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Adherence to Child Feeding Practices and Child Growth: A Retrospective Cohort Analysis in Cambodia
Somphos Vicheth Som1, Marinka Van Der Hoeven1, Arnaud Laillou2
1Section of Infectious Diseases, Department of Health Sciences, Vrije Universiteit Amsterdam, de Boelelaan 1091, 1081 HV Amsterdam, The Netherlands.
Insights
Adhering to age-appropriate feeding practices like adequate minimal dietary diversity (MDD) and minimal acceptable diet (MAD) significantly reduces stunting and improves growth in Cambodian children. Interventions should focus on improving food quality and quantity during the critical first 1000 days.
Area of Science:
- Child Health and Nutrition
- Global Public Health
- Developmental Pediatrics
Background:
- The first 1000 days of life are crucial for child development and growth.
- Inadequate feeding practices contribute to childhood stunting and wasting, particularly in low-resource settings.
- Understanding the impact of specific feeding indicators on child growth is vital for effective interventions.
Purpose of the Study:
- To investigate the association between adherence to age-appropriate feeding practices and child growth indicators in Cambodia.
- To quantify the impact of minimal dietary diversity (MDD), minimal acceptable diet (MAD), and age-appropriate daily feeding (ADF) on stunting and Z-scores.
- To inform public health strategies aimed at reducing malnutrition in young children.
Main Methods:
- Longitudinal study analyzing data from 1079 children in Cambodia over 30 months and six follow-ups.
- Generalized linear mixed-effect models were used to assess associations between feeding practices and growth outcomes.
- Key feeding indicators analyzed included MDD, MAD, ADF, and minimum meal frequency (MMF).
Main Results:
- Higher adherence to MDD, MAD, and ADF was associated with significantly lower rates of stunting compared to non-adherence.
- Increased adherence to MDD and ADF correlated with higher height-for-age Z-scores (HAZ).
- Greater adherence to MDD and MAD was linked to improved weight-for-height Z-scores (WHZ).
- Higher adherence to minimum meal frequency (MMF) was unexpectedly associated with lower HAZ.
Conclusions:
- Improving both the quality (MDD, MAD) and quantity (ADF) of food intake is essential for reducing stunting and wasting in children under two.
- Interventions should encompass the entire complementary feeding period to maximize positive impacts on child growth.
- Further research is needed to understand the paradoxical association between MMF and HAZ.
Abstract:
Appropriate feeding in the first 1000 days of a child's life is critical for their health and growth. We determined associations between adherence to age-appropriate feeding practices and child growth in Cambodia. Children (n = 1079) were included in the first follow-up (FU) data analyses and followed for 30 months (six FUs). Data were analyzed by generalized linear mixed-effect models. Children who adhered to feeding practices on at least three FUs, with an adequate minimal dietary diversity (MDD), a minimal acceptable diet (MAD), and age-appropriate daily feeding (ADF) were less stunted (14.8%, 12.3%, and 6.4%, respectively) than children who never adhered to these indicators (25.2%, 30.1%, and 24.8%, respectively). A higher adherence to MDD and ADF was associated with a higher height-for-age Z-score (HAZ) (β: 0.13, 95% CI: 0.01-0.25 and β: 0.36, 95% CI: 0.22-0.50), while a higher adherence to the MDD and MAD was associated with a higher weight-for-height Z-score (WHZ) (β: 0.19, 95% CI: 0.08-0.30; and β: 0.16, 95% CI: 0.05-0.27). A higher adherence to a minimum meal frequency (MMF) was associated with a lower HAZ (β: -0.99, 95% CI: -1.28--0.70). Our findings showed that to reduce wasting and stunting in Cambodia, interventions should focus on improving both the quality and quantity of food intake of children under two while targeting the whole complementary feeding period.
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