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One area within agriculture with tremendous potential to influence early childhood nutrition is the dairy sector. Dairy products have a range of nutritional and physical characteristics that make them an almost ideal complementary food. Undernourished children in poor countries are often deficient in foods rich in high-quality proteins comprised of essential amino acids that constitute the building blocks for linear growth and cognitive development (Semba, 2016). Dairy has a higher digestibility-corrected amino acid score than any other food (1.21) and is particularly efficacious at closing amino acid gaps in the monotonous diets prevalent in Africa and Asia (FAO, 2013), and in poorer populations more exposed to infections (Semba, 2016). Dairy is unique in stimulating plasma insulin-like growth factor 1 (IGF-1), a growth hormone that acts to increase the uptake of amino acids (FAO, 2013). Dairy is also dense in calories, fat, and various micronutrients (vitamin A and B12), as well as being exceptionally rich in calcium (which contributes to bone length and strength), potassium, magnesium, and phosphorus (Dror and Allen, 2014). Finally, the sheer density of multiple macro- and micronutrients in dairy products—as well as their taste, and familiar texture and consistency—makes them almost ideal for infants and young children with small stomachs incapable of consuming large quantities of nutrient-sparse foods so common in diets of poorer households.
Methods We used the cluster-randomised Sanitation Hygiene and Infant Nutrition Efficacy trial to determine the association of household-level food insecurity (FI) and water insecurity (WI) on LAZ and LAZ trajectory among infants during early life. Dimensions of FI (poor access, household shocks, low availability and quality) and WI (poor access, poor quality, low reliability) were assessed with the multidimensional household food insecurity and the multidimensional household water insecurity measures. Infant length was converted to LAZ based on the 2006 WHO Child Growth Standards. We report the FI and WI fixed effects from multivariable growth curve models with repeated measures of LAZ at 1, 3, 6, 12 and 18 months (M1–M18).
Results A total of 714 and 710 infants were included in our analyses of LAZ from M1 to M18 and M6 to M18, respectively. Mean LAZ values at each time indicated worsening linear growth. From M1 to M18, low food availability and quality was associated with lower LAZ (β=−0.09; 95% −0.19 to –0.13). From M6 to M18, poor food access was associated with lower LAZ (β=−0.11; 95% −0.20 to –0.03). None of the WI dimensions were associated with LAZ, nor with LAZ trajectory over time.
Conclusion FI, but not WI, was associated with poor linear growth among rural Zimbabwean infants. Specifically, low food availability and quality and poor food access was associated with lower LAZ. There is no evidence of an effect of FI or WI on LAZ trajectory.