World Health Organization , 2021. UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: Levels and Trends in Child Malnutrition: Key Findings of the 2021 Edition. Geneva, Switzerland: WHO.
Lu C, Black MM, Richter LM, 2016. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health (ePub 2016 Oct 4): 4--5, Table 1.
National Institute of Population Research and Training Medical Education and Family Welfare Division Ministry of Health and Family Welfare Dhaka, Bangladesh, The DHS Program ICF , 2019. Bangladesh Demographic and Health Survey 2017–18: Key Indicators. Available at: https://www.dhsprogram.com/pubs/pdf/PR104/PR104.pdf. Accessed March 18, 2022.
Martorell R, Khan LK, Schroeder DG , 1994. Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr 48 (Suppl 1):S45–S57.
Victora CG et al.2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371: 340–357.
Allen LH , 1994. Nutritional influences on linear growth: a general review. Eur J Clin Nutr 48 (Suppl 1):S75–S89.
Lucas A, Fewtrell MS, Cole TJ , 1999. Fetal origins of adult disease: the hypothesis revisited. BMJ 319: 245–249.
Popkin BM, Richards MK, Montiero CA , 1996. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J Nutr 126: 3009–3016.
Sawaya AL, Martins P, Hoffman D, Roberts SB , 2003. The link between childhood undernutrition and risk of chronic diseases in adulthood: a case study of Brazil. Nutr Rev 61: 168–175.
Silverman BL, Rizzo TA, Cho NH, Metzger BE , 1998. Long-term effects of the intrauterine environment: the Northwestern University Diabetes in Pregnancy Center. Diabetes Care 21 (Suppl 2):B142–B149.
Pollitt E, Gorman KS, Engle PL, Rivera JA, Martorell R , 1995. Nutrition in early life and the fulfillment of intellectual potential. J Nutr 125 (Suppl):1111s–1118s.
Prado EL, Dewey KG , 2014. Nutrition and brain development in early life. Nutr Rev 72: 267–284.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM , 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM , 2007. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137: 2464–2469.
Rivera JA, Hotz C, González-Cossío T, Neufeld L, García-Guerra A , 2003. The effect of micronutrient deficiencies on child growth: a review of results from community-based supplementation trials. J Nutr 133 (Suppl 2):4010s–4020s.
Slavin JL, Lloyd B, 2012. Health benefits of fruits and vegetables. Adv Nutr 3: 506–516.
Gu Y, He Y, Ali SH, Harper K, Dong H, Gittelsohn J, 2021. Fruit and vegetable intake and all-cause mortality in a Chinese population: the China Health and Nutrition Survey. Int J Environ Res Public Health 18: 342.
Wang X et al.2014. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 349: g4490.
Dror DK, Allen LH , 2011. The importance of milk and other animal-source foods for children in low-income countries. Food Nutr Bull 32: 227–243.
Thorne-Lyman AL, Shrestha M, Fawzi WW, Pasqualino M, Strand TA, Kvestad I, Hysing M, Joshi N, Lohani M, Miller LC, 2019. Dietary diversity and child development in the far west of Nepal: a cohort study. Nutrients 11: 1799.
Arimond M, Ruel MT, 2002. Progress in developing an infant and a child feeding index: an example using the Ethiopia Demographic and Health Survey 2000. Available at: https://www.ifpri.org/publication/progress-developing-infant-and-child-feeding-index.
Hatløy A, Hallund J, Diarra MM, Oshaug A , 2000. Food variety, socioeconomic status and nutritional status in urban and rural areas in Koutiala (Mali). Public Health Nutr 3: 57–65.
Hatløy A, Torheim LE, Oshaug A , 1998. Food variety: a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. Eur J Clin Nutr 52: 891–898.
Khamis AG, Mwanri AW, Ntwenya JE, Kreppel K , 2019. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatr 19: 518.
Kim R, Mejía-Guevara I, Corsi DJ, Aguayo VM, Subramanian SV, 2017. Relative importance of 13 correlates of child stunting in South Asia: insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan. Soc Sci Med 187: 144--154.
Krasevec J, An X, Kumapley R, Bégin F, Frongillo EA, 2017. Diet quality and risk of stunting among infants and young children in low- and middle-income countries. Matern Child Nutr 13 (Suppl 2): 5--6.
Onyango A, Koski KG, Tucker KL , 1998. Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. Int J Epidemiol 27: 484–489.
Thorne-Lyman A, Spiegelman D, Fawzi WW , 2014. Is the strength of association between indicators of dietary quality and the nutritional status of children being underestimated? Matern Child Nutr 10: 159–160.
Tufts University , 2021. Minimum Dietary Diversity (MDD) for Children 6–23 Months Old. Available at: https://inddex.nutrition.tufts.edu/node/158. Accessed March 18, 2022.
Onyango AW, Borghi E, de Onis M, Casanovas Mdel C, Garza C , 2014. Complementary feeding and attained linear growth among 6-23-month-old children. Public Health Nutr 17: 1975–1983.
McCormick BJJ et al., 2019. Intestinal permeability and inflammation mediate the association between nutrient density of complementary foods and biochemical measures of micronutrient status in young children: results from the MAL-ED study. Am J Clin Nutr 110: 1015--1025.
Marriott BP, White A, Hadden L, Davies JC, Wallingford JC , 2012. World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 8: 354–370.
Jones AD et al.2014. World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings. Matern Child Nutr 10: 1–17.
Sheikh N, Akram R, Ali N, Haque SR, Tisha S, Mahumud RA, Sarker AR, Sultana M, 2020. Infant and young child feeding practice, dietary diversity, associated predictors, and child health outcomes in Bangladesh. J Child Health Care 24: 260--273.
Zongrone A, Winskell K, Menon P , 2012. Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data. Public Health Nutr 15: 1697–1704.
George CM et al., 2021. Effects of a water, sanitation, and hygiene mobile health program on diarrhea and child growth in Bangladesh: a cluster-randomized controlled trial of the cholera hospital-based intervention for 7 days (CHoBI7) mobile health program. Clin Infect Dis 73: e2560--e2568.
George CM et al., 2019. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 19: 1028.
Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R , 2010. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics 125: e473–e480.
de Onis M, Onyango AW , 2008. WHO child growth standards. Lancet 371: 204.
USAID , 2006. Developing and Validating Simple Indicators of Dietary Quality and Energy Intake of Infants and Young Children in Developing Countries: Summary of findings from analysis of 10 data sets. Available at: https://www.fantaproject.org/sites/default/files/resources/IYCF_Datasets_Summary_2006.pdf.
Moursi MM, Arimond M, Dewey KG, Treche S, Ruel MT, Delpeuch F , 2008. Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar. J Nutr 138: 2448–2453.
Arimond M, Ruel MT , 2004. Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr 134: 2579–2585.
Yahia EM, Maldonado Celis M, Svendsen M , 2017. The contribution of fruit and vegetable consumption to human health. Yahi EM, ed. Fruit and Vegetable Phytochemicals. Hoboken, NJ: Wiley, 3–52.
Wang A et al.2017. The dietary diversity and stunting prevalence in minority children under 3 years old: a cross-sectional study in forty-two counties of western China. Br J Nutr 118: 840–848.
Som SV et al.2020. Adherence to child feeding practices and child growth: a retrospective cohort analysis in Cambodia. Nutrients 13: 8.
Muslimatun S, Wiradnyani LA , 2016. Dietary diversity, animal source food consumption and linear growth among children aged 1-5 years in Bandung, Indonesia: a longitudinal observational study. Br J Nutr 116 (Suppl 1):S27–S35.
Correia LL, Rocha HAL, Campos JS, Silva ACE, Silveira DMID, Machado MMT, Leite AJM, Cunha AJLAD, 2019. Interaction between vitamin A supplementation and chronic malnutrition on child development. Cien Saude Colet 24: 3037--3046.
Aguayo VM, Nair R, Badgaiyan N, Krishna V, 2016. Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra’s comprehensive nutrition survey. Matern Child Nutr 12 (Suppl 1):121–140.
Headey D, Hirvonen K, Hoddinott J , 2018. Animal sourced foods and child stunting. Am J Agr Econ 100: 1302–1319.
Murphy SP, Allen LH , 2003. Nutritional importance of animal source foods. J Nutr 133: 3932S–3935S.
The World Bank , n.d. Population Living in Slums (% of Urban Population). Available at: https://data.worldbank.org/indicator/EN.POP.SLUM.UR.ZS. Accessed March 18, 2022.
The World Bank , 2018. Urban Population (% of Total Population). Available at: https://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS. Accessed March 18, 2022.
The World Bank , 2019. Population, Total. Available at: https://data.worldbank.org/indicator/SP.POP.TOTL. Accessed March 18, 2022.
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Abstract Views | 6705 | 1541 | 213 |
Full Text Views | 161 | 21 | 4 |
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The objective of this study was to examine the association between dietary diversity and child growth among children 6 to 23 months of age in urban slums of Bangladesh. This prospective cohort study enrolled 192 participants 6 to 23 months of age in Dhaka, Bangladesh. To collect dietary intake information for children 6 to 23 months of age, consumption of five or more of the following eight minimum dietary diversity food groups was recorded using 24-hour dietary recall by the child’s caregiver: 1) breast milk; 2) grains, roots, and tubers; 3) legumes and nuts; 4) dairy products; 5) flesh foods; 6) eggs; 7) vitamin A–rich fruits and vegetables; and 8) other fruits and vegetables. Height and weight were measured at baseline and at a 12-month follow-up. Fifty-five percent of children (106 of 192) consumed five or more of the eight minimum dietary diversity food groups during their first visit to assess dietary intake. Eighty-two percent of children (157 of 192) had a report of consuming an animal source of food (e.g., eggs, dairy, flesh foods) in the past 24 hours, 85% (164 of 192) consumed any source of protein (e.g., eggs, dairy, flesh foods, nuts, and legumes), and 65% of children (125 of 192) were reported to consume any fruits and vegetables. Child consumption of fruits and vegetables was positively associated with change in length-for-age z-scores from baseline to the 12-month follow-up (coefficient, 0.86; 95% CI, 0.03–1.68). Inadequate fruit and vegetable consumption was associated with linear growth faltering among the young children residing in urban Dhaka, Bangladesh. These findings demonstrate the need for effective interventions to increase fruit and vegetable consumption in this susceptible pediatric population.
Financial support: This research was supported by a USAID grant awarded to the Johns Hopkins Bloomberg School of Public Health.
Authors’ addresses: Tahmina Parvin, M. Tasdik Hasan, Ismat Minhaj Uddin, Md Sazzadul Islam Bhuyian, Fatema Zohura, Munirul Alam, and Abu S. G. Faruque, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh, E-mails: tahminaph14@yahoo.com, tasdikhdip@yahoo.com, ismat.minhaj@icddrb.org, sazzadul.islam@icddrb.org, fzohura@icddrb.org, munirul@icddrb.org, and gfaruque@icddrb.org. Kelly Endres, Joel Gittelsohn, Jamie Perin, and Christine Marie George, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, E-mails: kendres4@jhu.edu, jgittel1@jhu.edu, jperin@jhu.edu, and cgeorg19@jhu.edu. Nicole Coglianese, Food for the Hungry, Washington, DC, E-mail: nicole.coglianese@gmail.com. Shwapon Kumar Biswas, Ministry of Health & Family Welfare, Dhaka, Bangladesh, E-mail: shwapon6@gmail.com.
World Health Organization , 2021. UNICEF/WHO/The World Bank Group Joint Child Malnutrition Estimates: Levels and Trends in Child Malnutrition: Key Findings of the 2021 Edition. Geneva, Switzerland: WHO.
Lu C, Black MM, Richter LM, 2016. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health (ePub 2016 Oct 4): 4--5, Table 1.
National Institute of Population Research and Training Medical Education and Family Welfare Division Ministry of Health and Family Welfare Dhaka, Bangladesh, The DHS Program ICF , 2019. Bangladesh Demographic and Health Survey 2017–18: Key Indicators. Available at: https://www.dhsprogram.com/pubs/pdf/PR104/PR104.pdf. Accessed March 18, 2022.
Martorell R, Khan LK, Schroeder DG , 1994. Reversibility of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr 48 (Suppl 1):S45–S57.
Victora CG et al.2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371: 340–357.
Allen LH , 1994. Nutritional influences on linear growth: a general review. Eur J Clin Nutr 48 (Suppl 1):S75–S89.
Lucas A, Fewtrell MS, Cole TJ , 1999. Fetal origins of adult disease: the hypothesis revisited. BMJ 319: 245–249.
Popkin BM, Richards MK, Montiero CA , 1996. Stunting is associated with overweight in children of four nations that are undergoing the nutrition transition. J Nutr 126: 3009–3016.
Sawaya AL, Martins P, Hoffman D, Roberts SB , 2003. The link between childhood undernutrition and risk of chronic diseases in adulthood: a case study of Brazil. Nutr Rev 61: 168–175.
