Nutritional impact of supplementation in the INCAP longitudinal study: analytic strategies and inferences

The effect of gender targeting of food transfers on child nutritional status: Experimental evidence from the Bolivian Amazon

Some research suggests women are more likely to allocate additional resources to their children than are men. This perception has influenced policies such as in-kind food transfer programs and cash transfer programs, which often target women recipients. We assess whether targeting in-kind rice transfers to female versus male adult household members has a differential impact on children's short-run nutritional status. We estimate the impacts of transfers of edible rice and rice seeds, randomly allocated to female or male adults, on three anthropometric indicators: BMI-for-age, arm-muscle area, and triceps skinfold thickness. The trial includes 481 children aged 3-11 years in a horticultural-foraging society of native Amazonians in Bolivia. On average, the gender of the transfer recipient does not influence child anthropometric dimensions, possibly due to norms of cooperation and sharing within and between households. We find limited evidence of heterogeneity in impacts. Transfers to women help children who were growth stunted at baseline to partially catch-up to their better-nourished age-sex peers and help boys (but not girls) and children in higher-income households increase their BMI-for-age. The results of this research point to the importance of considering cultural context in determining if allocating food transfers according to gender are most effective.

Effectiveness of Food Fortification in Improving Nutritional Status of Mothers and Children in Indonesia

Food fortification programs have been conducted in several countries to overcome micronutrient deficiency and related problems with various degrees of effectiveness. Available information regarding the success of food fortification programs in some developing countries, including Indonesia, is still limited. Thus, this study conducts a systematic review of the effects of food fortification of mothers and children using biochemical and anthropometric measures focusing on linear growth. Three databases were used in the literature search, namely PubMed, Science Direct and Google Scholar. Fifteen articles were included for analysis from 517 studies found consisting of Indonesian and English articles published from 2000 to June 2020. Fortification of iron, vitamin A, and iodine can increase the level of hemoglobin, serum ferritin, and serum retinol and median urine iodine excretion, especially in toddlers and schoolchildren. However, multinutrient fortification interventions were associated with various effects on hemoglobin, serum ferritin, and serum retinol but a positive association was found with linear growth indicators in the form of body length for age. The effectiveness of food fortification in reducing the prevalence of stunting still needs more and stronger evidence through studies with large sample size and longer duration.

Overweight and Obesity, Cardiometabolic Health, and Body Composition: Findings From the Follow-Up Studies of the INCAP Longitudinal Study

BACKGROUND

There has been increased interest in the hypothesis that undernutrition in early life predisposes to cardiometabolic disease risk in adulthood. The Institute of Nutrition of Central America and Panama Longitudinal Study is able to address one critical aspect of this field, specifically whether improvements in nutrition can prevent this increased risk.

OBJECTIVE

To describe the main findings on obesity and body composition across 5 waves of field work (1988-1989, 1991-1994, 1998-1999, 2002-2004, and 2015-2017) and on cardiometabolic health across 3 waves (1998-1999, 2002-2004, and 2015-2017).

RESULTS

Body weight and body fat increased considerably in adulthood, especially among women with sedentary occupations. Adiposity and weight in adulthood were strongly predicted by weight gain after the first 1000 days of life. On the other hand, exposure to improved nutrition in early life reduced diabetes risk by approximately 50% but increased the risk of overweight and obesity.

CONCLUSIONS

Future research will aid in clarifying the underlying mechanisms that drive the opposite associations among diabetes and obesity with early-life nutrition.

Closing the Nutrition Impact Gap Using Program Impact Pathway Analyses to Inform the Need for Program Modifications in Mexico's Conditional Cash Transfer Program

BACKGROUND

Mexico's Prospera-Oportunidades-Progresa Conditional Cash Transfer Program (CCT-POP) included the distribution of fortified food supplements (FFS) for pregnant and lactating women and young children. Rigorous evaluations showed significant impacts on nutrition outcomes but also substantial gaps in addressing nutrition problems.

