Dietary Diversity Is Positively Associated with Deviation from Expected Height in Rural Nepal(1)(2)(3)

Background: Recent research has highlighted the need for additional studies on the nutrition input required to stabilize growth. Objective: Our objective was to examine the association between dietary diversity and conditional growth in children aged 0–89 mo. Methods: We analyzed cohort data from 529 mothers and children living in a remote and food-insecure region in the mountains of Nepal. Children were aged 0–59 mo at baseline and were followed up after 9 and 29 mo. Conditional growth was calculated as the deviation from the expected height-for-age difference (HAD) trajectory based on previous measures of HAD and the pattern of growth in the population. Dietary diversity was assessed with the use of a count of the foods consumed from 7 food groups in the previous 7 d. The association between dietary diversity and conditional growth during the 2 follow-up periods (of 9 and 20 mo, respectively) was estimated with the use of ordinary least-squares regressions. Results: Prevalence of stunting and absolute height deficits was very high and increased over the course of the study. At the last measurement (age range 29–89 mo), 76.5% were stunted and the mean ± SD HAD was −11.7 ± 4.6 cm. Dietary diversity was associated positively with conditional growth in the later (May 2012–December 2013) but not the earlier (July 2011–May 2012) growth period. Children’s ages ranged from 0 to 59 mo in July 2011, 9 to 69 mo in May 2012, and 29 to 89 mo in December 2013. After adjustment, increasing the dietary diversity by one food group was associated with a 0.09 cm (95% CI: 0.00, 0.17 cm) increase in conditional growth in the second growth period. Conclusions: Increasing dietary diversity for children reduces the risk of stunting and improves growth after growth faltering. Future efforts should be directed at enabling families in food-insecure areas to feed their children a more diverse diet.