Abstract
Background: Complementary food supplements (CFSs) can enhance growth where stunting is common, but substitution for the usual diet may reduce observed benefits.Objective: We aimed to characterize dietary diversity from home foods in a CFS efficacy trial and determine whether supplementation reduced breastfeeding frequency or displaced home foods.Design: In a cluster-randomized controlled trial in rural Bangladesh, children (n = 5499) received, for 1 y starting at age 6 mo, periodic child feeding counseling for mothers (control) or counseling plus 1 of 4 CFSs fed as a daily snack. Breastfeeding status and past 24-h diet were assessed at enrollment and every 3 mo thereafter until 18 mo of age. A 7–food group dietary diversity score (DDS) was calculated from home foods only, and a DDS ≥4 constituted minimum dietary diversity (MDD).Results: Most children (97%) were breastfed through 18 mo of age, and 24-h breastfeeding frequency did not differ by supplementation group. Child dietary diversity was low; only 51% of children met the MDD by 18 mo. Rice, potatoes, and biscuits (cookies) were the most frequently consumed foods, whereas the legumes, dairy, eggs, and vitamin A–rich fruit and vegetable food groups were each consumed by <50% of children. The odds of meeting the MDD through the consumption of home foods were equal or greater in the supplemented groups compared with the control group at all ages. High socioeconomic status and any maternal education were associated with increased odds of MDD at age 18 mo, whereas child sex and household food security were not associated with MDD.Conclusions: In a setting where daily complementary food supplementation improved linear growth, there was no evidence that supplementation displaced breastfeeding or home foods, and the supplementation may have improved dietary diversity. Pathways by which supplementation with fortified foods may enhance dietary diversity, such as an improved appetite and increased body size, need elucidation. This trial was registered at clinicaltrials.gov as NCT01562379.
Highlights
In low- and middle-income countries where prevalent stunting persists and contributes to high rates of morbidity and mortality in childhood and throughout the life course [1,2,3], diet quality and feeding practices contribute to children’s risk of stunting [4]
Because the Complementary food supplements (CFSs) were deployed on the premise that inadequate dietary intakes were constraining growth during the vulnerable complementary feeding period, the aims of the current study were to 1) characterize the dietary diversity of home diets of children in control and supplemented groups, 2) assess the effect of providing daily small-to-medium quantity CFSs on the dietary diversity and breastfeeding frequency of participating children, and 3) examine factors associated with adequate dietary diversity in children at 18 mo of age
The dietary diversity score (DDS) was low with a median DDS of 1 (IQR: 0–2), and 5.2% of children met the minimum dietary diversity (MDD) cutoff ($4 food groups consumed)
Summary
In low- and middle-income countries where prevalent stunting persists and contributes to high rates of morbidity and mortality in childhood and throughout the life course [1,2,3], diet quality and feeding practices contribute to children’s risk of stunting [4]. The dietary diversity score (DDS) is widely used as an indicator of diet quality because it is easy to measure and is consistently associated with nutrient intakes and nutritional status in adults and young children [5, 6]. Feeding practices such as continued breastfeeding, proper timing of complementary food introduction, and meal frequency may be associated with better nutritional status during the complementary feeding period, some mixed findings have been reported [4, 7].
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