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. 2021 Jul 1;151(7):1956-1964.
doi: 10.1093/jn/nxab088.

Complementary Feeding Practices in 80 Low- and Middle-Income Countries: Prevalence of and Socioeconomic Inequalities in Dietary Diversity, Meal Frequency, and Dietary Adequacy

Giovanna Gatica-Domínguez  1 , Paulo A R Neves  1 , Aluísio J D Barros  1 , Cesar G Victora  1
Affiliations

Complementary Feeding Practices in 80 Low- and Middle-Income Countries: Prevalence of and Socioeconomic Inequalities in Dietary Diversity, Meal Frequency, and Dietary Adequacy

Giovanna Gatica-Domínguez et al. J Nutr. .

Abstract

Background: Adequate complementary feeding practices in early childhood contribute to better food preferences and health outcomes throughout the life course.

Objectives: The aim of this study was to describe patterns and socioeconomic inequalities in complementary feeding practices among children aged 6-23 mo in 80 low- and middle-income countries.

Methods: We analyzed national surveys carried out since 2010. Complementary feeding indicators for children aged 6-23 mo included minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Between- and within-country inequalities were documented using relative (wealth deciles), gross domestic product (GDP) per capita, and absolute (estimated household income) socioeconomic indicators. Statistical analyses included calculation of the slope index of inequality, Pearson correlation and linear regression, and scatter diagrams.

Results: Only 21.3%, 56.2%, and 10.1% of the 80 countries showed prevalence levels >50% for MDD, MMF, and MAD, respectively. Western & Central Africa showed the lowest prevalence for all indicators, whereas the highest for MDD and MAD was Latin America & Caribbean, and for MMF it was East Asia & the Pacific. Log GDP per capita was positively associated with MDD (R2 = 48.5%), MMF (28.2%), and MAD (41.4%). Pro-rich within-country inequalities were observed in most countries for the 3 indicators; pro-poor inequalities were observed in 2 countries for MMF, and in none for the other 2 indicators. Breast milk was the only type of food with a pro-poor distribution, whereas animal-source foods (dairy products, flesh foods, and eggs) showed the most pronounced pro-rich inequality. Dietary diversity improved sharply when absolute annual household incomes exceeded ∼US$20,000. All 3 dietary indicators improved by age and no consistent differences were observed between boys and girls.

Conclusions: Monitoring complementary feeding indicators across the world and implementing policies and programs to reduce wealth-related inequalities are essential to achieve optimal child nutrition.

Keywords: child nutrition; complementary feeding; health equity; infant and young child feeding; socioeconomic factors.

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Figures

FIGURE 1
FIGURE 1
Country-level scatter diagrams of MDD (A), MMF (B), and MAD (C) according to per capita GDP (log scale) for 80 countries with available household surveys from 2010–2019 by World Bank income group. R2 values were derived from linear regression. GDP, gross domestic product; MDD, minimum dietary diversity; MMF, minimum meal frequency; MAD, minimum acceptable diet; PPP, purchasing power parity.
FIGURE 2
FIGURE 2
Absolute income (log scale) and complementary feeding indicators: MDD (A), MMF (B), and MAD (C), by World Bank income group. Each dot represents 1 wealth decile within the 80 countries with available household surveys from 2010–2019; 10 deciles/country. MDD, minimum dietary diversity; MMF, minimum meal frequency; MAD, minimum acceptable diet.
FIGURE 3
FIGURE 3
Absolute income (log scale) and the 3 top and bottom countries according to prevalence of MDD (A), MMF (B), and MAD (C), by World Bank income group. Each dot represents 1 wealth decile within the 80 countries with available household surveys from 2010–2019; 10 deciles/country. MDD, minimum dietary diversity; MMF, minimum meal frequency; MAD, minimum acceptable diet.
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