Premature complementary feeding is associated with poorer growth of Vietnamese children

The objective of this longitudinal study was to investigate the association between the premature initiation of complementary feeding and physical gro wth of children. Four cohorts of newborn children were included, consisting of 90 infants born in 1981, 90 in 1982, 60 infants in 1983 and 60 in 1984. The weights and heights of children were measured monthly up to 1 y, then every 3 mo for y 2 and 3, and once every 6 mo in y 4. Information on feedin g practices and diseases of the children was obtained by interviewing the m others at each home visit. All but three children (98.6%) were breast-fed. Although 87.1 % of the mothers breast-fed their children for at least 1 y, only 3.3% of the infants were breast-fed exclusively at the age of 4 mo. In the analyses of growth, care was taken to address the biases of reverse ca usality, regression to the mean and confounding. There was little associati on between feeding pattern at 15 d and growth in length in mo 1. However, p artially breast-fed and weaned infants gained weight more slowly than those exclusively or predominantly breast-fed. From 1 to 3 mo, exclusively breas t-fed infants grew more quickly in both weight and length, followed by pred ominantly breast-fed infants. From 3 to 6 mo, exclusively breast-fed infant s gained more weight compared with the other groups, but there was a slight difference (P = 0.047) in length gain only between exclusively and partial ly breast-fed infants. In the older period (6-12 mo), exclusively and predo minantly breast-fed infants grew in length more quickly than partially brea st-fed and weaned groups. However, there was no difference in weight gain a mong groups. Morbidity from diarrhea and acute respiratory infections was s ignificantly lower for the greater than or equal to3 mo exclusively breast- fed group (chi (2) and Fisher-Exact Test). Over nearly the whole age range from 1 mo to 4 y, Z-scores for all indices (weight-for-age, height-for-age and weight-for-height) of the children who received complementary food were significantly lower than those of children who were exclusively breast-fed for at least 3 mo (repeated measures ANOVA, adjusted for sex, family size, maternal education and family income). These results show a long-term dete rioration of physical growth in infants who received premature complementar y feeding and confirm the importance of exclusive breast-feeding for infant s for at least 3 mo.