Minimum acceptable diet at 9 months but not exclusive breastfeeding at 3 months or timely complementary feeding initiation is predictive of infant growth in rural Bangladesh

• Type of Material: Article
• Authors: Aatekah Owais, Emory University; Benjamin Schwartz, Los Angeles County Department of Public Health; David Kleinbaum, Emory University; Parminder Suchdev, Emory University; A. S. G. Faruque, International Centre for Diarrhoeal Disease Research; Sumon K. Das, International Centre for Diarrhoeal Disease Research; Aryeh Stein, Emory University
• Language: English
• Date: 2016-10-24
• Publisher: Public Library of Science
• Publication Version: Final Published Version
• Copyright Statement: © 2016 Owais et al.
• Final Published Version (URL): http://dx.doi.org/10.1371/journal.pone.0165128
• Title of Journal or Parent Work: PLoS ONE
• ISSN: 1932-6203
• Volume: 11
• Issue: 10
• Start Page: e0165128
• End Page: e0165128
• Grant/Funding Information: AO was supported by funds from Laney Graduate School, Emory University, Atlanta, GA.; This study was supported by grants from CARE USA to Emory University and icddr,b.
• Keywords: Nutrition; Child Growth; Diet; Bangladesh; Literacy; Breastfeeding; Infants; Malnutrition
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.The association between suboptimal infant feeding practices and growth faltering is wellestablished. 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. Copyright: