Complementary Feeding Indicators Research Articles

Trends in Complementary Feeding Indicators in Children Aged 6–23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015–2019

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program—the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child’s age. The Prais–Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (−10.02%) and non-BFP children (−9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6–23 months, particularly for those experiencing greater social vulnerability.

The Influence of Feeding Practice on the Risk of Stunting in Toddler: A Scoping Review

Child stunting is a serious case that is difficult to overcome because it is caused by poor food quality and the amount of food that does not meet the body's needs during the first two years of life. The purpose of this study is to review the influence of feeding practices and feeding methods on the risk of stunting in children under five. PRISMA-ScR reporting guidelines are used to identify key concepts and knowledge gaps. This scoping review used a five-step framework approach. The databases used were PubMed, Wiley Online Library, ScienceDirect, and EBSCO. Manual searches used the Research Rabbit search engine. Based on the search results of 979 articles, ten articles were found that matched the inclusion criteria. Out of the seven themes found, four were in line with WHO's complementary feeding indicators, namely Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), Minimum Acceptable Diet (MAD), and Introduction of Solid, Semi-Solid or Soft Foods (ISSSF). While the other three themes are a time of first feeding, breastfeeding practices, and feeding methods. Overall, inadequate feeding practices result in child malnutrition, including stunting. Improper nutrition and care during the first 1000 days of birth is detrimental to a child's life, both in the short and long term as malnutrition that occurs at this early stage of life has serious and irreversible consequences. Large-scale studies are recommended to explore the role of IYCF in reducing stunting and qualitative studies to determine barriers and drivers to improve infant and young child feeding practices.

Complementary feeding indicators from the World Health Organization and the Ministry of Health: agreement analysis and comparison of estimated prevalence in a cohort of children in southwestern Bahia, Brazil, 2018

RESUMO Objetivo Analisar a concordância entre indicadores de alimentação complementar da Organização Mundial da Saúde (OMS) e do Ministério da Saúde (MS) e comparar as prevalências entre esses indicadores em crianças no primeiro ano de vida. Métodos Estudo transversal em uma coorte de 286 crianças de Vitória da Conquista, Bahia, Brasil; a concordância entre indicadores e a comparação entre prevalências foram analisadas pelo índice Kappa e teste de McNemar; foram calculadas as prevalências dos indicadores “introdução de alimentos complementares” (IAC), “diversidade mínima da dieta” (DMD), “frequência mínima de refeição” (FMR) e “dieta minimamente aceitável” (DMA). Resultados Três indicadores apresentaram concordância ruim, e apenas um moderada; as prevalências dos indicadores da OMS foram superiores às do MS (IAC, 94,3% versus 20,7%; DMD, 75,2% versus 50,7%; FMR, 97,2% versus 44,8%; DMA, 96,8% versus 26,9%). Conclusão A maioria dos indicadores tiveram concordância ruim e as prevalências de indicadores da OMS superaram as do MS.

Complementary feeding indicators from the World Health Organization and the Ministry of Health: agreement analysis and comparison of estimated prevalence in a cohort of children in southwestern Bahia, Brazil, 2018.

To assess the agreement between complementary feeding indicators established by the World Health Organization (WHO) and the Ministry of Health (MOH) and to compare the prevalence of these indicators in the first year of a child's life. : This was a cross-sectional study in a cohort of 286 children from Vitória da Conquista, state of Bahia, Brazil; agreement between indicators and comparison between prevalences were analyzed using the Kappa coefficient and McNemar's test; the prevalence of the indicators "introduction of complementary feeding" (ICF), "minimum dietary diversity" (MDD), "minimum meal frequency" (MMF) and "minimum acceptable diet" (MAD) were calculated. : Three indicators showed poor agreement, with only one demonstrating moderate agreement; prevalence of WHO indicators was higher than that of the MOH (ICF, 94.3% vs. 20.7%; MDD, 75.2% vs. 50.7%; MMF, 97.2% vs. 44.8%; MAD, 96.8% vs. 26.9%). The majority of indicators showed poor agreement and the prevalence of WHO indicators exceeded that of the Ministry of Health.

