Commentary From the Committee on Nutrition
The American Academy of Pediatrics (AAP) formed the Committee on Nutrition in 1954. The committee’s charge was to “concern itself with standards for nutritional requirements, optimal practices, and the interpretation of current knowledge as these affect infants, children, and adolescents.” Since 1954, the committee has published many manuscripts on a wide variety of nutrition topics in pediatrics. Many of the early works represent the very basic fundamentals of pediatric nutrition. As time progressed, the focus sharpened to specific issues in nutrition that needed to be addressed. Deciding which articles to review involved communicating with several former committee chairs. For the more recent publications, I also asked our legislative experts which publications had produced an impact on legislation and regulations from our government. Reviewing these seminal publications revealed that the committee had helpful insights to share and rarely had to change their recommendations. When they did, it was always because new data had emerged in an area that had previously relied on expert consensus. I encourage the readers to return to these manuscripts. The continued relevance is amazing.
Nutrition Committee Statements That Made a Difference
Mark R. Corkins, MD, FAAP
Affiliation: Le Bonheur Children’s Hospital, University of Tennessee Health Science Center, Memphis, TN
1948-October 1973
Highlighted Articles From Pediatrics
- Lowe CU, Pessin V. The conduct of clinical trials of substances proposed for the nutrition of infants and children; including a critique of the nitrogen balance technique for measuring protein anabolism. Pediatrics. 1957;19(4):694-700
- Committee on Nutrition, Clement DH, Forbes GB, Fraser D, et al. Composition of milks. Pediatrics. 1960;26:1039-1049
In this first quarter century, legends led the AAP Committee on Nutrition. The work during this era is the foundation for everything we do now. Early in the life of the committee, Drs. Lowe and Pessin wrote a paper that recognized the importance of providing guidance on how nutrition studies should be done. This manuscript is remarkable because it suggests parameters that should be measured and compared in nutrition studies. The authors also do a remarkable job of discussing the basics (including statistics) that actually apply to any clinical research study. This article would be valuable reading for anyone that plans on performing clinical research.
One of the most important manuscripts produced in the era was in 1960 when the Committee on Nutrition published a state-of-the-art review about the composition of milk. This work was very valuable because it compared the nutritional content of human and cow milk. The authors even provided information about the composition and production of human milk over time and under different circumstances, for instance, at different times of day and even between breasts. They cited the lack of sufficient literature on some of the topics. Unfortunately, in some areas the literature has not advanced since 1960.
November 1973-October 1998
Highlighted Articles From Pediatrics
- Fomon SJ, Filer LJ Jr, Anderson TA, Ziegler EE. Recommendations for feeding normal infants. Pediatrics. 1979;63(1):52-59
- Committee on Nutrition. The use of whole cow’s milk in infancy. Pediatrics. 1992;89(6):1105-1109
This is the era when the Committee on Nutrition began to assess basic day-to-day topics related to nutrition. In 1979, the Committee on Nutrition published their recommendations for feeding of normal infants but admitted that the recommendations were based on few data and a lot of opinion. They clearly stated an expectation that the recommendations would change as new information became available. This paper outlined the prevailing opinion that for the first 6 months of life the infant should be reliant on formula or breast milk as their primary source of nutrition. Solids should be delayed until 5-6 months of age, when the infant could indicate they were full. This manuscript did allow feeding evaporated milk formula to infants and the use of whole cow’s milk after 6 months of age, which was later admitted to be an injudicious recommendation. Notably, this paper was ahead of its time because the authors recommended avoiding juices in infants and continuing breastfeeding through the second year of life.
One of the most frequently downloaded articles from the committee was published in 1992. This manuscript admits that clinical studies had resulted in a change in the recommendations for infant nutrition. The use of evaporated milk or whole milk did not supply enough iron for infants during the second 6 months of life. The literature had shown that the use of whole cow’s milk was associated with nutritionally significant loss of iron in the stool. In a foreshadowing of more modern recommendations, they cited “new” studies suggesting that early iron deficiency resulted in behavioral changes that did not resolve with later iron intervention. Therefore, the committee firmly recommended that infants should ideally be fed breast milk until at least a year of age with iron-fortified infant formula as the sole acceptable alternative.
November 1998-Present
Highlighted Articles From Pediatrics
- Committee on Nutrition. Iron fortification of infant formulas. Pediatrics. 1999;104(1):119-123
- Committee on Nutrition. The use and misuse of fruit juice in pediatrics. Pediatrics. 2001;107(5):1210-1213
- Schwarzenberg SJ, Georgieff MK. Advocacy for improving nutrition in the first 1000 days to support childhood development and adult health. Pediatrics. 2018;141(2):e20173716
In the last quarter century, the Committee on Nutrition began to focus on issues that had important public policy implications. Three articles in this modern era had a major impact on nutrition policies and practice.
In 1999, the committee published a statement on iron fortification of infant formula. After this publication presented the data about the importance of adequate iron for infant nutrition, manufacturers ceased production of and pediatricians no longer recommended low-iron formulas.
Then in 2001, the committee published a statement on the hazards of fruit juice in infants. That led to the removal of juices from the WIC packages.
One of the most cited publications and one that is still influencing public policy today is the 2018 publication that presented the latest scientific data, which demonstrated the crucial role of appropriate nutrition in the 1,000 days from conception with respect to optimizing child development and programming the long-term health of the child. This article led to the Birth to 24 months (B-24) initiative to develop dietary guidelines for the previously neglected second year of life. It also has been used to advocate for public health investment in early nutrition programs during this crucial window of life.
