Temporal Dietary Diversity Patterns Are Associated with Linear Growth but Not Ponderal Growth in Young Children in Rural Vietnam

The first 2 y of life mark critical changes in children’s diet from milk-based food to diverse food rich in taste and texture, but few studies in low-resource settings have explored the changes in diet quality during this period. We examine temporal dietary diversity patterns between 6 and 25 mo of age and their associations with child growth outcomes in rural Vietnam. We used data from a prospective cohort (PRECONCEPT) and included 781 children that had dietary diversity data for 4 age windows: 6–8, 11–13, 17–19, and 23–25 mo of age. The temporal dietary diversity patterns were constructed by tracking how minimum dietary diversity changed over the 4 age windows. Multivariate logistic and linear regressions were used to assess the associations of dietary patterns with stunting and wasting at the 23–25 mo window and with relative linear and ponderal growth between 6 and 25 mo, respectively. Two key aspects of diet quality (the introduction and the stability of diverse diet) were used to define 5 temporal dietary diversity patterns: timely-stable (30% of the sample), timely-unstable (27%), delayed-stable (16%), delayed-unstable (15%), and super-delayed (12%). Compared with timely-stable pattern (the most optimal pattern), timely-unstable and super-delayed patterns were associated with a higher risk of stunting (odds ratio [OR]: 1.78; 95% confidence interval [CI]: 1.05, 3.04 and OR: 1.98; 95% CI: 1.02, 3.80, respectively) and slower linear growth (β: −0.24; 95% CI: −0.43, −0.06 and β: −0.25; 95% CI: −0.49, −0.02, respectively). No associations were found for wasting and relative ponderal growth. Delayed introduction of a diverse diet and failure to maintain a diverse diet are associated with slower linear growth but not ponderal growth in the first 2 y of age. This trial was registered at clinicaltrials.gov as NCT01665378.