Dietary Variation among Children Meeting and Not Meeting Minimum Dietary Diversity: An Empirical Investigation of Food Group Consumption Patterns among 73,036 Children in India

Trends in Complementary Feeding Indicators in Children Aged 6-23 Months According to Participation in a Conditional Cash Transfer Program: Data from the Brazilian Food and Nutrition Surveillance System, 2015-2019

Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.

Food deprivation among adults in India: an analysis of specific food categories, 2016-2021

Background

Adult undernourishment remains pervasive throughout India, and often results from food deprivation, which refers to the inadequate consumption of foods with caloric and nutrient significance. Therefore, understanding the extent to which food groups are missing from an individual's diet is essential to understanding the extent to which they are undernourished.

Methods

We used data from two National Family Health Surveys conducted in 2016 and 2021 for this cross-sectional analysis. The study population consisted of women and pregnant women between the ages of 15-49, and men between the ages of 15-54. We examined shifts in the percentage of people not consuming dairy, pulses/beans/legumes, dark leafy green vegetables, fruits, eggs, and fish and meat among women, pregnant women, and men between the two time points. We also examined these patterns by household wealth and education, two important markers of socioeconomic status.

Findings

Overall, we found that fewer women, pregnant women, and men were not eating each of the six food groups in 2021 than in 2016. Additionally, the gap in food group consumption between women, pregnant women, and men in the lowest and highest socioeconomic groups shrank between 2016 and 2021. Yet, food group deprivation remained most prevalent among those in the lowest socioeconomic groups. The two exceptions for this were for eggs and meat/fish. Nevertheless, the majority of India's poorest and least educated adults are not consuming high-quality protein sources, including dairy, the consumption of which is far more common among wealthier and more educated Indian adults.

Interpretation

Our results show that fewer adults were not consuming important food groups in 2021 than in 2016. However, many of India's poorest and least educated adults are still not consuming high-quality sources of protein or fruits, two food groups that are essential for good health. While adults might be getting protein and nutrients from pulses, legumes, beans, and other vegetables, efforts are needed to improve affordability of, and access to, high-quality sources of protein and fruits.

Funding

This work was supported by the Bill & Melinda Gates Foundation, INV- 002992.

Magnitude and predictors of anemia among preschool children (36-59 months) in Atingo town, Jimma, Ethiopia

Introduction

Anemia is a serious public health concern that affects more than 25% of the world's population. It is still widespread and at its most severe in Ethiopia. This study pointed to identify the magnitude and predictors of anemia in preschool children in Atinago.

Method

A structured interview and anthropometric metrics had been used in a cross-sectional study to collect data from 309 preschool children using a systematic sampling strategy from May 10 to June 25, 2022. Frequencies, percentages, means, and a bar chart were created as descriptive statistics. Factors that were significant at the 25% level in univariate analysis were run through multiple logistic models. Odds ratios with respective 95% confidence intervals were developed to determine the relevant predictors.

Result

The majority (51.7%) of preschool children in Atinago town had anemia. The finding reveals that poor dietary diversity (adjusted odds ratio [AOR] = 1.77, 95% confidence interval [CI] = 1.02-3.07), children from families with food insecurity (AOR = 2.28, 95% CI = 1.31-3.9), child-mothers used iron folate for less than 3 months during pregnancy (AOR = 1.93, 95% CI = 1.07-3.48), households with more than five children (AOR = 1.880, 95% CI = 1.12-3.18), and stunted children (AOR = 1.78, 95% CI = 1.05-3.01) were highly susceptible to anemia.

Conclusion

The findings indicate that anemia was a serious issue among preschool children in Atinago. Therefore, stakeholders should provide community-based nutrition training on consuming diverse diets, dietary improvements in the home, consuming iron-rich meals, and the like; encourage mothers to participate in early ANC follow-up; and strengthen activities aimed at identifying households with food insecurity status.