Validation of selected 2021 infant and young child feeding indicators for appropriate complementary feeding in relation to dietary adequacy and anthropometric status

Introduction: With the new set of 2021 infant and young child feeding (IYCF) indicators released by WHO and UNICEF, there is a need for its validation in the Philippine setting. The study evaluated the validity of cut-off points used for minimum dietary diversity and minimum feeding frequency in terms of micronutrient and energy intake adequacy, respectively, and minimum acceptable diet (MAD) in relation to anthropometric status. Methods: The study covered 8360 infants and young children aged 6-23.9 months with complete information on IYCF, anthropometric measurements, maternal information, and household characteristics from the 2018-2019 Expanded National Nutrition Survey (ENNS). Bivariate and correlation analyses using STATA version 15 (Corp LLC, Texas, USA 2017) were performed to determine the association of specific IYCF indicators: dietary diversity and feeding frequency with nutrient and energy intake adequacy, and MAD with anthropometric status. Sensitivity and specificity analyses were performed to evaluate the accuracy of dietary diversity score (DDS) and feeding frequency in identifying children with adequate nutrient and energy intakes, respectively. Results: Significant associations were found between DDS and micronutrient adequacy, and between feeding frequency and energy intake adequacy, regardless of breastfeeding status. A DDS of 5 and 6 and feeding frequency of 4-5 and 8 maximised sensitivity and specificity in identifying breastfed and non-breastfed children meeting 100% nutrient and energy adequacy, respectively. Conclusion: The selected 2021 complementary feeding indicators are practical guidelines to reflect dietary adequacy, but may not capture the entire process related to nutritional outcomes, especially stunting.

Feeding practices and nutritional status of children (6-23 months) in an urban area of Raipur, Chhattisgarh, India

Background: The first 1,000 days of a child’s life is a critical window for growth faltering, deficiencies, and common childhood illnesses. Even with optimum breastfeeding, children 6-23 months are at higher risk of being undernourished if they do not receive adequate and appropriate complementary feeding. Therefore, this study was carried out to assess the nutritional status of children 6-23 months and find the association between sociodemographic profile and nutritional status. Materials and Methods: Mothers of 411 children of age 6–23 months in an urban area of Raipur were interviewed using a pretested questionnaire based on the WHO indicators to record their complementary feeding practices. Weight, height, and mid-upper arm circumference (MUAC) was taken to assess the nutritional status. Overall and specific (sex-wise and severity-wise) prevalence rate of stunting, wasting, and underweight were calculated. The distribution of these according to various factors like infant and young child feeding practices, and details of study subject and family were calculated. Chi-square test of significance was applied to find the association between nutritional status and independent variables and their strength of association. Results: The prevalence of wasting was 25%, underweight 30%, and stunting 15%. Statistically significant association of underweight with age of the parents, both mother and father, was observed (P < 0.05). Minimum dietary diversity was achieved by only 4.1% and minimum acceptable diet by 2.4% children. Conclusions: The prevalence of wasting and undernutrition was assessed. Complementary feeding indicators were unsatisfactory among children. Ending all forms of malnutrition is the global goal. The Sustainable Development Goals (SDGs) that directly affect or indirectly influence nutrition have to be recalled at this stage and addressing malnutrition is a key element required to achieving them.

Minimum acceptable diet in a cohort of children aged between 6 and 15 months: Complementary feeding assessment and associated factors in the Brazilian western Amazon

ObjectiveThe goal of the article was to assess complementary feeding patterns, and associated factors, of children between 6 and 15-month old in Rio Branco-Acre, Brazil, based on the minimum acceptable diet indicator. MethodsThis study was cross-sectional, including 857 children between ages 6 and 15 mo, from a 2015 birth cohort of Rio Branco, Brazil. The prevalence of complementary feeding indicators, minimum meal frequency, minimum dietary diversity, and minimum acceptable diet was estimated based on the recommendations of the World Health Organization. Sociodemographic characteristics, infant and maternal habits, prenatal information, birth characteristics, breastfeeding, and complementary feeding were evaluated. Differences between the proportions were evaluated by the χ2 test and univariate and multiple logistic regression analyses, to determine associated factors with child minimum acceptable diet. ResultsThe minimum frequencies of meals and dietary diversity were observed in 81.0% and 51.8% of the children, respectively. The minimum acceptable diet prevalence was 47.1%. Also, minimum acceptable diet was inversely associated with C, D, and E social classes (adjusted odds ratio = 0.49; 95% CI, 0.33–0.72), number of living siblings (adjusted odds ratio for two or three children = 0.69; 95% CI, 0.48–0.98, and adjusted odds ratio for ≥ 4 children = 0.56; 95% CI, 0.37–0.84). Maternal regular consumption of fruits, vegetables, and legumes (adjusted odds ratio = 2.62; 95% CI, 1.69–4.05), child age from 12 to 15 mo (adjusted odds ratio = 2.05; 95% CI, 1.32–3.18), and receiving guidance regarding complementary feeding during postnatal consultations (adjusted odds ratio = 1.38; 95% CI, 1.03–1.86) were directly associated with minimum acceptable diet. ConclusionsFewer than 50% of the children received adequate food with adequate frequency and diversity. Low socioeconomic status and having ≥ 2 living siblings reduced the chance of minimum acceptable diet, whereas maternal healthy diet, child age (12–15 mo), and complementary feeding counseling during postnatal appointments increased the chance of minimum acceptable diet.