OBJECTIVES

To highlight the program design-related and implementation-related gaps and challenges that motivated further research and the eventual design and roll-out of a modified nutrition component for CCT-POP.

METHODS

We used a program impact pathway approach to highlight the extent and quality of implementation of CCT-POP, and its impact on nutrition outcomes. We drew on previously published and new primary data, organized into 3 sources: impact evaluations, studies to inform reformulation of the FFS, and a longitudinal follow-up study using qualitative and quantitative methods to document FFS use and the dietary intake of women and children.

RESULTS

Despite positive impacts, a high prevalence of malnutrition persisted in the population. Coverage and use of health services improved, but quality of care was lacking. Consumption of FFS among lactating women was irregular. Micronutrient intake improved among children who consumed FFS, but the pattern of use limited frequency and quantity consumed. Substantial diversity in the prevalence of undernutrition was documented, as was an increased risk of overweight and obesity among women.

CONCLUSIONS

Three key design and implementation challenges were identified. FFS, although well accepted for children, had limited potential to substantially modify the quality of children's diets because of the pattern of use in the home. The communications strategy was ineffective and ill-suited to its objective of motivating FFS use. Finally, the program with its common design across all regions of Mexico was not well adapted to the special needs of some subgroups, particularly indigenous populations. The studies reviewed in this paper motivated additional research and the eventual redesign of the nutrition component.

An agriculture-nutrition intervention improved children's diet and growth in a randomized trial in Ghana

Stunting in Ghana is associated with rural communities, poverty, and low education; integrated agricultural interventions can address the problem. This cluster randomized controlled trial tested the effect of a 12-month intervention (inputs and training for poultry farming and home gardening, and nutrition and health education) on child diet and nutritional status. Sixteen clusters were identified and randomly assigned to intervention or control; communities within clusters were randomly chosen, and all interested, eligible mother-child pairs were enrolled (intervention: 8 clusters, 19 communities, and 287 households; control: 8 clusters, 20 communities, and 213 households). Intention-to-treat analyses were used to estimate the effect of the intervention on endline minimum diet diversity (≥4 food groups), consumption of eggs, and length-for-age (LAZ)/height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WLZ)/weight-for-height (WHZ) z-scores; standard errors were corrected for clustering. Children were 10.5 ± 5.2 months (range: 0-32) at baseline and 29.8 ± 5.4 months (range: 13-48) at endline. Compared with children in the control group, children in the intervention group met minimum diet diversity (adjusted odds ratio = 1.65, 95% CI [1.02, 2.69]) and a higher LAZ/HAZ (β = 0.22, 95% CI [0.09, 0.34]) and WAZ (β = 0.15, 95% CI [0.00, 0.30]). Sensitivity analyses with random-effects and mixed-effects models and as-treated analysis were consistent with the findings. There was no group difference in WLZ/WHZ. Integrated interventions that increase access to high-quality foods and nutrition education improve child nutrition.

Challenges in Assessing Combined Interventions to Promote Linear Growth

Despite the recognition of stunting as a public health priority, nutritional and nonnutritional interventions to reduce or prevent linear growth failure have demonstrated minimal impact. Investigators and policymakers face several challenges that limit their ability to assess the potential benefits of combining available interventions into a linear growth promotion package. We use two common but very different interventions, deworming and multiple micronutrient supplements, to illustrate barriers to recommending an optimal linear growth promotion package based on the currently available literature. These challenges suggest that combining individual- and population-based as well as model-based approaches would complement existing research using systematic review, meta-analysis, and factorial randomized trials, and help integrate existing fields of research to inform the development of optimal linear growth promotion packages for children living in resource-limited settings.

Improved nutrition in the first 1000 days and adult human capital and health

OBJECTIVE

The aim of this article is to review why the first 1000 days of life are a vulnerable period of human development and the long-term effects of a nutrition experiment carried out in Guatemala (1969-1977).

