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Detailed data on food and nutrient intakes and dietary patterns in young children require other methods and sources of data. National individual-level dietary intake surveys generally use multiple-day interviewer-assisted 24-h recalls or detailed diet diaries to estimate nutrient intakes and evaluate food patterns, but even with comprehensive surveys, not all include intakes of young children. For example, Huybrechts et al. [3] identified 39 national individual-level food consumption surveys globally, but less than half included children under the age of 5 years. Out of 18 countries with national surveys in Europe (2000–2016), only two-thirds reported energy and nutrient intakes for children ≤5 years [4].

Other large-scale surveys, such as the Feeding Infants and Toddlers Study (FITS) [11] and the South East Asian Nutrition Survey (SEANUTS) [12], include detailed dietary assessments of young children. FITS is a cross-sectional study in the US started in 2002, with subsequent surveys collected in 2008 and 2016. FITS provides comprehensive dietary intake data for infants, toddlers, and young children from birth up to the age of 4 years. A similar approach was used in China for the Maternal Infant Nutrition Growth (MING) study [13, 14]. FITS has also been used as a model to analyze national survey data on toddlers and young children from other countries, including Mexico [15, 16], Russia [17], and the Philippines [18]. SEANUTS was conducted in Indonesia, Malaysia, Thailand, and Vietnam, and included data from children 6 months to 12 years of age; data from Indonesia are included here as an example [19]. Survey data from a multicenter study in 9 cities in Brazil [20] and nationwide samples of German toddlers [21, 22] are also included for comparison purposes.

Fig. 1. Macronutrient distribution in toddlers and young children in selected countries.

When looking at the detailed dietary intake studies, we find wide ranges in energy intakes for 2- to 3-year-old children, with lower intakes in the Philippines (839 kcal/day) [18] and Indonesia (965 kcal/day) [19], and higher intakes in Brazil (1,650 kcal/day) [20], the USA (1,397 kcal/day) [23], and Mexico (1,367 kcal/day) [16]. Energy intakes were intermediate in children 2–3 years old from Russia (1,243 kcal/day) [17], Germany (1,075 kcal/day) [21], and China (1,189 kcal/day) [13]. Energy intakes corresponded to higher rates of stunting in the Philippines, and higher rates of overweight and obesity in Brazil, North America, and Europe [2]. The distribution of energy from protein, fat, and carbohydrates also differs by country, with higher carbohydrate and lower fat intakes in Southeast Asia (Fig. 1).

Dietary fiber and vitamin D intakes are generally below recommendations for toddlers and young children, though vitamin D is not reported for every country (Table 2). Other nutrient gaps differ by country and are related to food availability and local dietary habits. For example, US children 2–4 years old regularly consume dairy products [24], and <10% (6.4% of children 24–35 months old and 9.2% of those 36–47 months old) fall below recommendations for calcium intakes [23]. In contrast, in the Philippines and Indonesia, where consumption of dairy foods is rare, 66–84% of children 2–4 years old fall below calcium recommendations [18, 19]. For vitamin E, we see relatively low levels of inadequacy in China (6%), moderate inadequacy for the US (32%) and Germany (43%), and high levels of inadequacy for the Philippines (>90%). Iron intakes are below recommendations for the majority of children in Indonesia (83%), the Philippines (75%), and Russia (64%), in contrast to those living in the USA, Mexico, and Brazil, where <5% are below recommendations.

In addition to nutrient intakes, detailed food consumption surveys can be analyzed to gain insights into dietary patterns, including amounts consumed from different food groups [24], food sources of energy and nutrients [14, 15, 18], or patterns of consumption, such as milk [17, 25] and beverage consumption [26, 27]. For example, we have been able to demonstrate the important role that fortified milk plays in the diet of young children in the Philippines [25] and have modeled the impact of fortified milk in reaching dairy recommendations in China [28]. These types of analyses provide insights into why certain nutrients may be below (or above) recommended levels and help to better understand the impact of potential changes to dietary habits for children in different countries of the world.