title: Socio-economic resources, young child feeding practices, consumption of highly processed snacks and sugar-sweetened beverages: a population-based survey in rural northwestern Nicaragua.
abstract: BACKGROUND
  Socio-economic resources may be associated with infant feeding in complex patterns in societies undergoing a nutrition transition. This study evaluates associations of housing quality, food security and maternal education to the World Health Organization (WHO) feeding recommendations and to consumption of highly processed snacks (HP snacks) and sugar-sweetened beverages (SSBs) in rural Nicaragua.
  
  
  METHODS
  Data were collected from May to November 2009, with mothers of 0- to 35-month-olds being asked about young child feeding using a food frequency questionnaire. A validated questionnaire was used to assess household food insecurity and data were collected on maternal education and housing quality. Pearson's chi-squared test was used to compare proportions and determine associations between the resources and young child feeding. The three socio-economic resources and other confounders were introduced to multivariate logistic regression analyses to assess the independent contribution of the resources to the feeding practices and consumption of HP snacks and SSBs.
  
  
  RESULTS
  Mothers with the lowest education level were more likely to be exclusively breastfeeding (EBF) their infants (OR not EBF: 0.19; 95% CI: 0.07, 0.51), whilst mothers of 6- to 35-month-olds in the lowest education category had more inadequate dietary diversity (DD) (OR for not meet DD: 2.04; 95% CI: 1.36, 3.08), were less likely to consume HP snacks (OR for HP snacks: 0.47; 95% CI: 0.32, 0.68) and SSBs (OR for SSBs: 0.68; 95% CI: 0.46, 0.98), compared to mothers with the highest level of education. Similarly, children residing in households with the highest food insecurity were also more prone to have inadequate dietary diversity (OR for not meet DD: 1.47; 95% CI: 1.05, 2.05). The odds for double burden of suboptimal feeding (concurrent inadequate diet and consumption of HP snacks/SSBs) were significantly lower in children of least educated mothers (OR: 0.64; 95% CI: 0.44, 0.92).
  
  
  CONCLUSIONS
  Higher level of education was associated with both more and less adherence to the WHO recommended feeding practices as well as with more consumption of HP snacks and SSBs. Regardless of educational strata, the children in the community were exposed to suboptimal feeding practices conducive to both under- as well as overnutrition.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. mariela.contreras@kbh.uu.se.
authors.forename: Mariela
authors.initials: M
authors.lastname: Contreras
authors.affiliation: Asociación para el Desarrollo Económico y Social de El Espino (APRODESE), Chinandega, Nicaragua. fundchica@gmail.com.
authors.forename: Elmer Zelaya
authors.initials: EZ
authors.lastname: Blandón
authors.affiliation: Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. lars-ake.persson@kbh.uu.se.
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Persson
authors.affiliation: Centre for Health Equity Studies, Karolinska Institutet/Stockholm University, Stockholm, Sweden. anders.hjern@chess.su.se.
authors.forename: Anders
authors.initials: A
authors.lastname: Hjern
authors.affiliation: Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. lotta.ekstrom@kbh.uu.se.
authors.forename: Eva-Charlotte
authors.initials: EC
authors.lastname: Ekström
mesh_terms: D000328:Adult; D001628:Beverages / Q000706:statistics & numerical data; D001942:Breast Feeding / Q000706:statistics & numerical data; D002241:Carbohydrates / Q000008:administration & dosage; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet / Q000706:statistics & numerical data; D005191:Family Characteristics; D005247:Feeding Behavior; D005260:Female; D005523:Food Supply; D006801:Humans; D007223:Infant; D008297:Male; D009035:Mothers / Q000193:education; D009527:Nicaragua; D009752:Nutritional Status; D012424:Rural Population; D062410:Snacks; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013549:Sweetening Agents / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D002241:Carbohydrates; D013549:Sweetening Agents