Quantity and Source of Protein during Complementary Feeding and Infant Growth: Evidence from a Population Facing Double Burden of Malnutrition
Abstract
:1. Introduction
2. Subjects and Methods
3. Results
3.1. Demographic Data
3.2. Prevalence of Malnutrition in the Study Population
3.3. Complementary Feeding Practices and Nutrient Intakes
3.4. Association between Dietary Protein and Growth Outcomes
3.5. Association between Dietary Protein Intake and Blood Levels of IGF-1, IGFBP-3 and Insulin at 12 Months of Age
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institution Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
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Demographic Data | Results |
---|---|
Infants | |
Sex, female (n, %) | 72 (49.7) |
Gestational age, weeks (means ± SD) | 38.8 ± 1.0 |
Route of delivery (n, %) | |
- Vaginal delivery | 96 (66.2%) |
- Caesarean section | 49 (33.8%) |
Child order, first born (n, %) | 93 (64.1%) |
Birth anthropometry (means ± SD) | |
- Body weight, kg | 3.2 ± 0.4 |
- Length, cm | 49.3 ± 1.9 |
- Head circumference, cm | 33.3 ± 1.4 |
Parents | |
Parental age, years old (means ± SD) | |
- Mothers | 29.8 ± 5.7 |
- Fathers | 32.0 ± 5.9 |
Parental BMI, kg/m2 (means ± SD) | |
- Mothers | 22.8 ± 4.0 |
- Fathers | 24.7 ± 3.6 |
Maternal educational attainment (n, %) | |
- Did not receive formal education | 2 (1.4) |
- Below bachelor’s degree | 74 (51.0) |
- Bachelor’s degree and above | 69 (47.6) |
Family characteristics | Results |
Main caregivers (n, %), choose more than 1 | |
- Mothers | 134 (92.4) |
- Fathers | 6 (4.1) |
- Grandparents | 17 (11.7) |
- Others | 2 (1.4) |
Family type (n, %) | |
- Nuclear family | 50 (34.5) |
- Extended family | 95 (65.5) |
Main financial providers (n, %), choose more than 1 | |
- Mother | 92 (63.5) |
- Father | 140 (96.6) |
- Grandparents | 13 (9.0) |
- Others | 2 (1.4) |
Family income per month 1, 2, THB (n, %) | |
- less than 10,000 | 11 (7.6) |
- 10,000–29,999 | 65 (44.8) |
- 30,000–49,999 | 51 (35.2) |
- ≥50,000 | 18 (12.4) |
Variable | Results |
---|---|
Age of first introduction of complementary foods (months), mean ± SD | 5.7 ± 0.6 |
Age of introduction of each food group (months), mean ± SD | |
- Rice | 5.7 ± 0.6 |
- Fruits | 5.8 ± 0.6 |
- Vegetables | 5.9 ± 0.5 |
- Eggs | 6.0 ± 0.5 |
- Meats | 6.3 ± 0.9 |
- Dairy products (excluding infant/follow-on formula) | 9.9 ± 2.2 |
Breastfeeding practices | |
- Exclusive breastfeeding until 6 months of age, n (%) | 64 (44.1%) |
- Receiving only breast milk alongside complementary foods until 12 months of age, n (%) | 53 (36.6%) |
- Duration of exclusive breastfeeding (months), mean ± SD | 4.4 ± 2.0 |
- Duration of predominant breastfeeding (months), mean ± SD | 8.4 ± 4.4 |
Formula and dairy products | |
- Receiving formula feeding, n (%) | 87 (60.0) |
- Receiving unfortified cow’s milk before 12 months of age, n (%) | 21 (14.5) |
- Duration of formula feeding (months), median (IQR) | 3 (0, 9) |
Growth Parameters | High (n = 36) | Median (n = 73) | Low (n = 36) | Mean Difference 2 (95%CI) | ||
