Do Early Infant Feeding Practices and Modifiable Household Behaviors Contribute to Age-Specific Inter-Individual Variations in Infant Linear Growth? Evidence from a Birth Cohort in Dhaka, Bangladesh

Abstract Background Causes of infant linear growth faltering in low-income settings remain poorly understood. Identifying age-specific risk factors in observational studies may be influenced by statistical model selection. Objectives To estimate associations of selected household factors and infant feeding behaviors within discrete age intervals with interval-specific changes in length-for-age z-scores (LAZ) or attained LAZ, using five statistical approaches. Methods Data from a birth cohort in Dhaka, Bangladesh (n = 1157) was analyzed. Multivariable-adjusted associations of infant feeding patterns or household factors with conditional LAZ (cLAZ) were estimated for five intervals in infancy. Two alternative approaches were used to estimate differences in interval changes in LAZ, and differences in end-interval attained LAZ and relative risks of stunting (LAZ←2) were estimated. Results LAZ was symmetrically distributed with mean (standard deviation) -0.95 (1.02) at birth and -1.00 (1.04) at 12 months. Compared to exclusively breastfed infants, partial breastfeeding (difference in cLAZ: -0.11, 95% CI: -0.20, -0.02) or no breastfeeding (-0.30, 95% CI: -0.54, -0.07) were associated with slower growth from 0 to 3 months. However, associations were not sustained beyond 6 months. Modifiable household factors (smoking, water treatment, soap at handwashing station) were not associated with infant growth, attained size or stunting. Alternative statistical approaches yielded mostly similar results as conditional growth models. Conclusions The entire infant LAZ distribution was shifted down, indicating that length deficits were mostly caused by ubiquitous or community-level factors. Early-infant feeding practices explained minimal variation in early growth, and associations were not sustained to 12 months of age. Statistical model choice did not substantially alter the conclusions. Modifications of household hygiene, smoking or early infant feeding practices would be unlikely to improve infant linear growth in Bangladesh or other settings where growth faltering is widespread.

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DO MODIFIABLE HOUSEHOLD BEHAVIORS AND EARLY INFANT FEEDING PRACTICES CONTRIBUTE TO VARIATIONS IN INFANT LINEAR GROWTH? EVIDENCE FROM A BIRTH COHORT IN DHAKA, BANGLADESH

Paediatrics & Child Health ◽

10.1093/pch/pxy054.120 ◽

2018 ◽

Vol 23 (suppl_1) ◽

pp. e47-e47

Author(s):

Sarah Silverberg ◽

Joy Shi ◽

Abdullah Al Mahmud ◽

Daniel Roth

Keyword(s):

