorie pattern for the 4- to 6-
year-old, but the older child would
probably be consuming closer to 1,600
calories. Older children could improve
their reported copper intake by eating
more legumes. Both the 1,300- and
1 ,600-calorie patterns were somewhat
31
low in vitamin E, but they exceeded
the CSFII 1989-91 reported consump­tion
levels of this nutrient. It is impor­tant
to reduce fat in the diet as children
age, from 2 to 5 years. Emphasis
should also be given to replacing a
portion of animal fats with vegetable
oils, both to decrease saturated fat
intakes and to increase vitamin E
intakes. The results of the analysis on
the RDA showed that most RDA would
be met when the children's composites
were used in the diet patterns. By
selecting foods somewhat differently
in the food groups and subgroups,
children can improve their nutrient
intakes.
Children's diets could be improved by
including more servings of vegetables,
especially dark-green and deep-yellow
vegetables and legumes, and more whole­grain
products. Replacing some of the
apple and grape juices that children
frequently drink with more servings
of whole fruit could improve consump­tion
of nutrients and dietary fiber.
Replacing some lunch meats with
lean meat, poultry, and fish may also
improve nutrient intakes. Children's
diets could be improved by their
choosing foods that contribute more
food guide servings and less added
sugars.
32
References
1. Cronin, F.J., Shaw, A., Krebs-Smith, S.M., Marsland, P., and Light, L. 1987.
Developing a Food Guidance System to implement the Dietary Guidelines. Journal
of Nutrition Education 19:281-302.
2. National Academy of Scie.nces, National ResearchthCouncil, Food and Nutrition
Board. 1989. Recommended Dietary Allowances (10 ed.). National Academy
Press, Washington, DC.
3. National Research Council. 1989. Diet and Health. National Academy Press,
Washington, DC.
4. Putnam, J.J. and Allshouse, J.E. 1996. Food Consumption, Prices, and Expenditures,
1996: Annual Data, 1970-94. U.S. Department of Agriculture, Economic Research
Service. Statistical Bulletin No. 928. pp. 59, 61 .
5. Tarone, C. 1999. Consumer research: Food Guide Pyramid for Young Children.
Family Economics and Nutrition Review 12(3&4):33-44.
6. U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. 1996.
The Food Guide Pyramid. Home and Garden Bulletin No. 252.
7. U.S. Department of Agriculture, Center for Nutrition Policy and Promotion. 1997.
U.S. Food Supply Series 1909-1994. (In-house data base.)
8. U. S. Department of Agriculture and U.S. Department of Health and Human
Services. 1995. Nutrition and Your Health: Dietary Guidelines for Americans
(4th ed.). Home and Garden Bulletin No. 232.
9. Welsh, S.O., Davis, C., and Shaw, A. 1993. USDA 's Food Guide: Background
and Development. U.S. Department of Agriculture, Human Nutrition Information
Service. Miscellaneous Publication No. 1514.
10. Williams, C.L., Bollella, M., and Wynder, E.L. 1995. A new recommendation
for dietary fiber in childhood. Pediatrics 96:985-988.
Family Economics and Nutrition Review
Catherine Tarone
Center for Nutrition Policy
and Promotion
1999 Vol. 12 Nos. 3&4
Consumer Research:
Food Guide Pyramid for
Young Children
Developed specifically as a guide for feeding young children, the Food
Guide Pyramid for Young Children adapts recommendations of the original
Food Guide Pyramid and provides messages, based on the food guide, that
are helpful to parents and caregivers in improving the nutritional status of
2- to 6-year-olds. A qualitative consumer research study was conducted to
identify needs of the target audience (parents and caregivers of 2- to 6-year­old
children), to explore, with this audience, messages based on the food
guide, and to evaluate prototype educational materials based on the food
guide-based messages directed at behavior change. Parent- and caregiver­participants
recommended emphasizing the message to "eat a variety of
foods" as a theme for nutrition education materials that are designed to
improve young children's diets. They also suggested that a "child-friendly"
graphic of the Food Guide Pyramid would help young children remember
the Pyramid. USDA produced a booklet presenting nutrition guidance
messages and a "child-friendly" poster of the Food Guide Pyramid.
he Food Guide Pyramid is
USDA's primary nutrition
education tool designed to
help healthy Americans
select a diet that is consistent with the
Dietary Guidelines. The Food Guide
Pyramid illustrates patterns of food
selection that provide adequate amounts
offood energy, protein, vitamins, minerals,
and dietary fiber for good health but
are moderate in fats, added sugars, and
sodium. Adaptation and translation of
dietary guidance into dietary practice
are important components of any effort
to help improve diets, including those
of young children.
