Complementary feeding practices and acute respiratory infection symptoms among children aged 12–23 months in remote rural China: a cross-sectional analysis

Abstract Background Appropriate complementary feeding may contribute to protection against childhood respiratory infections, but evidence for specific feeding practices remains limited, particularly in rural China. We examined associations between WHO/UNICEF complementary feeding indicators and acute respiratory infection (ARI) symptoms among children aged 12–23 months and explored whether these associations differed by overweight status. Methods We conducted a cross-sectional analysis of follow-up survey data collected in 2017–2018 from 16 remote rural counties across five provinces in China. The analysis included 519 children aged 12–23 months with complete data. Seven complementary feeding indicators were constructed according to WHO/UNICEF definitions. ARI symptoms were defined as caregiver-reported cough accompanied by rapid or difficult breathing related to the chest during the preceding 2 weeks. Modified Poisson regression with robust standard errors clustered at the county level was used to estimate adjusted relative risks (aRRs) and 95% confidence intervals (CIs). Effect modification by overweight status was assessed using interaction terms. Results Overall, 18.3% of children had caregiver-reported ARI symptoms. Minimum dietary diversity was met by 44.9% of children, and 62.4% consumed eggs and/or flesh foods. After adjustment for child, maternal, and household characteristics, minimum dietary diversity (aRR 0.64, 95% CI 0.43–0.95) and consumption of eggs and/or flesh foods (0.62, 0.43–0.89) were inversely associated with ARI symptoms. No statistically significant interaction was observed between overweight status and any complementary feeding indicator after adjustment for multiple testing. Conclusions Among children aged 12–23 months in remote rural China, minimum dietary diversity and consumption of eggs and/or flesh foods were associated with fewer caregiver-reported ARI symptoms.