Fruit, Vegetable, and Sugar-Sweetened Beverage Intake Among Young Children, by State — United States, 2021

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Good nutrition in early childhood supports optimal growth, development, and health (1). Federal guidelines support a dietary pattern with daily fruit and vegetable consumption and limited added sugars, including limited consumption of sugar-sweetened beverages (1). Government-published dietary intake estimates for young children are outdated at the national level and unavailable at the state level. CDC analyzed data from the 2021 National Survey of Children’s Health (NSCH)* to describe how frequently, according to parent report, children aged 1–5 years (18,386) consumed fruits, vegetables, and sugar-sweetened beverages, nationally and by state. During the preceding week, approximately one in three (32.1%) children did not eat a daily fruit, nearly one half (49.1%) did not eat a daily vegetable, and more than one half (57.1%) drank a sugar-sweetened beverage at least once. Estimates of consumption varied by state. In 20 states, more than one half of children did not eat a vegetable daily during the preceding week. In Vermont, 30.4% of children did not eat a daily vegetable during the preceding week, compared with 64.3% in Louisiana. In 40 states and the District of Columbia, more than one half of children drank a sugar-sweetened beverage at least once during the preceding week. The percentage of children drinking sugar-sweetened beverages at least once during the preceding week ranged from 38.6% in Maine to 79.3% in Mississippi. Many young children are not consuming fruits and vegetables daily and are regularly consuming sugar-sweetened beverages. Federal nutrition programs and state policies and programs can support improvements in diet quality by increasing access to and availability of fruits and vegetables and healthy beverages in places where young children live, learn, and play.

NSCH uses paper- and web-based questionnaires to collect information on the health and well-being of U.S. children and adolescents aged <18 years; it is funded and directed by the Health Resources and Services Administration’s Maternal Child Health Bureau and conducted by the U.S. Census Bureau. Households are randomly sampled from the Census Bureau’s Master Address File and contacted via mail to identify those with at least one child or adolescent aged <18 years. One child or adolescent per household is selected, and an age-specific questionnaire is completed by a household adult familiar with the selected child or adolescent’s health and health care. Children aged <6 years are oversampled. The surveys were available in English and Spanish. The 2021 weighted overall response and interview completion rates^† were 40.3% and 79.5%, respectively. Data were collected during June 2021–January 2022.

Respondents were asked three questions about children aged 1–5 years regarding the frequency of consuming fruits,^§ vegetables,^¶ and sugar-sweetened beverages** during the preceding week. Response options included the following: did not consume item, 1–3 times in the preceding week, 4–6 times in the preceding week, 1 time per day, 2 times per day, and ≥3 times per day. Categories were recoded to provide an estimate of daily (≥1 time per day in preceding week) or less than daily (<1 time per day in preceding week) consumption of fruit and vegetables. Categories of sugar-sweetened beverages were dichotomized to indicate consumption at least once or no consumption during the preceding week. Among the 18,830 children aged 1–5 years, 444 (2.4%) were missing data on at least one item and were excluded, leaving a final analytic sample of 18,386. Weighted percentages are presented overall, by child’s age, race and ethnicity, household food sufficiency,^†† and by state, using SPSS Complex Samples (version 1.0.0.1401; IBM) to account for the sampling procedures. Pearson Chi-square tests of independence were used to identify differences within each outcome by sociodemographic characteristics. This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy.^§§

In 2021, 32.1% of children aged 1–5 years did not eat a daily fruit, and 49.1% did not eat a daily vegetable during the preceding week; 57.1% drank a sugar-sweetened beverage at least once during the preceding week (Table 1). Daily consumption of fruit and vegetables and weekly consumption of sugar-sweetened beverages differed by age, race and ethnicity, and household food sufficiency. Children aged 1 year were more likely than were older children to eat either a daily fruit or a daily vegetable during the preceding week and were less likely to drink a sugar-sweetened beverage (chi-square p<0.05). The percentage of children who did not eat a daily fruit or vegetable was highest among non-Hispanic Black (Black) children and lowest among non-Hispanic White (White) children. Drinking a sugar-sweetened beverage at least once during the preceding week ranged from 47.5% among multiracial non-Hispanic children to 71.7% among Black children. Compared with children living in food-sufficient households, those living in households with marginal or low food sufficiency were less likely to eat either a daily fruit or vegetable and were more likely to consume sugar-sweetened beverages during the preceding week.

Estimates of intake varied by state (Table 2). The percentage of children who did not eat fruit daily during the preceding week ranged from 16.3% in Vermont to 49.9% in Louisiana. Vegetable intake also varied: 30.4% of children in Vermont did not eat a daily vegetable, compared with 64.3% in Louisiana. The percentage of children who consumed a sugar-sweetened beverage at least once during the preceding week ranged from 38.8% (Maine) to 79.3% (Mississippi). In 20 states, more than one half of children did not eat a daily vegetable during the preceding week (Figure). In 40 states and the District of Columbia, more than one half of children drank a sugar-sweetened beverage at least once during the preceding week.

