Skip to main content Accessibility help
×
Home

The interactive association of dietary diversity scores and breast-feeding status with weight and length in Filipino infants aged 6–24 months

  • Melecia J Wright (a1), Margaret E Bentley (a1), Michelle A Mendez (a1) and Linda S Adair (a1)

Abstract

Objective

To assess how breast-feeding and dietary diversity relate to infant length-for-age Z-score (LAZ) and weight-for-age Z-score (WAZ).

Design

Breast-feeding, dietary and anthropometric data from the Cebu Longitudinal Health and Nutrition Survey were analysed using sex-stratified fixed-effects longitudinal regression models. A dietary diversity score (DDS) based on seven food groups was classified as low (<4) or high (≥4). The complementary feeding patterns were: (i) non-breast-fed with low DDS (referent); (ii) breast-fed with low DDS; (iii) non-breast-fed with high DDS; and (iv) breast-fed with high DDS (optimal). Interactions between age, energy intake and complementary feeding patterns were included.

Setting

Philippines.

Subjects

Infants (n 2822) measured bimonthly from 6 to 24 months.

Results

Breast-feeding (regardless of DDS) was significantly associated with higher LAZ (until 24 months) and WAZ (until 20 months). For example, at 6 months, breast-fed boys with low DDS were 0·246 (95 % CI 0·191, 0·302) sd longer and 0·523 (95 % CI 0·451, 0·594) sd heavier than the referent group. There was no significant difference in size between breast-fed infants with high v. low DDS. Similarly, high DDS conferred no advantage in LAZ or WAZ among non-breast-fed infants. There were modest correlations between the 7-point DDS and nutrient intakes but these correlations were substantially attenuated after energy adjustment. We elucidated several interactions between sex, age, energy intake and complementary feeding patterns.

Conclusions

These results demonstrate the importance of prolonged breast-feeding up to 24 months. The DDS provided qualitative information on infant diets but did not confer a significant advantage in LAZ or WAZ.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The interactive association of dietary diversity scores and breast-feeding status with weight and length in Filipino infants aged 6–24 months
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The interactive association of dietary diversity scores and breast-feeding status with weight and length in Filipino infants aged 6–24 months
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The interactive association of dietary diversity scores and breast-feeding status with weight and length in Filipino infants aged 6–24 months
      Available formats
      ×