Adherence to complementary feeding indicators and their associations with coexisting forms of malnutrition in children aged between 6 to 23.9 months of age

AbstractObjectiveThis study aimed to explore the relationship between different complementary feeding (CF) indicators and coexisting forms of malnutrition (CFM) in Pakistan.MethodologyThis study involves secondary data analysis of eight national and regional datasets of Pakistan, which were retrieved from the Demographic Health Survey (DHS) and UNICEF. From these datasets, data of children aged between 6 to 23.9 months was analysed after excluding incomplete and/or invalid data related to their feeding practices and anthropometry. Thus, data of 30,097 Pakistani children between the ages of 6 to 23.9 months was analysed in this study using Jamovi software.ResultsThe prevalence of CFM in this sample of children was 28.1%. Cereals and dairy were chiefly used for CF. With the exception of continuation of breastfeeding and coadministration of breastmilk with solid/semi-solid/soft food, adherence to all other CF indicators (minimum dietary diversity, minimum meal frequency, iron & folate consumption, egg & flesh food consumption, zero vegetable & fruit consumption) were associated with reduced odds of various forms of CFM.ConclusionNutritional adversities in children may be prevented by improving the dietary diversity, meal frequency, protein consumption, iron & folic acid (IFA) use, and food fortification.

Time trends and social inequalities in infant and young child feeding practices: national estimates from Brazil's Food and Nutrition Surveillance System, 2008-2019.

To describe the time trends and socio-economic inequalities in infant and young child feeding practices in accordance with the Brazilian deprivation index (BDI). This time-series study analysed the prevalence of multiple breast-feeding and complementary feeding indicators based on data from the Brazilian Food and Nutrition Surveillance System, 2008-2019. Prais-Winsten regression models were used to analyse time trends. Annual percent change (APC) and 95 % CI were calculated. Primary health care services, Brazil. Totally, 911 735 Brazilian children under 2 years old. Breast-feeding and complementary feeding practices differed between the extreme BDI quintiles. Overall, the results were more favourable in the municipalities with less deprivation (Q1). Improvements in some complementary feeding indicators were observed over time and evidenced such disparities: minimum dietary diversity (Q1: Δ 47·8-52·2 %, APC + 1·44, P = 0·006), minimum acceptable diet (Q1: Δ 34·5-40·5 %, APC + 5·17, P = 0·004) and consumption of meat and/or eggs (Q1: Δ 59·7-80·3 %, APC + 6·26, P < 0·001; and Q5: Δ 65·7-70·7 %, APC + 2·20, P = 0·041). Stable trends in exclusive breast-feeding and decreasing trends in the consumption of sweetened drinks and ultra-processed foods were also observed regardless the level of the deprivation. Improvements in some complementary food indicators were observed over time. However, the improvements were not equally distributed among the BDI quintiles, with children from the municipalities with less deprivation benefiting the most.

Sociodemographic inequalities in vegetables, fruits, and animal source foods consumption in children aged 6-23 months from 91 LMIC.

