Dietary quality among children from 6 months to 4 years, NHANES 2011-2016

Background: The US Dietary Guidelines for Americans provide dietary recommendations for individuals aged >= 2 y and metrics exist to assess alignment. Nonfederal feeding recommendations exist for children <2 y. but limited metrics and assessment of dietary quality are available. Objective: We aimed to assess dietary quality of children aged 6 mo-4 y using a modified Diet Quality Index Score (DQIS). Methods: NHANES 2011-2016 dietary data were used to estimate the dietary quality of children 6 mo-4 y old using a modified DQIS. Differences in mean modified DQIS by demographics were assessed using linear regression. Results: Mean modified DQIS +/- SE was 22.4 +/- 0.23 out of 45 possible points (50%) for children 6 mo-4 y of age on a given day. Modified DQIS scores on a given day decreased with age (27.7 +/- 0.27 for 6- to 11-mo-olds, 23.9 +/- 0.31 for 1-y-olds, 21.4 +/- 0.26 for 2- to 3-y-olds. and 20.6 +/- 0.49 for 4-y-olds; P < 0.0001 for trend). Children 6-11 mo old had 16% higher overall modified DQIS scores than 1-y-olds (P < 0.0001) and higher modified DQIS subcomponent scores for refined grains and protein. indicating higher age-appropriate intakes (P < 0.05). Similarly, children 6-11 mo old also had higher modified DQIS subcomponent scores, indicating no or limited intake, for 100% fruit juice, sugar-sweetened beverages, other added sugars. and salty snacks (P < 0.02). Conclusions: Dietary quality declines with age and may begin as early as 1 y. The modified DQIS tool could help assess the dietary quality of young children. This may be important when identifying programmatic and policy efforts aimed at establishing and maintaining healthy dietary patterns beginning at an early age.