METHODS

In 1969-77, a supplement called Atole, containing high quality protein, energy and micronutrients, was provided to women during pregnancy and lactation and to children <7 years of age in two villages while in two control villages a low-energy drink called Fresco was provided. The villages were assigned at random to the treatment groups.

RESULTS

Several reasons explain the vulnerability of the first 1000 days: rapid growth and development, high nutritional requirements, greater susceptibility to infections, high sensitivity to programming effects and full dependence on others for care, nutrition, and social interaction. Compared with Fresco, Atole improved total nutrient intakes (protein, energy, and micronutrients) and reduced stunting, but only in children < 3 years of age. A study in 2002-2004 showed that schooling, reading, and intelligence were improved in Atole villages, but only in those who received Atole before the age of 3 years. Wages of men were increased by 46% in those provided Atole through the age of 2 years. Findings for cardiovascular disease risk factors were inconclusive, perhaps because of the young age of the sample. A new study focusing on chronic diseases is ongoing (ages 38-54 years).

CONCLUSIONS

The Guatemalan studies indicate that substantial improvement in adult human capital and economic productivity resulted from the nutrition intervention. This provides a powerful argument for promoting improvements in nutrition in pregnant women and young children in low income countries.

Prevalence and Predictors of Malnutrition among Guatemalan Children at 2 Years of Age

OBJECTIVE

To identify the prevalence and predictors of malnutrition among 2-year old children in the Western Highlands of Guatemala.

METHODS

Prospective cohort of 852 Guatemalan children in San Lucas Toliman, Guatemala followed from birth to age 2 from May 2008 to December 2013. Socio-demographic, anthropometric, and health data of children was collected at 2 month intervals.

RESULTS

Among the 402 males and 450 females in the cohort, mean weight-for-age Z-score (WAZ) declined from -0.67 ± 1.01 at 1 year to -1.07 ± 0.87 at 2 years, while mean height-for-age Z-score (HAZ) declined from -1.88 ± 1.19 at 1 year to -2.37 ± 0.99 at 2 years. Using multiple linear regression modeling, number of children <5 years old, vomiting in the past week, fever in the past week, and WAZ at 1 year were significant predictors of WAZ at 2 years. Significant predictors of HAZ at 2 years included household size, number of children <5 years old, diarrhea in the past week, WAZ at 1 year, and HAZ at 1 year. Vomiting in the past week and WAZ at 1 year were significant predictors of weight-for-height z-score (WHZ) at 2 years.

CONCLUSIONS

Number of children <5 years old, symptoms such as vomiting or diarrhea in the previous week, and prior nutritional status were the most significant predictors of malnutrition in this cohort. Future research may focus on the application of models to develop predictive algorithms for mobile device technology, as well as the identification of other predictors of malnutrition that are not well characterized such as the interaction of environmental exposures with protein consumption and epigenetics.

A Summary of Pathways or Mechanisms Linking Preconception Maternal Nutrition with Birth Outcomes

Population, human, animal, tissue, and molecular studies show collectively and consistently that maternal nutrition in the pre- or periconception period influences fetal growth and development, which subsequently affects the individual's long-term health. It is known that nutrition during pregnancy is an important determinant of the offspring's growth and health. However, now there is evidence that the mother's nutritional status at conception also influences pregnancy outcome and long-term health. For example, the mother's nutritional status at conception influences the way energy is partitioned between maternal and fetal needs. Furthermore, placental development during the first weeks of gestation reflects maternal nutrition and establishes mechanisms for balancing maternal and fetal nutritional needs. Also, maternal nutritional signals at fertilization influence epigenetic remodeling of fetal genes. These findings all indicate that maternal parenting begins before conception. The following papers from a symposium on preconception nutrition presented at the 2015 Scientific Sessions and Annual Meeting of the ASN emphasize the importance of maternal nutrition at conception on the growth and long-term health of the child.

