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

Background: 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. Objectives: We examine temporal dietary diversity patterns between 6 and 25 mo of age and their associations with child growth outcomes in rural Vietnam. Methods: 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. Results: 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, respec-tively) and slower linear growth (8: -0.24; 95% CI: -0.43, -0.06 and 8: -0.25; 95% CI: -0.49, -0.02, respectively). No associations were found for wasting and relative ponderal growth. Conclusions: 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.