Complementary feeding and attained linear growth among 6-23-month-old children.
OBJECTIVE
To examine the association between complementary feeding indicators and attained linear growth at 6-23 months.


METHODS
Secondary analysis of Phase V Demographic and Health Surveys data (2003-2008). Country-specific ANOVA models were used to estimate effects of three complementary feeding indicators (minimum meal frequency, minimum dietary diversity and minimum adequate diet) on length-for-age, adjusted for covariates and interactions of interest.


METHODS
Twenty-one countries (four Asian, twelve African, four from the Americas and one European).


METHODS
Sample sizes ranging from 608 to 13 676.


RESULTS
Less than half the countries met minimum meal frequency and minimum dietary diversity, and only Peru had a majority of the sample receiving a minimum adequate diet. Minimum dietary diversity was the indicator most consistently associated with attained length, having significant positive effect estimates (ranging from 0·16 to 1·40 for length-for-age Z-score) in twelve out of twenty-one countries. Length-for-age declined with age in all countries, and the greatest declines in its Z-score were seen in countries (Niger, -1·9; Mali, -1·6; Democratic Republic of Congo, -1·4; Ethiopia, -1·3) where dietary diversity was persistently low or increased very little with age.


CONCLUSIONS
There is growing recognition that poor complementary feeding contributes to the characteristic negative growth trends observed in developing countries and therefore needs focused attention and its own tailored interventions. Dietary diversity has the potential to improve linear growth. Using four food groups to define minimum dietary diversity appears to capture enough information in a simplified, standard format for multi-country comparisons of the quality of complementary diets.
1Department of Nutrition for Health and Development,World Health Organization,20 Avenue Appia,1211 Geneva 27,Switzerland.
Adelheid W
AW
Onyango
1Department of Nutrition for Health and Development,World Health Organization,20 Avenue Appia,1211 Geneva 27,Switzerland.
Elaine
E
Borghi
1Department of Nutrition for Health and Development,World Health Organization,20 Avenue Appia,1211 Geneva 27,Switzerland.
Mercedes
M
de Onis
1Department of Nutrition for Health and Development,World Health Organization,20 Avenue Appia,1211 Geneva 27,Switzerland.
Ma del Carmen
Mdel C
Casanovas
2Boston College,Chestnut Hill,MA,USA.
Cutberto
C
Garza
D001827:Body Height; D001942:Breast Feeding; D002657:Child Development; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004032:Diet / Q000009:adverse effects*; D005248:Feeding Methods; D005260:Female; D014943:Global Health; D006293:Health Promotion; D006801:Humans; D007223:Infant; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D008297:Male; D018673:Nutrition Policy; D009749:Nutrition Surveys; D010349:Patient Compliance; D012423:Rural Health; D014504:Urban Health