Gender perceptions predict sex differences in growth patterns of indigenous Guatemalan infants and young children

BACKGROUND

Nearly one-half of Guatemalan children experience growth faltering, more so in indigenous than in nonindigenous children.

OBJECTIVES

On the basis of ethnographic interviews in Totonicapán, Guatemala, which revealed differences in maternal perceptions about food needs in infant girls and boys, we predicted a cumulative sex difference in favor of girls that occurred at ∼6 mo of age and diminished markedly thereafter. We examined whether the predicted differences in age-sex patterns were observed in the village, replicated the examination nationally for indigenous children, and examined whether the pattern in nonindigenous children was different.

DESIGN

Ethnographic interviews (n = 24) in an indigenous village were conducted. Anthropometric measurements of the village children aged 0-35 mo (n = 119) were obtained. National-level growth patterns were analyzed for indigenous (n = 969) and nonindigenous (n = 1374) children aged 0-35 mo with the use of Demographic and Health Survey (DHS) data.

RESULTS

Mothers reported that, compared with female infants, male infants were hungrier, were not as satisfied with breastfeeding alone, and required earlier complementary feeding. An anthropometric analysis confirmed the prediction of healthier growth in indigenous girls than in indigenous boys throughout the first year of life, which resulted in a 2.98-cm height-for-age difference (HAD) between sexes in the village and a 1.61-cm HAD (P < 0.001) in the DHS data between 6 and 17 mo of age in favor of girls. In both data sets, the growth sex differences diminished in the second year of life (P < 0.05). No such pattern was seen in nonindigenous children.

CONCLUSIONS

We propose that the differences in the HAD that first favor girls and then favor boys in the indigenous growth patterns are due to feeding patterns on the basis of gendered cultural perceptions. Circumstances that result in differential sex growth patterns need to be elucidated, in particular the favorable growth in girls in the first year of life.

Oral protein calorie supplementation for children with chronic disease

BACKGROUND

Poor growth and nutritional status are common in children with chronic diseases. Oral protein calorie supplements are used to improve nutritional status in these children. These expensive products may be associated with some adverse effects, e.g. the development of inappropriate eating behaviour patterns. This is a new update of a Cochrane review last updated in 2009.

OBJECTIVES

To examine evidence that in children with chronic disease, oral protein calorie supplements alter daily nutrient intake, nutritional indices, survival and quality of life and are associated with adverse effects, e.g. diarrhoea, vomiting, reduced appetite, glucose intolerance, bloating and eating behaviour problems.

SEARCH METHODS

Trials of oral protein calorie supplements in children with chronic diseases were identified through comprehensive electronic database searches, handsearching relevant journals and abstract books of conference proceedings. Companies marketing these products were also contacted.Most recent search of the Group's Trials Register: 24 February 2015.

SELECTION CRITERIA

Randomised or quasi-randomised controlled trials comparing oral protein calorie supplements for at least one month to increase calorie intake with existing conventional therapy (including advice on improving nutritional intake from food or no specific intervention) in children with chronic disease.

DATA COLLECTION AND ANALYSIS

We independently assessed the outcomes: indices of nutrition and growth; anthropometric measures of body composition; calorie and nutrient intake (total from oral protein calorie supplements and food); eating behaviour; compliance; quality of life; specific adverse effects; disease severity scores; and mortality; we also assessed the risk of bias in the included trials.

MAIN RESULTS

Four studies (187 children) met the inclusion criteria. Three studies were carried out in children with cystic fibrosis and one study included children with paediatric malignant disease. Overall there was a low risk of bias for blinding and incomplete outcome data.Two studies had a high risk of bias for allocation concealment. Few statistical differences were found in the outcomes we assessed between treatment and control groups, except change in total energy intake at six and 12 months, mean difference 304.86 kcal per day (95% confidence interval 5.62 to 604.10) and mean difference 265.70 kcal per day (95% confidence interval 42.94 to 485.46), respectively. However, these were based on the analysis of just 58 children in only one study. Only two chronic diseases were included in these analyses, cystic fibrosis and paediatric malignant disease. No other studies were identified which assessed the effectiveness of oral protein calorie supplements in children with other chronic diseases.

