Complementary Feeding Practices and Determinants of Micronutrient Status of Rural Young Children in the Philippines
Eva A. Goyena1, Ma. Lynell V. Maniego1, Apple Joy D. Ducay1,
Nancy A. Tandang2, Ma. Theresa M. Talavera3, and Corazon VC. Barba3
1Department of Science and Technology – Food and Nutrition
Research Institute (DOST-FNRI), Taguig City, Philippines
2Institute of Statistics, College of Arts and Sciences, University of the Philippines Los Baños
3Institute of Human Nutrition and Food, College of Human Ecology, University of the Philippines Los Baños
*Corresponding Author: This email address is being protected from spambots. You need JavaScript enabled to view it.
ABSTRACT
Owing to suboptimum feeding practices, Filipino infants are vulnerable to undernutrition during the first two years of life. This present paper aimed to determine the complementary feeding practices of young children 6–23 mo old, and to assess the micronutrient status of children – with particular reference to hemoglobin (Hb), ferritin, zinc, and their determinants. The present paper was part of the randomized community trial (RCT) on micronutrient powder (MNP) supplementation involving four randomly selected barangays in Calauan, Laguna, Philippines, and covering a total of 126 children 6–23 mo old. Baseline and endline assessments were done to determine Hb, ferritin, retinol, zinc, and C-reactive protein (CRP) levels. Child’s breastfeeding and complementary feeding practices, weight, length, and dietary intakes were collected monthly for six months. Stepwise linear regression was performed to determine the biological and environmental factors associated with micronutrient status of the study children. The 24-hour dietary assessment showed that children consumed mainly thin porridge or lugaw – boiled rice mixed with broth of boiled fish, meat, or vegetables – and biscuits/bread as complementary foods. The majority of children had inadequate intake of energy, protein, and key micronutrients based on a single day food recall at endline assessment. Carbohydrates from complementary food remained the major energy contributor among children 6–11 mo (68.0%) and 12–23 mo old (66.9%). The prevalence of stunting, underweight, and wasting was 10.4%, 13.6%, and 8.0%, respectively. The mean Hb was 11.2 g/dL, of which 35.7% of infants were anemic (Hb<11.0 g/dL). The mean serum ferritin used to indicate storage iron was 23.8 ug/L, of which 27.8% of infants had low iron storage. Hb, ferritin, and zinc concentrations at endline consistently related to the corresponding outcome variables of Hb, ferritin, and zinc at endline, respectively. Adequacy of energy, vitamin A, and iron intake was positively associated with Hb at endline period. Other nutrition factors played a role in the level of Hb, including continued breastfeeding beyond one year and episode of diarrhea. Ferritin level at endline was associated with vitamin C adequacy, breastfeeding practices, child’s length, marker of infection (CRP), and occupation of household head in the expected directions. Stunting was strongly associated with zinc concentration at endline. There is an urgent need to improve the complementary food in terms of energy, protein, and micronutrient adequacy of complementary foods of children in the studied communities through increasing density and bioavailability of macro- and micronutrients.
INTRODUCTION
Most of the stunting happens in the first two years of life particularly after the first six months postpartum, when children have high nutrient demand alongside suboptimum complementary feeding. Congruently, feeding practices are considered the most important underlying determinants of a child’s growth and development, and yet somehow the most neglected contributing factors as argued in the Lancet Series of 2013 (Black et al. 2013). . . . read more
REFERENCES
ABESHU MA, LELISA A, GELETA B. 2016. Complementary Feeding: Review of Recommendations, feeding practices, and adequacy of homemade complementary food preparations in developing countries-lessons from Ethiopia. Frontiers in Nutrition 3: 1–9. Retrieved from https://www.frontiersin.org/articles/10.3389/fnut.2016.00041/full on 20 Nov 2017.
BEUTLER E, LICHTMAN MA, COLLER BS. 2001. Williams Hematology, 6th ed. New York: McGraw-Hill Book Co. p. 295–304, 447–470.
BLACK RE, VICTORA CG, WALKER SP, BHUTTA ZA, CHRISTIAN P, DE ONIS M, EZZATI M, GRANTHAM-MCGREGOR S, KATZ J, MARTORELL R, UAUY R. 2013. Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet. Retrieved from https://www.thelancet.com/series/maternal-and-child-nutrition
BLACK RE, ALLEN LH, BHUTTA ZA, CAULFIELD LE, DE ONIS M, EZZATI M, MATHERS C, RIVERA J. 2008. Maternal and child undernutrition: Global and regional exposures and health consequences. The Lancet Series 382(9890): 427–451. Retrieved from http://www.thelancet.com/pdfs/journals/lancet/
BROWN KH, LOPEZ DE ROMANA D, ARSENAULT JE, PEERSON JM, PENNY ME. 2007. Comparison of the effects of zinc delivered in a fortified food or a liquid supplement on the growth, morbidity, and plasma zinc concentrations of young Peruvian children. Am J Clin Nutr 85(2): 538–547.