Dietary diversity and its determinants among children aged 6-23 months in Ethiopia: evidence from the 2016 Demographic and Health Survey

Dietary diversity in children may be influenced not only by individual circumstances but also by the features of the community in which they live. Our study aimed to assess community and individual-level determinants of minimum dietary diversity among children aged 6-23 months in Ethiopia. We included 2960 children aged 6-23 months from the recent Ethiopia Demographic and Health Survey. A minimum dietary diversity was defined as the consumption of at least five food groups out of the eight reference food groups within 24 h by children aged 6-23 months. Multilevel logistic regression was used to investigate the drivers of minimum dietary diversity in Ethiopian children aged 6-23 months. About 12⋅5 % of children met the bare minimum of dietary diversification. Age of the child (9-11 months AOR, 3⋅3 (95 % CI 1⋅8, 5⋅6), 12-17 months AOR, 4⋅0 (95 % CI 2⋅4, 6⋅7), 18-23 months AOR, 3⋅5 (95 % CI 2⋅0, 5⋅8)), caregiver listening radio at least once a week AOR, 1⋅6 (95 % CI 1⋅1, 2⋅4) and wealth quantiles (Second AOR, 1⋅8 (95 % CI 1⋅1, 3⋅1), Fourth AOR, 2⋅9 (95 % CI 1⋅6, 5⋅2) and Highest AOR, 2⋅2 (95 % CI 1⋅1, 4⋅2)) were individual characteristics associated with dietary diversity. Place of residence was the only community-level characteristic associated with children's dietary diversity (Rural AOR, 0⋅4 (95 % CI 0⋅2, 0⋅6)). The minimum dietary diversity among Ethiopian children is suboptimal. Nutrition programmes aimed at enhancing dietary diversity should be strengthened in this population, particularly for those from poor families and residing in rural areas.

Complementary Feeding Practices among Young Children in China, India, and Indonesia: A Narrative Review

Under- and overnutrition are co-existing health issues in several countries across Asia. Poor complementary feeding (CF) is a significant determinant of malnutrition in children and a major cause of morbidity and mortality. The purpose of this narrative review is to summarize the most recent evidence regarding the CF practices in 3 countries with a high prevalence of stunting and overweight, and currently undergoing rapid economic and nutritional transition: China, India, and Indonesia. We focused particularly on the adequacy of CF, based on the WHO feeding indicators (2021) regarding timing, frequency, diversity, as well as the consumption of specific food groups. According to the findings, the majority of infants in the 3 countries are introduced to CF at an inappropriate time: either too early (particularly in urban/rural areas of China and Indonesia) or too late (India) compared with the WHO recommendation. Furthermore, in all countries, diets are characterized by a low variety and frequency of CF and consist mainly of staple foods with poor nutritional quality, such as rice, cereals, or noodles. Nutrient-dense and protein-rich foods, such as foods of animal origin, are either inadequately consumed (rural areas of China and India) or introduced too late (urban areas of China and Indonesia) in the diets of children. In all countries, the consumption of fruit and vegetables, especially during the early CF period, is poor. In contrast, a significant proportion of both urban and rural children, particularly in Indonesia and India, are consuming energy-dense/nutrient-poor snacks and sugary drinks during the CF period. The described practices may pose a significant risk for the development of energy and/or nutrient gaps, magnifying the double and triple burden of malnutrition present in these countries. Further research is warranted to understand the significance of the observed practices for stunting and/or overweight/obesity risk.

Most Commonly-Consumed Food Items by Food Group, and by Province, in China: Implications for Diet Quality Monitoring

Dietary quality is of great significance to human health at all country income levels. However, low-cost and simple methods for population-level assessment and monitoring of diet quality are scarce. Within these contexts, our study aimed to identify the sentinel foods nationally and by province of 29 food groups to adapt the diet quality questionnaire (DQQ) for China, and validate the effectiveness of the DQQ using data from the China Health and Nutrition Survey (CHNS). The DQQ is a rapid dietary assessment tool with qualitative and quantitative analysis to determine appropriate sentinel foods to represent each of 29 food groups. Dietary data of 13,076 participants aged 15 years or older were obtained from wave 2011 of CHNS, and each food and non-alcoholic beverage was grouped into 29 food groups of the DQQ. The data were analyzed to determine the most commonly consumed food items in each food group, nationally and in each province. Key informant interviews of 25 individuals familiar with diets in diverse provinces were also conducted to identify food items that may be more common in specific provinces. China's DQQ was finalized based on identification of sentinel foods from the key informant interviews, and initial national results of the quantitative data. Consumption of sentinel foods accounted for over 95% of people who consumed any food item in each food group, at national levels and in all provinces for almost all food groups, indicating the reliability of the sentinel food approach. Food-group consumption data can be obtained through DQQ to analyze dietary diversity as well as compliance with WHO global dietary guidance on healthy diets, providing a low-burden, food-group-based and simple method for China to evaluate diet quality at the whole population level.

