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To test the effect of different schedules of repeated exposure to a novel food on infants' consumption of the novel food. Fifty-nine infants (mean [SD] age = 11 months [2]; 41% female) caregiver (age = 32 years [4]; 20% Hispanic) dyads were enrolled in the Healthy Starts Study and randomly assigned to 1 of 3 repeated exposure schedules with artichoke as the novel food: (1) 10 exposures over 2 weeks (standard), (2) 5 exposures over 2 weeks, a 2-week break, then 5 more exposures over 2 weeks (take-a-break); or (3) 10 exposures over a 6-week period (extended). Consumption (g) was measured in a laboratory setting at baseline, postintervention, and after a 6-week extinction period. Mixed-effects models tested schedule effect on change in amount consumed between baseline and postintervention, with adjustment for child age and sex. Fifty-four dyads completed all visits (standard = 17, take-a-break = 20, extended = 17; 91% retention). At baseline, consumption did not differ among repeated exposure schedules. At postintervention, consumption in the standard schedule did not change (26.8 g [∼1.8 tbsp] to 22.9 g [∼1.5 tbsp]), whereas infants in the take-a-break and extended schedules significantly increased consumption (P = .024; baseline to postintervention; take-a-break: 21.1 g [∼1.4 tbsp] to 43.6 g [∼3.0 tbsp]; extended: 20.7 g [∼1.4 tbsp] to 33.6 g [∼2.0 tbsp]). Standard, intense exposure did not change consumption, yet less frequent exposure over a longer duration resulted in sustained increases in children's consumption of the novel food. Thus, persistence, rather than intensity of exposure, may offer greater benefit for improving infants' acceptance of novel foods. Healthy Starts Study, ClinicalTrials.gov: NCT05639361.

Objectives: The transition to complementary feeding represents an important interval in child nutrition and development. Nutrient demands for growth are high, yet less is known regarding how caregivers make decisions regarding the introduction of solid foods to their infants and what influences their choices and feeding practices. Methods: Semi-structured interviews were conducted via Zoom with caregivers (N = 46, 83% mothers) of typically developing children (6-24 months of age) residing in the United States. A content analytic approach, with consensus coding performed by team members, was undertaken. The Developmental Niche framework guided thematic analysis. Results: Four major themes and four subthemes were identified: (1) Caregivers' Approach Introducing Solid Foods with Anticipation and Concern, including subthemes of the (a) timing and order of complementary foods (CF) offered to children and (b) foods caregivers avoid offering; (2) Caregivers' and Children's Learning, including subthemes of (a) children's rapid learning and skill development, and (b) the concurrent rapid demands for changes in food parenting; (3) Drivers of Caregivers' Decisions Related to Offering Solid Foods to their Children; and (4) The Goal of CF: Integration of the Child into Family Mealtimes. Conclusions: Caregivers seek to provide adequate nutrition while balancing children's health needs with the challenge of encouraging acceptance of family foods and respecting individual preferences. Juggling myriad demands (e.g., time, convenience, other family members, cultural traditions, and expectations), caregivers seek to help their children develop a healthy relationship with food.

The 1st Foods Study identified factors associated with caregivers' decisions about when to introduce meat, specifically beef, a food rich in iron and zinc, to their children. Caregivers of 6-24-month-old children across the U.S. completed a survey on dietary habits, attitudes, and complementary food introduction, with a focus on the timing of meat introduction and the factors that influenced it. On average, caregivers introduced meat at ∼9 months, later than other food groups. Those who had not introduced meat breastfed longer (Mean = 10.0 mo, SE = 0.5) than those who had (Mean = 8.6 mo, SE = 0.3, p = 0.026). Caregivers were divided into groups based on the timing of beef introduction: Early (4-6 months, n = 52), Majority (7-11 months, n = 151), and Late (≥12 months, n = 85). Analyses of variance and chi-square tests identified group differences, and a multinomial regression with backward elimination identified predictors of the timing of beef introduction. Relative to the Majority group, children who enjoyed food more (p = 0.002), were fussier eaters (p = 0.024), and had a caregiver who ate meat more frequently (p = 0.010) had a greater odds of being in the Early group. The odds of being in the Late group were greater for children with older caregivers (p = 0.001), who had a weaker overall attachment to meat (p = 0.012), chose food based on familiarity (p = 0.017), and used food as a reward when feeding their child (p = 0.041). Delaying meat and beef introduction raises questions about the nutritional adequacy of children's diets, especially for those who are breastfed. Understanding factors that predict caregivers' decisions about when to introduce meat can aid in developing strategies to ensure adequate nutrition for young children.

Preconception diet and nutritional status are important determinants of reproductive and pregnancy health. As a comprehensive evaluation, this paper describes harmonization of diet data across multiple cohorts including over 50,000 participants and the differences between them. This information may be useful for developing targeted strategies to improve women's diet prior to pregnancy for optimal prenatal health outcomes. The Preconception Period Analysis of Risks and Exposures influencing health and Development (PrePARED) consortium incorporates studies covering the preconception period and includes both couples planning pregnancy and studies covering the reproductive period but not focused on pregnancy. We harmonized data on 56,520 participants from seven cohort studies that collected data during the preconception period. We generated data on diet quality according to the International Federation of Gynecology and Obstetrics (FIGO) nutrition checklist to examine diet quality measures across the cohorts and compare estimates of diet quality across studies. Four studies used food frequency questionnaires; one used a study-specific diet history; one used two 24 h dietary recalls; and one used a short series of general diet questions. Positive responses on the six FIGO questions were tallied to calculate a total diet quality score. Cohort samples varied in terms of age; socioeconomic status; race; ethnicity; and geographic region. Across the cohorts, participants met a median of three or four of the FIGO criteria for diet quality; those most commonly met were recommendations for consumption of meat and protein, while those least commonly met were recommendations for limiting consumption of processed foods and snacks. There was greater variation in meeting recommendations for the consumption of fruits and vegetables; dairy; fish; and whole grains. The percentage meeting ≤ 2 criteria ranged from 6.4% (Coronary Artery Risk Development in Young Adults) to 40.4% (Bogalusa Heart Study). There was wide variability across preconception cohort studies in the extent to which participants met FIGO dietary guidelines. Although studies were conducted in populations that were not likely to be malnourished, it was rare for women to meet all the preconception dietary recommendations. These findings illustrate a need for strategies to promote meeting dietary guidelines prior to conception to improve health outcomes.

Exposure to deleterious stressors in early life, such as poor nutrition, underlies most adult-onset chronic diseases. As rates of chronic disease continue to climb in the United States, a focus on good nutrition before and during pregnancy, lactation, and early childhood provides a potential opportunity to reverse this trend. This report provides an overview of nutrition investigations in pregnancy and early childhood and addresses racial disparities and health outcomes, current national guidelines, and barriers to achieving adequate nutrition in pregnant individuals and children. Current national policies and community interventions to improve nutrition, as well as the current state of nutrition education among healthcare professionals and students, are discussed. Major gaps in knowledge and implementation of nutrition practices during pregnancy and early childhood were identified and action goals were constructed. The action goals are intended to guide the development and implementation of critical nutritional strategies that bridge these gaps. Such goals create a national blueprint for improving the health of mothers and children by promoting long-term developmental outcomes that improve the overall health of the US population.

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