Abstract
The association between suboptimal infant feeding practices and growth faltering is well-established. However, most of this evidence comes from cross-sectional studies. To prospectively assess the association between suboptimal infant feeding practices and growth faltering, we interviewed pregnant women at 28–32 weeks’ gestation and followed-up their offspring at postnatal months 3, 9, 16 and 24 months in rural Bangladesh. Using maternal recall over the past 24 hours, exclusive breastfeeding (EBF) status at 3 months, age at complementary feeding (CF) initiation, and receipt of minimum acceptable diet (MAD; as defined by WHO) at 9 months were assessed. Infant length and weight measurements were used to produce length-for-age (LAZ) and weight-for-length (WLZ) z-scores at each follow-up. Generalized estimating equations were used to estimate associations of LAZ and WLZ with infant feeding practices. All models were adjusted for baseline SES, infant sex, maternal height, age, literacy and parity. Follow-up was completed by 2189, 2074, 1969 and 1885 mother-child dyads at 3, 9, 16 and 24 months, respectively. Stunting prevalence increased from 28% to 57% between infant age 3 and 24 months. EBF at 3 months and age at CF initiation were not associated with linear infant growth, but receipt of MAD at 9 months was. By age 24 months, infants receiving MAD had attained a higher LAZ compared to infants who did not receive MAD (adjusted β = 0.25, 95% CI: 0.13–0.37). Although prevalence of stunting was already high at age 3 months, ensuring infants receive a diverse, high quality diet from 6 months onwards may reduce rates of stunting in the second year of life.
Highlights
According to the most recent global estimates, 165 million children less than 5 years of age are undernourished, with 52 million suffering from severe malnutrition [1]
Inadequate infant and young child feeding practices are increasingly recognized as major contributors to poor infant nutrition and growth faltering [4,5,6], and the prevalence of poor Infant and young child feeding (IYCF) practices remains high in many parts of the world [7,8,9]
As described in detail previously [14], data for this study were collected in the context of evaluation of Window of Opportunity, a community-based nutrition and infant and young child feeding program implemented by CARE in six countries, including Bangladesh, where it was known as Akhoni Shomay
Summary
According to the most recent global estimates, 165 million children less than 5 years of age are undernourished, with 52 million suffering from severe malnutrition [1]. Undernutrition is the underlying cause of 3.1 million child deaths each year [1]. Infant and young child feeding (IYCF) practices are important determinants of nutritional status of children. The World Health Organization (WHO) recommends exclusive breastfeeding (defined as no other food or drink except for medicines and/or nutritional supplements) for the first six months of life, followed by introduction of complementary foods from age 6 months, with continued breastfeeding until the child is at least two years of age. Inadequate infant and young child feeding practices are increasingly recognized as major contributors to poor infant nutrition and growth faltering [4,5,6], and the prevalence of poor IYCF practices remains high in many parts of the world [7,8,9]
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