Effect of complementary food supplementation on breastfeeding and home diet in rural Bangladeshi children

Abstract

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.

Keywords: Bangladesh; breastfeeding; complementary food; dietary diversity; growth; stunting; supplementation.

FIGURE 1

Flow diagram for available dietary data of children enrolled in a randomized controlled trial of complementary food supplements in rural Bangladesh. Reasons for missing that are included in individual interview boxes pertain to that interview only, whereas those in boxes at the left of the figure apply to all subsequent interviews.

FIGURE 2

Distribution in breastfeeding-frequency categories by supplementation group and age of participants in a randomized controlled trial of complementary food supplements in rural Bangladesh. Breastfeeding frequency did not differ by supplementation group at any age (P > 0.50) according to ordinal logistic regression models with SEs adjusted for design effects. Sample sizes ranged from n = 5384 at the 6-mo interview to n = 5066 at the 18-mo interview. CFC, child feeding counseling; CP, chickpea complementary food supplement; PD, Plumpy'doz complementary food supplement (Nutriset); RL, rice and lentil complementary food supplement; WSB, fortified wheat-soy blend.

FIGURE 3

Proportion of children enrolled in a randomized trial of complementary food supplements in Bangladesh who consumed each of 7 food groups, by age at the time of interview. Sample size ranged from 5384 at the 6-mo interview to 5067 at the 18-mo interview. F/V, fruit and vegetables; Vit. A F/V, vitamin A–rich fruit and vegetables.