Novel method for estimating nutrient intakes using a semistructured 24-hour diet recall for infants and young children in rural bangladesh

Background: Nutrient-level intakes from home-prepared complementary foods are rarely estimated among infants and young children in low-income settings. The major constraints are related to lack of standard recipes and ingredients and portion sizes. Objectives: This article describes the feasibility, applicability, and validity of a post hoc qualitative methodology to estimate nutrient intakes in children using 24-h dietary recall. Methods: Semistructured, interviewer-administered caregiver 24-h diet recalls were conducted to assess food intake among children participating in a randomized trial of complementary food supplementation at ages 6, 9, 12, 15, 18, and 24 mo in rural Bangladesh. At the end of the diet data collection, focus group discussions with mothers (n = 6) and cooking activities (n = 5) were conducted to obtain standard recipes (and ingredients) and portion sizes for reported foods given at different ages. Nutrient intakes were calculated for children in the control group (n = 1438), and convergent validity of the data was tested by examining the association of energy and protein intakes with child age and socioeconomic status (SES). Results: Focus group discussions generated standardized recipes for 21 commonly consumed mixed dishes being fed to children. These recipes were cooked, and portion sizes of standardized measures used in 24-h recalls were quantified in grams. For discrete foods, we quantified women's perceptions of "small,""medium,"and "large"in grams. Across all ages, food groups consumed consisted mostly of staples, with the most common being rice, potatoes, and biscuits. Using portion size data and recipe ingredients, the 24-h dietary data, and Bangladeshi food composition tables, we successfully estimated nutrient intakes in children. Convergent validity analysis showed that energy and protein intakes were strongly associated with age and SES (both P < 0.001). Conclusions: We demonstrated the use of a validated, qualitative methodology for estimating nutrient intakes in young children from complementary foods in undernourished contexts.