No multi-country analysis described patterns and inequalities for the brand-new feeding indicators proposed by WHO/UNICEF: zero consumption of vegetables and fruits (ZVF) and consumption of eggs and/or flesh (EFF). Our aim was to describe patterns in the prevalence and social inequalities of ZVF and EFF among children aged 6-23 months in low-and middle-income countries. Data from nationally representative surveys (2010-2019) in 91 low-and middle-income countries were used to investigate within-country disparities in ZVF and EFF by place of residence, wealth quintiles, child sex and child age. The slope index of inequality was used to assess socioeconomic inequalities. Analyses were also pooled by World Bank income groups. The prevalence of ZVF was 44.8% and it was lowest in children from upper-middle income countries, from urban areas, and those 18-23 months. The slope index of inequality showed that socioeconomic inequalities in the prevalence of ZVF were higher among poor children in comparison to richest children (mean SII = -15.3; 95%CI: -18.5; -12.1). Overall, 42.1% of children consumed egg and/or flesh foods. Being a favorable indicator, findings for EFF were generally in the opposite direction than for ZVF. The prevalence was highest in children from upper-middle income countries, from urban areas, and those 18-23 months of age. The slope index of inequality showed pro-rich patterns in most countries (mean SII = 15.4; 95%CI: 12.2; 18.6). Our findings demonstrate that inequalities exist in terms of household wealth, place of residence, and age of the child in the prevalence of the new complementary feeding indicators. Moreover, children from low-and lower-middle countries had the lowest consumption of fruits, vegetables, eggs, and flesh foods. Such findings provide new insights towards effective approaches to tackle the malnutrition burden through optimal feeding practices.

Minimum dietary diversity and consumption of ultra-processed foods among Brazilian children 6-23 months of age.

The study aimed to estimate the prevalence of minimum dietary diversity (MDD) and consumption of ultra-processed foods in children 6-23 months of age according to sociodemographic variables. Three indicators of complementary feeding of 4,354 children from the Brazilian National Survey on Child Nutrition (ENANI-2019) were built based on a questionnaire about food consumption on the day before the interview: MDD, consumption of ultra-processed foods, and MDD without the consumption of ultra-processed foods. The prevalence and 95%CI were calculated, stratified by macroregion; race/skin color, education and work status of the mother or caregiver; enrollment in the Brazilian Income Transfer Program; household food security; sanitation; and child enrollment in daycare/school. The overall prevalence of MDD was 63.4%, with lower prevalences among children who lived in the North Region (54.8%), whose mothers or caregivers had 0-7 years of education (50.6%), and lived under moderate or severe food insecurity (52.6%). Ultra-processed foods were consumed by 80.5% of the children, with the highest prevalence in the North Region (84.5%). The prevalence of MDD without ultra-processed foods was 8.4% and less prevalent among children with black mothers or caregivers (3.6%) and among those whose mother or caregiver had 8-10 years of education (3.6%). The most frequently consumed food groups from the MDD indicator were grains, roots and tubers (90.2%), dairy products (81%) and those from ultra-processed food were sweet or salty cookies/crackers (51.3%) and instant flours (41.4%). The ubiquitous presence of ultra-processed foods in the diets of Brazilian children and the low frequency of diversified foods, especially among the most vulnerable populations, indicate the need to strengthen policies and programs to ensure adequate and healthy infant nutrition.

Prevalence and determinants of complementary feeding indicators in the first year of life in the Southwest of Bahia State

Resumo Objetivos: estimar as prevalências de indicadores da alimentação complementar e investigar seus determinantes. Métodos: estudo transversal com crianças aos 12 meses de idade do município de Vitória da Conquista, Bahia. Os indicadores diversidade mínima da dieta, frequência mínima de refeição e dieta minimamente aceitável foram construídos e adaptados às atuais recomendações do Guia alimentar para crianças brasileiras menores de dois anos. Utilizou-se análise de regressão de Poisson, com entrada hierarquizada das variáveis no modelo multivariado. Resultados: a prevalência de diversidade mínima da dieta foi de 38,8%, de frequência mínima de refeição 47,9% e de dieta minimamente aceitável 18,5%. A renda familiar maior que um saláriomínimo foi associada a diversidade mínima da dieta (RP= 1,49; IC95%= 1,39-2,26); o recebimento de orientações sobre alimentação complementar associou-se a frequência mínima de refeição (RP=1,37; IC95%= 1,05-1,78); e as crianças que receberam aleitamento materno exclusivo até 6 meses apresentaram prevalências significativamente maiores de todos os indicadores comparadas às que não receberam. Conclusões: foram observadas baixas prevalências dos indicadores da alimentação complementar. As variáveis renda familiar, recebimento de orientações sobre alimentação complementar e a oferta de aleitamento materno exclusivo por seis meses foram associadas as maiores prevalências dos indicadores estudados.