---|---|---|---|---|---|---|
H vs. L 3 | H vs. M 3 | M vs. L 3 | ||||
6M | ||||||
WAZ | −0.14 | −0.40 | −0.50 | 0.36 (−0.13, 0.85) | 0.27 (−0.16, 0.69) | 0.09 (−0.33, 0.52) |
WLZ | 0.02 | −0.06 | −0.05 | 0.07 (−0.46, 0.59) | 0.08 (−0.37, 0.54) | −0.02 (−0.47, 0.44) |
BMIZ | −0.08 | −0.14 | −0.16 | 0.08 (−0.46, 0.59) | 0.06 (−0.40, 0.52) | 0.02 (−0.44, 0.48) |
LAZ | −0.15 | −0.55 | −0.66 | 0.50 (−0.01, 1.01) | 0.40 (−0.05, 0.84) | 0.11 (−0.34, 0.55) |
9M | ||||||
WAZ | 0.03 | −0.46 | −0.59 | 0.62 (0.16, 1.08 5) | 0.49 (0.09, 0.89 4) | 0.13 (−0.27, 0.53) |
WLZ | 0.14 | −0.22 | −0.24 | 0.38 (−0.10, 0.86) | 0.36 (−0.06, 0.77) | 0.02 (−0.39, 0.43) |
BMIZ | 0.09 | −0.24 | −0.26 | 0.34 (−0.14, 0.83) | 0.32 (−0.10, 0.74) | 0.02 (−0.40, 0.44) |
LAZ | −0.17 | −0.48 | −0.69 | 0.52 (−0.01, 1.05) | 0.32 (−0.14, 0.77) | 0.20 (−0.24, 0.65) |
12M | ||||||
WAZ | 0.10 | −0.45 | −0.60 | 0.70 (0.24, 1.17 4) | 0.55 (0.15, 0.96 4) | 0.15 (−0.26, 0.56) |
WLZ | 0.25 | −0.30 | −0.39 | 0.64 (0.14, 1.16 4) | 0.55 (0.11, 0.99 4) | 0.10 (−0.35, 0.54) |
BMIZ | 0.29 | −0.19 | −0.31 | 0.60 (0.07, 1.13 5) | 0.48 (0.02, 0.94 5) | 0.12 (−0.34, 0.58) |
LAZ | −0.19 | −0.55 | −0.64 | 0.45 (−0.07, 0.96) | 0.35 (−0.09, 0.80) | 0.10 (−0.35, 0.54) |
Conditional | Average %PE 6–9 M | Average %PE 9–12 M | ||
---|---|---|---|---|
r | p-Value | r | p-Value | |
WAZ | 0.17 | 0.04 | 0.26 | 0.002 |
WLZ | 0.16 | 0.06 | 0.23 | 0.006 |
BMIZ | 0.12 | 0.16 | 0.20 | 0.02 |
LAZ | 0.09 | 0.26 | 0.07 | 0.39 |
Predictor and Co-Variates | Conditional WAZ | Conditional WLZ | ||
---|---|---|---|---|
β | 95%CI | β | 95%CI | |
%PE 9–12 M | 0.11 | 0.03, 0.18 1 | 0.12 | 0.05, 0.20 1 |
Duration of predominant BF | 0.02 | −0.05, 0.08 | 0.02 | −0.05, 0.09 |
Type of milk 9–12 M | 0.10 | −0.25, 0.45 | 0.19 | −0.16, 0.55 |
Non-protein energy 6–9 M | 0.002 | 0, 0.004 | 0.002 | 0, 0.004 |
Non-protein energy 9–12 M | <0.001 | −0.001, 0.002 | −0.001 | −0.002, 0.001 |
Maternal education | 0.06 | −0.07, 0.18 | 0.05 | −0.08, 0.17 |
Frequency of illness | −0.02 | −0.16, 0.12 | −0.03 | −0.17, 0.12 |
Maternal BMI | −0.02 | −0.06, 0.03 | −0.01 | −0.05, 0.03 |
Maternal age | 0.001 | −0.03, 0.03 | 0.001 | −0.03, 0.03 |
Predictor and Co-Variates | Conditional BMIZ | Conditional LAZ | ||
β | 95%CI | β | 95%CI | |
%PE 9–12 M | 0.10 | 0.02, 0.18 2 | 0.01 | −0.07, 0.09 |
Duration of predominant BF | 0.03 | −0.04, 0.10 | −0.02 | −0.08, 0.05 |
Type of milk 9–12 M | 0.23 | −0.13, 0.59 | −0.19 | −0.56, 0.18 |
Non-protein energy 6–9 M | 0.002 | −0.01. 0.004 | <0.001 | −0.002, 0.003 |
Non-protein energy 9–12 M | <0.001 | −0.002, 0.001 | 0.001 | −0.001, 0.003 |
Maternal education | 0.08 | −0.05, 0.20 | −0.05 | −0.18, 0.09 |
Frequency of illness | −0.01 | −0.15, 0.14 | 0.001 | −0.15, 0.15 |
Maternal BMI | −0.01 | −0.05, 0.03 | N/A | N/A |
Maternal age | 0.01 | −0.02, 0.04 | N/A | N/A |
Family income | N/A | N/A | 0.12 | −0.10. 0.34 |
2 Multiple linear regression analyses investigating associations between protein intakes from different food sources at age 9–12 months and conditional growth. | ||||