Silverman BL, Rizzo TA, Cho NH, Metzger BE , 1998. Long-term effects of the intrauterine environment: the Northwestern University Diabetes in Pregnancy Center. Diabetes Care 21 (Suppl 2):B142–B149.
Pollitt E, Gorman KS, Engle PL, Rivera JA, Martorell R , 1995. Nutrition in early life and the fulfillment of intellectual potential. J Nutr 125 (Suppl):1111s–1118s.
Prado EL, Dewey KG , 2014. Nutrition and brain development in early life. Nutr Rev 72: 267–284.
Berkman DS, Lescano AG, Gilman RH, Lopez SL, Black MM , 2002. Effects of stunting, diarrhoeal disease, and parasitic infection during infancy on cognition in late childhood: a follow-up study. Lancet 359: 564–571.
Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM , 2007. Early childhood stunting is associated with poor psychological functioning in late adolescence and effects are reduced by psychosocial stimulation. J Nutr 137: 2464–2469.
Rivera JA, Hotz C, González-Cossío T, Neufeld L, García-Guerra A , 2003. The effect of micronutrient deficiencies on child growth: a review of results from community-based supplementation trials. J Nutr 133 (Suppl 2):4010s–4020s.
Slavin JL, Lloyd B, 2012. Health benefits of fruits and vegetables. Adv Nutr 3: 506–516.
Gu Y, He Y, Ali SH, Harper K, Dong H, Gittelsohn J, 2021. Fruit and vegetable intake and all-cause mortality in a Chinese population: the China Health and Nutrition Survey. Int J Environ Res Public Health 18: 342.
Wang X et al.2014. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies. BMJ 349: g4490.
Dror DK, Allen LH , 2011. The importance of milk and other animal-source foods for children in low-income countries. Food Nutr Bull 32: 227–243.
Thorne-Lyman AL, Shrestha M, Fawzi WW, Pasqualino M, Strand TA, Kvestad I, Hysing M, Joshi N, Lohani M, Miller LC, 2019. Dietary diversity and child development in the far west of Nepal: a cohort study. Nutrients 11: 1799.
Arimond M, Ruel MT, 2002. Progress in developing an infant and a child feeding index: an example using the Ethiopia Demographic and Health Survey 2000. Available at: https://www.ifpri.org/publication/progress-developing-infant-and-child-feeding-index.
Hatløy A, Hallund J, Diarra MM, Oshaug A , 2000. Food variety, socioeconomic status and nutritional status in urban and rural areas in Koutiala (Mali). Public Health Nutr 3: 57–65.
Hatløy A, Torheim LE, Oshaug A , 1998. Food variety: a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. Eur J Clin Nutr 52: 891–898.
Khamis AG, Mwanri AW, Ntwenya JE, Kreppel K , 2019. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatr 19: 518.
Kim R, Mejía-Guevara I, Corsi DJ, Aguayo VM, Subramanian SV, 2017. Relative importance of 13 correlates of child stunting in South Asia: insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan. Soc Sci Med 187: 144--154.
Krasevec J, An X, Kumapley R, Bégin F, Frongillo EA, 2017. Diet quality and risk of stunting among infants and young children in low- and middle-income countries. Matern Child Nutr 13 (Suppl 2): 5--6.
Onyango A, Koski KG, Tucker KL , 1998. Food diversity versus breastfeeding choice in determining anthropometric status in rural Kenyan toddlers. Int J Epidemiol 27: 484–489.
Thorne-Lyman A, Spiegelman D, Fawzi WW , 2014. Is the strength of association between indicators of dietary quality and the nutritional status of children being underestimated? Matern Child Nutr 10: 159–160.
Tufts University , 2021. Minimum Dietary Diversity (MDD) for Children 6–23 Months Old. Available at: https://inddex.nutrition.tufts.edu/node/158. Accessed March 18, 2022.
Onyango AW, Borghi E, de Onis M, Casanovas Mdel C, Garza C , 2014. Complementary feeding and attained linear growth among 6-23-month-old children. Public Health Nutr 17: 1975–1983.
McCormick BJJ et al., 2019. Intestinal permeability and inflammation mediate the association between nutrient density of complementary foods and biochemical measures of micronutrient status in young children: results from the MAL-ED study. Am J Clin Nutr 110: 1015--1025.
Marriott BP, White A, Hadden L, Davies JC, Wallingford JC , 2012. World Health Organization (WHO) infant and young child feeding indicators: associations with growth measures in 14 low-income countries. Matern Child Nutr 8: 354–370.