Prevalência e determinantes de indicadores da alimentação complementar no primeiro ano de vida no Sudoeste baiano

Abstract Objectives: to estimate the prevalence of complementary feeding indicators and investigate its determinants. Methods: cross-sectional study with 12-month-old children from Vitória da Conquista, Bahia. The indicators minimum diet diversity, minimum meal frequency and minimally acceptable diet were constructed and adapted to the current recommendations of the food guide for Brazilian children under two years of age. Poisson regression analysis was used, with hierarchical entry of variables in the multivariate model. Results: the prevalence of minimum diet diversity was 38.8%, minimum meal frequency 47.9% and minimally acceptable diet 18.5%. Family income greater than one minimum wage was associated with minimal diet diversity (PR= 1.49; CI95%= 1.39-2.26); receiving guidance on complementary feeding was associated with a minimum meal frequency (PR= 1.37; CI95%= 1.05-1.78); and children who received exclusive breastfeeding for up to 6 months had significantly higher prevalences of all indicators compared to those who did not. Conclusions: low prevalence of complementary feeding indicators was observed. The variables family income, receiving guidance on complementary feeding and offering exclusive breastfeeding for six months were associated with the highest prevalence of the studied indicators.

Factors associated with suboptimal complementary feeding practices among mothers of infants and young children in India.

To examine the current complementary feeding practices among infants and young children aged 6 to 23 months in India, and factors influencing these practices at child, parental, household and community levels. Data on 74,095 last-born children aged 6 to 23 months used in this study were obtained from the 2015 India Demographic and Health Survey (IDHS). Complementary feeding indicators (timely introduction of complementary foods to infants aged 6 to 8 months old, minimum meal frequency, minimum dietary diversity, and minimum acceptable diets) were estimated, and their associated factors were identified using descriptive and multivariate (logistic regression) analyses. The prevalence of the timely introduction of complementary foods to infants aged 6 to 8 months was 45.1%. The proportion of children between ages 6 to 23 months who received the minimum meal frequency, minimum dietary diversity and minimum acceptable diets were 36%, 21% and 9.1%, respectively. Findings from the multivariate analyses revealed that mothers of infants delivered at home, mothers who had no antenatal check-up, mothers who are Hindus, mothers living in rural areas or those from the Western/Northern geographical regions of India were at higher risk of suboptimal complementary feeding practices.

Identifying Predictors for Minimum Dietary Diversity and Minimum Meal Frequency in Children Aged 6-23 Months in Uganda.

Adequate complementary foods contribute to good health and growth in young children. However, many countries are still off-track in achieving critical complementary feeding indicators, such as minimum meal frequency (MMF), minimum dietary diversity (MDD) and minimum acceptable diet (MAD). In this study, we used the 2016 Ugandan Demographic Health Survey (UDHS) data to assess child feeding practices in young children aged 6-23 months. We assess and describe complementary feeding indicators (MMF, MDD and MAD) for Uganda, considering geographic variation. We construct multivariable logistic regression models-stratified by age-to evaluate four theorized predictors of MMF and MDD: health status, vaccination status, household wealth and female empowerment. Our findings show an improvement of complementary feeding practice indicators in Uganda compared to the past, although the MAD threshold was reached by only 22% of children. Children who did not achieve 1 or more complementary feeding indicators are primarily based in the northern regions of Uganda. Cereals and roots were the foods most consumed daily by young children (80%), while eggs were rarely eaten. Consistent with our hypotheses, we found that health status, vaccination status and wealth were significantly positively associated with MDD and MMF, while female empowerment was not. Improving nutrition in infant and young children is a priority. Urgent nutritional policies and acceptable interventions are needed to guarantee nutritious and age-appropriate complementary foods to each Ugandan child in the first years of life.

Determinants of Complementary Feeding Indicators: A Secondary Analysis of Thailand Multiple Indicators Cluster Survey 2019.

