{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:43:51Z","timestamp":1786117431426,"version":"build-2736575974"},"reference-count":14,"publisher":"Ubiquity Press, Ltd.","issue":"1","license":[{"start":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T00:00:00Z","timestamp":1785974400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["89"],"abstract":"<jats:p>Background: Stunting is a pervasive issue in low\u2011 and middle\u2011income countries, reflecting biological processes that adversely affect childhood cognitive development and increase the risk of chronic disease in adulthood. Nutritional intake is an important causative factor in stunting. Understanding the nutritional intake patterns of children with stunting can help inform nutrition program development.\nObjective: To characterize breastfeeding and dietary patterns from a clinical cohort of children with stunting in Guatemala and identify factors associated with linear growth.\nMethods: We included children with at least one diet record and one length\/height\u2011for\u2011age z\u2011score below \u22122 from ages 0\u20135 years. We excluded children enrolled in complex care for severe non\u2011nutritional illness and records from prior to 6 months of age. We described adherence to World Health Organization infant and young child feeding indicators upon program enrollment. We longitudinally characterized breastfeeding and complementary feeding patterns of the cohort using generalized additive mixed modeling. We identified and quantified associations between various nutritional factors and linear growth using linear mixed effects models.\nResults: The final analytical dataset included 19,476 patient encounters from 2,352 children. Most children did not meet World Health Organization standards for dietary adequacy upon enrollment in the program. Dietary intakes were predominantly carbohydrate\u2011based. The factors most strongly associated with linear growth were food insecurity (negatively associated), portion size, and continued breastfeeding from 12 to 23 months. Adherence to the infant and young child feeding indicators was positively associated with linear growth. The intake of most food groups was also positively associated with linear growth.\nConclusions: These findings suggest that the nutritional focus of interventions should be on adequate dietary diversity, earlier introduction and higher frequency of the less frequently consumed food groups, age\u2011appropriate portion sizes, and breastfeeding through 2 years of age. Public policy measures to address food insecurity are also necessary.<\/jats:p>","DOI":"10.5334\/aogh.5266","type":"journal-article","created":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T12:57:42Z","timestamp":1786021062000},"page":"78","source":"Crossref","is-referenced-by-count":0,"title":["Breastfeeding and Complementary Feeding Practices of Children with Stunting in Guatemala"],"prefix":"10.5334","volume":"92","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9203-8994","authenticated-orcid":false,"given":"Stephen","family":"Alajajian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charis Eiren\u00e9","family":"Gudiel de Le\u00f3n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lilian Carolina","family":"Aj\u00fa Batz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7274-8315","authenticated-orcid":false,"given":"Peter","family":"Rohloff","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3285","published-online":{"date-parts":[[2026,8,6]]},"reference":[{"key":"1","doi-asserted-by":"crossref","unstructured":"Montenegro CR, Gomez G, Hincapie O, et al. The pediatric global burden of stunting: Focus on Latin America. Lifestyle Med. 2022;3(3):e67. doi:10.1002\/lim2.67.","DOI":"10.1002\/lim2.67"},{"key":"2","unstructured":"Soliman A, De Sanctis V, Alaaraj N, et al. Early and long\u2011term consequences of nutritional stunting: From childhood to adulthood. Acta Biomed. 2021;92(1):e2021168. doi:10.23750\/abm.v92i1.11346."