Historically, the Dietary Guidelines for Americans has focused on nutrition and food-based recommendations for health promotion and disease prevention for individuals ages 2 years and older. The Dietary Guidelines has not provided comprehensive dietary guidance for women during pregnancy or infants and toddlers under 2 years of age.

Over the years, there has been a growing demand to address the relationship between early child nutrition and health outcomes throughout the lifespan. Proper nutrition during the earliest stages of life is critical to support healthy growth and development during childhood and help promote health and prevent chronic disease through adulthood.

In 2012, the U.S. Department of Agriculture (USDA) and Department of Health and Human Services (HHS) initiated a project informally called the “B-24 project.” This multi-phase project was originally intended to conclude in 2018 with information that could help the Departments develop dietary recommendations for infants and toddlers for release separate from the Dietary Guidelines. The first phase was completed in 2012-2013.

In February 2014, Congress passed the Agricultural Act of 2014, also known as the Farm Bill, mandating that the Dietary Guidelines expand to include dietary guidance for infants and toddlers (from birth to age 24 months), as well as women who are pregnant, beginning with the 2020-2025 edition. Thus, USDA and HHS adjusted the purpose, timeline, and scope of the project. Now called the “Pregnancy and Birth to 24 Months project” or “P/B-24 project” to reflect the addition of pregnant women, this project is a joint initiative led by USDA and HHS in collaboration with programmatic and scientific experts. Rather than concluding in 2018 with dietary recommendations, the goal of the current project is to conduct a small number of systematic reviews on diet and health that are of public health importance for women who are pregnant and infants and toddlers from birth to 24 months of age. The findings from this work will be published in a peer-reviewed journal and made publicly available at the completion of the project.

It is important to note that the P/B-24 project is not a formal step of the 2020-2025 Dietary Guidelines process. Developing dietary guidance for these populations will be part of the 2020-2025 Dietary Guidelines process. More information on the process to develop the 2020-2025 Dietary Guidelines is available at www.DietaryGuidelines.gov.

Questions and Answers:

What came out of the first phase of the B-24 project?

From 2012-2013, the HHS Office of Disease Prevention and Health Promotion (ODPHP) and USDA Center for Nutrition Policy and Promotion (CNPP) partnered with the HHS National Institutes of Health (NIH) to explore areas that may have potential relevance to future dietary guidance for the birth to 24 months of age population. More specifically, research gaps, data needs, and potential systematic review questions for this population were identified. More information is available here.

Will you take comments for the P/B-24 project?

When the B-24 project originated in 2012, the goal was for the Departments to create dietary recommendations for children from birth to 24 months of age for release in 2018, separate from the Dietary Guidelines, which is why a call for public comments was included in the original timeline. However, when the 2014 Farm Bill was released, it mandated that the Dietary Guidelines expand to include dietary guidance for infants and toddlers (from birth to age 24 months), as well as women who are pregnant, in the 2020-2025 edition. Therefore, USDA and HHS adjusted the purpose, timeline, and scope of the project – to explore the area, not to develop dietary recommendations. Thus, the call for public comments has been deferred to the 2020-2025 Dietary Guidelines process. More information on the process to develop the 2020-2025 Dietary Guidelines is available at www.DietaryGuidelines.gov.

Will the P/B-24 project form the scientific basis of dietary guidance for infants, toddlers, and women who are pregnant?

The current work includes identifying topics of public health importance and conducting a small number of systematic reviews on diet and health for infants, toddlers, and women who are pregnant (expected to be completed in 2018); it will not include specific dietary recommendations or advice. The scientific basis for dietary guidance for these population groups will be informed by the advisory report of the 2020 Dietary Guidelines Advisory Committee.

What systematic review questions are being answered in the P/B-24 project?

Based on Federal policy and program needs, nutritionists from across USDA and HHS helped to prioritize the small number systematic review questions to be address through the P/B-24 project. USDA’s Nutrition Evidence Library is collaborating with programmatic and scientific experts in nutrition during pregnancy and early childhood to conduct systematic reviews on the questions listed below.

• What is the relationship between infant milk feeding practices(a) and 1) food allergies and other atopic allergic diseases; 2) chronic disease (risk of cardiovascular disease, diabetes, celiac disease, and inflammatory bowel disease); and 3) childhood leukemia?
• What is the relationship between complementary feeding(b) and 1) micronutrient status; 2) growth, size, and body composition; 3) developmental milestones; 4) food allergies and other atopic allergic disease; and 5) bone health?
• What is the relationship between repeated exposure to foods(c) and early food acceptance?
• What is the relationship between maternal diet(d) and infant/toddler food acceptance and dietary intake?
• What is the relationship between parental and caregiver feeding practices(e) and growth, size, and body composition outcomes?
• What is the relationship between dietary patterns(f) before and during  pregnancy and 1) risk of gestational diabetes; 2) risk of hypertensive disorders during pregnancy; 3) gestational age at birth; and 4) gestational age- and sex-specific birth weight?

When will the products of the P/B-24 project be published?

The systematic reviews conducted as part of the P/B-24 project are expected to be completed in 2018. These systematic reviews, along with detailed information about the methods used to conduct them, will be peer-reviewed externally and published in a journal. The supplement is expected to be published in the winter/spring of 2019. Additional documentation for each systematic review will also be available on our website.

Will the products of the P/B-24 project be used by the next Dietary Guidelines Advisory Committee?

The information that comes from this project will be made public. Similar to existing systematic reviews and reports created by other organizations, the next Advisory Committee will determine if and how it may include this information as part of its own review of the science for the topics and questions included in its charge.
 

(a) Aspects of infant milk-feeding practices to be examined are: a) shorter vs longer durations of any human milk feeding, b) shorter vs longer durations of exclusive human milk feeding (prior to the introduction of infant formula for outcome 1 only), c) never vs ever feeding human milk, d) feeding lower vs higher intensity/proportion/amount of human milk to mixed-fed infants, and e) feeding a higher intensity/proportion/amount of human milk at the breast vs by bottle (for outcome 1 only).

(b) Aspects of complementary feeding to be examined are: a) timing of introduction of complementary foods and b) types and amounts of complementary foods; complementary foods include foods other than human milk or infant formula (liquids, semisolids, and solids).

(c) Aspects of exposure to foods to be examined are: a) timing, b) quantity, and c) frequency

(d) Aspects of maternal diet to be examined are: a) maternal diet during pregnancy and amniotic fluid flavor and b) maternal diet in lactating women and human milk flavor.

(e) Feeding practices are defined as the strategies or behaviors parents use to direct child eating; aspects of feeding practices include control, pressure, restriction, monitoring, and responsiveness to satiety and hunger cues.

(f) Dietary patterns are defined as the quantities, proportions, variety, or combinations of different foods and beverages in diets, and the frequency with which they are habitually consumed. Aspects of dietary patterns to be examined are a) different levels of adherence to a particular dietary pattern and b) adherence to different dietary patterns.