Small Area Variations in Dietary Diversity Among Children in India: A Multilevel Analysis of 6-23-Month-Old Children

Dietary diversity is an important indicator of child malnutrition. However, little is known about the geographic variation of diet indicators across India, particularly within districts and across states. As such, the purpose of this paper was to elucidate the small area variations in diet indicators between clusters within districts of India. Overall, we found that clusters were the largest source of variation for children not eating grains, roots, and tubers, legumes and nuts, dairy, vitamin A-rich vegetables and fruits, and other vegetables and fruits. We also found positive correlations between the district percent and cluster standard deviations of children not breastfeeding or eating grains, roots, and tubers, but negative correlations between the district percent and cluster standard deviation for the remaining seven outcomes. These findings underscore the importance of targeting clusters to improve child dietary diversity.

Factors associated with minimum dietary diversity failure among Indian children

Recognising the importance of infant and young child feeding practices during the first 2 years of life, the World Health Organization's Global Nutrition Monitoring Framework developed a minimum dietary diversity (MDD) indicator for feeding children aged 6–23 months. MDD is defined as the consumption of food items from five or more groups out of a total of eight food groups. Food intake from less than five food groups is considered minimum dietary diversity failure (MDDF). Using the nationally representative National Family Health Survey (NFHS) dataset, the present study assessed the trend in MDDF between 2005–6 and 2015–16 and the factors associated with MDDF among children aged 6–23 months during 2015–16. The NFHS conducted in 2005–6 and 2015–16 covered a sample of 14 419 and 74 078 children aged 6–23 months, respectively. Overall, the MDDF reduced from 87⋅4  % (95  % confidence interval (95  % CI) 86⋅8  %, 87⋅9  %) in 2005–6 to 80⋅6  % (95  % CI 80⋅1  %, 81⋅0  %) in 2015–16. Multivariable logistic regression analysis revealed that increased child's age, second and third birth order children, higher maternal age and education, mass media exposure of mothers and more than four antenatal care visits had a negative association with the MDDF. Children living in rural areas and residing in high-focus states of India were observed with higher odds of experiencing MDDF. Exposure to community healthcare services was negatively associated with MDDF, and anaemic children were more likely to have MDDF. Socioeconomic status of mothers and children and encouragement of maternal and child healthcare use could be helpful in devising context-specific intervention to mitigate MDDF.

Minimum dietary diversity and its associated factors among infants and young children in Ethiopia: evidence from Ethiopian Demographic and Health Survey (2016)

Background

Adequate infant and young child feeding during the first 1000 days of life is very essential to improve child health, survival, growth, and development through minimum dietary diversity (MDD). Hence, this study aimed to assess MDD and its multi-level factors among infants and young children aged 6–23 months in Ethiopia.

Methods

Ethiopian Demographic and Health Survey (EDHS-2016) data was used to identify both individual and community-level factors of dietary diversity. Weighted samples of 2,962 children were eligible and a multi-level regression model was used for the analysis. Finally, factors with a P-value of <0.05 were considered statistically significant.

Results

The prevalence of MDD among children in Ethiopia was 12.09%. According to this study, factors such as having a mother who attended higher education (AOR = 3.09, (95% CI; _1.67–5.71)), being a female household head (AOR = 0.62, (95% CI; _0.40–0.95)), having a mother's agricultural occupation (AOR = 1.89, (95% CI; _1.10–3.23)) and living in the household in the richest wealth index were significantly associated at the individual level. At the community level, children living in rural areas (AOR = 0.62, 95% CI; 0.39–0.98) were significant risk factors for MDD (AOR = 0.62, 95% CI; 0.39–0.98).

Conclusion

The educational and occupational status of the mother, wealth index, and region were significantly associated with MDD. Hence, strengthening of the existing nutritional intervention is helpful to increase diversified food consumption among children.