WHO and Health differ on child nutrition – 04/14/2024 – Balance and Health

The indicators that evaluate infant nutrition are different between the WHO (World Health Organization) and the Ministry of Health, according to research by UFBA (Federal University of Bahia) published in the scientific journal “Epidemiology and Health Services”, in March.

There is a disparity between the guidelines for four indicators that evaluate complementary feeding for children under two years of age.

Complementary feeding includes the group of foods offered to the child in addition to breast milk. The introduction of this diet is the indicator with the greatest disagreement among health bodies.

The WHO recommendation evaluates food introduction considering the consistency of the foods offered — whether they are solid, semi-solid or pasty. The MS (Ministry of Health) considers whether children consume two fruits and one salt meal per day. The studied population reached more than 94.3% of the first definition, while the second has only a 20.7% prevalence.

The study followed 286 children born in maternity wards in Vitória da Conquista, in the southwest of Bahia, for two years, carrying out interviews and home visits from the first 30 days of each child’s life and return visits at 6, 12 and 24 months. The prevalence of complementary feeding was assessed according to the 2021 WHO and 2015 Ministry of Health definitions.

To collect data on nutrition, the researchers used a questionnaire containing a list of 20 foods from different food groups — such as cereals, grains, roots and tubers; legumes; Meat and eggs; vegetables and greens; fruits; milk and dairy products. Based on the information, indicators were constructed to evaluate complementary feeding, according to MS and WHO criteria.

The results of the study showed that complementary feeding practices fall far short of those recommended by the Ministry of Health, but not those recommended by the WHO.

“The criteria used by the MS for its definition are more detailed and take into account Brazilian peculiarities. The WHO proposes general guidelines for evaluating indicators in order to cover the greatest possible variety of countries”, says UFBA associate professor, Daniela Rocha.

Therefore, the authors suggest that the evaluation of eating practices be based on the MS criteria, taking into account the greater proximity to what is practiced in the country’s population.

The study also verified the behavior of interviewees regarding three indicators, which also showed disagreements between them: minimum diet diversity, minimum diet frequency and minimally acceptable diet.

A low prevalence in an indicator means that the health service needs to work on measures with the population to improve it, according to the researcher.

According to the study, the differences between the definitions of minimum dietary diversity are found in the fact that, for the Ministry of Health, breast milk and other dairy foods account for a single food group, as well as a single group for meat and eggs. It is different from the WHO definition, which classifies these foods into four distinct groups. This way, it is easier to achieve the minimum of five food groups required for dietary diversity.

“Meats in general, offal and eggs have similar nutritional characteristics as they are rich in proteins, fat, iron, zinc and B vitamins, which justifies their being added as a single food group”, says the research.

The minimum meal frequency indicator only takes into account the number of meals received, according to the WHO. Meanwhile, the Health Ministry’s definition considers a dietary routine, and two main meals to reach the minimum adequate parameter. The prevalence in the first case reaches 97.2%, while in the second, 44.8%.

The minimum acceptable diet indicator deals with the combination of minimum frequency and minimum dietary diversity indicators, and was 96.8% for the WHO and 26.9% for the MS.

“In practice, this difference [de parâmetros] will lead to different results in the evaluation of complementary feeding indicators and consequently in the necessary interventions in view of the results found”, says the researcher.