AUTHORS' CONCLUSIONS

Oral protein calorie supplements are widely used to improve the nutritional status of children with a number of chronic diseases. We identified a small number of studies assessing these products in children with cystic fibrosis and paediatric malignant disease, but were unable to draw any conclusions based on the limited data extracted. We recommend a series of large, randomised controlled trials be undertaken investigating the use of these products in children with different chronic diseases. Until further data are available, we suggest these products are used with caution.

Parental childhood growth and offspring birthweight: pooled analyses from four birth cohorts in low and middle income countries

Objective

Associations between parental and offspring size at birth are well established, but the relative importance of parental growth at different ages as predictors of offspring birthweight is less certain. Here we model parental birthweight and postnatal conditional growth in specific age periods as predictors of offspring birthweight.

Methods

We analyzed data from 3,392 adults participating in four prospective birth cohorts and 5,506 of their offspring.

Results

There was no significant heterogeneity by study site or offspring sex. 1SD increase in maternal birthweight was associated with offspring birthweight increases of 102 g, 1SD in maternal length growth 0–2 year with 46 g, and 1SD in maternal height growth Mid-childhood (MC)-adulthood with 27 g. Maternal relative weight measures were associated with 24 g offspring birth weight increases (2 year- MC) and 49 g for MC-adulthood period but not with earlier relative weight 0–2 year. For fathers, birthweight, and linear/length growth from 0–2 year were associated with increases of 57 and 56 g in offspring birthweight, respectively but not thereafter.

Conclusions

Maternal and paternal birthweight and growth from birth to 2 year each predict offspring birthweight. Maternal growth from MC-adulthood, relative weight from 2-MC and MC-adulthood also predict offspring birthweight. These findings suggest that shared genes and/or adequate nutrition during early life for both parents may confer benefits to the next generation, and highlight the importance of maternal height and weight prior to conception. The stronger matrilineal than patrilineal relationships with offspring birth weight are consistent with the hypothesis that improving the early growth conditions of young females can improve birth outcomes in the next generation. Am. J. Hum. Biol. 27:99–105, 2015. © 2014 The Authors American Journal of Human Biology Published by Wiley Periodicals, Inc.

Functional and nutritional evaluation of supplementary food formulations

Two type of ready to eat supplementary food formulations were developed by roller drying based on wheat, soy protein concentrate, whey protein concentrate, and green gram flour and were fortified with vitamins and minerals to meet the one third of the Recommended daily allowance (RDA). The supplementary food formulations contained 20-21% protein, 370-390 kcal of energy and 2,300 μg of β-carotene per 100 g serving. The physico-chemical, functional and nutritional characteristics were evaluated. The chemical score indicated that sulphur containing amino acids were the first limiting in both the formulations. The calculated nutritional indices, essential amino acid index, biological value, nutritional index and C-PER were higher for formula II. Rat bioassay showed higher PER (2.3) for formula II compared to formula I (2.1). The bioaccessibility of iron was 23%. Sensory studies indicated that the products were acceptable with a shelf life of 1 year under normal storage condition. However, the formulations were nutritionally better than only cereal based supplementary food formulations available commercially. The product could be served in the form of porridge with water/milk or in the form of small laddu.

Newborn length predicts early infant linear growth retardation and disproportionately high weight gain in a low-income population

BACKGROUND

Stunting is prevalent by the age of 6 months in the indigenous population of the Western Highlands of Guatemala.

AIM

The objective of this study was to determine the time course and predictors of linear growth failure and weight-for-age in early infancy.