Jones AD et al.2014. World Health Organization infant and young child feeding indicators and their associations with child anthropometry: a synthesis of recent findings. Matern Child Nutr 10: 1–17.
Sheikh N, Akram R, Ali N, Haque SR, Tisha S, Mahumud RA, Sarker AR, Sultana M, 2020. Infant and young child feeding practice, dietary diversity, associated predictors, and child health outcomes in Bangladesh. J Child Health Care 24: 260--273.
Zongrone A, Winskell K, Menon P , 2012. Infant and young child feeding practices and child undernutrition in Bangladesh: insights from nationally representative data. Public Health Nutr 15: 1697–1704.
George CM et al., 2021. Effects of a water, sanitation, and hygiene mobile health program on diarrhea and child growth in Bangladesh: a cluster-randomized controlled trial of the cholera hospital-based intervention for 7 days (CHoBI7) mobile health program. Clin Infect Dis 73: e2560--e2568.
George CM et al., 2019. Formative research for the design of a scalable water, sanitation, and hygiene mobile health program: CHoBI7 mobile health program. BMC Public Health 19: 1028.
Victora CG, de Onis M, Hallal PC, Blossner M, Shrimpton R , 2010. Worldwide timing of growth faltering: revisiting implications for interventions. Pediatrics 125: e473–e480.
de Onis M, Onyango AW , 2008. WHO child growth standards. Lancet 371: 204.
USAID , 2006. Developing and Validating Simple Indicators of Dietary Quality and Energy Intake of Infants and Young Children in Developing Countries: Summary of findings from analysis of 10 data sets. Available at: https://www.fantaproject.org/sites/default/files/resources/IYCF_Datasets_Summary_2006.pdf.
Moursi MM, Arimond M, Dewey KG, Treche S, Ruel MT, Delpeuch F , 2008. Dietary diversity is a good predictor of the micronutrient density of the diet of 6- to 23-month-old children in Madagascar. J Nutr 138: 2448–2453.
Arimond M, Ruel MT , 2004. Dietary diversity is associated with child nutritional status: evidence from 11 demographic and health surveys. J Nutr 134: 2579–2585.
Yahia EM, Maldonado Celis M, Svendsen M , 2017. The contribution of fruit and vegetable consumption to human health. Yahi EM, ed. Fruit and Vegetable Phytochemicals. Hoboken, NJ: Wiley, 3–52.
Wang A et al.2017. The dietary diversity and stunting prevalence in minority children under 3 years old: a cross-sectional study in forty-two counties of western China. Br J Nutr 118: 840–848.
Som SV et al.2020. Adherence to child feeding practices and child growth: a retrospective cohort analysis in Cambodia. Nutrients 13: 8.
Muslimatun S, Wiradnyani LA , 2016. Dietary diversity, animal source food consumption and linear growth among children aged 1-5 years in Bandung, Indonesia: a longitudinal observational study. Br J Nutr 116 (Suppl 1):S27–S35.
Correia LL, Rocha HAL, Campos JS, Silva ACE, Silveira DMID, Machado MMT, Leite AJM, Cunha AJLAD, 2019. Interaction between vitamin A supplementation and chronic malnutrition on child development. Cien Saude Colet 24: 3037--3046.
Aguayo VM, Nair R, Badgaiyan N, Krishna V, 2016. Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra’s comprehensive nutrition survey. Matern Child Nutr 12 (Suppl 1):121–140.
Headey D, Hirvonen K, Hoddinott J , 2018. Animal sourced foods and child stunting. Am J Agr Econ 100: 1302–1319.
Murphy SP, Allen LH , 2003. Nutritional importance of animal source foods. J Nutr 133: 3932S–3935S.
The World Bank , n.d. Population Living in Slums (% of Urban Population). Available at: https://data.worldbank.org/indicator/EN.POP.SLUM.UR.ZS. Accessed March 18, 2022.
The World Bank , 2018. Urban Population (% of Total Population). Available at: https://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS. Accessed March 18, 2022.
The World Bank , 2019. Population, Total. Available at: https://data.worldbank.org/indicator/SP.POP.TOTL. Accessed March 18, 2022.
Past two years | Past Year | Past 30 Days | |
---|---|---|---|
Abstract Views | 6705 | 1541 | 213 |
Full Text Views | 161 | 21 | 4 |
PDF Downloads | 117 | 23 | 4 |