Child complementary feeding (CF) practices meet dietary recommendations more often among educated, high-income groups. Much of the evidence for this association addresses inadequate CF for addressing child undernutrition. However, in many countries, including Thailand, child malnutrition assessments must now address under- and over-nutrition. More comprehensive data is needed to understand this complex situation. This study uses data from the Thailand Multiple Indicators Survey 2019, to identify the determinants of CF practices among 6–23-month children (n = 4125) using the newly developed WHO indicators. Logistic regression analysis was used to measure associations between sociodemographic factors and CF practices. In a fully adjusted model, child age, primary caregivers’ education, and household incomes were statistically associated with (in)appropriate CF practices. Older children aged 9–23 months, not only have better minimum dietary diversity (MDD), minimum acceptable diet (MAD), and egg and/or flesh food consumption (EFF), but also tend to consume more unhealthy foods. The proportion of inappropriate CF practices was higher among children living with caregivers other than their mothers. While maternal education and household income were positively associated with MDD and MAD, children of mothers from middle-class households consumed more sweetened beverages. Therefore, nutrition programs addressing different feeding problems should be developed specifically for different primary caregiver and demographic groups.

Prevalence and Predictors of Complementary Feeding Practices Among Children Aged 6-23 Months in Indonesia.

Poor complementary feeding practices have consistently contributed to the burden of child undernutrition in Indonesia. This study aimed to estimate the prevalence and predictors of the time of the introduction of solid, semi-solid, and soft foods (ISSSF), minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). We analyzed 4804 last-born infants aged 6-23 months from the 2017 Indonesia Demographic and Health Survey, which employed multistage cluster random sampling. The outcomes were calculated based on the 2021 World Health Organization/United Nations Children's Fund guidelines. The predictors of the 4 complementary feeding indicators were assessed using multivariate Poisson regression with robust variance adjusting for potential confounders and study design. The prevalence of ISSSF, MDD, MMF, and MAD was 86.1%, 54.3%, 71.8%, and 37.6%, respectively, with younger children less likely to meet 3 out of the 4 outcomes. Parental education, the presence of a birth attendant, and maternal media consumption were among the predictors of MDD and MAD. Children from families with higher income were more likely to meet MDD than those from low-income households (adjusted prevalence ratio [aPR], 1.16; 95% confidence interval [CI], 1.05 to 1.28). Living in an urban area was positively associated with MMF (aPR, 1.09; 95% CI, 1.04 to 1.15) and MAD (aPR, 1.12; 95% CI 1.02 to 1.24). In eastern regions, the prevalence of children achieving MDD and MAD was lower than in those living in Java and Bali. It is crucial that more attention and efforts are made to improve the recommended practices throughout Indonesia, since the prevalence of adequate complementary feeding practices remains low.

Evolution of infant feeding practices in children from 9 to 24 months, considering complementary feeding indicators and food processing: Results from the Brazilian cohort of the MAL-ED study.

Infant feeding practices impact children's nutritional and health status, influencing growth and development. This study aimed to analyse the evolution of infant feeding practices from 9 to 24 months of age, considering infant and young child feeding (IYCF) indicators and food processing. The infant feeding practices in children from the Brazilian site of the MAL‐ED study were evaluated at 9 (n = 193), 15 (n = 182) and 24 months (n = 164) using 24‐h dietary recalls. IYCF indicators were evaluated, and the extent of food processing was evaluated, using the NOVA classification. Breastfeeding declined significantly over time, from 77.6% at 9 months to 45.1% at 24 months. Although dietary diversity did not significantly change during the study period (80.5% at 24 months), the minimum acceptable diet significantly increased from 67.9% to 76.1% at 24 months (p < 0.0005). All the studied children consumed sweetened beverages from 9 months. Unhealthy food consumption and zero vegetable or fruit consumption significantly increased over time (p < 0.0005). Unprocessed food consumption decreased from 9 to 24 months of age (p < 0.0005), while ultra‐processed food consumption increased (p < 0.0005) during the study period. Logistic regressions showed that, at 9 months, breastfed children presented a lower risk for ultra‐processed food consumption (odds ratio [OR] = 0.31; 95% confidence interval [CI] = 0.13–0.77); and children reaching the minimum acceptable diet presented more risk for ultra‐processed food consumption (OR = 2.31; 95% CI = 1.01–5.27). In conclusion, data showed a reduction in the quality of infant feeding practices over the first 2 years of life, with a decrease in breastfeeding and an increase in the consumption of unhealthy and ultra‐processed foods.