Risk Factors ◽

Air Quality ◽

Infant Feeding ◽

Linear Growth ◽

Feeding Practices ◽

Household Wealth ◽

International Standards ◽

Infant Feeding Practices ◽

Early Infant ◽

Modifiable Factors

Abstract BACKGROUND Numerous postnatal risk factors have been associated with child length/height in cross-sectional studies in low- and middle-income countries. However, there have been few longitudinal studies of the effects of modifiable risk factors on postnatal linear growth during discrete developmental windows of infancy. OBJECTIVES We aimed to assess associations between modifiable household behaviours and conditional growth from birth to 1 year of life. DESIGN/METHODS We conducted a longitudinal cohort study using data from women and their infants (n=1162 pairs) in the Maternal Vitamin D and Infant Growth trial in Dhaka, Bangladesh. Infant length was measured tri-monthly from birth to 12 months, and infant feeding patterns were ascertained at weekly visits from 0 to 6 months of age. Confounder-adjusted associations of selected modifiable household factors (i.e., household air quality, sanitation/hygiene) or early infant feeding with change in length-for-age z-score (LAZ) were estimated in five intervals: birth to 3 months, 3 to 6 months, birth to 6 months, 6 to 12 months and birth to 12 months. In primary analyses, the outcome was conditional growth in LAZ (cLAZ) in each interval, derived as model residuals from regression of end-interval LAZ on initial LAZ. Effect estimates were expressed as mean difference in cLAZ (95% confidence interval) between the exposed versus referent group. RESULTS LAZ was symmetrically distributed, with mean (± standard deviation) LAZ of -0.95 (± 1.02) at birth and -1.00 (± 1.04) at 12 months. In multivariable-adjusted linear regression models, indicators of household air quality and sanitation/hygiene were not significantly associated with cLAZ in any interval. No breastfeeding and partial breastfeeding (versus exclusive breastfeeding), and any infant formula use (versus no formula use) were associated with slower growth in the 0–3 month interval: -0.11 (95% CI: -0.20, -0.02), -0.30 (95% CI: -0.52, -0.08), and -0.13 (95% CI: -0.22, -0.05), respectively, but not in later intervals. Several non-modifiable factors (maternal height, paternal education, and household wealth) were associated with cLAZ and LAZ in multivariable models. CONCLUSION Compared to international standards, the length distribution of infants in Dhaka, Bangladesh was harmonically shifted down at birth and throughout the first year of life, suggesting that observed infant length deficits relative to international norms were primarily caused by ubiquitous factors. Infant feeding practices explained some between-child variation in linear growth in the early postnatal period (0–3 months). Behaviors related to cooking or sanitation/hygiene were not related to infant linear growth trajectories.

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Early infant feeding practices of mothers attending a postnatal clinic in Ga-Rankuwa

South African Journal of Clinical Nutrition ◽

10.1080/16070658.2005.11734042 ◽

2005 ◽

Vol 18 (2) ◽

pp. 70-75 ◽

Cited By ~ 9

Author(s):

U E MacIntyre ◽

de Villiers ◽

P G Baloyi

Keyword(s):

Infant Feeding ◽

Feeding Practices ◽

Infant Feeding Practices ◽

Early Infant

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Early infant feeding practices in three African countries: the PROMISE-EBF trial promoting exclusive breastfeeding by peer counsellors

International Breastfeeding Journal ◽

10.1186/1746-4358-9-19 ◽

2014 ◽

Vol 9 (1) ◽

Cited By ~ 17

Author(s):

Ingunn Marie S Engebretsen ◽

Victoria Nankabirwa ◽

Tanya Doherty ◽

Abdoulaye Hama Diallo ◽

Jolly Nankunda ◽

...

Keyword(s):

Infant Feeding ◽

Exclusive Breastfeeding ◽

Feeding Practices ◽

Infant Feeding Practices ◽

African Countries ◽

Early Infant

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Infant feeding practices in a South African birth cohort-A longitudinal study

Maternal and Child Nutrition ◽

10.1111/mcn.12371 ◽

2016 ◽

Vol 13 (3) ◽

pp. e12371 ◽

Cited By ~ 15

Author(s):

Shrish Budree ◽

Elizabeth Goddard ◽

Kirsty Brittain ◽

Shihaam Cader ◽

Landon Myer ◽

...

Keyword(s):

Longitudinal Study ◽

South African ◽

Birth Cohort ◽

Infant Feeding ◽

Feeding Practices ◽

Infant Feeding Practices

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Infant feeding: a selective review and research needs

Paediatrica Indonesiana ◽

10.14238/pi28.7-8.1988.167-82 ◽

2019 ◽

Vol 28 (7-8) ◽

pp. 167-82

Author(s):

J. A. Kusin

Keyword(s):

Social Science ◽

Infant Feeding ◽

Infant Health ◽

Feeding Practices ◽

Research Needs ◽

Social Science Discipline ◽

Infant Feeding Practices ◽

Factors Influencing ◽

Growth Faltering ◽

High Prevalence

Growth faltering starting in infancy can be considered the onset of malnutrition. Infant feeding practices as well as a high prevalence of infectious diseases are causal in this process. While general recommendations on infant feeding are useful as guidelines, it is futile to attempt univorm recommendations as good feeding practices are bound to differ by community. It is felt that the biomedical and social science discipline should investigate the factors influencing infant feeding as well as the consequences of habitual practices on infant health and survival.

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