In Phase I of the project to develop a
Food Guide Pyramid for Young Children,
the Center for Nutrition Policy and
Promotion (CNPP) developed the tech­nical
nutrition basis for adapting the
Food Guide Pyramid (6,7). CNPP staff
determined that the nutrients in the
foods children consume, if eaten in
amounts recommended by the original
Food Guide Pyramid, would meet chil­dren's
nutrient needs. Because Pyramid
food groups and recommended numbers
of servings resulted in a nutritionally
adequate diet for young children, the
Pyramid graphic could be adapted for
young children. Also during Phase I,
eight message concepts emerged from
the review of literature (5), discussions
were held with nutrition educators, and
comparisons were made of actual food
group and subgroup consumption with
the recommendations of the Food Guide
Pyramid, as adapted for young children
33
(6) . The concepts were explored and
further developed during Phase II.
In support of USDA's nutrition education
efforts to translate dietary guidance into
consumer behaviors, CNPP conducted
a qualitative consumer research study in
Phase ll. Qualitative research is particu­larly
useful for gaining insights and a
better understanding of the target audience.
Qualitative research consists of open­ended,
structured discussions or inter­views
with individuals or small groups
of individuals-the purpose of which is
to gather a greater depth of information
than can be obtained by using quantita­tive
techniques ( 3 ).
CNPP conducted qualitative research
because consideration of the target audi­ence,
including its wants and needs, is
the foundation of this research project
to advance dietary guidance for children
in a way that motivates behavior change
in both adults and children. Recent
research on the effectiveness of nutri­tion
education programs, including
those with preschool children, found
that programs using educational methods
directed at behavior change as a goal
were more likely to be successful than
programs that focused on information
dissemination (4).
Methods
The focus group study was conducted
in two rounds. The objectives for the
first round were to assess the nutrition
information that parents and caregivers
of 2- to 6-year-old children needed, to
identify the key concerns for nutrition
education, to assess familiarity with the
Food Guide Pyramid, and to explore
nutrition guidance messages (based on
the food guide) for young children. The
objectives for the second round were
to determine whether the prototypes
34
effectively communicated nutrition
guidance to the target audience of parents
and caregivers of 2- to 6-year-olds. The
discussions for the second round were
designed to assess consumer reaction
to the prototype materials (including
their reactions to design and layout,
readability, and applicability of the
message concepts) and to identify any
confusing or misleading information.
Samples
For the first round, six focus groups,
three with parents and three with
caregivers, were conducted in January
1998. Parents were screened based on
their ethnicity, household income, and
educational level. Parents were also
screened to ensure that they had at least
one child 2- to 6-years-old and had not
participated in a focus group within the
last 6 months. Caregivers were included
if they cared for 2- to 6-year-olds. (They
could provide in-home care as well as
care in larger facilities.) Twelve people
were recruited for each group so that
at least eight would attend. Some geo­graphical
dispersion was obtained by
conducting one focus group with parents
and a separate focus group with care­givers
in each of three cities-Baltimore
(Maryland), Richmond (Virginia), and
Chicago (11linois). Fifty-two adults
participated in the first round of the
study.
In July 1998 the second round began.
One focus group with parents and an­other
focus group with caregivers were
held in each of three cities-Baltimore
(Maryland), Richmond (Virginia), and
Chicago (11linois)-for a total of six
groups. The screening criteria used for
the first round were also used for this
round. In addition, parents in Richmond
and Chicago with 5- to 6-year-olds were
screened to have their children partici­pate
in a mini-focus group. Twenty-seven
parents, 25 caregivers, and 8
children participated in the second
round; none had participated in the
first round.
Procedures
For the first round of focus group studies,
the moderator, with over 10 years of
experience working with focus groups,
led each group through the 2-hour
sessions. Each focus group began with
introductions and an icebreaker, followed
by discussions based on the objectives.
