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Articles

Premature Complementary Feeding Is Associated with Poorer Growth of Vietnamese Children¹

Le Thi Hop², Rainer Gross^*, Tu Giay, Soemilah Sastroamidjojo, Werner Schultink^** and Nguyen Thi Lang

National Institute of Nutrition, Ministry of Health, 48 Tang Bat Ho, Hanoi, Vietnam; ^* Deutsche Gesellschaft für Technische Zusammenarbeit (GTZ) GmbH, 65726 Eschborn, Germany; SEAMEO-TROPMED Regional Center for Community Nutrition, University of Indonesia, 10038 Jakarta, Indonesia; and ^** UNICEF, New York, NY

²To whom correspondence should be addressed.

The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical growth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feeding practices and diseases of the children was obtained by interviewing the mothers at each home visit. All but three children (98.6%) were breast-fed. Although 87.1% of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse causality, regression to the mean and confounding. There was little association between feeding pattern at 15 d and growth in length in mo 1. However, partially breast-fed and weaned infants gained weight more slowly than those exclusively or predominantly breast-fed. From 1 to 3 mo, exclusively breast-fed infants grew more quickly in both weight and length, followed by predominantly breast-fed infants. From 3 to 6 mo, exclusively breast-fed infants gained more weight compared with the other groups, but there was a slight difference (P = 0.047) in length gain only between exclusively and partially breast-fed infants. In the older period (6–12 mo), exclusively and predominantly breast-fed infants grew in length more quickly than partially breast-fed and weaned groups. However, there was no difference in weight gain among groups. Morbidity from diarrhea and acute respiratory infections was significantly lower for the 3 mo exclusively breast-fed group (² and Fisher-Exact Test). Over nearly the whole age range from 1 mo to 4 y, Z-scores for all indices (weight-for-age, height-for-age and weight-for-height) of the children who received complementary food were significantly lower than those of children who were exclusively breast-fed for at least 3 mo (repeated measures ANOVA, adjusted for sex, family size, maternal education and family income). These results show a long-term deterioration of physical growth in infants who received premature complementary feeding and confirm the importance of exclusive breast-feeding for infants for at least 3 mo.

KEY WORDS: • breast feeding • preschoolers • acute respiratory infection • diarrhea • growth • Vietnam

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