Background: Complementary food supplements (CFSs) can enhance growth where stunting is common, but substitution for the usual diet may reduce observed benefits.Objective: We aimed to characterize dietary diversity from home foods in a CFS efficacy trial and determine whether supplementation reduced breastfeeding frequency or displaced home foods.Design: In a cluster-randomized controlled trial in rural Bangladesh, children (n = 5499) received, for 1 y starting at age 6 mo, periodic child feeding counseling for mothers (control) or counseling plus 1 of 4 CFSs fed as a daily snack. Breastfeeding status and past 24-h diet were assessed at enrollment and every 3 mo thereafter until 18 mo of age. A 7–food group dietary diversity score (DDS) was calculated from home foods only, and a DDS ≥4 constituted minimum dietary diversity (MDD).Results: Most children (97%) were breastfed through 18 mo of age, and 24-h breastfeeding frequency did not differ by supplementation group. Child dietary diversity was low; only 51% of children met the MDD by 18 mo. Rice, potatoes, and biscuits (cookies) were the most frequently consumed foods, whereas the legumes, dairy, eggs, and vitamin A–rich fruit and vegetable food groups were each consumed by <50% of children. The odds of meeting the MDD through the consumption of home foods were equal or greater in the supplemented groups compared with the control group at all ages. High socioeconomic status and any maternal education were associated with increased odds of MDD at age 18 mo, whereas child sex and household food security were not associated with MDD.Conclusions: In a setting where daily complementary food supplementation improved linear growth, there was no evidence that supplementation displaced breastfeeding or home foods, and the supplementation may have improved dietary diversity. Pathways by which supplementation with fortified foods may enhance dietary diversity, such as an improved appetite and increased body size, need elucidation. This trial was registered at clinicaltrials.gov as NCT01562379.
Home foods did not meet the estimated micronutrient needs of 9-18-mo-old children in rural Bangladesh. Daily supplementation with fortified complementary foods filled many micronutrient intake gaps and did not displace home foods. Previously, CFSs were shown to also improve linear growth and reduce stunting in this cohort. Findings support the need for CFSs in similar settings to promote nutritional well being and growth. This trial was registered at clinicaltrials.gov as NCT01562379.
Background
Nutrient-level intakes from home-prepared complementary foods are rarely estimated among infants and young children in low income settings. The major constraints are related to lack of standard recipes and ingredients and portion sizes.
Objective
The manuscript describes the feasibility, applicability and validity of a post-hoc qualitative methodology to estimate nutrient intakes in children using 24-hour dietary recall.
Methods
Semi-structured, interviewer-administered caregiver 24-hour diet recalls were conducted to assess food intake among children participating in a randomized trial of complementary food supplementation at 6, 9, 12, 15, 18 and 24 months of age in rural Bangladesh. At the end of the diet data collection, focus group discussions with mothers (n = 6) and cooking activities (n = 5) were conducted to obtain standard recipes (and ingredients) and portion sizes for reported foods given at different ages. Nutrient intakes were calculated for children in the control group (n = 1438) and convergent validity of the data tested by examining the association of energy and protein intakes with child age and socioeconomic status (SES).
Results
Focus group discussions generated standardized recipes for 21 commonly consumed mixed dishes being fed to children. These recipes were cooked, and portion sizes of standardized measures used in 24-h recalls quantified in grams. For discrete foods, we quantified women's perceptions of “small”, “medium”, and “large” in grams. Across all ages, food groups consumed consisted mostly of staples, with the most common being rice, potatoes and biscuits. Using portion size data and recipe ingredients, the 24-h dietary data and Bangladeshi food composition tables, we successfully estimated nutrient intakes in children. Convergent validity analysis showed that energy and protein intakes were strongly associated with age and SES (both P < 0.001).
Conclusions
We demonstrate the use of a validated, qualitative methodology for estimating nutrient intakes in young children from complementary foods in undernourished contexts.
NCT01562379
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