Greater household food insecurity is associated with lower breast milk intake, but not prevalence of exclusive breastfeeding, among HIV-uninfected infants in western Kenya

: Household food insecurity has been hypothesized to negatively impact breastfeeding practices and breast milk intake, but this relationship has not been rigorously assessed. To generate an evidence base for breastfeeding recommendations among food-insecure mothers in settings where HIV is highly prevalent, we explored infant feeding practices among 119 mother-infant dyads in western Kenya at 6 and 24 weeks postpartum. We used the deuterium oxide dose-to-the-mother technique to determine if breastfeeding was exclusive in the prior 2 weeks, and to quantify breast milk intake. Sociodemographic data were collected at baseline and household food insecurity was measured at each time point using the Household Food Insecurity Access Scale. Average breast milk intake significantly increased from 721.3 g/day at 6 weeks postpartum to 961.1 g/day at 24 weeks postpartum. Household food insecurity at 6 or 24 weeks postpartum was not associated with maternal recall of exclusive breastfeeding (EBF) in the prior 24 hr or deuterium oxide-measured EBF in the prior 2 weeks at a significance level of 0.2 in bivariate models. In a fixed-effects model of quantity of breast milk intake across time, deuterium oxide-measured EBF in the prior 2 weeks was associated with greater breast milk intake (126.1 ± 40.5 g/day) and every one-point increase in food insecurity score was associated with a 5.6 (±2.2)-g/day decrease in breast milk intake. Given the nutritional and physical health risks of suboptimal feeding, public health practitioners should screen for and integrate programs that reduce food insecurity in order to increase breast milk intake.