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Potential for Misclassification of Infants' Usual Feeding Practices using 24-Hour Dietary Assessment Methods^1,2,3,

Ellen G. Piwoz⁴, Hilary Creed de Kanashiro^*, Guillermo Lopez de Romaña^*, Robert E. Black and Kenneth H. Brown

Department of International Health, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, MD 21205; ^* Instituto de Investigación Nutricional, Lima, Peru; and Department of Nutrition, Program in International Nutrition, University of California, Davis, CA 95616

Feeding patterns of 131 low income Peruvian infants were assessed by 1574 single-day studies (12-h observations plus 12-h recall) of dietary intake and by mothers' monthly reports of usual feeding practices to determine whether feeding pattern classification depends on the assessment method used. Results suggest that single-day studies produce a different view of feeding practices than do mothers' reports of usual behavior. Exclusive breast-feeding in infants younger than 4 mo was observed 25% more often than reported. Non-human milk consumption was reported 30% more often than observed. Disagreement between reported and observed practices was related by logistic regression analyses to mother's age and education, number of children younger than 5 y in the home and infant age and illness on the observation day. Most disagreement between reported and observed behavior could have been due to daily variation in feeding practices. Consumption during the past 24 h should not be used alone as the basis for classifying infant feeding practices in survey research.

KEY WORDS: • infant feeding practices • humans • misclassification • nutrition surveys • nutrition assessment

¹ These studies were supported primarily by the Diarrheal Disease Control Program of the World Health Organization and by the International Development Research Center. Additional funds were provided by the Office of Nutrition, U.S. Agency for International Development (Dietary Management of Diarrhea Program, Cooperative Agreement no. DAN-1010-A-00-5119-00).

² Presented in part at the Annual Meeting of the Federation of American Societies for Experimental Biology, April 1992, Anaheim, CA [Piwoz, E. G., Creed de Kanashiro, H., Lopez de Romaña, G., Black, R. E. & Brown, K. H. (1992) Comparison of reported feeding practices with observed dietary intakes by Peruvian infants. FASEB J. 1: 2551 (abs.)].

³ The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked "advertisement" in accordance with 18 USC section 1734 solely to indicate this fact.

⁴ To whom correspondence and reprint requests should be addressed, at 225 Chancery Road, Baltimore, MD 21218.

Manuscript received 3 February 1994. Revision accepted 30 June 1994.

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