Nutrition Intervention Of Infant Complementary Feeding In Chengdu, China

Complementary feeding (CF) is defined as the process starting when breast milk alone is no longer sufficient to meet the nutritional requirements of infants, and therefore other foods and liquids are needed, along with breast milk.Since 1980's, many research reports found out that growth retardation on infants after 4-6 month in developing countries were mainly caused by CF problems. And these problems included in introducing complementary foods in improper time or order, feeding low-energy-density foods, ignoring the practice of caregiver-child interactions, limited knowledge and understanding on prevention of food allergy, or taking excessive energy for infants. So many experts proposed that CF would be the priority and focus of 21^st infant nutrition researches.Investigation and assessment status of infant CF is important to resolve the CF problems. But the related reports have not been found in Chengdu. So, we first conducted a cross-sectional survey in Chengdu, which to evaluate the knowledge of infant caregivers, the feeding and growth status of infants, and the guiding capabilities of medical staff in child health services. Based on existing problems and requirements, a CF intervention program was developed by a new guiding pattern named "nutrition prescription" which included a set of infant menu as quantitative directions.5 child health clinics were selected as study sites from the five district maternal and child health (MCH) service hospitals in Chengdu. Study subjects were the infants aged at 4 month and their caregivers in these clinics. Subjects coming from two clinics selected randomly were divided into intervention group to receive the guidance by "nutrition prescription" pattern, and the subjects coming from the other three clinics were divided into control group getting ordinary child-health-care guidance. After 6 months, we compared the differences on CF knowledge and CF behavior between two groups' caregivers, and the differences on complementary food intakes and growth results between two groups' infants in 4, 5, 6 and 9 month separately. Then we evaluated the validity and feasibility of "nutrition prescription" and the rationality of "infant menu" and discussed the application perspective of this new guiding pattern. The study was aiming to provide a better way to improve elementary child-health-care services in the urban area of China.The main results of the study were as followed:1. Many problems in infant complementary feeding were found.The knowledge on CF of these infant caregivers was poor in Chengdu, China. About half of them didn't know pasted food was important to infants aged from 4 to 6 month. 2/3 of them didn't understand the right order while introducing complementary foods. 4/5 of them didn't know the iron deficiency was common in infant period. They liked and expected to get guiding from medical staff on food choices, diet preparation, introducing time of complementary foods and so on. But only 36% of them were satisfied with effect of child health services at present.The behaviors of CF were unreasonable in Chengdu. Among the age of 3⁶ month infants, 40.35%-54.78% of them had formula feeding and the median time of introducing formula was at the age of 1 month. About half of the infants began their CF before age of 4 month. So many infants didn't choose cereal as their first complementary food, but egg yolk or fruit juice. Nearly half of the infant had introduced meat before the age of 6 month. However, after the age of 6 month, most infants had porridge as their main complementary foods.The development of these infants aged from 3 to 12month was good. The means of their weight and height were up to the WHO-NCHS standard. Malnutrition rates were low, while the overweight and obesity rates were 7.02% and 1.41% respectively. Before the age of 6 month, WAZ of infants without cereal intakes was higher than that of infants having cereal intakes (P<0.05). After the age of 6 month, HAZ of infants with egg or meat intakes was higher than that of infants without such intakes (P<0.05). Significent effects of the time of introducing complementarty foods on infant's growth didn't be found.Survey with 157 medical personnel in Chengdu showed that their knowledge had great difference. Subjects with college education and working in senior MCH medical units got higher scores than those having secondary education and working in elementary units. About 2/3 medical staff did not understand well in principles of CF. About 1/2 medical staff didn't know why infant should taste foods one by one, which kind of foods should be introduced firstly, when to stop midnight breasting and so on. Some medical members still felt difficult when guiding infant caregivers on CF, such as the quantity of complementary foods, the diet preparation, the practice of responsive feeding and how to feed child patients. They hoped to improve themselves by training.2. The results of intervention with "nutrition prescription" guiding pattern were fine and worth of spreading.After 6 month of nutrition intervention, the results showed that the knowledge level between two groups' caregivers had significant difference. About 1/3 caregivers in intervention group got score "excellent", while less than 1/4 caregivers in the control group got such score. Infant caregivers of intervention group understood better on introducing time and principle of CF.The feeding behavior of infants in the intervention group was more reasonable than that of the control group. Only 2.78% of intervention group infants introduced complementary food before age of 4 month, while 15.19% of control group infants did that. In the intervention group, more infants chose cereal as their first complementary food. And their introducing order and time of complementary foods was more reasonable than those in the control group. At the age of 9 month, infants in the intervention group had various diets. However, there were still 18.18%-34.09% of control group infants hadn't introduced animal foods.During the age of 4 to 6 month, the infants of intervention group took less amount of cereal, vegetable and fruits, and less energy and macro-nutrients intakes from complementary foods than those in the control group. At the age of 9 month, more infants of intervention group introduced meat foods. There had no significant difference in the total amount, energy and energy resources of their complementary foods between two group infants.Male infants in the intervention group got a better development in both weight and length growth velocity than those in the control group while controlling their birth weight difference (P<0.05). And infants in the intervention group showed a better developing tendency than those in the control group. The morbidity between two group infants had no significant difference."Nutrition prescription" guiding pattern and "infant menu" quantified directions improved CF status in terms of timeliness, variety, quality and quantity, and help infants grow well in Chengdu. It got the high praise by the caregivers of intervention group and medical staff in child-health-care clinics.Conclusion: There were many problems on infant complementary feeding in Chengdu. With the measures of "nutrition prescription" guiding pattern and "infant menu" quantified directions, caregivers' knowledge, feeding behavior on CF was improved, and infants grown well. Such new kind of guiding pattern is worth spreading in elementary health care services in urban areas in China.