STUDY DESIGN AND SUBJECTS

One hundred and forty eight term newborns had measurements of length and weight in their homes, repeated at 3 and 6 months. Maternal measurements were also obtained.

RESULTS

Mean ± SD length-for-age Z-score (LAZ) declined from newborn -1.0 ± 1.01 to -2.20 ± 1.05 and -2.26 ± 1.01 at 3 and 6 months respectively. Stunting rates for newborn, 3 and 6 months were 47%, 53% and 56% respectively. A multiple regression model (R(2) = 0.64) demonstrated that the major predictor of LAZ at 3 months was newborn LAZ with the other predictors being newborn weight-for-age Z-score (WAZ), gender and maternal education∗maternal age interaction. Because WAZ remained essentially constant and LAZ declined during the same period, weight-for-length Z-score (WLZ) increased from -0.44 to +1.28 from birth to 3 months. The more severe the linear growth failure, the greater WAZ was in proportion to the LAZ.

CONCLUSION

The primary conclusion is that impaired fetal linear growth is the major predictor of early infant linear growth failure indicating that prevention needs to start with maternal interventions.

Adult consequences of growth failure in early childhood

BACKGROUND

Growth failure is associated with adverse consequences, but studies need to control adequately for confounding.

OBJECTIVE

We related height-for-age z scores (HAZs) and stunting at age 24 mo to adult human capital, marriage, fertility, health, and economic outcomes.

DESIGN

In 2002-2004, we collected data from 1338 Guatemalan adults (aged 25-42 y) who were studied as children in 1969-1977. We used instrumental variable regression to correct for estimation bias and adjusted for potentially confounding factors.

RESULTS

A 1-SD increase in HAZ was associated with more schooling (0.78 grades) and higher test scores for reading and nonverbal cognitive skills (0.28 and 0.25 SDs, respectively), characteristics of marriage partners (1.39 y older, 1.02 grade more schooling, and 1.01 cm taller) and, for women, a higher age at first birth (0.77 y) and fewer number of pregnancies and children (0.63 and 0.43, respectively). A 1-SD increase in HAZ was associated with increased household per capita expenditure (21%) and a lower probability of living in poverty (10 percentage points). Conversely, being stunted at 2 y was associated with less schooling, a lower test performance, a lower household per capita expenditure, and an increased probability of living in poverty. For women, stunting was associated with a lower age at first birth and higher number of pregnancies and children. There was little relation between either HAZ or stunting and adult health.

CONCLUSION

Growth failure in early life has profound adverse consequences over the life course on human, social, and economic capital.

Community-based supplementary feeding for promoting the growth of children under five years of age in low and middle income countries

BACKGROUND

Supplementary feeding is defined as the provision of extra food to children or families beyond the normal ration of their home diets. The impact of food supplementation on child growth merits careful evaluation in view of the reliance of many states and non-governmental organisations on this intervention to improve child health in low and middle income countries (LMIC). This is an update of a Cochrane review first published in 2005.

OBJECTIVES

To evaluate the effectiveness of community-based supplementary feeding for promoting the physical growth of children under five years of age in LMIC.

SEARCH METHODS

For this updated review  we searched the following databases on 31 January 2011: CENTRAL (The Cochrane Library), MEDLINE (1948 to January week 3, 2011), EMBASE (1980 to week 3, 2011), CINAHL (1937 to 27 January 2011), LILACS (all years), WorldCat for dissertations and theses (all years) and ClinicalTrials.gov (all years).

SELECTION CRITERIA

Randomised controlled trials (RCTs) evaluating supplementary feeding in comparison to a control group (no intervention or a placebo such as food with a very low number of nutrients and calories) in children from birth to five years of age in LMIC.

DATA COLLECTION AND ANALYSIS

Two review authors independently extracted and analysed the data.