BROWN KH, RIVERA JA, BHUTTA Z, GIBSON RS, KING JC, LONNERDAL B. 2004. Assessment of the risk of zinc deficiency in population and options for its control [International Zinc Nutrition Consultative Group (IZiNCG) technical document #1]. Food Nutr Bull 25(Suppl. 2): 199–203.
CHENG Y, YAN H, DIBLEY MJ, SHEN Y, LI Q, ZENG L. 2008. Validity and reproducibility of a semi quantitative food frequency questionnaire for use among pregnant women in rural China. Asia Pac J Clin Nutr 17: 166–177.
COLE CR, GRANT FK, SWABY-ELLIS ED, SMITH JL, JACQUES A, NORTHROP-CLEWER CA. 2010. Zinc and iron deficiency and their interrelation in low-income African American and Hispanic children in Atlanta. Am J Clin Nutr 91(4): 1027–1034.
DEMAEYER EM, DALLMAN P, GURNEY JM, 1989. Preventing and controlling iron deficiency anaemia through primary health care: A guide for health administrators and programme managers. Geneva: World Health Organization.
DOMELLOF M, HERNELL O. 2002. Iron-deficiency anemia during the first year of life [review article]. Taylor and Swift Health Sciences. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.919.8277&rep=rep1&type=pdf on February 18, 2018.
[DOST-FNRI] Department of Science and Technology – Food and Nutrition Research Institute. 2015. Philippine Nutrition Facts and Figures 2013. Taguig City, Philippines: DOST-FNRI.
[FANTA] Food and Nutrition Technical Assistance, [USAID] United States Agency for International Development. 2014. Overview of the nutrition situation in the seven countries in Southeast Asia. Retrieved from http:// www.fantaproject.org/sites/default/files/download/ Southeast-Asia-Nutrition-Overview-on 10 Apr 2016.
FURR HC, TANMIHARDJO SA, OLSON JA. 1992. Training Manual for Assessing Vitamin A Status by Use of the Modified Relative Dose Response and the Relative Dose Response Assays. Iowa, USA. 70p.
GIBSON RS, ABEBE Y, STABLER S, ALLEN RH, WESTCOTT JE, STOECKER BJ. 2008. Zinc, gravida, infection, and iron but not vitamin B12 or folate status, predict Hb during pregnancy in Southern Ethiopia. J Nutr 138(3): 581-586.
GOYENA EA, BARBA CVC, TALAVERA MTM, PAUNLAGUI MM, ROLA AR, TANDANG NA: 2018. Effects of micronutrient powder and complementary food blend on growth and micronutrient status of Filipino rural children: A randomized controlled trial. Mal J Nutr 24(4): 474–492.
[HF-TAG] Home Fortification Technical Advisory Group. 2013. Retrieved from http://hftag.gainhealth.org/
KENNEDY GL, PEDRO M, SEGHIERI C, NANTEL G, BROUWER I. 2007. Dietary diversity score is a useful indicator of micronutrient intake in non-breastfeeding Filipino children. The Journal of Nutrition (IN) 137(2): 472–477. https://doi.org/10.1093/jn/137.2.472.
LUTTER CK, DAELMANS BM, DE ONIS M, KOTHARI MT, RUEL MT, ARIMOND M, DEITCHLER M, DEWEY KG, BLOSSNER M, BORGHI E. 2011. Undernutrition, poor feeding practices and low coverage of key nutrition in children. J Pediatr (Rio J) 81(5): 361–367.
LYNCH S. 2011. Case study: Iron. Am J Clin Nutr 94(suppl): 673S–678S. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3142736/pdf/ajcn9420673S.pdf on 27 Jun 2016.
NAUPAL-FORCADILLA R, BARBA CVC, TALAVERA MT, DY MR. 2017. Determinants of zinc status of 2–3 years old children in Laguna, Philippines. Mal J Nutri 23(1): 9–16. Retrieved from http://www.nutriweb.org.my/publications/mjn0023_1/2Rodesa(9-16).pdf on 28 Feb 2018.
[PAHO] Pan American Health Organization. 2003. Guiding Principles for complementary feeding of the breastfed child. Retrieved from http://www.who.int/maternal_child_adolescent/documents/a85622/en/ on 03 Sep 2016.
