Objectives
Although access to foods/nutrients plays a central role in early nutrition, variability in feeding behaviors also influence children’s eating patterns. We examined the relations between maternal feeding behaviors (responsive and forceful) and dietary diversity among children at 24mo of age in rural Bangladesh.
Methods
Data were collected on 4,846 mother-child dyads enrolled in a complementary food supplementation trial. A context-specific 11-item caregiver feeding behaviors module was developed. Factor analysis revealed 2 theoretically derived constructs of feeding: responsive (5-items) and forceful (6-items). Each factor was dichotomized to reflect low and high behaviors. Dietary diversity score (DDS;range 0-7) was derived using a 24-hour dietary recall. DDS was also used to define minimum dietary diversity (MDD;DDS>4). Intake in the past 24 hours of individual food groups (grains, legumes, dairy, meat, eggs, vitamin A-rich fruits/vegetables, fruits/vegetables, and snacks/desserts) was also examined. Relations were examined using multivariate linear/logistic regression models, adjusting for confounders, intervention status, and study design.
Results
Mean (SD) DDS in the overall sample was 3.7 (1.4), and 54.8% of children met MDD. After adjustment, responsive feeding was positively associated with DDS (ß:0.09;95% CI:0.001,0.17), increased odds of meeting MDD (OR:1.2;95% CI:1.02,1.3), and higher consumption of meat (OR:1.2;95% CI:1.05,1.4). Forceful feeding was negatively associated with DDS (ß:-0.12;95% CI:-0.21,-0.04), reduced odds of meeting MDD (OR:0.82;95% CI:0.72,0.94) and lower consumption of grains, legumes and vitamin A-rich fruits/vegetables (OR:0.70;95%CI:0.51,0.98; OR:0.86;95% CI:0.75,0.99; OR:0.71;95%CI:0.63,0.81, respectively).
Conclusions
Findings suggest that in the context of high undernutrition, responsive feeding behaviors were associated with improved dietary diversity at 2 years.Funded by USDA, NIFA, the Johns Hopkins Center for Global Health, the Bill and Melinda Gates Foundation, and the Johns Hopkins Sight and Life Global Nutrition Research Institute.
