Nutritional status and complementary feeding among HIV-exposed infants: a prospective cohort study.
Complementary feeding is crucial for improving child survival and promoting growth and development, particularly among HIV-exposed children who have higher risk of morbidity and mortality than their un-exposed peers. This prospective study employed an infant and child feeding index (ICFI) to measure complementary feeding and determine its association with nutritional status among 2092 HIV-exposed infants followed from 6 to 24 months of age in Dar es Salaam, Tanzania. The ICFI measured both quality and quantity of complementary feeding, including current breastfeeding status, food consistency, dietary diversity scores (DDS), food group frequency score, and meal frequency. The ICFI score ranged from 0 to 9; the median score was 6 (Inter-Quartile Range, IQR= 4-7). After adjusting for potential confounders, high ICFI scores were associated with reduced risk of stunting (high vs. low tertile hazard ratio, HR: 0.72; 95% confidence interval, CI: 0.57, 0.91; P< 0.01) and underweight (high vs. low tertile HR: 0.79; 95% CI: 0.61, 1.02; P= 0.07). Low DDS were associated with higher risk of stunting (low vs. high tertile HR: 1.59; 95% CI: 1.23, 2.07; P< 0.01) and underweight (low vs. high tertile HR: 1.48; 95% CI: 1.12, 1.96; P= 0.01). In this setting, high DDS and ICFI scores were protective of stunting and underweight. We recommend for nutrition programs in low-income countries to emphasize educating HIV-exposed children's caregivers on the importance of dietary diversity and optimal complementary feeding to improve nutritional status in this important subpopulation.
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Pili
P
Kamenju
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Enju
E
Liu
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Ellen
E
Hertzmark
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Donna
D
Spiegelman
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Rodrick
R
Kisenge
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|United Nations Children's Fund, United Nations Children's Fund (UNICEF), New York, New York, USA.
Roland
R
Kupka
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Said
S
Aboud
Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Karim P
KP
Manji
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.|Boston Children's Hospital, Boston, Massachusetts, USA.
Christopher
C
Duggan
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Wafaie W
WW
Fawzi
D000328:Adult; D002675:Child, Preschool; D004032:Diet; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000453:epidemiology*; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007225:Infant Food; D007227:Infant Nutritional Physiological Phenomena; D015596:Nutrition Assessment; D009752:Nutritional Status; D011446:Prospective Studies; D012959:Socioeconomic Factors; D013636:Tanzania / Q000453:epidemiology; D013851:Thinness / Q000453:epidemiology*; D055815:Young Adult
HIV and infant feeding; child growth; complementary feeding; infant and child nutrition; low income countries; undernutrition
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