http://elynsgroup.com Copyright: © 2016 Borresen EC, et al. Research Article Journal of Food Nutrition and Dietetics Open Access Association between Infant Feeding Practices and Nutritional Status in Healthy Nicaraguan Infants Erica C. Borresen1, Milena C. Guajardo2, Luis E. Zambrana1,3,4, Johann Perez4*, Claudia Perez4, Lorann Stallones2,5, Sylvia Becker-Dreps6, Lijuan Yuan7, Samuel Vilchez4, and Elizabeth P. Ryan1,2* 1Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO 80523,USA 2Colorado School of Public Health, Colorado State University, Fort Collins, CO 80523, USA 3Center for Epidemiology and Health (CIDS), León, Nicaragua 4Department of Microbiology and Parasitology, Faculty of Medical Sciences, National Autonomous University of Nicaragua, León (UNAN-León), León, Nicaragua 5Department of Psychology, Colorado State University, Fort Collins, CO 80523, USA 6Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC,27599-7595, USA 7Department of Biomedical Sciences and Pathobiology, Virginia-Maryland College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, 24061, USA Received Date: Accepted Date: Published Date: *Corresponding August author: 26, Elizabeth 2016, P. Ryan, Department November of Environmental 11, 2016, and Radiological November Health Sciences,25, 2016. Colorado State University, 200 W. Lake St., 1680 Campus Delivery, Fort Collins, CO 80523-1680, USA, Tel: 970-491-1536; Fax: 970-491-7569; E-mail: [email protected]. Abstract Adherence to the World Health Organization’s infant feeding infants who are provided adequate nutrition through breast milk recommendations is intended to promote optimal growth, development, and complementary feeding have a reduced risk of morbidity and mortality, reduced risk of stunting, as well as improved mental and and health for infants. Evidence from the scientific literature shows motor development [6]. that cultural and family traditions play a major role in breastfeeding Selection of infant feeding methods depends on culture, family and complementary feeding behaviors. The objectives were to describe tradition, and available food and/or economical resources [7]. feeding practices during weaning stages and to examine associations between breastfeeding, bottle use, or complementary feeding practices Multiple Latin American countries report that majority of women and nutritional status, as measured by length-for-age (LAZ), weight- do not comply with this recommendation for a variety of reasons, for-age (WAZ), and weight-for-length z-scores (WLZ) in six-month old including but not limited to, maternal employment and family Nicaraguan infants. Data was collected from fifty-one healthy infant structure [8,9]. Within the Nicaraguan Ministry of Health, there is a participants (29 males and 22 females) and included LAZ, WAZ, WLZ, as health program called the Modelo de Salud Familiar y Communitario well as breastfeeding and complementary feeding history. A majority of (Model of Family and Community Health), or MOSAFC, that works participants were partially breastfed (76% males and 82% females), and with urban and rural communities in Nicaragua. One of the MOSAFC 66% males and 59% females began using a bottle before the age of two programs includes education on infant nutrition. Local nurses and months. Common supplementary foods included fruits and vegetables, with some reported intake of rice cereal, cheese, and cow’s milk. There pediatricians educate mothers about nutrition and other important health topics that aid in the development of the child [10]. However, wasp no statistical significance between breastfeeding and nutritional status. Consumption of cow’s milk was positively associated with LAZ family members beyond the nuclear family may have an influence ( = 0.04). This report describes infant feeding behaviors on a healthy on infant weaning behaviors that are highly related to exclusive Nicaraguan infant cohort and indicates that exclusive breastfeeding breastfeeding prevalence, and early introduction to bottle feeding recommendations up to six months of age were not in full compliance. and solid foods before six months of age [8,9]. Long-term follow-up on growth and development outcomes following a variety of breastfeeding and weaning patterns can yield valuable Nearly all infants between the ages 0 to 6 months are breastfed information about community compliance to global and national dietary in Nicaragua, but few are exclusively breastfed. Reports indicate that guidelinesTrial andRegistration: may inform future policy. https:// Nicaraguan infants are exclusively breastfed for a median of 21 days, Clinicaltrials.gov: NCT02615886, 58% use a bottle at less than one month of age (not adding breast