Academic journal article Bulletin of the World Health Organization

The Contribution of Breast Milk to Toddler Diets in Western Kenya. (Research)

Academic journal article Bulletin of the World Health Organization

The Contribution of Breast Milk to Toddler Diets in Western Kenya. (Research)

Article excerpt


When breast milk becomes inadequate to meet infants' needs for energy and nutrients, the complementary diet takes on an increasingly important role in maintaining optimal growth. If the combination of breast milk and dietary intake is adequate, this should be reflected in the nutritional status of the child population in the period of sustained breastfeeding, which may overlap with the second year of life. Few studies have examined the relative contributions of breast milk to overall energy and nutrient intakes during the period of complementary feeding (1). Studies from several developing countries indicate that children aged 12-23 months consuming average quantities of breast milk should obtain 750 kcal from the complementary diet to meet their daily requirements (1). However, there have been few analyses of nutrient intake in the second year of life (2, 3). Our data provide a profile of energy and nutrient intakes in the second year and some insights into the nutritional implications of the continuation or termination of breastfeeding for toddlers being weaned on diets similar to the typical food selection in this study population.

Breastfeeding is sustained until at least the latter part of the second year for most children in the agricultural community of Marachi Central Location, Busia District in western Kenya. Most infants begin to receive cereal- and cassava-based gruel before the age of 3 months. Gruel remains the most important food item in complementary diets until toddlers are weaned onto the household staple, ugali, a stiff porridge prepared from the same flours used for making gruel, served with a limited variety of vegetable and animal food accompaniments. Our study prospectively followed a cohort of 264 children. The findings of our investigation of the association between breastfeeding and growth in the second year have been published elsewhere (4). This paper evaluates the relative contributions of breast milk and the complementary diet to the energy and nutrient intake of these children. It presents analyses of data from the 250 children who were breastfed for any duration between November 1995 (baseline) and May 1996 (final assessment). Data from the other 14 toddlers, who had stopped breastfeeding before baseline assessment, were not taken into account.


During the study period, 24-h dietary recall interviews were administered once every 3 weeks. The data were processed using the Worldfood Program (WFP) to calculate intakes of energy and nutrients for each recall day (5). Daily nutrient and energy intakes written in D-Base IV format by the WFP were imported into SPSS 7.0 for further processing. Nutrient and energy, intakes from all available records for each subject were aggregated to calculate estimated mean intakes over the follow-up period. A phytate:zinc molar ratio was computed using nonaggregated data according to the formula of Murphy et al. (6): (phytate (g)/molar weight 660) / (zinc (mg)/atomic weight 65.4).

Diet diversity variables, including individual food and food group counts, were created in SPSS. The eight food groups counted were starch, vegetables, fruit, fats/oils, meat/fish/ poultry/insects, nuts/seeds/pulses, sugars/sweets, and miscellaneous (including spice mixtures). Although consumed regularly in the sample, salt (miscellaneous) and tea (beverages) were not included in the food counts.

A test-weighing study in a subsample of 50 children was carried out to estimate breast-milk intake in a single 24-hour period. We began from the northern end of the location and moved systematically through the study area. The subsample comprised children of mothers who had indicated willingness to participate in the test-weighing component and who, when the test-weighing team was working in their local area, were still breastfeeding and were available for observation.

Two fieldworkers arrived in the home at 07:00 and conducted weighing throughout the day. …

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