There is only limited nationally representative data in the United States (US) available on dietary supplement use and the subsequent nutrient exposures among infants. In the United Kingdom (UK) a scarcity of data also exists. A new study in the Journal of Nutrition has investigated the use of dietary supplements in infants in the US. This study characterises supplement use, estimates nutrient intake from the supplements and also assess trends in supplement use over time.
Nutrition in the Young
Optimal nutrition is essential for the healthy growth and development of infants and young children, especially during the critical period of rapid growth from birth to 24 months. Dietary supplements may be beneficial for certain subgroups of the population to help them obtain adequate amounts of key nutrients. In the US, The American Academy of Pediatrics (AAP) recommends a vitamin K supplement immediately after birth for all infants, vitamin D supplementation for all breastfed and partially breastfed infants, and iron supplementation beginning around 4 months for healthy infants born at term who are either fully or partially breastfed.
National Health and Nutrition Examination Survey
The National Health and Nutrition Examination Survey (NHANES) is a nationally representative cross-sectional survey of the civilian, non-institutionalised US population, conducted by the CDC’s National Center for Health Statistics (NCHS). Data was collected on dietary intake from foods, beverages, and supplements. This data gave the opportunity to estimate nutrient intake from all sources for the US population, including infants from birth to 24 months. A total of 2823 infants up to 24 months of age were included in this analysis.
This survey was utilised by the authors, Jaime J Gahche et al, to characterise the use of supplements, their nutrient contributions and time trends among US infants from birth to 24 months. The information garnered from the survey is important for the development of nutritional guidance and for informing other clinical and research applications for infants.
Supplement Use in Infants (0-24 months of age)
The most common supplements used in infants aged 0–5.9 months and 6–11.9 months were vitamin D only products (drops) and infant multivitamin drops. Chewable multivitamin products were most popular in infants aged 12–23.9 months. Hence, the number of micronutrients consumed from supplements increased with age and the form of product tended to shift from drops to chewable forms.
The micronutrients most frequently consumed from supplements were vitamins D, A, C, and E. For infants aged 0–5.9 months, a higher percentage of those fed breast milk than those fed formula consumed these nutrients via supplements. Supplement use remained steady for infants aged 6–11.9 months, but increased from 7% to 20% for infants aged 0–5.9 months from 1999–2014. Among those aged 1–2 years, the prevalence of any supplement use decreased from 54.8% to 30.9%. It is thought that the decrease in supplement use since the early 1970s could partly be due to the increase in commercial infant formulas containing all micronutrients required. These formulas became increasingly popular after the Infant Formula Act of 1980 was passed, making supplementation of commercial formula fed infants unnecessary.
Approximately 10% of infants aged 0–5.9 months consumed a vitamin D only product and approximately 8% consumed vitamin D as part of a multivitamin product. Data also highlighted that only 24% of breast milk fed infants <6 months old were using a vitamin D–containing supplement even though this micronutrient supplementation is recommended by the AAP.
Characteristics associated with any supplement usage were non-Hispanic white race, higher household income, higher educational status of the head-of-the-household, and consumption of breast milk.
The major reasons reported for taking supplements were to maintain health, supplement the diet due to food not being adequate enough and to improve overall health. Over half reported taking a product recommended by a physician or health care provider. For young infants aged 0–5.9 months and older infants aged 6–11.9 months, 84.8% and 76.3%, respectively, were given a product recommended by a doctor or another health professional. A significantly lower proportion of infants aged 12–23.9 months (45.9%) were taking a product that was recommended by a doctor or another health professional compared with both younger and older infants.
Final Thoughts on the NHANES Analysis
This is thought to be the first report characterising the supplement use among infants <2 years of age. It uses the most recent available population-based nationally representative data in the US from NHANES. Significantly, in the US, almost 1 in 5 infants (18%) <2 years of age use one or more supplement. Supplement use was higher among those aged 12–23.9 months than younger infants, and the type of supplement taken ie, drops to chewable tablets, changed with age. Surprisingly only a quarter of infants aged 0–5.9 months who were solely breast fed were taking a supplement containing vitamin D, the AAP recommend vitamin D supplementation for infants solely fed breast milk.
The information provided from population-based national data studies, like NHANES, is vital in collating information on the source of nutrient intakes, to ascertain whether dietary recommendations are being met, and also to track changes over time.
A similar study providing detailed high-quality data in the UK is merited to determine the UK population’s use of supplements from birth onwards. Furthermore, the continued monitoring of supplement use among infants is warranted.
Where are we on Supplement use in the Young in the UK?
It is know that growing children require certain vitamins and minerals, and when children don’t eat a varied diet they may not be consuming enough vitamins A and C. Furthermore, it is very hard to get enough vitamin D through food alone and the UK climate does not lend itself to aid in vitamin D absorption. That’s why the Department of Health recommends that all children aged 6 months to 5 years are given vitamin supplements containing vitamins A, C and D daily. Furthermore, the Department of Health also recommends that babies who are breastfed should be given a daily vitamin D supplement from birth. However, babies who are consuming more than 500ml of infant formula a day should not be given vitamin supplements due to infant formula being fortified with the required vitamins and minerals.
The Department of Health Recommendations:
• Babies from birth to 1 year of age who are being breastfed should be given a daily supplement containing 8.5 to 10 micrograms of vitamin D to make sure they get enough.
• Babies fed infant formula shouldn’t be given a vitamin D supplement if they’re having more than 500ml of infant formula a day.
• Children aged 1 to 4 years old should be given a daily supplement containing 10 micrograms of vitamin D.
Vitamins A and C
• Vitamin supplements containing vitamins A and C are recommended for babies and children aged 6 months to 5 years old, unless they’re getting more than 500ml of infant formula a day.
It is important for children to eat a well-rounded, healthy and varied diet to ensure that they are getting all the nutrients they require for energy and to grow and develop properly. When reinforcing this with supplements it is important for parents and carers to check product formulations to ensure that the recommended level of micronutrients are achieved.
Jaime J Gahche et al (2019) Dietary Supplement Use among Infants and Toddlers Aged <24 Months in the United States, NHANES 2007–2014. The Journal of Nutrition, Volume 149, Issue 2, pp 314–322.
Baker RD et al (2010) Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0–3 years of age). Pediatrics 126(5):1040–50.
Wagner CL et al (2008) Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics 122(5):1142–52.