Objective: To determine the relationship between infant feeding history and risk of xerophthalmia due to vitamin A deficiency (VAD) in early childhood.
Design: A case-control study of previously xerophthalmic and non-xerophthalmic children.
Setting: Rural lowland region of Nepal.
Subjects: One hundred and fifty-six children (aged 1-6 y old), half of whom previously had xerophthalmia due to vitamin A-deficiency, the other half matched by locale, age and the presence and age of a younger sibling (n = 102).
Methods: Xerophthalmia was determined by trained ophthalmic assistants on the basic of current Bitot's spots, corneal xerosis or report of night blindness. Infant feeding history was collected through a diet history method obtained from the mother of the focus child. Exploratory factor analysis was conducted to determine the presence of underlying patterns in infant feeding practices. Conditional logistic regression was used to estimate odds ratios.
Results: Mothers of control children tended to have a higher level of education (P < 0.10) and to have fewer children who had died (P < 0.10) than mothers of case children. Feeding of meat (OR = 0.09, CI = 0.01-0.70) or fish (OR = 0.41, CI = 0.17-0.99) with liver, eggs (OR = 0.11, CI = 0.01-0.88) and mango (OR = 0.28, CI = 0.13-0.60) were protective in association with xerophthalmia in early childhood. Factor analysis uncovered several distinct patterns in infant feeding, which varied by age of the infant. Only the 'animal flesh' feeding pattern (factor), practiced in the second year of life, proved significantly protective from xerophthalmia (OR = 0.43, CI = 0.20-0.94). Feeding patterns of younger children closely paralleled those of their older siblings with and without VAD.
Conclusions: The study supports the hypothesis that infant dietary practices can influence subsequent risk for VAD. Our findings emphasize the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.
PIP: The association between infant feeding patterns and vitamin A deficiency (VAD)-associated xerophthalmia was investigated in a case-control study of 156 children, 1-6 years old, from a rural lowland region of Nepal. The 78 children with previous xerophthalmia determined on the basis of current Bitot's spots, corneal xerosis, or night blindness were matched with 78 controls on the basis of locale, age, and the presence and age of a younger sibling. The diet history method was used to elicit infant feeding practices from mothers. Frequency of consumption of 21 key foods was calculated over the 2-year period of the diet history. The analysis supported the hypothesis that infant dietary practices can influence the subsequent risk for VAD. The feeding of meat (odds ratio (OR), 0.09; 95% confidence interval (CI), 0.01-0.70) or fish (OR, 0.41; 95% CI, 0.17-0.99) with eggs (OR, 0.11; 95% CI, 0.01-0.88) and mango (OR, 0.28; 95% CI, 0.13-0.60) was protective in association with xerophthalmia in early childhood. In factor analysis, only the "animal flesh" feeding pattern, practiced in the second year of life, was significantly protective against xerophthalmia (OR, 0.43; 95% CI, 0.20-0.94). These findings confirm the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.