PASRICHA SR, BLACK J, MUTHAYYA S, SHET A, BHAT V, NAGARAJ S, PRASHANTH NS, SUDARSHAN H, BIGGS BA, MBBS, SHET AS. 2010. Determinants of anemia among young children in rural India. Pediatrics 126(1): e140–e149. doi: 10.1542/peds.2009-3108.
RAHMAN S, AHMED T, RAHMAN AS, ALAM N, SHAMSIR AHMED AM, IREEN S, CHOWDHURY IA, CHOWDHURY FP, MUSTAFIZUR RAHMAN SM. 2016. Status of zinc nutrition in Bangladesh: the underlying associations. Journal of Nutrition Science 5 (25): 1–9. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4976114/pdf/S2048679016000173a.pdf on 26 February 2018.
SEMBA RD, BLOEM MW. 2002. The anemia of vitamin A deficiency: Epidemiology and pathogenesis. Eur J Clin Nutr 56: 271–281.
STEYN NP, HEL, J, LABADARIOS D, MAUNDER EMW, KRUGER SH. 2014. Which dietary diversity indicator is best to assess micronutrient adequacy in children 1 to 9 y? Nutrition 30 (1): 55–60. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0899900713002864.
SVEDBERG P. 2000. World Institute for Development Economic Research. Poverty and undernutrition: Theory, measurement and policy. Oxford; New York: Oxford University Press.
THURNHAM DI, CLEWES CA, KNOWLES J. 2015. The use of adjustment factors to address the impact of inflammation of vitamin A and iron status in humans. J Nutr 145(5): 1137S–1143S. doi: 10.3945/jn.114.194712.
THURNHAM DI, MCCABE LD, HALDAR S, WEIRINGA FT, CLEWES CA, MCCABE GP. 2010. Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: A meta-analysis. Am J Clin Nutr 92: 546–555. Retrieved from www. ajcn.nutrition.org. on 16 Feb 2017.
[UNICEF] United Nations Children's Fund. 2011. Programming Guide: Infant and Young Child Feeding. New York: UNICEF. Retrieved from: http://www.unicef.org/nutrition/files/Final_IYCF_programming_guide_2011.pdf.
[WHO] World Health Organization. 2014. Sixty-Seventh World Health Assembly. Geneva: WHO.
[WHO] World Health Organization, 2006. The WHO Child Growth Standards. Retrieved from http://www.who.int/childgrowth/en/ on 16 Apr 2018.
[WHO] World Health Organization. 2008. Indicators for assessing infant and young child feeding practices. Washington, DC: WHO. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/43895/9789241596664_eng.pdf;jsessionid=9A088250ED547E23E0E8F12124A97C68?sequence=1
[WHO] World Health Organization, [CDC] Centers for Disease Control and Prevention. 2008. Assessing the iron status of population, second edition. Retrieved from http://www.who.int/nutrition/publications/micronutrients/anemia_iron_deficiency/89241596107.pdf on 06 Sep 2016.
[WHO] World Health Organization. 2011a. Use of multiple micronutrient powders for home fortification of foods consumed by infants and children 6–23 months of age. Geneva: WHO.
[WHO] World Health Organization. 2011b. Serum ferritin concentration for the assessment of iron status and iron deficiency in populations: Vitamin and mineral nutrition information system. Retrieved from http://www.who.int/vmnis/indicators/serum_ferritin.pdf on 09 Aug 2016
[WHO] World Health Organization. 2011c. Serum retinol concentration for determining the vitamin A deficiency in populations: Vitamin and mineral nutrition information system. Accessed at http://www.who.int/vmnis/indicators/retinol.pdf on August 9, 2016.
[WHO] World Health Organization. 2016. Infant and young child feeding [Factsheet No. 342]. Retrieved from http://who.int/mediacentre/factsheets/fs342/en/ on 01 Jul 2016.
ZHANG Z, GOLDSMITH P, NELSON AW. 2016. The importance of animal source foods for nutrient sufficiency in the developing world. The Zambia scenario. Food and Nutrition Bulletin 37 (3): 303–316. Retrieved from http://journals.sagepub.com/doi/full/10.1177/0379572116647823 on Apr 2018.
ZIEGLER, EE, NELDON SE, JETER JM. 2014. Iron stores of breastfed infants during the first year of life. Nutrients 6: 2023–2034.
ZLOTKIN SH, ARTHUR P, SCHAUER C, ANTWI KY, YEUNG G, PIEKARZ A. 2003. Home-fortification with iron and zinc sprinkles or iron sprinkles alone successfully treats anemia in infants and young children. J Nutr 133: 1075–1080.