},{"key":"3","doi-asserted-by":"crossref","unstructured":"Leroy JL, Frongillo EA. Perspective: What does stunting really mean? A critical review of the evidence. Adv Nutr. 2019;10(2):196\u2013204. doi:10.1093\/advances\/nmy101.","DOI":"10.1093\/advances\/nmy101"},{"key":"4","doi-asserted-by":"crossref","unstructured":"Roberts JL, Stein AD. The impact of nutritional interventions beyond the first 2 years of life on linear growth: A systematic review and meta\u2011analysis. Adv Nutr. 2017;8(2):323\u2013336. doi:10.3945\/an.116.013938.","DOI":"10.3945\/an.116.013938"},{"key":"5","doi-asserted-by":"crossref","unstructured":"Raiten DJ, Bremer AA. Exploring the nutritional ecology of stunting: New approaches to an old problem. Nutrients. 2020;12(2):371. doi:10.3390\/nu12020371.","DOI":"10.3390\/nu12020371"},{"key":"6","unstructured":"World Health Organization. WHO Guideline for Complementary Feeding of Infants and Young Children 6\u201323 Months. Published 2023. Accessed March 5, 2026. https:\/\/www.who.int\/publications\/i\/item\/9789240081864."},{"key":"7","unstructured":"de Guatemala Gobierno. Cuarto Censo Nacional de Talla. Published 2015. Accessed October 3, 2025. https:\/\/portal.siinsan.gob.gt\/wp-content\/uploads\/Informe-Censo-de-Talla-en-Escolares-Guatemala-2015.pdf."},{"key":"8","unstructured":"Mendoza Silvestre JR. Clasificaci\u00f3n Integrada de la Seguridad Alimentaria en Fases. Published 2024. Accessed March 5, 2026. https:\/\/portal.sesan.gob.gt\/wp-content\/uploads\/2024\/08\/Informe-CIF_Guatemala_Jun2024-a-Mayo2025-2.pdf."},{"key":"9","unstructured":"Food and Nutrition Technical Assistance III Project (FANTA). Development of Evidence\u2011Based Dietary Recommendations for Children, Pregnant Women, and Lactating Women Living in the Western Highlands of Guatemala. Published 2013. Accessed March 5, 2026. https:\/\/www.fantaproject.org\/sites\/default\/files\/resources\/Guatemala-Optifood-June2014.pdf."},{"key":"10","doi-asserted-by":"crossref","unstructured":"Alajajian S, Guzm\u00e1n\u2011Abril A, Brewer J, Rohloff P. Dietary and agricultural patterns of households with malnourished children in two socioeconomically distinct indigenous communities in Guatemala. Estud Soc. 2020;30(55):e935. doi:10.24836\/es.v30i55.935.","DOI":"10.24836\/es.v30i55.935"},{"key":"11","doi-asserted-by":"crossref","unstructured":"Monroy\u2011Valle M, Estrada MR, del Carmen Caama\u00f1o M, Cord\u00f3n\u2011Arrivillaga K, Lane G, Vatanparast H. Preschoolers in severely food insecure Guatemalan Mayan households consume a monotonous grain\u2011based diet. BMC Public Health. 2025;25(1):2836. doi:10.1186\/s12889-025-24111-2.","DOI":"10.1186\/s12889-025-24111-2"},{"key":"12","doi-asserted-by":"crossref","unstructured":"Flores ME, Rivera\u2011Pasquel M, Mac\u00edas N, et al. Dietary patterns in Mexican preschool children are associated with stunting and overweight. Rev Saude Publica. 2021;55:1\u201313. doi:10.11606\/s1518-8787.2021055002350.","DOI":"10.11606\/s1518-8787.2021055002350"},{"key":"13","doi-asserted-by":"crossref","unstructured":"Toh S, Hern\u00e1n MA. Causal inference from longitudinal studies with baseline randomization. Int J Biostat. 2008;4(1):Article 22. doi:10.2202\/1557-4679.1117.","DOI":"10.2202\/1557-4679.1117"},{"key":"14","unstructured":"UCLA Office of Advanced Research Computing. Negative binomial regression: Stata data analysis examples. Statistical Consulting Group. Accessed October 3, 2025. https:\/\/stats.oarc.ucla.edu\/stata\/dae\/negative-binomial-regression\/."}],"container-title":["Annals of Global Health"],"original-title":[],"link":[{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5266\/files\/6a7481d607562.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5266\/files\/6a748793008d5.xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/5266\/files\/6a7481d607562.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,6]],"date-time":"2026-08-06T13:45:12Z","timestamp":1786023912000},"score":1,"resource":{"primary":{"URL":"https:\/\/annalsofglobalhealth.org\/articles\/10.5334\/aogh.5266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,6]]},"references-count":14,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.5334\/aogh.5266","relation":{},"ISSN":["2214-9996"],"issn-type":[{"value":"2214-9996","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,6]]}}}