Higher infant dietary diversity is associated with a reduced risk of stunting in the second year among a longitudinal cohort of HIV-unexposed and HIV-exposed but uninfected Kenyan children

Objective: Few studies have examined whether infant dietary diversity is prospectively associated with malnutrition risk in young children. We sought to assess whether dietary diversity and animal-source food (ASF) consumption were associated with malnutrition and body composition among children younger than 2 years at high risk of malnutrition. Design: Longitudinal cohort of HIV-exposed uninfected (HEU) or HIV-unexposed children with repeated measures of weight, length, circumferences and skinfold thicknesses from age 9 to 23 months from which WHO z-scores were calculated. FFQ assessed infants' dietary diversity, flesh foods and egg intake. Cox proportional hazards were used to examine whether minimum dietary diversity (MDD, dietary diversity scores ≥ 5) and consumption of ASF were associated with malnutrition, defined as z-score < -2. Setting: Western Kenya Participants: Infants (n 232; 48 % female; 49 % HEU; growth z-scores above -2 at 9 months). Results: At 9 months, 42 % of infants met MDD, and mean z-scores were above -1 sd. Meeting MDD at 9 months was associated with a lower risk of stunting from 9 to 23 months (HR 0·51; 95 % CI: 0·33, 0·80) but not wasting or underweight. MDD at 9 months was associated with 86 % (95 % CI 0·11, 0·51) lower risk of low subscapular skinfolds; similar trends were observed for flesh foods. Conclusions: In a cohort of Kenyan infants, MDD at 9 months was associated with reduced risk of stunting through the second year of life. Flesh food intake was associated with lower risk of low trunk adiposity. Improving dietary diversity during infancy may protect against early-life stunting.