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Community and International Nutrition

Growth Trajectories Are Influenced by Breast-Feeding and Infant Health in an Afro-Colombian Community¹

Beatriz Eugenia Alvarado², Maria Victoria Zunzunegui^*, Hélène Delisle and Jairo Osorno^**

Universidad del Cauca, Popayan, Colombia; ^* Département de Médecine Sociale et Préventive, Université de Montréal, Montréal, Canada; Département de Nutrition, Université de Montréal, Montréal, Canada; and ^** Universidad de Manizales, Manizales, Colombia

²To whom correspondence should be addressed. E-mail: be.alvarado.llano{at}umontreal.ca.

We conducted a longitudinal study among an Afro-Colombian population to investigate the influence of feeding practices and child morbidity on linear and ponderal growth during infancy. We enrolled 133 children at 5–7 mo and followed them until 18 mo. Repeated anthropometric measures were taken every 2–3 mo, with monthly interviews on feeding practices and daily self-reports on morbid conditions by the mothers of the infants. Mothers’ social conditions and infants’ fixed variables (gender and gestational age at birth) were measured at baseline. Growth starting points and trajectories were modeled via Hierarchical Linear Models (HLM). Children started with a mean length of 64.8 cm (95% CI: 59.8–69.7) and a mean weight of 7.68 kg (95% CI: 5.37–9.9), and gained length at a rate of 1.13–1.70 cm/mo, and weight at 66.5–319 g/mo. Breast-feeding, defined as receiving breast milk at any time within a 2–3-mo interval, was positively related to length gain (regression coefficient = 0.27 cm/mo; P = 0.04), after adjusting for social conditions and food consumption. Among mothers with low levels of education, breast-feeding had a positive effect on weight gain (regression coefficient = 0.30 kg/mo; P = 0.04); among nonbreast-fed infants, complementary food diversity generated a positive effect on weight (regression coefficient = 0.14 kg/mo; P = 0.03). Mean differences in length were related to the total proportion of healthy time (regression coefficient = 3.1; P = 0.02), whereas weight-gain rates were negatively associated with changes during illness (regression coefficient = –0.70; P = 0.04 for fever). No association was found between diarrhea episodes and infant growth. Our study confirms that breast-feeding after 6 mo of life is important for nutrition and health, likely by mitigating the negative effects of poor social conditions and diarrhea on infant growth.

KEY WORDS: • growth trajectories • multilevel models • infant feeding • morbidity • Colombia

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