The discussions identified goals, benefits,
and barriers to healthful eating, partici­pants'
knowledge of nutrition, and their
feeding practices. The session then
focused on the nutrition messages of the
Food Guide Pyramid and how they apply
to young children. Discussions ended on
the eight messages regarding nutrition
guidance and how to communicate
them to young children.
All sessions were audio-taped and tran­scribed
to obtain participants' exact
responses to questions. Once transcribed,
comments were color-coded and grouped
according to content; this allowed key
discussion themes to be uncovered. The
moderator and his staff recorded and
reported participants' verbal and non­verbal
emotional expressions.
After the first round, CNPP developed
the text of the materials to be used with
the participants in the second round.
The prototypes were designed and
produced through USDA's Office of
Communications Design Center. To
emphasize the variety theme, CNPP
used the slogan 1-2-3 Variety in all
three prototypes. The prototype for the
parents, a full-color, 12-page booklet,
A Parents' Guide to Using the Food
Guide Pyramid, contained an adapted
graphic of the Food Guide Pyramid.
Also included was general nutrition
Family Economics and Nutrition Review
information that gives a better under­standing
of
1. healthful eating,
2. tips on increasing the variety of
foods eaten,
3. meal planning and time-saving tips,
4. guidance on specific issues such
as serving sizes and fat intake
recommendations related to young
children, and
5. age-appropriate kitchen activities.
The brochure Caregivers: Using the
Food Guide Pyramid for Young Children
was based on the assumption that most
caregivers have access to nutrition
education materials and have some
knowledge of the Food Guide Pyramid.
The brochure contained the new graphic
and an explanation of changes made
from the original Pyramid graphic,
including text to make clear that the
adapted Food Guide Pyramid does
not replace the original Pyramid. Also
included were a list of foods to encourage
variety in the diet and a step-by-step
food activity designed to involve young
children. The third prototype, a poster
of the adapted Food Guide Pyramid
graphic, showed foods (drawn in a real­istic
style and shown in single serving
sizes when possible) commonly eaten
by young children. The names of the
food groups were simplified, and the
number of servings was represented by
a single number rather than a range of
numbers. The symbols for fat and sugars
were eliminated, and food pictures were
used in the tip.
One week before the sessions for the
second round, parent-recruits were sent
the text of the information that was
prepared for parents; caregiver-recruits
were sent the text of the information
that was prepared for the caregiver's
1999 Vol. 12 Nos. 3&4
brochure and the parents' booklet.
The recruits were instructed to read the
material before attending their sessions;
thus, focus group time would be used
for discussion rather than be used, to
a great extent, for reading.
The same moderator who led the first
round of focus groups led the 2-hour
second-round focus groups. At each
session, following introductions and an
icebreaker, participants were shown the
prototype poster, The Food Guide Pyramid
for Young Children, after which it was
discussed and put aside. Each parent
then received the information booklet
A Parents' Guide to Using the Food
Guide Pyramid for Young Children, and
the moderator led a discussion designed
to evaluate the booklet. Caregivers were
given the brochure Caregivers: Using
the Food Guide Pyramid for Young
Children. Following a discussion to
evaluate the brochure, each caregiver
was given the parent booklet. Through­out
these sessions, the participants were
asked to read and respond to several
sections of text and to the visual
presentation of the materials.
The mini-focus group sessions with the
children began with parents and children
in the same room. Following a brief
introduction and explanation of the
process, the children were taken to a
separate room where the moderator
showed them a prototype poster of the
Food Guide Pyramid. The moderator
led the children in a discussion of the
poster and the concept of healthful
eating. The children were not asked
about the other materials intended for
adults that required an eighth-grade
reading level. As with the first round, ·
all sessions in the second round were
audio-taped, transcribed, color-coded,
and grouped according to content.
The idea of using the
graphic of the Food
Guide Pyramid as a
teaching tool, as it
turns out, was a new
concept for some
parents.
35
Results
The First Round
The 27 parent-participants in the first
round of the focus group studies had
at least one child 2 to 6 years olds; 78
percent were female. Forty-nine percent
were African American; 37 percent,
White; 11 percent, Hispanic; and 3
percent, Asian. Almost 80 percent had
attended or graduated from college;
about 40 percent had a household income
between $20,000 and $40,000. Of the
25 participants who were caregivers,
24 percent worked in in-home child­care
facilities.