MAIN RESULTS

We included eight RCTs (n = 1243 children) that were at relatively high risk of bias. We found high levels of clinical heterogeneity in the participants, interventions and outcome measures across studies. Nevertheless, in order to quantify pooled effects of supplementary feeding, we decided to combine studies according to prespecified characteristics. These were the children's age (younger or older than 24 months), their nutritional status at baseline (stunted or wasted, or not stunted or wasted) and the duration of the intervention (less or more than 12 months). A statistically significant difference of effect was only found for length during the intervention in children aged less than 12 months (two studies; 795 children; mean difference 0.19 cm; 95% confidence interval (CI) 0.07 to 0.31). Based on the summary statistic calculated for each study, the mean difference (MD) between intervention and control groups ranged from 0.48 cm (95% CI 0.07 to 0.89) to 1.3 cm (95% CI 0.03 to 2.57) after 3 and 12 months of intervention, respectively. Data on potential adverse effects were lacking.

AUTHORS' CONCLUSIONS

The scarcity of available studies and their heterogeneity makes it difficult to reach any firm conclusions. The review findings suggest supplementary feeding has a negligible impact on child growth; however, the pooled results should be interpreted with great caution because the studies included in the review are clinically diverse. Future studies should address issues of research design, including sample size calculation, to detect meaningful clinical effects and adequate intervention allocation concealment. In the meantime, families and children in need should be provided appropriate feeding, health care and sanitation without waiting for new RCTs to establish a research basis for feeding children. 

Growth patterns in early childhood and final attained stature: data from five birth cohorts from low- and middle-income countries

Growth failure is cumulative, and short stature is associated with multiple indices of reduced human capital. Few studies have been able to address in a single analysis both consideration of the timing of growth failure and comparison across populations. We analyzed data from birth cohorts in Brazil, Guatemala, India, the Philippines, and South Africa (n = 4,659). We used data on length at birth (available for three of the five cohorts), 12 mo, 24 mo, and mid-childhood to construct cohort- and sex- specific conditional length measures. We modeled adult height as a function of conditional length in childhood. The five cohorts experienced varying degrees of growth failure. As adults, the Brazil sample was 0.35 ± 0.89 standard deviations (SD) below the World Health Organization reference, while adult Guatemalans were 1.91 ± 0.87 SD below the reference. All five cohorts experienced a nadir in height for age Z-score at 24 mo. Birth length (in the three cohorts with this variable), and conditional length at 12 mo (in all five cohorts) were the most strongly associated with adult height. Growth in the periods 12–24 mo and 24 mo to mid-childhood showed inconsistent patterns across tertiles of adult height. Despite variation in the magnitude of cumulative growth failure across cohorts, the five cohorts show highly consistent age-specific associations with adult stature. Growth failure prior to age 12 mo was most strongly associated with adult stature. These consistencies speak to the importance of interventions to address intrauterine growth failure and growth failure in the first 12 mo of life. Am. J. Hum. Biol. 2010. © 2009 Wiley-Liss, Inc.

Nutritional supplementation in girls influences the growth of their children: prospective study in Guatemala

BACKGROUND

Better early childhood nutrition improves schooling, adult health, skills, and wages, but there is little evidence regarding its effect on the next generation.

OBJECTIVE

We assessed whether nutritional supplementation in children aged <7 to 15 y affected their children's nutritional status 29-38 y later.

DESIGN

We studied 791 children 0-12 y who were offspring of 401 Guatemalan women who had participated as children in a nutritional supplementation trial in which 2 villages were randomly assigned to receive a nutritious supplement (atole) and 2 were assigned to receive a less-nutritious supplement (fresco). We compared anthropometric indicators between the offspring of mothers exposed to atole and the offspring of mothers exposed to fresco.

