Use of stable-isotope techniques to validate infant feeding practices reported by Bangladeshi women receiving breastfeeding counseling.
BACKGROUND
The World Health Organization recommends exclusive breastfeeding until age 6 mo. Studies relying on mothers' self-reported behaviors have shown that lactation counseling increases both the rate and duration of exclusive breastfeeding.


OBJECTIVE
We aimed to validate reported infant feeding practices in rural Bangladesh; intakes of breast milk and nonbreast-milk water were measured by the dose-given-to-the mother deuterium dilution technique.


METHODS
Subjects were drawn from the large-scale Maternal and Infant Nutrition Interventions, Matlab, study of combined interventions to improve maternal and infant health, in which women were randomly assigned to receive either exclusive breastfeeding counseling or standard health care messages. Data on infant feeding practices were collected by questionnaire at monthly visits. Intakes of breast milk and nonbreast-milk water were measured in a subsample of 98 mother-infant pairs (mean infant age: 14.3 wk) and compared with questionnaire data reporting feeding practices.


RESULTS
Seventy-five of the 98 subjects reported exclusive breastfeeding. Mean (+/-SD) breast milk intake was 884 +/- 163 mL/d in that group and 791 +/- 180 mL/d in the group reported as nonexclusively breastfed (P = 0.0267). Intakes of nonbreast-milk water were 40 +/- 80.6 and 166 +/- 214 mL/d (P < 0.0001), respectively. Objective cross-validation using deuterium dilution data showed good accuracy in reporting of feeding practices, although apparent misreporting was widely present in both groups.


CONCLUSIONS
The dose-given-to-the-mother deuterium dilution technique can be applied to validate reported feeding behaviors. Whereas this technique shows that the reports of feeding practices were accurate at the group level, it is not adequate to distinguish between feeding practices in individual infants.
Moore
Sophie E
SE
MRC International Nutrition Group, Nutrition & Public Health Interventions Research Unit, London School of Hygiene & Tropical Medicine, London, United Kingdom. sophie.moore@lshtm.ac.uk
Prentice
Andrew M
AM
Coward
W Andy
WA
Wright
Antony
A
Frongillo
Edward A
EA
Fulford
Anthony Jc
AJ
Mander
Adrian P
AP
Persson
Lars-Ake
LA
Arifeen
Shams E
SE
Kabir
Iqbal
I
D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D001942:Breast Feeding / Q000453:epidemiology* / Q000523:psychology*; D053198:Child Nutrition Sciences / Q000193:education; D003376:Counseling; D003903:Deuterium / Q000008:administration & dosage / Q000032:analysis / Q000652:urine; D004326:Drinking; D005260:Female; D006293:Health Promotion; D006801:Humans; D007201:Indicator Dilution Techniques; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D008895:Milk, Human / Q000737:chemistry; D012424:Rural Population; D012463:Saliva / Q000737:chemistry; D012650:Self Disclosure; D014944:World Health Organization
D003903:Deuterium