ABSTRACT
OBJECTIVE: This paper compares the accuracy of visual estimations of children's food intake in settings where several children eat together off 1 plate vs individual-plate eating scenarios. DESIGN: Eight trained observers were tested in their ability to estimate food portions consumed by children enacting common eating scenarios. Foods were categorized by food group and according to their presentation by individual-plate and shared-plate. Observed food weight estimates were compared to actual weights. SUBJECTS/SETTING: The 8 observers visually estimated 69 food portions of children eating alone and 26 portions where children were eating from a shared plate. This study was carried out in Sarlahi District, a rural, central lowland region of Nepal. STATISTICAL ANALYSES: Pearson's correlation coefficients were calculated to examine associations between estimated and actual weights. A fixed effects model was constructed to compare observers. RESULTS: Analyses revealed that observer estimates of food weights under field conditions were well correlated with actual weights for individual-plate (r = 0.89) and for shared-plate (r = 0.84) scenarios. Observers estimated food weights when children ate together on a shared plate less accurately than they did in settings where children ate alone. With the exception of 1 observer, observers did not differ significantly in their ability to estimate food weights. Accuracy of estimations was influenced by food weight with greater error associated with food quantities of less than 70 g. CONCLUSIONS: Visual estimation is a relatively accurate, valid method of assessing child food intake under rural field conditions, and the only method to obtain accurate information on dietary intake in regions where shared-plate eating is frequent.
Subject(s)
Diet Records , Eating , Child , Child, Preschool , Female , Humans , Infant , Linear Models , Male , Nepal , Rural PopulationABSTRACT
OBJECTIVE: To determine the relationship between infant feeding history and risk of xerophthalmia due to vitamin A deficiency (VAD) in early childhood. DESIGN: A case-control study of previously xerophthalmic and non-xerophthalmic children. SETTING: Rural lowland region of Nepal. SUBJECTS: One hundred and fifty-six children (aged 1-6 y old), half of whom previously had xerophthalmia due to vitamin A-deficiency, the other half matched by locale, age and the presence and age of a younger sibling (n = 102). METHODS: Xerophthalmia was determined by trained ophthalmic assistants on the basic of current Bitot's spots, corneal xerosis or report of night blindness. Infant feeding history was collected through a diet history method obtained from the mother of the focus child. Exploratory factor analysis was conducted to determine the presence of underlying patterns in infant feeding practices. Conditional logistic regression was used to estimate odds ratios. RESULTS: Mothers of control children tended to have a higher level of education (P < 0.10) and to have fewer children who had died (P < 0.10) than mothers of case children. Feeding of meat (OR = 0.09, CI = 0.01-0.70) or fish (OR = 0.41, CI = 0.17-0.99) with liver, eggs (OR = 0.11, CI = 0.01-0.88) and mango (OR = 0.28, CI = 0.13-0.60) were protective in association with xerophthalmia in early childhood. Factor analysis uncovered several distinct patterns in infant feeding, which varied by age of the infant. Only the 'animal flesh' feeding pattern (factor), practiced in the second year of life, proved significantly protective from xerophthalmia (OR = 0.43, CI = 0.20-0.94). Feeding patterns of younger children closely paralleled those of their older siblings with and without VAD. CONCLUSIONS: The study supports the hypothesis that infant dietary practices can influence subsequent risk for VAD. Our findings emphasize the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.
PIP: The association between infant feeding patterns and vitamin A deficiency (VAD)-associated xerophthalmia was investigated in a case-control study of 156 children, 1-6 years old, from a rural lowland region of Nepal. The 78 children with previous xerophthalmia determined on the basis of current Bitot's spots, corneal xerosis, or night blindness were matched with 78 controls on the basis of locale, age, and the presence and age of a younger sibling. The diet history method was used to elicit infant feeding practices from mothers. Frequency of consumption of 21 key foods was calculated over the 2-year period of the diet history. The analysis supported the hypothesis that infant dietary practices can influence the subsequent risk for VAD. The feeding of meat (odds ratio (OR), 0.09; 95% confidence interval (CI), 0.01-0.70) or fish (OR, 0.41; 95% CI, 0.17-0.99) with eggs (OR, 0.11; 95% CI, 0.01-0.88) and mango (OR, 0.28; 95% CI, 0.13-0.60) was protective in association with xerophthalmia in early childhood. In factor analysis, only the "animal flesh" feeding pattern, practiced in the second year of life, was significantly protective against xerophthalmia (OR, 0.43; 95% CI, 0.20-0.94). These findings confirm the importance of introducing vitamin A-rich foods during weaning to reduce the risk of VAD-associated xerophthalmia in the later preschool years.
