Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers

Abstract

Background: Prolonged breastfeeding in developing countries is routinely recommended as a valuable and cost-effective public health measure to promote early childhood growth. However, the effects of breastfeeding beyond 12 months are unclear, with some studies showing positive, and some showing negative effects. The role of complementary foods for children 1-3 years has been less studied.

Methods: We examined feeding behaviour and illness data in relation to anthropometric status among 154 rural western Kenyan children, aged 12-36 months.

Results: There was little difference in anthropometric status between partially breastfed and fully weaned children. Rather, dietary diversity (number of different foods consumed) was strongly and consistently related to anthropometric status in this age group. In addition, early complementation with starchy gruels was associated with stunting.

Conclusions: Public health efforts which focus only on prolonged breastfeeding (>12 months) in developing countries will not ensure adequate early childhood growth. Important complementary feeding recommendations that promote diet diversity, through the inclusion of a variety of foods in the diets of children in the 1-3 year age group, are needed.

PIP: The effects of breast feeding and complementary foods beyond 12 months of age on child growth were investigated in a survey of 154 children 12-36 months of age from rural western Kenya. The children were identified through a door-to-door survey conducted in six villages in Kenya's Busia district in 1988. Three nonconsecutive 24-hour dietary recall interviews were conducted and anthropometric measurements were performed. At the time of the study, 98 children (64%) were fully weaned and 56 (36%) were receiving breast milk in addition to foods from the family's regular diet. Termination of breast feeding generally occurred at 12-17 months of age. Exclusive breast feeding was rarely practiced beyond 3 months of age. Porridge was introduced to 23% of children in the first month of life and 86% were receiving gruel by 4 months of age. Fruit was introduced between 3 and 6 months. 59% of partially breast-fed and 74% of weaned children were consuming leafy green vegetables at the time of the survey. Dietary diversity was consistently, positively associated with nutritional status as well as each of the five anthropometric measures. Introduction of starchy gruels before 6 months of age was associated with stunting. Fully weaned children with low dietary diversity had the lowest height-for-age scores. Interactions between dietary diversity level and feeding group were not significant for any nutrient. These findings indicate a need for greater emphasis in nutrition education programs on increasing dietary diversity among weaning-aged children.