Snacks and nutrition during the complementary feeding period: a cross-sectional study among children 12-23 months of age in Kathmandu Valley, Nepal

Availability and consumption of processed foods has grown rapidly in low- and middle-income countries (LMIC), among both adults and children. While snacks provide energy during the nutritionally vital complementary feeding period, consumption of unhealthy snack foods and beverages (USFB), typically energy-dense and nutrient-poor, is concerning given young children’s high nutritional requirements and limited gastric capacity. However, there is limited information on the contribution of such foods to dietary intakes and the potential nutritional consequences among young children in LMIC. This thesis describes a cross-sectional study in Kathmandu Valley, Nepal that assessed dietary intakes of a representative sample of 12-23-month-old children (n=745) and examined the association between high consumption of USFB and nutritional status. We found that USFB contributed on average 5.2% of total energy intakes (% TEI) from non-breastmilk foods among the lowest tercile of USFB consumers and 46.9% TEI among the highest tercile. Nearly 9/10 of USFB were commercial products, with biscuits (10.8%), candy/chocolate (3.5%), and savoury snacks (3.4%) providing the largest % TEI. Compared to low USFB consumers, high USFB consumers had lower dietary intakes of 12 nutrients and were at greater risk of inadequate intakes for 8 nutrients. In a model adjusted for other covariates of undernutrition, mean length-for-age (LAZ) was 0.29 standard deviations lower among high USFB consumers than low consumers (p=0.003). No associations were found between high USFB consumption and stunting prevalence or iron status. The prevalence of overweight/obesity was low. Findings from this study indicate that high USFB consumption among young children is associated with increased risk of inadequate micronutrient intakes, which may contribute to poor growth outcomes. In LMIC contexts where the nutrient density of complementary feeding diets is low, addressing the increased availability of inexpensive, packaged products in LMIC food systems should be a priority for policies and programs aiming to safeguard child nutrition.