First foods: Diet quality among infants aged 6-23 months in 42 countries

Abstract

Diet quality is closely linked to child growth and development, especially among infants aged 6-23 months who need to complement breastmilk with the gradual introduction of nutrient-rich solid foods. This paper links Demographic and Health Survey data on infant feeding to household and environmental factors for 76,641 children in 42 low- and middle-income countries surveyed in 2006-2013, providing novel stylized facts about diets in early childhood. Multivariate regressions examine the associations of household socioeconomic characteristics and community level indicators of climate and infrastructure with dietary diversity scores (DDS). Results show strong support for an infant-feeding version of Bennett's Law, as wealthier households introduce more diverse foods at earlier ages, with additional positive effects of parental education, local infrastructure and more temperate agro-climatic conditions. Associations with consumption of specific nutrient-dense foods are less consistent. Our findings imply that while income growth is indeed an important driver of diversification, there are strong grounds to also invest heavily in women's education and food environments to improve diet quality, while addressing the impacts of climate change on livelihoods and food systems. These results reveal systematic patterns in how first foods vary across developing countries, pointing to new opportunities for research towards nutrition-smart policies to improve children's diets.

Keywords: Bennett’s law; Child diets; Child malnutrition; Dietary diversity.

Fig. 1

Mean child dietary diversity score at each age in months, by wealth tercile. Note: Data shown are local polynomial smoothing estimates with 95% confidence intervals (CI) for 76,641 infants aged 6–23 months with dietary intake data recorded in the Phase 5 & 6 surveys for 42 countries listed in supplemental Appendix Table A1, by tercile of household wealth computed as described in the text. The red line denotes the cut-off line for minimum dietary diversity (MDD). (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2

Intake of 8 nutrient-rich food groups for children 6–23 months, by wealth tercile. Note: Data shown are unweighted mean consumption prevalence of any food from each group in the past 24 h by terciles of the household wealth index described in Section 2, for children 6–23 months in 42 countries.