Predictor and Co-Variates | Conditional WAZ | Conditional WLZ | ||
β | 95%CI | β | 95%CI | |
%PE Milk/dairy | 0.18 | 0.03, 0.32 2 | 0.16 | 0.01, 0.30 2 |
%PE Non-dairy ASFs | 0.10 | 0.02, 0.18 2 | 0.12 | 0.04, 0.20 1 |
%PE Plant-based foods | 0.15 | −0.15, 0.45 | 0.16 | −0.15, 0.46 |
Duration of predominant BF | 0.02 | −0.05, 0.09 | 0.02 | −0.05, 0.09 |
Type of milk 9–12 M | −0.04 | −0.46, 0.09 | 0.13 | −0.30, 0.56 |
Non-protein energy 6–9 M | 0.002 | 0, 0.004 | 0.002 | 0, 0.004 |
Non-protein energy 9–12 M | <0.001 | −0.001, 0.002 | −0.001 | −0.002, 0.001 |
Maternal education | 0.05 | −0.07, 0.18 | 0.05 | −0.08, 0.17 |
Frequency of illness | −0.02 | −0.16, 0.12 | −0.02 | −0.16, 0.12 |
Maternal BMI | −0.01 | −0.06, 0.03 | −0.01 | −0.05, 0.03 |
Maternal age | 0.01 | −0.03, 0.04 | 0.003 | −0.03, 0.04 |
Predictor and Co-Variates | Conditional BMIZ | Conditional LAZ | ||
β | 95%CI | β | 95%CI | |
%PE Milk/dairy | 0.13 | −0.02, 0.28 | 0.07 | −0.08, 0.21 |
%PE Non-dairy ASFs | 0.10 | 0.01, 0.18 2 | <0.001 | −0.09, 0.09 |
%PE Plant-based foods | 0.14 | −0.16, 0.45 | 0.001 | −0.31, 032 |
Duration of predominant BF | 0.03 | −0.04, 0.10 | −0.01 | −0.08, 0.06 |
Type of milk 9–12 M | 0.17 | −0.26, 0.60 | −0.32 | −0.76, 0.12 |
Non-protein energy 6–9 M | 0.002 | −0.01. 0.004 | <0.001 | −0.002, 0.003 |
Non-protein energy 9–12 M | <0.001 | −0.002, 0.001 | 0.001 | −0.001, 0.003 |
Maternal education | 0.07 | −0.06, 0.20 | −0.05 | −0.19, 0.08 |
Frequency of illness | −0.002 | −0.15, 0.14 | −0.002 | −0.15, 0.14 |
Maternal BMI | −0.01 | −0.05, 0.03 | N/A | N/A |
Maternal age | 0.01 | −0.02, 0.05 | N/A | N/A |
Family income | N/A | N/A | 0.13 | −0.10. 0.35 |
Protein Intake (%PE) from | Correlation Coefficients (r) | ||
---|---|---|---|
IGF-1 (ng/mL) | IGFBP-3 (ng/mL) | Insulin (µU/mL) | |
All food sources | 0.11 | 0.13 | 0.03 |
| 0.331 0.381 | 0.202 0.212 | 0.202 0.202 |
Non-dairy ASFs | −0.16 | −0.04 | −0.14 |
Plant-based foods | −0.11 | −0.09 | −0.06 |
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Kittisakmontri, K.; Lanigan, J.; Wells, J.C.K.; Manowong, S.; Kaewarree, S.; Fewtrell, M. Quantity and Source of Protein during Complementary Feeding and Infant Growth: Evidence from a Population Facing Double Burden of Malnutrition. Nutrients 2022, 14, 3948. https://doi.org/10.3390/nu14193948
Kittisakmontri K, Lanigan J, Wells JCK, Manowong S, Kaewarree S, Fewtrell M. Quantity and Source of Protein during Complementary Feeding and Infant Growth: Evidence from a Population Facing Double Burden of Malnutrition. Nutrients. 2022; 14(19):3948. https://doi.org/10.3390/nu14193948
Chicago/Turabian StyleKittisakmontri, Kulnipa, Julie Lanigan, Jonathan C. K. Wells, Suphara Manowong, Sujitra Kaewarree, and Mary Fewtrell. 2022. "Quantity and Source of Protein during Complementary Feeding and Infant Growth: Evidence from a Population Facing Double Burden of Malnutrition" Nutrients 14, no. 19: 3948. https://doi.org/10.3390/nu14193948