As a qualitative research method, focus
groups are not projectable to any popu­lation;
however, they provide insight
into how the consumer views the world
and what the consumer thinks ( 8 ). Find­ings
from this focus group research can
be presented under four key discussion
themes: Current Feelings Toward Feeding
Young Children, Current Behavior and
Knowledge, Food Guide Pyramid, and
Nutrition and Dietary Behavior. All
quotes from participants are taken from
the unpublished reports prepared for
USDA (1).
Current Feelings Toward Feeding
Young Children. Identifying the key
concerns of parents and caregivers for
nutrition education and exploring
benefits and barriers to an improved
dietary pattern in young children
resulted in a key theme.
"One of the most important things to
teach them at an early age is to set
good standards and give them a good
foundation as they grow." (Caregiver)
36
"There are a variety of things we
try to accomplish through healthy
eating ... socialization, nutrition,
emotional stability, which are related
to food." (Caregiver)
"It's important that children learn
good nutrition habits, so as they grow
older, they will eat right instead of
eating at one fast-food place one day
and another fast-food place the next
day." (Parent)
"If you teach them now, they are more
apt to continue doing it rather than to
introduce them to healthy foods after
they have eaten years of junk food. It
is easier to do it now." (Parent)
Table 1 shows the benefits and barriers
in the descending order in which they
were mentioned by parents and care­givers.
Results showed that these parents
and caregivers think alike when
discussing the benefits of healthful
eating. They were asked: "What are the
benefits of preparing healthy meals for
younger children?" Most answered,
"good health." The second benefit
mentioned more often by both groups
was, "developing good eating habits at
an early age." Caregivers also pointed
out that children are better behaved,
have longer attention spans, and have
energy to do things when they are fed
well.
When it comes to feeding young children,
parents most often mentioned the fol­lowing
barriers to healthful eating: the
lack of time to plan and prepare meals,
inexperience in dealing with picky eaters,
and the negative influences of others.
"Time is needed in three different
places. You have to plan the meal,
purchase it, and prepare it. "
"/ need information on what to do
with an extremely picky eater who
won't eat anything."
-
"If they are with somebody else, you
don't have any control over the foods
they eat."
Caregivers seemed at ease when
discussing nutrition and how they
feed young children. Caregivers rarely
mention having difficulty with "picky
eaters." Instead, they said most children
were willing to try a new food if they
saw their friends eating the food. Several
caregivers said parents were the biggest
barrier to improving children's diets.
"It's just a lack of knowing what is
nutritious for a child. They [parents]
think that a bag of chips and a soda
are nutritious."
"Parents don't know what their
children are supposed to eat as a
balanced meal. I think it's important
that we send the information home to
the parents so that they [children]
can eat healthy and be consistent
with what we do. "
Current Behavior and Knowledge.
All groups were quite knowledgeable
about nutrition, based on the level of
discussion of most parents and care­givers.
When asked to rate themselves
on a scale of 1 to 10 on how well they
believe they provide their children with
healthful and nutritious meals, parents
rated themselves "average" to "above
average"; caregivers rated themselves
"above average" to "excellent." During
further discussion, in spite of their knowl­edge
of nutrition and ratings, many
parents expressed feeling ill-equipped
to feed their young children a healthful
diet. They knew the "why's" but not
the "how's."
Family Economics and Nutrition Review
Table 1. Benefits and barriers to improving children's diets
Parents say:
Good health
Good eating habits
Minds work better
Better attitude
Food is a key part of a loving home
Parents say:
Lack of knowledge
Lack of time to plan meals
Lack of time to prepare meals
Negative influences of others
Picky eaters
Cost of food/wasting food
"Not enough of the information
focuses on children. What we've been
doing is taking adult information and
applying it to children." (Parent)
"/ think of nutrition and feeding my
daughter as a challenge every day."
(Parent)
Most caregivers seemed both knowl­edgeable
and comfortable discussing
the "do's" and "don't's" of nutrition as
each concept related to young children;
caregivers were very comfortable with
the "how's."
"The goals of Head Start are pretty
clear that nutrition is an integral part
of the program."
During the parents' discussions, first­time
parents of very young children
were most concerned about serving
1999 Vol. /2 Nos. 3&4
Benefits to improving diets
Caregivers say:
Healthy children-less sickness
Good eating habits
Energy
Happy children-happy parents
Emotional, cognitive, social growth
Food is a key