Suboptimal situation: Kids in China, India and Indonesia risk triple burden due to poor complementary feeding – Review

By Nurul Ain Razali

- Last updated on GMT

Complementary feeding in Chinese subjects were found to have occurred either too early or late. ©Getty Images
Complementary feeding in Chinese subjects were found to have occurred either too early or late. ©Getty Images

Related tags China India Indonesia complementary feeding

Infants and toddlers in rapidly developing China, India and Indonesia are at risk for the triple burden of malnutrition due to poor complementary feeding, leading to a higher prevalence of stunting or being overweight.

Most of the children were introduced to complementary feeding at inappropriate times, either too early, specifically in urban and rural China and Indonesia, or too late, for India, compared to the WHO recommendation.

These findings were disclosed in a review titled “Complementary Feeding Practices among Young Children in China, India, and Indonesia: A Narrative Review” ​published by the journal Current Developments in Nutrition.

“The first 1,000 days of life represent a critical phase when adequate nutrition is essential for lifelong health and development. In particular, the period of six to 24 months – that is, in which complementary feeding becomes increasingly important – encompasses a sensitive period when nutritious foods are required.

“According to the World Health Organization (WHO), complementary feeding should be commenced at six months of age in order to fill the increasing energy and nutrient demands. Suboptimal feeding practices during this period of life may pose a risk for the development of both undernutrition as well as overweight/obesity.

“As the complementary feeding period is a vulnerable developmental phase and provides a window of opportunity to program later health, proper feeding during this time is of key importance to prevent later-life health issues. Therefore, the complementary feeding period provides an important window of opportunity for interventions targeting the prevention of malnutrition,”​ said the researchers.

The team then undertook a literature search to obtain information on complementary feeding practices for children below two years old in the selected countries. The studies were limited to 1 January 2010 to 1 January 2022, and 4,950 articles were found. It was narrowed to 56 for the current study.

Practices and regional variation

For China, the studies retrieved showed that complementary feeding occurred too early and late among the subjects. Early complementary feeding occurred in Chengdu and Jiaxing and the poorest areas, as proven by Xu et al.​ (2018), He et al.​ (2001) and Wang et al.​ (2005). Delayed complementary feeding was reported to be prevalent in general rural areas.

On diversity in complementary feeding, the prevalence of the minimum dietary diversity was estimated at 52.5%, especially for urban areas, and lowest for poor, rural areas. However, rural and urban areas shared common complementary foods like rice and rice products such as rice paste and porridge. For proteins, urban kids were exposed to mashed egg, pork, ham or fish by 24 months, whereas rural kids’ exposure was highly varied. The rural children were found to consume lesser protein, as shown by He et al.​ (2001), Yue et al.​ (2018) and Liu et al.​ (2009).

In India, past literature reported that complementary feeding usually began around six to nine months. However, only half of the Indian children were introduced to complementary feeding between the ages of six to eight months, according to the Indian National Family Health Survey (NFHS) 2007. There was also regional variation, whereby higher estimates were recorded in the south than the central and northern areas of the sub-continent.

In Indonesia, early complementary feeding was highly prevalent, with 50% of children receiving it at age four to five months and climbing to 90% by age six to eight months, as proven by the Indonesia Demographic and Health Survey (2017). On food diversity, the minimum dietary diversity increased with age, from 22.6% at six to eight months to 74.3% at 18 to 23 months. Like China, the typical carbohydrates given to the children used are rice and rice porridge across various regions.


Overall, the findings of this review showed suboptimal practices related to the timing, frequency and diversity of complementary feeding for children in the three countries. Scientists found low diet diversity and food with poor nutritional quality.

Based on the findings, the current researchers deduced that it was potentially due to underlying factors, such as poverty, low-level maternal education, fewer antenatal visits and limited to no media exposure.

“The described differences in the feeding practices within and between countries suggest that a country-specific approach is needed in order to improve the feeding of young children. The provided insights may facilitate the development of educational tools as well as create awareness for parents and health care professionals in the community about the importance of diet during the complementary feeding period,”​ concluded the researchers.

Source: ​Current Developments in Nutrition

“Complementary Feeding Practices among Young Children in China, India, and Indonesia: A Narrative Review”


Authors:​ Outi Sirkka et al.

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