Fathers’ Complementary Feeding Support Strengthens the Association Between Mothers’ Decision-Making Autonomy and Optimal Complementary Feeding in Nigeria

ABSTRACTBackgroundEvidence about the effects of mothers’ decision-making autonomy on complementary feeding is not consistent, generating hypotheses about whether complementary feeding social support moderates the relation between mothers’ decision-making autonomy and the practice of complementary feeding.ObjectivesThis study examined the moderation effect of fathers’ complementary feeding support on the association of mothers’ decision-making autonomy with the WHO complementary feeding indicators of minimum dietary diversity, minimum meal frequency, and minimum acceptable diet, and post hoc secondary outcomes of feeding eggs or fish the previous day. The study also examined the concordance between mothers’ and fathers’ perspectives of mothers’ autonomy and fathers’ complementary feeding support.MethodsData were from cross-sectional surveys of 495 cohabiting parents of children aged 6–23 mo enrolled in an Alive & Thrive initiative implementation research study in Kaduna State, Nigeria. Logistic regression models were used to examine moderation, and κ statistics and 95% CIs were used to assess the concordance in reported perspectives of the parents.ResultsThe moderation results show that the simple slopes for decision-making were significant for minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day when fathers offered ≥2 complementary feeding support actions. There were no significant findings in the moderation models for minimum dietary diversity or feeding children eggs the previous day. The findings from the concordance tests show moderate to substantial agreement (ranging from 57.6% to 76.0%) between parents’ perspectives of mothers’ autonomy, and moderate to excellent agreement (ranging from 52.1% to 89.1%) between parents’ perspectives of fathers’ complementary feeding support.ConclusionsIn Nigeria, high levels of fathers’ complementary feeding support strengthen the association of mothers’ decision-making autonomy with minimum meal frequency, minimum acceptable diet, and feeding children fish the previous day.This study was registered with clinicaltrials.gov (NCT04835662).

Fathers’ Complementary Feeding Support Moderates the Association Between Mothers’ Autonomous Household Decision-Making and Optimal Complementary Feeding

ObjectivesThe evidence base on the role of maternal decision-making autonomy in optimal complementary feeding practices is not consistent, leaving questions about moderation by social support. The objective of this research is to examine the moderation effect of fathers’ complementary feeding support on the association of maternal decision-making autonomy with complementary feeding indicators. MethodsWe used logistic regression interaction models to examine whether complementary feeding support was a moderator of the association between decision-making autonomy and complementary feeding using data from endline (cross-sectional) surveys administered to 495 cohabiting mothers and fathers of children aged 6–23 months in Igabi local government area (LGA), Kaduna State, Nigeria. The 12-month Alive & Thrive intervention engaged fathers through complementary feeding messages from religious and community leaders, text, and voice messages. Mothers received home visits and feeding bowls from community health extension workers (CHEWs). The intervention also included mass media messaging on radio and TV. ResultsMaternal decision-making autonomy was associated with minimum dietary diversity (AOR, 1.15; 95% CI, 1.00, 1.32), minimum meal frequency (AOR, 1.31; 95% CI, 1.11, 1.53), minimum acceptable diet (AOR, 1.24; 95% CI, 1.09, 1.41) and feeding children fish (AOR, 1.23; 95% CI, 1.08, 1.40). Complementary feeding support was associated with minimum dietary diversity (AOR, 1.38; 95% CI, 1.08, 1.75), minimum meal frequency (AOR, 1.34; 95% CI, 1.05, 1.70), minimum acceptable diet (AOR, 1.40; 95% CI, 1.14, 1.73), feeding eggs (AOR, 1.49; 95% CI, 1.16, 1.90) and feeding fish (AOR, 1.30; 95% CI, 1.06, 1.60). In the interaction models, the simple slopes for decision-making were significant for most of the complementary feeding indicators when fathers offered > 2 types of support. ConclusionsWithin the context of Kaduna, high levels of fathers’ complementary feeding support strengthen the association of maternal decision-making autonomy with complementary feeding practices. Funding SourcesThis research was funded by The Alive & Thrive initiative, managed by FHI Solutions, and funded by the Bill & Melinda Gates Foundation, Irish Aid, and other donors.