(P17-019-23) Meeting Minimum Dietary Diversity at Nine Months Is Associated With Lower Risk of Stunting in the Second Year of Life Among a Cohort of Infants in Kenya

Objectives: Low dietary diversity (DD) among infants and young children is associated with increased risk of micronutrient deficiency and poor health. The World Health Organization (WHO) recommends that infants and young children (ages 6-23 months) consume at least five of eight food groups in 24hrs to achieve minimum DD (MDD). The risk of low DD is high during the introduction of complementary foods, beginning around 6 months of age. We therefore sought to examine whether DD at 9 months, when more foods have been introduced, was associated with subsequent growth through 23 months among a cohort of infants in western Kenya.

Methods: Pregnant women (n=371, 24.8 ± 4.8 years old, 50.5% living with HIV) were enrolled from seven clinics in western Kenya between 2014-15 and followed for 23 months postpartum. Infant diet using a 24-hour recall and anthropometry data were collected by trained study staff at 9, 12, 15, 18 and 23 months. Longitudinal and Cox proportional hazard models were used to examine the relationship between DD (range 0-8) and MDD (DD≥5) with WHO weight-for-age (WAZ), length-for-age (LAZ) and weight-for-length (WLZ) z-scores and severe malnutrition (z-scores < -3) from 12 to 23 months, adjusting for infant size at 9 months, age, breastfeeding, food insecurity, maternal HIV status, and other covariates (n=240).

Results: At 9 months, mean±SD infant DD (0-8) was 3.96±2.03 and 40% met MDD. At 9 months, average WAZ was -0.09±1.26, LAZ was -0.63±1.26, and WLZ was 0.38±1.29, whereas at 23 months average WAZ was -0.44±1.17, LAZ was -1.61±1.31, and WLZ was 0.54±1.21. In adjusted models, meeting MDD compared to DD < 5 was associated with a 67% reduced risk of LAZ dropping below -3 SD (HR: 0.33; CI: 0.15,0.75) over the follow up period; similar inverse associations were observed for continuous DD with LAZ. DD and MDD were not associated with WAZ and WLZ, or severe malnutrition for WAZ or WLZ scores.

Conclusions: In our cohort of infants, mean WAZ and LAZ decreased from 9 to 23 months. Meeting MDD reduced the risk of severe stunting, characterized by poor linear growth by over 67%, compared to those not meeting MDD. Improving dietary diversity via complementary feeding throughout the first two years may help reduce the incidence of stunting and support optimal growth.

Funding Sources: NIMH, NIDDK, NICHD, PepsiCo Global R+D