Estimates of the quality of complementary feeding among Vietnamese 6‐23 month olds varied by how commercial baby cereals were classified in 24‐hour recalls

Abstract

The World Health Organization's (WHO) indicators for assessing infant and young child feeding practices do not include commercial baby cereals (CBC), which are derived from several food groups and fortified with micronutrients. We examined how different scenarios for classifying CBC affect estimates of the quality of complementary feeding in 6‐23‐month‐old children in Vietnam (n=4,767; in 2014). In addition to the standardized questionnaire from the WHO, we asked mothers about the consumption of CBC manufactured by Heinz, Hipp, Nestlé, Gerber, or Vinamilk. Five scenarios were: S1‐ omitted CBC; S2‐ classified CBC as grains; S3‐ as grains and legumes; S4‐ as grains, legumes and vegetables; S5‐ as grains, legumes, vegetables and dairy. The proportion of children fed CBC in the previous day was 16.5%. Including CBC results in a 5‐10‐percentage‐point increase in the percent of children fed each of the 7 food groups in the WHO standard questionnaire. Minimum dietary diversity (percent fed 蠅 4 out of the 7 food groups) was statistically higher in S4 (88%) and S5 (90%) than in S1 (84%) and S2 (84%). The percent who consumed a minimum acceptable diet was also statistically higher in S4 (78%) and S5 (80%) than in S1 (74%) and S2 (75%). The percent who consumed iron‐rich foods was 94% when CBC were accounted for, statistically higher than the alternative scenario (89%). To sum, when CBC were included in the 24‐hour recall and classified as grains, legumes and any other food group, population level estimates of dietary quality were higher than when they were omitted. This suggests that clearer guidance is required from WHO about how to account for consumption of baby cereals when estimating quality of complementary feeding.Funding: Bill & Melinda Gates Foundation, through Alive & Thrive, managed by FHI 360