Nutritional status and complementary feeding among HIV-exposed infants: a prospective cohort study
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Published on: September 6, 2019
Pili Kamenju1, Enju Liu1, Ellen Hertzmark1
1Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
Insights
Optimal complementary feeding, measured by the infant and child feeding index (ICFI), significantly reduces stunting and underweight risks in HIV-exposed infants. Ensuring dietary diversity is key for their healthy growth and development.
Area of Science:
- Pediatric Nutrition
- Public Health
- Infectious Disease Epidemiology
Background:
- Complementary feeding is vital for child survival and development, especially for HIV-exposed infants facing higher health risks.
- Nutritional status in early childhood is critical for long-term health outcomes.
Purpose of the Study:
- To assess the association between complementary feeding practices and nutritional status in HIV-exposed infants.
- To evaluate the effectiveness of the Infant and Child Feeding Index (ICFI) in measuring feeding quality and quantity.
Main Methods:
- A prospective study followed 2092 HIV-exposed infants from 6 to 24 months in Dar es Salaam, Tanzania.
- The Infant and Child Feeding Index (ICFI) assessed breastfeeding, food consistency, dietary diversity, food group frequency, and meal frequency.
- Statistical analyses adjusted for confounders to determine the impact of ICFI and Dietary Diversity Scores (DDS) on stunting and underweight.
Main Results:
- High ICFI scores were linked to a reduced risk of stunting (HR: 0.72) and underweight (HR: 0.79) in HIV-exposed infants.
- Low Dietary Diversity Scores (DDS) were associated with increased risk of stunting (HR: 1.59) and underweight (HR: 1.48).
- Both high DDS and ICFI scores demonstrated protective effects against malnutrition.
Conclusions:
- Optimizing complementary feeding, particularly enhancing dietary diversity, is crucial for improving nutritional status in HIV-exposed infants.
- Nutrition programs in low-income countries should prioritize caregiver education on optimal complementary feeding practices for this vulnerable population.
Abstract:
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.
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