Dietary Diversity Is Positively Associated with Deviation from Expected Height in Rural Nepal.
Recent research has highlighted the need for additional studies on the nutrition input required to stabilize growth.



Our objective was to examine the association between dietary diversity and conditional growth in children aged 0-89 mo.



We analyzed cohort data from 529 mothers and children living in a remote and food-insecure region in the mountains of Nepal. Children were aged 0-59 mo at baseline and were followed up after 9 and 29 mo. Conditional growth was calculated as the deviation from the expected height-for-age difference (HAD) trajectory based on previous measures of HAD and the pattern of growth in the population. Dietary diversity was assessed with the use of a count of the foods consumed from 7 food groups in the previous 7 d. The association between dietary diversity and conditional growth during the 2 follow-up periods (of 9 and 20 mo, respectively) was estimated with the use of ordinary least-squares regressions.



Prevalence of stunting and absolute height deficits was very high and increased over the course of the study. At the last measurement (age range 29-89 mo), 76.5% were stunted and the mean ± SD HAD was -11.7 ± 4.6 cm. Dietary diversity was associated positively with conditional growth in the later (May 2012-December 2013) but not the earlier (July 2011-May 2012) growth period. Children's ages ranged from 0 to 59 mo in July 2011, 9 to 69 mo in May 2012, and 29 to 89 mo in December 2013. After adjustment, increasing the dietary diversity by one food group was associated with a 0.09 cm (95% CI: 0.00, 0.17 cm) increase in conditional growth in the second growth period.



Increasing dietary diversity for children reduces the risk of stunting and improves growth after growth faltering. Future efforts should be directed at enabling families in food-insecure areas to feed their children a more diverse diet.
Institute for Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany; laura.busert@gmail.com.
Laura K
0000-0002-6768-3948
LK
Busert
Institute for Global Health, University College London, London, United Kingdom; and.
Melissa
0000-0002-8870-6504
M
Neuman
Institute for Medical Informatics, Biometry, and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany;
Eva A
EA
Rehfuess
Mother and Infant Research Activities, Kathmandu, Nepal.
Sophiya
0000-0002-2244-613X
S
Dulal
Institute for Global Health, University College London, London, United Kingdom; and.
Jayne
J
Harthan
Mother and Infant Research Activities, Kathmandu, Nepal.
Shiva Shankar
SS
Chaube
Mother and Infant Research Activities, Kathmandu, Nepal.
Bishnu
B
Bhandari
Institute for Global Health, University College London, London, United Kingdom; and.
Harry
H
Costello
Institute for Global Health, University College London, London, United Kingdom; and.
Anthony
A
Costello
Mother and Infant Research Activities, Kathmandu, Nepal.
Dharma S
0000-0001-8699-6774
DS
Manandhar
Institute for Global Health, University College London, London, United Kingdom; and.
Naomi M
0000-0002-1735-3684
NM
Saville
D001827:Body Height; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D004034:Diet Surveys; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D009390:Nepal / Q000453:epidemiology
Nepal; child growth; child growth faltering; child growth recovery; conditional growth; dietary diversity; stunting