Higher Energy and Zinc Intakes from Complementary Feeding Are Associated with Decreased Risk of Undernutrition in Children from South America, Africa, and Asia

Bruna L L Maciel; Priscila N Costa; José Q Filho; Samilly A Ribeiro; Francisco A P Rodrigues; Alberto M Soares; Francisco S Júnior; Ramya Ambikapathi; Elizabeth T R McQuade; Margaret Kosek; Tahmeed Ahmed; Pascal Bessong; Gangadeep Kang; Sanjaya Shresthra; Estomih Mduma; Eliwaza Bayo; Richard L Guerrant; Laura E Caulfield; Aldo A M Lima

doi:10.1093/jn/nxaa271

Higher Energy and Zinc Intakes from Complementary Feeding Are Associated with Decreased Risk of Undernutrition in Children from South America, Africa, and Asia

J Nutr. 2021 Jan 4;151(1):170-178. doi: 10.1093/jn/nxaa271.

Authors

Bruna L L Maciel¹, Priscila N Costa¹, José Q Filho², Samilly A Ribeiro², Francisco A P Rodrigues², Alberto M Soares², Francisco S Júnior², Ramya Ambikapathi³, Elizabeth T R McQuade⁴, Margaret Kosek⁵, Tahmeed Ahmed⁶, Pascal Bessong⁷, Gangadeep Kang⁸, Sanjaya Shresthra⁹, Estomih Mduma¹⁰, Eliwaza Bayo¹⁰, Richard L Guerrant¹¹, Laura E Caulfield¹², Aldo A M Lima²

Affiliations

¹ Nutrition Postgraduation Program, Department of Nutrition, Federal University of Rio Grande do Norte, Natal, Brazil.
² INCT-Instituto de Biomedicina do Semiárido Brasileiro(IBISAB), Faculty of Medicine, Federal University of Ceará, Fortaleza, Brazil.
³ Department of Public Health, Purdue University, West Lafayette, IN, USA.
⁴ Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA.
⁵ Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
⁶ Division of Nutrition and Clinical Services, icddr,b, Dhaka, Bangladesh.
⁷ University of Venda, Thohoyandou, South Africa.
⁸ Division of Gastrointestinal Sciences, Christian Medical College, Vellore, India.
⁹ Walter Reed/Armed Forces Research Institute of Medical Sciences (AFRIMS) Research Unit, Nepal (WARUN), Kathmandu, Nepal.
¹⁰ Haydom Global Health Research Centre, Haydom Lutheran Hospital, Haydom, Tanzania.
¹¹ Center for Global Health, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA.
¹² Center for Human Nutrition, Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Abstract

Background: Few studies have focused on quantitatively analyzing nutrients from infant diets, compromising complementary feeding evaluation and health promotion worldwide.

Objectives: This study aimed to describe dietary intake in infants from 9 to 24 mo of age, determining nutrient intakes associated with the risk of underweight, wasting, and stunting.

Methods: Usual nutrient intakes from complementary feeding were determined by 24-h recalls collected when infants were 9-24 mo of age in communities from 7 low- and middle-income countries: Brazil (n = 169), Peru (n = 199), South Africa (n = 221), Tanzania (n = 210), Bangladesh (n = 208), India (n = 227), and Nepal (n = 229), totaling 1463 children and 22,282 food recalls. Intakes were corrected for within- and between-person variance and energy intake. Multivariable regression models were constructed to determine nutrient intakes associated with the development of underweight, wasting, and stunting at 12, 18, and 24 mo of age.

Results: Children with malnutrition presented significantly lower intakes of energy and zinc at 12, 18, and 24 mo of age, ranging from -16.4% to -25.9% for energy and -2.3% to -48.8% for zinc. Higher energy intakes decreased the risk of underweight at 12 [adjusted odds ratio (AOR): 0.90; 95% CI: 0.84, 0.96] and 24 mo (AOR: 0.91; 95% CI: 0.86, 0.96), and wasting at 18 (AOR: 0.91; 95% CI: 0.83, 0.99) and 24 mo (AOR: 0.83; 95% CI: 0.74, 0.92). Higher zinc intakes decreased the risk of underweight (AOR: 0.12; 95% CI: 0.03, 0.55) and wasting (AOR: 0.19; 95% CI: 0.04, 0.92) at 12 mo, and wasting (AOR: 0.05; 95% CI: 0.00, 0.76) at 24 mo.

Conclusions: Higher intakes of energy and zinc in complementary feeding were associated with decreased risk of undernutrition in the studied children. Data suggest these are characteristics to be improved in children's complementary feeding across countries.

Keywords: child nutrition; dietary intake; energy; nutrient intake; zinc.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Africa / epidemiology
Asia / epidemiology
Developing Countries
Diet
Energy Intake*
Female
Food Analysis
Humans
Infant
Infant Nutrition Disorders / prevention & control*
Infant Nutritional Physiological Phenomena*
Logistic Models
Male
Malnutrition*
Nutritional Requirements
Nutritional Status*
South America / epidemiology
Thinness
Zinc / administration & dosage*

Substances

Zinc