RESULTS

Compared with the offspring of women exposed to fresco, the offspring of women exposed to atole had a 116-g (95% CI: 17, 215 g) higher birth weight, were 1.3-cm (0.4, 2.2 cm) taller, had a 0.6-cm (0.4, 0.9 cm) greater head circumference, had a 0.26 (0.09, 0.43) greater height-for-age z score, and had a 0.20 (0.02, 0.39) greater weight-for-age z score. The association for height differed by offspring sex. Sons of women exposed to atole were 2.0-cm (95% CI: 1.0, 3.1 cm) taller than the sons of women exposed to fresco. Supplementation was not associated with 6 other offspring anthropometric indicators that reflect measures of adiposity. Supplementation in boys did not affect their children's anthropometric measures.

CONCLUSION

Nutritional supplementation in girls is associated with substantial increases in their offsprings' (more for sons) birth weight, height, head circumference, height-for-age z score, and weight-for-age z score.

Nutritional supplementation in early childhood, schooling, and intellectual functioning in adulthood: a prospective study in Guatemala

OBJECTIVE

To estimate the association of improved nutrition in early life with adult intellectual functioning, controlling for years of schooling.

DESIGN

Prospective cohort study.

SETTING

Four villages in Guatemala, as well as locations within Guatemala to which cohort members migrated.

PARTICIPANTS

Individuals who had participated as children in a nutrition supplementation intervention trial from March 1, 1969, through February 28, 1977 (N = 2392). From May 1, 2002, through April 30, 2004, adequate information for analysis was obtained from 1448 of 2118 individuals (68.4%) not known to have died.

INTERVENTIONS

Individuals exposed to atole (a protein-rich enhanced nutrition supplement) at birth through age 24 months were compared with those exposed to the supplement at other ages or to fresco, a sugar-sweetened beverage. We measured years of schooling by interview.

MAIN OUTCOME MEASURES

Scores on the Serie Interamericana (InterAmerican Series) tests of reading comprehension and the Raven Progressive Matrices, obtained from May 1, 2002, through April 30, 2004.

RESULTS

In models controlling for years of schooling and other predictors of intellectual functioning, exposure to atole at birth to age 24 months was associated with an increase of 3.46 points (95% confidence interval, -1.26 to 8.18) and 1.74 points (95% confidence interval, 0.53-2.95) on the InterAmerican Series and Raven Progressive Matrices tests, respectively. There was no statistical interaction between exposure to atole at birth to age 24 months and years of schooling on either outcome (P = .24 and P = .60, respectively).

CONCLUSION

Improved early-life nutrition is associated with increased intellectual functioning in adulthood after taking into account the effect of schooling.

Growth indices, anemia, and diet independently predict motor milestone acquisition of infants in south central Nepal

The acquisition of bipedal locomotion is an important aspect of gross motor development that ultimately affects the cognition of young children. Evidence for associations between nutrition-related variables and walking acquisition exist; however, questions remain about the importance of weight-for-length and dietary factors and the independent contribution of anemia and growth to walking. We examined the effect of nutritional factors on the acquisition of walking in a cross-sectional cohort of 4- to 17-mo old Nepali children (n = 485) adjusting for age, sex, caste, and socioeconomic status (SES). Participants were identified from census data collected in 1 village development committee in Sarlahi District and enrolled in a cross-sectional, community-based study between January and March 2002. Hemoglobin and erythrocyte protoporphyrin (EP) were measured at baseline using a heel-prick technique. The mean hemoglobin concentration was 101 +/- 12.5 g/L; 58% were anemic (hemoglobin < 105 g/L), 2.1% were severely anemic (hemoglobin < 70 g/L), and 43% of the children had iron-deficiency anemia (hemoglobin < 105 g/L; EP > or = 90 micromol/mol heme). Growth was delayed, i.e., 33.7% were stunted and 20.6% were wasted. Multivariate logistic models that controlled for age, sex, caste, and SES revealed that children with higher length-for-age and weight-for-length Z-scores, no anemia, and meat consumption walked at an earlier age than children with lower scores, anemia, and no meat consumption. We conclude that growth, anemia, and diet are independently associated with delays in the onset of bipedal locomotion among young Nepali children.