Quantification and Validation of a Semi‐Structured 24‐ Hour Diet Recall for Infants and Young Children in Rural Bangladesh

Abstract

This study collected the additional recipe and portion size details needed to quantify data collected via a semi‐structured, interviewer‐administered 24‐hour diet recall administered to 1,438 mothers of children at 6 to 24 mo of age in rural Bangladesh.The 24‐h recall consisted of 29 single foods, cooked recipes, or food categories commonly consumed by infants and young children. Seven additional open‐ended questions were included to probe for foods not previously mentioned. Standardized utensils of varying unit sizes were used to report intake. Focus group discussions with mothers of children 6–24 mo of age (n=6) and 5 cooking activities (4 with mothers and 1 with a food vendor) were conducted to collect data for frequently consumed foods, recipes and portion sizes of reported foods collected as part of the 24‐h recall.Dietary diversity scores (DDS; range 0–7) were computed. Food intakes were converted to grams and linked to appropriate food composition tables, and energy intakes were estimated. Social economic status (SES) was defined using the living standards index (LSI) and dichotomized as low and high. Convergent validity was evaluated by examining the associations between DDS and energy intakes, with SES and child age. Relations were examined using mixed effects models, accounting for clustering, randomization, and repeat observations over time.By 6 months of age, 80.2% caregivers reported that their infants had consumed at least one type of food in the previous 24 h. Across all age groups, food groups consumed consisted mostly of staples (91.5%); followed by vitamin A‐rich fruits and green leafy vegetables (52.8 %), meats (42.3%), “other” fruits and vegetables (35.3%), dairy excluding breast milk (27.2%), legumes and nuts (26.1%), and eggs (22.6%). DDS was low among children across all age groups (mean = 2.98) but increased with child age (p<0.001) and household SES (p<0.001 for high vs. low SES). However, mean DDS remained low (3.92) among the oldest children in high SES families with 39.1% not achieving minimum dietary diversity. Overall energy intakes were lower than recommended for children 6–11 (139.4 vs. 255 kcal) and 12–23 months of age (289.9 vs. 548 kcal) but increased with child age (p<0.001) and baseline household SES (p<0.001).The quantification and validation of an easy to administer semi‐quantitative 24‐hour recall will allow future investigators to use a similar methodology to estimate food and nutrient intakes among infants and young children in similar South Asian contexts. Our findings support the need for interventions that ensure and encourage dietary diversity and the consumption of nutrient‐dense foods among infant and young children.Support or Funding InformationFunded by USDA, NIFA, the Johns Hopkins Center for Global Health, the Bill and Melinda Gates Foundation, and the Johns Hopkins Sight and Life Global Nutrition Research Institute.