Copyright

Corresponding author

* Corresponding author: Email meleciaw@live.unc.edu

References

Hide All
1. Victora, CG, de Onis, M, Hallal, PC et al. (2010) Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics 125, e473e480.
2. Bhutta, ZA, Ahmed, T, Black, RE et al. (2008) Maternal and child undernutrition 3: what works? Interventions for maternal and child undernutrition and survival. Lancet 371, 417440.
3. World Health Organization, UNICEF, US Agency for International Development et al . (2008) Indicators for Assessing Infant and Young Child Feeding Practices. Part 1: Definitions. Geneva: WHO.
4. Moursi, MM, Arimond, M, Dewey, KG et al. (2008) Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar. J Nutr 138, 2448.
5. Arimond, M & Ruel, MT (2004) Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr 134, 25792585.
6. Onyango, AW, Koski, KG & Tucker, KL (1998) Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. Int J Epidemiol 27, 484489.
7. Torheim, L, Ouattara, F, Diarra, M et al. (2004) Nutrient adequacy and dietary diversity in rural Mali: association and determinants. Eur J Clin Nutr 58, 594604.
8. Chua, EY, Zalilah, MS, Chin, YS et al. (2012) Dietary diversity is associated with nutritional status of Orang Asli children in Krau Wildlife Reserve, Pahang. Malays J Nutr 18, 113.
9. Sawadogo, PS, Martin-Prével, Y, Savy, M et al. (2006) An infant and child feeding index is associated with the nutritional status of 6- to 23-month-old children in rural Burkina Faso. J Nutr 136, 656663.
10. Ruel, MT (2003) Operationalizing dietary diversity: a review of measurement issues and research priorities. J Nutr 133, 11 Suppl. 2, 3911S3926S.
11. Daniels, MC, Adair, LS, Popkin, BM et al. (2009) Dietary diversity scores can be improved through the use of portion requirements: an analysis in young Filipino children. Eur J Clin Nutr 63, 199208.
12. Kennedy, GL, Pedro, MR, Seghieri, C et al. (2007) Dietary diversity score is a useful indicator of micronutrient intake in non-breast-feeding Filipino children. J Nutr 137, 472477.
13. Marriott, BP, White, A, Hadden, L et al. (2012) World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 8, 354370.
14. Steyn, N, Nel, J, Nantel, G et al. (2006) Food variety and dietary diversity scores in children: are they good indicators of dietary adequacy? Public Health Nutr 9, 644650.
15. Kramer, M & Kakuma, R (2004) The optimal duration of exclusive breastfeeding – a systematic review. Adv Exp Med Biol 554, 6377.
16. Yoon, PW, Black, R, Moulton, LH et al. (1996) Effect of not breastfeeding on the risk of diarrheal and respiratory mortality in children under 2 years of age in Metro Cebu, The Philippines. Am J Epidemiol 143, 11421148.
17. Popkin, BM, Adair, L, Akin, JS et al. (1990) Breast-feeding and diarrheal morbidity. Pediatrics 86, 874882.
18. Brown, K, Dewey, KG & Allen, L (1998) Complementary Feeding of Young Children in Developing Countries. A Review of Current Scientific Knowledge. WHO/NUT/98.1. Geneva: WHO.
19. Adair, LS, Hindin, MJ, Popkin, BM et al. (2011) Cohort profile: the Cebu longitudinal health and nutrition survey. Int J Epidemiol 40, 619625.
20. Briscoe, J (1991) Underlying and proximate determinants of child health: the Cebu Longitudinal Health and Nutrition Study. Am J Epidemiol 133, 185201.
21. WHO Multicentre Growth Reference Study Group (2006) WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl 450, 7685.
22. Food and Nutrition Research Institute of the Philippines (1980) Food Composition Tables. Manila: Department of Science and Technology, FNRI.
23. Allison, PD (2009) Fixed Effects Regression Models . Thousand Oaks, CA: SAGE Publications Inc.
24. StataCorp (2013) Stata 13 Base Reference Manual. College Station, TX: Stata Press.
25. Wiesmann, D, Bassett, L, Benson, TD et al. (2009) Validation of the World Food Programme’s Food Consumption Score and Alternative Indicators of Household Food Security. IFPRI Discussion Paper no. 00870. Washington, DC: International Food Policy Research Institute.
26. Adair, LS & Guilkey, DK (1997) Age-specific determinants of stunting in Filipino children. J Nutr 127, 314320.
27. Ricci, JA & Becker, S (1996) Risk factors for wasting and stunting among children in Metro Cebu, Philippines. Am J Clin Nutr 63, 966975.
28. Adair, L, Popkin, BM, VanDerslice, J et al. (1993) Growth dynamics during the first two years of life: a prospective study in the Philippines. Eur J Clin Nutr 47, 4251.
29. Jones, AD, Ickes, SB, Smith, LE et al. (2014) World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings. Matern Child Nutr 10, 117.
30. Zongrone, AA, Winskell, K & Menon, P (2012) Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data. Public Health Nutr 15, 16971704.
31. Alvarado, BE, Zunzunegui, MV, Delisle, H et al. (2005) Growth trajectories are influenced by breast-feeding and infant health in an Afro-Colombian community. J Nutr 135, 21712178.
32. Rose, D, Chotard, S, Oliveira, L et al. (2008) A comparative evaluation of dietary indicators used in food consumption assessments of at-risk populations. Food Nutr Bull 29, 113122.
33. Bork, K, Cames, C, Barigou, S et al. (2012) A summary index of feeding practices is positively associated with height-for-age, but only marginally with linear growth, in rural Senegalese infants and toddlers. J Nutr 142, 11161122.
34. Firebaugh, G, Warner, C & Massoglia, M (2013) Fixed effects, random effects and hybrid models for causal analysis. In Handbook of Causal Analysis for Social Research, pp. 113132 [SL Morgan, editor]. Dordrecht: Springer.
35. Victora, CG, Adair, LS, Fall, CHD et al. (2008) Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371, 340357.
36. Black, R, Allen, L, Bhutta, Z et al. (2008) Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371, 243260.

Keywords

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed