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Upadhyay RP, Taneja S, Strand TA, Hysing M, Koshy B, Bhandari N, Bahl R. Milk-cereal mix supplementation during infancy and impact on neurodevelopmental outcomes at 12 and 24 months of age: a randomised controlled trial in India. Br J Nutr 2023; 130:868-877. [PMID: 36539339 PMCID: PMC10404480 DOI: 10.1017/s0007114522003944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/30/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022]
Abstract
Inadequate protein intake and lack of micronutrients may affect neurodevelopment in infants. This randomised controlled trial was conducted to measure the effect of two milk-cereal mixes with modest and high amounts of protein and enriched with multiple micronutrients, given between 6 and 12 months, on cognitive, language, motor and behavioural scores at 12 and 24 months of age, compared with no-supplementation. The two supplements were also compared with each other. The study was conducted in urban Delhi, India, and the infants were randomised in a 1:1:1 ratio to the three study groups. At 12 and 24 months of age, 1134 and 1214 children were available, respectively. At 12 months of age, compared with no-supplement group, an increase in the motor scores (mean difference, MD 1·52, 95 % CI: 0·28, 2·75) and a decrease in the infant temperament scores (MD - 2·76, 95 % CI: -4·23, -1·29) in the modest-protein group was observed. Those in the high-protein group had lower socio-emotional scores (MD - 1·40, 95 % CI: -2·43, -0·37) and higher scores on Infant Temperament Scale (MD 2·05, 95 % CI: 0·62, 3·48) when compared with modest-protein group. At 24 months, no significant differences in any of the neurodevelopment scores between the three study groups was found. In conclusion, supplementation with modest amount of protein and multiple micronutrients may lead to short-term small improvements in motor function and infant temperament. There appears no advantage of supplementing with high protein, rather negative effects on infant behaviour were observed.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
- Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway
| | - Sunita Taneja
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Tor Arne Strand
- Department of Research, Innlandet Hospital Trust, Lillehammer, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Beena Koshy
- Department of Developmental Pediatrics, Christian Medical College, Vellore, India
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | - Rajiv Bahl
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
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Stein AD, Adair LS, Donati G, Wray C, Richter LM, Norris SA, Stein A, Martorell R, Ramirez-Zea M, Menezes AMB, Murray J, Victora C, Lee N, Bas I. Early-life stature, preschool cognitive development, schooling attainment, and cognitive functioning in adulthood: a prospective study in four birth cohorts. Lancet Glob Health 2023; 11:e95-e104. [PMID: 36521958 PMCID: PMC9764453 DOI: 10.1016/s2214-109x(22)00448-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 09/16/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Nutrition is important for growth and brain development and therefore cognitive ability. Growth faltering in early childhood, an important indicator of early adversity, is associated with poorer developmental outcomes, some into adulthood, but this association probably reflects early-life deprivation. We aimed to investigate the associations between early-life stature, child IQ, and adult IQ. METHODS In this cohort study, we used prospective longitudinal data collected in four birth cohorts from Brazil (born in 1993), Guatemala (born in 1969-77), the Philippines (born in 1983-84), and South Africa (born in 1990). Using multivariable linear models, we estimated the relative contributions of early-life stature, child IQ, and schooling (highest school year completed) to adult IQ, including interaction effects among the early-childhood measures and schooling. FINDINGS We included 2614 individuals in the analysis. Early-life stature was associated with adult IQ (range across eight site-by-sex groups -0·14 to 3·17 IQ points) and schooling (-0·05 to 0·77 years) per height-for-age Z-score. These associations were attenuated when controlling for child IQ (-0·86 to 1·72 for adult IQ and -0·5 to 0·60 for schooling). The association of early-life stature with adult IQ was further attenuated when controlling for schooling (-1·86 to 1·21). Child IQ was associated with adult IQ (range 3·91 to 10·02 points) and schooling (0·25 to 1·30 years) per SD of child IQ in all groups; these associations were unattenuated by the addition of early-life stature to the models. The interaction between schooling and child IQ, but not that between schooling and early-life stature, was positively associated with adult IQ across groups. INTERPRETATION The observed associations of early-life stature with adult IQ and schooling varied across cohorts and sexes and explained little variance in adult IQ beyond that explained by child IQ. These findings suggest that interventions targeted at growth for health and early development are important. Our results are consistent with the inference that improving long-term cognitive outcomes might require interventions that more specifically target early cognitive ability. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Linda S Adair
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Charlotte Wray
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Linda M Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa; Global Health Research Institute, School of Human Development and Health & NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Alan Stein
- Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Reynaldo Martorell
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manuel Ramirez-Zea
- INCAP Research Center for Prevention of Chronic Diseases, Institute of Nutrition of Central America and Panama, Guatemala City, Guatemala
| | - Ana M B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil; Human Development and Violence Research Centre, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Nanette Lee
- USC-Office of Population Studies Foundation, University of San Carlos, Talamban, Cebu City, Cebu, Philippines
| | - Isabelita Bas
- USC-Office of Population Studies Foundation, University of San Carlos, Talamban, Cebu City, Cebu, Philippines
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The associations between stunting and wasting at 12 months of age and developmental milestones delays in a cohort of Cambodian children. Sci Rep 2022; 12:17859. [PMID: 36284133 PMCID: PMC9596435 DOI: 10.1038/s41598-022-22861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/20/2022] [Indexed: 01/20/2023] Open
Abstract
Worldwide, over 250 million children under 5 years do not reach their developmental potential due to several causes, including malnutrition. In Cambodia, the prevalence of stunting and wasting among children remains high. This prospective cohort study aimed to assess acquisition of motor and cognitive developmental milestones in early childhood and their associations with stunting and wasting. Children aged from 0 to 24 months were recruited from three provinces in Cambodia and followed up to seven times from March 2016 to June 2019, until their 5 years. Data collection included anthropometry and developmental milestones. Seven motor and seven cognitive milestones were evaluated using the Cambodian Development Milestone Assessment Tool. Associations were assessed with parametric survival models. Hazard ratios (HR) below 1 stood for lower probabilities for achieving developmental milestones. Data were available for 7394 children. At 12 months, the prevalence of stunting and wasting were 23.7% and 9.6% respectively. Both were consistently associated with delays in most motor and cognitive milestones. Stunting was strongly associated with delays in gross motor milestones (HR < 0.85; p < 0.001). Wasting was more strongly associated with delays in fine motor development and most cognitive milestones (HR < 0.75; p < 0.001). Promoting nutritional programs in the first 1000 days to prevent malnutrition is essential to further the optimal growth and motor and cognitive development of Cambodian children.
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Ramakrishnan U. Impact of Nutrition on the Next Generation: The INCAP Longitudinal Study. Food Nutr Bull 2021; 41:S50-S58. [PMID: 33172290 DOI: 10.1177/0379572120915422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The design of the original nutrition supplementation trial that was conducted from 1969 to 1977 in 4 villages in rural Guatemala to evaluate the benefits of improving nutrition during pregnancy and early childhood, combined with several follow-up studies, provides unique data to examine the effects of improving nutrition on the next generation. OBJECTIVE This article provides a summary of the key findings from the INCAP Longitudinal Study on the intergenerational effects of improving nutrition on the growth and well-being of the next generation. METHODS The key outcomes include offspring birth size as well as attained size and body composition through age 11 years. The sample sizes varied from approximately 200 to 800 depending on the timing of the follow-up studies and data collection protocols. The effects of parental birth size, maternal linear growth from birth through adulthood, and exposure to the nutrition intervention, that is, Atole versus Fresco during critical periods from prenatal through age 15 years, have been examined using complex models and approaches. RESULTS Overall, these publications demonstrate clear improvements in the growth of the next generation. Effects were seen primarily for maternal exposure to Atole and were larger for boys compared to girls. Stunting during early childhood among girls was also a significant predictor of offspring birth size, and younger age at first pregnancy (<20 years) was associated with an increased risk of stunting in the offspring. CONCLUSIONS These studies have contributed significantly to our understanding of the importance of investing in nutrition, especially during early childhood for future generations.
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Affiliation(s)
- Usha Ramakrishnan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Aizawa T. Dynamic variation in receptive vocabulary acquisitions: Further evidence from the Young Lives study. COGNITIVE DEVELOPMENT 2021. [DOI: 10.1016/j.cogdev.2021.101031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Cohen Kadosh K, Muhardi L, Parikh P, Basso M, Jan Mohamed HJ, Prawitasari T, Samuel F, Ma G, Geurts JMW. Nutritional Support of Neurodevelopment and Cognitive Function in Infants and Young Children-An Update and Novel Insights. Nutrients 2021; 13:nu13010199. [PMID: 33435231 PMCID: PMC7828103 DOI: 10.3390/nu13010199] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
Proper nutrition is crucial for normal brain and neurocognitive development. Failure to optimize neurodevelopment early in life can have profound long-term implications for both mental health and quality of life. Although the first 1000 days of life represent the most critical period of neurodevelopment, the central and peripheral nervous systems continue to develop and change throughout life. All this time, development and functioning depend on many factors, including adequate nutrition. In this review, we outline the role of nutrients in cognitive, emotional, and neural development in infants and young children with special attention to the emerging roles of polar lipids and high quality (available) protein. Furthermore, we discuss the dynamic nature of the gut-brain axis and the importance of microbial diversity in relation to a variety of outcomes, including brain maturation/function and behavior are discussed. Finally, the promising therapeutic potential of psychobiotics to modify gut microbial ecology in order to improve mental well-being is presented. Here, we show that the individual contribution of nutrients, their interaction with other micro- and macronutrients and the way in which they are organized in the food matrix are of crucial importance for normal neurocognitive development.
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Affiliation(s)
- Kathrin Cohen Kadosh
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK; (K.C.K.); (M.B.)
| | - Leilani Muhardi
- FrieslandCampina AMEA, Singapore 039190, Singapore; (L.M.); (P.P.)
| | - Panam Parikh
- FrieslandCampina AMEA, Singapore 039190, Singapore; (L.M.); (P.P.)
| | - Melissa Basso
- School of Psychology, University of Surrey, Guildford GU2 7XH, UK; (K.C.K.); (M.B.)
- Department of General Psychology, University of Padova, 35131 Padova, Italy
| | - Hamid Jan Jan Mohamed
- Nutrition and Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Malaysia;
| | - Titis Prawitasari
- Nutrition and Metabolic Diseases Working Group, Indonesian Pediatric Society, Jakarta 10310, Indonesia;
- Department of Pediatrics, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusomo National Referral Hospital Jakarta, Jakarta 10430, Indonesia
| | - Folake Samuel
- Department of Human Nutrition, University of Ibadan, Ibadan 200284, Nigeria;
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China;
- Laboratory of Toxicological Research and Risk assessment for Food Safety, Peking University, 38 Xue Yuan Road, Haidian District, Beijing 100191, China
| | - Jan M. W. Geurts
- FrieslandCampina, 3818 LE Amersfoort, The Netherlands
- Correspondence: ; Tel.: +31-6-53310499
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Neves PAR, Gatica-Domínguez G, Santos IS, Bertoldi AD, Domingues M, Murray J, Silveira MF. Poor maternal nutritional status before and during pregnancy is associated with suspected child developmental delay in 2-year old Brazilian children. Sci Rep 2020; 10:1851. [PMID: 32024929 PMCID: PMC7002477 DOI: 10.1038/s41598-020-59034-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/23/2020] [Indexed: 01/17/2023] Open
Abstract
Inadequate pre-pregnancy BMI and gestational weight gain (GWG) have been associated with sub-optimal child development. We used data from the 2015 Pelotas (Brazil) Birth Cohort Study. Maternal anthropometry was extracted from antenatal/hospital records. BMI (kg/m2) and GWG (kg) adequacy were classified according to WHO and IOM, respectively. Development was evaluated using the INTER-NDA assessment tool for 3,776 children aged 24 months. Suspected developmental delay (SDD) was defined as <10th percentile. Associations between maternal exposures and child development were tested using linear and logistic regressions. Mediation for the association between BMI and child development through GWG was tested using G-formula. Sex differences were observed for all child development domains, except motor. Maternal pre-pregnancy underweight increased the odds of SDD in language (OR: 2.75; 95%CI: 1.30-5.80), motor (OR: 2.28; 95%CI: 1.20-4.33), and global (OR: 2.14; 95% CI: 1.05-4.33) domains for girls; among boys, excessive GWG was associated with SDD in language (OR: 1.59; 95%CI: 1.13-2.24) and cognition (OR: 1.59; 95%CI: 1.15-2.22). Total GWG suppressed the association of pre-pregnancy BMI with percentiles of global development in the entire sample. Maternal underweight and excessive GWG were negatively associated with development of girls and boys, respectively. The association of pre-pregnancy BMI with global child development was not mediated by GWG, irrespective of child's sex.
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Affiliation(s)
- Paulo A R Neves
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil.
| | - Giovanna Gatica-Domínguez
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Iná S Santos
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Andréa D Bertoldi
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Marlos Domingues
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
- Postgraduate Program in Physical Education, School of Physical Education, Universidade Federal de Pelotas. Rua Luís de Camões, 625, Três Vendas, 96055-630, Pelotas, Brazil
| | - Joseph Murray
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
| | - Mariângela F Silveira
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal de Pelotas. Rua Marechal Deodoro, 1160, Centro, 96020-220, Pelotas, Brazil
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Salve PS, Chokhandre P, Bansod DW. Substance use among municipal solid waste workers in Mumbai: a cross-sectional comparative study. JOURNAL OF SUBSTANCE USE 2019. [DOI: 10.1080/14659891.2019.1595195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Pradeep S. Salve
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
| | - Praveen Chokhandre
- Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, India
| | - Dhananjay W. Bansod
- Department of Public Health & Mortality Studies, International Institute for Population Sciences, Mumbai, India
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Cordon A, Asturias G, De Vries T, Rohloff P. Advancing child nutrition science in the scaling up nutrition era: a systematic scoping review of stunting research in Guatemala. BMJ Paediatr Open 2019; 3:e000571. [PMID: 32099904 PMCID: PMC7015046 DOI: 10.1136/bmjpo-2019-000571] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/17/2019] [Accepted: 11/22/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ever since the 1960s, Guatemala has been a principle site for global academic research on child growth and nutrition. Nevertheless, Guatemala still has one of the highest rates of child stunting in the world. Since 2012, Guatemala has had a comprehensive national policy on stunting, calling for a renewed investment in innovative, multilevel nutrition interventions and implementation science. Our objective was to perform a systematic search and scoping review of the literature on stunting in Guatemala to identify gaps in research and opportunities for responding to this unique policy opportunity. METHODS We conducted a systematic search and scoping review on stunting in Guatemala, searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were of any design or format, published in English and Spanish from 2000 to 2018. Articles were thematically grouped by those published before (2000-2011) and after (2012-2018) the new national policy initiatives. RESULTS We identified a total of 1934 articles through database searches. After full-text review, 104 were included in the synthesis. The volume of published articles on stunting increased from a mean of 3.2 to 9.4 articles/year before and after 2012. There was a shift toward articles generating new data on priority populations, including rural indigenous Maya populations (34% vs 61%, χ2 test, p=0.01). However, the proportion of studies conducting implementation evaluations or testing new interventions was low and did not change significantly (34% vs 18%, χ2 test, p=0.07). Among 17 identified intervention studies, only 4 tested multilevel interventions, and there were no published interventions incorporating nutrition-sensitive interventions. CONCLUSIONS A systematic search and scoping review of the literature on child stunting in Guatemala identified critical opportunities for new research in multilevel interventions, nutrition-sensitive interventions and implementation science.
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Affiliation(s)
- Ana Cordon
- Centre for Research in Indigenous Health, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala
| | - Gabriela Asturias
- Centre for Evidence-Based Development, Fundación Desarrolla Guatemala para la Educación y Salud (FUNDEGUA), Guatemala City, Guatemala
| | - Thomas De Vries
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Peter Rohloff
- Centre for Research in Indigenous Health, Wuqu' Kawoq
- Maya Health Alliance, Tecpán, Chimaltenango, Guatemala.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Hasan MT, Soares Magalhães RJ, Williams GM, Mamun AA. Long-term changes in childhood malnutrition are associated with long-term changes in maternal BMI: evidence from Bangladesh, 1996-2011. Am J Clin Nutr 2016; 104:1121-1127. [PMID: 27581468 DOI: 10.3945/ajcn.115.111773] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/18/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nutritional transition (from under- to overnutrition) among women of reproductive age (15-49 y) is becoming increasingly common in many developing countries, including Bangladesh. However, the influence of this transition on the nutritional status of children <5 y of age (U5s) is unknown. OBJECTIVES The aim was to determine whether a nutritional transition has taken place in the past 15 y (1996-2011) among U5s and their mothers in Bangladesh and to examine how the association between maternal body mass index (BMI) and malnutrition in U5s has changed over time. DESIGN We analyzed data assembled from 5 Demographic and Health Surveys conducted between 1996 and 2011 in Bangladesh to describe the nutritional status of 28,941 U5s and their mothers. A Poisson regression model was used to examine the associations between maternal BMI and stunting, underweight, and wasting in U5s over time. RESULTS A nutritional transition among mothers of U5s was observed between 1996 and 2011. The height- or length-for-age and weight-for-age z score distributions of U5s showed consistent improvement; however, there was no indication of a nutritional transition. An interaction was found between maternal BMI categorized as underweight [BMI (kg/m2) <18.5], healthy BMI (BMI: 18.5-24.9), and overweight or obese (BMI ≥25) and year of survey on the risks of stunting and underweight in children. In 1996, children of underweight mothers had a 5% higher risk of being stunted than those born to healthy-BMI mothers (RR: 1.05; 95% CI: 1.00, 1.10); in 2011, children of underweight mothers had a 21% higher risk of being stunted (RR: 1.21; 95% CI: 1.13, 1.30). Maternal overweight or obesity was associated with a reduced risk of malnutrition in children. CONCLUSIONS A nutritional transition among U5s has yet to occur in Bangladesh. However, our results indicate that improvement in maternal BMI in the past 15 y was accompanied by a reduction in malnutrition in U5s.
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Affiliation(s)
| | - Ricardo J Soares Magalhães
- Children's Health Research Centre, The University of Queensland, Herston, Australia; and School of Veterinary Science, The University of Queensland, Gatton, Australia
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Luque V, Closa-Monasterolo R, Escribano J, Ferré N. Early Programming by Protein Intake: The Effect of Protein on Adiposity Development and the Growth and Functionality of Vital Organs. Nutr Metab Insights 2016; 8:49-56. [PMID: 27013888 PMCID: PMC4803318 DOI: 10.4137/nmi.s29525] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 12/14/2015] [Accepted: 12/16/2015] [Indexed: 12/22/2022] Open
Abstract
This article reviews the role of protein intake on metabolic programming early in life. The observations that breastfeeding in infancy reduces the risk of being overweight and obese later in life and the differences in the protein content between formula milk and human milk have generated the early protein hypothesis. The present review focuses on a mechanistic approach to programmed adiposity and the growth and development of other organs by protein intake in infancy, which may be mediated by branched-chain amino acids, insulin, and insulin-like growth factor 1 via the mammalian target of rapamycin. Observational studies and clinical trials have shown that lowering the protein content in infant and follow-on formulas may reduce the risk of becoming obese later in life. The recent body of evidence is currently being translated into new policies. Therefore, the evolution of European regulatory laws and recommendations by expert panels on the protein content of infant and follow-on formulas are also reviewed. Research gaps, such as the critical window for programming adiposity by protein intake, testing formulas with modified amino acids, and the long-term consequences of differences in protein intake on organ functionality among well-nourished infants, have been identified.
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Affiliation(s)
- Veronica Luque
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain.; Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Ricardo Closa-Monasterolo
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain.; Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Joaquín Escribano
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain.; Hospital Universitari Sant Joan de Reus, Reus, Spain
| | - Natalia Ferré
- Pediatrics, Nutrition and Development Research Unit, Universitat Rovira I Virgili, IISPV, Reus, Spain
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Prado EL, Maleta K, Ashorn P, Ashorn U, Vosti SA, Sadalaki J, Dewey KG. Effects of maternal and child lipid-based nutrient supplements on infant development: a randomized trial in Malawi. Am J Clin Nutr 2016; 103:784-93. [PMID: 26843155 DOI: 10.3945/ajcn.115.114579] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 12/15/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Maternal and infant undernutrition is associated with poor infant development; however, few studies have examined the impact of combined pre- and postnatal dietary supplementation on infant development. OBJECTIVE Our objective was to determine whether provision of small-quantity lipid-based nutrient supplements (SQ-LNSs) to mothers during pregnancy and the first 6 mo postpartum, and to children aged 6-18 mo, improves infant development in Malawi. DESIGN We randomly assigned 869 pregnant women to receive one of the following daily: an iron and folic acid (IFA) capsule, a multiple micronutrient (MMN) capsule containing 18 micronutrients, or a 20-g sachet of SQ-LNSs containing 22 vitamins and minerals, protein, carbohydrates, essential fatty acids, and 118 kcal. Children in the lipid-based nutrient supplement (LNS) group only received SQ-LNSs from 6 to 18 mo of age. We monitored the acquisition of 11 developmental milestones monthly by maternal report; observed the attainment of 7 motor milestones at 6, 12, and 18 mo of age; and conducted a comprehensive assessment of motor, language, and socioemotional development and executive function at 18 mo of age. The primary analysis was by intention-to-treat. RESULTS By maternal report, children in the LNS group achieved walking alone (B = 0.53; 95% CI: 0.11, 0.94; P = 0.034) and waving goodbye (B = 0.60; 95% CI: 0.12, 1.08; P = 0.040) earlier than the IFA group and standing with assistance earlier than the MMN group (B = 0.51; 95% CI: 0.12, 0.89; P = 0.029). By researcher observation, there was a trend (P = 0.052) for a greater percentage of children in the LNS group (58%) to walk alone at age 12 mo than in the IFA (49%) and MMN (49%) groups. At age 18 mo, there were no significant differences between groups in any scores. CONCLUSION Although provision of SQ-LNSs to pregnant women and infants in Malawi may affect the age of acquisition of certain developmental milestones, it did not affect our assessments of motor, language, socioemotional, or executive function skills at 18 mo of age. This trial was registered at clinicaltrials.gov as NCT01239693.
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Affiliation(s)
| | - Kenneth Maleta
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Per Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; and
| | - Ulla Ashorn
- Department for International Health, University of Tampere School of Medicine, Tampere, Finland
| | - Steve A Vosti
- Department of Agricultural and Resource Economics, University of California Davis, Davis, CA
| | - John Sadalaki
- School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi
| | - Kathryn G Dewey
- Department of Nutrition, University of California Davis, Davis, CA
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Mental performance in 8-year-old children fed reduced protein content formula during the 1st year of life: safety analysis of a randomised clinical trial. Br J Nutr 2016; 122:S22-S30. [PMID: 31638498 DOI: 10.1017/s0007114515000768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In humans, maximum brain development occurs between the third trimester of gestation and 2 years of life. Nutrition during these critical windows of rapid brain development might be essential for later cognitive functioning and behaviour. In the last few years, trends on protein recommendations during infancy and childhood have tended to be lower than that in the past. It remains to be demonstrated that lower protein intakes among healthy infants, a part of being able to reduce obesity risk, is safe in terms of mental performance achievement. Secondary analyses of the EU CHOP, a clinical trial in which infants from five European countries were randomised to be fed a higher or a lower protein content formula during the 1st year of life. Children were assessed at the age of 8 years with a neuropsychological battery of tests that included assessments of memory (visual and verbal), attention (visual, selective, focused and sustained), visual-perceptual integration, processing speed, visual-motor coordination, verbal fluency and comprehension, impulsivity/inhibition, flexibility/shifting, working memory, reasoning, visual-spatial skills and decision making. Internalising, externalising and total behaviour problems were assessed using the Child Behaviour Checklist 4-18. Adjusted analyses considering factors that could influence neurodevelopment, such as parental education level, maternal smoking, child's gestational age at birth and head circumference, showed no differences between feeding groups in any of the assessed neuropsychological domains and behaviour. In summary, herewith we report on the safety of lower protein content in infant formulae (closer to the content of human milk) according to long-term mental performance.
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Abstract
This article reviews the central role of nutrition in advancing the maternal, newborn, and child health agenda with a focus on evidence for effective interventions generated using randomized controlled trials in low- and middle-income countries (LMIC). The 1000 days spanning from conception to 2 years of life are a critical period of time when nutritional needs must be ensured; failure to do so can lead to adverse impacts on short-term survival as well as long-term health and development [corrected]. The burden of maternal mortality continues to be high in many under-resourced settings; prenatal calcium supplementation in populations with low intakes can reduce the risk of pre-eclampsia and eclampsia morbidity and mortality and is recommended, and antenatal iron-folic acid use in many countries may reduce anemia, a condition that may be an underlying factor in postpartum hemorrhage. Sufficient evidence exists to promote multiple micronutrient supplementation during pregnancy to reduce fetal growth restriction and low birth weight. Early initiation of breastfeeding (within an hour), exclusive breastfeeding in the first 6 months of life, and vitamin A supplementation in the first few days of life in Asia (but not in Africa) reduce infant mortality. Biannual large-dose vitamin A supplements to children 6-59 months of age and zinc for treatment of diarrhea continue to be important strategies for improving child health and survival. Early nutrition and micronutrient status can influence child development but should be integrated with early responsive learning interventions. Future research is needed that goes beyond the 1000 days to ensure adequate preconceptional nutrition and health, with special emphasis on adolescents who contribute to a large proportion of first births in many LMIC. Thus, we make the case for integrating proven nutrition interventions with those for health in pregnant women, and with those for health and child development in neonates, infants, and young children to help advance the global MNCH agenda.
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Affiliation(s)
- Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E2541, Baltimore, MD 21205.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E2541, Baltimore, MD 21205
| | - Kristen M Hurley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E2541, Baltimore, MD 21205
| | - Joanne Katz
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E2541, Baltimore, MD 21205
| | - Robert E Black
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, E2541, Baltimore, MD 21205
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Halim N, Spielman K, Larson B. The economic consequences of selected maternal and early childhood nutrition interventions in low- and middle-income countries: a review of the literature, 2000-2013. BMC WOMENS HEALTH 2015; 15:33. [PMID: 25887257 PMCID: PMC4407878 DOI: 10.1186/s12905-015-0189-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 03/19/2015] [Indexed: 11/29/2022]
Abstract
Background Globally, 25% of children aged 0 to 4 years and more than 10% of women aged 15 to 49 years suffer from malnutrition. A range of interventions, promising for improving maternal and child nutrition, may also improve physical and intellectual capacity, and, thereby, future productivity and earnings. Methods We conducted a systematic literature review and summarized economic impacts of 23 reproductive, maternal, newborn and child health (RMNCH) interventions, published in 29 empirical studies between 2000 and 2013, using data from 13 low- and middle-income countries. Results We find that, in low- and middle-income countries, RMNCH interventions were rarely evaluated using rigorous evaluation methods for economic consequences. Nonetheless, based on limited studies, maternal and childhood participation in nutrition interventions was shown to increase individuals’ income as adults by up to 46%, depending on the intervention, demography and country. This effect is sizeable considering that poverty reduction interventions, including microfinance and conditional cash transfer programs, have helped increase income by up to 18%, depending on the context. We also found, compared to females, males appeared to have higher economic returns from childhood participation in RMNCH interventions. Conclusions Countries with pervasive malnutrition should prioritize investments in RMNCH interventions for their public health benefits. The existing literature is currently too limited, and restricted to a few selected countries, to warrant any major reforms in RMNCH policies based on expected future income impacts. Longitudinal and intergenerational databases remain needed for countries to be better positioned to evaluate maternal and early childhood nutrition intervention programs for future economic consequences.
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Affiliation(s)
- Nafisa Halim
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA.
| | | | - Bruce Larson
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, 801 Massachusetts Ave, Crosstown Center, 3rd Floor, Boston, MA, 02118, USA.
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Affiliation(s)
- Elizabeth L Prado
- Department of Nutrition; University of California at Davis; Davis CA USA
- SUMMIT Institute of Development; Mataram Nusa Tenggara Barat Indonesia
| | - Kathryn G Dewey
- Department of Nutrition; University of California at Davis; Davis CA USA
- SUMMIT Institute of Development; Mataram Nusa Tenggara Barat Indonesia
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Waber DP, Bryce CP, Fitzmaurice GM, Zichlin ML, McGaughy J, Girard JM, Galler JR. Neuropsychological outcomes at midlife following moderate to severe malnutrition in infancy. Neuropsychology 2014; 28:530-40. [PMID: 24635710 DOI: 10.1037/neu0000058] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE To compare neuropsychological profiles of adults who had experienced an episode of moderate to severe protein-energy malnutrition confined to the first year of life with that of a healthy community comparison group. METHOD We assessed neuropsychological functioning in a cohort of Barbadian adults, all of whom had birth weight >2268 g. The previously malnourished group (N = 77, mean age = 38 years, 53% male) had been hospitalized during the first year of life for moderate to severe protein energy malnutrition and subsequently enrolled in a program providing nutrition education, home visits and subsidized foods to 12 years of age. They also had documented, adequate nutrition throughout childhood and complete catch-up in growth by the end of adolescence. The healthy comparison group (N = 59, mean age = 38 years, 54% male) were recruited as children from the same classrooms and neighborhoods. RESULTS Adjusted for effects of standard of living during childhood and adolescence and current intellectual ability level, there were nutrition group differences on measures of cognitive flexibility and concept formation, as well as initiation, verbal fluency, working memory, processing speed, and visuospatial integration. Behavioral and cognitive regulation were not affected. CONCLUSIONS Postnatal malnutrition confined to the first year of life is associated with neurocognitive compromise persisting into midlife. Early malnutrition may have a specific neuropsychological signature, affecting response initiation to a somewhat greater extent than response inhibition.
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Affiliation(s)
| | | | | | | | - Jill McGaughy
- Department of Psychology, University of New Hampshire
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18
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Salinas-Miranda AA, Storch EA, Nelson R, Evans-Baltodano C. Challenges for Evidence-Based Care for Children With Developmental Delays in Nicaragua. J Cogn Psychother 2014; 28:226-237. [PMID: 32759158 DOI: 10.1891/0889-8391.28.3.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.
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Affiliation(s)
| | - Eric A Storch
- University of South Florida.,College of Medicine, American University, Nicaragua
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19
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Yousafzai AK, Rasheed MA, Bhutta ZA. Annual Research Review: Improved nutrition--pathway to resilience. J Child Psychol Psychiatry 2013; 54:367-77. [PMID: 23240891 DOI: 10.1111/jcpp.12019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early child nutritional deficiencies are prevalent in low- and middle-countries with consequences linked not only to poor survival and growth, but also to poor development outcomes. Children in disadvantaged communities face multiple risks for nutritional deficiencies, yet some children may be less susceptible or may recover more quickly from malnutrition. A greater understanding is needed about factors which moderate the effects of nutrition-related risks and foster resilience to protect against or ameliorate poor development outcomes. METHODS A literature review was undertaken from August to December 2011 and updated in August 2012. Key word searches using terms Nutrition, Malnutrition, Child Development, Responsive Care, Stimulation, Low and Middle Income Countries and Resilience were undertaken using PubMed and Psychinfo. RESULTS Dietary adequacy is critical for growth and development, but current evidence indicates that nutrition supplementation alone is insufficient to foster resilience to protect against, mitigate, and recover from nutritional threats and to promote healthy development. The combination of nutrition interventions with stimulation and responsive care is necessary. Combined nutrition and psychosocial stimulation approaches can potentially work effectively together to promote protective factors and mitigate risks for poor cognitive, motor, social, and affective functioning helping children to adapt in times of adversity. However, there are gaps in our existing knowledge to combine nutrition and psychosocial stimulation interventions effectively and promote these interventions at scale. CONCLUSIONS Research needs to address barriers at the level of family, community, programme, and policy which have prevented thus far the uptake of combined nutrition and psychosocial intervention strategies. Further investigations are needed on how to provide support to caregivers, enabling them to implement appropriate care for feeding and stimulation. Finally, the effect of combined interventions on pathways of care and protective mediators that foster resilience need to be better understood to determine focus areas for content of combined intervention curricula which help families in high-risk settings.
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Affiliation(s)
- Aisha K Yousafzai
- Department of Paediatrics and Child Health, Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
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20
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Galler JR, Bryce CP, Zichlin ML, Fitzmaurice G, Eaglesfield GD, Waber DP. Infant malnutrition is associated with persisting attention deficits in middle adulthood. J Nutr 2012; 142:788-94. [PMID: 22378333 PMCID: PMC3301995 DOI: 10.3945/jn.111.145441] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Infantile malnutrition is known to be associated with cognitive and behavioral impairment during childhood and adolescence. Data pertaining to longer-term effects on behavioral outcomes in adulthood are limited. In this study, we report associations between infantile malnutrition and attention problems in adults at midlife. Attention problems were assessed by the Conners Adult ADHD Rating Scales (CAARS) and the Conners Continuous Performance Test (CPT) in 145 Barbadian adults (aged 37-43 y) who had been followed longitudinally since childhood. Previously malnourished participants (n = 80) had experienced moderate to severe protein-energy malnutrition in the first year of life and were successfully rehabilitated thereafter. They were compared with healthy adults (n = 65) who were former classmates of the index cases and who had been matched for age, sex, and handedness in childhood. Multiple regression analyses showed persisting effects of childhood malnutrition on both the CAARS and the CPT, independent of effects of household standard of living assessed in childhood. The malnutrition effect on the CAARS ratings was independent of IQ, whereas this effect was attenuated for the CPT after adjustment for IQ. Teacher-reported attention problems in childhood predicted attention problems in adulthood, indicating continuity over the life span. Infantile malnutrition may have long-term effects on attentional processes nearly 40 y after the episode, even with excellent long-term nutritional rehabilitation and independent of socioeconomic conditions in childhood and adolescence. This finding has major public health implications for populations exposed to early childhood malnutrition.
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Affiliation(s)
- Janina R. Galler
- Judge Baker Children's Center, Harvard Medical School, Boston, MA,Barbados Nutrition Study, Bridgetown, Barbados,To whom correspondence should be addressed. E-mail:
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21
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Das S, Rahman RM. Application of ordinal logistic regression analysis in determining risk factors of child malnutrition in Bangladesh. Nutr J 2011; 10:124. [PMID: 22082256 PMCID: PMC3296641 DOI: 10.1186/1475-2891-10-124] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Accepted: 11/14/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The study attempts to develop an ordinal logistic regression (OLR) model to identify the determinants of child malnutrition instead of developing traditional binary logistic regression (BLR) model using the data of Bangladesh Demographic and Health Survey 2004. METHODS Based on weight-for-age anthropometric index (Z-score) child nutrition status is categorized into three groups-severely undernourished (< -3.0), moderately undernourished (-3.0 to -2.01) and nourished (≥-2.0). Since nutrition status is ordinal, an OLR model-proportional odds model (POM) can be developed instead of two separate BLR models to find predictors of both malnutrition and severe malnutrition if the proportional odds assumption satisfies. The assumption is satisfied with low p-value (0.144) due to violation of the assumption for one co-variate. So partial proportional odds model (PPOM) and two BLR models have also been developed to check the applicability of the OLR model. Graphical test has also been adopted for checking the proportional odds assumption. RESULTS All the models determine that age of child, birth interval, mothers' education, maternal nutrition, household wealth status, child feeding index, and incidence of fever, ARI & diarrhoea were the significant predictors of child malnutrition; however, results of PPOM were more precise than those of other models. CONCLUSION These findings clearly justify that OLR models (POM and PPOM) are appropriate to find predictors of malnutrition instead of BLR models.
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Affiliation(s)
- Sumonkanti Das
- Department of Statistics, Shahjalal University of Science & Technology, Bangladesh.
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22
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Pongcharoen T, DiGirolamo AM, Ramakrishnan U, Winichagoon P, Flores R, Martorell R. Long-term effects of iron and zinc supplementation during infancy on cognitive function at 9 y of age in northeast Thai children: a follow-up study. Am J Clin Nutr 2011; 93:636-43. [PMID: 21270383 DOI: 10.3945/ajcn.110.002220] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Iron and zinc are important micronutrients for child growth and development. One would expect that iron and zinc supplementation in infancy would affect long-term cognitive development and school achievement, but this has not been evaluated. OBJECTIVE We investigated the effect of iron or zinc supplementation or both during infancy on cognitive performance 8 y later. DESIGN A follow-up study was performed in 560 children aged 9 y or 92% of those who had participated in a randomized controlled trial involving 4 groups who received daily iron, zinc, iron plus zinc, or a placebo at 4-6 mo of age for 6 mo. Cognitive performance was assessed by using the Wechsler Intelligence Scale for Children-Third Edition (Thai version), the Raven's Colored Progressive Matrices (CPM), and school performance tests. General linear mixed models were used to assess long-term effects. RESULTS No significant differences in any of the outcomes at 9 y of age were observed at follow-up between the 4 groups. Mean intelligence quotients ranged across groups from 92.9 to 93.7 for full scale, 93.9-95.4 for verbal, and 93.1-94.0 for performance. The Raven's CPM score ranged from 21.4 to 22.4. CONCLUSION Supplementation with iron or zinc or both during infancy does not lead to long-term cognitive improvement in 9-y-old children. This trial was registered at clinicaltrials.gov as NCT00824304.
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Affiliation(s)
- Tippawan Pongcharoen
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA 30322, USA
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23
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Laus MF, Vales LDMF, Costa TMB, Almeida SS. Early postnatal protein-calorie malnutrition and cognition: a review of human and animal studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:590-612. [PMID: 21556206 PMCID: PMC3084481 DOI: 10.3390/ijerph8020590] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Revised: 01/26/2011] [Accepted: 02/10/2011] [Indexed: 11/17/2022]
Abstract
Malnutrition continues to be recognized as the most common and serious form of children's dietary disease in the developing countries and is one of the principal factors affecting brain development. The purpose of this paper is to review human and animal studies relating malnutrition to cognitive development, focusing in correlational and interventional data, and to provide a discussion of possible mechanisms by which malnutrition affects cognition.
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Affiliation(s)
- Maria Fernanda Laus
- Laboratory of Nutrition and Behavior, Department of Psychology and Education, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil; E-Mails: (M.F.L.); (L.D.M.F.V.)
| | - Lucas Duarte Manhas Ferreira Vales
- Laboratory of Nutrition and Behavior, Department of Psychology and Education, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil; E-Mails: (M.F.L.); (L.D.M.F.V.)
| | - Telma Maria Braga Costa
- Nutrition Course, University of Ribeirão Preto, Av. Costábile Romano, 2.201, Bloco U, 14096-900, Ribeirão Preto, SP, Brazil; E-Mail:
| | - Sebastião Sousa Almeida
- Laboratory of Nutrition and Behavior, Department of Psychology and Education, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, Av. Bandeirantes, 3900, 14040-901, Ribeirão Preto, SP, Brazil; E-Mails: (M.F.L.); (L.D.M.F.V.)
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Webb AL, Ramakrishnan U, Stein AD, Sellen DW, Merchant M, Martorell R. Greater years of maternal schooling and higher scores on academic achievement tests are independently associated with improved management of child diarrhea by rural Guatemalan mothers. Matern Child Health J 2010; 14:799-806. [PMID: 19685178 PMCID: PMC4457360 DOI: 10.1007/s10995-009-0510-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Appropriate home management can alleviate many of the consequences of diarrhea including malnutrition, impaired development, growth faltering, and mortality. Maternal cognitive ability, years of schooling, and acquired academic skills are hypothesized to improve child health by improving maternal child care practices, such as illness management. Using information collected longitudinally in 1996-1999 from 466 rural Guatemalan women with children <36 months, we examined the independent associations between maternal years of schooling, academic skills, and scores on the Raven's Progressive Matrices and an illness management index (IMI). Women scoring in the lowest and middle tertiles of academic skills scored lower on the IMI compared to women in the highest tertile (-0.24 [95% CI: -0.54, 0.07]; -0.30 [95% CI: -0.54, -0.06], respectively) independent of sociodemographic factors, schooling, and Raven's scores. Among mothers with less than 1 year of schooling, scoring in the lowest tertile on the Raven's Progressive Matrices compared to the highest was significantly associated with scoring one point lower on the IMI (-1.18 [95% CI: -2.20, -0.17]). Greater academic skills were independently associated with maternal care during episodes of infant diarrhea. Schooling of young girls and/or community based programs that provide women with academic skills such as literacy, numeracy and knowledge could potentially improve mothers' care giving practices.
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Affiliation(s)
- Aimee L Webb
- Department of Anthropology, University of Toronto, 19 Russell Street, Toronto, ON, M5S 2S2, Canada.
| | - Usha Ramakrishnan
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, 30322, USA
- Hubert Department of Global Health, The Rollins School of Public Health of Emory University, Atlanta, GA, 30322, USA
| | - Aryeh D Stein
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, 30322, USA
- Hubert Department of Global Health, The Rollins School of Public Health of Emory University, Atlanta, GA, 30322, USA
| | - Daniel W Sellen
- Department of Anthropology, University of Toronto, 19 Russell Street, Toronto, ON, M5S 2S2, Canada
- Hubert Department of Global Health, The Rollins School of Public Health of Emory University, Atlanta, GA, 30322, USA
| | - Moeza Merchant
- Department of Anthropology, University of Toronto, 19 Russell Street, Toronto, ON, M5S 2S2, Canada
| | - Reynaldo Martorell
- Nutrition and Health Sciences Program, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, 30322, USA
- Hubert Department of Global Health, The Rollins School of Public Health of Emory University, Atlanta, GA, 30322, USA
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Crookston BT, Dearden KA, Alder SC, Porucznik CA, Stanford JB, Merrill RM, Dickerson TT, Penny ME. Impact of early and concurrent stunting on cognition. MATERNAL AND CHILD NUTRITION 2010; 7:397-409. [PMID: 21902807 DOI: 10.1111/j.1740-8709.2010.00255.x] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Undernutrition is associated with poor cognitive development, late entry into school, decreased years of schooling, reduced productivity and smaller adult stature. We use longitudinal data from 1674 Peruvian children participating in the Young Lives study to assess the relative impact of early stunting (stunted at 6-18 months of age) and concurrent stunting (stunted at 4.5-6 years of age) on cognitive ability. Anthropometric data were longitudinally collected for children at 6-18 months of age and 4.5-6 years of age at which time verbal and quantitative ability were also assessed. We estimate that an increase in concurrent height-for-age z-scores (HAZ) by one standard deviation was associated with an increase in a child's score on the Peabody Picture Vocabulary Test (PPVT) by 2.35 points [confidence interval (CI): 1.55-3.15] and a 0.16 point increase on the cognitive development assessment (CDA) (CI: 0.05-0.27). Furthermore, we report that the estimate for concurrent HAZ and PPVT is significantly higher than the estimate for early stunting and PPVT. We found no significant difference between early and concurrent estimates for HAZ and CDA. Children from older mothers, children whose mothers had higher education levels, children living in urban areas, children who attended pre-school, children with fewer siblings and children from wealthier backgrounds scored higher on both assessments. Cognitive skills of children entering school were associated with early stunting but the strongest association was found with concurrent stunting suggesting that interventions preventing linear growth faltering should not only focus on the under 2s but include children up to 5 years of age.
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Affiliation(s)
- Benjamin T Crookston
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah 84108, USA.
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Webb AL, Sellen DW, Ramakrishnan U, Martorell R. Maternal years of schooling but not academic skills is independently associated with infant-feeding practices in a cohort of rural Guatemalan women. J Hum Lact 2009; 25:297-306. [PMID: 19190253 PMCID: PMC3780574 DOI: 10.1177/0890334408330449] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The effects of maternal academic skills on infant-feeding practices are not clear. From 1996 to 1999, the authors collected information on infant-feeding practices from birth on infants born to 279 mothers from 4 rural villages in Guatemala. They examined associations between maternal academic skills and indicators for the initiation of exclusive breastfeeding (EBF) and timely introduction of complementary foods (CF). Mothers in the highest category of academic skills had greater odds of initiating EBF, but this association failed to remain significant after adjusting for schooling. Compared with mothers with < 1 year of school, mothers with > 3 to <or= 6 years had greater odds of initiating EBF; mothers with > 6 years of school had greater odds of introducing CF early, while mothers with >or= 1 to <or= 3 years had greater odds of introducing CF late. Unmeasured schooling-related factors influenced infant-feeding practices to a greater extent than academic skills.
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Affiliation(s)
- Aimee L Webb
- Canadian Institutes of Health Research, Initiatives in Global Health, Department of Anthropology, University of Toronto, Ontario, Canada
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Stein AD, Wang M, DiGirolamo A, Grajeda R, Ramakrishnan U, Ramirez-Zea M, Yount K, Martorell R. Nutritional supplementation in early childhood, schooling, and intellectual functioning in adulthood: a prospective study in Guatemala. ACTA ACUST UNITED AC 2008; 162:612-8. [PMID: 18606931 DOI: 10.1001/archpedi.162.7.612] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
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.
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Affiliation(s)
- Aryeh D Stein
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322, USA.
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Homeless street children in Nepal: use of allostatic load to assess the burden of childhood adversity. Dev Psychopathol 2008; 20:233-55. [PMID: 18211736 DOI: 10.1017/s0954579408000114] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
As challenges to child well-being through economic disadvantage, family disruption, and migration or displacement escalate world wide, the need for cross-culturally robust understanding of childhood adversity proportionately increases. Toward this end, developmental risk was assessed in four contrasting groups of 107 Nepali children ages 10-14 years that represent distinctive, common conditions in which contemporary children grow up. Relative cumulative burden (allostatic load) indexed by multiple dimensions of physical and psychosocial stress was ascertained among homeless street boys and three family-based groups, from poor urban squatter settlements, urban middle class, and a remote rural village. Biomarkers of stress and vulnerability to stress included growth status, salivary cortisol, antibodies to Epstein-Barr virus, acute phase inflammatory responses (alpha1-antichymotrypsin), and cardiovascular fitness and reactivity (flex heart rate and pressor response). Individual biomarkers of risk and allostatic load differed markedly among groups, were highest in villagers, and varied by components of allostatic load. Such data suggest a need for critical appraisal of homelessness and migration as a risk factor to youth, given prevailing local conditions such as rural poverty, and represents the only multidimensional study of childhood allostatic load and developmental risk in non-Western settings.
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Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet 2008; 371:411-6. [PMID: 18242415 DOI: 10.1016/s0140-6736(08)60205-6] [Citation(s) in RCA: 275] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Substantial, but indirect, evidence suggests that improving nutrition in early childhood in developing countries is a long-term economic investment. We investigated the direct effect of a nutrition intervention in early childhood on adult economic productivity. METHODS We obtained economic data from 1424 Guatemalan individuals (aged 25-42 years) between 2002 and 2004. They accounted for 60% of the 2392 children (aged 0-7 years) who had been enrolled in a nutrition intervention study during 1969-77. In this initial study, two villages were randomly assigned a nutritious supplement (atole) for all children and two villages a less nutritious one (fresco). We estimated annual income, hours worked, and average hourly wages from all economic activities. We used linear regression models, adjusting for potentially confounding factors, to assess the relation between economic variables and exposure to atole or fresco at specific ages between birth and 7 years. FINDINGS Exposure to atole before, but not after, age 3 years was associated with higher hourly wages, but only for men. For exposure to atole from 0 to 2 years, the increase was US$0.67 per hour (95% CI 0.16-1.17), which meant a 46% increase in average wages. There was a non-significant tendency for hours worked to be reduced and for annual incomes to be greater for those exposed to atole from 0 to 2 years. INTERPRETATION Improving nutrition in early childhood led to substantial increases in wage rates for men, which suggests that investments in early childhood nutrition can be long-term drivers of economic growth.
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Affiliation(s)
- John Hoddinott
- International Food Policy Research Institute, Washington, DC, USA
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Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, Sachdev HS. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008; 371:340-57. [PMID: 18206223 PMCID: PMC2258311 DOI: 10.1016/s0140-6736(07)61692-4] [Citation(s) in RCA: 2059] [Impact Index Per Article: 128.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this paper we review the associations between maternal and child undernutrition with human capital and risk of adult diseases in low-income and middle-income countries. We analysed data from five long-standing prospective cohort studies from Brazil, Guatemala, India, the Philippines, and South Africa and noted that indices of maternal and child undernutrition (maternal height, birthweight, intrauterine growth restriction, and weight, height, and body-mass index at 2 years according to the new WHO growth standards) were related to adult outcomes (height, schooling, income or assets, offspring birthweight, body-mass index, glucose concentrations, blood pressure). We undertook systematic reviews of studies from low-income and middle-income countries for these outcomes and for indicators related to blood lipids, cardiovascular disease, lung and immune function, cancers, osteoporosis, and mental illness. Undernutrition was strongly associated, both in the review of published work and in new analyses, with shorter adult height, less schooling, reduced economic productivity, and--for women--lower offspring birthweight. Associations with adult disease indicators were not so clear-cut. Increased size at birth and in childhood were positively associated with adult body-mass index and to a lesser extent with blood pressure values, but not with blood glucose concentrations. In our new analyses and in published work, lower birthweight and undernutrition in childhood were risk factors for high glucose concentrations, blood pressure, and harmful lipid profiles once adult body-mass index and height were adjusted for, suggesting that rapid postnatal weight gain--especially after infancy--is linked to these conditions. The review of published works indicates that there is insufficient information about long-term changes in immune function, blood lipids, or osteoporosis indicators. Birthweight is positively associated with lung function and with the incidence of some cancers, and undernutrition could be associated with mental illness. We noted that height-for-age at 2 years was the best predictor of human capital and that undernutrition is associated with lower human capital. We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations. Its prevention will probably bring about important health, educational, and economic benefits. Chronic diseases are especially common in undernourished children who experience rapid weight gain after infancy.
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Engle PL, Black MM, Behrman JR, Cabral de Mello M, Gertler PJ, Kapiriri L, Martorell R, Young ME. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet 2007; 369:229-42. [PMID: 17240290 DOI: 10.1016/s0140-6736(07)60112-3] [Citation(s) in RCA: 472] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This paper is the third in the Child Development Series. The first paper showed that more than 200 million children under 5 years of age in developing countries do not reach their developmental potential. The second paper identified four well-documented risks: stunting, iodine deficiency, iron deficiency anaemia, and inadequate cognitive stimulation, plus four potential risks based on epidemiological evidence: maternal depression, violence exposure, environmental contamination, and malaria. This paper assesses strategies to promote child development and to prevent or ameliorate the loss of developmental potential. The most effective early child development programmes provide direct learning experiences to children and families, are targeted toward younger and disadvantaged children, are of longer duration, high quality, and high intensity, and are integrated with family support, health, nutrition, or educational systems and services. Despite convincing evidence, programme coverage is low. To achieve the Millennium Development Goals of reducing poverty and ensuring primary school completion for both girls and boys, governments and civil society should consider expanding high quality, cost-effective early child development programmes.
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Kuklina EV, Ramakrishnan U, Stein AD, Barnhart HH, Martorell R. Early childhood growth and development in rural Guatemala. Early Hum Dev 2006; 82:425-33. [PMID: 16431042 DOI: 10.1016/j.earlhumdev.2005.10.018] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Revised: 08/31/2005] [Accepted: 10/31/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Small size at birth and in early childhood has been associated with impaired neurodevelopment in studies from developing countries, but few have examined associations with growth. AIMS The objective of this study was to assess the relationship between growth and neurodevelopment during early childhood (birth-36 months). DESIGN Multivariate regression models were used to analyze the data collected in the course of a study of pregnancy outcomes and early childhood growth and development carried out in rural Guatemala in 1991-1999. Motor and mental development scores were based on the Psychomotor and Mental Development Indices, respectively, derived from the administration of an adapted version of the Bayley Scales of Infant Development (Second Edition, 1993) at 6, 24 and 36 months. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and head circumference-for-age (HCZ) were used as indicators of attained size; changes in these Z-scores over time represent growth. RESULTS Birth size was significantly associated with child development at 6 and 24 months. Gains in length and weight during the first 24 months were positively associated with child development, whereas growth from 24 to 36 months age was not associated with child development at 36 months. Motor development was more strongly and consistently related to child growth than was mental development. Head circumference gain after 6 months was not a significant predictor of child development at 24 and 36 months. CONCLUSIONS Small size at birth and poor physical growth during the first 24 months are related to neurodevelopmental delays. More evidence from developing countries will help explain the underlying mechanisms and identify appropriate interventions to prevent neurodevelopmental delay in early childhood.
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Affiliation(s)
- Elena V Kuklina
- Program in Nutrition and Health Sciences, Graduate Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA, USA
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Martorell R, Behrman JR, Flores R, Stein AD. Rationale for a follow-up study focusing on economic productivity. Food Nutr Bull 2005; 26:S5-14. [PMID: 16060208 DOI: 10.1177/15648265050262s102] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Past studies of nutrition, human capital formation, and economic productivity have been limited by the fact that biomedical researchers and economists work largely in isolation, with loss of complementarity. Biomedical researchers are faulted for not adequately addressing bias and measurement issues and for naive analyses and interpretation of results, whereas economists are criticized for using simplistic nutrition and physiological measures and for relying on statistical methods rather than experimental designs. To avoid these problems, a multidisciplinary team of biomedical investigators and economists undertook a follow-up study in 2002-04 of a cohort of young men and women, who participated as young children in a randomized community trial of nutrition supplementation carried out from 1969-77 Previous studies, particularly the original trial and a 1988-89 follow- up, are described to provide an overview of the data available for linkage with the 2002-04 follow-up. Key results from these earlier studies are reviewed but judged inconclusive because the data used were collected when many subjects were still growing and developing physically, in school, unmarried, and/or not yet settled into occupations. The subjects were 26 to 41 years of age in 2003, permitting a more complete assessment of human capital and economic productivity. The experimental design of the 1969-77 original study, 35 years of follow-up, use of robust methods of data collection, and the participation of a multidisciplinary team will likely lead to the most comprehensive assessment to date of the importance of nutrition for economic productivity.
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Affiliation(s)
- Reynaldo Martorell
- Department of Global Health, The Rollins School of Public Health of Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
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Watanabe K, Flores R, Fujiwara J, Tran LTH. Early childhood development interventions and cognitive development of young children in rural Vietnam. J Nutr 2005; 135:1918-25. [PMID: 16046717 DOI: 10.1093/jn/135.8.1918] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Little is known about the long-term benefits of interventions that aim to promote early childhood development programs. The goal of this research was to determine whether an early childhood development intervention added to a nutrition intervention during preschool ages had lasting effects on the cognitive development of school-age children in communes of Thanh Hoa province in rural Vietnam. The study focused on a total of 313 children aged 6.5-8.5 y (grades 1 and 2 in primary school) in 2 communes that were exposed to nutrition intervention or nutrition and early childhood development (ECD) intervention from 1999 to 2003. Measurements of height and cognitive test scores (Raven's Progressive Matrices Test) were collected from the children; household characteristics were determined by interviews with mothers. Longitudinal analysis was performed by integrating the data with that collected from the same children in past surveys. Significant effects of the ECD intervention compared with the nutrition intervention were detected. The beneficial effect of ECD intervention on the cognitive test scores was large for the most nutritionally challenged children whose height-for-age Z-scores declined or remained in the stunted range. The findings help provide useful insights into the development of an effective integrated model of ECD and nutrition intervention for children in rural Vietnam.
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Affiliation(s)
- Koichiro Watanabe
- Rollins School of Public Health at Emory University, Atlanta, GA 30322, USA.
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Pollitt E. Introduction. Food Nutr Bull 2005. [DOI: 10.1177/15648265050262s202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Stein AD, Barnhart HX, Wang M, Hoshen MB, Ologoudou K, Ramakrishnan U, Grajeda R, Ramirez-Zea M, Martorell R. Comparison of linear growth patterns in the first three years of life across two generations in Guatemala. Pediatrics 2004; 113:e270-5. [PMID: 14993588 DOI: 10.1542/peds.113.3.e270] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The secular increase in height is assumed to result from long-term improvements in nutritional intakes and reductions in infectious disease burdens. Nutritional supplementation in early life reduces stunting in chronically undernourished populations. It is not known whether these improvements have an impact on the growth of subsequent generations. Our objective was to estimate the intergenerational effect on offspring length of improved nutrition in the mother's early childhood. METHODS We studied 283 mother-child pairs (mothers born 1969-1977; children born 1996-1999). The mothers had received nutritional supplementation--either atole (enhanced protein-energy) or fresco (moderate energy, no protein), with both containing vitamins and minerals--prenatally and up to age 7 y as part of a community trial conducted in 4 villages in Guatemala. Length was measured on repeated occasions to 36 months of age in both mothers and children. Growth was modeled as a fractional polynomial. RESULTS Children grew faster than their mothers. Children of mothers who received atole grew faster than children of women who received fresco. In both groups, lengths of individual children were positively correlated with lengths of their own mothers at the same ages. Correlations were generally stronger when the mothers had received atole in early life. CONCLUSION We have confirmed a secular trend in growth of children in a developing country setting. The rate of child growth reflects, in part, the growth pattern of the mother, including improvements to that pattern resulting from nutritional supplementation.
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Affiliation(s)
- Aryeh D Stein
- Department of International Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA.
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Li H, DiGirolamo AM, Barnhart HX, Stein AD, Martorell R. Relative importance of birth size and postnatal growth for women's educational achievement. Early Hum Dev 2004; 76:1-16. [PMID: 14729158 DOI: 10.1016/j.earlhumdev.2003.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Child undernutrition, commonly measured by growth failure, is associated with functional disadvantages later in life. AIMS To assess relationships between child growth and women's educational achievement (EA). STUDY DESIGN AND SUBJECTS Women from four ladino Guatemalan villages were measured as children (1969-1977) and again at ages 20-29 years (1996-1999). The anthropometric measurements analyzed were weight, length, and head circumference (HC) at birth and 2 years and height at adulthood. Sample sizes were 120 at birth, 133 at 2 years, and 145 at adulthood; 108 cases had data at all three points. OUTCOME MEASURES Women's EA was computed based on five educational tests and was categorized into quintiles. Analysis was based on a proportional odds model. Generalized estimating equations were used to account for sibling clustering. Multiple Stage Least Squares analyses were used to assess the relative importance of birth size and of early (birth to age 2 years) and late postnatal growth (2 years to adulthood). RESULTS Size at 2 years (HC and length) but no indicator at birth was positively associated with women's EA. Schooling was a strong, positive predictor of women's EA (odds ratio (OR)=13.7, 95% confidence interval (CI) [6.1, 30.6]). Early postnatal growth but not birth size or late postnatal growth was associated with women's EA (OR with 1 standard deviation (S.D.) increment in length=1.5, 95% CI [1.05, 2.2]). CONCLUSIONS Growth in length and HC from birth to 2 years of age, but not birth size or growth after 2 years, is an important predictor of women's EA.
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Affiliation(s)
- Haojie Li
- Nutrition and Health Sciences Program, Division of Biological and Biomedical Sciences, Emory University, Atlanta, GA 30322, USA
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