title: Longitudinal Development of Infant Complementary Diet Diversity in 3 International Cohorts.
abstract: OBJECTIVE
  To evaluate international differences in the development of minimum dietary diversity (MDD) between 6 and 12 months of age.
  
  
  METHODS
  Breastfed infants (115, 100, and 109 in Shanghai, Cincinnati, and Mexico City, respectively) were enrolled near birth and dietary intake assessed weekly by 24-hour recall of food frequency. Diet diversity per month from age 6-12 months was assessed as at least 4 of 7 food groups provided on the previous day.
  
  
  RESULTS
  Across all cohorts, dietary diversity increased from 6 (31%) to 12 (92%) months of age. Shanghai infants were significantly more likely to achieve MDD than the other cohorts at each month of age. Meat/seafood accounted for a higher proportion of infant feeds in Shanghai compared with the other cohorts, and eggs were only fed in Shanghai, and proportional intake of dairy, grains, and fruit were highest in Cincinnati. Only 28% of Cincinnati infants fed >50% human milk achieved MDD between 6 and 12 months.
  
  
  CONCLUSIONS
  The proportion of infants between 6 and 12 months achieving MDD was significantly higher in Shanghai than in Mexico City or Cincinnati at all ages. Of particular concern was low dietary diversity among highly breastfed Cincinnati cohort infants, suggesting a need for greater education of breastfeeding mothers about the need to introduce a diverse complementary food diet.
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jessica G
authors.initials: JG
authors.lastname: Woo
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Herbers
authors.affiliation: Mead Johnson Pediatric Nutrition Institute, Evansville, IN.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: McMahon
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Davidson
authors.affiliation: National Institute of Medical Sciences and Nutrition, Mexico City, Mexico.
authors.forename: Guillermo M
authors.initials: GM
authors.lastname: Ruiz-Palacios
authors.affiliation: Children's Hospital of Fudan University, Shanghai, China.
authors.forename: Yong-Mei
authors.initials: YM
authors.lastname: Peng
authors.affiliation: Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Ardythe L
authors.initials: AL
authors.lastname: Morrow
mesh_terms: D001939:Bread; D001942:Breast Feeding; D053198:Child Nutrition Sciences; D002681:China; D003611:Dairy Products; D004032:Diet; D015930:Diet Records; D004531:Eggs; D005260:Female; D005638:Fruit; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D038622:Internationality; D008137:Longitudinal Studies; D008297:Male; D008460:Meat; D008800:Mexico; D008895:Milk, Human; D017747:Seafood; D014481:United States; D014675:Vegetables