Corresponding author: Heather C. Hamner, hfc2@cdc.gov.

¹Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, CDC; ²Office of Epidemiology and Research, Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, Maryland.

References

1. US Department of Agriculture. Dietary guidelines for Americans 2020–2025. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service; 2020. https://www.dietaryguidelines.gov/sites/default/files/2020-12/Dietary_Guidelines_for_Americans_2020-2025.pdf
2. Schwarzenberg SJ, Georgieff MK, Daniels S, et al.; Committee on Nutrition. Advocacy for improving nutrition in the first 1,000 days to support childhood development and adult health. Pediatrics 2018;141:e20173716. https://doi.org/10.1542/peds.2017-3716 PMID:29358479
3. Yoshida Y, Simoes EJ. Sugar-sweetened beverage, obesity, and type 2 diabetes in children and adolescents: policies, taxation, and programs. Curr Diab Rep 2018;18:31–47. https://doi.org/10.1007/s11892-018-1004-6 PMID:29671076
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6. Vos MB, Kaar JL, Welsh JA, et al.; American Heart Association Nutrition Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Cardiovascular Disease in the Young; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; Council on Functional Genomics and Translational Biology; and Council on Hypertension. Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation 2017;135:e1017–34. https://doi.org/10.1161/CIR.0000000000000439 PMID:27550974
7. Gurzo K, Lee DL, Ritchie K, et al. Child care sites participating in the Federal Child and Adult Care Food Program provide more nutritious foods and beverages. J Nutr Educ Behav 2020;52:697–704. https://doi.org/10.1016/j.jneb.2020.02.009 PMID:32268971
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* Denominators might not sum to total because of missing sociodemographic data.
^† Percentages are weighted to account for complex survey design and adjusted for the probability of selection, nonresponse, and demographic factors to represent noninstitutionalized children in the United States and in each jurisdiction.
^§ For each outcome, a Pearson’s chi-square test of independence was done to identify differences by sociodemographic characteristics; p<0.05 was considered statistically significant.
^¶ Persons who indicated they were American Indian or Alaska Native, or Native Hawaiian or other Pacific Islander were included in the Multiracial, non-Hispanic group because point estimates for all three dietary outcomes were unstable and needed to be interpreted with caution.
** Food sufficiency was assessed by asking, “Which of the following best describes your household’s ability to afford the food you need during the past 12 months?” Response options were recoded to Food sufficiency (could always afford to eat good nutrition meals), Marginal food sufficiency (could always afford enough to eat but not always the kinds of foods we should eat), or Low food sufficiency (sometimes or often we could not afford enough to eat).
^†† Based on National Survey of Children’s Health data, presentation criteria states that if the 95% CI width is >20 percentage points or 1.2 times the estimate (approximate relative SE >30%), data should be flagged for poor reliability and/or present a measure of statistical reliability (e.g., CI or statistical significance testing) to promote appropriate interpretation. https://www.census.gov/programs-surveys/nsch/data/datasets.html

* Percentages are weighted to account for complex survey design and adjusted for the probability of selection, nonresponse, and demographic factors to represent noninstitutionalized children in the United States and in each jurisdiction.
^† Based on National Survey of Children’s Health data, presentation criteria states that if the 95% CI width exceeds 20 percentage points or 1.2 times the estimate (approximate relative SE >30%), data should be flagged for poor reliability and/or present a measure of statistical reliability (e.g., CI or statistical significance testing) to promote appropriate interpretation. https://www.census.gov/programs-surveys/nsch/data/datasets.html

FIGURE. Percentage of children aged 1–5 years who (A) ate vegetables* less than once a day during the preceding week or (B) drank at least one sugar-sweetened beverage† in the preceding week, by state — United States, 2021

Abbreviation: DC = District of Columbia.

* Percentage of children aged 1–5 years who ate vegetables less than once a day during the preceding week: ≤30%, n = 0; 30.1%–40.0%, n = 4; 40.1%–50.0%, n = 27; 50.1%–60.0%, n = 19; 60.1%–70.0%, n = 1; 70.1%–80.0%, n = 0; and ≥80%, n = 0.

^† Percentage of children aged 1–5 years who drank at least one sugar-sweetened beverage in the preceding week: ≤30%, n = 0; 30.1%–40.0%, n = 1; 40.1%–50.0%, n = 9; 50.1%–60.0%, n = 24; 60.1%–70.0%, n = 13; 70.1%–80.0%, n = 4; and ≥80%, n = 0.