The Helen Keller International Food-Frequency Method Underestimates Vitamin A Intake Where Sustained Breastfeeding is Common

A recent innovation in assessing community vitamin A status is the Helen Keller International food-frequency method, which is based on weekly intakes of key foods among pre-school children. Since it excludes breastmilk, we investigated whether the amount of breastmilk received by 40 children aged one to three years in a rural area of Bangladesh contributed significantly to their vitamin A intake. Vitamin A intake was indirectly calculated from the consumption of breastmilk, which was quantified over a 9-hour period by a test-weighing technique. The estimated mean 24-hour milk intake was 548 g for the 97% who were breastfed at 12 to 23 months and 312 g for the 73% who were breastfed at 24 to 36 months. This represents an average daily intake of 41% and 23% of the safe recommended daily intake (400 RE) for vitamin A, respectively. The Helen Keller International food-frequency method should be revalidated for settings where breastfeeding is sustained beyond infancy.