Talking to Patients about the Benefits of Diet Diversity in Early Life

By Dr. Carina Venter, PhD, RD, Associate Professor, Pediatrics-Allergy/Immunology, University of Colorado School of Medicine

Early life nutrition plays an important role in modulating the microbiome, training the immune system and helping to prevent diseases later in life. This article introduces the important concept of Diet Diversity early in life, discusses its lifelong benefits, and provides talking points for clinicians to use with families to help support them on their infant feeding journey. 

Diet Diversity - What It Is and Why It Is Important 

Diet diversity is gaining traction as a critical, but often overlooked component of infant and early life nutrition. It is defined as the number of different foods, food groups or food allergens eaten over the first year of life.

Given the importance of dietary diversity, it is unfortunate that most commercially available infant foods lack in dietary diversity, and most notably, do not contain allergenic foods that should be introduced early in life [1]. Parents must actively take care to ensure their children benefit from a diverse diet early in life. 

The Many Benefits of Dietary Diversity 

It is important for children to consume a diverse diet because it may indicate a better quality diet. Diet diversity early in life has been shown to positively affect the microbiome[2] and nutrient intake [3-12]. Studies have also shown some association between diet diversity and positive growth outcomes [4, 12-19], for example height for age scores. Importantly, a more diverse diet may also reduce the likelihood the child will become obese. [21-23]

Dietary Diversity and Food Allergies

Research supports that regularly eating a diversity of food allergens may help a baby safely eat these foods for life. 

One study in particular showed that increased food allergen diversity (number of food allergens eaten; milk, egg, wheat, fish, soy, peanut, tree nuts, sesame) during the first year of life is associated with reduced food allergy outcomes in later childhood. In fact, for each additional food introduced by 6 months, the odds of developing food allergy over the first 10 years of life were reduced by 10.8%. Similarly, for each additional allergenic food consumed by 1 year, there was a significant reduction of 33.2% in the likelihood of food allergy over the first 10 years of life.  

Clinician Talking Points to Help Families with Dietary Diversity

1. The variety of foods matter.  A variety of food is more important than the amount of food. Even for young babies who have just started eating, it is better to feed 1-2 teaspoons of different fruits, vegetables and grains than to only feed cereal for 3-5 days or longer.
2. Allergens included. Most commercially available infant foods do not contain a diversity of common allergens. Parents should supplement with the most commonly allergenic foods: peanuts, tree nuts (almonds, cashews, hazelnuts, pecans, pistachios, and walnuts), milk, shellfish (shrimp), egg, fish (cod and salmon), grains (oats and wheat), soy, and sesame.
3. Consistency is key: Once an allergen has been introduced, it should stay in the diet. Like any great habit, research shows the immune system works best when it’s exposed to a wide variety of foods regularly throughout a child’s early years. 
4. Diverse diet has diverse benefits.  A healthy and diverse diet has benefits beyond the immune system and allergic conditions. A diverse diet indicates that the child has a better quality diet by eating more nutrients. This is important for growth and development. 
5. Decrease obesity risk. Increased diet diversity may also reduce the likelihood that the child will become obese – but remember that the diet has to contain a variety of healthy foods such as vegetables, fruits, grains, dairy, healthy fats and protein foods opposed to unhealthy foods.
6. Every food counts!  There are no cut-offs for high and low diversity. If toddlers become extremely picky or food allergic children are afraid of trying new foods, just remember, every food counts. Eating five foods is better than eating four. 

About the author: Dr. Carina Venter is a PhD Registered Dietician and Associate Professor of Pediatrics in Allergy and Immunology at University of Colorado School of Medicine. She has focused her research and clinical practice over the past 20 years on the prevention, diagnosis and management of food allergies and other allergic diseases.

Sources: 

1. Netting MJ, Gold MS, Palmer DJ. Low allergen content of commercial baby foods. J Paediatr Child Health. 2020;56(10):1613-1617.

2. Laursen, M.F., et al., Infant Gut Microbiota Development Is Driven by Transition to Family Foods Independent of Maternal Obesity. mSphere, 2016. 1(1).

3. Kant, A.K., Indexes of overall diet quality: a review. Journal of the American Dietetic Association, 1996. 96(8): p. 785-91.

