Consumption of fortified infant foods reduces dietary diversity but has a positive effect on subsequent growth in infants from Sumedang district, Indonesia

Abstract

Stunting and underweight among under-five children in Indonesia are common, raising public health concerns. Whether inappropriate complementary feeding (CF) practices compromise optimal growth during late infancy in Indonesia is uncertain. Therefore we characterized and evaluated CF practices in Indonesian infants and investigated their relationship with subsequent growth. We enrolled breastfed infants at 6 months of age (n = 230); and followed them at 9 (n = 202) and 12 months of age (n = 190). We collected socio-demographic and anthropometric data and two-day in-home weighed food records. Relations between WHO CF indicators, sentinel foods, and energy and micronutrient intakes at 9 months and growth at 12 months were explored using multiple linear regression. Stunting and underweight increased from 15.8% and 4.4% at 6 months to 22.6% and 10.5% at 12 months, respectively. Median intakes of calcium, iron, zinc, and riboflavin were below WHO recommendations. Infants consuming fortified infant foods (FIFs) at 9 months had diets with a lower dietary diversity (DD) score (2.3 vs.3.0), energy density, median energy (250 vs. 310 kcal/d) and protein (6.5 vs. 9.1 g/d) intake than non-consumers (p<0.01), despite higher intakes of calcium, iron, and vitamins A and C (p<0.001). Positive relations existed for 9-month consumption of iron-rich/iron fortified infant foods with length-for-age Z-score (LAZ) at 12 months (β = 0.22; 95% CI: 0.01, 0.44; P = 0.04), and for fortified infant foods alone with both LAZ (β = 0.29; 95% CI: 0.09, 0.48; P = 0.04) and weight-for-age Z-score (β = 0.14; 95% CI: 0.02, 0.26; P = 0.02) at 12 months. The positive association of FIFs with subsequent growth may be attributed to their content of both powdered cow’s milk and multi-micronutrient fortificants. Nonetheless, mothers should not be encouraged to over-rely on FIFs as they reduce DD.

Spoonfeeding is associated with increased infant weight but only amongst formula‐fed infants

“…Spoon‐fed infants are more likely to consume fortified infant cereals when compared with self‐feeding infants, especially when introduced to solid foods at an earlier date (Roess et al, ). Iron fortified cereals have been linked to increased gains in length‐for‐age at 12 months in Indonesia (Diana et al, ), although this finding has not been replicated in developed regions (Pasricha, Hayes, Kalumba, & Biggs, ).…”

Marketing and infant and young child feeding in rapidly evolving food environments

“…The use of fortified infant foods has been included in strategies to improve child nutrition after age 6 months since they can improve the intake of iron, zinc, and other nutrients often lacking in diets of young children (Campos Ponce, Polman, Wieringa, & Doak, ; Leyvraz et al, ; Lutter et al, ; Plessow, Arora, Brunner, & Wieser, ; Wieser et al, ; WHO, ). They have been shown to lead to enhanced growth (Diana et al, ; Ten Year Strategy to Reduce Vitamin and Mineral Deficiencies Maternal Infant and Young Child Working Group Formulation Subgroup, ) and improved iron status (Faber, Kvalsvig, Lombard, & Benadé, ; Lutter, ). However, studies assessing forms of micronutrients used or amounts provided in products sold on the market have been limited (Dimaria et al, ; Masters, Nene, & Bell, ).…”

Promotions of breastmilk substitutes, commercial complementary foods and commercial snack products commonly fed to young children are frequently found in points‐of‐sale in Bandung City, Indonesia

“…The use of breastmilk substitutes (BMS) is highly prevalent, with over one‐third of breastfed infants under 6 months fed BMS (BPS, BKKBN, Kemenkes, & ICF International, 2013). Complementary foods are often introduced too early (BPS, BKKBN, Kemenkes, & ICF International, ; Muslimatun & Wiradnyani, ), and a number of studies have documented micronutrient deficiencies among children in the complementary feeding period (Diana et al, ; Fahmida & Santika, ; Muslimatun & Wiradnyani, ; Santika, Februhartanty, & Ariawan, ). There is also growing evidence that commercial snack foods, with high levels of salt, sugar and fat, are becoming increasingly common in diets of infants and young Indonesian children (Green et al, ; Imanningsih, Jahari, Permaesih, Chan, & Amarra, ; Purwestri et al, ; Sekiyama, Roosita, & Ohtsuka, ; White et al, ), potentially displacing breastmilk and other nutrient‐rich foods (Pries et al, ).…”