milk clinicaltrials.gov/ct2/show/NCT02615886Keywords: to the bottle) and approximately 86% are introduced to solid foods before six months of age [8,9]. In Central and Latin America, mothers Breastfeeding; Complementary feeding; Nicaragua; introduce solid foods to their children by the age of four months, and Nutritional status are more likely to support infant overfeeding [11,12]. Abbreviations Evaluating breastfeeding bottle use, and complementary feeding patterns in specific geographical locations within and LAZ: Length-for-age z-score; UNICEF: United Nations Children’s across countries is necessary to determine if recommendations are Emergency Fund; WAZ: Weight-for-age z-score; WHO: World Health adhered to, and if not, how to provide an opportunity to develop Organization;Introduction WLZ: Weight-for-length z-score. culturally-specific interventions as part of prenatal and postnatal research [7,11]. It has been shown that infants who follow the exclusive breastfeeding recommendations have a lower risk of obesity in the future compared to infants who were formula fed in Infant feeding recommendations set by the World Health the first six months [13–17]. Assessing current weaning practices is Organization and promoted by the Nicaraguan Ministry of Health an important focus of child health and nutrition research to better include being exclusively breastfed for the first six months of life, understand not only short-term health outcomes, but also possible recommendationsfollowed by appropriate has shown complementary to aid in achieving feeding optimalwith continued growth, long-term health and development effects. breastfeeding until the age of two [1-3]. Adhering to these This present study utilized baseline data from an infant development, and health of an infant [1,2,4,5]. More specifically, cohort enrolled in a prospective trial located in León, Nicaragua. J Food Nutri Diete Page 1 of 6 ISSN: 2470-9794 J Food Nutri Diete ISSN: 2470-9794 Vol. 1. Issue. 3. 14000110 participant’s well visit at the health clinic was collected as a second Information about breastfeeding, bottle use, and complementary feeding practices were collected, alongside nutritional status. The measure and to confirm field data. This data was then calculated objectives were to describe breastfeeding and weaning practices for LAZ, WAZ, and WLZ following the World Health Organization at six months of age, and to examine any association between (WHO) child growth standards using the WHO Anthro software breastfeeding, bottle use, or complementary feeding practices and (version 3.2.2) [19]. Birth weight and premature status were also nutritional status, as measured by length-for-age (LAZ), weight-for- collectedStatistical for Methodsdescriptive purposes. age (WAZ), and weight-for-length z-scores (WLZ). We hypothesized that breastfeeding prevalence in this area of Nicaragua would be similar to other areas in Nicaragua that have been previously Statistical analyses were® completed on participant reported between 1998-2015 [4,8,9,18] and that breastfeeding, characteristics, breastfeeding, bottle use, and complementary bottle use, and common complementary foods would be associated feeding data using IBM SPSS Statistics 23.0. The food types were withMethods nutritional status. dichotomized where ‘0’ was equal to the child never has been given Study Design this food or used to give this food, but not anymore, and ‘1’ was equal to any current consumption of the food type. Pearson’s chi- square was used to assess differences between males and females for food types consumed breastfeeding, bottle use, and household Infant participants and their families living in León, Nicaragua characteristics independently. Multiple linear regression models were enrolled in a randomized-controlled dietary intervention trial were performed in order to evaluate the association between to assess the feasibility of consuming heat-stabilized dietary rice LAZ, WAZ, and WLZ and food types independent of sex, as well bran. The intervention occurred between March 2015 and October • as number of food types consumed. Participant characteristics 2015 (NCT02615886). Eligibility included: are presented as mean ± standard deviation or percent of study vaccinationInfants between the ages of 4-6 months at time of recruitment population.p Breastfeeding bottle use, and complementary feeding with no diarrheal episodes and received three doses of rotavirus are presented by percent of study population. Significance was • No prior hospitalization definedResults as ≤ 0.05 for all analyses. • • Not taking antibiotics or on prophylactic treatment A total of 51 six-month-old infants (n = 29 males and 22 females) were recruited