4. Ruel, M.T., IS DIETARY DIVERSITY AN INDICATOR OF FOOD SECURITY OR DIETARY QUALITY? A REVIEW OF MEASUREMENT ISSUES AND RESEARCH NEEDS. International Food Policy Research Institute, 2002: p. 1-58.

5. Hatloy, A., et al., Food variety, socioeconomic status and nutritional status in urban and rural areas in Koutiala (Mali). Public Health Nutr, 2000. 3(1): p. 57-65.

6. Hatloy, A., L.E. Torheim, and A. Oshaug, Food variety--a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. Eur J Clin Nutr, 1998. 52(12): p. 891-8.

7. Kennedy, G., Ballard, T., Dop, M., Guidelines for measuring household and individual dietary diversity. Nutrition and Consumer Protection Division, Food and Agriculture Organization of the United Nations, 2011: p. 1-60.

8. Ogle, B.M., P.H. Hung, and H.T. Tuyet, Significance of wild vegetables in micronutrient intakes of women in Vietnam: an analysis of food variety. Asia Pac J Clin Nutr, 2001. 10(1): p. 21-30.

9. Steyn, N.P., et al., Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy? Public Health Nutr, 2006. 9(5): p. 644-50.

10. Mirmiran, P., et al., Dietary diversity score in adolescents - a good indicator of the nutritional adequacy of diets: Tehran lipid and glucose study. Asia Pac J Clin Nutr, 2004. 13(1): p. 56-60.

11. Foote, J.A., et al., Dietary variety increases the probability of nutrient adequacy among adults. J Nutr, 2004. 134(7): p. 1779-85.

12. Arimond, M., et al., Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings. J Nutr, 2010. 140(11): p. 2059S-69S.

13. Sawadogo, P.S., et al., An infant and child feeding index is associated with the nutritional status of 6- to 23-month-old children in rural Burkina Faso. J Nutr, 2006. 136(3): p. 656-63.

14. Motbainor, A., A. Worku, and A. Kumie, Stunting Is Associated with Food Diversity while Wasting with Food Insecurity among Underfive Children in East and West Gojjam Zones of Amhara Region, Ethiopia. PLoS ONE [Electronic Resource], 2015. 10(8): p. e0133542.

15. Savy, M., et al., Measuring dietary diversity in rural Burkina Faso: comparison of a 1-day and a 3-day dietary recall. Public Health Nutr, 2007. 10(1): p. 71-8.

16. Savy, M., et al., Are dietary diversity scores related to the socio-economic and anthropometric status of women living in an urban area in Burkina Faso? Public Health Nutr, 2008. 11(2): p. 132-41.

17. Chandrasekhar, S., et al., Household food insecurity and children's dietary diversity and nutrition in India. Evidence from the comprehensive nutrition survey in Maharashtra. Maternal & Child Nutrition, 2017. 13(2).

18. Wright, M.J., et al., The interactive association of dietary diversity scores and breast-feeding status with weight and length in Filipino infants aged 6-24 months. Public Health Nutrition, 2015. 18(10): p. 1762-73.

19. Ey Chua, E.Y., et al., Dietary diversity is associated with nutritional status of Orang Asli children in Krau Wildlife Reserve, Pahang. Malaysian Journal of Nutrition, 2012. 18(1): p. 1-13.

20. Onyango, A., K.G. Koski, and K.L. Tucker, Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. International Journal of Epidemiology, 1998. 27(3): p. 484-9.

21. Vadiveloo, M., N. Parekh, and J. Mattei, Greater healthful food variety as measured by the US Healthy Food Diversity index is associated with lower odds of metabolic syndrome and its components in US adults.[Erratum appears in J Nutr. 2015 Jun;145(6):1373 Note: Parkeh, Niyati [Corrected to Parekh, Niyati]; PMID: 26034066]. Journal of Nutrition, 2015. 145(3): p. 564-71.

22. Vadiveloo, M., et al., Dietary variety is inversely associated with body adiposity among US adults using a novel food diversity index. Journal of Nutrition, 2015. 145(3): p. 555-63.

23. Mok, E., et al., Diet diversity, growth and adiposity in healthy breastfed infants fed homemade complementary foods. International Journal of Obesity, 2017. 41(5): p. 776-782.